COVID-19 Guidance for Home Health Care Workers
and Community Health Care Workers
Note: This guidance is based on the best information currently available and will be updated as necessary.
See New York City (NYC) Department of Health and Mental Hygiene (Health Department) Health Alerts and
other resources at nyc.gov/health/coronavirus and cdc.gov/covid19 for updates.
This guidance is intended for organizations that have health care workers who provide care to individuals in
a home residence or community setting (e.g., outreach on the street). It provides general safety and health
guidance in relation to COVID-19.
COVID-19 Background Information
There continues to be community transmission of COVID-19 in NYC and other parts of the U.S. Our current
understanding is that COVID-19 is transmitted primarily via respiratory droplets when a sick person coughs,
sneezes, sings or talks. COVID-19 can also be spread if someone touches a surface that has the virus on it
and then touches their eyes, nose or mouth with unwashed hands. There is strong evidence that people
without symptoms can spread the virus.
Symptoms may appear two to 14 days after exposure to the virus. Commonly reported symptoms include
cough, shortness of breath and fever. A more complete list of symptoms can be found at
nyc.gov/site/doh/covid/covid-19-symptoms-chronic-health-risks.page. As with other infections, older
patients may present with atypical signs or symptoms, such as delirium or falls.
Children have similar symptoms as adults and generally have mild illness, with the exception of an
extremely rare condition called multi-system inflammatory syndrome in children (MIS-C) that is associated
with COVID-19.
For purposes of this document:
• A confirmed case is a person with a positive viral RNA (e.g., polymerase chain reaction [PCR]) or
antigen-based laboratory test.
• A possible case is a person with symptoms of COVID-19 for whom testing was not or has not yet
been performed.
• A contact is anyone identified by a NYC contract tracer (either by the NYC Test & Trace Corps or
NYC Health Department) or their health care provider as having had close contact with a
confirmed case within the past 14 days. (For more information about the NYC Test & Trace Corps,
see nychealthandhospitals.org/test-and-trace/)
Using a face mask or face covering, maintaining at least 6 feet of distance from others when feasible, and
practicing good hand hygiene are critical to stopping the spread of COVID-19. In addition, NYC is conducting
contact tracing to minimize community transmission of the virus. Contact tracing identifies people who had
close contact with a person who was recently diagnosed with confirmed COVID-19. Contacts should
quarantine at home for 14 days from their last exposure to someone with confirmed COVID-19.
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People who have COVID-19 symptoms and test positive should isolate at home or another safe location
until all the following have occurred:
• At least 10 days have passed since they first developed symptoms (certain groups should isolate
longer, see below).
• They have been afebrile for at least 3 days (without using antipyretic medications).
• Their overall illness has improved.
People without symptoms who test positive for COVID-19 should isolate for at least 10 days from when the
positive specimen was collected.
In addition to the above criteria for ending isolation, people who reside or work in long-term care facilities,
are hospitalized, are immunocompromised, or live in congregate settings, including supportive housing or
shelters, should isolate for at least 14 days. A summary of recommended duration of isolation may be
found here.
How to Prepare and Manage Staff
Health care organizations that have staff who provide health care services in clients’ homes or a community
setting (“organizations”) should have protocols to protect staff and clients from COVID-19, including by
promptly identifying possible cases in staff, clients, and clients’ household members. There should also be
protocols in place to manage clients with COVID-19, which should be communicated to staff.
General Precautions for All Health Care Workers
Organizations should remind staff to take the following precautions to protect themselves and their clients:
• Monitor their health daily and before each shift for COVID-19 symptoms.
• Stay home if sick. Staff with confirmed or possible COVID-19 must isolate at home or another
safe location and may not return to work until completing isolation, as described above. See
NYC Health Department guidance on discontinuation of isolation and monitoring at
nyc.gov/assets/doh/downloads/pdf/han/advisory/2020/covid-19-update-05142020.pdf.
• Stay informed, including by visiting the NYC Health Department (nyc.gov/health/coronavirus),
Centers for Disease Control and Prevention (CDC) (cdc.gov/covid19), and New York State
Department of Health (health.ny.gov/coronavirus) webpages.
• Practice good respiratory and hand hygiene:
o Wash hands often with soap and water for at least 20 seconds. Use an alcohol-based hand
sanitizer if soap and water are not available.
o Cover coughs and sneezes with a tissue or inner arm (not hands).
o Avoid touching eyes, nose and mouth with unwashed hands.
• Be familiar with and regularly trained on CDC’s infection control practices and personal protective
equipment (PPE) recommended for COVID-19: cdc.gov/coronavirus/2019-ncov/hcp/infectioncontrol-recommendations.html.
• Maintain a distance of at least 6 feet from all people, including clients, whenever possible. This may
not be possible for clients requiring direct care.
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• Always wear a face covering while in public traveling to and from the clients’ residence. While in the
residence, wear a face covering or, if indicated, a mask that is medically appropriate to properly
manage the client. See the NYC Health Department’s answers to frequently asked questions on face
coverings at nyc.gov/assets/doh/downloads/pdf/imm/covid-19-face-covering-faq.pdf.
Implement Protocols and Plans
This guidance is intended to supplement, not replace, rules and guidance from regulatory agencies that
oversee health care organizations. Each organization will need to tailor these recommendations based on
the types of clients they care for, physical space, staffing and other considerations. Organizations may
develop their own policies, but these policies should be based on current science and facts, not fear, and
should never compromise client or employee health.
Organizations and their staff should:
• Review and update emergency preparedness plans. If the organization does not have a plan, a
template from the U.S. Department of Health and Human Services can be found at
asprtracie.hhs.gov/technical-resources/resource/3206/emncypreparedness-packet-for-homehealth-agencies.
• Create an emergency contact list.
• Have a sick leave policy that encourages staff to stay home when sick and ensure staff are aware of
sick leave policies.
• Have options for telephone or video client visits when possible.
• Screen clients and household members for symptoms of COVID-19 and ask if they have been
identified by a NYC contact tracer as a contact. Do this in advance by phone, and again at the time
of the visit.
o If screening identifies a person with symptoms of COVID-19, or if the client has been
identified as a contact, have options for rescheduling visits for people who do not require
immediate care.
• Implement plans to manage clients with possible or confirmed COVID-19 or who are contacts, and
whose medical needs cannot be postponed.
o Plans should include clear guidance on infection control and PPE for managing clients.
o Maintain a distance of at least 6 feet when direct care is not required.
o Include plans for when someone else in the residence is ill. For example, ensure the ill
person is isolated in a separate room from the health care worker and client. Advise the ill
person to contact their health care provider.
• Have contingency plans for continuing client care during staff shortages. Identify minimum staffing
needs and prioritize critical and essential services based on clients’ health status, functional
limitations, disabilities and essential needs.
o Learn how you can apply for or receive surge staffing during the COVID-19 pandemic at
nyc.gov/site/helpnownyc/index.page.
• Review, implement and reinforce an infection control plan for preventing disease transmission.
o Address when direct care staff should use transmission-based precautions for clients with
symptoms of respiratory infection. See CDC guidance at
cdc.gov/infectioncontrol/basics/transmission-based-precautions.html.
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o Clean and disinfect high-touch surfaces with Environmental Protection Agency (EPA)-registered disinfectant with a label stating it is effective against human coronavirus or
emerging viral pathogens. See list of EPA-registered sanitizers and disinfectants effective
against COVID-19.
• Identify ways to preserve PPE supplies. Develop protocols for managing clients using limited or no
PPE, including identifying ways to provide care without direct contact to maintain physical
distancing.
o See CDC strategies for optimizing the supply of PPE at cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
o See NYC Health Department guidance about PPE preservation at
nyc.gov/assets/doh/downloads/pdf/imm/strategies-for-the-conservation-of-respiratoryppe.pdf.
o At this time, the supply chain for PPE is recovering from the severe shortages experienced
earlier in the pandemic. The NYC Health Department encourages all providers to contact
their usual suppliers for PPE. For a list of suppliers in the NYC area, see
nyc.gov/assets/doh/downloads/pdf/imm/covid-19-ppe-suppliers.pdf.
Home and Community Health Care Worker PPE
• Shortages of some types of PPE (such as N95 respirators) continue. When possible, identify ways to
avoid direct contact and maintain physical distancing (6 feet or more) while providing care to
conserve PPE.
• When providing care to clients who are afebrile and otherwise without symptoms of COVID-19,
health care workers should use PPE that is appropriate for managing the client’s condition. If a staff
member finds, after entering the residence, that there is someone who has or may have COVID-19,
that staff member should:
o Follow organization protocol as to whether the staff member should exit the residence or
continue providing care; use hand sanitizer immediately upon exiting the residence.
o If staying to provide care, clean hands with soap and water or use an alcohol-based hand
sanitizer before putting on PPE.
o Notify their supervisor.
• General guidance on PPE to use with all clients:
o All home and community health care workers should wear a face covering when entering a
client’s residence. Face masks should be prioritized for visits to homes of clients with
possible or confirmed COVID-19.
o Home and community health care workers should also use eye protection (goggles or a face
shield) during close or prolonged contact with all clients. Examples include performing tasks
that require close contact, such as transferring, changing or bathing.
o The CDC recommends universal use of standard precautions when caring for any client.
Reinforce with staff the importance of strict adherence to standard precautions during all
client encounters. Standard precautions are based on the principles that all blood, body
fluids, secretions, excretions (except sweat), non-intact skin and mucous membranes may
contain transmissible infectious agents. The application of standard precautions is
determined by the interaction that occurs between the client and the health care provider
and the extent of anticipated pathogen exposure through contact. For example, a face mask