North Cook News

Illinois nursing homes are responsible for nearly 30 percent of reported Cook County COVID-19 deaths. But those deaths aren't certain to be from COVID-19, company officials tell North Cook News.

Government guidelines and economic incentives are driving over-classification of deaths as COVID-19, they say, distorting reported death counts and lethality rates.

“If there’s been any exposure in the building, in some places they are writing down COVID-19 with or without testing. It seems to be happening across the country," said Julie Beckert, spokesperson and assistant vice president of marketing and communications with HCR ManorCare, which operates facilities in Arlington Heights, Elk Grove Village and Northbrook. “We can’t comment on residents who have passed away because they had significant health issues, so it’s hard to say that it's related to COVID-19 completely.”

Of the 542 deaths in Cook County attributed to COVID-19 as of April 24, 146, or 27 percent, have occurred in a long-term care facility,  according to the Illinois Department of Health.

Using observation but not testing, HCR ManorCare’s nursing homes in Illinois reported 58 COVID cases and 13 deaths, according to media reports. 

Beckert said nursing homes can only do "symptom monitoring" and cannot actually test for COVID-19.

“Testing must be completed through a primary care physician or the (State of Illinois) Department of Health," she said.

But the state isn't testing every nursing home resident who dies in Illinois for COVID. Rather, it is assuming COVID as the cause of death for anyone in a facility, deeming them "epidemiologically linked," according to a spokesperson from the Illinois Department of Health.

“This means someone with known exposure to a laboratory-confirmed case and is experiencing symptoms compatible with COVID-19 meets the outbreak definition and would be reported in the case count," she said. "While reporting sounds fairly straight forward, it is quite complex and we are doing our best to be transparent, while also being responsible."

$13,000 vs. $5,000

Nursing homes and hospitals have another reason to classify their deaths as COVID: money.

That's because guidance from the U.S. Center for Disease Control (CDC) instructs hospitals and nursing homes to classify any hospitalization for or death related to COVID as caused by COVID. The federal government is paying more for COVID diagnoses -- $13,000 per COVID hospital admission versus $5,000 for a patient who has pneumonia.

In Illinois and other states, nursing homes must accept COVID-19 patients released from hospitals, mandates that some say are simply a means to free up hospital beds while promoting the spread of the coronavirus.

"This is a short-term and short-sighted solution that will only add to the surge in COVID-19 patients that require hospital care," the Society for Post-Acute and Long-Term Care Medicine said in a statement.

At HCR ManorCare's facilities in Cook County, they are doing what they can to keep their elderly residents and staff safe.

When residents are in the final stages of life, only one family member can visit in person. The rest, including pets, can say goodbye by iPad or telephone and in some cases through a window.

“We had a military veteran last week whose friend saluted him through the window,” Beckert said.

That’s because of federal guidance issued on March 13 by the Centers for Medicare and Medicaid Services (CMS)

“If their condition is such that their physician determines hospital evaluation and/or care is required, he/she writes an order for transfer/admission to the hospital,” Karen Messer, president and CEO of LeadingAge Illinois, a professional trade association that represents nearly 400 predominately not-for-profit senior living and service organizations, told North Cook News. “If the nursing home is equipped with appropriate staff, a sufficient supply of personal protective equipment (PPE) and has the ability to isolate the resident and maintain infection control precautions, the older adult may be able to remain in the nursing home.”

The one family member who is allowed to visit a resident at Manor Care homes in Illinois must wear a gown, face mask and gloves.

“That is our new normal,” Beckert said