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Guidance for the Domiciliary Care (Dom Care) Program

The Pennsylvania Department of Aging recognizes that the COVID-19 pandemic may have a long-term impact on providers, consumers, and standard operating policies and procedures of the Dom Care program. In accordance with Governor Wolf's strategic phased reopening plan for Pennsylvania, the following provides guidance to Area Agencies on Aging (AAAs) during the plan's Yellow and Green Phases for safely returning to in-home, face-to-face visits for purposes of conducting essential activities related to the Dom Care program. This guidance does not apply to Protective Services.

The safety of our Dom Care providers, consumers and the aging network is the primary concern; therefore, it will be important to continue to follow Centers for Disease Control and Prevention (CDC) and Pennsylvania Department of Health (DOH) guidelines for mitigating the spread of the COVID-19 virus. The Department of Aging and the AAA network recognize the perceived fears and uncertainty that providers, consumers and staff are experiencing as operations return to a "new normal" and will remain aware of this level of discomfort in making decisions regarding provider and consumer contact and related activities for the Dom Care program. 


​Yellow Phase:
Continue with telephonic assessments, Care Plan updates, and contacts unless there are extenuating circumstances, which may include emergency relocations and response to a behavioral or mental health issue

When the AAA believes it is necessary to conduct an in-home visit and the supervisor has approved, the Care Manager will:
    • Contact the provider to explain the need for and schedule the in-home visit
    • Complete a COVID-19 Consumer Comfort Level Screening of both the provider and consumer(s) 
        • Maintain a record of the screenings as a file attachment to the consumer’s record in SAMS
    • Complete a COVID-19 Consumer Health Screening of the provider, consumer(s), and other individuals in the home
        • Maintain a record of the screenings as a file attachment to the consumer’s record in SAMS
    • Schedule the visit if the provider and consumer(s) are comfortable with the in-home visit
    • Discuss any concerns with conducting the in-home visit with the supervisor
    • Document the reason for the in-home visit and outcomes of the Comfort Level Screenings and Health Screenings in a journal entry in SAMS  
The supervisor shall document their approval for the in-home visit in a journal entry in SAMS

If the provider or consumer(s) are not comfortable with the in-home visit, the Care Manager will:
    • Attempt to ask the provider or consumer(s) to explain what makes them uncomfortable about the in-home visit and what could be done to make them feel more comfortable
    • Discuss the situation with their supervisor
    • Explore alternatives to conducting the in-home visit, such as, conducting the meeting on the porch through the screen door (Applicable to situations that do not rise to the level of potential abuse or neglect)
    • Document the reasons in a journal entry in SAMS
On the day of the in-home visit, the Care Manager will:
    • Call the provider to reconfirm the in-home visit
    • Ask the provider if anything has changed since the last time you spoke
        • Confirm the provider and consumer(s) are still comfortable with the visit utilizing the COVID-19 Consumer Comfort Level Screening forms attached to the consumer’s record in SAMS 
        • Confirm no change in the health screenings utilizing the COVID-19 Consumer Health Screening forms attached to the consumer’s record in SAMS
    • Conduct a self-evaluation as to their own health condition and comfort level
    • Discuss any concerns with conducting the in-home visit with their supervisor
    • Reschedule the in-home visit if needed.  Document the reasons for rescheduling an in-home visit in a journal entry in SAMS

When conducting the in-home visit:

    • Follow applicable CDC Community Mitigation Guidelines and PA Department of Health Guidelines for Providers & Facilities (located in the Additional Resources section of this page)
        • Assure the Care Managers are equipped with appropriate safety and hygiene supplies (masks, hand sanitizer, etc.)
        • Maintain social distancing within the home
    • Consider Best Practices, such as:
        • Ask the provider during the call made on the day of the scheduled visit if they and other individuals in the home have masks
        • Bring extra masks to the home in the event the consumer(s) and other individuals in the home do not have masks
        • Utilize the Consumer Care Plan Report in SAMS to eliminate the need for multiple signatures on various documents
        • Bring extra pens that can be left at the provider’s home when a signature is needed

When a placement has been deemed necessary, the Care Manager will:

    • Follow applicable CDC Community Mitigation Guidelines and PA Department of Health Guidelines for Providers & Facilities (located in the Additional Resources section of this page)
        • Assure all parties involved in the placement utilize appropriate safety and hygiene protocols
        • Encourage the provider and consumer(s) to maintain social distancing within the home, as appropriate
        • Attempt to locate a home where the consumer has a private bedroom for social distancing measures, if available
        • Educate the provider on the use of CDC and PA Department of Health guidelines while assisting the consumer with Activities of Daily Living
    • Maintain frequent contact with the provider during the first two weeks to monitor the placement

Green Phase:

Within thirty (30) business days of a county/PSA moving into the Green Phase, return to conducting in-home visits, including routine placements, reassessments, home and provider certifications, and provider recertification activities, when the provider and consumer(s) are comfortable with the visit, and everyone residing in the home report no signs or symptoms of illness per the health screenings

When a Care Manager contacts the provider to explain the need for and schedule the in-home visit, the Care Manager will:

    • Complete a COVID-19 Consumer Comfort Level Screening of the provider and consumer(s)
        • Maintain a record of the screenings as a file attachment to the consumer's record in SAMS
    • Complete a COVID-19 Consumer Health Screening of the provider, consumer, and other individuals in the home
        • Maintain a record of the screenings as a file attachment to the consumer's record in SAMS
    • Discuss any concerns with conducting the in-home visit with the supervisor
    • Document outcomes of the Comfort Level Screenings and Health Screenings in a journal entry in SAMS
If the provider or consumer(s) are not comfortable with the in-home visit, the Care Manager will:
    • Attempt to ask the provider or consumer(s) to explain what makes them uncomfortable about the in-home visit and what could be done to make them feel more comfortable
    • Discuss the situation with their supervisor
    • Explore alternatives to conduct the in-home visit, such as conducting the meeting on the porch through the screen door (Applicable to situations that do not rise to the level of potential abuse or neglect)
    • Document the reasons in a journal entry in SAMS

On the day of the in-home visit, the Care Manager will:

    • Call the provider to reconfirm the in-home visit
    • Ask the provider if anything has changed since the last time you spoke
        • Confirm the provider and consumer(s) are still comfortable with the visit utilizing the COVID-19 Consumer Comfort Level Screening forms attached to the consumer's record in SAMS 
        • Confirm no change in health screening utilizing the COVID-19 Consumer Health Screening forms attached to the consumer's record in SAMS
    • Conduct a self-evaluation as to their own health condition and comfort level
    • Discuss any concerns with conducting the in-home visit with their supervisor
    • Reschedule the in-home visit if needed. Document the reasons for rescheduling an in-home visit in a journal entry in SAMS
Telephonic assessments, Care Plan updates, and contacts may be conducted, with supervisory approval, when the provider or consumer(s) are uncomfortable with the in-home visit or individuals residing in the home report symptoms of illness as per the health screenings
    • The Care Manager shall document the reason for not conducting the in-home visit, including outcomes of the Comfort Level Screening and Health Screening, in a journal entry in SAMS
    • The supervisor shall document their approval for a telephonic assessment, Care Plan update, or contact in a journal entry in SAMS
When conducting in-home visits, introductions, home and provider certifications, or recertifications:
    • Follow applicable CDC Community Mitigation Guidelines and PA Department of Health Guidelines for Providers & Facilities (located in the Additional Resources section of this page)
        • Assure Care Managers are equipped with appropriate safety and hygiene supplies (masks, hand sanitizer, etc.)
        • Assure the provider and consumer(s) wear masks
        • Maintain social distancing within the home
    • Consider Best Practices, such as:
        • Ask the provider during the call made on the day of the scheduled visit
        • if they and other individuals in the home have masks
        • Bring extra masks to the home in the event individuals in the home do not have masks
        • Utilize the Consumer Care Plan Report in SAMS to eliminate need for multiple signatures on various documents
        • Bring extra pens that can be left at the provider's home when a signature is needed 
When conducting a trial visit or placement, the Care Manager will:
    • Follow applicable CDC Community Mitigation Guidelines and PA Department of Health Guidelines for Providers & Facilities (located in the Additional Resources section of this page)
        • Assure all parties involved in the placement utilize appropriate safety and hygiene protocols
        • Encourage the provider and consumer(s) to maintain social distancing within the home, as appropriate
        • Attempt to locate a home where the consumer has a private bedroom for social distancing measures, if available
        • Educate the provider on the use of CDC and PA Department of Health guidelines while assisting the consumer with Activities of Daily Living
    • Maintain frequent contact with the provider to monitor the placement
Recommendations for Care Managers:
    • As day programs, businesses, and other congregate settings begin to reopen in this phase, providers and consumers may become concerned about the exposure to COVID-19. The Care Manager is encouraged to:
        • Assist providers and consumers with updating the House Rules, such as hand sanitizing when returning to the home, proper disposing of masks, or laundering cloth masks
        • Increase communication with the provider and consumers
        • Provide awareness to consumers as to how and where they spend their day
        • Educate providers and consumers on the risks, symptoms, and proper use of safety and hygiene supplies (masks, hand sanitizer, etc.)
        • Educate providers and consumers on the protocols being enforced as businesses reopen, such as social distancing measures and cleaning
    • Ensure Back-Up Plans continue to be current for consumers