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EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health


AFL 17-_
March 27, 2020


TO:
Essential/Emergency Personnel Providing Critical In-Home Services

SUBJECT:
California Department of Public Health Guidance on Novel Coronavirus Disease (COVID-19) for
Essential/Emergency Personnel Providing Critical In-Home Services


​This guidance applies to essential employees responsible for conducting services requiring entry to homes that are critical and cannot be postponed or conducted through remote means (e.g., utility customer service staff responding to smell of gas or social worker responding to crisis in a client’s home). This document is provided to support management and employee decision-making about whether a home visit is essential now that California has a stay at home directive because of COVID-19. This guidance provides recommendations to protect employees from exposure to potential and confirmed COVID-19 cases, reduce transmission when a home visit is essential, and considerations for postponing non-essential home visits. This guidance is not intended for home healthcare workers who must be in prolonged contact with sick patients.

Guidance on determining whether the service is essential vs. non-essential can be found at the U.S. Homeland Security, Cybersecurity and Infrastructure Security Agency (CISA) page or Governor Newsom’s order. Each industry will need to define the types of emergencies that require a home visit. Whether the situation is essential or an emergency may need to be determined on a case-by-case basis by the service provider and as new information continues to be acquired. Employers should also follow any agency or county policies or guidance if applicable.

Background 

COVID-19 is a respiratory illness caused by a novel virus that has been spreading worldwide. Community-acquired cases have now been confirmed in California. We are gaining more understanding of COVID-19’s epidemiology, clinical course, immunogenicity, and other factors as time progresses. The COVID-19 virus may be transmitted person to person through respiratory aerosols and droplets, such as from coughing or sneezing, or through contact with surfaces that may be contaminated with the virus. 

At this time, we recommend postponing non-essential home visits. 

Community transmission has occurred in California and employees should take steps to maintain social distancing and not enter homes whenever possible to decrease the risk of COVID-19 exposure, transmission, and infection within the communities served.

Alternatives include: 
  1. Conducting the interaction by phone.
  2. Postponing the home visit. 
  3. Doing a virtual visit using technology such as WhatsApp, FaceTime or Skype, as permitted by your jurisdiction’s privacy policies.

Everyday precautions for employees to take when a home visit is urgently needed for an essential or emergency service and cannot be done remotely or postponed 

  1. Employers should try to avoid assigning employees at higher risk due to personal factors (e.g., aged 60 or older, pregnant, immunocompromised, serious chronic health conditions) to work involving a home visit.
  2. During the initial scheduling of the home visit conducted by telephone, the scheduler should notify the household that precautions are being taken to prevent transmission of novel coronavirus, COVID-19, and explain what these precautions will be. 
  3. The scheduler should conduct a health screening by asking the household member:
    • In the last 14 days, has anyone in the household had a positive test for COVID-19, or been exposed to someone with a positive test
    • On that day or in the past 24 hours, has anyone in the household had a fever, felt feverish, or had chills, cough, sore throat, or difficulty breathing? 
  4. If the screening indicates there are household members responding “yes” to either of the 2 questions above, and the staff supervisor should be consulted immediately and consider whether the visit can be postponed. If not, the employee home visitor should take the extra precautions listed below during the home visit. Information about potentially ill family members should be communicated to the employee home visitor.
  5. The initial scheduler or employee home visitor should ask as many questions of the household as possible over the phone prior to the home visit to limit time spent in the home.
  6. Limit the number of employees who will conduct the home visit to the absolute minimum.
  7. Plan ahead to have all home visit supplies, including gloves, facemasks, and respirator, ready prior to entering the home to limit time spent inside the home.
  8. When arriving at the door of the home, employee home visitor should put on a facemask and conduct a second screening using the same screening criteria as identified in 3 above.
  9. If any household members respond “yes” to either of the two questions above, the employee home visitor should:
    • Request that those household members put on a facemask and stay in a room with the door closed, away from the employee home visitor while doing the home visit.
    • Take the extra precautions during the home visit listed below – or postpone or convert to a virtual visit.
  10. Notify all household members to maintain a distance of at least six feet away from the employee home visitor during the visit. Ask household members who do not need to communicate with the employee home visitor to move to a different room.
  11. Gloves: To protect against hand contact with possibly contaminated surfaces, wear vinyl or nitrile gloves and perform hand hygiene upon removal and disposal of used gloves. Do not touch or shake hands with clients or customers. Practice good hand hygiene at all times including prior to home entry, after leaving, before and after direct contact with other persons, and after contact with potentially contaminated items in the home. At the end of the visit and after leaving the home, employee home visitors should remove gloves and immediately clean their hands with hand sanitizer containing at least 60% alcohol.  As soon as possible after the home visit, the employee home visitor should wash hands for at least 20 seconds.

Extra Precautions for employees to take when any household member is potentially ill with COVID-19

In addition to the precautions above, take the following precautions:  

  • Wear Respiratory Protection. Respiratory protection can reduce the level of exposure to respiratory droplets and aerosols the employee could inhale while in the home. Respirators must be used in the context of a respiratory protection program including medical clearance, training, and fit testing of tight-fitting respirators. Respirators should be equipped with N95 or N, R, or P-100 filters. If respiratory protection is not available, wear a facemask.
  • Wear Gloves as described above.
  • Self-Monitor. Employees should self-monitor for symptoms of COVID-19 for 14 days and report back to their supervisor and their Employee Health Professional or Safety Manager if they experience any symptoms consistent with COVID-19. Employees should monitor their health starting from the day of the first close contact with an ill person and continue for 14 days. Watch for these signs and symptoms:
    • Fever (≥ 100.0 F) —take temperature twice a day 
    • Coughing
    • Shortness of breath or difficulty breathing
If a person in the home visited is unexpectedly found to have respiratory symptoms consistent with COVID-19, the employee home visitor should take the everyday and extra precautions, notify their supervisor immediately, and suggest that the ill person speak with their primary care physician. 

How to protect yourself and others from COVID-19 

Please review the COVID-19 prevention tips on CDPH’s website. In short, wash your hands regularly, avoid touching eyes, nose or mouth with unwashed hands,  cough or sneeze into a tissue or your elbow, regularly clean and disinfect frequently touched surfaces, avoid close contact with people who are sick, and stay home if you become sick. 

Stay informed on COVID-19 

Please visit the CDPH dedicated COVID-19 website for the latest updates. CDPH continues to work on addressing this issue with the White House, CDC, FDA, Cal/OSHA and other state agencies, local governments, health facilities and health care providers across the state, and other partners.
















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