COFAR blog

While testing of staff for COVID-19 remains voluntary in group homes funded by the Department of Developmental Services (DDS), state guidelines appear to require testing of staff in small facilities in which at least some individuals are symptomatic.

Meanwhile, a state senator, who filed a bill (S.2657) to make testing of staff mandatory in nursing homes, is reportedly supporting mandatory staff testing in the DDS system as well. A legislative aide to Senator Jamie Eldridge said Eldridge supports amending his bill to make testing mandatory for DDS group home staff.

Eldridge’s legislative aide said he notified the Legislature’s Public Health Committee of the senator’s support for that change. Eldridge’s bill is currently in the committee.

While DDS started a mobile program more than a month ago to offer tests to every resident and staff member in its residential system, DDS has stated that the tests are voluntary for staff. In addition, DDS has no current plans to undertake periodic re-testing of either residents or staff.

We have repeatedly raised the concern that staff are potentially the main source of introduction of the virus to group homes, in which residents have been locked down from nearly all visitation since mid-March.

As a result, even as the rate of COVID-19 cases among all residents of the state has started to taper off and Governor Baker has introduced a detailed plan to reopen the state’s economy, the number of COVID-19 cases in the DDS system appears to be continuing to rise rapidly.

As of May 11, the last day for which DDS provided data to us, 1,000 provider-run homes in the DDS system were reporting positive COVID-19 cases. That is nearly 50% of the total number of provider-run homes in the system, and that was up from 900 homes reporting positive cases as of May 7.  We are asking DDS for more up-to-date figures.

Despite the voluntary nature of the staff testing in the DDS system, COVID-19 testing guidelines from the Department of Public Health (DPH), dated May 13, state that “all individuals” who have “close contact” with persons showing symptoms “should be tested” for COVID-19.

Under DDS’s own guidelines, group homes appear to be a type of facility in which close contact is unavoidable. Those guidelines define “close contact” as “living in the same household as a person who has tested positive for COVID-19, caring for a person who has tested positive for COVID-19, or being within 6 feet of a person who has tested positive for COVID-19 for about 15 minutes.”

As a result, the DPH guidelines would seem to require that all staff be tested if they are working at least in those group homes in which one or more residents are symptomatic.

Also, guidelines from the federal Centers for Disease Control (CDC) identify “workers in congregate living settings” as a “high priority” for testing if they themselves have symptoms of COVID-19. Other persons in that high-priority class, if they have symptoms, are residents in those facilities and hospitalized patients.

DDS, however, is not requiring group home providers to test staff even if the workers have symptoms. While those staff are precluded from working in the residences while they are ill, they can return to work three days after recovering from their illness without necessarily getting tested.

Guidelines have some apparent contradictions regarding staff testing

Despite the clear-sounding statements in the guidelines regarding staff testing, DDS may consider that it has some leeway in complying with those statements because some seemingly contradictory language can also be found in those same documents.

For instance, while the DPH guidelines state, as noted, that anyone in a residence who has close contact with a symptomatic individual should be tested, the same guidelines also contain the following statement:

Asymptomatic individuals can be recommended for diagnostic testing at the discretion of their healthcare provider, a state agency, or an employer. Individuals are encouraged to confirm with their insurance whether the test will be covered.  (My emphasis)

That language in the latest DPH guidance seems to directly contradict the previously noted language in the same document that states that “all individuals” having close contact with persons who are symptomatic “should be tested.”

Meanwhile, despite the CDC’s guidelines that refer to staff with symptoms as a “high priority” for testing, another set of CDC guidelines allows infected healthcare staff to return to work without necessarily getting tested. Those latter guidelines and guidelines from the Baker administration’s COVID Command Center both appear to leave it to the discretion of the provider or individual state agencies as to whether to re-test staff returning to work after they have recovered.

Both the CDC and the state COVID Command Center refer to “test-based” and “symptom-based” strategies for returning to work.

Guidance sent by DDS last month to all group homes appears to adopt the “symptom-based strategy” for allowing a staff worker who has COVID-19 symptoms to return to work after they have recovered without being tested. Under the DDS guidance, that worker would be prohibited from working in the group home for three days after recovering from the illness. If the staff worker were to be tested at any point and the test was positive, that worker would be excluded from work for seven days from the date of the test as long as the worker showed no symptoms.

In neither of those cases does the DDS guidance require testing or re-testing for COVID-19 before that worker can return to the group home or to one of the state’s two developmental centers.

DDS has stated that “very  few” staff have so far refused to cooperate with the testing program; however, we have received a number of reports from family members of some group home residents that none of the staff in those homes, or very few of them, were being tested.

The situation is different in nursing homes in which staff testing is required if the nursing homes want to receive grant money made available last month by the administration.

DDS Ombudsman Christopher Klaskin maintained last week that DDS “continues to follow the CDC and DPH (state Department of Public Health) guidance for testing in our group homes.”

Klaskin added that both the CDC and DPH “differentiate between nursing facilities (which are health care facilities) and congregate care settings (like group homes), so operational protocols issued for these two systems are different.”

In our view, however, the CDC guidelines do not appear to differentiate between healthcare facilities and congregate care settings, but rather state that workers in both types of facilities either are or potentially are priorities for COVID-19 testing.

As a result, I wrote to Klaskin on May 13, asking why DDS does not at least require re-testing of group home staff before returning to work after those persons have previously tested positive or had symptoms.

In a related development, we have written to the chairs of the House and Senate Ways and Means Committees and to a key senator, asking for a change in a separate bill (S.2695) that would require DPH to publicly report testing data on residents and staff in DDS group homes.

The bill, as currently written, requires DPH to collect and report data on residents and staff in nursing homes and other DPH long-term care facilities as well as correctional centers. But the bill does not mention DDS group homes.

As we’ve said before, we are concerned that even as Governor Baker cautiously reopens the Massachusetts economy based on encouraging data on the incidence of COVID-19 in the population of the state as a whole, the administration does not appear to be showing the same caution or concern for clients in the DDS system.

At the very least, DDS should adhere to written federal and state guidelines regarding testing of group home staff.

We are encouraging people to call the Public Health Committee, and urging them to support an amendment to Senator Eldridge’s bill (S.2657) that would make testing of DDS staff mandatory.  The phone numbers are (617) 722-1532 for the office of the Senate chair of the committee, and (617) 722-2130 for the House chair.