Michigan audit to show 'nearly 30%' more COVID deaths tied to long-term care facilities

Craig Mauger
The Detroit News

Lansing — A much-anticipated state investigation will report the number of COVID-19 deaths linked to long-term care facilities in Michigan is "nearly 30%" above what state officials previously tallied, according to two state officials who've reviewed the audit.

In a letter revealed Wednesday, Elizabeth Hertel, director of the Michigan Department of Health and Human Services, criticized the findings ahead of their formal release by the Michigan Office of the Auditor General, which are due out Monday. Hertel questioned the methods used by the office to arrive at its conclusions, which have not been reviewed in detail yet by The Detroit News.

State departments almost never issue a rebuttal to a Michigan auditor general report before it's released.

Hertel said almost half of the difference between the state health department's tracking and the audit's was attributed to the inclusion of facilities that are not subject to state reporting requirements. The director also said the Auditor General's Office had included individuals who resided at non-reporting facilities on shared campuses with a facility required to report its COVID-19 deaths.

"I fear that your letter will be misinterpreted to question the work and integrity of long-term care facilities, local health departments, coroners and other frontline workers who we rely on to report data," Hertel wrote in her Sunday letter to Doug Ringler, Michigan's auditor general.

A worker dressed in personal protection equipment at a Detroit nursing home watches a protest outside in April 2020 during the early days of the COVID-19 pandemic.  A report that's expected to be released Monday will suggest the number of COVID-19 deaths linked to long-term care facilities in Michigan is "nearly 30%" higher than state officials have tallied, according to the state health department's director.

Since the beginning of the pandemic, Michigan's health department has tracked 28,228 deaths linked to COVID-19. According to its current state data, 6,309 deaths, or 22% of the state's total, have been tied to long-term care facilities.

While the report itself won't be revealed until Monday, the early release of Wednesday's letter by the Department of Health and Human Services was a sign of the attention the findings will likely receive.

Democratic Gov. Gretchen Whitmer's handling of nursing homes during the COVID-19 pandemic has been a key point of disagreement with GOP lawmakers, and legislators have been working to investigate the data at the center of the debate.

House Oversight Chairman Steve Johnson, R-Wayland, confirmed the 30% finding in a Wednesday evening interview.

"The 30% number is accurate, and it's incredibly troubling," Johnson said of the Auditor General's finding.

The decision of 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.

Skilled nursing facilities, or nursing homes, are one type of long-term care facility in Michigan. There are about 447 of them. Other types of long-term care facilities are adult foster care facilities and homes for the aged. Johnson has said there are many long-term care facilities that didn't have to report their COVID-19 statistics to the state, including thousands of small adult foster care facilities.

The Auditor General's report will indicate the state health department tracked the COVID-19 deaths generally accurately under the federal Centers for Disease Control and Prevention guidelines.

The CDC defines a long-term care facility COVID-19 death as a resident who died from COVID-19-related complications, including deaths in the facilities and at other locations where the resident was transferred.

Hertel's letter asserted the upcoming Auditor General report included long-term care residents who were hospitalized for a non-COVID-19 reason, such as a fall, and then subsequently acquired COVID-19.

"The data table in section 2 is misleading and appears to suggest that there was a nearly 30% underreporting, when almost half of this difference can be attributed to facilities not subject to reporting requirements," Hertel's letter said.

Members of Whitmer's administration have argued the upcoming report attempts to compare apples to oranges.

Kelly Miller, state relations officer for the Auditor General, declined to respond to Hertel on Wednesday. The office on Wednesday released its findings to Johnson, who requested the report, Miller said.

"We will post it to our website on Monday, and we are not releasing any details at this time," Miller said.

State Rep. Steve Johnson, R-Wayland, holds a Sept. 28, 2021 press conference on the state’s Unemployment Insurance Agency. Johnson and Republican lawmakers have criticized the Whitmer administration's handling of COVID-infected residents of long-term care facilities.

Johnson requested the Office of Auditor General undertake a "comprehensive study of reported and unreported deaths in long-term care facilities" in June following questions over the reliability of the state's data. 

The state Department of Health and Human Services created controversial 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 entirely 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.

In addition, some nursing homes struggled to implement isolation and safety protocols to contain the virus.