These are kids in group caring facilities, sort of nursing homes for the very physically and often intellectually and emotionally broken kids.
I knew a nurse who used to work in this facility as an LPN; the children there were severely handicapped, physically and usually cognitively. Not emotionally. Children with really bad brain damage or genetic disease, on vents and trachs, needing total care that their families could not provide.
One of her patients died, a little girl on a vent, and she was broken up about it, told me that all the staff were upset. So it isn’t a lack of caring there, unless things have changed in ten years.
It’s possible that the staff had gotten casual about infection control; Medicare/Medicaid had rated them below average. A respiratory infection can progress to pneumonia easily in patients like this; pneumonia may be the most common cause of death for them.