Mich. Auditor General reports 2,386 more long-term care COVID deaths; state disputes tally

Craig Mauger
The Detroit News

Lansing — Michigan's auditor general is reporting 2,386 more COVID-19 deaths linked to long-term care facilities than previously tallied by the state health department using different tracking methods.

The report by the Office of the Auditor General, obtained Friday by The Detroit News, examines long-term care facility deaths through July 2. It described the difference between the state health department's count and the auditor general office's finding as 29.6%.

The auditor general's office tallied 8,061 COVID-19 deaths tied to long-term care facilities. The state health department, using self-reported numbers from facilities, counted 5,675, so the report's finding is up 42% from the previous total.

The tallies are likely to become the focus of a continuing and heated debate between Democratic Gov. Gretchen Whitmer's administration and Republican lawmakers, who control the state Legislature and requested the auditor general report, which will be officially released Monday.

The two sides have battled for 20 months over the handling of the pandemic in nursing homes, where elderly residents were especially vulnerable to the virus.

The Michigan Department of Health and Human Services disagreed with 1,511 deaths included in the auditor general's tally — 63% of the newly added deaths — because the report used address information from the state disease surveillance data to link death certificates to long-term care facilities.

"Based on our rationale ... including conducting further procedures to corroborate the addresses, we contend the address field is reliable," wrote Doug Ringler, Michigan's auditor general, in a Jan. 12 letter to House Oversight Chairman Steve Johnson, R-Wayland.

On Sunday, Elizabeth Hertel, Michigan's health director, responded to the report in her own letter to Ringler, saying the address information could be inaccurate or incomplete.

"Skilled nursing facilities may be part of complexes including other service types," Hertel wrote. "The address that matches a skilled nursing facility may also be the same address as a hospice, assisted living facility or other residential setting."

The state health department tracked long-term care facility deaths by requiring facilities it regulated — which does not include all of the facilities in the state — to self-report COVID-19 cases and deaths.

The auditor general's office "verified" that the state health department accurately posted the self-reported COVID-19 numbers from long-term care facilities, according to the new report, which is not officially an audit under the office's practices.

Whitmer's spokesman, Bobby Leddy, said the report confirmed Michigan counted "100% of COVID-19 deaths that were reported to the state" under federal guidelines and accurately reported the numbers provided by nursing homes.

"Through the pandemic, the state of Michigan closely followed the data and science within CDC's guidelines to slow the spread of the virus and save lives," said Leddy, referring to the federal Centers for Disease Control and Prevention.

The state Department of Health and Human Services created regional hubs in April 2020 to help care for nursing home residents with COVID-19. The hubs were existing nursing homes that were supposed to have the isolated space, equipment and personnel to help elderly individuals with the virus who were being discharged from hospitals or resided in other facilities that couldn't properly handle them.

But Republican lawmakers repeatedly called for the creation of separate facilities to care for those with COVID-19 to stem its spread among a vulnerable population. Nearly half of the nursing homes that Michigan initially selected to serve as regional hubs to care for elderly individuals with COVID-19 had below-average quality ratings from the federal government.

Ringler, the current auditor general, was chosen by a majority vote of lawmakers for an eight-year term. Ringler's office is tasked with conducting "post financial and performance audits of all branches, departments, offices, boards, authorities, and other institutions," according to the office's website.

According to Ringler's report, the health department conducted "high level" reviews to ensure the facilities reported and did "limited" checks on the integrity of the state.

The auditor general office's process went further by using death certificates, on which COVID-19 was linked to the death; case surveillance data on COVID-19 infections and outbreaks; and a listing of all long-term care facilities in the state.

Of the new deaths tracked by the auditor general, 923 or 39%, were linked to facilities that didn't have to report to the state, including hospice-only skilled nursing facilities and homes for the aged that were exempt from state regulations.

Members of the Whitmer's administration have argued that they relied on CDC guidelines to do their count of COVID-19 deaths in long-term care facilities. Using the CDC definitions allows for comparisons between different states, they say.

The auditor general's review appears to show Michigan's overall tracking captured the vast majority of COVID-19 deaths.

Analyzing death certificate data from Jan. 1, 2020, through July 2, 2021, the office found 788 additional COVID-19 deaths or 3% that weren't in the state's count.

Johnson, the state House Oversight chairman, on Wednesday called the nearly 30% difference between the auditor general office's overall tally and the health department's count "incredibly troubling."

The decision by Whitmer's administration to care for patients with COVID-19 in long-term care facilities was "disastrous," Johnson said. GOP lawmakers pushed for wholly separate facilities that Whitmer's team resisted, questioning the feasibility of the idea.

Tori Sachs, executive director of the conservative political group Michigan Freedom Fund, called for a "thorough investigation" into the long-term care numbers.

"These were people’s lives — not data points — that the Whitmer administration chose to ignore," Sachs said.

But Andrea Acevedo, president of the Service Employees International Union Healthcare Michigan, said the review confirmed that officials and front-line workers did "their job to report this data with accuracy and integrity."

"Going forward, the Legislature should find ways to support our front-line heroes, not attack them," Acevedo said.