COFAR blog

As the number of group homes reporting positive cases of COVID-19 continues to rise in Massachusetts, a Department of Developmental Services (DDS) official said the Department is considering making staff testing for COVID-19 mandatory.

COFAR has raised a concern that there currently is not a requirement that staff working in the group homes get tested even though DDS began an effort on April 10 to test all residents and staff in more than 2,300 residences across the state.

In addition, it is not clear that DDS has any plans to test residents and staff in its facilities more than once.

COFAR maintains that infected staff may be introducing the virus into group homes and other long-term care facilities. Unless all staff are required to be tested on a periodic basis, it appears likely that positive cases and deaths will continue to increase in those residences.

Christopher Klaskin, the DDS ombudsman, told COFAR yesterday (April 27) that “mandatory testing of all employees would impact multiple EHS (Executive Office of Health and Human Services) agencies and collective bargaining agreements, and we are exploring this option.”

Klaskin added that “very few employees have refused (to be tested), and those situations are addressed on a case-by-case basis.”

In a follow-up email to Klaskin, we said it was welcome news that DDS is exploring the option of mandatory testing, but asked why DDS hasn’t made staff testing a requirement before now.

We also asked how many staff have refused to be tested. It would take only one infected staff to infect an entire group home. We also noted that because DDS is still early in the group home testing program, it is likely that the number of staff refusing to be tested will continue to grow.

An official with one DDS provider, the New England Center for Children, told Boston.com yesterday that the first case of COVID-19 in the Center’s group homes came six weeks ago from an infected staff member who was asymptomatic. The provider’s group homes were locked down even at that time.

There is similarly no requirement that all staff in nursing homes around the state be tested. More than 56% of the total deaths in the state are in nursing homes and rest homes, the Boston Globe reported this week.

Numbers of infected DDS group homes rising rapidly

Data provided to COFAR by DDS shows that over a four-day period ending Sunday (April 26), the number of DDS-funded group homes reporting positive cases of COVID-19 rose from 560 to 720, out of a total of 2,353 corporate provider-operated and state-operated residences. That is an increase from 24% to 31% in the proportion of homes reporting infected residents.

As of April 26, a total of 1,886 staff and residents in the group homes and two remaining DDS developmental centers had tested positive. That is up 252 persons from just four days earlier. There have been 30 deaths in the DDS system from COVID-19.

Repeat testing needed

Earlier this month, DDS announced that the state was contracting with Fallon Ambulance Service to begin testing staff and residents throughout the system.  DDS apparently does not have a timeline for Fallon to complete its testing of what we are estimating to be 22,000 or more residents and staff in the DDS group home system.

It is also unclear whether DDS plans to have Fallon or any other entity periodically retest those individuals and staff who did test negative the first time.

COFAR President Thomas Frain termed a negative test result “a transitory label.” He added that, “Representing to the public that you are at war with the virus but aren’t retesting is akin to chasing Bin Laden across Afghanistan but allowing him free access to the Pakistan border.”

Referring to the need for repeat testing in nursing homes, Simon Johnson, a professor at the MIT Sloan School of Management and a cofounder of the COVID-19 Policy Alliance, told the Boston Globe that  a single round of testing is a “recipe for disaster.”

Johnson said the state needs to move “as quickly as possible to help implement a regular comprehensive surveillance testing program for all residents and staff, so we know who is infected and who is not.” Not only do some people carry the virus without displaying symptoms, some may test negative even though they have already been infected, Johnson told the newspaper.

State may be in violation of Medicaid waiver requirements

In an email to Klaskin and DDS General Counsel Marianne Meacham on Saturday, COFAR asked whether the lack of mandatory staff testing so far is a potential violation of client safety “assurances” under the federal Medicaid Home and Community Based Waiver.

The Waiver, which authorizes Medicaid funding for group homes and other community-based programs, states that states must provide assurances that “necessary safeguards have been taken to protect the health and welfare of the beneficiaries of the services.”

Klaskin responded that DDS and all EHS agencies follow testing protocols from the Centers for Disease Control and Prevention, “so they meet all federal safety regulations.” He added that DDS “must adhere to (the testing protocols) to meet our waiver requirements and safeguards.”

Klaskin added that “pop-up” testing locations are being set up across the state, “giving state and provider staff across multiple shifts another option for testing.”

We are continuing to monitor the testing of group homes across the commonwealth, and are hopeful DDS will make the right changes, particularly making the testing mandatory and repetitive. If that happens, we think and hope the numbers testing positive will peak sooner than they otherwise would, and will start to diminish.