Guidance for Direct Service Providers

What do Direct Service Providers for people with disabilities need to know about COVID-19?

Direct Service Providers (DSPs) include personal care attendants, direct support professionals, paraprofessionals, therapists, and others. They provide a wide variety of home and community-based, health-related services that support people with disabilities. Services provided may include personal care, activities of daily living, access to health services, and more. DSPs have close and consistent contact with people with disabilities and those providing healthcare support services in day and residential programs for people with disabilities. DSPs are considered to be in the same general risk category as health care personnel. DSPs are essential for the health and well-being of the people they serve. DSPs should be aware of how the coronavirus disease 2019 (COVID-19) spreads, risk factors, and prevention actions.

• Some groups may be at an increased risk for severe illness from COVID-19.
• Knowing how COVID-19 spreads can help DSPs protect themselves and others.

• DSPs should follow everyday prevention actions when working with clients without suspected or confirmed COVID-19, and healthcare provider guidance for standard and transmission-based precautions when providing care for clients with COVID-19.
  • Risk of infection with COVID-19 is higher for people providing direct care (such as DSPs and household members) for someone known to have COVID-19 because of their close contact with the infected person.
• Older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.
• The COVID-19 pandemic may be a source of stress. Learning to cope with stress effectively will make you, the people you care about, and your community stronger.
• For more information, go to CDC’s Fact Sheet: What you need to know about coronavirus disease 2019 (COVID-19).

Here are commonly asked questions that DSPs have about caring for people with disabilities during the COVID-19 pandemic.

How can I protect myself and the people I work with?

As a DSP, your risk of exposure will depend on factors including the setting you work in, the number of people you provide services to, and the spread of COVID-19 in your community. Check with your employer for any specific policies and procedures related to COVID-19 and practice everyday prevention actions when working with clients without suspected or confirmed COVID-19. In addition:

• When possible, keep at least 6 feet of distance between yourself and others in the home or community setting.
• Wear a mask when you are at work.
• Encourage your client to wear a mask.
  • Wearing masks may be difficult for people with sensory, cognitive, or behavioral issues. Masks are not recommended for children under 2 or anyone who has trouble breathing or is unconscious, incapacitated or otherwise unable to remove the covering without assistance.
• If there is potential that you may be splashed or sprayed by bodily fluids during your work, use standard precautions. Personal protective equipment (PPE) includes a facemask, eye protection, disposable gloves, and a gown.

• Wash your hands with soap and water: when entering and leaving the home or community setting; when adjusting or putting on or off facemasks; or before putting on and after taking off disposable gloves. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Learn more about proper handwashing.
• Wear disposable gloves when touching the client (e.g., dressing, bathing/showering, transferring, toileting, feeding), handling tissues, when changing linens or doing laundry. Safely dispose of gloves after use. As noted above, wash your hands before and after taking off disposable gloves. If gloves are unavailable, wash hands immediately after touching the client or handling their belongings.
• Launder work uniforms or clothes after each use with the warmest appropriate water setting for the items and dry items completely.

• Monitor yourself for symptoms. Do not go to work or care for others if you develop symptoms.

If you work in the home of an individual with disabilities, also practice these additional prevention actions:

• Clean and disinfect frequently touched objects and surfaces (e.g., counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, bedside tables), and equipment (e.g., wheelchairs, scooters, walkers, canes, oxygen tanks and tubing, communication boards and other assistive devices).
• Help the client plan for possible changes in service due to COVID-19.
  • Plan for what to do if you or other DSPs get sick.
  • Create a contact list of family, friends, neighbors and local service agencies that can provide support.
  • Review with the client:
    • How to monitor for symptoms.
    • When and how to contact their healthcare provider. Many healthcare providers have developed new ways to provide healthcare services, such as using telehealth. Help the client find out how those are arranged and any additional information.

• Help make or update care plans or an emergency notebook.
  • Care plans typically include important information about a person’s medical conditions, how to manage those conditions, how to contact healthcare providers, therapists and pharmacy, information on allergies, medications (names, dosages, and administration instructions), preferences (food and other), daily routines and activities.
  • This information may help the client and new DSPs provide consistent care if the usual provider is unavailable.
• Plan at least two ways of communicating from home and work that can be used rapidly in an emergency (e.g., landline phone, cell phone, text-messaging, email). Write this information down for both you and the client. Each of you should keep a copy with you.
• Plan to have enough household items and groceries for a few weeks, at least a 30-day supply of over the counter and prescription medicines and any medical equipment or supplies that might be needed.
  • Some health plans allow for a 90-day refill on prescription medications.
  • Make a photocopy of prescriptions, as this may help in obtaining medications in an emergency.

If you provide services for a client in a community-based setting, such as a group home or day program,

• Follow any employer, facility, and program guidance for additional precautions related to COVID-19.
• Encourage the clients you work with to practice everyday prevention actions, if possible, and assist them when needed.
• Follow everyday prevention actions if there are no known or suspected cases of COVID-19 in the community-based setting where you work.

CDC has also provided guidance for group homes for people with disabilities. Many of the recommendations for COVID-19 preparation and response described in that guidance document also apply to DSPs.

What if my client or someone they live with has been exposed to COVID-19, has symptoms of COVID-19, or tests positive for COVID-19?

• Encourage your client to contact their healthcare provider or help them contact their provider if assistance is needed. Clients may need help accessing telehealth.
• If hospitalization for your client is not needed, your client may require assistance with home care for COVID-19.
  • See guidance for implementing home care of people not requiring hospitalization.
  • Follow recommended infection prevention and control measures, including the use of recommended PPE.
• Follow healthcare provider guidance for standard and transmission-based precautions to protect yourself when providing care for clients with COVID-19.
  • Masks are not PPE and should not be worn in place of proper PPE for the care of clients with known or suspected COVID-19.
• Sick clients should also wear a facemask (if tolerated).
  • Wearing masks may be difficult for people with sensory, cognitive, or behavioral issues. Masks are not recommended for children under 2 or anyone who has trouble breathing or is unconscious, incapacitated or otherwise unable to remove the covering without assistance.
• Review the Administration for Community Living COVID-19 website regularly for information and contact your state’s Developmental Disability Administration, Disability Council, or Independent Living Council for local information regarding availability and assistance in obtaining resources.
• If you are caring for someone with COVID-19 in their home, monitor for emergency signs, prevent the spread of germs, treat symptoms, and follow recommendations for when to end home isolation.
• Call your healthcare provider for medical advice regarding your own health.

What if I become sick or am exposed to someone who has COVID-19?

• Stay home and self-isolate, except to get medical care.
  • Staying at home helps protect the people you work with who may be at greater risk of infection or severe illness from COVID-19. It also helps protect others in the community.
• If you develop symptoms such as a fever, cough, difficulty breathing, or new loss of taste or smell or you have been exposed to COVID-19, call your healthcare provider for further guidance.
• Notify your employer, the client with disabilities and, if applicable, their guardian as soon as possible so appropriate plans for an alternate DSP can be made. The client should be monitored for COVID-19 symptoms.

Are my clients at increased risk for becoming infected or having severe illness from COVID-19?

People with one of the disability types listed may be at increased risk of becoming infected or having severe illness from COVID-19.

• People who have limited mobility and/or who cannot avoid coming into close contact with others who may be infected
• People who have trouble understanding information or practicing preventive measures, such as hand washing and social distancing
• People who may not be able to communicate symptoms of illness
• People who are blind or have low vision who rely on touch or tactile information
• People who need alternative communication methods, such as sign language or braille, who may not have access to information

Adults with disabilities are three times more likely than adults without disabilities to have serious underlying medical conditions. They may have an increased risk for serious illness from COVID-19 if they are older adults live in a long-term care facility or have certain underlying medical conditions. Learn more about people who are at higher risk for severe illness.

How can I cope with stress during the COVID-19 pandemic?

Remember to take care of your physical and mental health as you continue to provide important services to people with disabilities. It is important for you to maintain healthy behaviors, manage stress, and seek additional support during the COVID-19 pandemic. Here are some important steps to take to help you manage and cope with stress:

• Take care of your body.
  • Take deep breaths, stretch, or meditate.
  • Try to eat healthy, well-balanced meals.
  • Exercise regularly.
  • Get plenty of sleep.
  • Avoid alcohol and drugs.
• Make time to unwind and remind yourself that strong feelings will fade. Try to do some other activities you enjoy.
• Take breaks from watching, reading, or listening to news stories. It can be upsetting to hear about the crisis and see images repeatedly.
• Connect with others in a safe way (maintaining social distancing). Talk with people you trust about your concerns and how you are feeling.

If you are feeling overwhelmed with emotions like sadness, depression, anxiety, or thoughts of hurting or killing yourself or others:

• Call 911 if you feel like you want to harm yourself or others.
• Visit the Disaster Distress Helpline, call or text 1-800-985-5990
• Visit the National Domestic Violence Hotline or call 1-800-799-7233 and TTY 1-800-787-3224.
• Visit the 988 Suicide & Crisis Lifeline or call 988.

During this pandemic, it is critical that you recognize what stress looks like, take steps to build your resilience and cope with stress, and know where to go if you need help.