Data posted online this week by the Pennsylvania Department of Health shows 76,336 residents at an Elk County nursing home have died from covid-19. The home is licensed to house 138 residents.
The state listed 133 deaths at an Erie facility that previously reported no cases among residents or staff. That facility is licensed to house 133 residents.
These are obvious and extreme errors. But they are two examples of challenges the health department continues to face in its effort to report weekly snapshots of how nursing and long-term care facilities are coping with the coronavirus pandemic.
Two months ago, the first facility-level reports included errors and disputes over whether some deaths should be attributed to covid-19. Today, those errors are causing frustration for families who have loved ones in homes and those who must make the difficult decision to place a relative in such a facility during the pandemic.
“We’re trying to get a handle on where the cases are, how many,” said Diane Menio, executive director of the Philadelphia-based advocacy group CARIE, the Center for Advocacy for the Rights and Interests of the Elderly. “We hear things anecdotally through residents and families, but we’re not necessarily aware other than seeing these reports.”
Such reporting mistakes typically are redacted by health department team members and replaced with “no data” before the reports are made public, spokeswoman Maggi Mumma said in an email Tuesday. “But it would appear that these errors were missed,” Mumma said.
That is small consolation, Menio said.
“Many of the facilities we’re looking for have no data,” she said. “We want to know where the hot spots are.”
Discrepancies in the data
Nursing home residents — generally elderly people with underlying health conditions, living in communal settings — have been among the most vulnerable populations since the start of the coronavirus pandemic earlier this year.
The need to track cases at long-term care facilities became apparent in March as outbreaks hit nursing homes in Washington state, Illinois and New Jersey, where cases were linked to staff who worked at multiple facilities. Shortages of personal protective equipment for staff and residents also contributed to the spread of the virus.
In Pennsylvania to date, nursing home resident deaths make up about 68% of the nearly 7,000 deaths attributed to covid-19, state data shows.
The state’s weekly facility-level report released Tuesday reflects a statewide total of as many as 3,437 nursing home deaths. But a separate daily coronavirus report generated by the state that same day lists 4,712 nursing home deaths — a difference of more than 1,000 people.
The discrepancy, Mumma said, is because the different reports rely on different sources for data. The numbers in the daily update are pulled from the National Electronic Disease Surveillance System, or NEDSS. The weekly report, though it previously included data from NEDSS, was changed in June to rely only on data reported directly by the nursing facilities.
“We still have challenges with facilities reporting and cannot rely on facility reports for an overall statewide picture,” Mumma said.
Of the 694 facilities included Tuesday in the weekly report, 132 long-term care facilities reported “no data.” That included facilities that previously reported double-digit case and death counts.
St. Barnabas Nursing Home in Richland is one such facility. State reports last included data from the 152-bed facility on June 10 and indicated that those figures were pulled from NEDSS.
That report showed 62 resident cases — 14 staff cases and 31 resident deaths — which was more deaths than at any other facility in Allegheny County, both at the time of that report and according to the most recent data.
But those figures are likely not accurate, said J.D. Turco, senior vice president and chief financial officer for St. Barnabas Health System.
“I do believe that those numbers are elevated,” Turco said. “I’m going to say they’re probably between 15% to 20% high. However, still take that into consideration, it’s not a good number.”
Facilities are required to report data to several agencies in addition to the state health department. Definitions across agencies often differ for what qualifies as a covid-19 death or case. That leads to disputes over how many individuals were residents of a facility when they were sick, Turco said.
Since June 10, St. Barnabas has added one staff member case and one resident case, Turco said. There have been no additional deaths, he said.
“We are reporting our data every day,” Turco said. He added that the state has confirmed it is receiving the information, but he couldn’t explain why those figures were not updated in the weekly report.
Technical issues and typos add to challenges
A weekly report released July 7 included 211 facilities that listed “no data,” up from 106 facilities a week earlier.
That increase was caused by a problem with the software used to collect data from facilities, health department spokeswoman April Hutcheson said at the time.
Mumma on Wednesday added that the department is no longer relying on NEDSS to fill gaps in the self-reported, facility-level data.
“We want to encourage folks to report,” she said. “We are only including the self-reported data.”
Officials from Pinecrest Manor in St. Marys, the Elk County facility incorrectly reporting more than 76,000 deaths, did not respond to multiple messages seeking comment. Previous health department reports show that the facility did not report any covid-19 deaths or cases prior to Tuesday’s report.
Officials from Guardian Healthcare, which manages Western Reserve Healthcare and Rehabilitation Center in Erie, said Tuesday’s report of 133 deaths was a typographical error. They confirmed that the facility has had no cases or deaths to date.
“The safety of our residents and our employees remains our top priority,” a statement from Guardian Healthcare said. “We are exceptionally proud of our caregivers for all of their hard work during recent months; they are truly health care heroes.”
Mumma said those facilities likely uploaded data into incorrect fields.
Zach Shamberg, president and CEO of the Pennsylvania Health Care Association, which represents for-profit nursing homes in the state, said it’s unfair to blame facilities for problems with the state’s data collection system.
Pinecrest Manor, Western Reserve Healthcare and Rehabilitation Center and St. Barnabas Nursing Home are not members of PHCA, Shamberg said. But members have reported confusion over definitions of what data must be submitted, log-in issues and technical problems such as not receiving a receipt to confirm that data was successfully submitted, he said.
“Providers are spending every waking moment — or at least they should be — to try to protect their staff and residents,” Shamberg said. “No administrator, no front-line staffer, should be spending hours in front of a computer trying to log in to this system. That’s just not good enough.”
In a June 18 letter, the health department threatened nursing home administrators with daily fines or prison time if they did not comply with reporting requirements.
Health department officials confirmed Thursday that no penalties have so far been issued.
“We are continuing our work to hold nursing home operators accountable who are not complying with the department’s orders, and will take action, as needed,” health department Spokesman Nate Wardle said.
All of these reporting issues are playing out as facilities work to fulfill a health department directive requiring facilities to test all residents and staff by July 24.
As of Wednesday, 349 — or about 50% — of the state’s facilities had completed the testing.
Those results are included in NEDSS and the public facility-level data, Mumma said.
The next weekly facility-level update is expected to be released July 21.
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Pa. nursing home data used to track covid-19 deaths, cases riddled with errors
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