At least 512 nursing home residents who died from COVID-19 are missing from state reports.
Also unaccounted for in state reports are 25 nursing home staff who died from COVID-19.
On March 1, the state health department reported 1,863 long-term care residents in Oklahoma had died from the coronavirus since the pandemic began.
The most recent federal data reports 2,375 such deaths as of March 6, increasing the state’s casualties by 27%.
Federal reports include only residents at nursing homes funded by Medicare and Medicaid, meaning they capture fewer than half of Oklahoma’s long-term care facilities.
The state health department was the only agency tracking COVID-19 deaths of residents at assisted living, retirement communities that are not federally funded and veteran homes, which had some of the state’s highest death and case counts. Officials say the department is now relying on facility staff and families to voluntarily report those cases. Because reporting is not mandatory, the state will no longer release case or death information for those facilities to the public.
Without those counts, Oklahomans are left with a fragmented picture of the virus’ toll on the state’s 660 care homes and their residents.
The state’s report of resident infections is also deficient.
The health department reported 11,031 COVID-19 cases on March 1, compared to 17,346 reported by the federal agency for fewer facilities. That’s 57% more than the state reported.
“We recognize that that information was not in any way accurate and was not giving an accurate picture of what was occurring in these facilities,” said Jolianne Stone, the state epidemiologist. “We do our best with validation and we do our best with trying to portray the most accurate picture that we have but surveillance has limitations, and unfortunately, this is one of the limitations of surveillance.”
State Now Relies on Federal Data
The federal agency that oversees nursing homes, Centers for Medicare and Medicaid Services, continues to track deaths, cases and vaccinations at 297 Oklahoma facilities. That data is available online but it can be difficult to navigate.
The state is now utilizing federal data to produce its weekly reports, which include only active cases among residents and staff.
As more mask restrictions are lifted and some Oklahomans are trying to regain a sense of pre-pandemic normalcy, vulnerable long-term care residents continue to die from the virus. And the state is no longer reporting those deaths to the public.
An 85-year-old farmer who lived at Beadles Nursing Home in Alva died Feb. 27 after contracting COVID-19 for the second time. He was vaccinated and boosted, and had been out of quarantine for about two weeks when the toll became too much.
“He was my classmates’ dad so I knew him since high school,” said Adam Jordan, whose family has owned the nursing home for nearly a century. “He subbed as a bus driver for my kids when they were little.”
Jordan fills out the federal reports every week. But the farmer isn’t accounted for because they didn’t know for sure that COVID-19 was the cause of death until the death certificate was completed this week. Jordan said he plans to go back to the previous report and add the resident as a COVID death, bringing the home’s total to six lives lost.
Unknown or delayed cause of death rulings are one of many factors that make accurate reporting a challenge.
The federal agency that regulates nursing homes requires facilities to provide weekly COVID-19 updates. Facilities that don’t comply face penalties that could impact their funding.
Facilities reported some of the same information to the state. But officials said those reports were unreliable and delayed, so they chose a different method for tracking COVID-19’s impact on long-term care.
Once a positive COVID-19 test was reported to the health department by a lab, hospital or long-term care facility, it was assigned to an investigator or contact tracer. The investigator called the patient or family member, using information on the form completed at the test site, and asked whether they lived in a high-risk setting such as a nursing home, and which one.
“We rely on individuals reporting information to us,” Stone said. “It is their choice whether they chose to do that or not.”
If a patient or family member did not answer the phone or refused to talk to the investigator, they were left out of the long-term care counts.
This strategy was employed by all 50 states, Stone said. It is not unique to Oklahoma and neither are the gaps in cases and deaths, she said.
In January, the state stopped calling everyone who tests positive. Instead, they’re sending text messages asking them to text “yes” if they would like to provide more information.
The health department’s weekly epidemiology report was revamped this month. It does not include vaccination rates or deaths, which are part of the federal database.
During the first week of March, nine nursing home residents died from COVID-19 at six facilities, federal data shows.
Health officials said the reports are intended to inform family members and the public about a facility’s outbreak status before deciding whether it’s safe to visit.
Nearly 42% of facilities were missing information about active cases in the first iteration of the new report.
For nursing homes with five or fewer cases, the exact number was omitted.
Following questions from Oklahoma Watch about the value of that information to the public, the health department again changed its report.
State Cites Privacy Concerns
The most recent report, released Thursday, includes resident totals and the number of active infections among residents and staff. Of nearly 300 facilities, 20 are missing information. The specific infection count is now included for facilities with five or fewer cases.
Kendra Dougherty, director of the state’s acute disease investigation, said the reporting changes reflect the agency’s transition from a pandemic response to endemic response while still serving the public.
When asked why deaths were no longer being reported, Dougherty cited privacy concerns.
The state has been releasing specific counts of infections and deaths by facility for nearly two years. The move also goes against the advice of former Attorney General Mike Hunter that COVID-19 information can be released as long as no person can be identified.
LaTrina Frazier, a health department deputy commissioner who works with the state’s facilities, said early reporting was needed to help the public understand the challenges staff and residents were facing when they were closed to the public.
Frazier said it’s time for those facilities to go beyond fighting COVID-19 and shift some of their focus to other aspects of care like the mental health of residents, which fell dramatically during lockdowns.
Whitney Bryen is an investigative reporter at Oklahoma Watch covering vulnerable populations. Her recent investigations focus on mental health and substance abuse, criminal justice, domestic violence and nursing homes. Contact her at (405) 201-6057 or firstname.lastname@example.org. Follow her on Twitter @SoonerReporter.