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Staffing shortages and low pay affecting care in DDS group homes

July 19, 2021 6 comments

As the Department of Developmental Services (DDS) system in Massachusetts emerges from the COVID crisis, a number of systemic problems are lingering, including reports of staffing shortages in group homes.

The staffing shortages may not be directly due to the pandemic, but the pandemic may have brought matters to a head.

Staffing shortages have long been a potential result of the low pay provided to direct care workers in the DDS system compared with high salaries provided to executives managing the nonprofits operating most of the group homes.

Even with a $4.2 billion surplus in state budget revenues projected for the current fiscal year, there appears to be no sign of urgency on Beacon Hill to address the direct care wage problem. Legislation (H.4171) that would have boosted minimum direct care wages in the DDS system to $20 per hour died at the end of the previous legislative session last December, and apparently hasn’t been revived.

We sent an email query on July 13 to state Health and Human Services Secretary Marylou Sudders and DDS Commissioner Jane Ryder, seeking confirmation of the staffing shortages and reasons for them. We sent a similar query to the Legislature’s Children, Families, and Persons with Disabilities Committee.

In our emails, we asked whether there are legislative efforts underway to boost direct care pay in the DDS system in order to recruit more caregivers and prevent others from leaving the system.

Neither Sudders nor Ryder has responded to our query.

A staff member of the Children and Families Committee did get back to us last week, saying a bill has been proposed for the second year in a row that would gradually raise the pay of direct care workers employed by DDS providers to the level earned by similar workers employed by the state.

Unlike last session’s bill, which would have raised direct care pay to $20 per hour, no actual hourly payment amount is specified in this year’s bill, H.237. The measure was referred to the Children and Families Committee on March 29.  A “tentative” vote on the bill isn’t scheduled by the Committee until this coming fall.

In response to a separate query we sent earlier this month to our membership, a number of family members maintained that staffing shortages exist and have caused problems in their loved ones’ residences. One parent said a DDS regional director had confirmed to her that “there is a staff shortage statewide and they are working to recruit people.”

In one case, a DDS official emailed a parent of a state-operated group home resident, saying DDS was “in touch with (the group home management) …to ensure proper staffing ratios are being met at all times.”

But a number of family members said they did not believe staffing has lately been adequate in the residences. One parent said her son needs two staff to assist him. She said, however, that there were only two staff available per shift in the entire residence, whereas there used to be five staff per shift. The parent termed the staffing situation “potentially dangerous.”

Another parent said several staff in her son’s residence were either on vacation, had resigned, or were in training elsewhere. She said the situation resulted in a recent incident in which a resident of the home left the residence unnoticed and was eventually found outside and brought back by staff.

Affecting quality of care

The parent cited above added that the shortage of staff in the residence has been accompanied by a shortage of hygienic supplies such as disposable wipes and body wash. “The lack of good personal hygiene is neglect,” the parent said.

Use of temporary employment agencies

Two family members said the providers running the group homes were using temporary staffing agencies to fill full-time positions. “They come into the house,” said one parent, “turn on the TV and sit down.” The parent said the temporary staff are not allowed to drive, so her daughter “is stuck inside the house all day, sometimes day after day, which is contributing to her health issues.”

A parent of a resident in a state-run group home said a number of the group home Occupational Therapy and Physical Therapy staff were also working in provider-run homes in order to supplement the staffing there.

Need for higher pay for direct care workers

A number of parents pointed out the connection between the staffing shortages in the group homes and low pay for direct care workers.

As one parent put it in an email to us, “Since the governor has a $4 billion surplus, maybe he could give DDS money,” specifically to increase group home staff wages.

A state budget fund was created a number of years ago, in part, to boost direct care wages. The problem is that while the fund has generated surplus revenues for many providers in recent years, little of the money has apparently gone to boost direct care pay.

In 2018, Governor Baker did sign legislation to raise the minimum wage of direct care and other workers to $15 an hour; but the minimum wage won’t reach that amount until 2023. In 2017, the Legislature rejected efforts to raise direct care wages to $15 as of that year, and rejected a bid in 2019 and again last year to raise direct care wages to $20 per hour.

EOHHS no longer tracking staff vaccinations

Also possibly due to the staffing shortage, the administration is not only not requiring working staff to be vaccinated for COVID-19, the administration is no longer tracking the number of staff who are vaccinated. EOHHS said it has never tracked the number of staff refusing vaccinations.

In a response to a June 28 Public Records Request we submitted for the latest numbers on residents and staff in the DDS system who have been vaccinated, EOHHS said they stopped tracking that information as of April 23. That was the last time they provided that information to us.

On April 23, EOHHS gave us information from early that month, indicating that about 50% of staff in DDS-funded group homes had been vaccinated, and 75% to 90% of residents in group homes had been vaccinated. So apparently with only half of the staff in the system vaccinated, EOHHS decided to stop tracking it.

Perhaps given the fact that the administration doesn’t require DDS staff to get vaccinated, the administration decided it isn’t necessary to know how many staff have actually done so. That seems to be a risky approach.

It also seems one of the administration’s biggest fears has been that the COVID crisis would lead to staffing shortages. As a result, the administration was slow to require testing of staff for COVID-19, and has declined to require that staff get vaccinated.

Despite that fear, the administration and Legislature apparently don’t seem to want to do the one thing that would go furthest to prevent staffing shortages — that is, ensure that direct-care staff are adequately paid for the difficult and important work they do.

Our July newsletter is available onlne

The July 2021 issue of our newsletter, The COFAR Voice, is now available on our website, with articles reporting that:

  • The Department of Developmental Services (DDS) has decided to finally lift family visitation restrictions in light of declining COVID rates in group homes and other residential facilities.
  • New data show the number of DDS clients entering the mainstream workforce dropped after October 2019.
  • The Legislature has upheld Governor Baker’s proposed cuts in funding for state-run DDS group homes, ICFs, and day programs; but COFAR made progress this past spring in getting Senate sponsors for budget amendments to restore that funding.

We also have an article about the retirement in June of Colleen M. Lutkevich, COFAR’s longtime, volunteer executive director. But not to worry — Colleen will continue to be available to do what she has done for 35 years — advocate on behalf of families and guardians of persons with intellectual and developmental disabilities.

Check out those articles and more in the new newsletter.

As usual, we welcome your thoughts about these issues, and your feedback in the comments section below.

As COVID rates drop, DDS finally lifts restrictions on visiting group homes

July 2, 2021 1 comment

With numbers continuing to drop of residents testing positive for COVID-19 in the Department of Developmental Services (DDS) system, DDS has finally lifted restrictions on visitation, according to an announcement on the Department’s website.

In the announcement, dated June 14, DDS Commissioner Jane Ryder stated that DDS had “asked our residential settings to return to their pre-pandemic visitation policies and practices” with the following exceptions:

  • Continued screening of all visitors for symptoms of illness and COVID-19 infection.
  • Suspended visitation when a resident is isolating due to COVID infection or there is a COVID-19 outbreak at the program.
  • Visitors must wear masks indoors at the home except if fully vaccinated and visiting a fully vaccinated resident in their room. Staff are still required to wear masks in group homes, regardless of vaccination status.
  • Residents who are fully vaccinated may visit with loved ones who are fully vaccinated without maintaining social distancing or wearing masks, if they choose.

The relaxed visitation guidelines hopefully mean the end of the imposition of contradictory and seemingly arbitrary restrictions, in some cases, on visitation by families of loved ones in the DDS system.

Ryder’s statement came just as the most recent COVID testing data published online, on June 15, showed that positive cases have reached new lows in the DDS system.

For the first time since COVID testing data has been kept, there were zero positive cases among residents in provider-run DDS group homes, and less than 5 residents testing positive in state-run group homes. (See graph below for the testing trend for provider-run residents since June 2020.)

Source: EOHHS online data

In the weeks prior to June 15, the number of residents testing positive in the provider-run homes had held steady at close to 30, while the number testing positive in the state-run group homes had held steady at about 10.

It remains to be seen whether the lower positive rates as of June 15 will continue.  The answer to that question will apparently not be known publicly until July 13, when the next results will be published.

As of June 16, the Executive Office of Health and Human Services (EOHHS) indicated on its COVID reporting site that DDS testing data will be published only every four weeks instead of weekly, as had previously been the case during the COVID crisis.

It is still unclear how many staff in provider-run group homes in the DDS system are continuing to test positive for COVID. That information has never been included in the DDS facilities reports.

The latest report as of June 15 shows less than 5 COVID-positive staff in the state-operated group homes, and zero positive staff and zero positive residents in the Wrentham and Hogan developmental centers.

Staff vaccination rates still unclear

COVID vaccination rates among staff and residents in the DDS system are also not published online.

Based on information provided by EOHHS in response to Public Records Requests from COFAR, we last reported that as of April 9, less than 50% of staff in state-operated group homes were fully vaccinated.  In provider-run group homes, only 51% of staff were fully vaccinated as of April 12.

Some 75% and 90% of residents in provider-run and state-run group homes respectively had been vaccinated as of April 12.

We filed a renewed Public Records request on Monday (June 28) with EOHHS for the latest staff and resident vaccination rates. EOHHS stated that a response will be provided by July 13.

As we have previously noted, the relatively low staff vaccination rates as of April may have been keeping COVID present in the DDS system. However, if COVID rates among residents do remain at zero or close to it in the weeks following June 15, it would almost certainly be due to a high vaccination rate among those residents.

Ryder continuing to push vaccinations for residents

In her June 14 message, however, Commissioner Ryder implied that not all DDS clients have been vaccinated. She noted that a “Homebound Vaccination Program” was available across the state to anyone with trouble getting to a vaccination site.  The number is 1-833-983-0485 to schedule an in-home vaccination.

Restarting day programs

Ryder also said DDS was working with providers to return clients to in-person day and employment programs. She said, however, that those programs are currently “struggling” with staff shortages.

We have reported that day programs were also targeted for major cuts in the governor’s Fiscal Year 2022 state budget. The fiscal year began Thursday (July 1), but the budget has not yet been approved by the Legislature.

Ryder did not mention in her message that in January, Governor Baker specified a $25 million, or 11%, cut in the DDS Community Based Day and Work (CBDW) line item. A major cut in the line item could also make it difficult to return clients to in-person day programs.

The House and Senate subsequently added $15 million back to the CBDW line item, noting that the add-back would primarily be for the development of services in response to the COVID pandemic. But even the House and Senate versions would cut the line item by $10 million, or 4.2%, from the previous fiscal year.

We have previously reported that the COVID crisis resulted in a major shift to remote attendance in the CBDW programs via platforms such as Zoom. As of November 2020, 36% of day program clients were attending remotely only, according to DDS data.

As usual, it would be helpful to have more timely information from the administration about the state of the DDS system, particularly regarding COVID vaccination and testing rates for provider staff. The outlook for DDS day programs also remains cloudy as we emerge from the pandemic.

At the same time, the dropping positive COVID rates among DDS group home and facility residents, and the promised return to pre-pandemic visitation policies are very hopeful developments.

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