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Guidance: ICF Situational Response

To prevent the introduction of coronavirus (COVID-19) into intermediate care facilities (ICFs), there is a mandatory visitation order from the Ohio Department of Health (ODH).

With respect to visitation in ICFs, the Ohio Director of Health issued an order that requires the following: (Note: ICFs are included in “Homes.”)

  • Restrict access to all Homes only to those personnel who are necessary for the operation of the Homes. People who are "absolutely necessary for the operations of the Homes" include, but may not be limited to, home staff, contracted and emergency healthcare providers, contractors conducting critical on-site maintenance, and governmental representatives and regulators and their contractors. No visitors of residents shall be admitted to any Home, except for end-of-life situations. 
  • Restrict access to all Homes only to those personnel who have been screened for COVID-19 each day each time they enter their Homes. Screening guidance is available from the U.S. Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services, as well as from the Ohio Department of Health. Screening should include questions about exposure to COVID-19 and assessing visitors and personnel for respiratory symptoms to include for cough, shortness of breath, and body temperatures of 100.4 degrees and higher. This order does not apply in exigent circumstances, to emergency medical services, first responders, and similarly situated individuals. 
  • Restrict access to all Homes to as few points of entry as is possible, with the Ohio Department of Health recommending one point of entry. This does not apply to emergency ingress or egress of facilities. 
  • Restrict access to all Homes only to those persons who produce legal federal- or state-issued identification, other satisfactory identification, or are a known person, and provide the Homes with business telephone numbers and addresses. It is the responsibility of the Homes to log such information, maintaining it for at least six months. 
  • Allow residents to discharge from Homes at any time and in accordance with applicable state and federal law, understanding that residents that then return to the Homes while this Order is in effect are subject to the directives above. 

Recommended Situational Guidance from DODD and ODH

The Ohio Department of Developmental Disabilities (DODD) recognizes that the following situational actions may seem excessive or unattainable due to the lack of personal protective equipment (PPED), facility space, or for small ICFs and ICFs 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 staff entering the ICF should be screened for symptoms using the Entry Screening Process for Prevention of COVID-19 Transmission tool. Facility staff performing health check screenings should wear facemasks.

Health care providers (HCPs) and other facility staff with symptoms or with temperatures greater than 100.4 degrees Fahrenheit should be sent home, and HCP and other facility staff who develop symptoms or fever while in the facility 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 referral for evaluation and treatment, as necessary.  

If there are suspected cases of COVID-19 in an ICF

Residents suspected of infection with COVID-19 should be given a facemask to wear, and the facility should contact the resident’s HCP 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 resident must be isolated in a separate room with the door closed. Staff attending the resident, 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 resident, except for brief, necessary interactions.

Facilities should bundle care and minimize the number of HCP and other staff who enter the room to reduce the number of personnel requiring facemasks. 

If there are confirmed cases of COVID-19 in an ICF

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 risk level of exposure and requirements for quarantine or monitoring of non-ill residents. 

In ICFs, actively monitor all residents on affected units 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 residents may be quarantined. Cancel group activities and communal dining. Offer other activities for residents in their rooms to the extent possible, such as video calls. 

Do not float staff between units. Cohort residents diagnosed with COVID-19 with dedicated HCP and other direct care providers. Minimize the number of HCP and other direct care providers entering rooms. 

In ICFs, patients diagnosed with COVID-19 should be placed on droplet and contact precautions. HCP and other direct care providers should wear gown, gloves, eye protection (goggles or a face shield), and N95 respirators (or equivalent) if the facility has a respiratory program with fit tested staff and N95s.

Otherwise, HCP and other direct care providers should wear gown, gloves, eye protection, and facemasks. Facilities may implement extended use of eye protection and facemasks/N95s when moving from resident to resident (i.e., not changing between residents) unless other medical conditions which necessitate droplet precautions are present. However, gloves and gowns must be changed, and handwashing must be performed. 

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

Residents on affected units who have been exposed to COVID-19 and are being quarantined or monitored do not require droplet and contact precautions, but social distancing, cough covering, handwashing and other routine infection prevention activities should be in place. 

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

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

For ICF Resident Access to the Community

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

Respite in ICFs

DODD recognizes that many licensed facilities, including ICFs, provide much needed respite services. During this time, facilities should cancel all non-emergency respite stays. If a facility 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 facility may provide respite services to the person following the guidance above for initial screening of the person. If, by having a person using respite in the facility, the facility is caused to go over capacity, the facility must still submit a request for a waiver of licensed capacity. Those requests will be reviewed and responded to as quickly as possible.  

Facilities 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.