Guidance: Behavior Supports, Including Rights Restrictions
Attention All Providers of Developmental Disabilities Services:
As the Ohio Department of Developmental Disabilities (DODD) responds to coronavirus (COVID-19), please continue to exercise flexibility to ensure the health and safety of Ohioans with developmental disabilities and their families. DODD appreciates the unique role that service providers and direct support professionals (DSPs) play throughout the developmental disabilities system.
Related to behavior supports, including rights restrictions, the following guidance should be followed. Please note that this is an update to guidance previously issued on March 26, 2020.
Restrictive Measures, Human Rights Committee Process
The continuation of current procedures (restraint, time-out, and rights restrictions) that may need to be extended beyond the current approval period remains permissible during the state of emergency. These should occur in conjunction with all other supports in a person’s plan that may be continued if a remote planning meeting cannot be arranged, or the team is unable to obtain consent. If this occurs for any person, the Service and Support Administrator (SSA) or Qualified Intellectual Disability Professional (QIDP) should maintain documentation concerning the reason a remote meeting could not occur.
Existing restrictive measures that are due to expire can be continued without the Human Rights Committee (HRC) review during the state of emergency.
However, as more work is completed virtually, county boards, waiver providers, and intermediate care facilities (ICFs) should work to complete the HRC process in such a manner if in-person meetings are not optimal. If virtual meetings cannot occur, the county board, waiver provider, or ICF should maintain documentation concerning why the meeting did not occur.
Restrictive Measure Notification Submission
Restrictive measure notification (RMN) submissions can be postponed during the state of emergency. However, as more work is completed virtually, county boards, waiver providers, and ICFs should work to complete the RMN process as restrictions are developed or authorized.
Starting in May 2020, Ohio began ‘reopening’ and many of the orders that had restricted Ohioans’ movements have been lifted, including the ‘Stay at Home’ Order and orders closing most businesses to the public.
With this lifting of statewide restrictions, waiver providers (including licensed waiver facilities) can no longer implement blanket restrictions of rights for people with developmental disabilities. This includes restricting someone’s ability to have visitors inside their home; restricting someone’s ability to go into the community for activities, appointments, etc., prohibiting someone from returning to their home if they leave, and requiring someone to quarantine when they return to their home. The ODH orders restricting group sizes for Adult Day Services and Vocational Habilitation as well as visitation restrictions at ICFs remain in place. These limitations continue to not be categorized as restrictive measures.
For a waiver provider to be able to continue implementing other restrictions, the requirements for a restrictive measure outlined in OAC 5123-2-06 need to be met on an individual basis, including, but not limited to: meeting the risk of harm or likelihood of legal sanction requirements, having an assessment that meets the rule requirements, and approval by the HRC. Any rights restrictions that are implemented without meeting these requirements should be reported as a major unusual incident (MUI) or unusual incident (UI).
DODD recognizes that some people may choose on their own to not have visitors or resume community activities at this time. Personal choice and self-empowerment should always be promoted. Independently choosing to limit these things should not be considered a rights restriction.
Providers should continue to assist people with making informed decisions, including encouraging them to follow ODH and CDC recommendations related to social distancing and wearing facial coverings in public. Education and assistance should also be offered regarding continued COVID-19 concerns, hygiene practices, and minimizing the risk of infection. Information related to COVID-19 should be explained in a manner best understood by the person. Local municipality requirements that vary around the state concerning safety precautions such as wearing masks, social distancing, and other preventative actions should be followed and will not be considered restrictive measures.
Isolation Due to COVID-19 Exposure, Exhibiting Symptoms
There continues to be a need for people to be quarantined or isolated if they are exposed to someone who tests positive for COVID-19, or if they exhibit possible COVID-19 symptoms.
If a person requires quarantine or isolation and refuses to comply, the team must first attempt non-restrictive measures that ensure the health and welfare of that person and everyone else in the home.
If the person continues to refuse the safety measures, the team will consider guidance from medically licensed professionals who know the person and risks to their health. The
team should meet, via technology or over the phone phone, if possible, and determine the least restrictive actions that will best serve the person’s health and welfare. The restrictions may include manual, mechanical, and chemical restraint as the last options. If the decision is made to use these restrictions, the major unusual incident (MUI) or unusual incident (UI) process should be followed.