At the end of a June night, after taking the trash to the dump, as he used to do, a young man who lived in a disabled home in Clinton missed his family and decided to start walking home.
The 22-year-old, who lives with autism and other disabilities, has been away at least six times in the past two weeks. But with the facility engulfed in a wave of COVID-19 cases, the two members of the Whitten Center team assigned to their unit did not know this. They were taking care of 14 people, far more than they should have.
In fact, they didn’t notice his absence until 45 minutes later, when the police called to report that the young man had been hit by a car and was recovering at the local hospital.
The SC Department of Disabilities and Special Needs, which runs the Whitten Center and seven other similar locations across the state, says the outbreaks of COVID-19 have been difficult to prevent. Already understaffed, the coronavirus pandemic aggravated a understaffed problem and, at times, caused dangerous conditions for employees and residents.
The total number of cases in the Laurens County area – 230 in employees and residents on Friday morning – is greater than the gross numbers in any nursing home or assisted living facility in South Carolina since the pandemic began, according to with the Department of Health and Environmental Control of SC data.
The state disability agency says they followed the protocol. Regulators disagreed and, during the summer, even threatened to withdraw federal funding, according to state and federal records obtained by the Post and Courier.
While COVID-19 spreads to nursing homes and other centers that care for people for a long time, disability advocates say South Carolina does not have a roadmap to do what would keep people safer: removing them .
South Carolina is one of the few states that has no plan to get people out of group settings 20 years after the United States Supreme Court’s Olmstead ruling ruled that unnecessary institutionalization violates people’s civil rights.
Lack of staff leads to critical problems
Situated in a small town between Greenville and Columbia, the Whitten Center is home to people with some of the most serious disabilities. The 100-year-old operation struggles to find staff to take care of them. Sometimes people unfit for work got jobs there.
In an incident last year, a staff member assaulted a resident in the face, which resulted in criminal charges by the State Law Enforcement Division. On another occasion, in March, an employee took a resident’s arm and covered his nose while administering medication. And in April, an employee hit another with a chair; the battered employee went home and called the police.
The employees responsible for these incidents were fired.
But that did not solve the staffing problems and COVID-19 had not yet arrived.
As was the case across the state, the coronavirus was spreading rapidly in Laurens County and the rest of the state in early July.
On June 26, Whitten’s administrator, Randy Davis, sent a letter to residents’ employees and families. He wrote that it is “possible to overcome these challenges” and said that “our agency has taken proactive steps to respond to COVID-19”. He also berated team members for sharing about the outbreak on their social media pages.
“This is harmful and has no positive purpose,” Davis wrote. The department instituted a $ 3 hourly wage increase for staff working with COVID-19 patients. At that time, 17 people in Whitten’s care were positive.
On June 29, the day a resident was hit by a car, there were 140 cases between employees and residents, and staffing problems worsened. An official told regulators that “they did not think there were enough staff to ensure the safety of customers” that day and that “employees and customers were in a dangerous situation”.
But the outbreak was not made. At the end of July, 30% of residents and 40% of employees had become ill. A spokeswoman for the state disability agency said that despite the high rate of illness, the death rate in the area was low. Eight residents and three employees died.
That said, researchers from the state and federal health departments found that the operation did not follow some COVID-19 guidelines. There were gaps in the health checklists. Team members came to work when they felt bad, exposing the people around them. Inspectors noticed that a person was removed from the room when they took COVID-19, but their dirty sheets and belongings were left behind, posing a risk to a roommate.
The residents were kept together even after someone tested positive for the virus. The disinfectant ran out and employees were instructed to share protective equipment when they were not supposed to.
“Some employees worked 24 hours and still have to go back to the next shift,” warned an unidentified person to investigators. “Workers are exhausted and concerned with the quality of care between the proportion of residents and the lack of rest”.
Inspectors discovered in a walk-through in early July that “there is no backup plan” when personnel levels at the center drop sharply. Promises made to resolve the problem were initially considered insufficient by the Medicare and Medicaid Service Centers, which threatened to stop reimbursing the Whitten Center, unless more substantive changes were made.
The Whitten Center was able to assure regulators that they would improve labor shortages.
The team also claimed – in a TV newscast and in complaints to investigators – that protective equipment was kept locked away from people who needed it, even though the virus was spreading. The state agency disputes this, with agency leaders saying that employees received the appropriate equipment at the right time, and inspectors found no evidence that the allegations were true.
In an interview, associate director of state Rufus Britt pointed out that inspections at other facilities at the agency this year came back with clean reports. Britt said the agency has learned to deal with the virus over the months. And he kept the agency doing the best it could with the available resources.
South Carolina’s disability advocates say it would have been better if people weren’t grouped together in arrangements like the Whitten Center.
A possible solution
In October, disability and legal defense groups appealed to Governor Henry McMaster to remove people from institutions like asylums and the Whitten Center as soon as possible, due to the rapid spread of COVID-19.
Anna Maria Conner, a lawyer for the Protection and Defense of People with Disabilities, said that many people with disabilities have health problems that make them vulnerable to the virus.
“One way to protect these people is to reduce the population in these health centers,” said Conner. “You do this by moving people to less restrictive environments.”
The 1999 Olmstead decision considered violating people’s civil rights to keep them in institutions if they could live with support in their communities. The decision also asked states to develop a roadmap that defined how this change could happen. Across the country, state psychiatric hospitals and other major institutions began to close, driven by government lawsuits.
However, 20 years later and long after most states have agreed, South Carolina is one of less than five states that lack any type of Olmstead Plan and is not working to create one, according to a Post review and Courier.
So, said Conner, his organization along with ACLU, AARP and a coalition of others are pressing the South Carolina government to develop a plan.
Some states, like Florida, have a set of policies distributed by agencies. Michigan has similar fragmentation, but has also eliminated all facilities like the Whitten Center, said a Michigan Disability Rights spokesman.
Sarah Nichols, director of public relations at Able South Carolina, said COVID-19 highlighted the urgent need to create a plan. But the imperative of one was evident long before 2020.
“This is something that has been fermenting for a long time,” said Nichols. “South Carolina really failed in that regard to provide this plan and these services to people in the state.”
Nichols added that the development of an Olmstead Plan could be done at no cost to the state.
Lawsuits by the U.S. Department of Justice, however, can be expensive. While South Carolina has so far escaped a Justice Department lawsuit, other states without a plan have been the target of protracted court battles. Government lawyers began an investigation into North Carolina’s mental health services in 2010, for example, culminating in a 2012 deal that required the state to overhaul its system. North Carolina is now creating an Olmstead Plan.
Not having a plan does not violate federal law, but having one gives states a reinforced legal argument that they have taken steps to support people with disabilities living in their communities.
Britt said that taking people out of group settings “is naturally part of our mission.” The people in the system are constantly evaluated to determine whether they can be moved.
Asked if anything could have been different to prevent the outbreak, Britt said the agency’s focus is on educating its workforce and hiring.
During a committee meeting in mid-July, agency director Mary Poole said of COVID-19, “it is something that all congregated health centers that rely on staff to provide outreach care will face.”
This is certainly true in the SC Disability and Special Needs Department, where four of its six major locations have outbreaks of active COVID-19 – including at the Whitten Center.