Objectives

To determine whether the Office for People With Developmental Disabilities (OPWDD) adequately addressed the needs of the vulnerable population it serves in its emergency plans and took appropriate actions to care for this vulnerable population during the COVID-19 pandemic. The audit covered the period from January 2019 to April 2022.

About the Program

OPWDD is responsible for coordinating services for individuals with intellectual and developmental disabilities (IDD) – a lifelong disability that involves functional limitations in the areas of learning, language, and behavior. OPWDD provides these services, which include employment, day services, and housing, directly through State-operated programs and through a network of private non-profit agencies (voluntary agencies). Several residential service options, such as Individualized Residential Alternatives (IRAs) and Intermediate Care Facilities (ICFs), allow clients to live in a community home setting with others and be as independent as possible. As of November 24, 2021, 34,117 clients were living in either an IRA (30,652, or 90%) or an ICF (3,465, or 10%). Voluntary agencies operate the majority of these facilities and are responsible for 83% (28,553) of OPWDD’s total population of community home residents.

OPWDD is responsible for certifying and regulating all residential facilities and providing guidance and best practices to both its own staff at State-operated facilities and voluntary agency staff. One component of OPWDD’s mission is to provide a safe environment for all staff, clients, and families served in homes and programs that it operates and/or certifies, including disaster preparedness. OPWDD’s regulations require certified community residences such as IRAs and ICFs to have written policies or procedures addressing emergencies or disasters and health and safety issues. Further, OPWDD has developed its own Emergency Management Operations Protocol (EMOP), which applies to all OPWDD-operated and/or certified facilities or programs, including OPWDD staff who manage and deliver specialized care. The EMOP includes OPWDD’s overarching policies, authorities, and response organizational structure to ensure an integrated and coordinated local approach to managing emergencies. However, the EMOP does not specifically apply to the emergency management planning and response efforts of voluntary agency-operated facilities; rather, it provides a mechanism for communications between OPWDD and its network of voluntary agencies. As per State and federal regulations, voluntary agencies are responsible for creating their own emergency management programs and plans.

People with IDD have a higher prevalence of comorbidities and immune dysfunction that render them more vulnerable in a public health emergency, such as the COVID-19 crisis, and result in more severe, potentially deadly, outcomes. Further, congregate living poses special challenges to infection control. From March 2020 to April 5, 2022, OPWDD reported a total of 13,079 COVID-19 cases and 657 deaths among clients within its residential programs.

Key Findings

• OPWDD did not provide consistent oversight and guidance to all types of homes to ensure they were adequately prepared to manage public health emergencies. For instance, OPWDD developed and issued specific COVID-19 plans to only State-operated ICFs – eight facilities that accounted for less than 1% of OPWDD’s residential clients. The remaining 6,921 facilities, which collectively account for 34,048 clients (99%), were required to create their own plans – but could have benefited from OPWDD’s expertise. Although we did not establish a causal relationship between OPWDD’s actions and COVID cases, we did find that these homes accounted for the majority of COVID-19 cases and deaths among OPWDD residential clients (12,895 and 649 vs. 33 and four, respectively, for the eight ICFs).
• While OPWDD’s emergency management and overarching emergency planning documents considered pandemics as a risk even before the COVID-19 pandemic, OPWDD did not take proactive steps to ensure that all homes – either State- or voluntary agency-operated – had followed suit in their own emergency plans.
  • Among the 16 homes (seven State- and nine voluntary agency-operated) that we visited, only one had expressly considered pandemics in its emergency plans.
  • Some of the homes updated their plans to address pandemics after the COVID-19 state of emergency was declared; however, many of the plans did not include important aspects of an emergency response, such as staffing strategies, personal protective equipment inventory, and public health protective measures.
• OPWDD took some steps in response to the COVID-19 pandemic to enhance the protection of IDD clients, such as issuing guidance and conducting surveys to ensure compliance; however, its efforts have been largely reactive rather than proactive. Further, there are still improvements that can be made now, before another pandemic or infection control incident, to ensure a stronger response.
  • COVID-19 reviews did not adequately provide assurance that homes were in compliance with OPWDD guidance. Investigators didn’t always use the most current checklist during COVID-19 reviews, creating the risk that a given home is not being held accountable for compliance with critical requirements for proper infection control.
• OPWDD officials were uncooperative with the audit team at the beginning of the audit – questioning OSC’s authority to conduct the audit and rejecting initial data requests. Ultimately, it took several months for OPWDD officials to provide data and access to key personnel to complete our audit tests, including 10 requests over an 8-month period to receive data related to COVID-19 cases and deaths in homes. Although OPWDD’s cooperation subsequently improved, officials were not forthcoming with concerns they had with our preliminary findings – not providing substantive comments during verbal discussions of the audit findings, as well as not responding openly to auditor requests to discuss concerns they had with the findings.

Key Recommendations

• Periodically review and update as necessary the EMOP and supplemental documents to ensure all homes implement current policies and procedures in the event of another public health emergency.
• Develop procedures to ensure facility-level emergency plans encompass planning for and responding to public health emergencies.
• Establish effective communication with individuals responsible for infection control policies and procedures when pertinent deficiencies are identified.
• Ensure monitoring and review protocols address infection control practices, are well developed, and are consistently applied when conducting reviews at homes.