Intermediate care facilities rank second highest in Ohio for COVID-19 cases among developmental disability individuals

Hartville Meadows, an intermediate care facility in Stark County where individuals with developmental disabilities live, went 10 months before any residents tested positive for COVID-19. After a staff member came to work sick on New Year’s Eve and tested positive for the virus the next day, 17 clients were exposed.

“[The staff member] worked in two sections so they had exposed 17 clients. And over the next week, all 17 got COVID,” said Roxanne Schnabel, the administrator and director of nursing at Hartville Meadows.

Intermediate care facilities rank the second highest among residents with developmental disabilities at 27% to have contracted the virus, while congregate settings rank the highest at 38%, according to the Ohio Association of County Boards of DD.

Intermediate care facilities are defined as at least four people living together, with shared bedrooms and on-site staffing 24 hours a day, including nursing care. A congregate setting is defined by the Ohio Department of Health as an intermediate care facility or other licensed developmental disability facilities, such as a group home that provides nursing care, according to the Ohio Department of Developmental Disabilities website.

Hartville Meadows consists of four sections that totals 32 residents. The east side of the building has more medically fragile clients and the west side of the building contains more stable residents, where the virus was active.

Independence of Portage County Inc. also had residents test positive for the virus at one of their intermediate care facilities.

“At the end of April [in 2020] we had a client test COVID positive after going to the hospital and we [ended up having] three individuals out of a six bed ICF test positive,” said Michelle Madden, the chief executive officer at Independence of Portage County Inc.  

The provider serves more than 100 residents with developmental disabilities across six intermediate care facilities and 15 supported living homes such as a congregate setting environment with roommates.

They had the county’s first COVID-19 case for individuals with developmental disabilities, Madden said.

Hartville Meadows and Independence of Portage County Inc. put together a surge plan before their residents began testing positive for the virus.

Last March, after Madden was appointed as the new CEO of Independence of Portage County Inc., she was sitting in a policy meeting for Ohio Provider Resource Association in Columbus where her colleagues were talking about the coronavirus.

“Sitting there with people a lot smarter than me and had been in the industry and they were talking about this coronavirus and ‘What are we going to do?’ Nobody knew what to do,” Madden said. “How am I going to keep people safe [and] alive with something I don’t even know anything about.”

While driving home from Columbus she contemplated on what to do, she said.

Independence of Portage County Inc. put together a crisis team between their nursing department and their leadership team. They closed two intermediate care facilities in order to conserve staff and moved at least six individuals into other intermediate care facilities that had openings. They began distributing personal protective equipment to staff members and residents from their supply area, which they called “war chests.”

While Hartville Meadows had more time to prepare, Schnabel held monthly staff meetings to educate her employees on the protocol if residents tested positive. Staff also used picture cards to help explain mask wearing and hand washing to the clients.

When Independence of Portage County Inc. had their first resident test positive for the virus, Madden called all of the employees to discuss the next plan of action. Staff members deep-cleaned the rooms where COVID was active and placed the residents in a separate quarantine room for 14 days after returning home from the hospital. When placed under the crisis protocol, staff was also paid a higher rate than normal, which Madden calls a “thank you pay.”

Once the residents began testing positive for the virus at Hartville Meadows, staff moved everything out of the activity room and isolated the clients who had the coronavirus. Within seven days all 17 residents had COVID, and Schnabel and her team sealed off that side of the building with plastic dividers and created separate entrances for employees. Eight staff members ended up testing positive for the virus, but a few of the cases were not related to Hartville Meadows exposure.

As the providers began taking care of residents who had COVID-19, they monitored their symptoms.

There were two kinds of symptoms at Hartville Meadows, Schnabel said. The residents either had coughing and severe fatigue or vomiting and diarrhea.

Two residents could not stop vomiting and went to the emergency room to get treated for dehydration. Another resident who was already receiving hospice services died after getting the virus.

When the three residents tested positive for the virus at Independence of Portage County Inc., two of the clients were put on ventilators, but they recovered in the hospital and returned home within 30 days. The third client had minimal symptoms.

Staff at Hartville Meadows thought a male resident had a heart attack on the ninth day of the virus. Schnabel stayed up with him throughout the night to flood his lungs with oxygen because his family didn’t want him to go to the hospital. An electrocardiogram later confirmed the heart attack.

“Day five and day 10 were the worse. …I researched this, and I knew that I had to really watch them on day five and day 10 of the disease and it was absolutely true, that’s when they got the sickest,” Schnabel said.

Residents who tested positive for the virus at both facilities averaged between the ages of 50 to 60 years old. Independence of Portage County Inc.’s youngest resident to test positive was 25 and the oldest was 78. Along with the average ages, Hartville Meadows also had many residents who were in their 20s.

While individuals with developmental disabilities between the ages of 51 to 60 rank the highest in Ohio for positive COVID-19 cases at 20%, according to the Ohio Association of County Boards of DD, the ages between 50 to 59 ranks third for Ohio’s overall COVID-19 positive cases, according to the Ohio Department of Health’s COVID-19 dashboard.

We should have lost more individuals according to research, but we are the abnormal congregate setting, Schnabel said.

“My assistant director and I worked 12 hours shifts, … seven days a week for three weeks because we didn’t want the nurses to cross over into the COVID unit and then go back to the other side, so we stayed in a hotel here in Hartville and it was insanity, …but neither one of us got COVID,” Schnabel said. “Within three weeks, we had completely isolated it and we were testing completely negative.”

Hartville Meadows last COVID-19 case was Jan. 19, 2021.

Independence of Portage County Inc.’s next positive case was August of 2020 and they have had under 10 cases total.