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Guidance: COVID-19 Prevention for Waiver Providers of Multiple Residents in a Single Home

The following procedures are recommendations from the Ohio Department of Health (ODH) and the Ohio Department of Developmental Disabilities (DODD) to prevent the spread of coronavirus (COVID-19) in residential waiver settings.

DODD recognizes that the following situational actions may seem excessive or unattainable due to the lack of personal protective equipment (PPE), residential space, the number of direct support professionals (DSP) or residential waiver settings that do not serve elderly or medically compromised people.

However, the following is intended to serve as a guide and is highly recommended to protect the people who the department serves and those caring for them.

All DSPs entering the residential waiver setting should be screened for symptoms using the Entry Screening Process for Prevention of COVID-19 Transmission tool. Staff performing health check screenings should wear facemasks.

DSPs with symptoms or with temperatures greater than 100.0 degrees Fahrenheit should be sent home, and DSPs who develop symptoms or fever while in the residential waiver setting should immediately go home (not to the urgent care or emergency room unless severely ill). 

Advise people who screen positive to contact their primary care physician by phone or telehealth. The HCP will determine whether the person needs to be evaluated in-person and will make a referral for evaluation and treatment, as necessary.  

If there are suspected cases of COVID-19 in a residential waiver setting

People suspected of infection with COVID-19 should be given a facemask to wear, and the provider should contact the person’s doctor to determine evaluation and treatment needs. The most recent guidance is that only severely ill patients should be tested for COVID-19. And if severely ill, they should be sent to the hospital (call ahead before transporting).

The person must be isolated in a separate room with the door closed. DSPs supporting the person, if and until they are transferred, should wear gowns, gloves, eye protection (goggles or a face shield), and facemasks, and they should maintain social distancing of at least six feet from the person, except for brief, necessary interactions.

Residential waiver settings should bundle care and minimize the number of DSPs and other staff who enter the room to reduce the number of personnel requiring facemasks. 

If there are confirmed cases of COVID-19 in a residential waiver setting

Notify your local health department and the Ohio Department of Health (ODH), if not already involved, and notify your county board of developmental disabilities. Individuals diagnosed with COVID-19 should be isolated per Centers for Disease Control and Prevention (CDC) guidance. 

The local health department will determine the risk level of exposure and requirements for quarantine or monitoring of non-ill people. 

Residential waiver settings should actively monitor all people, once per shift. This monitoring must include a symptom check and vital signs.

Based upon risk determined by the local health department, some or all people may be quarantined. Cancel group activities and communal dining. Offer other activities for people in their rooms to the extent possible, such as video calls. 

Do not float DSPs between residential waiver settings. People diagnosed with COVID-19 with dedicated DSPs and other direct care providers. Minimize the number of HCP and other direct care providers entering rooms. 

People with COVID-19 who are isolated should have their own bathroom when possible.

If shared bathrooms are used for non-ill people, frequent cleaning with EPA-approved disinfectants should occur. 

People who have been identified as contacts of another person with COVID-19 should be tested in the event they develop fever or respiratory symptoms.

For Access to the Community

In areas of high concentrations of positive COVID-19 cases, people should remain at home. If people access the community, and community transmission is recognized in the area where the residential waiver setting is located, the provider must have staff available to screen people for symptoms or potential exposure to someone with COVID-19. 


DODD recognizes that many places, including residential waiver settings, provide much-needed respite services. During this time, providers should cancel all non-emergency respite stays. If a residential waiver setting is contacted to provide respite services, they must first contact the person’s local county board of developmental disabilities to discuss the need for the respite service.

If it is determined that the need is of an emergency nature, the provider may provide respite services to the person following the guidance above for the initial screening of the person.

Information and Resources

Residential waiver settings should also refer to the following resources for more information.

Centers for Disease Control and Prevention resource.

Centers for Medicare and Medicaid Services resource.

DODD support teams are available and consist of staff ready to help county boards and providers.

DODD has set up a dedicated web page for department communications and links to helpful resources that will advise people with disabilities, their families, service providers, direct support professionals, county boards of developmental disabilities, and the community at large.

For specific questions about COVID-19 and additional information and resources, DODD urges you to use the Ohio Department of Health’s call center. Call 1-833-4-ASK-ODH (1-833-427-5634), or visit coronavirus.ohio.gov.