Take Extra COVID-19 Precautions at Section 202 Elderly Housing Sites

HUD’s Section 202 program is focused on expanding the supply of affordable housing with supportive services for the elderly. Occupancy in Section 202 housing is open to any very low-income household comprised of at least one person who is at least 62 years old at the time of initial occupancy. And it provides very low-income elderly with options that allow them to live independently but in an environment that provides support activities such as cleaning, cooking, and transportation.

Residents of these sites are considered at higher risk of severe COVID-10 outcomes because of older age and because they may have underlying health conditions, such as chronic heart disease, diabetes, or lung disease. According to the CDC, eight out of 10 deaths reported in the U.S. have been in adults 65 years old and older. And among adults with confirmed COVID-19 reported in the U.S., an estimated 31 to 70 percent of adults 85 years old and older and 31 to 59 percent of adults 65 to 84 years old are requiring hospitalization. Owners and managers of these sites must take additional precautions.

The CDC has issued interim guidance for these elderly housing sites that are not also healthcare facilities. This guidance takes into account that residents in these communities generally care for themselves.

What Owners and Staff Can Do

Cancel all public or nonessential group activities and events. For essential group activities that can’t be canceled, implement the following social distancing measures, if possible:

• Alter schedules to reduce mixing (for example, stagger meal, activity, arrival/departure times);
• Limit programs with external staff;
• Limit the number of attendees at a given time to fewer than 10 people and ask participants to maintain a distance of at least 6 feet from one another; and
• Place chairs and tables at least 6 feet apart during communal dining or similar events.

Inform residents, workers, volunteers, and visitors about COVID-19. Sharing the facts about COVID-19 and what to do if one becomes ill can make an outbreak less stressful and help prevent or slow the spread of disease. Staff can support residents who have no or limited access to the Internet by:

• Delivering print materials to their residences. Printable materials for community-based settings are available at www.cdc.gov/coronavirus/2019-ncov/communication/index.html;
• Providing easy to understand handouts and high-visibility posters in high-traffic locations; and
• Ensuring educational materials and information are provided for non-English speakers and low literacy persons.

Encourage personal protective measures. Workers, contractors (such as barbers, hairdressers, sitters, and housekeepers), and volunteers providing care in multiple homes or sites can serve as a source of coronavirus transmission between residences. These persons should be advised to limit the number of people they interact with who are at higher risk of serious complications from COVID-19, and retain a distance of more than 6 feet when interacting.

Establish a “buddy” system to ensure residents stay connected. Owners and staff may want to identify residents who have unique medical needs (including behavioral health needs), and access and functional needs to encourage them to develop a plan if they or their primary caretaker(s) become ill.

They can assist in finding volunteers to help residents who may need extra assistance in getting the medical help they need and train these volunteers in following personal protective measures. These volunteers shouldn’t be individuals who are at higher risk for serious illness from COVID-19. Volunteers can also consider checking up on residents via electronic means if appropriate.

Consider limiting the number of nonessential visitors. Sites may want to consider limiting visitation (for example, a maximum of one visitor per resident per day, and restricting visitors with recent travel and those with symptoms of COVID-19), especially in common areas, to workers, volunteers, and visitors who are essential to preserving the health (including mental health), well-being, and safety of residents. Advise persons that maintaining social distancing (at least 6 feet) can help reduce coronavirus transmission.

Remember that any COVID-19 visitation policy changes are voluntary and up to the individual site. HUD does not approve or disapprove of site-level visitation policies. These policies are set by individual sites and take into consideration any local or state requirements and cannot be discriminatory under the Fair Housing Act.

Screen, when possible, and advise workers and essential volunteers. When possible, administrators may want to consider screening workers and essential volunteers who will be interacting with residents for signs and symptoms of COVID-19. This includes actively taking each person’s temperature using a no-touch thermometer, and asking whether or not the person is experiencing shortness of breath or has a cough. They should be advised that if they develop fever or symptoms of respiratory infection while at work, they should immediately put on a facemask, inform their supervisor, and leave the workplace.

When a COVID-19 Case Has Been Confirmed

If a person with COVID-19 resides in or recently has been to your site, the CDC recommends the following measures in addition to cleaning and disinfecting site’s facilities:

Coordinate with local health officials. Upon learning that a resident, staff member, volunteer, or visitor of your site has COVID-19, ask the person to self-isolate and contact local health officials. Notify the local health department about any clusters of residents or workers with respiratory illness such as three or more persons with onset of respiratory symptoms within 72 hours). Local health officials will help determine the appropriate course of action for risk assessment and public health management in the site.

Communicate with residents, workers, volunteers, and visitors. In coordination with local health officials, communicate the possible COVID-19 exposure to all residents and workers, volunteers, and visitors. This can be done by placing signage in common areas and entrances/exists and by letter to all residents. Residents could be advised to inform their recent personal visitors of potential exposure.

Your communications must maintain confidentiality as required by the Americans with Disabilities Act (ADA) and Health Insurance Portability and Accountability Act (HIPAA). And messages should attempt to counter potential stigma and discrimination

Ask residents to self-monitor for 14 days and take action, if sick. Self-monitoring means a person takes her temperature twice a day and pays attention to cough or difficulty breathing. If a resident feels feverish or her temperature is 100.4°F/38°C or higher, or if she has a cough or difficulty breathing during the self-monitoring period, the following actions will help prevent spreading further illness:

• Stay home;
• Limit contact with others;
• Report illness to staff;
• Seek advice by telephone from a healthcare provider or their local health department to determine whether medical evaluation is needed; and
• Follow CDC guidance on when to discontinue isolation, which can be found at www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html.

IN A NUTSHELL

• Cancel all public or nonessential group activities.
• Inform residents, workers, volunteers, and visitors about COVID-19.
• Encourage personal protective measures.
• Establish a “buddy” system to ensure residents stay connected.
• Limit the number of nonessential visitors.
• Screen and advise workers and essential volunteers.