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Posts Tagged ‘COVID-19’

Families still restricted in visiting loved ones in DDS system even if residents have been vaccinated

May 19, 2021 2 comments

Throughout the COVID-19 pandemic, we have questioned overly restrictive and sometimes contradictory family visitation policies imposed by both the Department of Developmental Services (DDS) and its residential providers.

What seems surprising is that now, with most residents in the system apparently having been vaccinated, those restrictive and contradictory policies appear to be continuing.

In response to a query sent to our members last week, several said they were continuing to be sharply restricted or even prohibited entirely from entering group homes in which their loved ones are living. Some of those family members are nevertheless allowed to take the residents home for visits.

As we have reported, while most residents of group homes and developmental centers in the DDS system appear to have been vaccinated, a significant percentage of staff have not been. Yet, the restrictions on visitation or contact appear to be aimed exclusively at family members and guardians of residents.

“To hold families and guardians to a higher standard than direct care is unfair and makes no sense,” said Thomas J. Frain, COFAR Board president. “Family visits at this time should not be any more restrictive than they were before the crisis. But some residential managers are clearly using COVID restrictions as a weapon to control family access to their loved ones.”

In an email sent Monday (May 17) to DDS Commissioner Jane Ryder, I asked why visitation restrictions were still ongoing in residences in which all residents have been vaccinated. Ryder, to date, has not responded.

DDS visitation guidance, dated March 19 of this year, continues to give providers discretion to limit the number of visitors and restrict visits under any circumstances the providers deem pose a threat to safety. The guidance document states that any such restrictions should not be arbitrary.

While the March guidance does allow visitors who are fully vaccinated to meet with vaccinated residents in their rooms, it states that providers must restrict all visitation if any staff are infected or presumed infected within the past 14 days. It apparently doesn’t matter under the policy whether all residents have been vaccinated or not.

Family members and guardians cite arbitrary restrictions

A number of other COFAR members said this past week that they have been subjected to differing and sometimes seemingly arbitrary restrictions on visitation.

Colleen Lutkevich, COFAR executive director, said all residents in her sister’s house on the Wrentham Developmental Center campus have been quarantined from May 11 through May 21 because two staff tested positive for COVID. Yet, all residents have been vaccinated, she said, and none are currently testing positive.

Frain said he, himself, was subjected to what appeared to be an arbitrary restriction by staff after his brother experienced a medical emergency in his group home in March. Frain had entered the residence along with ambulance personnel to attend to his brother.

When the emergency was over, Frain said, he was singled out by two staff members and told he alone must leave by the back door of the residence because he hadn’t been tested on entering for COVID. Frain said he complied with the order, but feels it was unnecessary and was possibly an effort to personally humiliate him as a family member.

One COFAR member said that even though her son has been vaccinated — and she believes all other residents of his group home have been vaccinated as well — she and her husband have not been allowed to enter the residence. Nevertheless, she said, they are allowed to take their son home for overnight visits.

“It makes no sense,” the COFAR member wrote in an email. “At least we can be with him, so I really can’t complain, but it would be nice to see what is going on in the house.”

As is the case with a number of families, the COFAR member said she needs to go through her son’s clothes for the seasonal change to spring.  Because of the no-entry restriction, the staff brought his belongings to the backyard. “I cannot bend over,” she wrote, “so it was difficult.”

Yet we were told that in another group home even unvaccinated family members were allowed inside to their loved-one’s bedroom to change his wardrobe to spring.

Another COFAR member, who wanted to change her son’s clothing from winter to spring, said she is currently allowed to enter the residence once a week.  She too can take her son home at any time.

Another provider requires a week’s notice prior to visits by family members. In yet another case, visitors are allowed in the house, but only for a maximum of 30 minutes.

COVID infection rates not correlated with restrictions on family visits 

State data show the rate of COVID infection in the DDS system among both residents and staff declined earlier this year, reaching lows at the end of March. But since then, as recent weekly online state facility reports show, the decline has stalled, and rates of infection have held steady.

As of May 11, 10 residents and 14 staff in the state-operated group home system continued to test positive for COVID. As of that date, 37 residents in provider-run group homes and an unreported number of staff continued to test positive.

There were as many as 5 deaths among residents in the group home system due to COVID in the seven days prior to May 11.  No data on COVID-related deaths are available for staff.

While administration officials have not responded to our requests for comment on the matter, we think the decline in the COVID rate in the DDS system from January through March was largely due to the vaccinations of most of the residents and at least some staff, which began in January.

Although data is lacking, we think the continuing presence of at least some COVID in the system since the end of March may be due to the apparent continuing resistance of a significant number of staff to getting the vaccine.

As far as we can tell, residential DDS providers have continued to impose the same types of restrictions on family visits that they imposed prior to the first vaccinations in January. So, we don’t see that those restrictions as related to the decline in COVID rates since January or to the continuing presence of infection in the system.

It’s time, as Tom Frain said, for DDS to issue new, unambiguous guidance to providers to restore visitation policies to what they were prior to the pandemic.

State House approves cuts to DDS day program funding, increases for provider group homes

May 5, 2021 4 comments
In approving a state budget plan for Fiscal Year 2022, the Massachusetts House late last week largely followed Governor Baker’s lead with regard to the Department of Developmental Services (DDS).
 
Both the House and governor’s budget proposals involve cutting funding for DDS community-based day programming, state-run group homes, and the two remaining developmental centers. Meanwhile, funding would be boosted, as has been the case for the past decade, for corporate provider-run group homes.
 
The budget deliberations will now be taken up by the Senate.
 
Community-Based Day Program cuts
 
The House did make a few tweaks to the governor’s proposals for DDS. In its budget plan, the House added $15 million to the governor’s proposed funding for the Community-Based Day and Work (CBDW) program line item (5920-2025). However, even the House funding would involve a significant cut of $19 million, or 8%, to the line item from the current year.
 
In his budget proposal in January, Baker specified a $34.6 million, or 14%, cut in the CBDW line item.
 
The House budget states that the $15 million added back to the CBDW line item would primarily be for the development of services in response to the COVID-19 pandemic. Those services were listed as including remote and virtual day program supports, and “in-home or in-community services.”   
 
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 the March 9 DDS data. 
 
The proposed cuts in the CBDW line item would appear to signal further bad news for integrated employment prospects for DDS clients because the CBDW line item is used, in part, to fund job skills training and other activities to help clients make the transition to the mainstream workforce.
 
We also previously reported that DDS data revealed a 53% drop-off in “group and individual supported employment” among clients between October 2019 and February 2020.
 
Along with the cut to the CBDW program account, the House plan would cut the DDS transportation line item by $6.2 million, or 18.6%. That would not be as deep a cut as the governor’s January proposal to cut the transportation line item by nearly 40%.
 
Corporate-provider group home funding would be increased while state-operated group home funding would be cut
 
The House adopted the governor’s proposed funding increase for corporate provider-run group homes of $120.7 million, or 9.4% (line item 5920-2000). But as we previously reported, that may be an understatement of the increase sought by Baker. The nonpartisan Massachusetts Budget and Policy Center has pegged that proposed increase at $157 million, or 12.2%. 
 
If the Senate concurs with the proposed increase, the corporate provider line item would be funded at more than $1.4 billion, which would represent a 91% increase over the funding appropriated for the same line item a decade previously, in Fiscal 2012.
 
Funding for state-funded group homes and developmental centers, in contrast, have been on a relatively flat or downward trajectory respectively, and Fiscal 2022 would be no different. (See graph below.)
Source: Mass. Budget and Policy Center

The House budget would add $100,000 to the governor’s proposed Fiscal 2022 funding for state-operated group homes (line item 5920-2010). However, when adjusted for inflation, even the House budget proposal would amount to a cut in funding for this line item of somewhat less than 1%. (We are basing that assessment on numbers from the Massachusetts Budget and Policy Center’s “Budget Browser.”)

The two remaining developmental centers would similarly see their funding cut in Fiscal Year 2022 by $2.1 million under the House budget, when adjusted for inflation (line item 5930-1000). Since Fiscal 2012, funding for the developmental center line item will have been cut by 32%.

COFAR is continuing to raise concerns regarding the ongoing under-funding of state-run DDS programs. We believe this has led to unchecked privatization of programs and services.

We are also concerned that even within provider accounts, we may be seeing a permanent pullback in funding for day programming, with much of that funding ultimately going to provider-run group homes.

Last month, we sent an issue paper raising those concerns, among others, to Senator Adam Gomez and Representative Michael Finn, the new chairs of the Legislature’s Children, Families, and Persons with Disabilities committee. You can find our issue paper here.

Staff resistance to COVID vaccine may be keeping virus in DDS system

April 27, 2021 1 comment

Resistance among group home staff in the Department of Developmental Services (DDS) system to getting vaccinated against COVID-19 seems to be an ongoing problem, and we’re concerned that it may be linked to the continuing presence of COVID in the system.

The latest online weekly COVID testing data for the DDS system show that while the number of infected staff and residents in the system has declined from historic highs in December and January, the rate of that decline may have stalled in the past several weeks. 

The vaccination effort in the DDS system started in December.

It is concerning that as of April 9 — some four months after the vaccination program began — less than 50% of staff in state-operated group homes were fully vaccinated, according to data provided last week by the Executive Office of Health and Human Services (EOHHS).  In provider-run group homes, only 51% of staff were fully vaccinated as of April 12. 

The data are as of April 12 for provider-operated group homes, and as of April 9 for state-operated group homes and the state’s two developmental centers or Intermediate Care Facilities (ICFs). The data were provided to COFAR in response to a Public Records Request. EOHHS and DDS provided data for February and March in response to a previous records request.

In the ICFs, the current level of staff vaccinations appears to be higher than in the group homes, but the numbers are still somewhat concerning. Some 68% of the staff at the Wrentham Developmental Center (WDC) and 66% at the Hogan Regional Center in Danvers were fully vaccinated as of April 9.

That this apparently low level of staff vaccinations is not simply due to a slow vaccination process appears to be borne out from the data. First of all, among residents of both state and provider-run facilities, the vaccination picture looks much brighter.

Among residents in state-run group homes, some 90% were fully vaccinated as of April 9. At WDC, 99% of residents were fully vaccinated, and 91% of residents at Hogan were fully vaccinated as of April 9.

In provider-run residences, 75% of residents were fully vaccinated, although18% had not gotten their first shot as of April 12.

The graphs below illustrate the differences in numbers of persons getting vaccinated among the different settings, and differences in vaccination levels between staff and residents. 

The graphs show that relatively large numbers of staff were still unvaccinated (the orange bars) in the provider and state-operated group homes, while the numbers of unvaccinated residents in all of the settings (the yellow bars) were much lower.

Data appear to show resistance by staff to vaccinations

Vaccination data regarding state-run and provider-run group homes appears to imply that there is a relatively large group of staff that are resisting getting the vaccine. 

For instance, of the 1,596 staff in DDS state-run group homes who did get a first dose of the vaccine as of Feb. 16, most appear to have gone on to get their second shot as of April 9. A total of 1,728 staff in the state-run group homes were fully vaccinated as of April 9, up from 277, as of February 16.

However, 1,966 staff had still not gotten their first shot as of February 16. And the data indicate that only 279 of those staff had gotten their first dose as of April 9. That left 1,687 staff still unvaccinated in the state-run group homes as of that April date.

As a result, the number of unvaccinated staff in the state-run group home system dropped by only 7.8% between February 16 and April 9, declining from 55.2% to 47.4%. 

Decline in COVID-19 in the DDS system may have stalled

As some staff have apparently continued to resist getting vaccinated, the rate of decline of COVID in the DDS system appears to have stalled.

For DDS state-operated group homes, a low in the infection rate was reached as of March 30, when 9 residents and 12 staff tested positive. That is compared to highs of 43 residents testing positive in January, and 111 staff testing positive in December. 

But as of April 20, the latest date for online data, the number of COVID positive residents in the state-operated group homes was still at 9, and the number of positive staff had crept up to 14.

In the provider-operated group homes, a low of 29 positive residents was reached as of March 23. That number was up to 31 residents as of April 20. No information is made available by the administration, for unknown reasons, on the number of staff testing positive in provider-operated homes.

At the Hogan Center, no staff or residents have tested positive since February; but at WDC, as many as 5 staff tested positive as of April 13 and April 20. No exact number is given for 5 or fewer persons testing positive in a given setting. Zero residents at WDC have tested positive since January.

So it may be the case that as long as at least some staff are continuing to resist getting vaccinated, the number of staff and possibly even of residents in the DDS system who get COVID may never reach zero.

There have been no deaths in either ICF from COVID since last November. But there have continued to be as many as five deaths per week in the group homes as recently as of April 13. That lower number of deaths in the ICFs may also reflect the fact that the vaccination rate among staff and residents in the ICFs has been higher than in the group homes.

We can only speculate as to whether the administration considers it a problem that the vaccination rate among staff in the DDS system is still as low as it is. Neither Health and Human Services Secretary Mary Lou Sudders nor DDS Commissioner Jane Ryder has responded to our multiple requests for comment about the vaccination process in the DDS system.

Until and unless the Baker administration decides that the public has a right to know their thinking on this, we will have to keep guessing.

COVID-19 vaccinations appear to be working in the DDS system, but information is lacking

April 5, 2021 1 comment

Data received last week from the state show that as of early March, more than 80% of residents and a little over 50% of staff in residential facilities directly run by the Department of Developmental Services (DDS) had been fully vaccinated for COVID-19.

One would assume that by now, all residents in the DDS system and most of the staff have been vaccinated. But the numbers are almost a month old, and DDS said it does not have vaccination data on residents or staff in provider-run homes.

DDS provided the vaccination numbers for the sate-run facilities on March 29 in response to a Public Records Request we had sent on February 18.

Vaccination data also provided on March 29 by the Executive Office of Health and Human Services (EOHHS) in response to the same Public Records Request does include numbers on vaccinations of residents and staff in provider-run homes. But the EOHHS data is even more out of date than the DDS data.

A spreadsheet provided by EOHHS is dated February 23. The EOHHS data showed that as of February 23, 24% of staff and 38% of residents in the DDS provider-run group home system had been fully vaccinated. EOHHS is the state’s umbrella human services agency, and DDS is located under it.

The chart below, based on the DDS data, therefore shows the most up-to-date information we have from the administration on vaccinations in the DDS system:

Source: DDS

On April 1, I submitted a new Public Records Request to EOHHS, this time asking for current data on vaccinations in both provider-run group homes and state-run residential programs.

In addition to the lack of up-to-date vaccination data, both EOHHS and DDS said they did not have any records on numbers of staff or residents refusing vaccinations. We think the difficulty involved in getting this information on vaccinations in the system is troubling.

Since last May, the Baker administration has been posting at least some information in its online weekly state facilities reports on COVID test results of residents and at least some staff in the DDS system. But getting information on vaccinations is another story.  

COVID test results continue to be promising

Those COVID test results continue to be encouraging, apparently reflecting the large numbers of residents and staff that have been vaccinated.

As of the March 30 state facilities report, residents testing positive in both state and provider-run group homes declined to some of their lowest levels since the COVID crisis began. There have been no residents or staff testing positive at either the Hogan Regional Center or the Wrentham Developmental Center since late February. There have been no deaths of any residents in either facility due to COVID since last November.

The numbers of infected residents and staff in DDS state-operated group homes and in the two developmental centers have also declined to all-time lows since the crisis began.

As of March 30, 9 residents and 12 staff in state-operated group homes tested positive, compared to highs of 43 residents testing positive in January, and 111 staff testing positive in December.

In the provider-run group home system, 32 residents tested positive as of March 30, compared to a high of 305 in January. As we have previously noted, no information is made available by the administration, for unknown reasons, on the number of staff testing positive in DDS provider-operated homes.

Administration won’t comment on the vaccinations or test results

In February, I emailed both EOHHS Secretary Mary Lou Sudders and DDS Commissioner Jane Ryder, asking for comment on whether the vaccines were responsible for the declining numbers of infected persons in the DDS system even at that early period in the vaccination effort. Neither Sudders nor Ryder ever responded. Why the administration won’t comment on this is perplexing.

Month-long delay in providing records

On February 18, I filed an initial Public Records Request with both EOHHS and DDS, asking for:

 1. Records and internal emails that discuss projected timeframes for vaccinating residents and staff in DDS residential facilities; and

2. Records indicating the number of residents and staff who have been vaccinated in DDS residential facilities, broken down by type of facility.

On February 23, I additionally asked for:

3. Records indicating the number of staff and residents in the residential facilities who have refused vaccinations.

As noted, neither DDS nor EOHHS responded with any records until March 29. In its response, DDS stated that it had no internal emails discussing vaccination time frames. While EOHHS did indicate that it had such emails, the agency said it would only provide them if we were willing to pay $1,150 for search and redaction fees.

Also, as noted, both agencies said they had no records on numbers of individuals refusing vaccines.

While DDS had no internal emails on vaccine timelines, the Department stated that the administration had placed residents and staff in congregate care settings under Phase 1 of its vaccine distribution plan. Phase 1 ran from December 2020 through February 2021.

What we know now

At this point, all we can say with any degree of certainty is that most of the residents in state-run congregate care facilities in the DDS system have probably been vaccinated by now. The rest is pretty much conjecture despite our repeated efforts to get more concrete information out of the administration. Those efforts have now included filing two Public Records Requests.

In a letter, dated March 24, to the “DDS community,” Ryder maintained that the administration had heard the “voice” of that community in responding over the past year to the pandemic. “Your voice was instrumental in driving and shaping these developments. You let us know when our policies and protocols went too far – or not far enough,” she wrote.

Ryder added that, “DDS remains committed to hearing your voice, and keeping you informed and engaged as we go.”

If Commissioner Ryder is truly committed to hearing our voice and keeping the DDS community informed, she can start by providing up-to-date information on vaccine distribution in the system, and by responding to our repeated requests for her comment on these matters.

DDS numbers show pre-COVID drop in mainstream employment of DDS clients

March 25, 2021 6 comments

Despite continuing clams by the state that people with developmental disabilities are finding jobs and thriving in the mainstream workforce, newly provided state data show a steep drop in “supported” or “integrated employment” for those persons as of early 2020.

A comparison of the new data from the Department of Developmental Services (DDS) with data previously available from the Department reveals a 53% drop-off in “group and individual supported employment” between October 2019 and February 2020. (See graph below)

As the graph shows, the employment numbers actually rebounded a little bit as of November 2020, which was during the COVID period, but then dropped again as of February 2021.

DDS Individual and Group employment totals

Source: DDS

The employment numbers starting from November 2019 were provided by DDS to COFAR on March 9 in response to a Public Records Request. The previous numbers from June 2014 through October 2019 are from an online DDS December 2019 “Employment First Progress Report.” 

The drop in the number of DDS clients in “individual and group supported employment” positions is prior to the COVID crisis, so COVID-19 and its impact could not be the cause.

The DDS data raise further questions about the state’s claims in closing all sheltered workshops as of 2016 that DDS clients would find better and more fulfilling work opportunities in the mainstream workforce.

Baker administration officials since 2016 have attempted to put a positive spin on the situation, with then DDS Commissioner Elin Howe maintaining that year that “there are now more people working in individual jobs in the community than ever before.” But even then, it appeared the administration was gaming the numbers.

The DDS 2019 “Employment First Progress Report” continued to try to cast mainstream employment prospects for developmentally disabled persons in the most positive light. While recognizing a “difficulty in obtaining job opportunities for individuals with more significant disabilities,” the progress report nevertheless touted:

An increase in the total number of individuals now employed, earning minimum wage or higher, and receiving the same benefits as other employees;

An increase in the number of individuals earning minimum wage or higher in small Group-Supported employment services to 71%; and

Continued evolution of Community-Based Day Support programs that support individuals on their pathway to future employment via skill-building and other meaningful activities.

But COFAR and a number of family members have pointed out that what actually occurred in the wake of the closures of the sheltered workshops was the transfer of thousands of clients to day programs where there was little or nothing for them to do.  It appeared early on that the numbers of available job opportunities in “integrated” or or mainstream settings was extremely limited.

DDS does not yet appear to have published a further progress report on integrated employment since the December 2019 report.

DDS day programs continue to draw clients, but more than a third began attending remotely

As we have previously noted, the numbers of Massachusetts DDS clients placed in Community-Based Day and Work (CBDW) programs since the closures of the sheltered workshops has outpaced the number of clients who have been given integrated employment opportunities.

The newly provided data from DDS show a 22% drop in overall CBDW participation during the initial months of the COVID crisis — from February 2020 through November 2020. But the numbers began to rise after that; and as of February of this year, the number of day program participants hit an all-time high of 7,569 clients.

DDS CBDW program totals

Source: DDS

Nevertheless, the COVID crisis resulted in a major shift to remote attendance in the day programs via platforms such as Zoom. As of November 2020, 36% of day program clients were attending remotely only, according to the March 9 DDS data. DDS did not provide figures after November 2020 on the number attending remotely.

Due to that remote attendance rate, CBDW programs are now being subjected to proposed funding cuts by Governor Baker in his Fiscal Year 2022 budget.

That is apparently further bad news for integrated employment prospects because the CBDW line item in the DDS budget is used, in part, to fund job skills training and other activities to help DDS clients make the transition to the mainstream workforce.

No response from Commissioner Ryder

On March 16, I sent an email query to DDS Commissioner Jane Ryder, asking for a comment on the apparent drop in client participation in integrated employment, and for her assessment of possible reasons for it. Ryder so far has not responded to my request.

DDS said it does not possess records relating to the future of CBDW programs

In its March 9 response to our Public Records Request, DDS stated that the Department does not possess any records concerning projections of the number of clients who will be enrolled in CBDW programs in FY22 and beyond, or concerning the number of such programs that will exist, the financial viability of such programs, or the number of clients who will attend remotely.

One question the DDS response leaves us with is whether it implies that DDS does not engage in planning regarding CBDW programming.

Need is greater than ever for work opportunities in day programs

It seems clear that the administration’s integrated employment promises for persons with developmental disabilities were not being realized even prior to the COVID crisis.

Recognizing that problem, we had supported a bill in 2019 (H.88), which would have required that meaningful work activities be provided in CBDW programs themselves. Unfortunately, the language in the bill was subsequently replaced by the Children, Families, and Persons with Disabilities Committee with language establishing yet another Commission on the Status of Persons with Disabilities.

What the latest DDS data confirms, in our view, is that the administration and Legislature need to rethink the ideology that led to the closures of the sheltered workshops, and take substantive action to provide work opportunities to people with developmental disabilities.

Records imply ‘strong’ disagreement in Baker administration last summer over mandatory COVID testing of DDS staff

February 25, 2021 3 comments

Top administrators in the Baker administration appeared to strongly disagree last summer over whether to require testing of staff for COVID-19 in group homes and other residential facilities for persons with developmental disabilities, according to emails received under a state Public Records Law request.

The emails, provided earlier this month to COFAR by the Department of Public Health (DPH), appear to imply that as late as last July, both Health and Human Services Secretary Marylou Sudders and Assistant Secretary for MassHealth Daniel Tsai strongly opposed mandatory testing of staff in residential facilities in the Department of Developmental Services (DDS) system.

At the same time, the emails indicated that DPH Commissioner Monica Bharel and members of her office supported mandatory testing.

Sudders has not responded to a request for comment on the matter. In an email to COFAR sent today (February 25), Jennifer Barrelle, Bharel’s chief of staff, said Sudders “was supportive of mandatory testing…”  However, Barrelle’s email was unclear as to when Sudders’ support began.

Sudders’ agency, the Executive Office of Health and Human Services (EOHHS), oversees departments such as DDS and DPH. By mid-August, EOHHS finally issued a directive requiring testing of staff throughout the human services system. However, this was some five months after the pandemic became a full-blown crisis in the state.

The apparent opposition by Sudders and Tsai at the top of the human services secretariat as late as July could help explain the lengthy delay in implementing the mandatory testing of residential staff.

COFAR and other advocacy organizations had urged mandatory testing as early as April 2020, arguing that staff were potentially a major source of the introduction of the virus in group homes and other residential facilities. Sudders and other administration officials have never explained why it took so long to finally require staff to be tested.

I sent emails on Sunday (February 21) to both Sudders and Bharel, asking for their comment on the newly provided emails. As noted, Sudders has not responded.

In one internal DPH email, dated July 8, 2020, Bharel stated to several members of her office that she had just spoken with Assistant EOHHS Secretary Tsai:

 …and he feels strongly and say (sic) the Secretary (Sudders) does too — around mandatory testing for staff. But he is willing to think it through and learn more. We can discuss at our 10 am call Friday- I know folks on this email have strong beliefs.

Bharel didn’t say in the email what those beliefs were — just that Sudders, Tsai, and “folks on this email” had “strong beliefs” about mandatory testing of staff. The implication, however, was that Sudders and Tsai had different beliefs than did Bharel and her team.

Meanwhile, an internal DPH discussion document in July recommended mandatory testing of congregate care staff.

In her July 8 email, Bharel asked a member of her office to find other instances around the country in which staff testing was mandatory, apparently in order to help make the case to Sudders and Tsai for mandatory testing in Massachusetts.

Bharel further asked in the email whether there was “a model for how many staff need to be tested to feel the surveillance (ongoing testing of staff) is enough? 50%? 60%? How do you decide?”

In her email to COFAR today, Barrelle said that in implementing the mandatory testing program, the administration was involved in negotiations with state employee unions. At least one union filed unfair labor charges against the state for the mandatory testing program, she said.

“You are incorrectly interpreting that Secretary Sudders was opposed to mandatory staff testing,” Barrelle’s email to COFAR stated. “Secretary Sudders was supportive of mandatory testing and rolled it out across all congregate care programs within health and human services within weeks of these (July internal DPH) emails.”

Barrelle’s email to COFAR was not clear, however, as to whether Sudders’ support for mandatory testing may have only begun after July.

DPH office found examples of mandatory staff testing

In a July 9, 2020, email in response to Bharel’s query to her office about other jurisdictions that had implemented mandatory staff testing, the office member provided links to online media accounts in July of testing requirements for staff in colleges and private sector settings.

The office member then noted that in June, the State of Connecticut had begun requiring staff in nursing homes and congregate care settings in that state to be tested for the virus. That was some two months before the Baker administration in Massachusetts issued its mandatory testing directive.

DPH July discussion document recommended staff testing

In addition to the July emails within DPH, a document slated for discussion in Bharel’s office in July included, as a “key question for discussion,” whether COVID testing should be a “mandatory requirement” of staff in state-operated facilities, including hospitals and congregate care facilities.

Option A, which was recommended in the discussion document, was “Yes, testing is a mandatory requirement in state-operated facilities with a goal of achieving full (~90%) compliance.” It wasn’t clear whether this option did or did not include provider-operated facilities.

Under Option A, staff would be given three chances to comply with testing, with a first refusal resulting in a 5-day leave; a second refusal resulting in a 14-day leave; and a third refusal resulting in termination of employment.

Option B was “No, staff are able to refuse testing.”

This second option stated that without mandatory testing, “experience demonstrates that to-date, state-operated facilities are able to achieve 50-65% compliance when access barriers (e.g., shift timing) are limited to the extent possible.”

EOHHS guidance on staff testing, which, as noted, was issued in August by the administration, does not appear to refer to any penalties for staff testing refusals.

Records came from DPH, but not from EOHHS 

We initially filed Public Records Law requests last May with EOHHS, DPH, and DDS for internal emails regarding the mandatory testing issue. In June, after EOHHS indicated their responsive records would be voluminous, we modified our request to limit it to emails between Sudders and her executive team.

We received the emails noted above from DPH on February 1. We never received any records from DDS.

On September 30, after two appeals, EOHHS provided us with just one internal email, dated May 22, which consisted solely of a reprint of a blog post that we had published about mandatory testing a few days previously (COFAR Blog: DDS may be flouting state and federal guidelines in failing to make testing of group home staff mandatory).

That sole EOHHS email did not include Sudders on the thread and contained no comment on the subject of mandatory testing or our blog post. Given EOHHS’s initial claim that they had a large number of responsive emails, we again appealed to the Public Records Division, contending it was unlikely there was only one email in existence in the agency on the issue.

On October 15, 2020, the Public Records Supervisor ordered EOHHS to identify other potentially responsive records within 10 days to our original public records request. But EOHHS never acted in compliance with the Supervisor’s order. We received no further communications from EOHHS.

In our email to Sudders on Sunday, we asked why EOHHS still had not complied with the Public Records Supervisor’s October 15 order regarding our records request, and whether the agency intends to comply with it.

Administration still does not report COVID testing results for provider-based staff

In addition to being slow to require testing of staff in the DDS system, the administration has had a spotty record of reporting the results of that testing.

It was not until May that EOHHS began publicly reporting testing data in the DDS system; but the reporting system has continued to have major gaps in it. Those reports contain no information, for instance, on the number of infected staff in DDS provider-run residences, which constitute, by far, the largest network of DDS group homes.

Starting in November, weekly state facility reports had begun showing results of testing on provider staff in all EOHHS human services group homes. But not only were those reports not broken down by individual agency, such as DDS, the reports started combining provider-run group home results with state-run group homes as of February 16 of this year (see final page).

We previously reported that eight emails we did receive from EOHHS in August, based on a separate Public Records Request, showed a consensus in that agency to reduce public reporting of testing data in the human services system.

EOHHS’s lack of commitment to keeping the public informed about the impact of COVID-19 on the DDS system is disturbing. It is also concerning that EOHHS was apparently not in favor for five months of mandatory testing of staff for the virus.

The lack of such testing potentially exposed thousands of residents of DDS facilities to infection. Had mandatory staff testing occurred earlier, an untold number of COVID cases among residents and staff in the system may have been prevented.

 

As more people get vaccinated in the DDS system, COVID rates appear to be declining

February 15, 2021 Leave a comment

Reflecting a decline in COVID-19 infection rates in the state as a whole, the latest data available in weekly state facilities reports show a drop-off in recent weeks in the numbers of persons testing positive in the Department of Developmental Services (DDS) system.

While that decline appears to be at least partly due to vaccinations that have been ongoing in the system, Baker administration officials have not yet responded to our request last week for comment on the possible trend.

Here are some COVID testing numbers in various DDS residential categories, taken from the latest state facilities report as of February 9, and from previous reports:

DDS state-operated group homes

The number of residents in state-operated group homes testing positive for COVID-19 reached a high of 43 as of January 26, and dropped to 18 as of February 9.

The number of staff in those residences testing positive reached an all-time high of 111 as of December 22, and dropped to 60 as of February 9.

DDS provider-operated group homes

The number of residents in provider-operated group homes testing positive reached an all-time high of 305 as of January 19, and dropped to 111 as of February 9.

There are no data specifically regarding COVID-positive staff in DDS provider-operated group homes.

Wrentham Developmental Center (WDC)

The number of residents at WDC testing positive reached an all-time high of 11 as of January 12, and dropped to 0 as of February 9.

The number of staff at WDC testing positive reached an all-time high of 32 as of January 12, and dropped to 12 as of February 9.

Hogan Regional Center

The number of residents at Hogan testing positive reached a high of 8 as of January 12, and dropped to 0 as of February 9.

The number of staff at Hogan testing positive reached an all-time high of 23 as of December 29, and dropped to less than 5 as of February 9.

Below is a graph showing the positive test curve for provider group home residents since last June. It’s typical of the data arc for the other categories:

Possible role of vaccinations

It appears possible that the recent decline in COVID positive test results in the DDS system is at least partly due to the introduction of vaccines in DDS facilities.

Phase 1 of the state’s Vaccination Plan included residents and staff of DDS long-term care and congregate-care facilities as priority vaccination recipients. But there has been no information provided by the administration on how many DDS residents and staff have been vaccinated so far.

CNN reported Sunday that officials were hopeful that for the nation as a whole, the continued ramping up of vaccinations was “beginning to shift the pandemic’s course in a positive direction.”

Little information available on vaccinations in the DDS system in Massachusetts

The Baker administration recently began publishing online information showing the number of vaccine doses shipped to Massachusetts and the number administered to residents, broken down by age, gender, county, race, and ethnicity. But the online data does not break the numbers down by disability or show how many people have been vaccinated in the DDS system.

On Friday (February 12), I emailed state Health and Human Services Secretary Marylou Sudders and DDS Commissioner Jane Ryder, asking whether they would agree that there has been a potentially significant drop in COVID-positive residents and staff in the DDS system.  I also asked whether that drop might be due to the vaccinations of residents and staff in the system. As noted, I haven’t yet received a reply.

The decline in positive test results could be temporary

The CNN article noted above reported that some 38 million people have received their first dose of the two-dose vaccines available to the US market, and about 14 million people have been fully vaccinated.

But the article stated that while Covid-19 numbers may be trending in the right direction now, four key factors will determine whether those trends continue. Two factors contributing to the downward trajectory in infection rates are the increasing vaccinations and a pattern of lower transmission that’s likely in the US during the spring and summer months.

Two other factors, however, can slow or even reverse the declines. One of those factors is the spread of the B.1.1.7 variant, which was first identified in the UK. Another key factor is increased behaviors that favor COVID-19 transmission such as frequenting high-risk settings, including indoor dining.

The article reported that experts believe now is not the time for the US to let down its guard, “even as a growing list of governors loosen Covid-19 restrictions.”

We will continue to monitor the state’s COVID testing reports for DDS facilities. While those reports could be more informative — they should include test results for provider staff, for instance — they at least provide measurable data on COVID infection rates in the DDS system.

We hope the administration will begin to provide similar online information on vaccine doses administered in the DDS system so that we can all better understand ongoing COVID trends in that system.

Pandemic relief bill would jeopardize jobs for people with developmental disabilities by eliminating subminimum wages

February 9, 2021 1 comment

President Biden’s $1.9 trillion economic stimulus bill now being negotiated in Congress contains vital economic relief for individuals, businesses, and state and local governments.

But it is also the latest vehicle for continuing efforts to eliminate both subminimum wages and congregate or vocational work centers for persons with disabilities.

In an email we sent yesterday (February 8) to Massachusetts Senator Elizabeth Warren, we noted that the elimination in the COVID pandemic relief bill of subminimum wages would reduce or eliminate employment opportunities for thousands of people with intellectual and developmental disabilities (I/DD) in Massachusetts and other states.

Warren has, in the past, taken a lead role in calling for the elimination of the Section 14(c) wage certificates that allow the payment of subminimum wages to persons with disabilities.

We previously contacted Senator Warren about this issue, hoping she might reverse her position on it. We’re still hoping for such a reversal from Warren and many other members of Congress, but that may be an uphill battle.

Myths about paying subminimum wages

The claim that vocational work centers and 14(c) certificates promote exploitation or segregation of people with I/DD is misinformed. First of all, vocational work centers, which were formerly known as sheltered workshops, have always been a choice available to disabled persons and their families and guardians. No one has been forced to work in those centers in order to support themselves financially.

Our national affiliate, the VOR, notes that the vocational centers and 14(c) certificates “afford workers opportunities to build self-esteem, develop friendships, and engage in their communities.” As the VOR points out, people who work at these centers “do so without fear of being fired or of having to live up to competitive standards of productivity in order to show their worth. Earned wages, though appreciated, are not the substantive reward for these individuals.”

Among the other myths that have led to the movement to eliminate the 14(c) certificates is that paying low wages to people with disabilities will harm their economic potential and will force them to remain reliant on state and federal support.

What that myth overlooks is the reality that people with I/DD have chronic and lifelong disabilities that will not change for them. The fact that they are reliant on state and federal support is not a failure on their part, but rather an indication that for some members of society, public assistance will always be needed.

But whether legislators agree or disagree with the concept of subminimum wages for the disabled, we don’t think emergency economic stimulus legislation is a proper vehicle for that debate. We are asking lawmakers and their staffs to take time to consider this issue before moving ahead with the elimination of these critically important wage certificates and vocational programs.

We are also asking you to call your members of the U.S. House and Senate to urge them to remove the provision in the stimulus bill that would eliminate the 14(c) certificates.

A contact link for your senators and representatives is here. You can copy and paste in this text on the legislators’ website contact forms.

The linked text asks lawmakers to listen to family members and guardians, such as yourself, who know what is best for their loved ones.

Gov’s proposed FY22 DDS budget would boost provider-run group home funding, but cut day program and transportation funding

February 2, 2021 3 comments

UPDATE TO OUR FEB. 2 BLOG POST:

A DDS spokesperson confirmed yesterday (Feb. 3) that cuts proposed in Governor Baker’s Fiscal 2022 budget in DDS community-based day and transportation programs are due to “the ripple effects of COVID-19 restrictions.”

Those COVID restrictions are expected to continue into Fiscal 2022, which starts on July 1, according to DDS spokesman Christopher Klaskin.

Klaskin said the administration has proposed transfer language to reallocate funding to the community-based day and work and transportation accounts if demand for those programs increases.

If so, that’s good news, although it remains to be seen to what degree those allocations would be made.

Klaskin also stated that DDS and its providers “have worked to accelerate” virtual programming such as Zoom sessions “that can supplement and in some cases replace in-person day services.” (my emphasis)

It is concerning to us that even prior to COVID, many day programs were apparently providing little in the way of meaningful work activities to clients. We have frequently heard from families and guardians that their loved ones have been frustrated and bored in their day programs, particularly after the closures of the sheltered workshops.

The problem has been made worse by the pandemic; and the use of remote or virtual communication formats such as Zoom has not been a satisfactory substitute for many clients, according to reports we’ve gotten.

I asked Klaskin in our email exchange this morning if DDS is considering the use of virtual programming to permanently replace some day program activities.

Our original blog post from February 2 is below:

Governor Baker’s proposed Fiscal Year 2022 budget would boost funding to the Department of Developmental Services (DDS) overall; yet the governor is proposing significant cuts in DDS-funded day and transportation programs.

The proposed cuts appear to reflect the impact of the COVID crisis on the day programs, in particular.

As usual, the governor’s budget would provide a huge increase in funding to the corporate provider-based residential system. And as usual, his budget would shortchange state-operated group homes and developmental centers.

Overall, Baker’s proposal would raise the total DDS budget from $2.1 billion to $2.3 billion. Within that DDS budget, the day program line item would be cut by 14.4%, or $34.6 million. The transportation line item would be cut by 40%, or $13 million.

Among the questions we have is whether the administration believes the day programs will only slowly recover clients who were kept out of them due to the pandemic. Will those DDS clients continue to be without day programs over the next year?

At the start of the COVID crisis last March, DDS shut down all day programs. However, as the crisis appeared to be subsiding somewhat, day programs for DDS clients were reopened in late July.  Guardians were nevertheless asked by the administration to sign a release form that would absolve day program providers of legal liability if a client contracted the virus.

Many family members indicated they didn’t want to sign such a form, and an undetermined number of residential providers declined to send residents to the day programs. In mid-August, the administration appeared to backtrack on the release form requirement. DDS Commissioner Jane Ryder said guidance on the form was being revised, but confusion remained over the matter.

In an email query on Monday morning to Ryder, I asked whether the apparent retrenchment in day programs might be permanent.

I also asked what the current number of clients in day programs is, and how that number compares to the pre-COVID period. Also, how many day programs have closed entirely due to the pandemic? We think answers to those questions would be very important for our families in the DDS system to have.

Usual commitment to provider group homes while starving the state-run group homes

Baker’s budget proposes a $121 million, or 9.4% increase in the provider residential line item, bringing total funding under the line item to $1.4 billion. Much of that increase may have actually been implemented in the current fiscal year in the form of emergency funding due to the COVID crisis.

Additional funding also appears to have come from the Chapter 257 reserve fund, which is intended to fund provider residential contracts. The Chapter 257 fund received a huge increase in the current fiscal year — from $41 million last year, to $160 million. That appears to be a one-time infusion. Baker’s FY22 budget would fund the reserve fund at $79 million. That is nevertheless an increase over FY 2020 of $38 million.

As usual, the state-operated group homes would get relatively little in FY22. The state-operated group home line item would be increased by only 1.2%, or $2.7 million, to $240.5 million under Baker’s budget. That may not even be more than the inflation rate. The developmental center line item would, as usual, be cut by about half a million dollars.

The chart below shows the different trajectories of funding approved by the Legislature for both provider-run and state-run group homes, and state-run developmental centers since FY 2012.

As we’ve previously noted, the major increases in funding to the provider-based line item since FY12 have enabled the corporate providers in the DDS system to garner sizeable surplus revenues in the intervening years. Those surpluses have enabled the providers to provide yearly increases in executive salaries, but have not translated into living wages for direct-care workers employed by them.

Also slated for major funding cuts under Baker’s FY22 budget are the DDS autism accounts. The respite and family supports account would be level-funded, which amounts to a cut if adjusted for inflation.

The DDS administration account, which funds service coordinators, would get a modest 1% increase in funding under the governor’s budget, which would not keep up with inflation. However, the Turning 22 program would get a major increase — from $25 million to nearly $80 million.

The governor’s budget would continue a series of increases in recent years to the Disabled Persons Protection Commission (DPPC), which would get a $2 million or 36% increase over the current-year appropriation. The DPPC, which is the state’s only independent agency for investigating abuse and neglect of disabled adults under age 60, remains chronically underfunded.

Unfortunately, as noted, the governor and Legislature continue to maintain an imbalance in funding between provider-run and state-run services in the DDS system. Our immediate concern, however, are the planned cuts in funding to day and transportation programs. We hope to get some answers regarding those programs soon.

Legislative report misses an opportunity on employment of the developmentally disabled

January 26, 2021 1 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 language in the bill was subsequently removed by the Children and Families Committee and replaced with 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.

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