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Updated Guidance: Adult Day Services

As Ohio’s economy continues to reopen, Ohioans with developmental disabilities are looking to safely return to the places, jobs, and activities they love. It is imperative that people can engage in the activities they choose, with the services they need in the safest way possible. Given the higher rate of COVID-19 transmission and the likelihood of complications for people with developmental disabilities, providers will still need to submit written assurance to the Ohio Department of Developmental Disabilities (DODD) that all mandatory standards have been met prior to reopening or initiating services.

Person-Centered Team Process

  1. The person receiving services, their family or guardian, or Adult Day Services (ADS), Vocational Habilitation (VH), or Intermediate Care Facility (ICF) Day Program provider, notifies the service and support administrator (SSA) or qualified intellectual disabilities professional (QIDP) that the person wishes to resume facility-based services.
  2. A team, which consists of the person receiving services, their family or guardian, day service and residential providers, and SSAs or QIDPs, will work together using the Risk/Benefit Discussion Guide to inform the conversation about the risks and benefits of the person attending facility-based day services under the Ohio Department of Health ADS Order.
  3. If the team determines that the person should attend facility-based ADS, VH, or ICF Day Program, the person receiving services, their family or guardian, and the SSA or QIDP, completes the Team Acknowledgment Form and corresponding Risk/Benefit Discussion Guide.

The Team Acknowledgment Form is submitted to the ADS, VH, ICF Day Program, or transportation provider by the SSA or QIDP. Once the SSA or QIDP receives a request from the person, parent or guardian, or provider that someone would like to attend facility-based ADS, VH, or ICF Day Program, the SSA or QIDP has seven business days to complete the Risk/Benefit Discussion Guide and outline the plan for resuming facility-based services. The SSA or QIDP, through the team process, may need to revise the person’s service plan to reflect current conditions, services, and outcomes.

The above steps must be completed for each person requesting to resume facility-based services, and the provider must maintain all required documentation.

Though not required, DODD recommends that both staff and people with developmental disabilities utilize the availability of testing for COVID-19. Testing centers can be located here.

Facility-based services may not be the wish of every person or the desire of every team. The team should consider, at any time in the process, alternative ADS, VH, or ICF Day Program options, including virtual or in-home services.

Mandatory General Requirements

  1. Require employees to wear face coverings at all times unless:
    • working alone in isolated workspaces, or
    • working in low-risk environments, such as outdoors.
  2. Services must be provided in groups of 10 people or less, including direct support professionals (DSPs).
  3. Employees must perform daily symptom assessment, and agencies must require employees to stay home if symptomatic. Following the ODH Guidance for Discontinuing Transmission-Based Precautions, employees can return 10 days after symptoms first appeared, at least 24 hours have passed since there has been no fever without the use of fever-reducing medication, and there has been an improvement in other symptoms.*

*Updated July 31.

Per the CDC, the following is a list of symptoms:
 

Fever or chills Headache
Cough New loss of taste
Shortness of breath or difficulty breathing Congestion or runny nose
Fatigue Nausea or vomiting
Muscle or body aches Diarrhea
Sore throat  


*This list does not include all possible symptoms. CDC will continue to update this list as we learn more about COVID-19.

Mandatory Practices for Arrival and Dismissal

  1. Participant must be assessed for COVID-related symptoms prior to entering the facility (this could be prior to accessing transportation) using the COVID-19 symptom monitoring log.
  2. Participant must wash or sanitize their hands before beginning services, and the provider must provide assistance if needed.
  3. Participant must be assessed for COVID-related symptoms using the COVID -symptom monitoring log, prior to leaving the facility.
  4. Encourage the participant to wear face coverings unless there is an exception for medical, functional, or practical reasons, as documented in the person-centered team, process, and included in the Team Acknowledgment Form.

Best Practices for Arrival and Dismissal

  1. Providers should stagger pick-up and drop-off times to ensure appropriate social distancing.
  2. Providers should use curbside pick-up and drop-off. This would include assisting participants into the facility.
  3. Providers should limit parent and visitor entry into the facility.
  4. Providers should limit the personal belongings a participant brings into the facility.

Mandatory Practices for Providing Services Throughout the Day

  1. Providers must disinfect all hard and non-porous surfaces daily and after use. Throughout the day, providers must also clean and sanitize high touch areas such as doorknobs, bathrooms, and common areas.
  2. Providers must have a supply of personal protective equipment (PPE) capacity and must provide training to DSPs on the use of gloves and face coverings.
  3. Providers must follow infection control standards, including handwashing before and after contact with participants.
  4. Providers must require personnel, who are helping a person with eating or other personal care activities, to use gloves and face coverings.
  5. Providers must provide/install hand sanitizer in high-contact areas.

Best Practices for Providing Services Throughout the Day

  1. Providers should have the resources and ability to offer activities that will not require handling shared items (unless people handling materials are properly gloved).
  2. Providers should plan activities that include limited food consumption (to avoid the need to remove face coverings). If meals are required or necessary, providers should ensure surfaces are cleaned before and after eating, ensure employees wash hands before providing food to people. To the extent possible, providers should utilize single serve packing, which can be easily disposed of after a meal.
  3. Providers should assess and plan how to safely administer medication, including avoiding aerosolizing procedures, if possible, and having a private place to use inhalers and nebulizers.
    • When a provider is involved in these activities, the use of N95, eye protection, gown, and gloves is recommended PPE.
    • Provider should be educated on donning and doffing of PPE and disposal.
    • Cleaning and sanitizing of the area must be performed after each use.
    • Consider extending time between use of the area given concern for lingering aerosols.
  4. Providers should plan activities that maximize social distancing and avoid unnecessary contact between individuals.

Mandatory Practices for the Physical Environment

  1. Providers must designate an isolation space, not utilized for other activities, for anyone who presents with symptoms during service delivery and immediately arrange for transportation to take the participant to an appropriate place (residential setting, health care provider, etc.).
  2. Providers must establish a reduced building maximum capacity not to exceed 50 percent of the Fire Marshal’s permitted building occupancy capacity at any one time or per one shift.
  3. Providers must assure each area accommodates no more than 10 total people, including people receiving services and DSPs.
  4. When separate entrances/exits and restrooms for each group are not possible, the provider will stagger arrival, departure, and break times for thorough sanitization of the area and minimal contact between individuals.
  5. Providers must assign dedicated employees for each group/cohort.
  6. Providers must have a schedule for deep cleaning, which can occur daily but must occur once a week at a minimum. This should occur outside of normal business hours.

Best Practices for the Physical Environment

  1. Providers can use temporary walls to divide a building into smaller areas to serve multiple groups, under the following limited circumstances:
    1. Dividers must be at least six feet in height,
    2. Dividers must be made from non-porous material or other material that can be sanitized,
    3. Dividers must meet any requirements set by the Department of Commerce, local building department, state fire marshal, or local fire safety inspector.
  2. Providers should install barriers when 6 feet of distancing is not possible to maintain physical distance (if 6 feet of distance is not possible, face coverings should be worn).

Mandatory Practices for Confirmed Cases

  1. Contact the local health department about confirmed cases or exposures and work with the local health department to facilitate contract tracing, notifications, and testing, as requested by the local health department.
  2. Shut down the facility or area as directed by the local health department for the day and perform deep sanitation.
  3. Notify the appropriate county board of developmental disabilities about confirmed cases or exposures.