All categories of long-term care facilities covered by this guidance document should follow the recommendations provided, with modifications for specific categories of facilities and programs as provided below.
Assisted living facilities and other similar arrangements
For Assisted Living Facilities (ALF), Shared Housing Establishments (SHE), Sheltered Care Facilities, and Supportive Living Facilities (SLF), the following modifications are recommended:
In CMS Phases 1 and 2, the general visitation rules apply to visitation at these facilities. In CMS Phase 3, facilities should follow these modifications:
- Indoor and outdoor visits do not need to be supervised.
- Visits can be in common areas or in residents’ apartments, with six-foot separation and cloth face covering or masking by visitors and residents.
In all CMS phases, dining in apartments is encouraged. For dining in communal dining room, observe same rules as for other facilities in whatever CMS phase applies.
Facilities for people with developmental disabilities
Facilities for people with developmental disabilities face special challenges in limiting the spread of COVID-19. Residents of these facilities may have difficulty understanding and maintaining social distance, inability to tolerate or safely wear cloth face coverings, and need for assistance with hand hygiene. These factors may compound the risk of COVID-19 transmission in congregate living settings. An individualized approach for COVID-19 may be needed for individuals with physical and intellectual disabilities who have limited mobility and/or difficulty absorbing new information and making changes in their everyday routines.
For Intermediate Care Facilities for the Developmentally Disabled (ICF/DD), State-Operated Developmental Centers (SODC), and Medically Complex/Developmentally Disabled Facilities (MC/DD), modifications to the guidance for nursing homes are recommended, as follows.
Face shields for residents who cannot tolerate masks. Residents in ICF/DD, SODC, and MC/DD facilities who cannot tolerate cloth face coverings or facemasks may be able to tolerate face shields. In such cases the face shield, although less protective than a face covering or mask, may be substituted as a second-best alternative for universal source control.
Community Day Services
Community Day Service (CDS) programs take place in a non-residential setting, separate from the participant's residential living arrangement. Typically, clients from various residential settings mingle in transport vehicles and at the CDS, increasing the risk of transmission among facilities.
A structured instrument, such as the “Illinois COVID-19 Risk Benefit Discussion Tool,” will be helpful in weighing the risks and benefits of participation. Such tools are designed to facilitate discussion with the client, their family/guardian, and the service provider:
The Department of Human Services approved a very limited opening of CDS programs starting August 1, 2020. Participation is subject to adequate facility preparation and safety precautions as well as individual risk-benefit assessments. A larger opening is planned to start September 1, 2020, still subject to significant capacity restrictions and safety precautions, and contingent on trends in COVID-19 prevalence.
Specialized Mental Health Rehabilitation Facility (SMHRF)
Due to the behavioral health conditions of SMHRF residents, some clients may have difficulty complying with the recommendations for social distancing, hand hygiene, and use of face coverings. In these cases, facilities should consider a harm reduction approach with those residents who have difficulty with these measures. Continued engagement and encouragement will be needed.