Many of our clients provide critical home and residential support services to children, individuals with intellectual and physical disabilities, and the elderly. We understand there is widespread concern regarding how COVID-19 will impact your operations. Below are frequently asked questions we have received.

This situation is rapidly changing, as is the guidance from CDC, public health officials, and regulators. We encourage you to contact your attorney if you have any questions or would like assistance developing your policies, procedures, communication pieces, and action plans.

1. What should HCBS waiver, residential support or other community service providers do now to address the potential spread of COVID-19?

Even if COVID-19 is not spreading within your community, there is much you can and should be doing now to address the potential for community spread within your region. We recommend you access the CDC resources. Guidance includes:

• Preventing the Spread of Coronavirus Disease 2019 in Homes and Residential Communities
• Interim US Guidance for Risk Assessment and Public Health Management of Persons with COVID-19 Exposures
• Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for COVID-19

A common misconception among some community providers is if an individual tests positive for COVID-19, they will be admitted to a hospital or other setting for monitoring. Based on the information currently available from public health officials, if an individual’s condition does not warrant hospitalization, they would likely stay in their home.

Therefore, community services providers should be prepared for the possibility they will be faced with a client who tests positive for, or has been exposed to, COVID-19. Additionally, community service providers should take measures to limit the potential spread of COVID-19 between staff, clients, and others. To prepare for such a possibility, we recommend community service providers access the CDC resources referenced above and be prepared to address the following issues should COVID-19 impact their communities:

• What precautions will we take to limit spread between staff, clients, and others?
• If a client we serve in a residential capacity tests positive or is undergoing testing for COVID-19, how will we continue to serve this individual?
• What staffing challenges might we face if there is community spread within our region and what alternatives can we implement to allow us to continue to provide services?

2. What specific precautions should a community service provide consider implementing now before community spread?

Based on the CDC guidance, we recommend community service providers implement the following precautions:

• Educate your staff on the signs and symptoms of COVID-19 and require that they alert you if a client is experiencing any of them;
• Encourage your staff who feel sick to stay home;
• Encourage personal protective measures among staff and clients, including hand washing and respiratory etiquette;
• Have staff clean surfaces frequently and ensure hand hygiene supplies are readily available;
• Identify clients that may be particularly vulnerable to COVID-19, including the elderly and those with underlying health conditions;
• Determine what policies you will need if there is community spread of COVID-19 in your area;
• Contact client family members and educate them about your plans;
• Contact your local public health department and discuss your policies and intentions should COVID-19 become widespread and request their input;
• Continue to monitor the recommendations and guidance available from CDC and state and local public health officials.

3. Can residential service providers limit client visitors or restrict clients from leaving?

Yes, we think reasonable limitations in the interest of protecting the health and safety of your clients is allowable in these unprecedented circumstances. If transmission of COVID-19 is widespread in your community, it would be prudent to limit visitors, especially if your clients are elderly or have underlying medical conditions.

Even before widespread community transmission, it would be reasonable to consider screening visitors for recent travel history and potential symptoms or limit the number of visitors. Similarly, you should think about when and how client activities might be impacted. For example, if you provide residential services to clients who work, you may want to consider when and how outside activities might be impacted.

Additionally, if you provide residential services and several clients reside in the same home, you should consider how the activities of the entire household need to be limited. We recommend discussing your policies with clients and family members and communicate frequently and often about how you intend to handle this evolving situation. Depending on the vulnerability of the clients you serve, limiting and screening visitors is a reasonable precaution to take.

4. What will happen if a client tests positive for COVID-19?

Assuming the client is experiencing only mild symptoms, it is very likely they will be left in their home; however, they would likely need to be isolated for 14 days. If they live with others, this may be difficult to implement depending on the population you serve. According to CDC guidance, local public health officials would evaluate the client’s living situation and determine whether a home setting would be appropriate. Depending on the severity of the outbreak, there may not be other options than remaining in the home if the client has mild symptoms. Because this situation is likely to arise if there is widespread community transmission, we recommend community service providers have an action plan for this scenario, including:

• Reviewing the CDC guidance for Implementing Home Care for People Not Requiring Hospitalization for COVID-19;
• Working with your local public health officials to determine an appropriate plan;
• Assessing any additional staffing needs this situation would present and potential staffing challenges, such as how to protect staff members from exposure; and
• If the client shares a home with others, the family members of his/her roommates should be contacted and you should work with local public health officials to determine whether these clients should be moved or can remain in the home.

5. Can and should we screen staff?

Given the current situation we believe it is prudent to screen staff. Examples of screening measures include asking staff about recent travel history and cold or flu-like symptoms. If there is community spread in your region, you may want to consider implementing additional screening measures such as temperature and respiratory symptom checks when they report to work. These screenings should be logged. If staff have been exposed to COVID-19, test positive for COVID-19, have cold or flu-like symptoms, or restrictions based on travel, you should consider what your leave policies will be. In addition, you should monitor new developments relating to paid leave as federal or state law may change.

6. Can and should clinic providers screen patients and families?

We suggest you post signs on entrances requesting individuals with recent travel history to countries with travel restrictions or those experiencing cold/flu symptoms to refrain from entering. Alternatively, you could ask about recent travel history or cold/flu symptoms at check in. Patients and/or families with travel history to areas significantly impacted by COVID-19 or experiencing cold/flu symptoms could be asked to reschedule. If you have community spread within your region, you may want to consider closing clinic locations for a period of time depending on the services you provide. Additionally, if you provide both clinic and residential services you may need to divert staffing resources from clinic locations to residential services if you are experiencing staff shortages.