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Guidance for Adult Day Services Centers

Summary of Recent Changes

Vaccines are widely accessible in the United States. Everyone aged 12 years and older should get a COVID-19 vaccination as soon as possible.

Key Points

  • Adult Day Services Centers (ADSC) provide social or health services to adults ages 65 and over and adults of any age living with disability.
  • Older adults and people with disabilities who are not fully vaccinated are at highest risk for severe illness from COVID-19, which may include hospitalization, intensive care, and death.
  • COVID-19 vaccines are safe, effective, and widely accessible in the United States.
  • The guidance outlines strategies that ADSC administrators, staff, volunteers, and participants can use to help maintain healthy environments and operations and lower the risk of COVID-19 spread in their programs.
  • Preventive measures include getting vaccinated, wearing a mask, practicing physical distancing, and washing hands.
  • Consistent and layered use of multiple prevention strategies can help reduce the spread of COVID-19 and protect people who are not fully vaccinated, administrators, staff, volunteers, participants, and their families.


Adult Day Services Centers (ADSC) are professional care settings where adults receive social or health services for some part of the day (For further information about ADSCs, visit National Adult Day Services Association. ADSC 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.

There are many ways for ADSC to implement layered prevention strategies to protect people who are not fully vaccinated. Several factors should be considered about the ADSC participants, volunteers, and staff, as well as the surrounding community. The primary factors to consider include:

  • Level of community transmission of COVID-19
  • COVID-19 vaccination coverage, including among participants, staff, volunteers, and visitors
  • Use of a robust and frequent COVID-19 screening testing program with high participation from participants, staff, volunteers, and visitors who are not fully vaccinated
  • Any local COVID-19 outbreaks or variants of concern

Any removal of a layer of prevention strategies (such as mask use, physical distancing, ventilation by people who are not fully vaccinated, hand hygiene, respiratory etiquette, and other controls) should be implemented one at a time and monitored closely (with adequate testing through the ADSC or community) for any outbreaks or increases in COVID-19 cases.

Additionally, these factors should be discussed in collaboration with local or state public health partners.

Promoting Vaccination

Vaccination is the leading public health prevention strategy to help end the COVID-19 pandemic. COVID-19 vaccines are safe and effective, widely accessible in the U.S., and available at no cost to all people living in the United States. People who are fully vaccinated are at low risk of symptomatic or severe infection. A growing body of evidence suggests that people who are fully vaccinated are less likely to have asymptomatic infection or transmit COVID-19 to others.

  • Administrators, staff, volunteers, and participants should get vaccinated as soon as possible.  COVID-19 vaccines are safe and effective in preventing COVID-19 and are recommended for everyone ages 12 and older.
  • Staff, volunteers, and participants who are fully vaccinated can resume indoor and outdoor activities without wearing a mask or staying 6 feet apart, except where required by federal, state, local, tribal or territorial laws, rules and regulations including local business and workplace guidance.
    • People who have a condition or are taking medications that weaken the immune system should talk to their healthcare provider to discuss their activities. They may need to keep taking all prevention measures to prevent COVID-19, including masking and physical distancing.
  • People who are not fully vaccinated should follow all prevention measures until fully vaccinated. Preventive measures include getting vaccinated, wearing a mask, practicing physical distancing, and hand hygiene.
  • ADSCs with people who are fully vaccinated and people who are not fully vaccinated, or with people whose vaccination status is unknown, should continue to use prevention strategies including mask use, AND physical distancing by people who are not fully vaccinated, and ensuring good ventilation, hand hygiene, respiratory etiquette, and other controls.

Wearing Masks

Participants, staff, volunteers, and visitors who are not fully vaccinated should wear a mask. Assist ADSC participants who are not fully vaccinated to wear a mask, if assistance is needed.

  • Consistent and correct mask use by people who are not fully vaccinated is especially important indoors and in crowded settings, when physical distancing cannot be maintained.
    • Indoors. Mask use is recommended for people who are not fully vaccinated.
    • Outdoors. In general, people do not need to wear masks when outdoors. However, particularly in areas of substantial to high transmission, CDC recommends that people who are not fully vaccinated wear a mask in crowded outdoor settings or during activities that involve sustained close contact with other people who are not fully vaccinated. If not everyone is fully vaccinated, prioritize outdoor activities over indoor activities when possible.
  • Masks should cover the 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 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 assessment .

Physical Distancing

  • Maintain a distance of 6 feet between people, combined with indoor mask wearing by people who are not fully vaccinated, to reduce transmission risk.
  • Cohorts (keeping people together in a small group and having each group stay together throughout an entire day) can be used to limit the number of participants, volunteers, and staff who come in contact with each other. The use of cohorts can limit the spread of COVID-19 between cohorts, but should not replace other prevention measures within each group. It is not recommended to cohort people by vaccination status.
    • Paratransit drivers should take extra care in transporting patients with special needs and take all necessary prevention measures to prevent COVID-19. Please visit What Paratransit Operators Need to Know about COVID-19 for more information.
    • If not everyone is fully vaccinated, consider creating participant cohorts to limit mixing and create distance between passengers on buses, vans and other transport vehicles (for example, skip rows) when possible.

Making Sure Indoor-Spaces Are Well-Ventilated

  • Improving ventilation is an important COVID-19 prevention strategy that can reduce the number of virus particles in the air. Along with other preventive strategies, including wearing a well-fitting, multi-layered mask, bringing fresh outdoor air into a building helps keep virus particles from concentrating inside. This can be done by opening multiple doors and windows, using fans to increase the effectiveness of open windows, and making changes to the HVAC or air filtration systems.
  • During transportation, open or crack windows in buses and other forms of transportation, if doing so does not pose a safety risk. Keeping windows open a few inches improves air circulation.

Encouraging Staff, Volunteers, and Participants to Stay Home When Sick

  • Regardless of vaccination status, staff, volunteers, and participants who have symptoms should stay home.
  • CDC recommends testing people for COVID-19 who show any signs or symptoms of COVID-19, for all close contacts, and for those who are not fully vaccinated.
  • Staff, volunteers, and participants who have tested positive for SARS-CoV-2, the virus that causes COVID-19, should isolate and follow CDC-recommended steps, regardless of whether someone has symptoms of COVID-19.
  • People who are not fully vaccinated and who are well, but have had contact with someone who has tested positive for COVID-19 in the last 14 days, should stay home.
  • If staff, volunteers, and participants who are not fully vaccinated are unsure whether they should stay home, they or their caregiver can use the coronavirus self-checker to help make decisions on when to seek testing and medical care.
  • In accordance with state and local laws and regulations, ADSCs should notify local health officials, staff, volunteers, participants and their caregivers, and others in the facility of cases of COVID-19 in their facility while maintaining confidentiality in accordance with the Americans with Disabilities Act (ADA) .

Cleaning and Disinfecting

When no people with confirmed or suspected COVID-19 are known to have been in a space, cleaning once a day is usually enough to sufficiently remove any virus that may be on surfaces. Disinfecting (using disinfectants on the U.S. Environmental Protection Agency COVID-19 list) removes any remaining germs on surfaces, which further reduces any risk of spreading infection.

  • For more information on cleaning a facility regularly, when to clean more frequently or disinfect, cleaning a facility when someone is sick, safe storage of cleaning and disinfecting products, and considerations for protecting workers who clean facilities, see Cleaning and Disinfecting Your Facility.
  • If a facility has had a person who is sick or someone who tested positive for COVID-19 within the last 24 hours, clean AND disinfect the space.

Mental Health Resources

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

For Crisis Situations:

Suicide Prevention:

Other Mental Health Resources

Additional Resources

Vaccine Resources

Communication Strategies

  • Display visual posters with instructions for staying 6 feet apart, wearing masks, 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) and language(s) of staff, volunteers, and participants. Use COVID-19 easy to read resources, if applicable.
  • Learn about additional considerations for adults with developmental or behavioral disorders.
  • CDC’s Toolkit for Older Adults & People at Higher Risk for population specific posters and messaging.

Testing Resources

Resources to Share with ADSC Participants and Their Family Members or Caregivers

Additional Information and Resources for People Providing Care