Archive

Archive for January, 2021

Legislative report misses an opportunity on employment of the developmentally disabled

January 26, 2021 Leave a comment

Even before the COVID crisis, people with intellectual and developmental disabilities (I/DD) in Massachusetts were facing daunting problems in finding meaningful opportunities for employment.

Ever since the closures of all remaining sheltered workshops in the state in 2016, hundreds if not thousands of clients of the Department of Developmental Services (DDS) have been left in DDS day programs with little or nothing to replace the work opportunities they previously had.

For a potentially significant number of DDS clients, mainstream work settings have never been a viable option. They aren’t able to function in those settings or don’t desire to do so.

But even for those people with I/DD who can function in mainstream settings, it has always been difficult to find jobs. Now with unemployment a major problem in the state as a whole due to the pandemic, competing for opportunities in that workforce is an even more daunting prospect for people with I/DD.

For those reasons, we were glad to see a legislative subcommittee undertake a review of the subject of employment of the disabled in Massachusetts, although we were somewhat skeptical that the review would be unbiased and thorough. Unfortunately, our concerns appear to be well-founded based on the report that has now been released by the “Workability Subcommittee” of the Children, Families, and Persons with Disabilities Committee.

We think the Workability Subcommittee, which is headed by Representative Josh Cutler, missed a major opportunity to address the problems described above.

Report buys in to anti-congregate care ideology 

While Cutler’s 33-page report has some good recommendations regarding persons with disabilities in general, it unfortunately seems to have largely missed the challenges faced by people with I/DD.

A key reason for that is that the report subscribes to the ideology behind the privatization of DDS services and against congregate work programs for people with I/DD such as sheltered workshops. The report is a cheerleader for the view that everyone can function in the mainstream workforce, no matter what type or level of disability they have.

The report even termed the sheltered workshop closures “a necessary and important step.” Yet there is no supporting analysis behind that statement in the report.

That isn’t surprising given that the Arc of Massachusetts, a key opponent of sheltered workshops, played an “instrumental” role in assisting the Subcommittee in its work, according to the report’s acknowledgements.

What the closures of the workshops did was take away a choice that was available to people and their families and guardians to continue to participate in settings in which they were comfortable and could function.

There has been nothing adopted to replace that choice, and the report doesn’t offer anything.

Vague recommendation on accommodating those who can’t handle the mainstream workforce

In November 2019, Patty Garrity, a COFAR member, and I met with Rep. Cutler to discuss the employment problems noted above. Patty’s brother, Mark, is one of the former sheltered workshop participants who has been left with little or no meaningful work activities.

Cutler’s report does contain one mention and one recommendation regarding that concern.

Unfortunately, the report’s recommendation is overly vague. The recommendation states that the Legislature should ensure that providers “have the capacity to serve these individuals so they, in turn, can have meaningful work opportunities.”

That’s it. There is no specificity in the recommendation as to how those providers could or should serve those persons.

Even prior to COVID, Patty had to fight on a daily basis for activities for Mark in his day program after his sheltered workshop program closed. As Patty noted in a recent email conversation, Mark can’t handle mainstream settings.  He can’t meet productivity standards. He can’t even attend his day program right now because he doesn’t understand social distancing.

“At the moment,” Patty wrote, “I am back to visiting Mark through the window (of his group home), and everyday he will ask me, “work tomorrow?”

In our October 2019 testimony to the Subcommittee, we urged it to recognize that like Mark, not every DDS client is capable of or desires to participate in the mainstream workforce. We urged the Subcommittee to support H.88, a bill which would have required that meaningful work activities be provided in DDS community-based day programs.

But no mention is made in Cutler’s report of that bill or anything like it.

The bill was, in fact, approved by the Children and Families Committee. But the language in the bill was subsequently replaced by language establishing a Permanent Commission on the Status of Persons with Disabilities that Cutler’s Subcommittee recommended. Yet the Commission’s charge does not appear to include any effort to address the lack of work opportunities for people like Mark. 

No acknowledgement of the lack of work opportunities due to COVID pandemic

There is a lot of boosterism in the Subcommittee report regarding companies that have adopted hiring programs for persons with disabilities. But despite the delay in issuing the report until well into the COVID crisis, there is virtually no acknowledgement in it of the huge challenge the pandemic has posed to employment in general in the state.

As noted, if it was difficult for people with I/DD to get jobs pre-COVID, it is even more daunting now that thousands of people are out of work. You wouldn’t know that from reading the report, however.

The only employment stats mentioned in the report are from 2019 when the commonwealth’s average unemployment rate was 2.9%. There is no follow-up on the impact of the COVID-19 pandemic on that unemployment rate, which now stands at 7.4%.

This kind of incomplete analysis may be partly why the report fails to acknowledge the monumental difficulty of placing developmentally disabled persons in mainstream work settings, particularly now.

The report includes what the Subcommittee obviously considered hopeful numbers on mainstream or integrated employment of the disabled, again from 2019. But other than printing the numbers in a chart on Page 11, the report didn’t analyze them. Had the Subcommittee done so, it might not have characterized the numbers in such hopeful terms.

The chart shows the number of DDS clients in integrated or supported employment rose by 1,297 between 2014 and 2018. But the chart also shows the number of clients in day programs, which provide little or no employment activities, rose by 3,159.

In other words, the numbers show the promise of integrated or mainstream employment hasn’t materialized. More than twice as many former sheltered workshop participants had been transferred to day programs as had been placed in integrated employment.

In testimony submitted to the subcommittee in October 2019, we noted that the Legislature never provided adequate funding for the transition from sheltered workshops to mainstream employment. After 2014, it appears DDS was placing fewer and fewer clients in mainstream employment even as the sheltered workshops were closing.

The Subcommittee report seems to be primarily concerned with disabled people with normal cognitive abilities

Overall, there seems to be little focus on people with I/DD in the report. Even the finding that mentions our concern about individuals with little to do following the closures of the sheltered workshops doesn’t specify that the people involved have I/DD.

There is no distinction made between high and low-functioning persons. The main focus of the report seems to be on how mainstream employers need to do more to hire people with disabilities in general.

Report acknowledged it did not deal with subminimum wage issue

In our October 2019 testimony, we urged the Subcommittee to recognize that it is necessary to allow employers willing to hire persons with I/DD to pay them a subminimum wage in order to ensure that those work opportunities are not reduced further.

The report acknowledged that it did not examine that issue.

As noted, we think this report is a missed opportunity. In an email exchange with us yesterday, Rep. Cutler defended the report, saying, “we don’t have a solution for every challenge presented.”

But this is not a matter of having a solution for every challenge presented. Rather it is a matter of recognizing the problems that exist and being open to addressing them.

DDS group home providers have different options for providing COVID vaccinations

January 19, 2021 1 comment

Group homes and developmental centers in the Department of Developmental Services (DDS) system have a number of options for obtaining COVID-19 vaccines and administering them to their residents and staff, as part of a major vaccination effort that officially begins this week.

In a letter to families that she issued last week, DDS Commissioner Jane Ryder termed the DDS vaccination program “complex,” and said the timing will vary by provider.

Ryder said that vaccinations of both residents and staff of DDS residential congregate care programs would officially begin this week, and that vaccinations of “home-based healthcare workers” would begin in early February.

Ryder said that latter category of staff slated for vaccinations in early February includes shared living providers, home-based respite, individual/family support staff who provide in-home services, and “participants who self-direct their services.”

Provider options for vaccinations

In guidance issued last week, the Department of Public Health (DPH) outlined three options available to group home and other congregate care providers for obtaining and administering the vaccines. Those options are “self-administration,” which involves receiving the vaccines directly from DPH; existing partnerships with pharmacies and other healthcare providers; and scheduling vaccinations at mass-vaccination sites.

In her letter, Ryder discussed the latter two methods, but didn’t mention the self-administration option. She said the partnerships apply to providers that have relationships with either CVS or Walgreens to provide and administer the vaccinations.

In some of those cases, vaccinations have already begun, Ryder said. That appears to explain an apparent discrepancy between the reports we received about some vaccinations having started prior to this week, and the official announcement that vaccinations in DDS group homes would start this week.

As part of that partnership option, Ryder said, some providers are arranging with local pharmacies or healthcare providers such as a local hospital or community health center to have vaccinations delivered and administered to residents and staff.

Self-Administration Option

The DPH guidance lists a primary option for congregate care facilities of directly receiving and administering vaccines from DPH (“self-administration”).  The guidance states that this option “is likely to be the most convenient for staff and residents and the quickest method for them to obtain the vaccine.”

However, as noted, Commissioner Ryder didn’t mention this option in her letter. In an email query to Ryder last week, I asked if that meant that none of the DDS group home providers meet the qualifications for the self-administration option, which include having the capacity to vaccinate 200 persons and having refrigeration storage capacity for the vaccines. To date, I haven’t received a reply.

Ryder’s additional points

In her letter, Ryder listed additional points about the vaccines in the DDS system:

  • Vaccination is voluntary for staff and residents.
  • DDS is seeking consent from legal guardians prior to residents receiving the vaccine.
  • Surveillance testing and infection control measures, including the use of face masks and PPE, hand hygiene, and social distancing, will remain in place until further notice.

More information on getting vaccinated in congregate care settings is available here.

Latest COVID test results:

Meanwhile, the administration’s latest online COVID test data for congregate and long-term care facilities shows some mixed results for COVID in the DDS system. The COVID situation had looked last week as though it was improving in the system, but this past week’s report showed the infection numbers headed back up for provider group home residents and staff, and for Wrentham Developmental Center residents and staff.

Provider group home residents testing positive jumped from 236 to 280 in the week ending Tuesday, January 12. New results will be posted online tomorrow (January 20).

The latest report shows the Hogan Regional Center holding steady on the number of residents testing positive. There was even a drop in the number of staff infected, from 14 to 9 at Hogan this past week. But Wrentham saw a sharp increase in staff testing positive — from 14 to 32, while residents testing positive went from 3 to 11.

Please let us know what your experience has been with the vaccination program in the DDS system.

COVID vaccination new update: Program starting next week in DDS group homes

January 13, 2021 1 comment

UPDATE to our previous Update:

Department of Developmental Services (DDS) Commissioner Jane Ryder issued a letter to families and providers this afternoon (January 13), stating that vaccinations of both residents and staff in DDS state-run and provider-run group homes will begin next week, the week of January 18.

This is in line with what Governor Baker announced today (see below), but seems to contradict information earlier this week from DDS that the vaccinations were starting this week.

We have also heard from some families of group home residents who were informed that vaccinations were starting this week.

Ryder also stated in her letter that vaccinations of home-based healthcare workers will begin in early February. For DDS, that includes shared living providers, home-based respite, individual/family
support staff who provide in-home services, and participants who self-direct their services.

Ryder also forwarded guidance from the Department of Public Health on vaccine distribution in congregate care facilities.

Elizabeth Morse, DDS deputy commissioner for operations, had stated in an email on Monday that the vaccination program was starting in DDS congregate programs this week.

Morse said a “small amount of vaccines” were previously distributed to the Hogan Regional Center and Wrentham Developmental Center “to help get the vaccine clinics set up.”

Governor provides some details

In a news briefing today, Governor Charlie Baker said the vaccines would be administered in congregate care settings starting on Monday, the 18th. However, as noted, Morse said the vaccination program was starting in the DDS settings this week.

According to The Boston Globe, the governor said congregate care facilities “can administer the vaccine in multiple ways.” Those facilities can self-administer the vaccine on site if they meet certain criteria, work with an existing pharmacy or provider to provide the vaccinations, or use mass vaccination sites such as one opening Monday for first responders at Gillette Stadium.

Earlier this week, we heard from a number of family members of DDS group home residents that the vaccinations were scheduled to start this week or next week for both residents and staff.

The providers were still waiting earlier this week for guidance from DDS on the vaccines. One family forwarded an email from their provider, dated Monday, informing them that, “Once we have a definite plan for vaccination, we will be reaching out to all families and guardians to let them know.”

A COFAR member received word last week from a medical staff person at the Wrentham Center that staff at the center were first in line for vaccinations, and were starting that day (January 5). However, the COFAR member was also told the center received less than half the necessary doses of the vaccine needed for the staff, which is listed at 850 persons.

DDS developmental centers and group homes fall under Phase 1 of the state’s vaccination plan, but have not been at the top of the Phase 1 order.

The Phase 1 order, which began in December and is scheduled to run through February, is:

1. Clinical and non-clinical healthcare workers doing “direct and COVID-facing care”
2. Long-term care facilities (which apparently include the Wrentham and Hogan Centers and nursing homes)
3. Police, fire, and emergency medical services
4. Congregate care settings (which apparently include DDS group homes, shelters, and prisons)
5. Home-based healthcare workers
6. Healthcare workers “doing non-COVID-facing care.”

Phase 2 of the distribution plan, which is scheduled to run from February through April, includes members of the general population with two or more medical comorbidities, residents over age 75, teachers, grocery workers, sanitation and public health workers; residents over 65, and individuals with one comorbidity.

The vaccines are projected to be available to members of the general public in Phase 3, which runs from April through June.

We will report to you on the promised additional details about vaccine distribution in the DDS system as soon as we hear about them.

Confusion persists as administration remains mum on COVID vaccinations in the DDS system

January 11, 2021 Leave a comment

Information continues to be sparse and confusing over COVID-19 vaccinations and testing of residents and staff in the Department of Developmental Services (DDS) system.

All of the information we have gotten so far regarding vaccine distribution in the system has been in the form of unofficial reports to COFAR members from facility staff. We heard unofficially, for instance, that staff at the Wrentham Developmental Center began receiving vaccinations last week, but that less than half the necessary doses were available for the center’s 850 staff.

At the same time, we were told late last week that an initial unofficial report that residents and staff at the Hogan Regional Center had gotten vaccinated in late December was false, and that no one at Hogan had yet gotten the vaccine. As a result, we have corrected our January newsletter, which had initially reported the incorrect information.

Unfortunately, our repeated attempts to get official information about the vaccine distribution in the DDS system either from Health and Human Services Secretary Marylou Sudders or from DDS Commissioner Jane Ryder have been rebuffed.

Infection rate may be leveling off

Amid all the confusion and uncertainty, there appears to be some potentially good news that the number of residents testing positive in the DDS system may be leveling off after a second COVID surge that began in October.

Our chart below is based on the administration’s latest official weekly state facilities report, and shows the results of COVID testing of residents in provider-operated group homes.

Administration officials not responding to emails

So far, however, we haven’t gotten a clear picture of the vaccine distribution situation.

On December 2, I emailed both DDS Commissioner Ryder and HHS Secretary Sudders to ask whether the Baker administration would include DDS residents and staff in its plans for distribution of the first doses of the vaccine that Massachusetts received. I never received a response to that query.

While the administration did issue a general vaccine distribution plan in early December, the plan doesn’t mention or make clear how DDS clients and staff fit into the overall picture.

When we heard that the unofficial report was false that vaccinations had been given at the Hogan Center, I sent a second email last week (January 7) to Sudders, Ryder, and DDS’s ombudsman asking for any information they could provide about the vaccination schedule in the DDS developmental centers and group homes. Again, no answer.

On Saturday (January 9), I emailed Marylouise Gamache, EOHHS ombudsman, with the same question. No answer so far.

In addition to the confusion over the developmental centers, it remains unclear when DDS group home residents will get the vaccine, and where those residents fall within Phase 1 of the state’s vaccine distribution plan. It appears all residents of DDS group homes and developmental centers are included in Phase 1 of the plan, which stretches through February. But it is unclear as to whether group home clients, in particular, are closer to the top or the bottom of the Phase 1 priority order.

As one COFAR member put it, it doesn’t seem as though it should be difficult for the administration to provide information for DDS families and guardians about the vaccination schedule and dosages delivered and administered. We think that data could easily be added to the online weekly state facility reports.

COVID testing in DDS system indicates some leveling off of the rate of infection

As noted, the picture may be improving regarding COVID testing in the DDS system. The infection numbers in the administration’s latest weekly report are still relatively high, but the peak may have occurred as of the Dec. 22 reporting date when 248 residents were listed as COVID positive. That number of positive residents was down to 236 as of last week’s reporting date on Wednesday. (See chart above.)

The numbers in those weekly reports for infected staff in provider residences are actually two weeks behind. Even so, that positive test rate may have also leveled off. The latest weekly report shows the positive test rate for provider staff in all EOHHS group homes was 3.12% as of the latest reporting date of Dec. 23, down from 3.16% as of Dec. 9.

Hopefully those downward numbers will continue, but it may be too early to say this is a downward trend.

Reporting of testing results should include tracking of “long-haul” effects

We have previously reported that the administration’s public reporting of testing results of both residents and staff in the DDS system has been spotty. For instance, while the weekly facility reports finally began to include information about provider staff testing positive, the numbers are for all human service provider agencies, not just DDS.

We would also like to see tracking of “long-haul” effects on residents and staff in the DDS system. Long-haul effects are lingering complications from the virus that can be debilitating even if individuals have recovered from the immediate effects of the infection.

The weekly reports do track what is termed “current clients recovered.” The reports define clients recovered as those who have tested negative or have met symptom and time-based recovery guidelines. Our guess is someone could meet those guidelines and still have long-haul effects of the virus.

Also, the numbers in the reports are apparently not cumulative because the reports state that those numbers don’t include “all recoveries over time.”  They are listed as  “current clients recovered” each week.

For months, we have been saying that we need more and better information from the administration about its response to the virus. While the administration has made some strides in this area, the continuing lack of communication about vaccine distribution, in particular, is frustrating and disturbing.

%d bloggers like this: