No long-term care advocate is surprised by what was hiding behind Gov. Andrew Cuomo’s mask of self-congratulatory competence. Indeed, his reckless disregard for the lives of nursing home residents in the face of the COVID-19 pandemic was a centerpiece of an academic article of mine.
As I noted in the Quinnipiac Health Law Journal, in Cuomo’s actions he came across no better than Texas Republican Lt. Gov. Dan Patrick, who infamously made the utilitarian argument last March that seniors should be willing to die so the economy would not be hindered by pandemic restrictions.
Rivaling former New Yorker Donald Trump in his hubris, Cuomo was peddling a “New York Tough” poster lauding his own performance even as nursing home residents were dying. He later published a book on “leadership lessons” that omitted a lesson in what some might consider negligent homicide: His administration, in a since-rescinded March 25, 2020 directive, forced nursing homes to take COVID-positive hospital patients into a setting where Cuomo himself said the virus spread like “fire through dry grass.”
Last July Cuomo’s Department of Health put out a report exonerating his administration for the deaths caused by his directive, and it was no surprise the accompanying press release featured praise from two hospital executives. Hospitals, after all, were the beneficiaries of booting several thousand of their infected patients into nursing homes. Further, the methodology of the report was laughable. Among other things, the report blamed workers alone for spreading the virus and did not address to what degree forcing admission of infected patients contributed to deaths and suffering.
Now the truth is out there, thanks to investigative journalism and a report put out by New York Attorney General Letitia James proving the state dramatically understated the number of nursing home deaths – a revelation Cuomo flippantly responded to by stating it did not matter which setting people died in from COVID-19. Perhaps the truth mattered to the health officials fleeing Cuomo’s administration. And the facts matter to those left bereft by the deaths of loved ones in nursing homes that Cuomo’s budgets so long knowingly underfunded even before his COVID-19 admission directive turned them into killing fields.
A flailing Cuomo, having previously blamed nursing home workers for spreading the virus, has now focused on those owning nursing homes – promising to limit profits. What profits? COVID-19 has decimated the sector. For nursing homes, even before the pandemic, the March 2020 annual report to Congress by the Medicare Payment Advisory Commission noted that “[f]or the first year since 2000, the total margin . . . was slightly negative in 2018 (–0.3 percent).” Why? Because of governors like Cuomo, who dictate “state policies regarding the level of Medicaid payments[.]”
In November 2019, union members and providers alike joined forces to “blast” a unilateral Cuomo Administration nursing home cut amounting to $352 million a year. Now New York Senate Democrats are touting legislation requiring “nursing homes to spend at least 70% of a facility’s revenue on direct patient care.” That should be confined to Medicaid revenue in a state that so egregiously underfunds care already. In a state like Washington, where the weighted average Medicaid rate is posted online, 65% of the current Medicaid rate goes to a direct care component alone, and surely costs such as food, and wages for dietary, housekeeping, and maintenance staff are part of care too.
Those who are neglected by state payments include not only the residents of nursing homes, but a frontline caregiving workforce that, data shows, is 92% women – predominantly women of color. Having been marginalized and seen their wages compressed by Cuomo, and his legislative allies, they suffered the further indignity of being blamed by him entirely for the deaths of their wards caused by his actions.
Finally, to recognize Cuomo’s failings regarding COVID-19 is not to exonerate President Trump for his own egregious failings, as Cuomo’s apologists have suggested. The critical difference is only Andrew Cuomo still holds office.
Brendan Williams is the president/CEO of the New Hampshire Health Care Association and author of “Left for Dead: Nursing Home Care Amidst the COVID-19 Pandemic” in the Quinnipiac Health Law Journal.