Ohio homes for disabled struggle with COVID-19

Intermediate care facilities for people with developmental disabilities rank second in coronavirus cases

By Kelly Krabill

Hartville Meadows, an intermediate care facility in Stark County for people with intellectual and developmental disabilities, 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 and within seven days of exposure, they all tested positive for COVID-19.

“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,” said Roxanne Schnabel, the administrator and director of nursing at Hartville Meadows. “Within three weeks, we had completely isolated it and we were testing completely negative.”

Among residents with intellectual and developmental disabilities, intermediate care facilities rank the second highest 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. The facilities are in the category of a nursing home but host adults with intellectual and developmental disabilities, 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 its facilities.

“At the end of April [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.  

As far as COVID-19 cases in Portage County with people who have intellectual and developmental disabilities, “I think we were the first,” Madden said.

Hartville Meadows and Independence of Portage County, Inc. are among several intermediate care facilities in Ohio with COVID-19 cases. However, the counties rank differently on Ohio Department of Health’s COVID-19 Dashboard.

Stark County ranks the eighth highest for Ohio’s overall COVID-19 positive cases and Portage County ranks twenty-second on the dashboard. Franklin County takes the lead with the highest number of positive cases for Ohio, while Cuyahoga County comes in at second place.

The data is not measured per county for people with intellectual and developmental disabilities, according to the Ohio Association of County Boards of DD, but just like Stark and Portage counties, facilities in Franklin and Cuyahoga counties have had positive cases among residents.

Park West Buildings, an intermediate care facility in Franklin County, has 67 intellectual and developmental disability residents. Twenty-four of the 67 have had COVID-19, which is 36% of the housed individuals. Another facility in Franklin County, I Am Boundless, Inc., has more than 90 residents and around 22 people have tested positive for the virus, which is nearly a fourth of the facility’s population at 24%.

“It just required management to be on site almost 24/7 and just constant follow-up,” said Becky Sharp, the executive director at Park West Buildings. “We ended up streamlining and having a COVID hotline, …[and] we quickly learned that we needed one line to report testing [and to] report symptoms.”

While Franklin County’s COVID-19 cases were heightened among people with intellectual and developmental disabilities who lived in intermediate care facilities, Cuyahoga County was seeing an increase with hospitalizations at some facilities.

Cuyahoga County’s intermediate care facility, Koinonia Homes, had 12 hospitalizations out of 18 cases, which is 67%. Another Cuyahoga County facility, Northeast Care Center, was at 60% of hospitalizations, with almost 6 out of 10 cases.

“We had people that were very, very sick and in respiratory failure and went on ventilators,” said Jeanne Greene, the chief clinical and program officer at Koinonia Homes.

Cuyahoga County ranks the highest in hospitalizations for Ohio’s overall population, according to the Ohio Department of Health’s COVID-19 dashboard.

Intermediate care facilities have been following the Centers for Disease Control and Prevention guidelines and the Ohio Department of Developmental Disabilities guidance. Some facilities had to implement the emergency plan sooner than others.

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?”

During her two-hour drive home, she “started contemplating on ‘OK, what are we going to do,’” she said.

Independence of Portage County, Inc. put together a crisis team between its nursing department and 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.

Once the first resident tested 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.

Northeast Care Center also had its first COVID-19 case around April 2020 in one of the intermediate care facility homes where eight clients live.

“The Department of Health came in and tested everybody in that home,” said Jesse Malave, the executive director at Northeast Care Center. “[They tested] all the staff, everybody that had contact with that home [and] all the clients. They did all the testing, and then we found out that we had two other individuals that tested positive and a few of the staff.”

Koinonia Homes has 19 intermediate care facilities in Cuyahoga County and had its first COVID-19 case in April 2020. The virus infected home was put on quarantine, and only certain employees could go in and out of the building.

Park West Buildings set up an isolation unit in a separate building at the end of March. It took 13 weeks before the provider received N95 masks and many clients needed oxygen, but there was a shortage. The individuals were sent to the hospital when the facility could not provide oxygen.

“We were told that we were the fourth in line of priority,” Sharp said. The hospital system, EMS, long-term care, then we were at the bottom of the list. Our field needs to obviously have some more emergency preparedness in place. I think that’s the biggest lesson that we learned as far as the efficiency of getting supplies. We should be on a priority list if we’re providing direct service.”

Some providers had new cases throughout the summer, but others experienced many during the holidays.

A resident living at Park West Buildings visited their mother in December.

“They tested negative when they left and came back, and then they started [exhibiting] symptoms like two days later,” Sharp said.

The client tested positive for COVID-19 after returning home, and 16 people ended up testing positive in the home.

“All I could think of was not only have I let them down,” Sharp said. “This individual going out, who persisted, but I also am now ruining their holidays.”

When Hartville Meadows’ residents began testing positive for COVID-19 in January 2021, staff moved everything out of the activity room and isolated the clients who had the coronavirus. Once all 17 residents tested positive for the virus, 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, Schnabel said.

As staff 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.

“We had this medical regime set up that depending on their symptoms, they got this group of treatment,” she said.

Some residents at Park West Buildings have developed new health conditions after having COVID-19.

Diabetes, delirium and “episodes of being unresponsive,” Sharp said. “That’s been a new one for us, and it’s been three particular individuals.”

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.

Two residents from Koinonia Homes were on ventilators at the hospital, while Northeast Care Center had one person and Park West Buildings had four. All three providers said one of the clients died while on a ventilator.

Hartville Meadows reported a death as well, but the resident was already receiving hospice services.

Hartville Meadows last COVID-19 case was Jan. 19, 2021, but “it’s still not normal”, Schnabel said.

“About half [of the residents] are much more medically fragile that we are very protected of, that have not had COVID,” she said. “They only had the vaccine. They do not leave the building during the day, but they do go down into the activity room, and we have day programming for them. The other side, 18 [residents], go to various day programs that we have.”