Adult day services, adult day care centers, adult day programs, and adult pre-vocational 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/programs should follow all appropriate provisions in the COVID-19: Long-Term Care Facilities and Services accordion/dropdown/section on this page for:

• Visitors to facilities
• Guidance for all facilities
• Resources

Develop a COVID-19 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/program leadership are encouraged to provide support for staff/employees/volunteers such as time off, scheduling flexibility, or assurance that a job won’t 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 on Emergency Paid Sick Leave rights for eligible employees through December 2020 is available,

Prepare your setting

• 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 that 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 6 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/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, facemasks or face coverings, or other necessary personal protective equipment are available for both program participants and program/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.
• Utilize hands-free systems as much as possible, for example, install foot operated trash containers, 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/facility serves. See the following infographics and print materials.
  • Coronavirus disease
  • Please do not visit
  • Wash your hands!
  • Tips for staying safe
  • How to make a face cloth covering
  • How to protect yourself

Develop 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 Taskforce comprised of 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/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 6 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 (e.g., 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/guardians, residential staff, and care teams informed of most up to date practices.

Prepare for 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 each staff, volunteers and participant’s temperature and to check for signs and symptoms of COVID-19 every day before arriving to the facility. Individuals who have a fever of 100.4F or above, or other signs of illness should not attend the day program until cleared by a healthcare 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 personal protective equipment (PPE), and consider strategies to best conserve PPE, when it is available.

Prepare and support participants

• Participate in person centered planning with the individual and their legal guardian, family or care team to create back up plans should the setting experience a COVID-19 outbreak.
• Every effort should be made to allow an individual to maintain their paid employment. See 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 6-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, such as 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—assistance toileting, feeding, cleaning of ports etc.; 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 that 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 guidelines for people who provide Medicaid transportation. Here are some additional recommendations from the 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 pick up/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. Clean and disinfect frequently touched surface. Ensure safe and correct application of disinfectants. Follow CDC guidance for disinfecting non-emergency transport vehicles. Ensure safe and correct application of disinfectants.
  • Ensure that ventilation systems operate properly and increase circulation of outdoor air as much as possible such as 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.

Guidance during drop off and pick up

• Consider staggering arrival and departure times and plan to limit direct contact with family/friends as much as possible. If this isn’t possible, put tape on the ground, signage, or some other indicator for 6 feet of distance so a line/crowd doesn’t form while people are waiting to wash hands/sign-in/get their temp checked, etc.
• Have anyone entering the site utilize the entrance with hand hygiene station and screening stations.
  • If conducting temperature screening facility staff should take 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 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 persons and sending individuals 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 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; 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, volunteer sites, or if they use public transportation. Follow specific guidance for Wisconsin businesses and transportation.
• Follow these recommendations for all outings into the community:
  • 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 6 feet part).
  •  The cloth face covering is not a substitute for social distancing.
  • The number of staff who support individuals who require personal cares, job coaching or other supports that don’t 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 can be found at CDC Website:
    • How to Protect Yourself & Others
    • What You Can Do

Response strategies include:

Respond when an individual has symptoms

• 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 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.
• This information is constantly evolving, so please continually check the DHS COVID-19 webpage for updated information.