Michigan health director stands by nursing home COVID-19 death tracking

Craig Mauger
The Detroit News

Lansing — Michigan health Director Elizabeth Hertel told lawmakers Thursday she believes the state's tracking of COVID-19 deaths linked to nursing homes is accurate, but a key Republican said he wants the Auditor General's office to examine the numbers.

The comments highlighted the continued and contentious dispute between Democratic Gov. Gretchen Whitmer's administration and the Republicans who control the Legislature over the handling of long-term care facilities during the pandemic.

Democratic and GOP lawmakers even briefly disagreed Thursday over the official description of the agenda for the House Oversight Committee's hearing. Republican legislators argue the Department of Health and Human Services is under-counting coronavirus deaths in nursing homes, but direct proof of that claim remains sparse 15 months after the state reported its first COVID-19 cases.

Elizabeth Hertel, Michigan Department of Health and Human Services directly, addresses the media before a COVID-19 vaccination facility opens on March 31, 2021. On Thursday, June 3, 2021 Hertel defended her department's counting of nursing home deaths caused by COVID-19 while testifying to state legislators.

"The number that is being reported is accurate," Hertel told the House Oversight Committee on Thursday morning. "Because the number we have reported on our website is self-reported from the nursing homes."

She added later, "I don't think that the nursing homes have any reason or incentive to try to hide the deaths that have occurred in their residents."

Michigan has relied on requirements that force long-term care facilities themselves to report COVID-19 cases and deaths. Providing false information could lead to a nursing home losing its license to operate.

There are more than 400 nursing homes in Michigan. As of Thursday, skilled nursing facilities accounted for 4,257 deaths linked to the virus, 22% of the statewide total.

When homes for the aged and adult foster care facilities are included, long-term care facilities account for 5,740 deaths, including residents and staff, or about 30% of the statewide total, according to state health department data.

During the pandemic, Whitmer's administration has focused on caring for elderly individuals with the virus in isolated areas of existing nursing homes. But GOP lawmakers pushed for wholly separate facilities that the Democratic governor's team resisted, questioning the feasibility of the idea.

Clash on death certificates

Now, after those policy debates, the free-market-oriented Mackinac Center for Public Policy and others have argued the state's COVID-19 numbers for nursing homes aren't accurate and suggested the actual numbers could be significantly higher. The Mackinac Center has cited vital record reviews of death certificates as evidence that more COVID-19 deaths are occurring in nursing homes than have been tracked.

The health department examined a sample of vital records from March 2020 through June 2020 and found 44% of the deaths "could be tracked back to a nursing home facility," Mackinac Center attorney Steve Delie told lawmakers.

If that percentage were applied to the rest of the deaths tallied through vital record reviews, there would be an additional 2,400 nursing home deaths in Michigan, Delie said, adding he believes that's even a significant underestimate.

But his statements aren't right, Hertel said. Deaths tracked through vital records are already reported through the nursing homes because they are two different streams of information. So a tally from one can't be added to another, she said.

The data from nursing homes don't include personal identifying information, so state officials can't compare the deaths tracked through vital records reviews with the self-reported numbers. Plus, Hertel said in a Thursday interview, the 44% figure that's been tied to the vital records review from early in the pandemic is not accurate.

The Mackinac Center wants the state to go through the death certificates to check the death figures reported by the nursing homes themselves.

However, Hertel said the certificates alone don't provide enough information because the addresses listed on them might not be a nursing home for someone who was a nursing home resident and because they might not include someone who died in a hospital after getting the virus in a nursing home.

After the Thursday hearing, Rep. Steve Johnson, R-Wayland, chairman of the House Oversight Committee, said there are many long-term care facilities that aren't reporting their COVID-19 statistics to the state, including thousands of small adult foster care facilities.These facilities, which could be private residences, can serve as few as a handful of adults each.

"We know that the long-term care facility death numbers that the department is giving are low," Johnson said. "They're all but admitting that. I don't trust them to do their own investigation."

Requesting auditor general review

Asking the Auditor General's office to examine the data could provide a more accurate picture of the numbers, Johnson said.

The auditor general is appointed by a majority vote of lawmakers to serve an eight-year term, and Auditor General Doug Ringler was appointed in June 2014. The office, which didn't immediately respond to a request for comment, frequently examines state financial records. Its mission is to "improve the accountability for public funds and to improve state government operations for the benefit of Michigan’s citizens," according to the website.

It's unclear what information the Auditor General's office might be able to access to tally nursing home COVID-19 deaths that the health department can't.

Asked whether lawmakers should pass a bill to require facilities to report more information to the state, which the legislators haven't done so far during the pandemic as they criticized the existing statistics, Johnson said the key is the department providing an accurate number.

The description of Thursday's committee hearing on the official agenda was a "presentation on details regarding the state under-counting nursing home deaths." Rep. Julie Brixie, D-Meridian Township, said she didn't believe the description itself was accurate.

"We have not been presented with any facts or evidence today that would support the preconceived conclusion," Brixie said.

Johnson replied that it might be a "semantics issue" because under the umbrella of all long-term care facilities, the state's death number is lower than reality. Hertel then interjected that she acknowledged only that the number "could be" lower.

Republican lawmakers have been pressing for more information about the Whitmer administration's handling of nursing homes for months. The data could be key in the ongoing debate over whether the emergency policies were successful in comparison with other states.

In February, eight Republican state senators sent a letter to the state and U.S. attorneys general questioning whether there were discrepancies in the way nursing home cases and deaths were tallied in Michigan.

Federal requirements mandate that nursing facilities report data on residents with suspected or confirmed cases of COVID-19 who died in the nursing home or elsewhere, Hertel said earlier this year.


Staff Writer Beth LeBlanc contributed.