Guidance: Setting Up a Temporary Relocation Site for Congregate Settings or Community Settings

Definitions

Congregate Care Setting (CCS): Congregate care settings include intermediate care facilities (ICFs) or other licensed developmental disabilities facilities if the setting can provide nursing care to the degree needed to adhere to the health care needs according to the person’s health status. ICFs that are not able to provide the degree of nursing or nurse-delegated care will follow the guidance pages for Community Settings.

Community Setting: This includes personal family homes and homes where waiver supports are provided.

Combined Setting: A combined setting is a location that brings together people who receive services with different funding sources or brings together people served by a different provider(s).

Congregate Care Settings

Congregate Care Settings as defined in the Long-Term Services and Supports (LTSS) Pre-Surge Planning Toolkit:

1. A person living in a congregate care setting, upon exposure (orange path) or symptoms/diagnosis of coronavirus (COVID-19) (purple path), may be moved to a quarantine/isolation area or building owned by the provider of the congregate setting.
2. If the area or building to be used is part of the existing congregate care setting, the move may occur immediately.
3. If the building to be used is not part of the existing congregate care setting used for residential purposes, or a building off-site, a virtual walk-through of the building will be conducted by the Ohio Department of Developmental Disabilities (DODD).
   • For people who typically reside in an ICF, who need to relocate to an unlicensed setting, they would need to follow the process for requesting bed-hold days.
     • The provider should include the address of where the person will be residing during the use of bed-hold days.
   • For people who typically reside in a licensed waiver home that meets the definition of a “congregate care setting,” their Homemaker/Personal Care (HPC) services can be utilized in an unlicensed setting if the person needs to temporarily relocate.
     • The service and support administrator (SSA) needs to be notified of the change in location of services and the reason why.
     • If the setting is licensed and has space available, a waiver of licensed capacity will be granted, upon request, to meet the need.
     • No more than four people receiving HPC services may reside in an unlicensed setting.
     • If there is a need for more than four people receiving HPC services to reside in the unlicensed setting, the setting will have to be licensed utilizing either vacant beds or beds on hold already owned by the provider.
       • In order to license the setting, DODD will conduct an abbreviated licensing process that includes a virtual feasibility of the site.
     •  If there is a need for more than four people receiving HPC services to reside in the unlicensed setting, and the provider/licensee does not have access to vacant beds or beds on hold, DODD will, upon approval of the director, provide licensed beds to the provider (utilizing DODD beds on hold*) for a period of time that will end June 30, 2020, which can be extended if necessary upon request. 

*The ownership of the bed will remain with DODD and will automatically revert to DODD immediately at the end of the term or when the building is no longer needed to meet emergency needs.

Community Settings

Community Settings as defined in the Long-Term Service and Supports Pre-Surge Planning Toolkit:

1. The Ohio Department of Health (ODH) is advising that people in community settings should not be moved to another site for quarantine (orange path) or isolation (purple path).
2. It should be assumed that if a person in a community setting has been exposed, or exhibits symptoms, that all members of the household have been exposed and quarantine/isolation practices should be put in place within the home.
3. Alternative settings may be utilized if essential services are no longer possible with usual providers.
   • If this is the case, then the provider may relocate people:
     • First, by utilizing existing service capacity within their own organization.
     • Second, by utilizing family/unpaid supports.
     • Third, by utilizing existing service capacity from another provider agency.
4. If an alternative setting is required due to essential services no longer being possible, and the setting is licensed and has space available, a waiver of licensed capacity will be granted, upon request, to meet the need.
   • The SSA needs to be notified of the change in location of services and the reason why.
5.  If utilizing existing service capacity within your own organization due to essential services no longer being available will result in more than four people receiving HPC services to reside in the unlicensed setting, the setting will have to be licensed utilizing either vacant beds or beds on hold already owned by the provider.
6. In order to license the setting, DODD will conduct an abbreviated licensing process that includes a virtual feasibility of the site.
7.  If there is a need for more than four people receiving HPC services to reside in the setting and the provider/licensee does not have access to vacant beds or beds on hold, DODD will, upon approval of the director, provide licensed beds to the provider (utilizing DODD beds on hold*) for a period of time that will end June 30, 2020 which can be extended if necessary upon request. 

*The ownership of the bed will remain with DODD and will automatically revert to DODD immediately at the end of the term or when the building is no longer needed to meet emergency needs.

Combined Settings

If a provider operates both ICFs and waiver homes, then the provider should not plan to combine these services unless essential services are no longer possible with usual direct support professionals.

Providers should not plan to combine people served by different provides unless essential services are no longer possible with usual providers or direct support professionals.

•  In the event that the provider needs to combine services into a single setting or provide for people typically served by another provider, the provider must:
  • Notify DODD of the need by contacting the Support Team member for their region.
  • Then, the Support Team member will notify Sara Lawson, Ann Weisent, and Ginnie Whisman with request.
  • DODD representatives will contact provider to discuss the plan and ensure that the movement is necessary based on the allowable exception as identified in the LTSS Pre-Surge Planning Toolkit.
  •  
  • If there will be no more than four people receiving HPC services in the unlicensed setting, the provider may immediately initiate the move as soon as a virtual walk-through of the setting is completed (same day as notification).
  • The SSA needs to be notified of the change in location of services and the reason why.
  • If the setting is licensed and has space available, a waiver of licensed capacity will be granted, upon request, to meet the need.
  • If there is a need for more than four people receiving HPC services to reside in the setting, the setting will have to be licensed utilizing either vacant beds or beds on hold already owned by the provider.
  • In order to license the setting, DODD will conduct an abbreviated licensing process that includes a virtual feasibility of the site.
  •  If there is a need for more than four people receiving HPC services to reside in the setting and the provider/licensee does not have access to vacant beds or beds on hold, DODD will, upon approval of the director, provide licensed beds to the provider (utilizing DODD beds on hold*) for a period of time that will end June 30, 2020, which can be extended if necessary upon request.

*The ownership of the bed will remain with DODD and will automatically revert to DODD immediately at the end of the term or when the building is no longer needed to meet emergency needs.

If a person leaves the residence to receive supports either paid or unpaid from an entity other than their current provider/their primary residence, they must follow the corresponding path to return to the facility as outlined in the DODD COVID-19 LTSS Pre-Surge Planning Toolkit.

Approval Process for Relocation Sites

Whether a setting needs to be temporarily licensed or not, providers should ensure that relocation sites, if not already in a licensed setting,          

• have a single access point in which anyone coming in or out of the using the Entry Screening Process for Prevention of COVID- 19 Transmission (DODD Guidance dated March 19, 2020).
• have the ability to ensure services are delivered in a manner consistent with the guidelines from ODH and the Centers for Disease Control and Prevention (CDC), including, having no more than 10 people and staff in the location at one time and allowing for at least 6 feet of social distancing between each person.
• have appropriate handwashing, bathing, and toileting areas available.
• have appropriate sleeping areas available.
• have operational utilities, including water, sewer, and HVAC.
• must have two means of egress on each floor used for sleeping.
• are to the greatest extent possible, free of any known hazards.

These minimum requirements will be reviewed via a virtual walk-through survey.