The state department of health (DOH) was unprepared to respond to infectious disease outbreaks at nursing homes, even before the COVID-19 pandemic hit New York, an audit released by New York State Comptroller Thomas DiNapoli found.

DiNapoli said that a persistent lack of funding for public health over the last decade forced DOH to operate without critical information systems and staff that could have identified and helped limit the spread of COVID-19 at nursing homes.

State auditors also found that DOH did not provide the public with accurate COVID-19 death counts and became entangled in the undercounting of those deaths as the Executive took control of information provided to the public. DOH would not provide auditors with a breakdown by name of the nursing home residents who died from COVID-19, and the actual number of nursing home residents who died is still uncertain. The audit revealed that, on many key indicators, New York significantly trailed other states in surveying nursing homes and developing strategies to stop infections from spreading in facilities.

“The pandemic was devastating and deadly for New Yorkers living in nursing homes. Families have a right to know if their loved one’s COVID-19 death was counted, but many still don’t have answers from the state Department of Health,” DiNapoli said. “Our audit findings are extremely troubling. The public was misled by those at the highest level of state government through distortion and suppression of the facts when New Yorkers deserved the truth. The pandemic is not over, and I am hopeful the current administration will make changes to improve accountability and protect lives. An important step would be for DOH to provide the families who lost loved ones with answers as to the actual number of nursing homes residents who died. These families are still grieving, and they deserve no less.”

DOH’s inadequate nursing home oversight and low standards for compliance have been long-standing issues. Previous reports issued by DiNapoli’s auditors have taken issue with the department for setting minimum standards for compliance and setting a low bar for accountability for nursing homes.
As the CDC cites the workforce as a “first line of defense against disease outbreaks and other health threats,” inadequate support led to some of the major problems that arose during the pandemic and delays in setting up infectious disease control procedures at health facilities.

Pres. Biden in February called on Congress to provide additional funding to support health and safety inspections at nursing homes. The Comptroller urges Congressional support for this initiative as these funds could significantly help DOH improve its data systems and examine workforce needs, which have been limited by underinvestment.

The audit recommended the executive chamber assess and improve its internal control environment, including improving cooperation with state oversight inquiries, communication with localities, and external reporting.

It also recommends the DOH expand its use of infection control data to identify patterns, trends, areas of concern or non-compliance that will help create policy recommendations for infection control practices and nursing home surveys; improve quality of public reported data; and strengthen communication and coordination with localities on collection and reporting and use of infection control data.

The DOH should collect supplemental data through other sources, such as the CDC, and incorporate it into its current data sets to establish a foundation to adequately address public health emergencies.
DOH agreed with some of the comptroller’s recommendations but took exception to some statements in the audit.