Pull Out the Christmas Lights and Create a Dance Studio: Direct Care and Residential Programs During a Global Pandemic

REM Ohio provides an array of supports and services for adults with intellectual and developmental disabilities, most of which involve direct, face-to-face, hands-on, and physical proximity. So how do these services continue in the era of social distancing? We discuss with Buffie LaBelle, regional director for the East region of the state, and Heather Reynolds, a program supervisor.

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SIMON BUEHRER: Welcome to Inspiring Change from OCALI, our forum of stories and connections from our ongoing work of inspiring change and promoting access for people with disabilities. I'm Simon Buehrer. Many adults with intellectual and developmental disabilities receive support from direct care professionals through different types of day and residential programs. These services can range from assistance with life skills, such as cooking or housekeeping, social skills development, recreational activities, transportation and community outings, job training and placement, and much more. The best of these programs and services provide personalized, customized, and flexible supports in order to meet the individual needs and unique interests of the adults served, and which actively engage and involve them in planning, selecting, and then actually doing the activities. 

The key to delivering many of these services is this notion of direct support, which almost always involves face-to-face, hands-on, physical proximity, and even contact between the adult and the direct support professionals. So how exactly does this work in the era of social distancing? Here in Ohio, Governor Mike DeWine, and Ohio Department of Health Director Dr. Amy Acton recognized the important work of direct support professionals, as providing essential activities that should continue during the state's stay-at-home order. 

However, just like the majority of workers, trying to figure out and negotiate these new dynamics, the work and activities of direct support professionals was also directly affected, and required some adjustments and changes. We wanted to know more about how a provider agency was dealing with and adapting to these changes and continuing to deliver services during a worldwide pandemic. 

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REM Ohio is an agency that provides a variety of services and supports for people with both intellectual and developmental disabilities all across Ohio. They provide day programs, intermediate care facilities, in-home personal care services, and more. They're also part of The Mentor Network, a national alliance of providers focused on community based services in more than 30 states across the country so there's a local focus and a national connection to their work. 

Buffie LaBelle is a regional director at REM Ohio. And Heather Reynolds is the program supervisor. Their office is located in Akron, and they serve over 200 people in the eastern region of the state, mostly in Summit County. Buffie, could we maybe just start with you? Can you just give us-- for people who don't know about REM Ohio, can you just give a brief description of what your agency does and who you serve? 

BUFFIE LABELLE: Sure. We provide a variety of supports to folks with developmental disability, mostly adults, so folks over 18, who do HBC or homemaker personal care services, both drop-in support in family homes, but also in residential settings, group homes. [INAUDIBLE] and we also have some day program services for folks with developmental disabilities. And there are some homes and a couple of day programs specifically for folks with autism. 

SIMON BUEHRER: What did your services look like prior to COVID-19, the services and supports that you provide for the adults and the people that you work with? 

HEATHER REYNOLDS: Well, our services in the day centers, we have a lot of activities going on, both within the centers and out in the community, with that, some of that being supported employment, some of it being just social, going to the zoo, library, spending time there with some of the different activities. The libraries offer part, going to movies, also working with folks within the center. 

We have a yoga instructor that comes in. And then we also have music therapy that comes in. And those are those once-a-week things. There's also an art teacher that comes to one of our centers. And we kind of-- not only do we go out into the community with folks, but we'll go to each other's centers to participate in some of those things. 

Parties, birthday parties, parties centered around holidays. And also, working with folks to increase their independence and self-care as well as care for their environment. So a lot of that has been multiple environments, even though it's provided by the day program staff. 

SIMON BUEHRER: Yeah, so a really vibrant and very active series of outings and activities. Probably a lot of those have been severely impacted by what's been happening the last few weeks or so, I would imagine. 

BUFFIE LABELLE: Very much so. 

HEATHER REYNOLDS: Absolutely. 

BUFFIE LABELLE: Even before the stay-at-home order went in full effect, we were limiting outings in the community, keeping folks in the center, trying to keep up socially distant from each other at the center. And that led us into the stay-at-home order, where then the center closed down. So it's been very challenging for folks. 

SIMON BUEHRER: Yeah, OK. I see. So you were already moving in that direction before the stay-at-home order was announced. When did you start that? 

BUFFIE LABELLE: Probably about two weeks before the stay-at home order. yes. So we were starting to limit things, just in an attempt to keep everyone safe and healthy. And then our center's last day was March 20th, which was the Friday before the stay-at-home order actually came out. At that point, we'd had a number of folks throughout our center who were already self-quarantining and not coming in. So attendance was pretty low by that point anyway. 

SIMON BUEHRER: Was it really? Yeah. Yeah, so moving in that direction anyway. 

BUFFIE LABELLE: Sure. 

SIMON BUEHRER: Yeah. Good could each of you talk about your thoughts and your emotional reaction in those early days when it became clear what was happening and the impact that it was going to have, both on the people that you serve as well as your co-workers and employees of REM Ohio. 

HEATHER REYNOLDS: I think, for me, my reaction was more, OK, so services are going to look different. And who is going to need what? How can we help people? And when I say that, I don't just mean the folks that we provide services to, but my co-workers, and my supervisors, and the staff that I am responsible to lead. I was like, OK, this is going to be different. And we know it is. So how can we support each other? 

When we talked about our last day to be that Friday, the conversations, and I have to really give kudos to the staff that I work with that it was, OK, so we're going to be working with folks from our homes. What can we take from the center to those home to keep activities going? What kind of stuff is here? Who's home am I going to be working in? What are some of their favorite things? Let's take that to that person's home. And that way we can continue some kind of continuity, some kind of familiarity with what already happened during the day on those days. 

So I'm definitely nervous and just worried about-- it's hard to see people that you don't know become ill, but worry about the ones that you do know. 

BUFFIE LABELLE: So, for me, I think my emotional reaction has been over the place. I try to be calm and the voice of reason for the folks that I support and lead. But I mean this has been very challenging. We all worry about we need to keep our individuals healthy. We need to keep our staff healthy. So that's what drives us and gets us through it. 

Like Heather, I've been very impressed with the staff's resilience and ability to carry things on and keep things moving in just a different way of doing things. And then there's always the fear of we're not going to have any staff to work. Everyone's going to be sick. But thus far, everyone's been pretty healthy, and doing what they need to do to stay healthy, both to themselves, and to [INAUDIBLE] are concentrating on making sure they're not bringing things into the houses. So it's all we can do at this point. 

SIMON BUEHRER: And so talk to me a little bit about that. What changes have you made to ensure both the safety of your staff members, as well as those they're working with? 

BUFFIE LABELLE: So they're checking their temperature to make sure they don't have a fever when they come in, and they're wearing their PPE. They're working on just trying to work with our individuals on social distancing, which is challenging with some [LAUGHTER]. Personal space isn't really big on some of their lists. But we try. 

SIMON BUEHRER: Yeah. It's a hard thing for a lot of us, I think, to figure out and to work through. And it's definitely a new social dynamic that we're all trying to figure out. I was going to ask, Buffie, do you have enough supplies, equipment to support your staff? 

BUFFIE LABELLE: I would say at this point, yes. We are-- because we're part of The Mentor Network, that's our parent company. And they have been able to secure masks that it took some time to get them in the quantity that we need. But we now have those in the houses for staff to be making sure they're wearing a mask all the time when they're working instead of just if somebody's sick. So Yeah. Right at this moment, we're set pretty good. But it's a worry. 

SIMON BUEHRER: Yeah, sure. Sure. 

BUFFIE LABELLE: The sizes are slow to come when you do place an order, So trying to think of in advance to make sure we have what we need is a challenge. 

SIMON BUEHRER: Yeah, yeah, definitely. Can we go back to talking about a few more examples of maybe the impact on some of your programs and services, and some of the changes that are adaptations that you've had to make? 

BUFFIE LABELLE: Sure. One of the changes is having restricted visitations in group homes. And that's been challenging for a number of families who like to come over frequently. We've done a lot early on just doing a screening forum. But as things have progressed, and we've worked our way through this curve, we've reached a point where we cut off visitation altogether. But we tried to do as much as we can virtually with phone calls, and Skype, and anything else we can do to support continued contact with their loved ones. 

SIMON BUEHRER: So do you help set those up with the families, the Skype calls, and coordinate those? 

BUFFIE LABELLE: Right. 

SIMON BUEHRER: Yeah. Yeah, that's great. No. That was going to be my next question, if there were any, anything that you had done using technology or providing any kind of virtual support, either directly or with families? 

BUFFIE LABELLE: The other thing that we're doing is we have a virtual calendar that we put together, like an activity calendar that we've sent out to all the houses so that staff working can have some other things that they can do at the house. So all the houses have a Chromebook. So they can click on a link to go tour a museum, or any of those type of things that we find. 

And our music therapist, the Groovy Garfoose Company, they sent us links to the music therapy videos. So every week, we send those out to the houses so that everyone, whether they attend our day center or another center, everyone in our home is able to benefit from those videos as well. 

SIMON BUEHRER: Oh, that's great. Yeah, so it takes the place of some of those activities or outings that otherwise, people were enjoying. Yeah. 

BUFFIE LABELLE: Yeah. And they're short, short, little videos. But it helps break up the day. 

SIMON BUEHRER: Yeah, break up the monotony of the day. Yeah, absolutely. 

BUFFIE LABELLE: Right, we've done-- we've done gift bags, or treat bags when we put different activities together for the houses, word searches, adult coloring books, sidewalk chalk, all that, and deliver that to all the houses, just before Easter. 

SIMON BUEHRER: Yeah. Can you talk a little bit about any of the challenges that you had in the folks that you work with in explaining to them what was happening and trying to help navigate the changes in schedule or the inability to go out anymore? Like how has that been? 

BUFFIE LABELLE: Yeah. Heather, you want to start with that? 

HEATHER REYNOLDS: It was initially pretty rough. It's still a little bit bumpy from day to day. We created-- we basically worked with the Summit County SLP. She sent out some communication boards for some folks that that's the best form of communication with them to walk through what was happening. And then also-- 

SIMON BUEHRER: I'm sorry, Heather. You said the Summit County, the speech language pathologist? 

HEATHER REYNOLDS: Yes. She had it early on when this was-- knew it was coming. She had sent some things out to help us communicate that. And then basically, prior to us shutting down, at least in my center with the folks that we work with here, tried to have those conversations based on their communication. It's like a vacation. It's spring break type thing. 

And we will see each other again. But we're gonna take a break for a while. And then working, and then being assigned to the home, and working with folks in their homes, once it did get started, reassuring, and talking about to the level that they wanted to talk about it, what's happening, why is it happening, and what can we do in the meantime. The center-- now, some of the folks have understood it, been frustrated with it, and others, we have to on a daily basis remind that no, 

we don't go to the day center today, but we can but we set up a routine for them that is based on day programming type things. So that there at least is that kind of difference between their daytime and their evening. It doesn't all just clump together. Try to separate it a little bit. 

SIMON BUEHRER: Yeah. I think we could all, all of us use those lines of distinction because it's challenging when you're in the same spot all the time to know what the difference is between home life, and activity life, or employment life, or education life. When it's all in one spot, it's hard. 

BUFFIE LABELLE: And it's not just that they're day program's closed. McDonald's is closed, the library is closed. You're not taking folks to the store. So everything's closed. And that's really hard for folks to understand, and cope with, and deal with. 

SIMON BUEHRER: Yeah, I'm sure. Yeah. 

BUFFIE LABELLE: We encourage folks to maybe go for a ride, some limited go through a drive-through here or there to get a treat. And then we've said this. They can go to parks, as long as they're not crowded, or just like the gentleman that Heather works with, likes to just go for a walk in his neighborhood. And that's been doable. So yeah. Well, just even a little physical activity, even if it's in the houses, is really important, I think, for all of us-- so trying to encourage that where we can as well. 

HEATHER REYNOLDS: And using some of those extra spaces, sometimes when you're in a house, maybe you don't go to the basement very often, but it's quite a large basement, or you've got the rooms upstairs that don't get used as much. You repurpose those spaces to be a yoga studio, or a movie theater, or you get creative so that you're not staying in the same four rooms for the time that you're in the house. And if the weather ever does break, we can get creative in the backyards or on the porches. 

SIMON BUEHRER: Yeah. Yeah. But that's great too, to use that creativity and that innovation with what you already have, and rethinking the use of the space that you have. 

HEATHER REYNOLDS: Yeah. Pull out the Christmas lights and create a dance studio. 

SIMON BUEHRER: I love it. What about-- we touched on it briefly, but what has been conversations, interactions, that you've had with the families. You mentioned helping to coordinate some Skype or some virtual visits. Are there any-- anything else that-- any other interactions, or things that you're doing with families to help them also go through what we're all going through? 

HEATHER REYNOLDS: Some of the folks that we provide services to at the day program, but we don't provide any essential services too-- so they're with their families-- is just reaching out and talking to them. Hi. How are you? And keeping that relationship going. And then seeing if there's anything we can do to help them. Buffie encouraged all of us to think outside the box. And so just-- there's one gentleman that we work with. 

He absolutely loves Play-dough. So we're going to drop some Play-dough off to his house. He may be stuck at home, but maybe some Play-dough might keep him busy for a couple of days and make him happy. So just in addition to making sure that the folks that we provide services to residentially, that we're also thinking about the ones that we only see during the day. And so how can we keep that relationship going. 

BUFFIE LABELLE: In residential, you think that's a case-by-case basis. For the most part, families have been very understanding of what's going on. Thankful that we've taken the precautions that we are. But worried and scared-- and want to make sure that the individuals are safe, and happy, and don't feel that they've been abandoned by their family. So we try to work through each thing, each situation individually to see how we can make that work for them. 

SIMON BUEHRER: And has-- I understand that DODD has allowed some flexibility in the rules right now regarding services and environments. Has that had any-- impact on what you've been able to do, or how you've been able to do it? 

BUFFIE LABELLE: Well, and we were able to offer one of the folks, who lives with their family that attend our day program the opportunity to come to one of the houses. There in the beginning before we shut down. So his parents could continue to work because they're both essential employees. And I think that that, they were appreciative of that. They never took us up on that opportunity. 

They're sheltering him in place, which is fine. But we're constantly looking for ways that we can support folks. I think what's probably helped the most for us has been some of the flexibility with the hiring and onboarding process, so we can get folks started a little faster because we're still hiring. We were in a staffing crunch before this and this hasn't helped any. 

SIMON BUEHRER: And what positions are you hiring? 

BUFFIE LABELLE: Mostly, direct support positions, although we have a program director position open and a program supervisor position as well. 

SIMON BUEHRER: Wow. So in the midst of all these, so many people with losing their jobs and stuff, that's a bright spot to hear that there are positions available. 

BUFFIE LABELLE: Right. And I think another bright spot is that we've been able to-- we've been trying to use the technology more in our hiring and training process so this has kind of forced that issue. So our trainer, the guy who does most of our training is kind of immunocompromised, due to some medical issues. But he's still working. He's just doing his training from home and using technology to make that happen. So those types of things have pushed the envelope that we haven't had to deal with in the past. 

SIMON BUEHRER: As long as we're talking about staff, I wanted to ask, is there anything extra that you're doing there at REM Ohio to support staff members with their physical or even their mental well being? 

BUFFIE LABELLE: We've done things like ordering pizza nights for all of the different houses so staff didn't have to cook. The Mentor Network has been great, apart from sending out daily emails from different departments on things that they're doing to support us, things like our employee assistance program, things like just resources for some mental health counseling. The network has put together a program that staff are struggling financially because of COVID, or even one of the houses, the individuals that who are in a community-based home. They're struggling with groceries of something. We have a grant program that can help provide some financial relief that way as well. 

HEATHER REYNOLDS: And even saying that too, that, the informal stuff, we have some really great supervisors here, and they really listen when we speak. Even if it's just a little pick me up, little pat on the back, or just a little motivation, and just working together and bouncing ideas off of each other. Those-- I think that would truthfully fall under that as well. It's not some of those informal things, I think are, are just as important, if not more important at times, and should really be mentioned. 

SIMON BUEHRER: Yeah, absolutely. And those ways of affirming, and just letting people know that what they do is valuable, and that there is this support system behind them, and, really, that we're all in this together, right? 

HEATHER REYNOLDS: Yeah, absolutely. 

SIMON BUEHRER: Buffie, you mentioned it a couple of times. But could you just explain what The Mentor Network is? 

BUFFIE LABELLE: Sure. The Mentor Network is our parent organization. So the mentor network is a nationwide organization of health care providers. So REM Ohio is part of The Mentor Network. Ohio Mentoring is our kids foster care program. They're part of The Mentor Network. And we have rehab services, TBI services, neuro restorative services. There's all kinds of different programs that operate under The Mentor Network umbrella. 

SIMON BUEHRER: Gotcha. And that's the national umbrella organization for-- so most of the members are similar to you, but located in other states. 

BUFFIE LABELLE: Right. There's some that do DD services, and some that don't have anything to do with DD. But they may be focused on aging or neurorestorative care, that type of thing. 

SIMON BUEHRER: Yeah. So it's a wide range of services and populations. 

BUFFIE LABELLE: Absolutely. 

SIMON BUEHRER: Gotcha. 

BUFFIE LABELLE: And they work really hard to make sure we all have what we need, PPE-wise and support-wise to get through this. 

SIMON BUEHRER: That alone makes it sound like a really valuable national partnership. What about some of your local partnerships and alliances? 

BUFFIE LABELLE: What I have been impressed with is just in this area, in Summit County here, just how everyone with a stake in the game is really trying to work collaboratively. Summit County Board of DD, today, is even having a donation drive collecting things from the community that could be used in the house and things, like PPEs and cleaning supplies, and even activity type of supplies and that type of stuff. 

And Summit County is the biggest county that I work in. But most of the counties are doing very similar types of things. We've got county boards going in, and bringing food into different houses to help relieve staff. There's just story after story of more collaboration than I've seen in a long time. Our provider trade association OPRA and and those type of organizations are working very hard to help impact funding, but also to help just with getting supplies that are needed, and use it to look at group buying power to help make sure folks can get what they need. So everybody has really been working really well together. 

SIMON BUEHRER: That's great. That's really great. This is going to require long term sustained collaboration and partnerships. That's the mantra that we keep seeing everywhere, right? We're in this together. And what about-- are there activities or practices that are occurring now that you think you'll continue going forward? 

BUFFIE LABELLE: Well, I think we've dabbled more into virtual stuff than we have in the past. And I see that continuing well beyond this crisis because it is very helpful. And I think it's helped everybody realize that even under, quote, "normal circumstances" we can do a lot more virtually, just to offer more experiences and support for folks. 

SIMON BUEHRER: Buffie, I know REM Ohio also offers supports and coaching and assistance with placement for job seekers. How have those services been impacted by the shutdown? 

BUFFIE LABELLE: We have a very small employment services program here in Summit County. Well, REM does. But I talked to our supervisor today, Barry. And he just helped somebody get hired at Sam's Club. He said the retail stores, cleaning jobs anything in a hospital, they're all still hiring. So he has been able to help folks get some jobs, or get some hours increased even that way. 

Some folks, of course, have lost jobs, or been furloughed, or laid off. But there is opportunity that they're willing to look at in a different area. And that's kind of the rub, because people are scared. The individuals themselves, I don't know to work at Walmart, or-- there's too many people there. And their family members too are worried about that, so which is the same fears all of us have about going to the store or anything else. 

So it's a delicate balance. Another bright spot that I haven't really talked about is our Ohio Shared Living Program. We have a pretty big vibrant adult foster care program here in Ohio. And with these programs being closed and the shelter in place, our mentors have done an outstanding job. With their individual home 24/7. Keeping folks busy, engaged, and getting through this crisis. And that has definitely been a bright spot. 

SIMON BUEHRER: Can you can you explain that Ohio Shared Living Program a little bit, Buffie for people who may not be familiar with it? 

BUFFIE LABELLE: Absolutely. It's a base-- it's an adult foster care program. So folks with developmental disabilities that are looking for a place to live, and they move into a home with a mentor, is what we call them, and their family-- So they have their own bedroom. They participate in all the activities that the family participates in, and just become part of that family unit. It's a very nice service, and works well for many of our individuals. 

SIMON BUEHRER: That's great. That's great. That's really great. One thing that I did want to ask both of you we're calling this series of podcasts that we're doing "Voices, Visions, and Victories. And so I'm particularly interested to hear from each of you. What would you say is your victory right now? 

BUFFIE LABELLE: I think our biggest victory right now from my standpoint is that everyone's healthy and doing pretty well. our incident reports are much lower than even normal, which is not what I expected would happen going into this. So folks are doing well, which tells me that staff are keeping folks engaged, and busy, and doing a good job working through this with individuals. 

HEATHER REYNOLDS: And I guess I would say that I would look at it as a victory when the amount of pictures that I'm getting from the staff that have gone to these different homes to work, and I see the things that they've been doing, and the smiles on folks' faces, the smiles on staff faces, seeing people not just step up and do as expected, but to just put everything into it, and do more than is expected. 

When calloffs, and people being willing to step up and cover those shifts, and continue to be positive about it, I think that's just really awesome to see. Positive energy that's coming out of a very negative situation I think is a victory. 

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SIMON BUEHRER: You're listening to Inspiring Change from OCALI, our forum of stories and connections from our ongoing work of inspiring change and promoting access for people with disabilities. I'm your host and producer Simon Buehrer. I've been talking with Buffie Labelle and Heather Reynolds of REM Ohio, an agency that provides an array of services and supports for people with intellectual and developmental disabilities. 

Buffie and Heather serve the eastern region of Ohio, primarily in Summit County. But, as was mentioned, REM Ohio has locations throughout the state, and is also a partner in The Mentor Network, a national alliance of providers and agencies committed to offering high quality community-based services in over 30 states. You can learn more about REM Ohio's programs and services at rem-oh.com. that's R-E-M dash O-H dot com. 

Be sure to subscribe to Inspiring Change wherever you get your podcasts. And if you or someone you know needs an accessible version of this podcast, go to OCALI podcasts, and click on the link to Inspiring Change. While you're there, you can also visit our sister program, From My Perspective, produced by our friends and colleagues in the family and Community Outreach Center here at OCALI. 

Thanks again for listening, because the need for change is everywhere, and inspiration can come from anywhere. I'm Simon Buehrer. See you soon.