There's one thing that distinguishes the nursing homes in New York that have reported patient deaths from COVID-19. According to an NPR analysis, they are far more likely to be made up of people of color.
NPR looked at 78 nursing homes in New York in which six or more residents have died of COVID-19. In one facility, 55 people have died as of April 20. Ten others report 30 or more deaths.
Seven of the 11 nursing homes with the highest number of deaths report that 46 percent or more of their residents are "non-white." Most of these "non-white" residents are black and latinx. At one facility, the Franklin Center for Rehabilitation and Nursing in Queens, which reported 45 deaths, 80 percent of the residents are minority, including 47 percent who are Asian.
NPR filed a public records request with the Centers for Medicare and Medicaid Services and collected data on every nursing home in the United States. We focused our analysis on New York because that state has the most deaths of COVID-19, by far.
Fifty-eight percent of the deaths in the state happened in nursing homes in New York City. Those nursing homes, the NPR numbers show, are notable for their high percentages of residents of color.
But even most of the residents who died in facilities in other parts of the state were living in nursing homes that had a high percentage of residents of color. The population in those facilities tend to reflect the demographics of the counties where they were located.
The racial imbalance in the deaths in New York nursing homes reflects another national trend: That among all fatalities, across the country, from COVID-19, black and Hispanic people make up a disproportionate share of the dying.
NPR analyzed other data too, including the federal government's system for rating nursing homes that gives each facility a star rating from one to five.
In New York state, nursing homes that recorded deaths actually had better quality scores than other nursing homes. Half of the facilities that report deaths get four or five star ratings from Medicare's Nursing Home Compare website, indications of "above average" or "much above average" quality.
On other indicators, there was little difference between nursing homes with deaths reported and other facilities in the state. Staffing levels were about the same. Their reliance on Medicaid patients — who bring lower reimbursements — was similar, too. Their occupancy rates — which can indicate problems at a facility if low — also were roughly the same.
But the nursing homes with outbreaks were often larger facilities. Three of those facilities have 700 or more residents. Almost half — 38 out of the 78, including some of the largest in the state — are in New York City.
Nationwide, people living in nursing homes and other long-term care facilities make up close to one out of five deaths nationwide from COVID-19, according to The New York Times.
"It is not surprising that this is exaggerated," Dr. Clyde Yancy, chief of cardiology at Northwestern University's Feinberg School of Medicine, said of NPR's findings of the racial imbalance in deaths at nursing homes. He wrote in the Journal of the American Medical Association about the long history of racial disparities in health care and how it plays out now in this pandemic.
For "someone living in a nursing home who has suffered more extensive complications to a disease process because of already embedded health disparities," says Yancy, "one can only imagine what happens when that individual now is facing coronavirus infection, potential COVID-19 complications."
Years of inequality can lead to less access to health care, to hard lives and jobs, to a greater likelihood of developing diabetes, asthma and other conditions that now put people in those nursing homes at greater risk.
Nursing homes are now being recognized as one of the front lines of the pandemic. The residents are often frail, they have underlying health problems.
Nurse aides — who work for low wages — do the hands-on care. They get people out of bed, bathe them and take them to the toilet. They and other staffers were some of the last to get masks, gloves and other personal protective equipment. That made it easier for the virus to spread, notes Dr. Dora Hughes, of the Milken Institute School of Public Health at George Washington University.
"For all of our pandemic response, much of our attention has focused, appropriately, on hospitals. But I think for what we've seen with the nursing home is a fairly stark reminder that we need to really expand our thinking in terms of essential workers," says Hughes. "The direct care staff, should have been a greater priority."