Medicare deaths among nursing homes increased by 32% last year, with two horrific nails separated by eight months, a government spy reported on Tuesday in full view of the current Covid-19 vandalism among its most vulnerable victims.
A report from the inspector general of the Department of Health and Human Services found that about 4 out of 10 who received Medicare in nursing homes had Covid-19 by 2020, and that overall mortality had risen by 169,291 since last year, before the coronavirus emerged.
“We knew this was going to be bad, but I don’t think we who work in the area thought it would be so bad,” said Harvard health policy professor David Grabowski, a world-renowned health care expert, who reviewed The Associated Press report.
“It wasn’t the people who were going to die anyway,” Grabowski added. “We’re talking about a very large number of people who have died excessively.”
Investigators used a generally accepted method of estimating “excessive” death in a group of people after a catastrophic event. It did not involve examining individual mortality certificates for Medicare patients, but compared the total mortality between those in nursing homes and the rates recorded last year. This method was used to quantify mortality in Puerto Rico after Hurricane Maria in 2017 and in New York City after the first coronavirus outbreak last spring. It does not indicate the cause of death, but is seen as a barometer of influence.
Mortality rates were higher last month compared to 2019. The report listed two speakers that have a significant impact on government policy and on protecting those most at risk from the spread of life-threatening diseases. In April last year, 81,484 Medicare patients in nursing homes died. Eight months later, after incarceration and impressive efforts to increase screening – but before vaccines became more widely available – elderly home patients had a mortality rate of 74,299 in December.
“This is happening long after it is clear that nursing homes are at high risk,” said Nancy Harrison, deputy district inspector general who worked on the report. “We really have to look at that. Why do they remain so insecure?
Tuesday’s report was clear but from the government because it included last year’s figures, when the coronavirus epidemic began. Medicare does not require nursing homes to report Covid-19 cases and deaths that occurred before May 8, more than four months this year.
In a number of new findings, the report showed that cases and deaths of Asian patients were followed by the worst effects seen on blacks and Latinos. Indeed, Asian Medicare enrollment in nursing homes has seen a dramatic increase in mortality rates, with 27% dying by 2020 compared to 17% last year. For whites, the mortality rate has grown to 24% by 2020 from 18% by 2019, a significant increase but not as predicted.
The death rate for Spanish and Black patients was 23% last year, up from 15% in 2019.
The inspector general’s office relies on its analysis of Medicare billing information, including patients on Medicare Advantage programs sold by private insurers. Medicare covers the majority of patients living in nursing homes, and the report includes long-term and temporary residents at a rehabilitation center.
Health economist Tamara Konetzka of the University of Chicago, who also reviewed the AP report, said creating a standardized estimate of individual death certificates would face another challenge. Especially in the first wave of the epidemic, many of the dead could not be tested for Covid-19, for example.
Konetzka said that by looking at excessive deaths you can move away from some of the measurement problems and say how much worse things are in 2020 than in 2019.