On August 31, 2020, the Ohio Department of Health (ODH) issued a Director’s Order allowing the opening of adult day care services and senior centers starting September 21, 2020. The Director's Order was amended on October 16, 2020.
These frequently asked questions (FAQ) were created to help answer questions facility administrators, staff, participants, or families may have about the reopening process for senior center services. This FAQ may be updated from time-to-time as strategies and processes evolve. This FAQ is not intended to be inclusive of all potential scenarios presented by the reopening effort.
Public Health Order and General Operations
1. What is the authority being used to implement this Order?
Under Ohio Revised Code 3701.13 the Director of Health can create special public health orders. Effective 12:01 AM, September 21, 2020, facilities may open with a limited capacity that complies with safe distancing as required by the Order.
2. Where can I find the Public Health Order and state issued guidelines?
The Senior Center Order and guidance can be found online.
3. Which facilities are subject to the Order?
All senior centers are subject to the Order.
4. Are facilities required to reopen pursuant to the Order?
Facilities are permitted, but not required to reopen. The state strongly encourages facilities to safely reopen so long as all requirements of the Order and state issued guidelines can be met.
Testing and Screening
1. Are facilities required to participate in the State’s process for testing?
Facilities can meet the requirements of the Order by participating in state-supported testing or by conducting testing without state support. If the facility elects to privately contract for testing services, that testing must comply with state guidelines. It is the responsibility of the facility to monitor these guidelines and have policies and procedures developed to implement and monitor participant and staff testing consistent with the Order and state issued guidance.
2. How will facilities verify compliance with the requirement to have staff tested for COVID-19 at least once every other week?
Facilities will verify that they meet the requirements of the Order to retest staff and participants by submitting a report following each bi-weekly testing cycle. Responses will provide summary-level testing results for each round of retesting.
In addition, facilities should maintain individual-level COVID-19 test results for compliance purposes. Staff refusals and extended absences should be documented. Upon request, test results must be made available immediately in spreadsheet format and must include the date of testing for each individual. Request fulfilments must remove any personal health information that may identify the individuals.
3. How does a facility report test results to the State?
Following the close of each bi-weekly testing cycle, the State will send a link to the reporting tool. Each facility is required to report the results of your bi-weekly testing efforts using an online reporting tool. Reporting is required regardless of whether a facility is utilizing state-supported testing. All questions in the reporting tool must be fully and accurately reported within the reporting period.
4. What kind of tests are considered compliant for the purposes of the Order?
All testing completed to comply with the Order must be conducted using diagnostic RT-PCR or Rapid Point-of-Care (POC) Antigen Testing that is authorized under an FDA Emergency Use Authorization (EUA).
5. Can antibody testing be used to comply with the Order?
No, only diagnostic testing outlined above complies with the Order.
6. Do COVID-19 tests need to be ordered by a medical professional?
Yes, COVID-19 tests for screening and diagnostic purposes must be ordered by a physician or other appropriate health care professional acting under his/her scope of practice.
7. Which facility staff must be tested?
The Order applies to all facility staff. For purposes of this Order, staff includes volunteers. While not subject to this Order, it is strongly recommended that non-staff members who come and go from the facility be tested every other week. This includes, but is not limited to, contract and agency staff, and private caregivers. Facilities are required to perform testing of all staff at least every other week.
8. If staff are on leave or are unavailable when testing is occurring, are they still required to be tested?
Yes. Facilities are required to verify staff have been tested if they were unavailable during scheduled testing.
9. Which participants are subject to testing?
Strategic testing of participants is required. This may include, but not be limited to, testing of high-risk participants, those presenting with COVID-19 symptoms, or those with suspected exposure to COVID-19.
10. Who is subject to repeat testing?
All staff are subject to repeat testing at least every other week. Refer to the following for additional guidance.
11. If staff work at multiple facilities, are they required to be tested at each facility?
No. The facility is required to ensure all staff have been tested and shall obtain and retain test records for all staff to demonstrate compliance with the Order. This applies to all tests, including initial testing, that have occurred within the facility’s designated testing period.
12. Is documentation of participant or staff consent required for testing?
Facilities should follow their standard consent procedures for both participants and staff as they work to comply with the Order.
13. If a participant refuses to be tested, may they receive any services?
Any participant refusing testing as required by the Order and state issued guidance may not enter the facility to participate in any services. Likewise, any participant whose legal representative with the appropriate scope of authority declining testing for a participant if the participant is unable to consent or decline the testing, may not enter the facility to participate in any services.
14. What should a facility do if staff refuse testing?
Each facility shall require its staff to be tested in accordance with state issued guidelines. It is important for facility leadership to educate and inform staff of the requirements and value of ongoing testing.
15. Can staff continue working while waiting for test results?
Asymptomatic staff may work while awaiting test results. All facilities must comply with ODH Contingency and Crisis Facility Staffing Guidance before considering scheduling staff that have tested positive, been exposed to, or are displaying symptoms of COVID-19. All staff should continue infection control precautions and should wear appropriate personal protective equipment (PPE), including greater levels of PPE during performance of an aerosol-generating procedure and when in direct contact with infectious secretions.
16. What should facilities do if they identify participants or staff who need to be tested because they are symptomatic, and/or have known exposure to COVID-19?
- Staff who are symptomatic should cease activities and notify their supervisor or occupational health services prior to leaving work to arrange further evaluation. Staff who have known exposure to COVID-19 should quarantine for 14 days from last known exposure or return to work in accordance with ODH Contingency and Crisis Facility Staffing Guidance.
- Participants who are symptomatic or report known exposure to COVID-19 should be immediately isolated and not wait among other participants while awaiting further evaluation and care.
- Facilities should identify a separate, well-ventilated space that allows participants to be separated by 6 or more feet, with easy access to respiratory hygiene supplies.
17. If staff or participants test positive for COVID-19, will the facility be required to undergo contact tracing?
Yes, if staff or participants test positive within the facility, the facility should work proactively with the LHD to coordinate contact tracing as soon as possible.
18. When can staff who have tested positive, been exposed to, or are displaying symptoms of COVID-19 begin working again?
All facilities must comply with ODH Contingency and Crisis Facility Staffing Guidance before considering scheduling staff that have tested positive, been exposed to, or are displaying symptoms of COVID-19. This guidance is relevant for all health care personnel, as well as potentially exposed staff not directly involved in patient care (i.e., clerical, food, and laundry service). Additional CDC guidance can be found here.
19. Where can staff get tested for COVID-19?
For facilities not participating in state-supported testing, a map of testing sites, including private companies and community health centers, can be found online at Testing and Community Health Centers.
20. Who is responsible for payment of testing?
The State is the payer of last resort for those facilities participating in state-supported testing. While reimbursement from third-party payers will be sought whenever possible, neither the person being tested, nor the facility will be charged for testing.
State-Supported Assistance with Testing
1. Is the State supporting facility testing?
Yes, the State is supporting facility testing. State support may include assistance with:
- Training
- Scheduling
- Procuring nasal test kits
- Delivery
- Lab processing
2. Who is the state-supported testing partner?
MAKO Medical Laboratories, LLC
3. What specimen collection method will be used?
Nasal (Anterior Nares) specimen collection will be utilized.
4. How will specimens be collected and handled?
The clinical collection of specimens can be self-administered or administered by facility staff. To avoid contamination of the specimen sample be sure to don personal protective equipment as outlined in CDC guidance for safely collecting and handling specimens.
5. How will testing supplies be delivered to the facilities?
MAKO Medical Laboratories, LLC will coordinate delivery of testing supplies. Further information can be found here.
6. Who should I contact if I have not received testing supplies and our facility is scheduled for testing?
All questions regarding testing scheduling and shipment of supplies should be directed to MAKO Medical at RNibert@makomedical.com or JTucker@makomedical.com.
7. How will scheduling for testing occur?
MAKO Medical Laboratories, LLC will coordinate with the Ohio Department of Aging (ODA) to schedule testing.
8. What is the role of the facility point of contact?
Every facility must designate a point of contact. The point of contact is responsible for the overall testing program including, among other roles, portal management, communication, compliance, logistics, registration, and repeat testing.
9. How quickly should a facility expect to receive test results?
Generally, once the lab receives the specimens, results are available within 48 hours by logging into an online portal. To ensure the shortest timeframe possible, it is important the facility completes testing on its scheduled testing day. Please see instructions for accessing the online portal.
Facilities
1. Are facilities able to open without testing all participants?
Facilities must comply with all requirements of the Order, including pre-screening and strategic testing of any high-risk participants that present with COVID-19 symptoms or suspected exposure to COVID-19.
2. Will the state provide a list of items that need to be checked as participants enter a facility?
Each facility is responsible for developing its own pre-screening resources. Providers may use the information located here to assist their development of screening tools.
3. If a facility refuses to comply with the rules and does not have the necessary funds to provide the signage, materials, and supplies required, may they open?
No, only those facilities who meet all requirements of the Order and state issued guidance may reopen at this time.
Reduced Capacity, Spacing
1. What is meant by limited capacity?
Recognizing that facilities vary greatly (size, capacity, resources, staffing, populations, etc.), there is no universal definition of limited capacity. So long as all safe distancing requirements in the Order are met and each facility considers all the following criteria in determining their ability to reopen at a limited capacity, each facility is given discretion to determine what limited capacity means for its facility:
- Ohio’s Safe Business Practices for Getting Back to Work;
- Case status in surrounding community, including the Ohio Public Health Advisory System and associated risk levels;
- Case status in the facility;
- Facility staffing levels;
- Access to adequate testing for participants and staff;
- Ability of participants to wear masks;
- Personal protective equipment and supplies; and
- Local hospital capacity.
2. What is meant by “designate six-foot distances?” Is six foot-distancing required or recommended best practice?
Designating with signage, tape, or by other means, including plastic barriers is an acceptable way to ensure six-foot spacing for employees and participants to maintain appropriate distance. Per the Order, six-foot distancing is required, if possible.
3. What is meant by a phased approach?
It is important to ensure participant, staff, family, provider, and caregiver health and safety during this pandemic. The state has initiated this first phase to responsibly restart senior centers with limited capacity. As the availability of COVID-19 testing increases, and cases decrease, the state will continue to evaluate increasing capacity during future phases.
Sanitation
1. The Order states it is mandatory to have a hand washing station at the entrance, but many sites are not configured that way. Is it acceptable to walk individuals to a handwashing station upon entry?
The Order requires that “a hand washing and/or sanitation station shall be available upon entry to facility.” So long as a station is made available upon entry, the Order does not require it to be located at the entrance of a facility. CDC provides additional information on hand hygiene here.
2. What constitutes a sanitation station? Is a sanitation station simply a hand sanitizer dispenser?
Given the diverse needs, populations, capacity, resources, and staffing of facilities, each facility needs to evaluate what makes sense for their individual business and individuals served. Factors to consider may include, but not be limited to, staffing resources, scheduling, participant attendance, and population health needs.
3. Is there a minimum recommendation of adequate PPE supplies and equipment?
Given the diverse needs, populations, capacity, resources, and staffing of facilities, each facility needs to evaluate what makes sense for its individual business and individuals served. The expectation is that facilities have enough PPE supplies and equipment to safely provide services to all participants returning to the facility.
4. Are there recommendations on how often to “frequently perform enhanced environmental cleaning” (e.g. every 2 hours?)
Given the diverse needs, populations, capacity, resources, and staffing of facilities, each facility needs to evaluate what makes sense for their individual business and individuals served. Factors to consider may include, but not be limited to, staffing resources, scheduling, participant attendance, and population health needs. Every two hours may be acceptable for facilities with less participants or the ability to schedule and stagger participant attendance but may not be acceptable for high-traffic, frequently visited facilities. CDC provides additional information on cleaning and disinfecting facilities here.
Signage/Communication
1. Will ODA provide standardized signage?
ODA has Safe practices posters available for use by facilities on the following topics:
Facilities may also order a limited number of materials for free here.
Additionally, facilities are also encouraged to download and print posters on Responsible Restart Ohio, as applicable, here.
Entering Facility
1. In lieu of a log, can a facility document in each person’s personal chart?
The Order requires maintaining a log. If facilities wish to also designate attendance in a personal chart, nothing in the Order prohibits this practice.
2. Does prescreening of participants have to be done via telephone prior to each visit?
Yes, at this time, to minimize contact with potential symptomatic individuals, all pre-screening shall occur via telephone prior to each visit. The Responsible Restart Ohio guidance document includes the tool for use with pre-screening.
3. How should facilities manage “drop in” visits from participants?
Given the need to complete pre-screening via telephone prior to entering a facility, “drop-in” participants wishing to enter the facility are not feasible during this initial phase. Providers are to indicate with signage that drop-in visits are not permitted and must be scheduled in advance according to facility policy. This should be communicated through each facility’s communication plan.
4. What if a participant refuses to participate in pre-screening?
Participants refusing to participant in pre-screening shall not be permitted to enter a facility. These individuals do remain eligible for in-home services.
Facial Coverings
1. Are facial coverings required to be worn by all participants during the initial phase, or are there exceptions to this requirement?
To facilitate a responsible restart and manage the continued health and safety of participants, staff, and families, all participants are required to wear facial coverings. There are no exceptions currently.
Congregate Activities
1. What constitutes a “large-group event”?
Facilities need to critically evaluate if they can meet the Order requirements while hosting congregate activities and will need to determine adequate capacity limitations through their policies and communications plan.
2. How long should participants/cohorts have to consume their meals?
Facilities should take into consideration the unique needs of each individual and cohort in determining the length of time to provide for congregate activities and plan accordingly.
Transportation
1. Can pre-screening be conducted at the time of pick up instead of via telephone in advance?
The Order requires pre-screening to occur via telephone prior to the time of pick up.
Confirmed Cases
1. What should facilities do to provide an isolation area when facility space is limited space?
In order to be able to reopen, the facility must prioritize the designation of space to provide an isolation area.
2. If a facility is exposed to COVID-19, would non-congregate services be able to be provided during a closure?
In this scenario, a facility should consult with the local health department and ODA to determine if non-congregate services can safely be provided.
Miscellaneous
1. If facilities are not in compliance with the Order or state issued guidance, where should non-compliance be reported?
All non-compliance should be reported to the local health departments, who will consult with ODH as necessary.
2. If a facility opens, yet determines it must close due to COVID-19 reasons, are staff eligible for unemployment if laid off?
Questions regarding unemployment status should be referred to the Ohio Department of Job and Family Services, facility human resources staff, and facility legal counsel, as appropriate.
3. Related to sick leave policies, are facilities require to retain an employee while an employee is self-quarantining or ill? If they are ill, does this allow for FMLA?
Questions regarding employment policies and procedures should be referred to facility human resources staff and facility legal counsel, as appropriate.
