COFAR blog

As Governor Baker continues to reopen the state’s economy due to declining rates of infection in the general population from the coronavirus, the Department of Developmental Services (DDS) announced it is allowing strictly controlled visitation by family members and guardians of loved ones in its residential system.

Yet at the same time, DDS appears to be reducing its levels of testing of individuals for COVID-19 in its group homes.

We strongly support the resumption of family visits. But we are concerned about the apparent lack of consistency by DDS in relaxing testing of residents and staff as the homes are being opened to visitors after a lockdown since March.

The numbers of positive tests for DDS residents are continuing to climb, and the number of deaths in the system, while still relatively low, have been rising as well.

At this critical juncture, DDS appears to be making life difficult for families and easy for providers. The new visitation rules appear not only to have onerous provisions, they contain multiple threats that visits will be terminated and family members banned from any further visits if the providers determine they are in violation of any of the provisions.

Under the new visitation rules, which go into effect tomorrow (June 10), the duration and nature of family visits will be sharply limited, and providers will have discretion to set the terms for the visits and to ban families for perceived violations.

But if DDS is so concerned about family members violating its restrictive visitation policies, the Department does not appear to be concerned that:

• An undetermined number of providers have decided that there will be no COVID-19 testing in their group homes
• Testing of staff continues to be voluntary
• The pace of mobile testing of the group home system appears to be slowing almost to a standstill
• Retesting of individuals appears to be sporadic at best or nonexistent at worst.

Last week, I emailed Christopher Klaskin, the DDS ombudsman, asking whether DDS remains committed to testing the entire group home system, or whether the Department believes that universal testing of residents and staff is not necessary or no longer necessary.

Klaskin did not respond to the question. He did say that DDS is currently “educating providers on the importance of testing and how that data ultimately will inform how we proceed in the phased reopening of our facilities.”

The declining rate of DDS COVID-19 testing may reflect a drop in the rate of testing of the population of the state as a whole. The Boston Globe reported yesterday that even as the administration is opening up businesses throughout the state, COVID-19 testing has dropped to the lowest rate in months.

Testing that has been done by DDS shows that the number of persons in the residential system is continuing to rise (see graph below), and the rate of DDS residents testing positive remains higher than general population. The death rate in the DDS system is still low, but deaths are still rising.

Given the factors noted above about the testing rate and requirements, the positive infection rates in DDS group homes may be higher than the DDS data show.

Source: DDS

Testing rate appears to be slowing

Fallon Ambulance Service, which started mobile testing of the DDS residential system on April 10, has tested only 72% of residents and staff in group homes. More than 2,000 residents have yet to be tested.

As the chart below shows, the daily testing rate by Fallon is actually down to less than 200 tests a day. The overall average daily rate since Fallon started on April 10 is 438. But that average is driven by a large spike of tests on April 29, when Fallon actually did more than 2,200 tests.

While Fallon is apparently capable of doing more than 2,000 tests per day, they haven’t done anywhere near that amount per day since the end of April.

Source: DDS

We filed a Public Records Request with the state last month for Fallon’s contract and related procurement documents. The Executive Office of Health and Human Services has asked for an extension until June 12 to provide those documents.

We have expressed concerns for some time about the slow pace of Fallon’s testing, and have gotten no response from Health and Human Services Secretary Marylou Sudders as to why no additional companies have been hired to supplement Fallon’s work.

DDS says it isn’t requiring testing of all group homes

Also concerning to us is that DDS has acknowledged for the first time that not all provider residences are being tested for residents and staff who might be infected with the virus. This appears to violate DDS guidance and previous statements made by the Department.

I asked DDS ombudsman Christopher Klaskin last week about the matter after we heard from a parent of a resident of a provider-run group home who said she was informed that no one in the home had been tested because no one was symptomatic, and that the provider did not intend to implement mobile testing in its residences.

DDS guidance, which was sent in April to all providers states that the intent of the Department’s mobile testing program is to “have all individuals and staff tested,” and that those that are symptomatic would be “prioritized.” (my emphasis). That is also the message that DDS Commissioner Jane Ryder gave us when we talked with her in a conference call in April.

On Friday, Klaskin confirmed that “some locations have not requested testing” if staff or residents have not been symptomatic. Klaskin said that in those cases, DDS has told the providers that all residents and staff need to be continuously monitored and that they must request mobile testing or another means of testing “as soon as an individual shows symptoms or has been exposed to the virus.”

DDS’s written guidance, however, doesn’t state that testing will be done only if providers request it, or that asymptomatic residents can be monitored rather than tested. The guidance specifically states the Department’s intent is to test all individuals and staff.

It appears providers can avoid testing altogether by stipulating to DDS that no one in their residences is symptomatic. Thus far, 52% of provider-operated homes have reported positive cases to DDS, according to departmental data; so the remaining 48% could conceivably decline testing. We have asked DDS for the number of homes that have declined all testing.

Retesting may be being done only in ICFs and state-operated group homes

The issue of retesting of residents in the DDS system is critically important in ensuring that the true rate of infection over time is known and controlled. However, the amount of retesting that is being done in the system is unknown, and the nature of any retesting that is being done appears to be sporadic at best.

In April, when we first asked about the issue, Klaskin implied that DDS was not doing any retesting.  In an email on April 20, in response to a question about the issue, Klaskin wrote, “DDS and Fallon are currently focused on testing all facilities before mobile retesting can be made available.”

Early this month, however, we began to receive reports that Fallon was actually returning to some state-operated group homes to retest residents there who had previously been tested. When I asked Klaskin about that and specifically asked where the retesting was being done, Klaskin said only that Fallon “has increased their capacity to now retest locations meeting CDC criteria for retesting.”

Klaskin didn’t respond to my questions where the retesting was being done or why some residents were being retested while others were still waiting to be tested for the first time.

Family members singled out for visitation restrictions

In light of the decision to loosen a virtually complete ban on visitation, DDS issued new guidelines on June 6. But those guidelines appear to be harder on families than the COVID-related requirements DDS is imposing on the providers themselves.

Under the new rules, families will not be allowed inside the residences for any reason. Residents are limited to two visitors at a time, and providers have discretion to limit the number of visits, times per week, and length of visits.

At the same time, the guidance says visits will be limited to a maximum of once a week and 30 minutes. Failure to adhere may result in a “termination of the visit” and a “temporary ban” on visits. DDS or providers can change the policy with “little notice,”  and providers can also prohibit visits if they determine for any reason that the visits are not safe.

We have seen many cases in which providers have banned family members and even guardians from visiting loved ones on the basis of flimsy pretexts.

Yet despite the virtual ban since March on visits, and the severity of the restrictions even now, one parent said her daughter has been taken out by staff during the lockdown to commercial establishments and fast food restaurants.

There appears to be little consistency in DDS’s response to the ongoing coronavirus crisis. Even as the Department is opening up the residential system to visitors, it is slowing down the COVID-19 testing rate and allowing providers to avoid testing altogether if they stipulate that no one is symptomatic.

DDS officials will not even commit publicly to the clear statement in their guidance that all residents and staff in the system should be tested.

And despite the relaxed attitude DDS has adopted toward testing for the spread of the virus in the group home system, in particular, it is maintaining harsh restrictions on family visitation and giving providers the discretion to ban family members from residences for any perceived violations.

We think DDS needs to rethink both of those stances. The Department should recommit itself to universal testing in its system; and it should not give providers complete discretion to ban families from visits for perceived violations of overly onerous restrictions.