Michigan auditor general: Unfair to call nursing home COVID death count an 'under-report'

Craig Mauger
The Detroit News

Lansing — Michigan Auditor General Doug Ringler told lawmakers Thursday that his office did not believe it was "fair" to label the state health department's tracking of COVID-19 deaths in long-term care facilities as an "under-report."

Ringler made the comment at a three-hour hearing in Lansing where Republican lawmakers scrutinized his finding of 2,386 more long-term care COVID-19 deaths in Michigan than Gov. Gretchen Whitmer's administration tallied. 

“We knew that the department wasn’t tracking all the ones that we reflected in our letter," the auditor general said, noting that his office reviewed more types of long-term care facilities than fell under the state's tracking. "So we didn’t feel the word 'under-report' was fair. We cited it as a difference."

Elizabeth Hertel, director of the Michigan Department of Health and Human Services, defended how the state counted COVID-19 deaths at the long-term care facilities.

Ringler's statement came in response to a question from state Sen. Jeff Irwin, D-Ann Arbor, who indicated there was a preliminary document in which "under-report" was used.

The numbers are at the center of an intense political debate over Whitmer's handling of nursing homes during the pandemic. It's a disagreement that's expected to continue into the November election.

The Democratic governor's health department focused on caring for elderly individuals with COVID-19 inside isolated areas of current nursing homes, while Republicans repeatedly called for separate facilities to combat the spread of the virus. 

Republicans have argued the auditor general's report, which debuted on Monday, is evidence Whitmer was wrong. But Elizabeth Hertel, director of the state Department of Health and Human Services, blasted the conclusions of the review, saying it used improper and unfair methods to do its research.

More: Michigan nursing homes ordered to offer on-site booster shot

Ringler, who's appointed by lawmakers, stood by his office's findings on Thursday during a joint hearing of the House and Senate oversight committees.

"In black and white, we identified what it was we did," he said. "We identified the pluses of our work. We identified some of the warts that existed in trying to do data analytics. It’s there in black and white.”

At the request of House Oversight Chairman Steve Johnson, R-Wayland, Ringler's report examined 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 was up 42% from the previous total.

Hertel argued Thursday that the auditor general's office included facilities that were not required to report their COVID-19 deaths to the state in the count, including adult foster care facilities licensed for 12 or fewer beds. The director also emphasized the auditor general relied on the Michigan Disease Surveillance System, which is used for tracking infections and doing contact tracing, to link facilities to COVID-19 deaths. The system is not reliable for tracking deaths and isn't meant for that purpose, she said.

Senate Oversight Chairman Ed McBroom, R-Vulcan, pressed Hertel about her criticisms.

"Is it your contention today to these committees that almost the entirety of that discrepancy is based on them utilizing the MDSS system?" he asked.

Hertel replied, "I believe that that universe of numbers is a universe that cannot be verified with the information that we have available to us. It requires more information to verify."

As of Wednesday, the state health department had tracked 6,322 COVID-19 deaths among long-term care facility residents. Those are individuals who lived in nursing homes, adult foster care locations with 13 or more residents and homes for the aged. The number represents about 22% of the total COVID-19 deaths in the state since the pandemic began in March 2020.

In April 2020, Whitmer issued an executive order, stipulating that long-term care facilities could not prohibit the admission or readmission of a resident based on COVID-19 testing requirements. The administration has said it never forced a nursing home facility to take a person with the virus for whom the facility didn't want to provide care. But lawmakers have contended that some facilities thought they had to comply with the order before it was changed.

House Oversight Committee Chairman and Rep. Steve Johnson, R-Wayland, requested the auditor general's report on COVID-19 deaths in Michigan's long-term care facilities.

While the debate has been heavy over whether Michigan is an outlier, tracking by the Centers of Disease Control and Prevention shows the state ranks 14th nationally for the most nursing home COVID-19 deaths per population.

Michigan has had 4,008 COVID-19 deaths among nursing home residents, amounting to about 140 deaths per 1,000 residents. Indiana leads the nation with 175 COVID-19 deaths per 1,000 nursing homes residents, or 5,849 overall, according to the data.

Those numbers are based on nursing home reports submitted through the CDC. The CDC and the Centers for Medicare & Medicaid Services have performed "quality assurance checks on the data and may suppress data that appear to be erroneous."

Johnson said the federal government's tracking doesn't account for deaths in all of the long-term care facilities that Whitmer's executive order affected. Republican lawmakers said it's crucial to get numbers that reveal the total impact of the long-term care policies.

Michigan was one of a "handful of states" that decided to put individuals with COVID-19 into the facilities, Johnson said.

"For us to not count them would be insane."

However, Irwin said Michigan's performance with nursing homes was better than those of other other states even though Michigan was hit harder early on when less was known about to combat the virus.

"I think that’s remarkable," Irwin said. "I think that shows some of the things we were doing here were right."

On Thursday, the state health department issued a new epidemic order, requiring nursing homes to offer the on-site administration of COVID-19 vaccines to residents who aren't up to date with their vaccinations.

For someone who is unable to make their own medical decisions, nursing homes must contact the person legally authorized to make medical decisions on behalf of the resident.

In the spring of 2020, the state Department of Health and Human Services created regional hubs 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.

At one point Thursday, Johnson asked Hertel if she agreed that the state should never put infectious people into nursing homes in the future.

"No, I would not say that," Hertel replied. "What I would say is what we need to do is ensure that facilities who are caring for patients, in particular medically frail patients, have the resources that they need to properly control for infectious diseases."