Federal data suggests Indiana is undercounting COVID-19 nursing home deaths

Federal data released this week suggests Indiana has been undercounting COVID-19 deaths in nursing homes.

At least 1,141 nursing home residents have died from the coronavirus in Indiana, according to new data released Monday by the federal Centers for Medicare & Medicare Services.

That's nearly 200 more than the state reported the same day.

"We are currently looking into these differences and trying to figure out how we get closer to the real number," said Dr. Daniel Rusyniak, chief medical officer for the Indiana Family and Social Services Administration. 

The discrepancy could stem from a difference in how the data has been reported in Indiana.

Initially, nursing homes used a system called Gateway to report deaths to the state. But after Indiana State Health Commissioner Kristina Box ordered facilities to report deaths to the state within 24 hours, facilities began using a different system, said Zach Cattell, president of the Indiana Health Care Association, which represents nursing home operators. 

As a result, the state may not have counted the deaths reported through the earlier system, he said.  

"There may be just simply a data cleanliness problem," he said. 

The discrepancy is especially surprising because the state requires nursing home and assisted living facilities to report deaths, while CMS only requires nursing homes to do so. 

Rusyniak acknowledged the two different reporting methods may have played a role. He said the state requested facilities to provide a "quick one-time assessment" of deaths prior to Box's order.

"It's possible that the facilities were not able to accurately account for and report the deaths at that time," he said.

The state now plans to transition to a reporting system that more closely aligns to CMS, he said. 

AARP, one of the nation’s largest senior advocacy groups, called the discrepancies between the state and federal data “incredibly concerning.”

The organization has called on Gov. Eric Holcomb to publicly identify nursing homes with positive cases and deaths, but he has refused to do so. Most other states, including all of Indiana’s neighbors, share at least some facility-level data to help residents and their loved ones make care decisions.

“We hope that the state quickly identifies where the calculation breakdown took place and promptly fixes the issue,” AARP State Director Sarah Waddle said. “Regardless of what caused the numbers to be different, it shows yet again why the state needs to publicly report this data.”

The new federal data also shows for the first time that eight nursing home employees have died from the virus. State officials have refused to provide information about staff because employees sometimes work at more than one facility, making it difficult to determine to which facility the death should be attributed.

Together, the 1,149 deaths reported by CMS constitutes 58% of all COVID-19 deaths in Indiana, a far higher percentage than previously known.

The new numbers highlight the virus's devastating impact in nursing homes, which have failed to stop its spread despite staunch visitor restrictions that have left many residents to die without their families by side.

New plan to test all employees

Nursing home residents are particularly vulnerable to the virus, which kills the elderly and those with underlying medical conditions at far higher rates than others. Efforts to contain the virus have been hampered by limited testing, which was restricted only to those showing symptoms during the first months of the pandemic. 

State health officials announced Wednesday a new plan to test all nursing home employees by late June or early July.

Rusyniak said this would give the state a better sense of the virus's prevalence among workers and the number of asymptomatic carriers. The results will inform state officials on what additional steps to take.

Families of residents and senior advocates have been calling for universal testing in nursing homes for months. But nursing home operators say it would cost $13 million in Indiana just to test every resident and staff once. Routine testing at that scale would quickly become unsustainable, Cattell said. 

The state also announced new guidance that would allow outdoor visitations between family members and residents who have been separated since March because of fears that visitors might bring the virus into facilities. 

Indiana is far from the only state to see large number of deaths in its nursing homes. USA TODAY found at least 40,600 coronavirus deaths at nursing homes across the country. One advocate called the death toll a "national disgrace."

Contact IndyStar reporter Tony Cook at 317-444-6081 or tony.cook@indystar.com. Follow him on Twitter: @IndyStarTony.