DHS COVID-19 Guidance for Congregate Care Settings: Group Homes, Intermediate Secure Care, Therapeutic Schools, Outdoor Youth Programs, Social Detox, Recovery Residences, Licensed Residential Treatment and Residential Support Programs, and Certified Residential Support

The guidance in this document and on the DHS Provider FAQ constitutes DHS policy and therefore requires adherence by DHS licensed and contracted providers during this pandemic. As the risk level in Utah evolves this document may change, and our guidance may be updated at any time. This document includes guidance for a broad range of settings, and some of the following may not apply to your specific context. 

To request a variance from the following protocols, please email oqdcontracts@utah.gov with the request, populations served, any identified high-risk clients or staff, why the request is in the best interest of your client(s), how you ensure the health and safety of staff and clients, and the proposed start and end date.

Please note, these guidelines have been developed with the understanding that residing in a congregate or residential facility in itself can increase risk of transmission for all individuals in the setting, as physical distancing may be challenging, multiple individuals are coming and going on a daily basis, and employees may work in multiple congregate settings. Due to the increased risk of the setting, some guidelines may be more restrictive than what is advisable for the general public.


Take additional precautions with high-risk individuals

  • If a setting cares for a high-risk individual as defined by the CDC and Utah Department of Health, the setting must follow guidance for high-risk individual procedures, including taking appropriate precautions for visitation and interaction outside their place of residence. Individuals caring for or living with a high-risk individual should conduct themselves as if they are a significant risk to the high-risk individual. 
  • Providers should take extra precaution on behalf of individuals in high-risk populations by limiting their close contact with multiple people, including having the same caretakers whenever possible.
  • High risk individuals are discouraged from leaving their places of residence for non-essential purposes, which may include day programs or outpatient treatment. This determination should be made by the individual and their team. 
  • In addition, while disability alone may not be related to a higher risk for getting COVID-19 or having severe illness, individuals with limited mobility or who cannot avoid coming into close contact with others, those who have trouble practicing preventative measures such as hand washing, physical distancing, and wearing face coverings, and those who may not be able to communicate symptoms of illness may be at higher risk of becoming infected or having unrecognized illness.

Strongly encouraged to use face coverings to protect clients and staff

  • Employees are strongly encouraged to wear face coverings (e.g. cloth or surgical mask if available) indoors at all times, unless they are alone in an office or other room with the door closed, or are unable to due to a medical condition, in which case continuous physical distancing of 6 feet or more is strongly encouraged; clients are encouraged to wear face coverings whenever possible
  • Face coverings are strongly encouraged to be worn outdoors when physical distancing cannot be maintained
  • Change or launder cloth face coverings routinely
  • Cloth face coverings should not be placed on young children under the age of 2, anyone who has trouble breathing, or is unconscious, incapacitated, or otherwise unable to remove the mask without assistance
  • Personal Protection Equipment (PPE) should not be shared and should be utilized and disposed of properly, or properly cleaned
  • Follow additional CDC guidance for using face coverings here

Create a safe environment for clients and staff through enhanced hygiene, cleaning and physical distancing protocols

  • Follow strict hygiene standards including:
  • Make hand sanitizer, soap and water, or effective disinfectant readily available
  • Frequent hand washing for clients and staff with soap and water for at least 20 seconds, or hand sanitizer if soap and water are unavailable; establish a procedure, appropriate to the population served, to prompt and support individuals throughout the day to wash their hands
  • Promote etiquette for coughing, sneezing, and handwashing; prompt clients to avoid touching face, especially eyes, nose, and mouth; place posters that encourage hand and respiratory hygiene
  • Clean and disinfect high-touch surfaces (e.g. workstations, countertops, handrails, doorknobs, breakrooms, bathrooms, common areas), using an EPA-registered cleaner either twice a day or after each use; keep a logbook of cleaning regimen
  • Follow CDC guidance for cleaning and disinfecting community facilities
  • Don’t use toys or items that can’t be washed and disinfected; items used should be disinfected after each use

  • Increase circulation of outdoor air as much as possible by opening windows and doors, using fans, and other methods; do not open windows and doors if doing so poses a safety or health risk, or risk of violating client privacy
  • Follow any other standards communicated by the Centers for Disease Control and Prevention (CDC), the Utah Department of Health, and local health department

Recommended to maintain consistent physical distance whenever possible.

  • Except when staff are providing necessary assistance to an individual receiving services; individuals should maintain 6 feet of physical distance from others
  • Limit group sizes to 20; there may be more than one group in a setting if groups are separated by a wall
  • Avoid handshaking or any unnecessary physical contact
  • Maintain signage and establish other prompts to remind groups to stand at least 6 feet apart and avoid congregating in common areas
  • See additional physical distancing best practices for congregate settings in Appendix

Maintain physical distance and wear face coverings when transporting clients; do not transport high-risk clients in groups

  • Employees and clients wash hands or use hand sanitizer before entering and after exiting the vehicle
  • Employees and clients who are able to wear face coverings are strongly encouraged to do so
  • Avoid using the recirculated air option for the car’s ventilation during passenger transport; use the car’s vents to bring in fresh outside air and/or lower the vehicle windows, unless open windows pose a safety risk to passengers or employees
  • If possible, have only one individual per row; maintain small groups and physical distancing within the vehicle
  • Individuals who cannot wear face coverings and are not of the same household/residence should be on a row by themselves, or the provider should consider alternative transportation options, including public transportation or use of informal supports
  • Consider multiple trips or staggering arrival and departure times for clients
  • Clients should be dropped off and picked up curbside
  • High-touch areas of the vehicle should be sanitized before and after use, including the steering wheel, handles inside and outside, and seat belt buckles

Practice safety when taking clients into the community

  • Staff and clients are strongly encouraged to wear face coverings when in public; providers are responsible for ensuring that the client has a face covering
  • Avoid large, dense crowds and stay at least 6 feet away from others when outside the home - refer to community guidelines for group sizes, families are encouraged to stay in their household groups with, members of your household
  • Follow the state of Utah guidelines for individuals including “Social Guidelines,” “Use of Face Coverings,” “Family Gatherings (e.g. Funeral, Wedding, Religious Ceremonies),” “Children, including Playgrounds,” “Outdoor Recreation, Youth Outdoor Sports, including Parks, Playgrounds, Pavilions,” “Pools, Water Parks, Spas,” and “Religious Services.”
  • The decision related to an individual’s participation in a group setting, such as a Day Service, must be assessed on a case-by-case basis, based on an individual’s needs, choice, and personal risk, with their team and in consultation with their healthcare provider if needed
  • Avoid handshaking or any unnecessary physical contact
  • If use of public transportation (train or bus) cannot be avoided, take additional precautions
  • Maintain a 6-foot distance from other passengers as much as possible
  • Wear a face covering
  • Avoid touching high-touch surfaces such as handrails, and wash hands or use hand sanitizers as soon as possible after leaving
  • Limit riding in cars with members of different households. If that’s not possible:
  • Limit close contact and create space between others in the vehicle
  • Avoid using the recirculated air option for the car’s ventilation; use the car’s vents to bring in fresh outside air and/or lower the vehicle windows, unless open windows pose a safety risk to passengers or employees
  • Strongly encouraged to wear face coverings while in the vehicle

Recommended to monitor employees, visitors, and clients for symptoms. No symptomatic employees or visitors allowed on site

  • Employees and visitors are strongly encouraged to go through screening and symptom checking[1] before every shift, or visit, including temperature. A log must be kept and available for inspection by the health department and DHS. The log should include the employee or visitor name, date, time, symptoms checked, and whether or not their temperature is at or above 100.4 degrees Fahrenheit. The log does not need to include actual temperature, and should be treated as Protected Health Information (PHI). For visitors, include the reason for the visit on the log.
  • Clients are strongly encouraged to go through screening and symptom checking daily, including temperature; a log must be kept and made available for inspection by the health department and DHS. The log should include client name, date, time, symptoms checked, and client temperature
  • Ensure staff are aware of sick leave policies and are encouraged to stay home if they are sick; advise staff to check for any symptoms before reporting to work each day and notify their supervisor if they become ill when at work
  • Train managers/leadership to spot symptoms of COVID-19 and to be clear on relevant protocols
  • Employees exhibiting symptoms of illness should be sent home immediately and should contact their healthcare provider for testing; even if an individual has not been tested or confirmed to have COVID-19, those with symptoms should be considered contagious
  • Employees engaging in business travel must follow all physical distancing, face covering, and hygiene guidelines; consider designating specific employees to conduct essential work travel

Home visits when necessary with strict protocols

  • Home visits may be appropriate in limited circumstances, and must follow COVID-19 HOME VISITATION PROTOCOL
  • Recommended that clients who are new to the setting or returning from a home visit must adhere to the following protocols as much as reasonably possible for 14 days upon entering or reentering the program:
  • If possible, client should be in a separate room and use a separate bathroom
  • Client should wear a face covering whenever they are not in their room and whenever 6 feet of physical distance cannot be maintained if they are in a shared room
  • Have the client avoid group activities including dining to the greatest extent possible

In-person visitation is allowed when following all parameters, virtual visits still encouraged

  • Providers should work to facilitate virtual visits that are more frequent than in-person visits would have been, and consider if they can be unmonitored so the individual has the opportunity to have a more natural interaction with their family, friends, and other loved ones
  • Maintain a single controlled visitor entrance; post signs at entrance instructing visitors not to visit if they are sick and indicating new visitor screening policies
  • Display posters for reducing risk, social distancing, handwashing, and proper use of face coverings

  • Set up a hand sanitation and screening station and strongly encourage hand sanitation and screening before entry for all visitors; a log with visitor name, visit date and time, reason for visit, and symptoms checked and temperature must be kept and available for inspection by the health department and DHS
  • Reasonable accommodations must be made to ensure the safety of high-risk individuals in the setting
  • The decision for an in-person visit should be agreed upon with the Child and Family Team (DCFS or JJS), Person-Centered Planning Team, or other collaborative team working with the individual
  • If it is determined that in person visits are important for the individual, the following standards must be met:
  • Prior to the visit, issue communications to potential visitors regarding visitation protocols, including outlining alternative methods for visitation, visitation requirements, and initial screening questions
  • Visits should be scheduled and kept to an hour or less; visit times should be staggered to prevent an influx of individuals at the program at one time
  • Face coverings for visitors are strongly encouraged inside and outside if physical distancing cannot be maintained
  • Hold visits outside whenever possible; if visits cannot be held outside, designate a visitor area that is not in the general population area; visit area must be disinfected before and after each visit
  • Limit the number of individuals that may visit a client at one time to two, unless there is ample space to allow for more visitors while maintaining at least 6 feet of physical distance between individuals
  • Physical distancing should be maintained throughout the visit; the team must determine if this can be accomplished through guidance or if additional coaching or supervision during the visit is needed
  • Visits using the same protocols as described above may also be appropriate at another location

Review and update emergency, continuity of operations, and infectious disease protocols

  • Work with your licensing entity and (for DHS contracted providers) the Office of Quality and Design to address background screening, variance, and adaptations to this guidance if needed by emailing dhsinfo@utah.gov 
  • Consider what reserve supplies may be necessary to obtain (e.g., cleaning supplies, gloves or other protective equipment); visit this link for assistance accessing personal protective equipment
  • Develop/Update plans and procedures for management of clients with COVID-19 symptoms* upon admission to the facility, including admission to a dedicated location within the facility for management of illness or to a pre-identified facility where clients with COVID-19 will be supported during the course of their illness

Work with your local health department to address suspected or confirmed cases of COVID-19

  • Immediately contact your local health department if COVID-19 is suspected among clients or staff and follow all health department guidance on testing, quarantining, protective equipment and mitigation strategies; notify DHS by submitting an incident report
  • Providers must also inform parents or guardians of affected individuals; for individuals receiving services under a contract with DHS, work with the individual’s team to determine what family members need to be contacted and by whom
  • Follow this Health Department guidance for isolating and quarantining individuals who are exposed to COVID-19 and contact your local health department for further instructions
  • Discontinue all new admissions, visits to the facility and client home visits if a client tests positive for COVID-19 unless the facility has access to a separate isolation location or area - exposed individuals should quarantine for 14-days and have a negative test before going on a home visit. If the local health department gives stricter guidance on visits, providers must follow that.

APPENDIX: Physical Distancing Best Practices in Congregate Settings

Work with the team supporting the individuals in the program to achieve the following physical distancing best practices:

Recommended Sleeping Arrangements

-Increase spacing so beds are at least 6 feet apart

-If space allows, put fewer  within a dorm/unit

-Arrange beds so that individuals lay head-to-toe (or toe-to-toe), or use neutral barriers (foot lockers, curtains) to create barriers between beds

-Move residents with symptoms into separate rooms with closed doors, and provide a separate bathroom, if possible

-Do not house high-risk individuals in the same room as people with symptoms

Recommended Mealtimes

-Stagger mealtimes to reduce crowding in shared eating facilities

-Have the same individuals in consistent meal time groups to minimize possible spread

-Stagger the schedule for use of common/shared kitchens

Recommended Bathrooms and Bathing

-Create a staggered bathing schedule to reduce the amount of people using the facilities at the same time

Recommended Recreation/Common Areas

-Stagger the use of common spaces

-Reduce activities that congregate many residents at once such as “house meetings” and opt for smaller group activities

Recommended Communication

-Reduce the amount of face-to-face interactions with residents for simple informational purposes

-Consider using bulletin boards, signs, posters, brochures, emails, phone, mailbox or sliding information under someone’s door

 The Utah DHS COVID-19 Guidance for Congregate Settings as of 9.15.20                                                                                                                                                                                               

[1] Symptoms may include fever of 100.4 degrees Fahrenheit or above, cough, trouble breathing, sore throat, sudden change in taste or smell, muscle aches or pains.