Objective

To determine the extent of implementation of the four recommendations included in our initial audit report, Pandemic Planning and Care for Vulnerable Populations (Report 2021-S-9).

About the Program

The Office for People with Developmental Disabilities (OPWDD) is responsible for coordinating services for individuals with intellectual and developmental disabilities (IDD). People with IDD face significant health issues making them more vulnerable in an emergency. For example, individuals with IDD have a higher prevalence of comorbidities and immune dysfunction; are more susceptible to infectious diseases; and are at greater risk for more severe outcomes (e.g., invasive mechanical ventilation and mortality). OPWDD’s clients largely receive services in congregate settings, posing special infection control challenges. OPWDD provides services directly, through State-operated programs, and through a network of about 425 private non-profit agencies (voluntary agencies). 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 agencies that deliver direct care to people with IDD. One component of OPWDD’s mission is providing a safe environment for all staff, people receiving services, and families served in homes and programs operated and/or certified by OPWDD, including disaster preparedness.

The objectives of the initial audit were to determine whether OPWDD adequately addressed the needs of the vulnerable population it serves in its emergency plans and to determine whether OPWDD took appropriate actions to care for the vulnerable population it serves during the COVID-19 pandemic. The audit covered the period from January 2019 to April 2022. Our initial audit found OPWDD did not provide consistent oversight and guidance to all homes to ensure they were adequately prepared to manage public health emergencies. Specifically, OPWDD developed and issued specific COVID-19 plans to only State-operated Intermediate Care Facilities (ICF), which accounted for less than 1% of OPWDD’s residential clients. The remaining facilities, which collectively accounted for 34,048 clients (99%), were required to create their own emergency plans. Additionally, 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. 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 were largely reactive rather than proactive. Further, COVID-19 reviews did not adequately provide assurance that homes were following OPWDD guidance.

Key Findings

OPWDD has made progress in addressing the problems identified in our initial report; however, improvements are still needed. Of the initial report’s recommendations, all four have been partially implemented.

Key Recommendation

OPWDD officials are requested, but not required, to provide information about any actions planned to address the unresolved issues discussed in this follow-up within 30 days of the report’s issuance.