COVID-19 Guidance for Community Supported Residential Settings

Illinois Department of Human Services

Information Bulletin

Division of Developmental Disabilities

DD.23.011

This guidance is intended for small community supported homes, including Community Integrated Living Arrangements (CILAs) and Community Living Facilities (CLFs), as defined in the Community-Integrated Living Arrangements Licensure and Certification Act (210 ILCS 135/) and the Community Living Facilities Licensing Act (210 ILCS 35/).

Introduction/Background: 

This guidance outlines layered infection prevention strategies that service providers can use to lower the risk of COVID-19 transmission to help maintain healthy environments and operations. The guidance also includes measures for controlling outbreaks that should be implemented in collaboration with public health officials to prevent the spread of COVID-19.

Please note that vaccination status is no longer used for making determinations about COVID-19 prevention and mitigation measures. Instead, monitoring the COVID-19 New Hospital Admission Levels as part of risk assessment is emphasized.

The CDC no longer uses COVID-19 Community Transmission levels as an indicator of risk level of contracting COVID-19. The CDC now uses local hospitalization rates. Please see Appendix A.

Definitions

  • COVID-19 New Hospital Admission Levels are HIGH
    New COVID-19 Hospital admissions level of 20 per 100,000 population over the past week.
  • Isolation
    Individuals and staff with COVID-19 can spread the virus to others. Isolation is used to separate people with confirmed or suspected COVID-19 from those without COVID-19.
  • Outbreak
    An outbreak investigation is triggered by a single case of COVID-19 in a home or facility. Two COVID-19 cases in a home, where one person acquired COVID-19 from the other, constitutes an outbreak.
  • Signs of Severe COVID-19
    • Trouble breathing.
    • Persistent pain or pressure in the chest.
    • New-onset confusion.
    • Inability to wake or stay awake.
    • Blue-colored skin, lips, or nail beds, depending on skin tone.
    • These signs and symptoms indicate severe illness due to COVID-19 and require immediate emergency medical attention. If someone is showing any of these signs, call 911.
  • Up to date
    An individual or staff member has received the primary series of COVID-19 vaccine (either two doses or one dose, depending on the vaccine), and has received all additional and booster doses for which they are eligible as recommended by the CDC. (CDC up to date recommendations for COVID-19 vaccines)

Assessing Risk

Homes should use both the COVID-19 New Hospital Admission Levels, and setting-specific risks to guide decisions about when to apply COVID-19 prevention actions. Assessing the following factors can help decide the level of risk of contracting COVID-19 in a home:

  • Home structural and operational characteristics: Assess whether the home characteristics or operations contribute to COVID-19 spread. For example, some homes may have a higher risk of transmission if they have staff who work at multiple homes, a high volume of outside visitors or poor CDC Ventilation in Buildings , or areas where more than one person shares a room.
  • Risk of severe health outcomes: Assess what portion of people in the home are more likely to get very sick from COVID-19, for example, due to underlying health conditions (HRST scores of 4 and above), lack of COVID-19 vaccination, older age, pregnancy, or poor access to medical care.
  • COVID-19 transmission in the home: Assess the extent to which transmission is occurring within the home, through diagnostic testing of people with COVID-19 symptoms and their close contacts, as described in the Appendix B, Table B1: "Evaluating Exposure Risk for Individuals and Staff".

COVID-19 Vaccination

The goal is for every person to be able to easily get vaccinated and remain up to date (CDC up to date recommendations for COVID-19 vaccines). Below are recommendations for encouraging vaccination:

  • Providing clear, consistent, transparent information to ensure individuals feel comfortable receiving the COVID-19 vaccine.
  • Making vaccines available on-site through partnership with the local health department (LHD) or other healthcare provider.
  • If on-site vaccinations are not available, helping individuals identify locations where they can receive the COVID-19 vaccine and providing transportation or other resources to facilitate acquisition of the vaccine.
  • Integrating reminders into the process for vaccinating individuals and staff to ensure they receive all required vaccine doses including boosters.
  • Resources to encourage COVID-19 vaccinations are available at: CDC Vaccinate with Confidence.

Screening for Signs and Symptoms of COVID-19

When COVID-19 New Hospital Admission Levels are HIGH

Screening and other Procedures for Newly Admitted Individuals

  • Screen individuals upon moving into a new home for signs or symptoms of COVID-19.
  • Educate newly admitted individuals on the core principles of infection prevention and control and instruct them to comply with masking, physical distancing, hand hygiene, and environmental cleaning, particularly when in shared spaces.
  • Strongly encourage and facilitate vaccination for unvaccinated new admissions and booster vaccines for eligible individuals.

Screening for Individuals and Staff

Active screening (e.g., completing screening tool, taking temperatures, or directly asking screening questions) before someone enters a home is no longer required. Instead, homes must establish a process to inform staff, individuals, and visitors of recommended actions to prevent the transmission of COVID-19 and other respiratory infections. This information should include instructions about current infection prevention and control (IPC) recommendations (e.g., when to use masks and perform hand hygiene).

  • Screen individuals daily for signs or symptoms of COVID-19 at times when COVID-19 New Hospital Admission Levels are HIGH.
  • Staff should not work when sick. Staff who develop symptoms at home should not report to work. Staff who develop symptoms at work should immediately notify their supervisor and go home.

Visitation

Individuals have the right to receive visitors of their choice and to choose the time of their visit(s). Providers should encourage safe visiting. There should be no restriction on visitation without a reasonable clinical or safety cause. There are measures that should be taken if the house is in outbreak status or if there are individuals more susceptible to negative outcomes of COVID-19.
For more information on Visitation, please see Appendix C.

Core Infection Prevention Measures

There are a number of measures that providers can take to prevent the spread of infection, such as:

  • Masking when COVID-19 New Hospital Admission Levels are HIGH.
  • Physical distancing when the home has an outbreak.
  • Practicing good hand hygiene.

For more information on Core Infection Prevention Measures, please see Appendix D

Building Considerations

There are many prevention measures that providers should take to prevent and slow infection, such as:

  • Thorough cleaning before and during an outbreak.
  • Improving ventilation.

For more information on Building Considerations, please see Appendix E

Testing Plan and Response Strategy:

A person with COVID-19 can spread the virus beginning two days prior to the onset of any symptoms (or two days prior to a positive test if they do not have symptoms).

Testing Plan

Administrators of homes should implement the testing plan below to identify cases of COVID-19 among individuals and staff. Local health departments and health care providers can be helpful partners. Key components of the testing plan include:

Types of tests

  • Homes may utilize PCR tests (preferred), which would typically be performed at a laboratory, or point of care (POC) rapid antigen tests (acceptable).
  • Homes that perform point-of-care antigen testing must comply with state and federal regulations and must report all positive tests to IDPH. More information about point-of-care antigen test requirements and reporting is online.
  • No testing is required if individuals have had COVID-19 within the last 30 days, as the risk of reinfection is low.

Testing

  • Test individuals and staff with signs or symptoms of COVID-19 immediately.
  • Test following moderate-risk or higher-risk exposures (formerly "close contacts").
    • Asymptomatic individuals and staff no longer need to quarantine following a moderate- or higher-risk exposure with someone who has COVID-19. (Appendix B, Table B1: Evaluating Exposure Risk)
    • Individuals and staff should wear a well-fitting mask for 10 days after a moderate- or higher-risk exposure.
    • If symptoms occur, individuals should immediately isolate until a negative test confirms symptoms are not attributable to COVID-19.
    • For all those exposed, best practice would also include a test for SARS-CoV-2 at day 5 after exposure, counting the day of exposure as day 0.
    • No testing is required for those that have had COVID-19 in last 30 days, as the risk of reinfection is low.

Testing to identify if there is an outbreak
Must be performed whenever a case is identified or suspected. There are two testing options which can be employed, in consultation with the local health department.

  • Contact-tracing testing option
    • Targeted testing is done as described above for all individuals and staff who had a moderate-risk or higher-risk exposure to the COVID-19 case.
    • If no additional cases are identified, no testing is needed beyond the testing completed on day 5.
  • Home-wide testing option
    • Test all individuals and staff, regardless of vaccination status or known exposure.
    • Repeat testing of all previously negative individuals and staff (e.g., every 3-7 days or as directed by the local health department) until no new cases are identified over a period of at least 14 days.

For Persons who have COVID-19

  • Homes should develop a plan to isolate individuals who are symptomatic or who test positive for COVID-19.
  • Staff who will have close contact with individuals who are in isolation precautions, including during transport, should wear a high-quality NIOSH approved N95, KN95 or comparable level respirator, eye protection (goggles/face shield), gowns/coveralls, and gloves. Here is a link for more information from the CDC: masks/respirators.
  • If a staff member develops symptoms while working, they should put on a high-quality mask and limit contact with individuals and other staff.
  • Staff who develop symptoms of COVID-19 while working must contact their supervisor and arrange for coverage to go home.
  • Individuals and staff who test positive for COVID-19 should:
    • Isolate for at least 5 days.
  • Remain in isolation until fever resolves for 24 hours without the use of fever-reducing medication and symptoms resolving.
  • Discontinue isolation after 5 days if asymptomatic.
    • Continue to wear a mask around others for an additional 5 days after discontinuing isolation precautions.
    • Screen/assess individuals with COVID-19 at least daily for signs of severe illness. Minimize the number of staff interacting with COVID-positive individuals.

Outbreak Response:

Because of the risk of unrecognized infections among individuals or staff, a single new case of COVID-19 in any staff or individual should be evaluated as a potential outbreak. The residence or home must contact their local health department promptly to report all positive case(s) for both staff and individuals and develop a response plan.

Procedures for Individual Cases:

  • Isolate the individual for 5 days from symptom onset or from the positive test date (if asymptomatic); a private bedroom with a private or designated bathroom is preferred.
  • Activate procedures for staff to perform daily symptom assessments and serve meals to the person wearing full PPE (face shield, gown, gloves). If a fit-tested N95 respirator is not available, a KN95 face mask is preferrable, followed by a well-fitted surgical mask with face shield are the next best options.
  • Organizations can reach out to their LHD for assistance with a fit-testing program and obtaining the necessary respirators for staff.
  • Assess the extent of potential exposures in the home by identifying areas the person may have visited or communal activities that may have put others at risk. For homes with shared spaces (e.g., bathrooms, eating areas, shared bedrooms) that make physical distancing challenging, everyone residing in the same house as the individual should be considered a close contact (Close contact refers to a moderate- or higher-risk exposure. See Appendix B, Table B1).
  • Identify any close contacts Understanding Your Exposure Risk (staff or individual) to the individual who is sick 2 days prior to symptom onset or 2 days prior to the positive test date (for asymptomatic cases). Close contact refers to a moderate- or higher-risk exposure. See Appendix B, Table B1.
  • Clean and disinfect all areas the infected individual encountered while they were infectious.
  • Reinforce policies for individuals regarding adherence to universal masking, physical distancing, hand hygiene, and promptly reporting illness so that isolation and testing may be initiated.
  • Reinforce policies for staff regarding adherence to universal masking, physical distancing, hand hygiene, staying home if sick, limited staff interacting with positive cases, proper and appropriate use of PPE when interacting with infected individuals.
  • Multiple cases may be cohorted in the same room if space is limited.

Support Timely Access to Treatment

  • Effective treatments are now widely available and must be started within a few days after symptoms develop.
  • Treatment has been shown to reduce the risk of severe COVID-19 disease and hospitalization, especially in the elderly, and those with underlying health conditions. Individuals with IDD have had high rates of death from COVID-19 independent of overall health status.
  • As soon as an individual is diagnosed with COVID-19, contact the individual's medical provider to assess if specific antiviral treatment is indicated. The severity of an individual's initial symptoms does not predict the risk of complications from COVID-19 infection, including the development of long COVID.
  • Antiviral treatment reduces severity of illness, likelihood of hospitalization or death, and the development of long COVID.

Treatment Information is available at:

  • National Institutes of Health (NIH) COVID-19 treatment guidelines.
  • A clinical decision tree PDF is also available to help clinicians determine if an individual is eligible for COVID-19 treatment and the right choice of treatment.
  • Resources are available for onsite COVID-19 treatment, through long-term care pharmacies and mobile response teams. Contact the LHD right away if you have trouble securing treatment for individuals with COVID-19.

References

  • Centers for Disease Control and Prevention. Staying Up to Date with COVID-19 Vaccines.
  • Centers for Disease Control and Prevention. Isolation Precautions for People with COVID-19.
  • Centers for Disease Control and Prevention. COVID-19 by County.
  • Centers for Disease Control and Prevention. When and How to Clean and Disinfect a Facility.
  • United States Department of Labor. Occupational Safety and Health Administration (OSHA). Protecting Workers: Guidance on Mitigating and Preventing Spread of COVID-19 in the Workplace. PPE per OSHA standards, including OSHA Standard 1910.134
  • EPA United States Environmental Protection Agency. About List N: Disinfectants for Coronavirus (COVID-19).
  • Centers for Disease Control and Prevention. Interactive Home Ventilation Tool American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE): Top 10 Ways Homeowners can Ensure Good Indoor Air Quality
  • Illinois Department of Public Health (IDPH). COVID-19 Treatments and Medications

Appendix A

KEY POINTS

The previous CDC metrics, COVID-19 Community Transmission and Community Levels, will no longer be available following the expiration May 11 of the COVID-19 Public Health Emergency declaration. However, the CDC COVID-19 Data Tracker will continue to provide relevant data that can be used to guide decision making.

Facilities should continue to monitor the CDC COVID-19 Data Tracker weekly and implement select infection prevention and control measures (e.g., masking) based on the COVID-19 New Hospital Admission Levels over the past week in their county. This is the same metric that will be utilized by the CDC to issue alerts to the public regarding higher levels of SARS-CoV-2 circulating in the community and the need to take additional protective actions.

  • IDPH is recommending that a COVID-19 new hospital admissions level of 20 per 100,000 population over the past week be used as the measure at which facilities should consider implementing Enhanced Prevention Strategies ("HIGH").
  • If there is a steady increase in hospital admissions for respiratory infections, including flu and RSV over two weeks regardless of the actual rate of admissions, facilities should be vigilant and prepared to implement enhanced measures if necessary.

Facilities and individuals may choose to implement additional protective measures when the COVID-19 Hospital Admission Level is lower based on their discretion and taking into account the activity of other respiratory infections, such as flu and RSV.

Appendix B

CDC Post-Exposure Guidance
Asymptomatic individuals and staff who have a moderate- or higher-risk exposure should test 5 days after exposure and should wear a well-fitted mask while indoors around others for 10 full days. Staff who were wearing appropriate PPE (high-quality NIOSH-approved KN95 or N95 respirator and eye protection) are not considered exposed.

Table B1: Evaluating Exposure Risks of Individuals and Staff (Based on the CDC's Understanding Your Exposure Risk)
Evaluate an exposure for each criterion and write the level of risk in the last column (Write low, moderate, or high in the box for each criterion evaluated)

Criteria Lower Risk Moderate Risk High Risk Evaluate Exposure
Exposure Time Short duration
(Very brief time, e.g., passing in hall, store, etc.)		 Moderate duration
(Less than 15 minutes, e.g., working out in a gym, sitting in group setting together)		 Longer duration
(15 minutes or more, e.g., worked together all day, live together)		 -
Activities that may involve exertion Little to no exertion (e.g., sitting watching tv, meditation, yoga, quiet activity) Some exertion: (e.g., sitting together and talking to each other) Exertion: Coughing, singing, shouting, or breathing heavily -
Symptomatic Asymptomatic-infected person did not display any symptoms Not applicable Symptomatic-infected person coughing, etc. -
Mask wearing* Both persons were masked One person was masked No masks were worn by either person -
Ventilation Encounter with infected person was outdoors Well ventilated indoor setting (fans going, air filters, windows open, etc.) Poorly ventilated indoor setting -
Distance Distance of 6 feet or more between the infected person and exposed person Moderately close, (within 3 feet) to the infected person Very close or touching the infected person -

Scoring Exposure Risk & Required Action Steps
If all 6 criteria are lower-risk--no further action is required by the facility, individual, or staff.
If 1 or more criteria are evaluated as a moderate-risk or higher-risk follow the guidance contained in this document.
*Staff who were wearing an appropriate mask and eye protection are not considered exposed, even if the person with COVID-19 was not wearing a mask.

Appendix C

Visitation
General Visitation

  • Harm reduction strategies of improved ventilation, mask wearing, or outdoor visiting can be supported as options especially at times of high COVID-19 New Hospital Admission Levels.
  • If visitors have any of the following, they should limit or defer non-urgent in-person visitation while they are infectious or potentially infectious:
    • A recent positive COVID-19 test
    • Signs or symptoms of COVID-19 or other infectious respiratory viruses
    • Recent exposure to someone with COVID-19
  • CDC Guidelines can be located here:
  • If an individual's roommate is immunocompromised, visits should not be conducted in the individual's room with the roommate present, if possible.
  • The safest practice when COVID-19 New Hospital Admission Levels are HIGH, is for individuals and visitors to wear well-fitted masks and physically distance.
  • Homes may choose to offer well-fitting masks to visitors when COVID-19 New Hospital Admission levels are high, or the home is experiencing an outbreak.

Visitation During an Outbreak

  • While it is safer for visitors not to enter the home during an outbreak, visitors may still be allowed, subject to the screening processes described above.
  • If individuals would like to have a visit during an outbreak, they should wear face coverings or masks during the visit, regardless of vaccination status, and visits should ideally occur outdoors or in the individual's room.
  • Visitors should be made aware of the potential risk of visiting during an outbreak and adhere to the core principles of Infection Prevention Measures (described in this document).

Appendix D

Core Infection Prevention Measures
Masking

  • Homes should provide high-quality masks/respirators to all individuals and staff when COVID-19 New Hospital Admission Levels are HIGH, as well as during outbreaks.
  • Staff and visitors should consider wearing a well fitted mask or face covering when indoors, when COVID-19 New Hospital Admission Levels are HIGH.
  • Individuals may consider wearing a well fitted mask or face covering at any time when indoors (outside of their rooms) and when staff or other visitors enter their rooms. Wearing a mask in communal areas when the COVID-19 New Hospital Admission Levels is HIGH should be considered.
  • If the home is experiencing an outbreak, then well fitted masks should be worn by staff, visitors, and individuals in communal areas.

Physical Distancing

  • Physical distancing, also called social distancing, is the practice of staying at least 6 feet away from others to prevent the spread of a contagious disease such as COVID-19. Physical distancing is no longer generally recommended unless the home is experiencing an outbreak.
  • If the home is having an outbreak, consider altering schedules to reduce mixing and close contact by staggering meals and other social and group activities.

Hand Hygiene

  • Hand hygiene is an important strategy to reduce the spread of all infectious diseases including COVID-19. Providers should educate and support individuals and staff to perform hand hygiene appropriately and frequently by: (a) washing hands with soap and water for at least 20 seconds or, (b) using an alcohol-based hand sanitizer with at least 60% alcohol when hands are not visibly soiled or if soap and water are not available. Important times to perform hand hygiene are:
    • Before, during, and after preparing food;
    • Before and after eating food;
    • Before and after caring for someone at home who is sick;
    • After using the bathroom;
    • After blowing your nose, coughing, or sneezing; and
    • After providing personal care support.
  • Provide alcohol-based hand sanitizers that contain at least 60% alcohol at key points, including, entrances/exits and eating areas.
  • Make sure bathrooms and other sinks are consistently stocked with soap and drying materials for handwashing.

Appendix E

Building Considerations
Environmental Cleaning During Outbreaks:

  • When a home is experiencing an outbreak:
    • Clean and disinfect frequently touched surfaces at least daily and shared objects between use with an EPA-registered disinfectant.
    • Ensure that staff have received training on the proper use and handling of cleaning and disinfecting products.
    • Clean high use areas/shared spaces daily; twice a day for bathrooms.
    • Provide disposable gloves for cleaning.

Considerations for Improving Ventilation:

  • Consider using natural ventilation (i.e., opening windows if possible and safe to do so) to increase outdoor air dilution of indoor air when environmental conditions and building requirements allow. If temperatures outside make it difficult to leave multiple windows open, consider safely securing window fans or box fans (sealing the perimeter around the box fan) to blow air out of selected windows.
  • Ceiling fans can improve room air mixing when windows are open, helping to distribute clean air and dilute viral particle concentrations throughout the room. This will reduce the likelihood of stagnant air pockets where viral concentrations can accumulate.
    • Avoid the use of the high-speed settings.
    • Use ceiling fans at low velocity and potentially in the reverse-flow direction (so that air is pulled up toward the ceiling).
  • Consider using air purifying devices such as portable High-Efficiency Particulate Air (HEPA) Filtration systems to help enhance air cleaning (especially in higher-risk areas such as rooms occupied by COVID-positive individuals).
  • Exhaust fans should remain functional in the kitchen and restrooms and utilized when individuals are in the home. Fans should be run while visitors are in the home and for a minimum of an hour after they leave. Collaborate with the LHD and experts in heating, ventilation, and air conditioning (HVAC) to identify resources for improving ventilation and air quality.
  • For more information: CDC Ventilation in Buildings.

Effective Date:

10/10/23