Archive for October, 2020

Questions surround supervision of DDS client with violent history

October 26, 2020 7 comments

Anthony Remillard, an intellectually disabled man who fatally assaulted another man at the former Templeton Developmental Center in 2013, has been released from prison to a group home amid lingering questions about his supervision.

Dennis Perry, who was also intellectually disabled, died in the sudden and unprovoked attack in which Remillard shoved him against the side of a boiler in the dairy barn of the former facility.

Nancy Perry Mias, Dennis Perry’s sister, told us in September that she had been notified that Remillard, who was convicted of the crime and served seven years in prison, has been placed in a group home funded by the Department of Developmental Services (DDS).

Nancy said her concern is for the residents at the group home, as Remillard obviously has violent tendencies and probably didn’t get the help he needs while in prison. “I do have sympathy for this man,” she wrote to us in an email, “but I just feel as if the other families at the group home could be blindsided as we were, when we found out his history.”

In response to a Public Records Law request we sent to DDS in September, the Department responded that it does not have specific policies to alert the police, families, the community, or other residents when people with violent or criminal tendencies are placed in group homes.

DDS does provide special staff training, known as Crisis Prevention, Response and Restraint (CPRR), in group homes that house persons with potentially violent behaviors, an official stated. But it is not clear whether the group home to which Remillard has been admitted has implemented the CPRR curriculum, as specified in DDS regulations.

We’ve blogged about this case a number of times, also questioning the lack of supervision of Remillard at Templeton. We’ve also questioned whether it was appropriate to place him in prison where he wasn’t likely to get treatment, but would possibly be exposed to even more violence.

While Templeton was a functioning Intermediate Care Facility (ICF), it housed a number of clients with violent behaviors. But Remillard was a resident there after the facility was targeted for closure and was being phased down. Templeton was closed in 2015.

Although an internal DDS investigation of Perry’s murder cleared the Templeton staff of any omissions of care, we raised questions about the lack of thoroughness of the DDS report and the fact that the Department was essentially investigating itself in the matter.

In September, after learning of Remillard’s release from prison, we filed the public records request to determine what policies DDS has to protect other residents and the community when potentially violent residents are placed in DDS facilities. We asked, among other things, for any policies to alert the police and other residents and guardians and members of the community to the criminal backgrounds of clients in group homes.

DDS stated that it doesn’t have any policies of its own on alerting family members or the police in those cases. The DDS response stated only that the Department “supports” clients in following laws requiring them to register as sex offenders or to report to law enforcement or probation.

The only thing DDS stated that it has specifically done to ensure the safety of clients in these cases is to have developed the CPRR training program for staff of facilities with residents who have violent behaviors. As part of the their response to us, DDS included an “approved CPRR” workbook, dated 2017 and titled, “Proactive Approaches to Behavioral Challenges.”

The focus of the workbook is on “de-escalation and prevention of challenging behaviors.” The document describes a 20-hour training curriculum, and states that staff in group homes with potentially violent residents receive 1-year certifications in the use of “least restrictive techniques” and in the use of restraints as a last resort.

The workbook discusses the importance of providing reassurance and support to residents who exhibit “challenging behavior.” It states that many people who become violent do so out of feelings of powerlessness and vulnerability. The workbook suggests that “helping this person feel stronger and safer is a major means of reducing the probability of aggression.”

The workbook also states that most people exhibit “cues” or warning signs of aggression, and that “knowledge of these and their typical order of occurrence is a key to having a positive outcome to the situation.”

The workbook then lists several handholds and other techniques as “a last resort” to control physically aggressive individuals who endanger themselves, staff, or others. The techniques are presented in a sequence of least restrictive actions to most restrictive.

We assume, or hope, that Remillard has been sent to a group home that provides that training. We have no way, however, of evaluating the quality of the training described.

Ultimately, a single training curriculum is probably not sufficient to ensure the proper supervision of potentially violent individuals in the DDS system, and to keep other residents and the community safe.

This case is yet another reason to question the state’s longstanding policy of closing highly supervised ICF-level facilities such as Templeton, and then privatizing those functions.

But those types of questions have not been raised in recent years by the Legislature or successive administrations about either this case or any number of other abuse and neglect cases that afflict the DDS system with tragic regularity. The Legislature’s Children, Families, and Persons with Disabilities Committee has blown opportunity after opportunity to examine these systemic problems.

The Committee is a symbol of legislative failure in this regard, but it is hardly alone in that. The state Attorney General’s Office has similarly failed to take action to protect persons with developmental disabilities.

Nancy Perry Mias and other members of her family initially sought help from members of the state’s congressional delegation in obtaining an independent investigation of the DDS system in the immediate aftermath of Dennis Perry’s killing. They met with the staff of U.S. Senator Elizabeth Warren and with Representative Jim McGovern himself.

They all promised to look into the matter, Nancy said, “but we never heard a word back from them.” She said McGovern even said at the time that, “You certainly deserve an apology.” But, she said, the family never got one.

Baker’s revised budget for the current year would cut funding for day programs, increase funding for implementing ‘Nicky’s Law’

October 20, 2020 4 comments

Governor Charlie Baker last week proposed a revised state budget for the current fiscal year in light of the COVID crisis that would boost funding for some programs for persons with developmental disabilities, but would sharply cut day program funding.

The community-based day program cut reflects the impact of the COVID pandemic on in-person programs, according to a statement from the Department of Developmental Services (DDS). The resulting changeover to virtual programs on platforms such as Zoom has not been welcomed by some families and guardians who say the quality of in-person programs cannot be replicated on virtual platforms.

Baker’s $45.5 billion state budget does contain a proposed increase of $780,000 over his original plan in January in order to fund the implementation of “Nicky’s Law.” The new law would create a registry of names of caregivers in the DDS system who have had abuse cases substantiated against them.

It isn’t clear, however, that Baker’s budget plans will be approved by the Legislature. The governor’s revised budget proposes increases in overall state spending beyond what he proposed in January despite the projected loss of $3.6 billion in state tax revenues due to the pandemic.

Overall, the impact of the governor’s revised budget on programs and services funded by DDS appears mixed. Also, while Baker’s budget would boost Medicaid funding by  $834 million, it isn’t clear how that would affect DDS programs.

Day program funding would be cut

As noted, the news isn’t good in Baker’s revised budget for the provider-based line item for community-based day programs (5920-2015). The budget proposes a cut of $22.4 million, or 9.2%, in that line item when adjusted for inflation.

Baker had originally proposed a 6% increase in the day program line item in January.

DDS Ombudsman Chris Klaskin issued a statement from the Department that appears to indicate that a significant number of DDS clients aren’t attending day programs in light of the pandemic:

The proposed funding level incorporates revisions to (day) program forecasts as a result of DDS provider agency closures, reduced demand for services, and capacity requirements to maintain physical distancing in transportation and congregate settings advised by the Centers for Disease Control and Prevention (CDC).

Over the course of COVID-19 pandemic, DDS and its agency providers have worked in partnership to accelerate and incentivize alternative day programming in virtual and remote settings (i.e. Zoom classes) to supplement in-person services in the interim.

Some families have indicated to us that Zoom-based activities don’t work well with their loved ones who are DDS clients. At the same time, those families do not want to expose their loved ones to possible COVID infection in in-person programs.

We have noted that while staff working in residential DDS programs are now required to be tested for COVID-19, there still is apparently no such requirement for staff in day programs.

I sent a follow-up request to Klaskin today for information on the number of day program agencies that have closed, and the amount of the drop-off in demand for the programs.

Transportation funding would be boosted

In addition to the increased funding for the implementation of Nicky’s Law, Baker’s revised budget proposes a $3.5 million, or 11.7%, increase in the DDS transportation line item (5911-2000). It’s not clear why that provider-based line item would be increased by such a large percentage at the same time that the day program line item is being cut.

Mixed news for provider-run group homes

It appears the largest DDS line item — provider-operated group homes (5920-2000) — would get a very modest increase from Fiscal 2020 under the governor’s proposal. It’s actually a small cut of 0.33% when adjusted for inflation.

However, despite that apparent slow-down in funding this year, the provider-run group home line item will have been boosted since Fiscal 2012 by almost $423 million, or 49%, to $1.28 billion, if Baker’s proposal is adopted.

We have frequently noted that overall, the Legislature and successive administrations have steadily increased funding for privatized DDS-funded functions while either cutting or providing minimal increases in funding for state-run services.

Also, the governor proposed what appears to be a big increase in the Chapter 257 Reserve Fund (1599-6903), which goes to the residential providers in the form of rate increases. Baker would increase that line item by $119 million to $160 million. It isn’t clear, though, that the entire increase would take effect in the current fiscal year, which would be half over by the time the governor’s budget were to go into effect.

State-run developmental center funding cut as usual

Funding for the two remaining state-run developmental centers (5930-1000) would be cut as usual. Baker’s revised budget would cut the line item by $1.7 million, or 1.6%, when adjusted for inflation. That line item will have been cut  by more than $70 million since Fiscal 2012. Since then, four of six remaining centers have been closed.

Under Baker’s revised budget, the relatively small state-operated group home line item (5920-2010) would get a modest increase of $3.86 million this year, or 1.7%, when adjusted for inflation.

Also, the DDS administration line item (5911-1003) would get a proportionally larger increase of $4.5 million, or 6%. At least some of that funding is for DDS service coordinators, who manage and oversee services to thousands of DDS clients.

Funding increased to implement Nicky’s Law

One piece of potential good news is that the governor’s revised budget would boost funding to the Disabled Persons Protection Commission (DPPC) by $909,600, or 18.6%. That is $781,000 more than the 2.6% increase that Baker proposed in January for the DPPC.

As noted, the additional funding is intended to implement Nicky’s Law. That funding would enable the administration to avoid a lengthy delay in implementing the long-sought legislative initiative to prevent abusive caretakers from continuing to work in the system.

A member of the staff of state Representative Kay Khan, House Chair of the Legislature’s Children, Families, and Persons with Disabilities Committee, said the additional $910,000 for the DPPC is a pro-rated amount. It is based on the DPPC’s original Fiscal 2021 request for $1.2 million to establish the registry.

Andrew Levrault, DPPC assistant general counsel, said the agency anticipates hiring additional investigatory and legal staff, in part, to defend the agency in legal appeals of the placement of individuals on the registry. He said more than 700 provider agencies are expected to access the registry each year to conduct checks on thousands of prospective employees.  In addition to the investigative and legal staff, the DPPC “needs to substantially expand its information technology infrastructure” to meet the registry access needs of the providers.

As usual, the budget process raises many concerns about the near-term and long-term future of care for those in the DDS system; and answers are often hard to come by. The COVID crisis is vastly complicating an already complicated process.

Confirming our concerns, the Globe reports the administration is withholding COVID testing info

October 13, 2020 3 comments

The Boston Globe has recently been reporting that the Baker administration is withholding COVID-19 testing information from the public regarding nursing homes and other congregate care facilities.

Unfortunately, the Globe has repeatedly failed to mention that these “other congregate care facilities” include group homes and developmental centers in the Department of Developmental Services (DDS) system.

But a Globe editorial on Monday, (October 12) confirms our own reporting about the lack of public information from the Baker administration about COVID testing.

As the editorial stated:

…it’s worrisome that the Baker administration has provided only partial access to important COVID infection data in nursing homes and other long-term care facilities, even after the governor signed a law to enhance data reporting.

We have been posting for months about this issue as it relates to the DDS system. Our latest post on October 7 discloses that the administration’s online Weekly State Facility reports do not contain any COVID testing data on what may be more than 25,000 staff working in provider-operated group homes.

Further, as we reported, there is no information listed in the weekly reports on the numbers of deaths of staff working in any type of DDS setting. Data provided by DDS in June showed that anywhere from 3 to 15 staff members in group homes had died of COVID-19 as of the end of that month.

In addition to the missing staff data in the weekly reports, the positive test numbers for residents of DDS facilities are not cumulative, and there are no exact numbers given when there are less than 5 deaths or positive cases in any category in a given week.

Globe finds similar lack of data

With regard to nursing homes, the Globe has found many of the same information problems that we have disclosed with regard to DDS. The Globe reported last month that the administration is providing ranges of numbers rather than exact numbers on nursing home residents testing positive; and the newspaper said there is no cumulative testing data in the administration’s reporting on certain assisted living facilities.

MassLive reported on October 1 that no data is published by the administration, as required by a new public reporting law, on whether people who tested positive for COVID-19 have a disability.

Administration strategy to withhold COVID information

Given our findings and the reporting by the Globe and MassLive, it appears withholding COVID-related information is a deliberate strategy by the administration.

In early August, we reported that internal emails in June among the Baker administration’s top human services administrators revealed an apparent consensus to reduce public reporting of COVID-19 test results in congregate care facilities.

That consensus appears to have led to decisions to stop publicly reporting cumulative COVID testing data, and not to report test data on DDS provider staff working in group homes. For reasons that are unclear to us, the administration publicly reports only the number of staff testing positive in state-run group homes.

In one email, a senior manager at MassHealth appears to have wanted to “sunset” congregate care reporting in general. That was apparently just as Governor Baker was signing legislation into law that would increase reporting requirements about COVID-19 infection rates in congregate care facilities.

Lack of compliance with Public Records Law

It’s not clear whether the Globe or any other state media outlet followed up on our reporting on those internal emails.

However, the Globe did file its own public records requests in June for internal emails on COVID testing; and, like us, they’ve gotten little information. The Monday editorial stated that the Executive Office of Health and Human Services (EOHHS) was not complying with orders from the Public Records Supervisor to release the records to the Globe.

We have also reported that the administration has not complied with orders by the Public Records Supervisor to provide us with records or responses to numerous public records requests regarding COVID testing in the DDS system.

Meanwhile, our repeated requests over the past six months to Health and Human Services Secretary Mary Lou Sudders for information about the administration’s response to the virus have all been ignored.

Globe calls for accountability, but the newspaper itself has a blind spot

In its editorial, the Globe gave Governor Baker credit for bringing the pandemic “more or less under control in the state.” But the newspaper maintained that, “we can’t afford any more blind spots. The public needs to keep a close eye on the trends — and hold the state accountable when required.”

We agree that the administration’s lack of adequate public reporting on the COVID crisis shows it is failing to hold itself accountable for its response to the crisis. We hope that changes.

Yet the Globe and the rest of the media in Massachusetts have their own blind spot in that they appear to be largely uninterested in issues facing people with intellectual and developmental disabilities in the state.

We hope that the administration finally ends its circle-the-wagons approach when it comes to providing information and relevant data about the COVID crisis.

At the same time, we hope both the administration and the media will stop treating people in the DDS system as an afterthought at best, particularly with regard to the pandemic.

No Data: DDS group home staff data largely absent from administration’s public COVID test reports

October 7, 2020 5 comments

Even though the Baker administration announced in August that they were requiring staff to be tested for COVID-19 in group homes for persons with developmental disabilities, it appears only a small portion of the results of those tests on staff are being made publicly available.

The administration’s Weekly State Facility Reports list numbers of state-operated group home and developmental center residents and staff who are currently COVID positive. But they do not contain any COVID testing data on what may be more than 25,000 staff working in the much larger network of provider-operated group homes.

Further, there is no information listed in the weekly reports on the numbers of deaths of staff working in any type of DDS setting. Data provided by DDS in June showed that anywhere from 3 to 15 staff members in group homes had died of COVID-19 as of the end of that month.

We created the chart below based on the administration’s online Weekly State Facility Reports from May 26 through the most recent report, dated September 29. (You can click on the chart to make it larger.)

The chart illustrates the data gaps, and points to some other problems with the way the administration reports the results of COVID testing in the Department of Developmental Services (DDS) system. In addition to the missing staff data, the positive test numbers are not cumulative, and there are no exact numbers given when there are less than 5 deaths or positive cases in any category in a given week.

We also have questions about the data on “residents recovered” from COVID. A note to the data states that the numbers “do not include all facility cases and recoveries over time.” As a result, it isn’t clear what portion of all recovered residents are included in the data.

As discussed below, the number listed in the weekly reports for residents having recovered from the virus in state-operated group homes — 146 — did not change from July 21 through September 29.

There is no similar data listed in the reports on recovered staff.

There are some 4,800 staff caring for some 1,400 residents in state-operated group homes and developmental centers run directly by DDS, according to the administration.

DDS has no figures on the total number of staff caring for the 7,800 residents in provider-run group homes around the state; but we are estimating that the number of such staff may be higher than 25,000.

EOHHS reports provide more limited data even for residents

The chart illustrates the gaps in staff data by including categories labeled “no data.”

Even with regard to residents, the Weekly State Facility Reports provide exact numbers only if more than 5 residents are positive or have died in a given week. As the chart shows, there are a number of entries that say <5, meaning the true numbers are anywhere from 1 to 4.

As a result, it can’t be determined in those instances exactly how many individuals were positive with COVID or died in a given week, in given settings.

For instance, it can’t be determined for the week of September 29 how many group home residents actually died of the virus. The data state only that the number was <5. It’s not clear why the numbers aren’t more exact. Among other problems, listing the data as a number range precludes adding numbers from different weeks together to obtain cumulative totals.

Data reporting changeover as of October 1

From April through September 30, DDS did provide us, upon written request, with total numbers of residents and staff testing positive in all group homes and developmental centers. DDS also provided exact numbers and provided cumulative testing data.

DDS has now referred us for testing numbers going forward to the Executive Office of Health and Human Services (EOHHS), which posts the Weekly State Facility Reports.

Since June 16, the Weekly State Facility Report numbers are for the current week only. Prior to that date, the reports did offer cumulative testing numbers, which are listed in red font in the chart above.

The changeover in data reporting from DDS to EOHHS coincides with a new testing system under which DDS and other human services providers must arrange for their own COVID testing.

I emailed Health and Human Services Secretary Mary Lou Sudders on Monday to ask whether EOHHS can provide us with more complete data, similar to the data that DDS provided.  I also emailed Helen Rush-Lloyd, records access officer for the Department of Public Health (DPH). I was told DPH actually produces the Weekly State Facility Reports.

Neither Sudders or Rush-Lloyd has responded to my emails.

No longer listing cumulative data for positive tests

As noted, the Weekly State Facility Report data on positive test results are no longer cumulative. The reports list the number of group home and developmental center residents who are currently positive each week.

While previous weekly reports are available online, it isn’t clear if cumulative positive testing totals can be gleaned from them. As noted below, it also isn’t clear whether the numbers of recovered residents are actually cumulative.

The week of June 16 may have  been the last Weekly State Facility Report listing clearly cumulative data. As of June 16, the report listed a cumulative total of 1,428 state and provider-operated group home residents as having tested positive.

That number, however, does not line up with our data from DDS. DDS at that time reported a cumulative total of 1,575 group home residents as having tested positive.

COVID recovery numbers didn’t change for state-operated group home residents

As noted above, it isn’t clear what the numbers listed in the Weekly State Facility Reports for recovered residents actually means, or whether the numbers are cumulative. The reports list the category as “Current Clients Recovered.”

A note at the bottom of each report states that the numbers listed for recovered residents “do not include all facility cases and recoveries over time.”

Recovered patients are further defined as having tested negative or having met symptom and time-based recovery guidelines issued by the Massachusetts DPH and federal Centers for Disease Control.

As the chart above shows, the number of state-operated group home residents listed as recovered remained at 146 from July 21 through the end of September. Prior to July, a cumulative total of 156 residents of those facilities were listed as having contracted COVID-19.

From June 15 on, as many as 24 additional state-operated group home residents, or as few as 6, contracted the virus, according to the data. It isn’t clear whether the 146 listed each week as having recovered represents the same group of residents, and whether no additional residents recovered from the virus after July 21.

We have similar questions about the number of residents listed as recovered in provider-operated group homes. While 1,187 residents of those facilities were listed as recovered in the June 23 Weekly State Facility Report, that number rose by only 52 — to 1,239 — as of September 29.

It isn’t clear to us whether only 52 additional residents recovered from the virus in the provider-run group homes in the three-month period after June 23. It is also unclear what the cumulative total was of those residents testing positive was during that same period of time.

We hope that EOHHS improves its public reporting of COVID testing results in the DDS system by eliminating the gaps in the data, making all the numbers exact, and providing cumulative data in addition to current data.

In not providing clear and complete reporting on the COVID crisis in the system, and in failing to respond to questions about the reporting, the administration loses a bit more of its credibility every day in that respect.

%d bloggers like this: