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Actions for Caregivers of Older Adults During COVID-19

To slow the spread of COVID-19, it is now necessary to further tighten protocols governing inhome caregivers for older adults. The aim of this guidance is to prevent direct care workers from becoming sources of disease transmission among the vulnerable individuals they serve.


The Michigan Department of Health and Human Services (MDHHS) strongly urges in-home caregivers for older adults to take the following steps while providing support for nonemergency medical care, activities of daily living, and instrumental activities of daily living.

  • Before making any individual visits to individuals who live independently, direct care workers should engage in daily telephonic wellness checks, video calls, or telehealth appointments.
  • Direct care workers should engage with clients face-to-face only after:
    • Attempted phone contact. The direct caregiver should try to reach the client by phone and receive an assurance that the client does not need support to sustain life.
    • Attempted use of client network. If the direct caregiver cannot reach the client, or if the client is reached and is need of help, the direct caregiver should attempt to reach all known members of the client’s informal caregiver network. The caregiver should seek assurance that a member of the network will contact the client and, if necessary, visit the client to sustain life, provided the friend or family member is healthy, not in a group at high-risk of COVID-19, and otherwise practicing social distancing. Such a friend or family member can conduct caregiver visits to one individual with less risk of repeatedly transmitting COVID-19 than a direct care worker.
    • The direct care worker may work with members of the client’s network to establish a regular cadence of visits which can be conducted by personal friends, family, or other contacts, not direct care workers.
  • The direct caregiver should visit the home only if no one can reach the client or if the client or caregiver network has confirmed a need which they cannot meet in order to sustain the client’s life.
  • For cases where visits remain necessary, care managers shall review clients’ care plans to ensure a one-to-one ratio between the direct care worker and the client to the extent possible.
  • Direct care workers should take precautions as follows, pursuant to CDC Guidance here:
    • If a visit must be made to sustain the life of a client confirmed to have COVID-19 or a Person Under Investigation for COVID-19, the client should wear a disposable facemask during the visit. If the client is unable to wear a disposable facemask, then the direct care worker should wear a disposable facemask.
    • Facemask and gloves should be used while handling the patient’s blood, stool, or bodily fluids.
    • Gloves and facemasks should be discarded immediately after use with a client who is confirmed or suspected to have COVID-19.
    • Hands should be washed with soap and water after removal of gloves and facemask.
  • Direct care workers who are sick should stay home for at least 14 days. Direct care workers should screen themselves for respiratory and fever symptoms prior to any in-home visits. If symptoms exist, direct care workers are instructed to contact the care manager and notify them that the service will not be provided.
  • MDHHS will work with managed care entities, including (but not limited to) Integrated Care Organizations, MI Choice waiver agencies, and Medicaid Health Plans, and Home Help providers to ensure this guidance is appropriately executed.

For purposes of guidance:

  • “Direct care worker” includes but is not limited to personal care assistants (PCAs), certified nurse aides (CNAs), home health aides, private duty nurses (RNs), direct support professionals, and informal caregivers who do not reside at clients’ home.
  • “Care Manager” includes but is not limited to care coordinators functioning in a managed care environment, supports coordinators, case managers, and adult services worker.
  • “Clients” includes to all recipients of in-home services and supports provided by direct care workers.
  • “Older adults” are people age 60 years and older.

Source: MDHHS