COFAR blog

The Department of Developmental Services (DDS) is defending the discretion it gives to providers to restrict visits by families to residents in the system, and will apparently not update its September 23 visitation guidance in order to provide standards for visitation restrictions.

Christopher Klaskin, a DDS spokesman, stated in a December 2 email that the September 23 guidance “permits flexibility for providers to address COVID-related health and safety concerns specific to their residential sites.”

In a post here on December 1, we reported that we had raised a concern with DDS that the Department appeared to be giving too much discretion to the providers, resulting in some cases in contradictory and overly restrictive visitation policies.

The September 23 DDS guidance, for instance, permits in-house visits by family members. But an undetermined number of providers have recently issued bans on in-house visits in light of rising COVID rates in the DDS system.

Also, different providers appear to have adopted widely varying and sometimes onerous policies on testing and quarantining residents after the residents have left group homes even for short visits to their family homes.

In an initial email on November 30 to DDS Commissioner Jane Ryder, we stated that the biggest COVID risk to residents in the DDS system does not appear to come from family members who visit under controlled conditions, but from staff who face few restrictions in going in and out of group homes.

For instance, DDS currently has no requirement that providers ban staff from entering a group home even if they have just previously been in another residence where individuals had the virus. Yet some providers are currently banning in-house visits by family members entirely, regardless of whether those family members have otherwise been isolating themselves from social contact.

In his December 2 response to us, Klaskin stated that:

The DDS congregate care system is diverse so this flexibility (in visitation requirements) is needed to account for differences like populations being served, provider staff capacities, geographic locations of group homes and COVID-positive data in their area.  Specifically, providers are permitted to amend the (September 23) policy when (1) a resident, visitor or staff tests positive, or (2) visitation cannot be safely accommodated.

In a written response to Klaskin and Ryder on December 4, we noted that the question we have about their argument is that it isn’t clear to us that any of the factors Klaskin cited could account for the wide variations in the providers’ policies on visiting, quarantining and testing in connection with in-home and off-site visits.

One provider has not allowed any indoor visits by families since March, according to a family member. The provider has also sharply limited outdoor visits by families, and banned visits by residents out of the group home to their families.

Another provider allows off-site visits, but has required that residents taken off site receive a negative COVID test less than 48 hours before returning to a group home or other DDS-funded setting.

Yet another provider requires a resident taken for an off-site visit to remain at the family home for 14 days before even getting tested. Even if the test is negative, the provider’s directive states that the resident must remain in isolation in the group home for an additional 72 hours and then needs a second COVID test.

While we understand the need for flexibility and some discretion on the part of the providers in these situations, the problem is that there appears to be no overriding guidance as to when and under what circumstances that flexibility should be exercised. At what point does in-home visitation become unsafe, for instance? Each provider is left to make their own assessment of that threshold.

Klaskin’s email to us also did not address the area in which we think the COVID risk in the DDS system primarily appears to lie — the largely unrestricted entrances of staff to the residences.

Ultimately, the problem with leaving it almost entirely up to the providers to make decisions in an area like family visitation is that residents and families end up bearing a disproportionate share of the burden of these policies.

Excessive discretion on visits was a similar problem last spring

As we reported last spring, DDS first partially lifted its then almost-complete COVID lockdown in group homes in early June by permitting limited outdoor visits. No in-house visits were yet allowed.

Under those then new visitation rules in June, providers were given discretion to set the terms for the visits and to ban families for perceived violations. We soon began getting reports that some of the restrictions placed on those visits by certain providers were onerous and others inconsistently applied.

We contacted Commissioner Ryder at that point, and DDS finally issued its September 23 guidance document. That new guidance loosened some of the restrictions and began allowing in-house visits.

But, as Klaskin noted to us in his December 2 email, even that September document continued to give the providers the discretion to override the Department. As a result, we have begun to get calls once again from families about excessively restrictive visitation policies.

Having visits from family members and friends is one of the fundamental rights of clients in the DDS system. DDS shouldn’t be leaving it almost entirely up to its state-funded providers as to how to interpret that right.