In recent days, academic researchers and politicians have made distressing disclosures about the terrible toll the coronavirus pandemic took on the aged, injured, and sick in nursing homes and other long term care facilities with new data suggesting the disease infected more of the vulnerable and killed more of them than previously known.

Government officials, in the pandemic’s early days, may have failed to count 16,000 nursing home deaths due to the coronavirus, researchers at Harvard, UCLA, the University of Minnesota, and Massachusetts General Hospital reported in an online section of the Journal of the American Medical Association.

Before federal reporting rules took effect in May 2020, officials also may have missed 68,000 more nursing home infections, the researchers found.

Karen Shen, the study’s lead author and a recent Ph.D. in the economics department at Harvard University, told USA Today that researchers decided to dig into the information on the pandemic’s harms inflicted on the vulnerable, fearing the figures were inaccurate:

“We would just lose a sense of those people’s lives in the history books. That just didn’t feel right to us.”

The expert analysis, working from data provided from 20 states that compiled their information and comparing this information against federal statistics, produced disturbing mismatches with researchers finding that the official U.S. pandemic death toll in nursing homes may be off by 14% and the infections by 12%. And this has big bottom-line implications, USA Today reported:

“Applying their findings to the entire nation, they pegged the true impact on nursing homes at 592,629 cases and 118,335 deaths by the end of 2020.”

(That number itself may be understated, as AARP, the nation’s largest advocacy group for older Americans, estimates the pandemic’s death toll among nursing home residents and staff at 186,000. The New York Times, in its last, June update, put the mortality number at 184,000, saying that these deaths then were still a third of all coronavirus fatalities recorded).

Because the pandemic slammed Northeastern states early, figures from them may be skewed most, the researchers said, adding to what has been a major political mess that hung over the head of Andrew Cuomo, the now disgraced New York governor forced to resign due to sexual harassment charges. As USA Today reported:

“[D]eath counts captured by the federal tracker would suggest similar outcomes between nursing homes in California and New York. But after accounting for early reporting gaps, the study found stark disparities: New York nursing homes experienced 8 deaths per 100 beds, compared to 5.5 per 100 in California.”

The researchers wrote in the medical journal study that they hope improved fatality and infection statistics will be helpful as other experts try to assess what went wrong in long-term care and what steps must be taken to remedy the shortcomings:

“To date, both academic and policymakers’ analyses of facility-level determinants of infections and mortality have likely been limited owing to the reliance on federal estimates. In particular, use of the unadjusted federal data may help explain why some reports found an association between lower-rated nursing homes and Covid-19 outbreaks (a conclusion that guided early enforcement actions against nursing homes), while others did not. Our data, which we have made publicly available, also offer the ability to credibly study the associations of facility responses and state and federal policy in the early months of the pandemic with slowing the spread in nursing homes, which is not possible with the federal data owing to missing data.”

By the way, the academic study was accepted by JAMA in June and clearly could not account for recent revelations about New York’s hotly contested data on nursing home deaths and infections, which Cuomo had staunchly defended, and critics derided as inaccurate and under-reported to benefit a politician with higher aspirations. With Cuomo gone, Kathy Hochul, the former lieutenant governor and new governor, announced in late August that New York would align its tallies with those of the federal government, increasing the nursing home and other pandemic deaths by 12,000. As CNN reported:

“The announcement … means that New York’s Covid-19 death toll is now at 55,395, a significant jump from the tally under Cuomo …The nearly 12,000 deaths are not new, but Cuomo’s administration had tallied deaths from an internal reporting system that accounted only for hospitals, nursing homes, and adult care facilities. It did not factor death certificate data submitted to the CDC, which included deaths in any location, including at home.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them and their loved ones by neglect and abuse in nursing homes and other long-term care facilities.

The pandemic became a deadly way for the public to see the many unacceptable ways that nursing home owners and operators pursued profits at the expense of residents and their loved ones. The industry claims it did the best it could under tough, unforeseen circumstance.

But after dumping billions of dollars in taxpayers’ hard-earned money into them, where is the accountability for the debacle that occurred with them? What heads would roll in a Fortune 100 company if the crucial data from its financial experts were off by 12% or 14%? The federal response under the previous administration, especially in long-term care, was nothing less than shambolic, early and later in the pandemic.

Critics love to slam malpractice lawyers and the civil justice system. But many nursing home residents and their families, struggling still with the consequences of the pandemic, are thinking hard if their best recourse may be lawsuits to seek justice for wrongs done to them. As a colleague of mine who specializes in legal matters affecting nursing homes and their residents pointed out, civil lawsuits may be crucial for those harmed (patients and loved ones) because skilled lawyers often can dig out concrete facts and evidence faster and far better during a court case than many regulators might.

Spokespeople for the facilities owners and operators have tried to cast themselves in the best light, saying that the federal government must collect and make public better data about long term care. That’s information which they, of course, could offer — such as posting the lagging and slowing increasing vaccination rates of the over worked and underpaid health workers they employ.

We have much work to do to learn all we can about the pandemic debacle in long-term care as we struggle to fix this nightmare, so the aged, injured, and sick who require intensive help receive it in safe, affordable, and excellent ways.