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Guidance for Reopening & Operation of Older Adult Daily Living Centers 

During COVID-19 in Counties That Have Transitioned to the GREEN PHASE

The role of Older Adult Daily Living Centers (Centers) in caring for the Commonwealth’s elderly population is critically important to older adults and their families. The implementation of policies and procedures when reopening is crucial and essential to ensure the health and safety of participants, Center staff and families. 

The following are measures Centers should take to protect individuals in Centers. Adults in dual-licensed centers not subject to chapter 11 Older Adult Daily Living Center requirements should follow guidance issued by the Pennsylvania Department of Human Services Office of Developmental Programs. Be sure to watch for updates as new Pennsylvania Department of Aging (PDA) guidance develops.

Centers have the flexibility to make decisions and implement policies and procedures regarding the safety of Center participants. Implemented policies and procedures shall not conflict with current directives issued by the Governor during the Disaster Declaration, or current regulation, unless waived by PDA during the Disaster Declaration.

Prior to Reopening

Prior to reopening, clean and disinfect the Center and Center-owned vehicles for infection control according to the Pennsylvania Department of Health (DOH) and Centers for Disease Control (CDC) guidelines. Once the Center is open, practice daily periodic routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks and cell phones). Also, request the cleaning and disinfecting of contracted transportation services. If possible, avoid mass transit. 

Daily Health Checks for Participants and Staff:

  • If feasible, Centers should conduct wellness checks prior to staff or participants entering the Center. Centers should maintain consistent, daily communication about wellness checks. Wellness checks can be conducted through email, in person, or over the telephone for participants and staff, using the written wellness checklist. If possible, assess participants’, staff’s, and families’ health prior to their access to the program areas.
  • It is strongly recommended that Center staff take the temperature of all participants and staff upon arrival and record whether they have a fever. No-touch methods are preferred to reduce contact. A fever for the purposes of this screening is > 100° F. If not done as part of the telephone check, Center staff should also administer a written wellness checklist to ascertain whether it is appropriate for a participant or staff member to attend the center. A screening area away from the general population must be identified for on-site center screenings and should be separate from the holding area for persons with symptoms.
  • Exclude participants and staff with symptoms, as stated in current DOH and CDC guidance, which currently includes fever and respiratory symptoms (cough, runny nose, sore throat, shortness of breath, fast breathing), diarrhea, chills, repeated shaking with chills, muscle pain, headache, new loss of taste or smell).
  • Exclude staff or participants with temperatures of > 100° F or other symptoms as stated in current DOH and CDC guidance from the program area and direct them to the holding area. Staff with temperatures of > 100° F or other symptoms will be sent home and directed to contact their physician for consultation.
  • Contact the family or caregiver of a participant with a temperature of >100 °F, and if needed contact the participant’s physician in accordance with current regulatory guidance. The physician’s guidance will be reviewed, including documentation of when they can return to the center.
  • Once an individual with symptoms leaves the Center, sanitize the holding area, program areas and transportation in accordance with CDC guidelines. If a transportation provider is impacted, notify them immediately of need to sanitize.
  • Staff members, family members and participants who test positive for COVID-19 must immediately notify the Center, regardless of whether they are showing any symptoms. If a Center is notified that a person has tested positive for COVID-19, the Center staff will follow DOH procedures for contact tracing
  • Program areas contacted by individuals with symptoms will be sanitized following CDC guidelines. In accordance with DOH and CDC guidelines, the Center may be closed for a period as a result of exposure to an individual who tests positive. Center staff should contact their local health department for guidance if a staff member or participant tests positive for COVID-19.

Protection of participants while at the Center:

1. Entry
  • ​Upon arrival, all participants and staff must immediately sanitize their hands.
  • Masks should be worn by staff while in the Center and participants who are asymptomatic (as able) in accordance with DOH guidelines. 
  • Limit personal items coming into the day program. Disinfect any necessary personal items.
​2. Location, ratios and program activities:
  • ​Centers should maintain care for participants in their normal licensed program areas and locations.
  • Centers should maintain required staff-to-participant ratios.
  • Centers must reduce staff-to-participant ratios if required by DOH or CDC guidelines to maintain social distancing. Centers should use social distancing (6 feet apart) within groups as required by DOH or CDC guidelines. Centers shall assess program areas and make appropriate adjustments to maintain social distancing.
  • Centers should determine if they can serve all enrolled individuals while maintaining social distancing.
  • Centers should consider an evaluation of participants, caregivers, and caregivers’ availability to provide or access care for participants, in order to determine who are the most care-dependent and have the greatest need, who should have the highest priority for Center services. Centers must develop a plan for enrolled individuals who cannot be served, including notification of on-hold status, homecare, possible schedule alternatives, or referral to another day center.
  • Meals should be plated and served to participants. Family-style meals are prohibited. Staff must wear appropriate PPE to serve meals to participants, as well as meet SERV Safe requirements.
  • Centers should plan activities that do not require close physical contact between multiple participants. Centers should limit item sharing.
  • Centers should host any events in accordance with DOH and CDC guidelines.

​3. Participant care:
  • ​Centers should update care plans for all individuals and incorporate information to address high-risk participants with any additional measures that might be necessary to reduce the risk of infection of COVID-19.
      • High-risk participants include people of any age who have serious underlying medical conditions including the following:
          • People with chronic lung disease or moderate to severe asthma
          • People who have a serious heart condition
          • People who are immunocompromised (Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications)
          • People with severe obesity (body mass index [BMI] of 40 or higher)
          • People with diabetes
          • People with chronic kidney disease undergoing dialysis
          • People with liver disease
  • Centers should keep current on guidance issued by DOH and CDC.
​4. Protection of participants, staff and families:
​5. Infection control:
  • ​Centers should use strict hand hygiene at all times. Lather for 20 seconds with soap and water or use 60-95% alcohol-based hand sanitizer after any contact with participants and after contact with high touch areas, i.e., doorknobs, countertops, and especially anything at the level that individuals touch.
  • Centers should enforce strict respiratory etiquette. Cough or sneeze into a tissue and deposit into a waste receptacle, cough or sneeze into an elbow or shoulder, and avoid any touching of your eyes, nose, mouth, or face.
  • Centers should refer to the guidance stated above in the Daily Health Checks for Participants and Staff section and follow established procedures for participants who become sick at the Center.
  • Masks should be worn in accordance with DOH guidelines. PPE shall be used in accordance with DOH and CDC guidelines, with special attention paid to the rules regarding one-on-one participant/staff contact.
  • Centers should practice daily periodic routine cleaning of frequently touched surfaces (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks & cell phones). Request that contracted transportation services also clean and disinfect (If possible, avoid mass transit). Cleansers should not be left unattended in accordance with current licensing standards.
  • If the Center learns that a participant or staff person tested positive for COVID-19, inform the PDA Division of Licensing by contacting the appropriate Regional Human Services Licensing Representative, or the Division Chief at 717-433-0393. Consistent with the Governor’s Emergency Disaster Declaration, Centers shall submit reports of COVID-19 immediately to PDA due to the urgent need to quickly respond to proactively mitigate the spread of COVID-19.
​6. Staff illness:
​7. Documentation:
  • ​Centers should maintain daily documentation of staff and participant temperatures taken at arrival to the program and throughout the day if needed. The Center must document staff and participant temperatures >100° F.
  • Centers should maintain daily documentation of any staff or participants who were refused entry or returned home due to exhibiting symptoms of the virus.
  • Centers should document daily sanitization of the day program areas prior to opening.
  • Centers should document daily participant attendance and staffing numbers.
  • Centers should maintain daily documentation of the number of participants or staff returned home due to implementation of measures to maintain social distancing. This includes participants who must return home because they cannot comply with social distancing due to a mental or physical condition.
  • Centers should document the issuance of PPE to staff, if the use of PPE is recommended by DOH.
  • In order to meet these documentation requirements, Centers may use the form provided by the PDA’s Division of Licensing or their own form if it meets the requirements contained in the Division of Licensing’s form.
​8. COVID-19 Specific Training:
  • ​Training provided by the Center to Center staff should be consistent with guidance issued by the Office of Developmental Programs.
  • Training created shall reflect the Center’s reopening guidance. Training should contain materials covering the following policies and procedures created to address:
      • Prior to reopening
      • Daily health checks for participants and staff
      • Protection of participants while at the Center (entry, location, ratios and program activities, participant care, protection of participants, staff and families, infection control, staff illness, and documentation).