Illinois Department of Human Services
Division of Developmental Disabilities
Community Day Service Operations Under COVID-19
DD.23.XXX
Community Day Services (CDS) is a program of day habilitation that assists with acquisition, retention, or improvement in self-help, socialization, and adaptive skills that takes place in a non-residential setting, separate from the participant's private residence or other residential living arrangement. Activities and environments are designed to foster the acquisition of skills, appropriate behavior, greater independence, and personal choice.
CDS providers must be certified by the Bureau of Accreditation, Licensure and Certification as a CDS provider. CDS providers are able to bill 31U (site-based), 31C (community-based) and/or 31V (virtual) for services provided to individuals with intellectual and developmental disabilities.
All public health criteria included in this document are subject to change. As research and data on this novel coronavirus continue to develop, this plan can and will be updated to reflect current local, state and federal guidance.
This Information Bulletin replaces DD.22.006
Overarching:
When making decisions about prevention strategies and individual behaviors, CDS providers should consider current information about COVID-19 community levels and the risk of severe illness for the population served. See the map of COVID-19 community levels in Illinois on the IDPH website:
The State developed the Illinois Risk Benefit Discussion Tool as a resource for individuals, their families/guardians, and their provider to have important discussions in weighing the benefits and risks of participation. Providers can use this instead of their own developed tool. If a provider chooses to use their own tool, they should consider this tool as the floor of what would be required in their own document.
In addition, individuals should continue to work with their Independent Service Coordination (ISC) agencies to develop a Personal Plan that best meets their needs and identifies a provider to implement the plan.
Helpful Links for Individuals and Providers:
State of Illinois COVID-19 response page
Illinois Department of Public Health Information on COVID-19 Outpatient Treatment
Illinois Department of Public Health Information on COVID-19 Testing Locations
Guidance for Employers and Employees on Workers' Rights and Safety During the Restore Illinois Plan PDF
CDC Guidance, COVID-19 Community Levels
CDC Guidance, "When You've Been Fully Vaccinated"
Department of Human Services DDD COVID-19 Resources People who need to take extra precautions:
Disability and Health
CDC COVID-19 Communication Tools and Resources:
General Health Screening:
- Providers should adopt a screening process and screen all staff and individuals prior to transport and/or participation in programming. Encourage staff, individuals, and visitors to check for symptoms of COVID-19 prior to traveling to or entering a CDS site.
- Symptoms of COVID-19 include fever, chills, cough, shortness of breath, fatigue, muscle aches, headache, new loss of taste or smell, sore throat, runny nose, vomiting or diarrhea. Staff and individuals experiencing symptoms should remain home and seek evaluation by a health care provider. includes a range of symptoms. Providers should review the most updated guidance from the CDC.
Vaccination Status:
- Vaccination is the leading public health prevention strategy for limiting the adverse consequences of COVID-19. CDS providers should promote COVID-19 vaccination, boosters, and additional doses, and if possible, provide opportunities for vaccination for all eligible staff and clients.
- Because CDS providers provide services to individuals who may be at higher risk for severe COVID-19 illness, staff at CDS sites should be up to date on COVID-19 vaccinations.
- Staff are considered "up to date" on COVID-19 vaccinations when they have received all CDC-recommended COVID-19 vaccines, including any booster dose(s) when eligible.
- Individuals should be encouraged to be up to date on their COVID-19 vaccinations, however, services cannot be denied based on vaccination status.
Core Infection Prevention Measures:
In addition to vaccination, the following COVID-19 prevention strategies outlined in this guidance can protect CDS staff and individuals, especially those who are not up to date with COVID-19 vaccination and allow the delivery of in-person services to continue.
Masking:
- Because CDS providers serve individuals who may be at higher risk for severe illness related to COVID-19, staff should continue to wear well-fitting masks both on and off the CDS site to limit the risk of exposure.
- Individuals should consider wearing a well-fitted mask or face shield while attending CDS when the COVID-19 Community Level is medium or high. This can be done at the discretion of the provider or individual or guardian if applicable.
Hand Hygiene:
- Signage should be posted, reminding individuals and staff to wash hands.
- Frequent hand washing by staff and individuals is important to limit the spread of COVID-19, and an adequate supply of soap/paper towels and/or alcohol-based hand sanitizer should be available.
- Providers should provide hand washing capability or alcohol-based hand sanitizer to staff and individuals.
- Individuals should be supported to properly wash their hands at regular intervals.
- Individuals should wash their hands before and after eating.
Considerations for Improving Ventilation:
When indoors, improving ventilation and increasing the number of times fresh or filtered air enters a room can help reduce viral particle concentration and have been proven to decrease COVID-19 transmission.
When consulting with their HVAC professional, providers should consider the following approaches to improving ventilation:
- Increasing the introduction of outdoor air.
- Ensuring ventilation systems are operating properly as defined by ASHRAE Standard 62.1
- Optimizing the use of engineering controls to reduce or to eliminate exposures.
- Exploring options to improve ventilation delivery and indoor air quality in all shared spaces. The higher number of air exchanges per hour will result in better results with respect to purging airborne contaminants. Refer to the CDC suggested options for Air Changes per Hour (ACH).
- Using portable room air cleaners with a High-Efficiency Particulate Air (HEPA) filter to enhance air cleaning. Air cleaners need to have the appropriate CADR (Clean Air Delivery Rate) rating for the room size [e.g., a 300-ft2 room with an 11-foot ceiling will require a portable air cleaner labeled for a room size of at least 415 ft2 (300 × [11/8] = 415)]3. CDC FAQ #5 Ventilation in Buildings
- The following resources provide evidence-based guidance:
Efficacy of Portable Air Cleaners and Masking for Reducing Indoor Exposure to Simulated Exhaled SARS-CoV-2 Aerosols - United States, 2021 MMWR Morb Mortal WKLY Rep / July 9, 2021 / 70(27);972-976 DOI:
Entry Signage - symptom screening, face covering, physical distancing
- Display signage at entry with symptoms of COVID-19, face covering requirements and physical distancing guidelines in multiple languages as needed. IDPH has developed various signage PDFs that can be utilized.
- "Cover your cough" signs should be displayed reminding staff, visitors, and individuals to wash their hands frequently and cover their nose and mouth with a tissue when coughing or sneezing.
- All allowed visitors must follow the same guidance as staff and individuals, symptom screening and the donning of a face covering.
Staff and Individuals Who Have COVID-19 (Isolation)
Link to CDC Isolation Guidance Staff or individuals who are symptomatic or test positive for COVID-19 should be directed to isolate (remain at home or be sent home immediately) and referred to a provider for evaluation if they become ill at the CDS site, per IDPH and CDC guidelines. Providers should adopt a screening process and screen all staff and individuals prior to transport and/or participation in programming.
- Staff or individuals should not return to a CDS site until all of the following are true:
- They have had no fever for at least 24 hours without the use of medicine that reduces fever.
- Symptoms, such as cough or shortness of breath, and overall condition have improved.
- At least 5 days have passed since symptoms first appeared, or there was a positive test, for those without symptoms. The day of symptom onset or positive test is counted as day "0", with the first day of isolation (day "1) counted as the following day.
- Staff and individuals returning to CDS sites after at least 5 days of isolation should wear a well-fitted mask for an additional 5 days when around others. If staff and individuals are not able to reliably wear a well-fitted mask, best practice is that they should not return to CDS until after 10 full days of isolation.
- However, for some individuals and staff, wearing a mask can be very difficult. A negative viral test, (either a PCR or antigen test) may be used to determine if mask wearing can be shortened, once the 5 days of isolation are completed.
- If using a PCR test from a clinic or testing site, a single test result must be obtained, no sooner than day 5 of isolation, prior to returning to CDS.
- If using a home antigen test, two negative tests must be obtained. The first one must be no sooner than day 5 and the second 48 hours later.
- Note: If the test results are positive, the individual is still infected and poses a risk of infecting others. The individual should remain home in isolation, continue wearing a mask and wait at least 48 hours before taking another test.
Treatment for COVID-19
Upon learning of a new diagnosis of COVID-19, inform or remind staff, individuals, and guardians of the potential benefits of early treatment for COVID-19 (within 5-7 days of starting symptoms). Strong evidence supports that these treatments reduce the chance of severe illness outcomes including hospitalization, long COVID and death. Individuals at greatest risk are over the age of 65, have other medical issues, or have not been vaccinated or currently are not up to date. Individuals should be encouraged to discuss these options with their primary care provider. More information can be found at:
- IDPH Outpatient COVID-19 Treatment
- CDC COVID-19 Treatments and Medications
Asymptomatic Staff and Individuals who Test Positive and Masking Recommendations:
- Asymptomatic COVID-19 positive staff and individuals may return to work after at least 5 days have passed since the date of their positive test result.
- Staff and individuals returning to CDS sites after at least 5 days of isolation should wear a well-fitted mask for an additional 5 days when around others.
- If staff and individuals are not able to reliably wear a well-fitted mask, best practice is that they should not return to CDS until after 10 full days of isolation.
- However, for those who have difficulty wearing a mask, the test-based strategy described above for removing masks sooner than 10 days is applicable here as well.
Staff and Individuals who have been Exposed to COVID-19
CDC Guidance for Individuals Who Were Exposed to COVID-19
Staff and individuals can develop COVID-19 up to 10 days after exposure.
- As long as the exposed staff or individual does not develop symptoms of COVID-19, they may participate in CDS.
- It is important that anyone who has been exposed to COVID-19 wears a well-fitted mask when around others for 10 days.
- Staff and individuals who were exposed to COVID-19 should get tested at least 5 full days after the exposure, even if they do not develop symptoms. The exception is anyone who had COVID-19 during the prior 30 days, and does not have symptoms, does not need to test, as the risk of reinfection is very low. A more detailed discussion of interpreting COVID-19 test results for persons who have recently had COVID-19 can be found here: CDC: COVID-19 Testing, What You Need to Know.
- If even mild or atypical symptoms occur, individuals with exposure should immediately isolate until a negative test confirms symptoms are not attributable to COVID-19.
- In general, staff and individuals should not attend CDS with symptoms of an infectious disease until they have been evaluated by a healthcare provider or symptoms have resolved.
Quarantine
Excluding individuals who were exposed, but not yet ill with COVID-19) is no longer recommended for the general public.
Because of the potential for rapid transmission of COVID-19 in CDS settings, some providers may prefer to continue implementing quarantine protocols for individuals and staff who have been exposed to someone with COVID-19.
CDS providers can base their quarantine policy on their risk tolerance, including factors such as the health of their staff, the individuals they serve, and the impact of quarantine on mental health and staffing coverage. Exposure is defined here:
If a CDS provider decides to use quarantine strategies, there should be clear polices that guide its use which are communicated to individuals, families, and guardians.
Programming and Support (Physical Distancing):
- Providers should assess the ability of their site(s) to appropriately serve individuals with consideration of, comfort, and safety of individuals.
- CDS providers should consider lunch breaks and/or snacks to be facilitated so that groups eat together in their programming space.
- When possible and appropriate, programming should happen in the community or outdoors.
- Providers should be prepared to explain policies and procedures, including safety measures and screening processes, to individuals using developmentally appropriate language that the individual can understand. The use of social stories can assist in this process.
- In the event a provider becomes aware of a positive case of staff or individual in their CDS program, they should notify their local health department as well as impacted individuals, families and partnering providers.
Transportation Guidance:
For CDS programs that are providing individuals with transportation when community transmission levels are high:
- Providers should provide alcohol-based hand sanitizer at the entrance of the vehicle. All riders should wash or sanitize hands prior to boarding or exiting the vehicle.
- Consider requiring masks for individuals and staff using transportation when the COVID-19 Community Level is medium or high.
- If a rider in the vehicle is identified as being COVID-19 positive, CDC cleaning and disinfecting protocols should be performed as soon after the confirmation as practical and before the vehicle is put back in service.
- Other riders who were transported in a vehicle with another rider who tested positive for COVID-19 must be notified immediately and should not participate in CDS until they receive guidance from their primary care provider.
Under this new guidance, Covid safety protocols should not conflict with compliance with the federal HCBS Settings Rule implementation including in the areas of visitation, individual choice and community integration.
This guidance should not be construed as legal advice, as a provider you should consult your legal counsel.
Effective Date:
01.31.23
