COVID-19: Home Care and Home and Community-Based Service Providers

This guidance applies to the following:

  • 1–2 bed adult family homes
  • Supported living apartments
  • Adult day services
  • Adult day care centers
  • Adult day programs
  • Adult employment and prevocational programs
  • Home care agencies
  • Supportive home care agencies
  • Home health agencies
  • Hospice
  • Personal care agencies
  • Private duty nursing services
 

These homes, facilities, agencies, and services are collectively referred to as “providers.” Individuals receiving services from these providers are referred to as “participants.” By helping providers improve their infection prevention and control practices in order to prevent the transmission of COVID-19, together, we can flatten the curve.

Providers should monitor the Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), and Wisconsin Department of Health Services (DHS) websites for the most current information and resources related to COVID-19 and also contact their local public health department when needed.

DHS recommends the following actions in accordance with Wis. Stat. Chs. 50 and 252, Wis. Admin. Code Ch. DHS 145, and CMS guidance. Recommendations may change as we move through Wisconsin's roadmap to reopen using public health principles of testing, tracing, and tracking the new coronavirus to decrease COVID-19 cases and death.

If a health care worker or participant is diagnosed with COVID-19, immediately contact your local public health department to receive further guidance on infection control.

All Providers

Visitors

Individuals with symptoms of a respiratory infection (fever, cough, shortness of breath, or sore throat) should not be permitted to enter locations where a participant is receiving services. 

It is recommended visitors that are permitted to enter must wear a face mask while in the building and restrict their visit to the participant’s room or other location designated by the provider. Providers should also remind visitors to frequently perform hand hygiene, especially after coughing or sneezing.

Screening

Providers should implement active screening of participants and staff for fever and respiratory symptoms.

Staff should be screened at the beginning of their shift. Actively take their temperature and document the presence of a fever and respiratory symptoms, including new or worsening cough, unexplained myalgia, and sore throat.

If staff develop signs and symptoms of a respiratory infection while on the job, they should:

  • Immediately stop work, put on a face mask, and self-isolate at home.
  • Inform their manager or supervisor.
  • Contact their local health department for next steps.​

Testing

If participants have symptoms of COVID-19 or have been exposed to someone who has COVID-19, they should get tested. 

Personal protective equipment

Providers should assess their supply of personal protective equipment (PPE) and initiate measures to optimize their current supply, such as extended use of face masks and eye protection or prioritization of gowns for certain participant care activities.

Keeping participants engaged

    Technology resources

    • Tablets, laptops, and smartphones capable of connecting to Wi-Fi
    • Smart home visual devices (Amazon Echo, Facebook Portal, Nest Hub)
    • Smart home control technology (thermostats, doorbells, lights)
    • Simplified tablets (GrandPad)
    • Amplified telephones
    • Personal listening devices
    • Handheld or desktop style magnifiers
    • Tablet holders and cases
    • Wheelchair trays
    • Walker bags
    • Recreational assistive technology, such as card holders, pencil grips, or other needs for participation in activities
    • Remote volunteers to facilitate communication and skill building
    • Video meetings (Zoom, FaceTime, Facebook Messenger, Google Meet or Hangouts, Skype)
    • Apps for communication (Facebook, Instagram, text messaging, email, Skype, TikTok)
    • Apps specific for disabilities (Glide and Marco Polo for consumers who are deaf)
    • Apps for creative ideas (Facebook, Instagram)
    • Apps for mental health (meditation guidance, soothing sounds, drawing apps)
    Funding or donation options
    • Telecommunications Equipment Purchase Program (TEPP). This fund is available to assist with the acquisition of basic and essential telecommunications for distance communication for people who are hard of hearing, deaf, have combined hearing and vision loss, have a speech disability, or have a mobility impairment. The disability must prevent the use of regular telecommunications equipment. Program-specific rules apply. Staff from the Independent Living Centers and DHS WisTech are available to answer questions or assist with applications.
    • Telecommunications Assistance Program (TAP). This fund is available to assist with the acquisition of basic and essential telecommunications for distance communication for people who are hard of hearing or deaf or who have a combined hearing and vision loss that prevents the use of regular telecommunications equipment. Program-specific rules apply. Staff from the Independent Living Centers and DHS WisTech are available to answer questions or assist with applications.
    • iCanConnect (ICC). This fund is available to assist with the acquisition of technology needed for distant communication for people with combined hearing and vision disabilities. Financial eligibility must also be met. Staff from the Center for Deaf-Blind Persons can provide information, assist with applications, and provide assessments.
    • WisTech Assistive Technology Program. This program uses project partners to provide device loans, demonstrations, and reutilized equipment.
    Device cleaning recommendations

    Nontechnology strategies (programming, structural, and instructional)

    • Do creative activities.
    • Encourage friends and families to:
      • Do face-to-face visits via windows and signs.
      • Send cards and letters.
      • Send books or other small, random gifts.
      • Assist with online grocery or person item orders for participants isolated in apartments.
      • Send photos, photo book, calendar, mug, etc. from an online service.
      • Send books, puzzles, and games.

    Resources

     

    1-2 Bed Adult Family Homes and Supported Living Apartments

    This guidance applies to providers of 1-2 bed adult family homes and their participants, as well as supported living apartments and their household members. The guidance also applies to the staff (live-in and periodic) who work there.  

    The purpose of this guidance is to provide the best information currently available to help providers prevent the spread of COVID-19 and additional guidance for responding to a suspected, probable, or confirmed case of COVID-19 in your home or facility. One and two-bed adult family homes and supportive apartments should follow all appropriate provisions in the All Providers section as well.

    Preparedness

    • Ensure participants, household members, and staff have access to adequate supplies of soap, paper towels, tissues, hand sanitizers, cleaning supplies, garbage bags, and a supply of disposable gloves and face masks or face coverings.
    • Follow DHS guidance regarding the appropriate use of PPE, and consider strategies to best conserve PPE, when possible.
    • Place alcohol-based hand sanitizer and trash containers throughout the home. Make sure tissues are available and any sink is well stocked with soap and paper towels for handwashing.  
    • Monitor the temperatures of residents and staff and check for signs and symptoms of COVID-19 each day when individuals come into the home. 
    • Anyone who has a fever of 100.4 or above, or other signs of illness, should notify their physician. 
    • Notify your local public health department if a resident, household member, or staff is suspected of having COVID-19. 
    • Ensure there is a backup plan if staff members become ill. 
    • Ask staff who become ill at work to immediately stop work, put on a face mask, and go home and self-isolate. 
    • Identify space within the home or apartment where a resident or household member may be isolated. If the home has more than one bathroom, be prepared to limit the use of one bathroom to anyone in the household who becomes ill.
    • Put communication plans in place with family members and legal guardians to ensure transparency and understanding of new safety protocols, including timely communication about new COVID-19 cases involving residents or staff. Communication with residents, families, and/or guardians should be proactive and clearly explain the reasons for any changes to normal practices.
    • Identify methods of support for those residents who may require specialized understanding or who are likely to experience increased emotional or behavioral impact.

    Infection prevention and control

    Post signs and fact sheets. Social stories and visual task lists may be helpful for some individuals. The following are examples of signs and fact sheets that may be helpful:

    Wash Your Hands! publication P-01710                                            Cough etiquette P02673

    Wash your hands! P-01710                                            Cough etiquette, P-02673
    English | Hindi | Hmong | Somali | Spanish                   English | Hindi | Hmong | Somali | Spanish   

    Thank you for physical distancing                                            Thank you for protecting your employees and community, P02671

    Thank you for physical distancing P-02673B            Thank you for protecting your employees and community, P-02671
    English | Hindi | Hmong | Somali | Spanish                  English | Hindi | Hmong | Somali | Spanish

    Cleaning and disinfecting your facility

    Routinely during the day clean and disinfect surfaces and objects that are frequently touched in common areas (for example, door handles, faucets, toilet handles, light switches, handrails, countertops, chairs, tables, remote controls, and shared electronic equipment).

    Use all cleaning and disinfection products according to the directions on the label. 

    Hygiene

    You can spread COVID-19 to others even if you do not feel sick, so you should follow these hygiene practices:

    • Wash your hands often with soap and water for at least 20 seconds, especially after you have been in a public place or after blowing your nose, coughing, or sneezing.
    • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol.
    • Avoid touching your eyes, nose, and mouth with unwashed hands.
    • CDC recommends wearing cloth face coverings in public settings where it is difficult to stay six feet away from others. Some people cannot wear a cloth face covering safely. Others with sensory or other disabilities may not be able to comply. Cloth face coverings should not be placed on children under age 2, anyone who has trouble breathing, or anyone who is unable to remove the covering without assistance. In addition to medical considerations, individuals may fear racial profiling or discrimination based on wearing—or not wearing—a face covering. Businesses requiring cloth face coverings should allow for exceptions based on health and safety concerns of individuals. Accommodations due to disability should be made when appropriate. This does not apply when household roommates are together or for owners and residents in an owner-occupied adult family home. 
    • Cover coughs and sneezes with your elbow, even if wearing a cloth face covering. 

    Going out into the community

    • Discourage nonessential outings into the community. 
    • Every effort should be made to allow an individual to maintain their paid employment.
    • Follow WEDC guidance for outdoor gatherings.
    • Train participants if possible to follow appropriate social distancing and hygiene routines if they leave the home for work or day programs or if they use public transportation. Follow specific guidance for Wisconsin businesses and transportation
    • Everyone should wear a cloth face covering when they have to go out in public (for example, to the grocery store or to pick up other necessities). The cloth face covering is not a substitute for social distancing.
    • Staff should strongly encourage participants to comply with social distancing (i.e., remaining at least six feet part). This does not apply to household roommates who are living together.
    • The number of staff who support individuals who require personal care, job coaching, or other supports that do not allow for social distancing should be limited.
    • The ability of someone to comply with wearing a mask should not mean they cannot interact with the community. Every effort should be made to ensure all participants are able to get outside, see family and friends while engaging in social distancing when possible, and engage in safe activities outside of the home that do not involve direct contact with the public. 

    More information is available from CDC: How to Protect Yourself & Others.

    Suspected, probable, or confirmed case of COVID-19

      With a suspected, probable, or confirmed case of COVID-19:  

      • Continue to follow all the recommendations above, including monitoring family, participant, household member, and anyone entering the home, for symptoms of COVID-19, including fever, cough, or shortness of breath. 
      • If you are concerned that you or a household member may have COVID-19, call your doctor or visit Wisconsin Health Connect, an online screening tool that can connect you with clinicians who can answer your care questions. More information can be found on the CDC website.

      If a participant is suspected of or has been confirmed to have COVID-19: 

      • Isolate the participant immediately.
      • Establish contact with the participant’s primary care physician and plan for check-ins as necessary, including through telehealth. 
      • Notify the local public health department.
      • Limit any visitors to the home to only those who are essential. 
      • Ensure regular communication with family, legal guardian, and care team about the participant’s health status. 
      • Educate all household members and any essential visitors about COVID-19 and the risks.  
      • Participants with known or suspected COVID-19 should stay in one room, away from other people, including staff, as much as possible. 
      • Obtain testing for staff and residents when appropriate and applicable. 
      • If the participant requires personal care, limit the specific staff who support that person and ensure use of appropriate PPE at all times. Establish strategies to conserve the use of PPE.
      • If possible, have the sick person use a separate bathroom. If a separate bathroom is not available, the bathroom should be cleaned and disinfected after each use by the sick person. 
      • Closely monitor roommates and other participants who may have been exposed to the person with COVID-19 and, if possible, avoid placing unexposed residents into a shared space with them. Support both the sick person and other participants to understand importance of mask-wearing and social distancing when in shared spaces, if sharing of space cannot be avoided. 
      • Ensure guardians and family members are all informed of proper protocols to take with participants who are not sick, but live in a home with confirmed cases of COVID-19 and provide additional communication methods if visits are not possible.
      • Move regularly used furniture and other household items to maintain a six-foot distance between people in any shared space. 
      • Wash the laundry of the person with COVID-19 thoroughly. If laundry is soiled, wear disposable gloves and keep the soiled items away from your body while laundering. Wash your hands immediately after removing gloves.

      To continually monitor a sick participant:

      • Increase monitoring of sick participants to at least three times daily in order to identify and quickly manage any serious infections. If exhibiting emergency warning signs, including trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face, call 911 and seek medical attention immediately.
      • Keep the participant’s family, legal guardian, and care team informed at all times. Communications with participants, families, and/or guardians should be proactive and clearly explain the reasons for any changes to normal practices.
      • If participants must leave isolation for any reason, they should wear a cloth face covering (if tolerated), perform hand hygiene, and stay at least six feet away from others wherever possible. 
      • If the participant requires additional care beyond what the usual staff can provide, staff should seek medical attention from the participant’s health care provider. 

       

      Adult Day Services, Adult Day Care Centers, Adult Day Programs, and Adult Prevocational Programs

      Adult day services, adult day care centers, adult day programs, and adult prevocational programs are at increased risk for COVID-19 transmission because there is increased risk when multiple people gather and interact. Careful considerations should be made related to capacity, spatial separation, physical distancing, infection control practices, and staffing. Facilities and programs should follow all appropriate provisions in the All Providers section as well.

      Prevention and response plan

      Develop or review business continuity plans to help prevent the spread of disease and to keep critical services functional if staffing levels drop due to illness, or taking care of ill family members, friends, or children that may be temporarily out of child care or school settings. A “delegation of authority” clause should be developed to ensure organizational leadership is clearly defined in the event current leadership is personally impacted. Employers or facility or program leadership are encouraged to provide support for staff, employees, and volunteers, such as time off, scheduling flexibility, or assurance that a job will not be lost if work is missed due to illness or caring for others who are ill or children that are out of child care or school settings.

      Additional information is available on emergency paid sick leave rights for eligible employees through December 2020.

      Preparedness

      • Each group setting should assess the number of participants they serve who are at greatest risk of COVID-19, including those with underlying conditions, disabilities, and/or who are older than age 65, using CDC guidelines.
      • Each group setting should determine the number of people who can safely socially distance given the square footage and layout of the facility. Consider adding visual markings throughout the facility to assist with social distancing and to indicate where allowed seating and standing may take place. Consider staggered scheduling and/or identify small groups of individuals who can receive services together and remain with the same staff member, to the extent possible, in an effort to limit exposure.
      • Provide “this is what six feet is” signs throughout facilities to offer a visual of the physical distance expectation. Individuals with visual impairments should be offered additional assistance and support to ensure proper physical distancing.
      • Design common areas to maintain physical separation among participants whenever possible. Consider limiting seating options by removing unnecessary chairs in reception and meeting areas, lunch rooms, and other areas where people ordinarily congregate.
      • Identify a location in the facility to isolate an individual if they develop symptoms of COVID-19, including fever, cough, or shortness of breath, during the day until they are able to safely return home.
      • Design activities and schedules to limit movement throughout spaces; the fewer surfaces or areas an individual person comes into contact with helps to lower the risk of spread or exposure to both participants and staff.
      • Consider controlled entrance into buildings to manage visitors. Consider locking entrances and installing wireless doorbells, etc.
      • Ensure you have adequate supplies of soap, paper towels, tissues, hand sanitizers, cleaning supplies, and garbage bags, as well as a sufficient supply of disposable gloves, face masks or face coverings, or other necessary PPE are available for both program participants and program and facility staff, volunteers, and essential visitors. Have a process in place for ensuring the cloth face covering is changed and/or laundered should it become visibly soiled or wet.
      • Place alcohol-based hand sanitizer and trash containers throughout the facility. Make sure tissues are available and any sink is well stocked with soap and paper towels for hand washing.
      • Hand hygiene stations should be set up at the entrance of the facility so that people can clean their hands before they enter. If a sink with soap and water is not available, provide hand sanitizer with at least 60% alcohol. If feasible, establish one door to be the facility entrance and one door to be the exit. If possible, place sign-in stations outside, and provide sanitary wipes for cleaning pens between each use.
      • Use hands-free systems as much as possible (for example, install foot operated trash containers and hands-free soap and paper toweling dispensers).
      • Use signage, posters, and fact sheets to educate staff, family, friends, visitors, designated representatives, and participants of ways to protect themselves and others. Materials should be offered in the languages used among participants, staff, and the community that the program or facility serves.

      Infection prevention policies and procedures

      • Designate a staff person to be responsible for responding to COVID-19 concerns. Staff, volunteers, participants, and family or guardians should know who this person is and how to contact them. Consider an internal COVID-19 Taskforce comprising a cross-section of employees to continually review policy and practices and to respond to changing recommendations from the CDC and other sources.
      • Have a process in place to notify your local or tribal public health department if a participant or staff member is suspected of having COVID-19. In addition, notify the participant’s primary residence if they live in a congregate setting.
      • Create communication systems for staff and families for self-reporting of symptoms and notification of exposures and closures.
      • CDC recommends wearing cloth face coverings in public settings where it is difficult to stay six feet away from others. Some people cannot wear a cloth face covering safely. Cloth face coverings should not be placed on anyone who has trouble breathing, who is unable to remove the covering without assistance, or who expresses unmanageable discomfort wearing a mask. In addition to medical considerations, individuals may fear racial profiling or discrimination based on wearing—or not wearing—a face covering. Businesses requiring cloth face coverings should allow for exceptions based on health and safety concerns of individuals.
      • Routinely during the day, clean and disinfect surfaces and objects that are frequently touched in common areas (for example, door handles, faucets, toilet handles, vending machines, telephones, light switches, handrails, countertops, chairs, tables, remote controls, and shared electronic equipment). Document all cleaning activities.
      • Use all cleaning and disinfection products according to the directions on the label.
      • Develop and provide regular personal hygiene and infection control training for staff and program participants.
      • Create a communication plan for keeping participants, families or guardians, residential staff, and care teams informed of the most up-to-date practices.

      Daily operations

      • Consider cross training personnel to perform essential functions so the facility is able to operate even if key staff are absent. Cross training is an essential part of business continuity plans and should be an area of focus in response to a wide variety of emergency situations.
      • Develop plans to monitor absenteeism of staff and participants in the facility in order to identify if there is a cluster of illness associated with the program.
      • Ensure staffing levels are adequate to maintain physical distancing of six feet between people during meals, activities, and daily routines.
      • Have a process in place for designated representatives to take staff, volunteer, and participant temperatures and to check for signs and symptoms of COVID-19 every day before arriving to the facility. Individuals who have a fever of 100.4 degrees Fahrenheit or above or other signs of illness should not attend the day program until cleared by a health care professional.
      • Develop policies, following CDC guidelines, for the safe return of individuals who demonstrate symptoms of COVID-19.
      • Follow DHS guidance regarding the appropriate use of PPE, and consider strategies to best conserve PPE, when it is available.

      Preparing and supporting participants

      • Participate in person-centered planning with the individual and their legal guardian, family, or care team to create backup plans should the setting experience a COVID-19 outbreak.
      • Make every effort to allow an individual to maintain their paid employment. See the Employment and Financial Rights document from the Board for People with Developmental Disabilities for additional information.
      • Encourage family, legal guardians, and providers to proactively introduce the use of a cloth face mask to the individual, photos of people wearing masks and shields, informal exercises to practice standing on six-foot “circles” at the setting. Consider employee use of photo badges or pins with photos of themselves without masks to assist participants in identification of staff behind cloth masks.
      • Alternative ways to provide a service should be implemented for individuals who have disability-related reasons making compliance with COVID-19 rules difficult (for example, sensory issues or breathing challenges that interfere with wearing a mask), have difficulty understanding or following instructions to successfully socially distance, exhibit challenging behaviors, or need a greater level of personal care (for example, assistance toileting, feeding, cleaning of ports). These individuals are still entitled to receive services.
      • Consider developing and offering a virtual platform that will allow options for individuals to continue to meaningfully engage and receive services, particularly for those who are unable to return to congregate settings at this time.
      • Create or access credible COVID-19 educational materials and information for participants and staff to support them during the day.
        • You can spread COVID-19 to others even if you do not feel sick, so you should follow these hygiene practices.
        • Wash your hands often with soap and water for at least 20 seconds, especially after you have been in a public place or after blowing your nose, coughing, or sneezing.
        • If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol.
        • Avoid touching your eyes, nose, and mouth with unwashed hands.
        • Cover coughs and sneezes with your elbow, even if wearing a cloth face covering.

      Transportation

      For those programs that are also involved with transportation of participants, see the guidelines for people who provide Medicaid transportation. The following are some additional recommendations from CDC:

      • Institute measures to physically separate or create distance of at least six feet between all occupants to the extent possible. This may include closing every other row of seats and reducing maximum occupancy and increasing the number of pickup or drop-off routes. If it is not possible to meet the six-foot distancing requirement, DHS recommends that all vehicle occupants wear face masks or cloth face coverings during transport to the extent feasible.
      • Promote healthy hygiene practices.
      • Intensify cleaning and disinfection.
      • Ensure that ventilation systems operate properly and increase circulation of outdoor air as much as possible (for example, by opening windows and doors). Do not open windows and doors if they pose a safety risk to passengers or employees or other vulnerable individuals.

      Drop-off and pickup

      • Consider staggering arrival and departure times and plan to limit direct contact with family and friends as much as possible. If this is not possible, put tape on the ground, signage, or some other indicator for six feet of distance so a line or crowd does not form while people are waiting to wash hands, sign in, get their temperature checked, etc.
      • Have anyone entering the site use the entrance with hand hygiene station and screening stations.
        • If conducting temperature screening, facility staff should take the temperatures of employees, volunteers, participants on-site with a no-touch thermometer each day before they enter the facility. Health checks should be conducted safely and respectfully and in accordance with any applicable privacy laws and regulations. The most protective methods involve maintaining a distance of six feet from others and/or physical barriers to minimize close contact with employees. If you screen employees, please follow these CDC guidelines, and develop written policies or procedures.
        • If not conducting temperature screening on-site, staff, volunteers, and participants should take their own temperature before entering the facility daily. Normal temperature should not exceed 100.4 degrees Fahrenheit.
        • If a staff member, volunteer, or participant has a positive symptom screen or a fever, they should not attend or enter the day program. Staff may need to consult with a supervisor for proper next steps if the positive symptom screen is a participant.
        • If someone is identified as ill, follow your response plans for isolating ill people and sending them home. See below for additional information.
      • Create a process to assist individuals with cloth face coverings prior to entrance to the building and when exiting the building. Individuals should be frequently reminded not to touch their face covering and to wash their hands frequently. Information should be provided to individuals and caregivers on the proper use, removal, and washing of cloth face coverings.

      Going out into the community

      • Day programs should discourage nonessential outings into the community. When outings are essential, follow WEDC guidance for outdoor gatherings.
      • Ensure proper physical distancing inside vehicles, and ensure vehicles are large enough to meet physical distancing standards.
      • Assist individuals to follow appropriate social distancing and hygiene routines if they go to work or volunteer sites or if they use public transportation. Follow specific guidance for Wisconsin businesses and transportation.
      • Everyone should wear a cloth face covering when they have to go out in public (for example, to the grocery store or to pick up other necessities).
      • Staff should strongly encourage residents to comply with social distancing (i.e., remaining at least six feet part).
      • The cloth face covering is not a substitute for social distancing.
      • The number of staff who support individuals who require personal care, job coaching, or other supports that do not allow for social distancing should be limited.
      • The ability of someone to comply with wearing a mask should not mean they cannot interact with the community. Every effort should be made to ensure all residents are able to get outside, see family and friends while engaging in social distancing when possible, and engage in safe activities outside that do not involve direct contact with the public.

      More information is available from CDC: How to Protect Yourself & Others.

      Response strategies

      • Do not allow symptomatic people to come to work or the program site. Send individuals home if they arrive at the site, and do not allow them to return until they meet one of the CDC strategies to discontinue isolation and have consulted with a health care provider or health department.
      • If you identify someone who is ill throughout the day, isolate the individual immediately and send them home.
      • Establish contact with the individual’s family, legal guardian, or care team immediately.
      • If you identify multiple individuals who are ill and have had close contact, contact your local or tribal health department for guidance. Cooperate fully with state or local health department contact tracing efforts.
      • Closely monitor staff and other individuals who may have been exposed to an individual with suspected or confirmed COVID-19 for symptoms of COVID-19, including fever or chills, cough, shortness of breath, headache, sore throat, congestion, and more.
      • Implement the previously developed COVID-19 response and communication plan. For additional information, please see the Wisconsin Economic Development Corporation’s guidance for employers.
      • Ensure guardians and family members are all informed of proper protocols to manage a situation if a suspected or confirmed COVID-19 exposure occurs.
      • Ensure all documentation and reporting is done in a manner that protects the confidentiality of the person infected.
      • If an individual or employee is suspected or confirmed to have COVID-19, in most cases, you do not need to shut down your facility. Close off any areas used for prolonged periods of time by the sick person. Use CDC cleaning and disinfection recommendations if an employee has been diagnosed with COVID-19 and has used the facility in the last six days. Only properly trained individuals should perform the required cleaning and disinfection.
        • Wait 24 hours before cleaning and disinfecting to minimize potential exposure. If waiting 24 hours is not feasible, wait as long as possible.
        • During this period, open outside doors and windows to increase air circulation in these areas.
        • Clean dirty surfaces with soap and water before disinfecting them.
        • Always wear gloves and protective clothing appropriate for the chemicals being used when you are cleaning and disinfecting.

       

      Home Care Providers, Hospice, Home Health Agencies, Personal Care Agencies, and Private Duty Nursing

      This guidance applies to home care providers and staff, in-home hospice providers, certified home health agencies, personal care agencies, supportive home care agencies, and private duty nursing. The purpose of this guidance is to provide the best information currently available to help providers prevent the spread of COVID-19 to the participants they serve and to the staff who deliver their care. Providers should follow all appropriate provisions in the All Providers section as well.

      Regulatory and policy changes

      Division of Quality Assurance Waivers and Variances for Home Health Agencies and Hospices

      The DHS Division of Quality Assurance (DQA) will notify providers through its existing notification process if any blanket waivers of Wisconsin Administrative Code are issued. DQA-regulated home health agencies and hospices can apply for an individual waiver or variance to Wisconsin Administrative Code by completing and submitting the Waiver or Variance Request form, F-02527. Home health agencies and hospices are encouraged to notify the managed care organizations with which they contract if they receive DQA approval for an individual waiver or variance. 

      Department of Safety and Professional Services Waivers and Variances

      The Wisconsin Department of Safety and Professional Services (DSPS) is responsible for licensing requirements for registered nurses (RNs) and other health care professionals. Refer to the DSPS website for the most current information on waivers and more.

      ForwardHealth (Medicaid) Policy Changes

      Providers should review the ForwardHealth Portal for information about ForwardHealth (Medicaid) policies that may have changed as a result of the COVID-19 outbreak. For specific questions about COVID-19 as it relates to ForwardHealth (Medicaid) coverage and policy, please contact DHS.

      Federal Regulation Waivers

      CMS has issued blanket waivers of some federal regulations. Federal requirements without a blanket waiver remain in effect. To request a waiver of a federal requirement not covered under a blanket waiver, a provider must submit a request for a Section 1135 waiver on an individual basis to CMS. Providers should review the CMS 1135 waiver guide to ensure their request contains all necessary information and elements. Questions regarding Section 1135 waivers should be emailed to CMS 1135 waiver. Providers are encouraged to notify the managed care organizations with which they contract if they receive CMS approval for an individual waiver.  

      Note: A federal waiver does not necessarily waive Wisconsin Administrative Code. Providers should review state policy pertaining to the services rendered.   

      Infection prevention and control

      Older individuals, individuals with disabilities, and medically vulnerable individuals have significantly increased risk of severe illness and death from COVID-19, necessitating that all reasonable efforts are taken to prevent introduction and spread of this infectious disease into each participant’s home.

      Health care workers, visitors, and others interacting with this population are the most likely sources of introduction of COVID-19 into participant residences.

      Providers should review, implement, and reinforce infection prevention and control interventions for preventing communicable disease among all home care workers, staff, and participants.

      If one of your home care workers, staff, or participants is diagnosed with COVID-19, immediately contact your local public health department to receive further guidance on infection prevention and control.

      Staffing

      Providers should immediately implement procedures for evaluating employees for symptoms of respiratory illness before every visit involving direct participant care. Monitoring should include temperature monitoring and query of symptoms of COVID-19-like illness, which include any of the following:

      • Measured temperature >100.0 degrees Fahrenheit (37.8 degrees Celsius) or subjective fever
      • New or worsening cough, new or worsening shortness of breath, unexplained muscle or body aches, and/or sore throat

      Monitoring may be performed either by designated staff at the providers’ office or remotely by employees themselves with allowances for documentation of the symptoms screen to supervisors (for example, via text, email, or other methods).  

      Refer to DHS guidance for recommendations on when health care personnel without symptoms who were exposed to COVID-19 can return to work.

      Any staff who develop signs and symptoms of a respiratory infection while on the job should:

      • Immediately stop work, put on a face mask, and self-isolate at home.
      • Inform the clinical manager, manager or supervisor of information on individuals, equipment, and locations the person came in contact with.
      • Contact their local health department for next steps.

      Providers should take additional staffing precautions with any staff who work in multiple settings or multiple facilities as they pose a greater risk for contributing to intra- and inter-facility spread of COVID-19. Home care providers should schedule or assign staff appropriately to ensure they do not place individuals in the location where participants are receiving services at risk for COVID-19. Staff who work in multiple locations should be encouraged to tell providers if they have had exposure to other settings with recognized COVID-19 cases.

      Providers should have a contingency plan for continuing participant care if a large proportion of staff become sick. The contingency plan should identify minimum staffing needs and priorities for critical and nonessential services based on the health status, functional limitations, disabilities, and essential needs of their participants.

      Participant care

      Providers should:

      • Consider limiting the number of in-person home care visits to prevent the introduction of the virus into the participant’s home, if appropriate, based on their care needs.  
      • Consider substituting telehealth (consultation by phone or video chat) for an in-person visit. While telehealth may not be appropriate for many types of visits, telehealth may be an alternative for certain visits, such as those done by personal care worker’s RN supervisors, social workers, etc. Providers should refer to federal and state guidance regarding telehealth.

      Workers should:

      • Continue to follow all standard infection prevention and control protocols, including but not limited to, hand hygiene (handwashing or use of alcohol-based hand rub), cough etiquette, appropriate use of PPE, when available, etc.  
      • When not performing direct care, limit contact as much as possible with the participant and other individuals in the household by identifying ways to avoid direct contact and maintain physical distancing (six feet or more).  
      • Limit contact with surroundings through measures, such as placing a barrier between equipment and the object the equipment will rest on, placing a barrier on furniture before sitting down, etc.
      • Only bring in necessary supplies, equipment, and materials.
      • Wear the recommended PPE that is appropriate for the given situation. Due to PPE shortages, providers should identify ways to preserve PPE supplies and should develop protocols for managing clients or patients with limited or no PPE. If N95s or face masks are not available, providers should implement use of universal cloth face coverings by all workers (source control) when they enter the participant’s residence.  

      Providers and/or workers should screen participants before or immediately upon arrival to the home. Providers and/or workers should ask the participant if they or anyone who is in the residence currently, or in the past seven days, have new onset of fever OR cough OR shortness of breath OR sore throat that cannot be attributed to an underlying or previously recognized condition (for example, asthma, emphysema).  

      • If NO, then COVID-19 may be less of a risk. If the participant reports other illness, providers should manage as per their organization’s usual protocols.
      • If YES, then providers should manage per their organization’s COVID-19 protocols:
        • If the participant is sick and needs immediate medical attention (for example, difficulty breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, bluish lips or face) call 911 for transport to a hospital and inform 911 that the participant may have COVID-19 to ensure appropriate infection control is implemented.
        • Notify the participant’s medical provider. If staff are unable to enter the residence and rescheduling the appointment may not be an acceptable option, the medical provider and your organization may need to evaluate whether the participant can still safely receive home care or should be transferred to a hospital or other health care facility. Also notify the client or patient’s managed care organization or other care coordinator, if applicable.
        • If direct care is not required, remember to maintain a distance of six feet or more from the person who is sick and any other people in the residence.
        • When appropriate, postpone the visit for a time when the person who is ill has had at least seven days following onset of illness and 72 hours after being consistently afebrile without use of antipyretics and with resolving respiratory symptoms. If not possible and it is the participant who is sick, prepare to manage them with appropriate PPE and in accordance with your organization’s COVID-19 protocols.
        • In some cases, telehealth (consultation by phone or video chat) may be substituted for an in-person visit.  

      Providers should contact their local health department for questions and frequently review the CDC website dedicated to COVID-19 for health care professionals.  

      Participant rights and well being

      All participants should continue to be made aware of their rights. If a participant’s visitation with family and friends is limited, efforts should be made to support them to continue their relationships through means, such as phone calls.

      Last Revised: September 8, 2020