Coronavirus (COVID-19) has disrupted the personal and professional lives of all Ohioans. Health and well-being have been the primary focus when deciding how to best respond during this state of emergency. Adult day service providers who serve large groups of people have been affected significantly by restrictions on group size. The Ohio Department of Health (ODH) has issued a new order on January 29, 2021 that replaces the prior ODH order issued in March 2020. Restrictions put into place through this order remain in place until rescinded by the director of ODH or until the governor ends the state of emergency.
Providers will need to continue to find ways to comply with the order and deliver services in smaller settings, in homes, or virtually.
During this state of emergency, small group service within a facility designated for adult day support services and vocational habilitation services where group sizes do not exceed 12 people, not including direct support professionals (DSPs) can be an important option for people with disabilities and their families. To accomplish this, providers must operate at a reduced capacity that allows for six feet of social distancing and must assure each area or cohort accommodates no more than 12 total people, not including DSPs.
Service delivery continues to evolve to ensure the health and safety of Ohioans with developmental disabilities as services are being provided in innovative ways that are both meaningful and safe for all persons involved. This process applies to all facility-based Adult Day Support (ADS), Vocational Habilitation (VH), and Intermediate Care Facility (ICF) Day Program providers, regardless if services were discontinued after the order was issued.
The person-centered team and the provider assurance processes can happen concurrently. There is no order in which they must be completed.
Person-Centered Team Process
- 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.
- 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 (link to new order).
- 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 DSPs 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.
Provider Assurance Process
As more Ohioans with developmental disabilities are receiving vaccines, they are looking to safely return to the places, jobs, and activities they love. It is important for people to 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 DODD that all mandatory standards have been met before reopening or initiating services.
- The ADS, VH, or ICF Day Program, provider completes the Provider Assurance Form. If facility-based ADS, VH, or ICF Day Program services are provided in multiple settings, a separate form must be completed for each setting.
- Completed Provider Assurance forms are submitted to DODD (via email: OSSAS@dodd.ohio.gov) and the appropriate county board(s).
- DODD and the county board(s) will confirm with the provider their receipt of the forms within one (1) business day.
- The Office of System Support and Standards (OSSAS) will complete a virtual walk-through of the setting(s) with the provider within 48 hours of receiving the provider assurance form.
This process only needs to be completed once per setting. Providers can resume their facility-based services once their assurance documentation is submitted to DODD and the appropriate county board(s), and they have received a confirmation email from both.
For providers who have previously submitted an assurance form and been approved for groups of 10 under the previous ODH order, those services may continue and a new assurance form does not have to be submitted unless the provider is adding areas not previously approved. Any questions about the setting can be answered during the virtual walk-through with OSSAS. If the provider needs to arrange a virtual walk-through later than 48 hours, OSSAS will accommodate the request.
Once a person’s team completes the person-centered team process, and their chosen provider has completed the assurance process, services may begin for that person.
This process begins with the person’s choice to resume services and is bolstered by a team discussion of the risk and benefits of that decision. Safety is ensured by the provider taking all necessary measures to decrease the spread of COVID-19 and keeping all who are in their setting as healthy as possible.
Mandatory General Requirements
- Facial Coverings - Employees are required to wear facial coverings at all times while delivering Services. People receiving services are required to wear facial coverings unless an exception for a medical, functional, or practical reason is documented by the Team in the person’s person-centered plan.
- Group Sizes - Adult Day Support Services and Vocational Habilitation Services can be delivered in groups not to exceed 12 people receiving services, which does not include employees or DSPs.
- Social Distancing Requirements - Must maintain at least six-foot social distance. Facilities must take proactive measures to ensure compliance with Social Distancing Requirements, including where possible:
- Designate six-foot distances. Designating with signage, tape, or by other means six-foot spacing for employees and people receiving services.
- 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 December 22, 2020.
Per the CDC, the following is a list of symptoms:
- Fever or chills
- Shortness of breath or difficulty breathing
- Muscle or body aches
- New loss of taste or smell
- Sore throat
- Congestion or runny nose
- Nausea or vomiting
*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
- People receiving services must be assessed for COVID-related symptoms before entering the facility (this could be before accessing transportation) using the COVID-19 symptom monitoring log.
- People receiving services must wash or sanitize their hands before beginning services, and the provider must assist if needed.
- Encourage the person receiving services 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
- Providers should stagger pick-up and drop-off times to ensure appropriate social distancing.
- Providers should use curbside pick-up and drop-off. This would include assisting people into the facility.
- Providers should limit parent and visitor entry into the facility.
- Providers should limit the personal belongings brought into the facility.
Mandatory Practices for Providing Services Throughout the Day
- 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.
- 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.
- Providers must follow infection control standards, including handwashing before and after contact with people receiving services.
- Providers must require personnel, who are helping a person with eating or other personal care activities, to use gloves and face coverings.
- Providers must provide/install hand sanitizer in high-contact areas.
Best Practices for Providing Services Throughout the Day
- Providers should have the resources and ability to offer activities that will not require handling shared items (unless people handling materials are properly gloved).
- 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.
- 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.
- Providers 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 the time between the use of the area given concern for lingering aerosols.
- Providers should plan activities that maximize social distancing and avoid unnecessary contact between people.
Mandatory Practices for the Physical Environment
- 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 person to an appropriate place (residential setting, health care provider, etc.).
- Providers must operate at a reduced capacity that allows for six feet of social distancing. Providers must assure each area accommodates no more than 12 total people, not including DSPs.
- Providers must assign dedicated employees for each group/cohort and must maintain those assignments and cohorts to the extent feasible.
- 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
- Providers can use temporary walls to divide a building into smaller areas to serve multiple groups, under the following limited circumstances:
- Dividers must be at least six feet in height,
- Dividers must be made from non-porous material or other material that can be sanitized,
- Dividers must meet any requirements set by the Department of Commerce, local building department, state fire marshal, or local fire safety inspector.
- Providers should install barriers when 6 feet of distancing is not possible to maintain physical distance.
Mandatory Practices for Confirmed Cases
- 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.
- Immediately isolate and seek medical care for any person who develops symptoms while at the facility and shut down their area for deep sanitation after identification of any person receiving services or staff who tests positive for COVID-19.
- Initiate appropriate care and tracing with their local health department.
- Notify the appropriate county board of developmental disabilities about confirmed cases or exposures.
- Ensure all people with suspected infection or exposure are tested before returning to the facility for services.