Caretakers at two Arkansas centers for people with disabilities ignored rules about wearing masks, gowns and face shields to slow the coronavirus spread, records show, even after inspectors rebuked the facilities for it several months ago.
During inspections between November and March, regulators cited the state-run Arkadelphia and Conway Human Development Centers three times for the staffs not wearing personal protective equipment while working with residents, according to files obtained under public-records laws.
The inspectors' findings follow similar citations last year at both facilities, as well as related violations at a sister facility in Booneville. Those violations were the focus of a Nov. 1 article in this newspaper. State officials said at the time that such lapses weren't "widespread" in the facilities.
The newly released documents, however, show a pattern of hit-and-miss use of equipment intended to protect residents and staff members from covid-19, even during the pandemic's peak months.
Division of Developmental Disabilities Services Director Melissa Stone acknowledged some issues in a statement last week, but said the staff and administrators worked "extremely hard" to protect clients during the public health emergency.
"Yes, there have been instances in which employees did not wear [protective equipment] correctly as they were trained to do, which can happen when you have about 2,000 [Human Development Center] employees at any one time and a lot of employee turnover," she said.
The centers train workers on the use of equipment at the time of hiring and quarterly, Stone said. Supervisors also model the proper use and "correct improper usage when they see it. All of the [Human Development Centers] have rigorous infection-control procedures that we follow."
Since June, at least 615 clients across five centers (a population of around 850) tested positive for the coronavirus, state statistics show. More than 30 people were hospitalized, and three died.
Disability Rights Arkansas Executive Director Tom Masseau said in a phone interview that the reports of equipment failures raise "serious concerns," especially knowing that some workers declined vaccinations and may not wear masks when they're off-campus.
They "could be carrying whatever, without any regard to the residents," he said.
"At some point, you know, you can't hide behind turnover. What are you doing when you onboard people to get them to understand the importance of [protective equipment and] health and safety of residents?"
"Congregate settings," such as nursing homes, jails and group homes, are high-risk for disease transmission, but facilities like the Human Development Centers were uniquely imperiled as the dangerous virus emerged. Center staff members are in frequent close contact with residents, helping many bathe, eat, dress, use the toilet and more.
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Adding to the risk is that some people with disabilities have concurrent health conditions that make them more likely to become seriously ill or die from covid-19, according to the federal Centers for Disease Control and Prevention. That's particularly true at a special Conway unit for residents who use feeding tubes to eat or are otherwise medically fragile.
Yet in January -- one of Arkansas' deadliest months of the pandemic -- inspectors discovered that more than a dozen workers in seven buildings at the Conway facility either weren't wearing required equipment -- including gowns, goggles or face shields -- or were wearing them incorrectly.
In one building, a staff member who wasn't wearing a mask, face shield or goggles was sitting at a table near a client, an inspector wrote in a report.
"When [the employee] was asked if she was supposed to be wearing a mask and goggles, she stated, 'Yes,'" the report said.
A March revisit found that the facility was "still not" in compliance with health standards, a letter from regulators to the facility's administrator said.
According to a November report, a nursing assistant at Arkadelphia was working without gloves in a building that had been quarantined. The worker wore only a disposable mask, rather than a more-protective N95 or KN95 mask.
"Can we not wear these anymore?" the aide reportedly asked the inspector.
A sign on the door of the building where the employee was working gave instructions that gloves and N95 or KN95 masks were required inside, the inspector wrote.
Rebekah Young, an epidemiology and biostatistics expert who directs the University of Southern Mississippi's Institute for Disability Studies, said mask-wearing is "not about you, individually. It's about you protecting people who are more vulnerable -- and those would be people who live in congregate care settings or residential treatment facilities."
Resistance to the garments is a bit "difficult to comprehend" for that reason, Young said, adding that colleagues in Mississippi report encountering unmasked staff members in treatment centers.
"When you have one person in that facility that is not wearing a mask, you probably have more than just one," she said.
'CONTINUE TRYING'
Over the past eight months, an investigation by the newspaper has revealed recurring problems with care at the Human Development Centers beyond spotty protective equipment use, and the deaths of two residents last year.
In one incident, a 42-year-old resident died after being physically restrained by three Booneville Human Development Center staff members, records show. At a different facility, a 38-year-old resident with Down syndrome choked to death on cake when left "unsupervised" by his caregivers.
Experts on disability issues have said events that hurt residents are common in large institutional settings for people with disabilities. That's one reason many in the field advocate for a shift to home- and community-based care options.
The pandemic, they said, made that need more clear.
While comprehensive data on covid-19's toll in group treatment centers doesn't exist, state-specific research suggests that it's severe. One October study of New York's group homes for people with intellectual disabilities found a covid-19 death rate of four times the rate in the general population.
"A lot of times people are comforted with the out-of-sight, out-of-mind notion of [long-term-care facilities] as opposed to the actual reality of what these places look like, and what's actually happening inside of them," Rebecca Cokley, director of the Disability Justice Initiative at the Center for American Progress, said in a previous interview.
Most Human Development Center clients now are vaccinated. But because vaccines aren't 100% effective and may not work as well against new virus variants, it will be some time before protective measures such as masks can be relaxed in group care settings.
"We need to continue trying to protect them," Young, of the University of Mississippi, said of people who live in such facilities.
Public health experts also point to plateauing or rising case counts across the U.S. in recent weeks that have raised fears of a fourth surge.
In contrast with clients, vaccination rates sputtered among staff members at the Arkansas centers. Fewer than half of workers at the Booneville, Jonesboro and Warren centers are vaccinated, and the vaccination rate for Conway workers has hovered below 35% since late February.
Stone, the division's director, said the vaccine's emergency-use approval from regulators means the state can't require it among center employees. Unvaccinated workers are tested weekly, and workers must continue to wearing masks, despite the recent end of Arkansas' face-covering mandate.
Most clients had covid-19 "earlier on when we were still learning about the illness and how people could carry it asymptomatically. We have only a small number of active cases," Stone wrote in an email.
The Conway Human Development Center saw a dozen new cases among its residents in March, according to the Arkansas Department of Health.