COFAR blog

Residents with intellectual and other developmental disabilities in group homes have tested positive for COVID-19 at a significantly higher rate than the general population in Massachusetts since the end of April, according to an analysis by COFAR.

The numbers appear to demonstrate the importance of maintaining safe conditions in the homes and testing all staff, particularly if the administration begins to loosen lockdown restrictions in coming weeks.

COFAR analyzed cumulative testing data provided by both the Department of Developmental Services (DDS) and the Department of Public Health (DPH). DDS tracks testing data for residents and staff in its residential facilities, and DPH tracks and publishes testing data for the general population on a daily basis.

COFAR found that on a cumulative basis, the COVID-19 positive rate of DDS residents was 18.4% between April 23 and May 26, while the positive rate in the general population was 12.5% during that same period. That’s a 47% higher positive rate for DDS residents.

While the high rate of COVID-19 infection in nursing homes is widely known, it hasn’t been reported in the media in Massachusetts that residents of DDS group homes have apparently also contracted the virus at a higher rate than the general population.

The number of deaths in DDS group homes has been lower on a percentage basis than in nursing homes, but that death toll is continuing to rise. As of May 28, there have been 87 deaths in the DDS system, up from 78 deaths ten days earlier.

It is not clear why the death toll has been relatively low in the DDS system. But it should not come as a surprise that the conditions that have caused the quick spread of the virus through nursing homes are similar to those that exist in DDS-funded group homes.

Group homes are small, household sized facilities in which DDS residents have been locked down since March. As such, a virus can spread quickly in a group home especially if it is introduced by an outside source — namely staff who are, in many cases, not being tested.

COFAR tracked cumulative DDS and DPH testing data within a period from April 23 through May 26. DPH publishes testing data on a daily basis and breaks it down among several demographic categories.

The general population data that COFAR analyzed is contained in this linked DPH report, which is referred to as the DPH “COVID-19 Dashboard,” and is updated and published daily by that agency.

But the DPH report does not break out data for persons with intellectual and developmental disabilities.  COFAR has obtained testing data on persons in the DDS system after directly contacting DDS on a daily basis.

We compared DDS and DPH  testing data after April 23 because that was the first date for which we received data from DDS showing the total number of residents tested in the system.  The state engaged Fallon Ambulance Service on April 10 to begin testing residents and staff in group homes and at the Wrentham and Hogan developmental centers.

Starting April 10, DDS began reporting results on positive tests on a cumulative basis. DPH has, in contrast, reported test results and test numbers on a daily basis; so we added the DPH daily testing numbers together since April 23 in order to make the numbers from both agencies comparable.

In the period between April 23 and May 26, Fallon Ambulance Service tested a total of 4,500 residents in both DDS group homes and the two developmental centers. During that time, 826 DDS residents tested positive, according to the DDS data.  That appears to be a cumulative positive test rate of 18.4%.

During that same period, the DPH website document linked above shows that 320,243 members of the general population were tested in Massachusetts, and that of that number, 39,928 had tested positive — a cumulative positive test rate of 12.5%.

(Note: DDS ombudsman Christopher Klaskin maintained that the numbers provided by DDS of residents testing positive include the results of tests done by sources in addition to Fallon, whereas the total numbers of tests done reflect only those tests done by Fallon since April 10. As a result, he maintained, the numbers provided by DDS of persons testing positive cannot be compared to the numbers provided of tests done.

Klaskin said DDS doesn’t track either the number of positive results from tests done by sources other than Fallon or the number of tests done by those other sources.

As a result of Klaskin’s assertions, we limited our comparison to tests done after April 23, the date for which we first got a breakdown from DDS on the total number of residents tested.  We do not think it is likely that more than a negligible number of tests have been done in the DDS group home system outside of Fallon’s mobile testing process.)

Governor, planning to restore visitation, cites declining positive test rate

According to the State House News Service, Gov. Charlie Baker said last week that COVID-19 public health data indicates “that we are trending in the right direction.” As a result, the head of the state’s COVID-19 Command Center said plans are in the works to allow people to once again visit their loved ones in long-term care settings.

Residential facilities in the DDS system have been locked down, with few visitors permitted to enter them since March. DDS group home licensure inspections have been discontinued as well.

In that light, we are urging that the administration take measures to better ensure the safety of the residents in DDS facilities. We think DDS can start in that direction by making testing of staff mandatory.

Disability Law Center echoes our concerns on staff testing and safety

A May 21 letter from the Disability Law Center in Massachusetts, a partially federally funded nonprofit organization, echoes many of the concerns COFAR has raised with regard to testing and safety conditions in the DDS system.

The DLC letter to Dan Tsai, assistant secretary for MassHealth, calls for mandatory testing of staff in the DDS system, better training of staff in using Personal Protective Equipment in group homes, and better reporting of data by DPH.

The DLC letter adds that there is still no “firm rule” which prevents direct support staff from working for multiple employers in different DDS group home settings. The letter also notes that the waiting period for previously COVID-positive staff to return to work is seven days, whereas the public health standard is 14 days.

Also, according to the letter, there are no “clearly enforced protocols” against DDS-funded staff working with COVID-positive and COVID-negative residents within the same shift. COVID-positive and COVID-negative residents “are being confined together in close quarters within group homes, often with COVID-egative residents getting little or no fresh air,” the letter stated.

The DLC letter stated that there is a lack of “strong protocols” for testing, screening, and separating transportation providers, such as van drivers, who may be COVID-positive.

The letter added that to the extent that there may be legal barriers to imposing additional safety requirements on providers, such as mandatory testing,  those barriers may be overcome through DPH’s emergency powers or DDS’s ability to adopt emergency regulations, as many other jurisdictions have done.

Secretary Sudders still has not responded to us

Meanwhile, the pace of testing remains slow in the DDS system. Health and Human Services Secretary Marylou Sudders has not responded to our question, emailed to her on May 20, why only one company, Fallon Ambulance Service, is being used to do the testing.

Moreover, we received reports this past weekend that while thousands of residents are still waiting for their first COVID-19 test, residents in some group homes were being retested on a regular basis.

We have asked DDS for an explanation of the testing sequence in the group home system.

In sum, the DDS group home system remains a potential tinderbox that still could erupt if additional safety precautions are not taken. The higher-than-average COVID-positive rate of residents in the system over the past month is evidence of that potential.

It is unfortunate that at this critical juncture in the COVID-19 crisis, in which the administration is considering loosening many of the restrictions that have kept the crisis under control, top administration officials appear to lack accountability.

It is unconscionable that Health and Human Services Secretary Sudders does not feel it necessary even to respond to basic questions about the testing process for residents and staff in the DDS system.

The administration needs to do a better job of ensuring the safety of clients of the DDS system and of demonstrating to families and the public in general that it is in control of the situation.