Guidance for Adult Day Services Centers

Guidance for Adult Day Services Centers

Strategies for Administrators and Staff to Prevent the Spread of COVID-19

Key Points

  • Adult Day Services Centers (ADSCs) provide social or health services to community-dwelling adults aged 65 and over and adults of any age living with disability.
  • Older adults and persons with disabilities are at highest risk for severe illness from COVID-19 including hospitalization, intensive care, and death.
  • ADSC administrators and staff can help protect themselves and program participants (that is, adults attending ADSCs) from COVID-19 by promoting and engaging in preventive behaviors that reduce spread and maintain healthy operations and environments at ADSC facilities.

Introduction

Adult Day Services Centers (ADSCs) are professional care settings where community-dwelling adults receive social or health services for some part of the day. (For further information about ADSCs, visit National Adult Day Services Association [NADSAexternal icon] and Regulatory Review of Adult Day Services: Final Reportexternal icon). ADSCs often serve adults age 65 years or older who may require supervised care and adults (of any age) living with dementia, cognitive decline, or disability. ADSCs are designed to provide a safe, community-based group setting where specific needs are addressed and individualized therapeutic, social, or health services are delivered. These centers provide needed services to participants and also support caregiver employment and provide respite, which benefits the mental health of both participants and caregivers.

ADSCs provide important services for participants and caregivers, but some ADSC characteristics – such as frequent social activities, group dining facilities, communal spaces, and shared transportation – may increase the risk of COVID-19 spread.

Administrators, staff, and volunteers at ADSCs should use the following guidance to plan for and implement prevention strategies to prevent COVID-19 spread at their facilities. This guidance is meant to supplement—not replace—any Federal, state, tribal, local, or territorial public health and safety laws, rules, and regulations with which adult day services center programs must comply. For additional information on steps for reducing risk and other prevention strategies visit extra precautions for older adults and how to protect yourself and others.

Promote behaviors that reduce spread

Encourage COVID-19 vaccination

Stay home when appropriate

  • Educate staff and participants about when they should stay home and when they can safely return to the ADSC.
  • If staff and participants are unsure whether they should stay home, they or their caregiver can use the coronavirus self-checker to help them decide.
  • Staff and participants should not enter the ADSC from the screening area if they:
    • Have symptoms of COVID-19, including:
      • Fever of 100.4o F (38.0o C) or higher or report feeling feverish
      • Presence of signs of illness, which could include flushed cheeks, sweating inappropriately for ambient temperature, or difficulty with ordinary tasks
    • Are undergoing evaluation for COVID-19 (such as pending viral test)
    • Have been diagnosed with COVID-19 in the prior 10 days (or longer if individual had severe or critical illness or if they are immunocompromised).
    • Have had close contact to someone with COVID-19 during the prior 14 days
  • Provide education on COVID-19 related symptoms and reminders to notify center staff if anyone is feeling symptoms of COVID-19. This is critical to provide timely assistance

Wear a mask and assist participants in wearing theirs

  • Staff should wear a mask when in the presence of others. Masks protect the wearer, as well as those around them. Masks work best when everyone wears one.
  • Masks should cover your nose and mouth, fit snugly, and have multiple layers.
    • Wearing masks may be difficult for people with sensory, cognitive, or behavioral issues; people with some disabilities; or people with dementia. Staff members should pay close attention and provide necessary support to participants who have trouble remembering to put on a mask, keeping it on, and removing it when needed.
    • Masks should not be placed on anyone who has trouble breathing, or is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.
    • Masks should not be worn by a person with a disability who cannot wear a mask, or cannot safely wear a mask.
    • Masks should not be worn by a person for whom wearing a mask would create a risk to workplace health, safety, or job duty as determined by the workplace risk assessmentexternal icon.
  • A mask is not a substitute for physical distancing. Continue to keep at least 6 feet between yourself and others, when possible, even when wearing a mask.
  • More information on masks is available at Guidance on Wearing Masks

Wash your hands often, and ensure participants can wash their hands appropriately

  • Staff and participants should wash hands often with soap and water for at least 20 seconds, especially after you have been in a public place or common area or after blowing your nose, coughing, or sneezing.
    • If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry.
    • Staff members should assist people with sensory, cognitive, or behavioral issues, and people with a disability or dementia, who may have challenges washing their hands properly and as frequently as recommended.
  • Visit CDC’s Life is Better with Clean Hands page to download resources to help promote handwashing.

Maintain healthy operations

Reinforce prevention strategies using signs and messages throughout the facility

  • Display visual posters with instructions for maintaining 6-ft physical distancing, wearing masks, taking daily temperatures, and monitoring for other COVID-19 symptoms. Find free print and digital resources on CDC’s COVID-19 communications page.
  • Develop signs and plain language messages in alternative formats (for example, large print, Braille for people who have low vision or are blind).
  • Develop signs and messages in the preferred language(s) of staff and participants. Use COVID-19 easy to read resources, if applicable.
  • Use tape markings on floors to help people to maintain distancing.
  • Place directional arrows to establish the flow of traffic.
  • Designate different doors for entering and exiting center/rooms, if possible.
  • Post signs in highly visible locations (e.g., at building entrances, in restrooms) that promote everyday protective measures and describe how to stop the spread of germs by properly washing hands and properly wearing masks.
  • Use reminders for staff and participants to monitor for COVID-19 symptoms.
  • Broadcast regular announcements on reducing the spread of COVID-19 on public address system, if available.
  • Include messages (for example, training videos for staff, periodic guidance letters for participants to take home) about behaviors that prevent spread of COVID-19 when communicating with staff, participants, and others who may be in your center.
  • Please visit CDC’s Toolkit for Older Adults & People at Higher Risk for population specific posters and messaging to be used as reminders to wear a mask.

Health screening

  • Make employee health screenings as private as possible to prevent stigma and discrimination in the workplace. Do not make determinations of risk based on race or ethnicity and be sure to maintain confidentiality of each individual’s medical status and history. If screening in person, participants, screening staff and employees being screened should wear masks and maintain physical distancing.
  • Consider virtual health checks for employees and participants (for example, symptom and temperature screening) before they arrive at the center, in accordance with state and local public health authorities and your occupational health services (if applicable).
  • Before collecting health-related information from staff or participants, center administrators should comply with requirements of Health Insurance Portability and Accountability Act of 1996 (HIPAA).
  • Remember that symptom and temperature screening cannot identify people with COVID-19 who are asymptomatic (do not have symptoms) or are pre-symptomatic (have not developed signs or symptoms yet but will later). Therefore, wearing masks, physical distancing, hand hygiene, cleaning, and other prevention strategies should still be used to reduce transmission.
  • Refer the individual to their primary care provider immediately or, in case of emergency, call 911, if you think someone is exposed to COVID-19 or may be exhibiting symptoms.
  • For more information, visit Interim Guidance for SARS-CoV-2 Testing in Non-Healthcare Workplaces.

Isolate and transport staff and participants who have symptoms while at the ADSC

  • Plan to have an isolation room or area (preferably with access to a dedicated restroom) you can use to isolate a sick participant or staff member. Ensure that isolated participants are wearing masks, are at a distance of 6 feet or greater from others, and remain under supervision.
  • Staff should isolate people who begin to have these symptoms from others. Prepare a list of all individuals who have been in close contact with sick participant(s) or staff member(s).
  • Notify an emergency contact regarding the sick person’s symptoms and arrange safe and accessible transportation home. Arrange emergency transport to a healthcare facility for participants or staff with severe symptomspdf icon.
  • Close off areas used by a sick person and do not use these areas until after cleaning and disinfecting them; this includes surfaces or shared objects in the area, if applicable.
  • Wait as long as possible (at least several hours) before cleaning and disinfecting. You should ensure safe and proper use of cleaning and disinfection productsexternal icon.
    • Close off areas used by the person who is sick.
    • Open outside doors and windows to increase air circulation.
    • Increase ventilation and wear a mask (in addition to other protection needed for safe use of cleaning and disinfection products) while cleaning and disinfecting.
    • Clean and disinfect all areas used by the person who is sick, such as offices, bathrooms, and common areas.

Notify health officials and close contacts

Modify layouts

  • Arrange tables and chairs to allow for physical distancing. People from the same household can be in groups together. Space seating at least 6 feet apart. Provide visual cues such as tape or chalk to guide spacing.
  • Increase access to handwashing stations or hand sanitizer dispensers at key locations.
  • Minimize traffic in enclosed spaces, such as elevators and stairwells. Consider limiting the number of individuals in an elevator at one time and designating one-directional stairwells, if possible.
  • Ensure the facility entry door and exit door are separate to avoid interaction between incoming and outgoing traffic to ADSC.
  • Ensure that limiting the number of participants and physical distancing can be maintained in shared rooms, such as television, game, or exercise rooms, or rooms for shared worship services.

Physical barriers and guides

  • Install plexiglass barriers in reception and other face-to-face interaction areas.
  • Install physical barriers, such as sneeze guards and partitions, particularly in areas where it is difficult for individuals to remain at least 6 feet apart (for example, reception areas).
  • Provide physical guides, such as tape on floors or sidewalks and signs on walls, to ensure that individuals remain at least 6 feet apart.

Activities

  • Alter schedules, such as staggering meal and activity times, and creating pods (that is, forming small groups that regularly participate at the same times) and do not mix with individuals in other groups.
  • Practice physical distancing and wear masks whether indoors or outdoors, for both staff and participants.
  • Prioritize outdoor activities over indoor activities when possible. Staff should ensure sun safety for all participants and staff of ADSC.
  • Clean tools, materials, and computer or other equipment before and after the participant has finished using them, or at least daily.
  • Postpone musical activities and performances that include playing wind instruments, singing, chanting, or shouting during events, especially when participants are in close proximity to each other.
  • Avoid holding any in-person events that include people who are not staff in the ADSC. If an event is held, follow COVID-19 event considerations, and consider not serving food or having prepackaged boxes or bags instead of a buffet or family-style meals.

Transportation

  • Schedule and stagger drop off or pick up times for participants to avoid crowding.
  • Encourage physical distancing among staff and participants at the entrance and exit during these drop off and pick up times with use of visual cues like tapes and signs.
  • Transport and bus drivers should practice all safety actions and protocols as indicated for other workers (for example, hand hygiene, masks).
    • Follow guidance for bus transit operators to clean buses or other transport vehicles.
    • Seat participants at least 6 feet apart while in transport vehicles.
    • Drivers should provide ventilation by opening the windows or setting the air ventilation/air conditioning on non-recirculation mode when the vehicle is in service.
    • Paratransit drivers should take extra care in transporting patients with special needs and take all necessary safety precautions to prevent COVID-19. Please visit What Paratransit Operators Need to Know about COVID-19 for more information.
    • Create participant pods (keeping small groups together) to limit mixing and create distance between passengers on buses, vans and other transport vehicles (for example,  skip rows) when possible.
  • Encourage participants, workers, and other people at the ADSC who use public transportation to consider using alternatives that minimize close contact with others (for example, walking, biking, driving, or riding by car—alone or with household members only), if feasible. Those who use public transportation should follow CDC mandate on wearing a mask on public transportation and other ways to protect themselves when using transportation.

Maintaining healthy environments

Ventilation

  • Make sure indoor spaces are well-ventilated (for example, open windows or doors when doing so does not pose a safety or health risk to building occupants) and large enough to accommodate physical distancing.
  • Ensure ventilation systems operate properly and increase circulation of outdoor air as much as possible both in the facility as well as any vehicles used by the ADSC.
  • Consider improving the engineering controls using the building ventilation system.

Cleaning and disinfecting

  • Reduce risk of transmission of the virus on frequently touched surfaces and in common areas of the facility through routine cleaning.
  • Clean and disinfect the facility when someone is sick or has a COVID-19 diagnosis.
  • If more than 3 days have passed since the person who is sick visited or used the center, additional cleaning and disinfection is not necessary. Continue routine cleaning.

Restrooms

  • Limit the number of people occupying restrooms at one time to prevent long lines or crowds. Remember to maintain a distance of at least 6 feet.
  • Stock restrooms with enough supplies such as soap, tissues, paper towels or hand dryer, no touch trash cans (preferably covered), and EPA approved hand sanitizer with at least 60% alcohol.
  • Ensure restrooms are fully functional and that high-touch surfaces such as doorknobs, countertops, faucets, light switches, and toilets have been cleaned every day before the facility opens.
  • Staff should assist participants in following proper masking and hand hygiene protocols
  • Visit CDC’s Handwashing Campaign: Life is Better with Clean Hands page to download resources to help promote handwashing in your facility.
  • When changing a participant’s briefs or diapers, staff should wash their hands and the participant’s hands before they begin and wear gloves. Follow safe brief changing procedures. Procedures should be posted in all brief changing areas. Steps include:
    • Prepare (includes putting on gloves)
    • Clean the participant
    • Remove trash from the immediate area (soiled brief or diaper and wipes)
    • Replace briefs or diaper
    • Wash participant’s hands
    • Clean diapering area – sanitize the changing area with a fragrance-free product appropriate for the surface. If the surface is visibly soiled, it should be cleaned with detergent or soap and water prior to sanitizing.
    • Remove gloves and then wash hands.

Shared kitchens and dining rooms

  • Staff can serve food and drinks to participants when wearing a mask and gloves.
  • Avoid offering any self-serve food or drink options, such as buffets, salad bars, and drink stations. Serve grab-and-go items or individually plated meals instead. For individually plated meals, identify one staff per meal service station to serve food so that multiple staff are not handling the same serving utensils.
  • Restrict the number of people allowed in the kitchen and dining room at one time so that everyone can stay at least 6 feet apart.
  • Modify layouts to reduce crowding and encourage physical distancing of at least 6 feet apart.
  • Make sanitizing wipes available for anyone who uses a microwave and similar food preparation appliances (for example, waffle maker). Sanitize high-touch surfaces of appliances after each use.
  • Wash, rinse, and sanitize used or dirty food contact surfaces with an EPA-approved food contact surface sanitizer. If a food-contact surface must be disinfected for a specific reason, such as a bodily fluid cleanup or deep clean in the event of likely contamination with COVID-19, use the following procedure: wash, rinse, disinfect according to the label instructions with a product approved for food contact surfaces, rinse, then sanitize with a food-contact surface sanitizer.
  • Discourage sharing of items that are difficult to clean or sanitize.
  • Limit any sharing of food, tools, equipment, or supplies by staff members.
    • Ensure adequate supplies to minimize sharing of high-touch materials (for example, serving spoons) to the extent possible; otherwise, limit use of supplies and equipment to one group of workers at a time and clean and sanitize between use.
    • Avoid items that are reusable, such as menus, condiments, and any other food containers. Instead, use disposable or digital menus, single serving condiments, and no-touch trash cans and doors.
    • Clean frequently touched surfaces such as counters, tables, or other hard surfaces between use.
  • Use gloves when removing garbage bags and handling and disposing of trash. After removing gloves, wash hands with soap and water for at least 20 seconds.

Water systems

  • The temporary shutdown or reduced operation of a building and reductions in normal water use can create hazards for returning occupants. To minimize the risk of Legionnaires’ disease and other diseases associated with water, take steps to ensure that all water systems, water-using devices, and water features (for example, ice machines, drinking fountains, decorative fountains) are safe to use after a prolonged shutdown or reduced operation.
  • Drinking fountains, like all high-touch surfaces, should be cleaned, but encourage participants, staff, volunteers, and visitors to bring their own water to minimize use and sharing of water fountains.

Mental health resources

Staff and participants along with their caregivers may be experiencing feelings of sadness, worry, or stress. Visit How Right Nowexternal icon to find out how to help. How Right Now is an initiative to address people’s feelings of grief, loss, and worry during COVID-19.

If you or someone you know are feeling overwhelmed with emotions like sadness, depression, or anxiety:

If you need to find treatment or mental health providers in your area:

Substance Abuse and Mental Health Services Administration (SAMHSA) Find Treatmentexternal icon

If you are in crisis, get immediate help:

If you feel you or someone in you know may harm themselves or someone else:

Other mental health resources

Additional COVID-19 resources

Vaccine resources

Testing resources

Resources to share with ADSC participants and their family members or caregivers

Additional information and resources for people providing care