Iowa Discloses Long-withheld Data Showing Miscalculated Nursing Home Infections

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

The latest in a series of headlines comes from my home state – Iowa.  Like you, I’ve been seeing a growing number of reports showing states incorrectly calculated COVID-19 infections in LTC facilities. Keeping track of data over the past 13+ months has been difficult, to say the least.  We rely on accurate data to make decisions about the care we provide and the care that is provided in LTCFs.  LTCFs are judged by the public based on such data – I cite Care Compare as one such example.  An article last month in the New York Times is another example.  I often say that data is king.  I still believe that.  I also believe that data absolutely must be accurate and well-guarded against attempts to manipulate it for any reason.  Peoples’ lives depend on accurate data – that is one of the lessons that this pandemic has taught us. 

Back to Iowa.  I’ve been trying to follow my state’s COVID data since the PHE began. I watched the databases (which were frequently rearranged, changed and “updated”), followed countless public health reports as well as the Governor’s news conferences and everything else that I could get in front of me to try to get my head around what really was happening.  Now comes this article in the Times Republican by Clark Kauffman. LTC industry veterans in Iowa knows Clark Kauffman and have read many of his reports over the years.  I am grateful that he chose to report on this topic at this time with the facts as delivered by IDPH.   Below are some key excerpts – I’ll let you read the specifics for yourself.  Facility names and numbers are part of the disclosure.

  • Newly disclosed COVID-19 data shows the state of Iowa has retroactively reduced the number of nursing home infections that it publicly reported last year.
  • Despite repeated requests, IDPH never produced the list until March 31, when the agency’s attorney sent a copy to the Iowa Public Information Board.
  • A comparison of that list with an earlier version made public last fall shows that most of the nursing home outbreaks that began and ended prior to November 2020 have been retroactively scaled back in size, with the total number of reported infections reduced.
  • Asked why so many of the nursing home infection counts had been reduced, IDPH spokeswoman Sarah Ekstrand said that at some point IDPH realized it had incorrectly categorized some Iowans as living or working in an Iowa nursing home.
  • Also, she said, infection counts changed when the state followed new Centers for Disease Control and Prevention guidance on whether a person who has twice tested positive within 90 days should be counted as two separate cases — one of infection and one of reinfection — or as one lingering case.
  • Iowa has about 440 licensed nursing homes. During the pandemic, there have been 427 outbreaks in those homes, with many facilities reporting two or more outbreaks. The 427 outbreaks have resulted in 15,359 infections among residents and staff, according to the newly disclosed data.
  • To date, COVID-19 had killed 2,246 Iowa nursing home residents. State public health officials say they track infections among Iowa’s nursing home workers, but not their deaths, so it’s not clear how many care facility workers have died due to the pandemic.
  • The state does not track infections and deaths in Iowa’s assisted living centers. The state also says it has no data on vaccine-refusal rates among workers in Iowa’s privately run nursing homes, although the governor has said it’s about 40 percent.

I chose to blog on this disclosure because the lives of Iowans are part of the data – miscalculated or not.  Iowans have been told, as have citizens in all other states across the U.S., that LTC facilities are responsible for as much as 40% of the COVID-19 cases and deaths during this pandemic.  Attention to infection prevention and control was cited as the major reason for outbreaks in LTC facilities and all were locked down on March 13, 2020.  ALL congregate settings, including AL facilities, were on the frontline of this pandemic and its not done with us yet.  Testing was not quickly implemented; PPE supplies were difficult and sometimes impossible to locate and hard to keep in stock to protect those working in the most difficult environment of all – senior living facilities.  Community spread being the cause of cases in senior living communities was not acknowledged until months into the PHE. Denial and failure to act quickly on the part of our elected officials contributed to far more deaths (see this for more information).  The one bright spot was that healthcare workers and LTCF residents were chosen for initial targets when the first two COVID-19 vaccines were available via EUA (see this blog for where we are now with cases in LTC).  The senior living industry – LTC and AL included – have much more work to do in order to increase employee vaccinations as well as vaccinations within their overall communities but we’re getting there.

Another critical element of our autopsy of this pandemic must include how data is reported, calculated and disseminated to all those that need to know.  We must figure out how to accurately collect public health data.  Very clear parameters and standards must be established before the next health crisis.  Honest and transparent reporting of such data must be paramount.  Accomplishing this can’t be that hard – LTC facilities submit critical data every day in the form of the MDS and Payroll-Based Journaling.   We are judged by such data as well as the health inspection reports from our state survey agencies and CMS.  We continue to report this data while in the throes of a pandemic that threatens the lives of the residents in our buildings as well as the employees that enter and provide needed care every single day.  Let’s start tracking infections and deaths as well as vaccinations in senior living facilities across each state – let it start with Iowa.  Doing so might just push us in the right direction to provide health care and not just sick care.