New York Gov Andrew Cuomo, who has won bipartisan praise for rallying supplies for his ravaged hospitals and helping slow the coronavirus, is coming under increasing criticism for not bringing that same level of commitment to a problem that has so far stymied him: nursing homes.
In part-lecture, part-cheerleading briefings that have made him a Democratic counter to President Donald Trump, Cuomo has often seemed dismissive and resigned to defeat when asked about his state leading the nation in nursing home deaths.
"We've tried everything to keep it out of a nursing home, but it's virtually impossible," Cuomo told reporters. "Now is not the best time to put your mother in a nursing home. That is a fact."
Residents' relatives, health care watchdogs and lawmakers from both parties cite problems with testing and transparency that have prevented officials, and the public, from grasping the full scale of the catastrophe.
And they are second-guessing a state directive that requires nursing homes take on new patients infected with COVID-19 -- an order they say accelerated outbreaks in facilities that are prime breeding grounds for infectious diseases.
"The way this has been handled by the state is totally irresponsible, negligent and stupid," said Elaine Mazzotta, a nurse whose mother died last month of suspected COVID-19 at a Long Island nursing home. "They knew better. They shouldn't have sent these people into nursing homes."
Of the nation's more than 25,000 coronavirus deaths in nursing homes and long-term care facilities, more than a fifth of them -- about 5,300 -- are in New York, according to a count by The Associated Press, and the toll has been increasing by an average of 20 to 25 deaths a day for the past few weeks.
"The numbers, the deaths keep ticking up," said MaryDel Wypych, an advocate for older adults in the Rochester area. "It's just very frustrating."
Cuomo faced criticism at a recent briefing for saying that providing masks and gowns to nursing homes is "not our job" because the homes are privately owned.
"It was such an insensitive thing to say," said state Assemblyman Ron Kim, a Queens Democrat who noted that it wasn't until just this past week that New York and neighbouring states announced a plan to combine forces to buy protective gear and medical supplies for nursing homes.
"If we had focused on that early on," he said, "we could have saved a lot of lives."
Cuomo's administration defended its response to the crisis, saying it has provided more than 10 million pieces of protective equipment to nursing homes and created a database of 95,000 workers who have helped out in hundreds of New York homes.
"This was an overwhelming situation for everyone," said Jim Malatras, who serves on the governor's COVID-19 task force. "There were deaths and it's unfortunate. But it doesn't mean we weren't aggressive."
One key criticism is that New York took weeks after the first known care home outbreaks to begin publicly reporting the number of deaths in individual homes, and still doesn't report the number of cases.
By the time New York began disclosing the deaths in the middle of last month, the state had several major outbreaks with at least 40 deaths each, most of which were a surprise to the surrounding communities and even some family members.
"They should have announced to the public: 'We have a problem in nursing homes. We're going to help them, but you need to know where it is,'" said former New York Lt. Gov. Betsy McCaughey, a Republican who now heads the nonprofit Committee to Reduce Infection Deaths.
"Instead, they took the opposite tack: They hid it." Further, there has been a lack of testing in several recent New York outbreaks, including one that killed 98 residents, many of whom died with COVID-19 symptoms without ever being tested.
Unlike West Virginia, New York has not mandated testing in its more than 1,150 nursing homes and long-term care facilities.
Nor has Cuomo followed the lead of such states as Maryland, Florida, Tennessee and Wisconsin in dispatching National Guard teams to homes to conduct testing, triage and some care.
To be sure, it's difficult to gauge the impact of such actions. While those states reported fewer nursing home deaths than New York, several have a larger share of nursing home deaths out of their state's totals than New York's 25 percent.
"No state is doing even close to an adequate job," said Elaine Ryan, AARP's vice president for state advocacy.
New York has faced particular scrutiny for a March 25 state health department directive requiring nursing homes to take recovering coronavirus patients.
"A number of nursing homes have felt constrained by the order and admitted hospital discharged patients without knowing what their COVID status was," said Chris Laxton, executive director of the Society for Post-Acute and Long-Term Care Medicine. "This order made an already difficult situation almost impossible."