State discloses long-withheld data showing it miscalculated nursing home infections

Newly disclosed data identifies the privately run nursing homes in Iowa that have had the most infections among residents and staff, the most outbreaks, and those that have spent much of the past year in outbreak status. (Photo by Centers for Disease Control and Prevention)

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.

The data identifies the privately run nursing homes that have had the most infections among residents and staff, the most outbreaks, and those that have spent much of the past year in outbreak status.

Last December, the Iowa Capital Dispatch asked the Iowa Department of Public Health for an updated list of all COVID-19 outbreaks in Iowa nursing homes during the pandemic. 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.

For example:

  • At the state-run Iowa Veterans Home, which has had four outbreaks — the most of any nursing home in Iowa — IDPH initially reported two outbreaks that ended prior to November and had resulted in 78 infections. Now the agency says there were 48 infections associated with those outbreaks.
  • A six-week outbreak last spring at the Fleur Heights Center for Wellness in Polk County was initially reported to have left 66 people infected. IDPH now says 43 people were infected.
  • At the Bethany Life care facility in Story County, an outbreak that ended last July was reported last fall to have caused 32 infections. Now, it is 22 infections.
  • An outbreak that ended last June at the Holy Spirit Retirement Home in Woodbury County was reported last fall to have caused 33 infections. Now, the state says 20 infections are associated with that outbreak.
  • Last fall, Ramsey Village in Polk County was said to have had one outbreak resulting in 24 infections. Now, the state says there were two outbreaks and a combined total of 15 infections.
  • Last fall, IDPH reported a two-week outbreak, in September, at Scott County’s Kahl Home, resulting in eight infections. Now, IDPH data shows no outbreak and no reportable infections at the Kahl Home during that time.

State asks for dismissal of open-records complaint

The newly released data on COVID-19 outbreaks in Iowa nursing homes was first requested by the Iowa Capital Dispatch on Dec. 9, 2020. By March, the department still hadn’t provided the data, saying the delay was due to the need for “redactions” to the document.

The Capital Dispatch filed a formal complaint with the Iowa Public Information Board on March 5, after which an IDPH attorney produced a list that omitted the dates of all outbreaks, making comparisons with previously released data impossible. The Capital Dispatch complained again to IPIB, and on March 31, the attorney sent IPIB a version of the list with the dates included. She asked that IPIB dismiss the complaint against the health department.

The news organization has asked the board to pursue the matter and penalize the IDPH for failing to provide the requested information within the timeframe allowed by law.

In his request to IPIB, Capital Dispatch reporter Clark Kauffman stated that “this information was requested in the immediate aftermath of the largest and deadliest surge of COVID-19 infections in Iowa, and the information was withheld by IDPH for 108 days. While IDPH sat on this request, dozens of vulnerable Iowans were admitted to the very same care facilities you see detailed in this report, and because of IDPH’s actions, these people had no way of accurately determining how many COVID-19 outbreaks had occurred in their new home over the course of the pandemic.

“This is information that would have allowed older Iowans — the people most at risk of death — to at least make informed decisions that could have an impact on whether they lived or died. IDPH’s repeated refusal to disclose this information is not only illegal, it is unconscionable.”

Assistant Attorney General Heather Adams has acknowledged to the board that “there was a delay” in IDPH releasing the data. She said that delay wasn’t attributable to the previously claimed need for redactions, but to the fact that the health department no longer maintained a list of Iowa’s nursing home outbreaks.

“This delay was due to the changes in their data systems and of course the significant demands on staff time and resources due to the ongoing COVID-response and the vaccine rollout,” Adams told the board. “While I understand that this delay was frustrating, my point is that no violation of the Open Records Law occurred because there was no public record in existence (i.e., no “updated list”) until IDPH created this spreadsheet in response to Mr. Kauffman’s requests, and once it was created it was provided to him immediately.”

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.

Many of the outbreaks reported by IDPH are relatively small, so the revisions made to the infections tied to those outbreaks are, as well.

For example, an outbreak at Friendship Village in Black Hawk County that ended in June has been scaled back from 53 infections to 47 infections. An outbreak at Thomas Rest Haven in Carroll County that ended in early October has been reduced in size from 19 infections to 13 infections. An August outbreak at Valley Vue Care Center in Emmet County, initially reported to have resulted in 63 infections, is now said to have caused 55 infections.

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 be considered an “outbreak” by the state, a care facility must have three or more infections.)

The newly disclosed data also shows that the state-run Iowa Veterans Home not only has had the most outbreaks of any nursing home in Iowa, with four distinct outbreaks occurring between April 2020 and February 2021, it also is among the homes to have remained in outbreak status the longest during the pandemic.

Over a 41-week period, the home was in outbreak status for a total of 26 weeks. Over a seven-month period, the Risen Son Christian Village in Pottawattamie County was in outbreak status for all but five weeks. Ottumwa’s Good Samaritan Home was in outbreak status for five uninterrupted months last year, from late July through late December.

The Iowa nursing home with the greatest number of infections during the pandemic is the Good Shepherd Health Center in Cerro Gordo County. An outbreak there last summer resulted in 119 infections, and an outbreak this past winter resulted in 127 infections.

The homes with the biggest single outbreaks, each with 100 or more infections, were Luther Manor Communities in Dubuque County; the Longview Home in Harrison County; Hiawatha Care Center and Heritage Specialty Care in Linn County; Ravenwood Specialty Care in Black Hawk County; the Good Shepherd Health Center in Cerro Gordo County; Bishop Drumm Retirement Center in Polk County; Risen Son Christian Village in Pottawattamie County; Clearview Home in Ringgold County; the Davenport Good Samaritan Home in Scott County; and the Ottumwa Good Samaritan Home in Wapello County.

The homes that have experienced three outbreaks include: Alverno Senior Care Community in Clinton County, with a total of 64 infections; Bishop Drumm Retirement Center in Polk County, with a total of 121 infections; Fleur Heights Center for Wellness in Polk County, with 80 infections; Park Ridge Specialty Care in Polk County, with 77 infections; and Vista Woods Care Center in Wapello County, with 53 infections.

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%.

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