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Medically Fragile Child Guidance

Planning actions for a home health care agency during an infectious disease pandemic

  • Review your list of clients and ensure it is up to date and includes levels of informal support available to individuals. Providers should consider how to benefit from sharing client health information electronically with local partners (hospitals, local health departments, emergency medical service providers), if they receive a legitimate request.
  • Work with local agencies/facilities to establish plans for mutual aid, taking into account business continuity plans and considering arrangements to support sharing of the workforce between home care providers, local primary and community services, and with the deployment of volunteers, where that is safe to do so.
  • Note the arrangements that local authorities are putting in place to refer vulnerable people self-isolating at home to volunteers who can offer practical and emotional support.
  • Use telemedicine and other non-direct care services when appropriate.
  • Develop back up plans for continuation of care using alternate family or additional nursing support, or hospitalization, as needed, when the primary guardian is unable to care for the patient during hours when health care providers (HCPs) are not regularly scheduled.

How to prevent respiratory germs from entering your home

  • Stay home as much as possible and consider alternate methods (friends or delivery of services) to get food, medications, and supplies.
  • Post signs outside restricting entry to anyone with symptoms of illness/respiratory infection.
  • No outside visitors should be allowed unless necessary, like HCPs or maintenance/repair workers. For these persons, a log shall be maintained that includes date/time they were in your home, their name, phone number/cell number, and email.
  • Anyone required to be in the home should be checked for fever before entering.
  • Home health care agency’s should screen HCPs for COVID-19 symptoms at the start of shift and prior to dispatching to a client residence.
  • If HCPs have signs and symptoms of a respiratory infection, they should NOT work.
  • If HCPs do not have symptoms of COVID-19, but do have mild respiratory illnesses, they may work if they have been fever-free for 72 hours without medication and their symptoms are improving. While working, the employee must wear a face mask.
  • If a HCP develops signs and symptoms of a respiratory infection while on the job they should:
    • Immediately stop work, put on a face mask, remove themself from the client area, and self-isolate at home.
    • Inform the agency supervisor.
    • Contact the local health department for next steps.

Preventative actions for the spread of respiratory germs WITHIN your home

  • Monitor the child daily for COVID-19 signs and symptoms.
  • Promptly isolate anyone in the home with COVID-19 symptoms, including the use of a procedure mask (as tolerated by children). Clean/disinfect the area after the ill person leaves.
  • Monitor and enforce hand hygiene among residents of the home.
  • Avoid shaking hands as a social greeting.
  • Ensure anyone working with the medically fragile child cleans their hands according to Centers for Disease Control and Prevention (CDC) guidelines, including before and after contact with others, and after contact with contaminated surfaces or equipment.
  • Set up alternate hand washing supplies or place alcohol-based hand rub containing at least 60 percent alcohol in every room.
  • Home health staff should wear recommended PPE. In addition, the number of home health staff should be limited to essential personnel. Any supplies brought into, used, and removed from the home must be cleaned and disinfected in accordance with environmental infection control guidelines.
  • Teach and reinforce healthy hygiene as age appropriate (covering coughs/sneezes; disposing of tissues; hand washing; keep fingers away from eyes, nose, and mouth) for all residents of the home.
  • Make sure tissues are available and sinks are well-stocked with soap and paper towels for hand washing.
  • Position trash cans for easier discarding of tissues and paper towels for residents of the home and health care workers.
  • Increase cleaning and disinfecting of frequently touched items, including doorknobs, toilet flush handles, medical equipment, toys, phones, keyboards, computer mice, and other items identified as frequently handled.
  • More information can be found here:
  • If HCPs undertake routine cleaning duties, they should use household products like detergents and bleach, as these will be effective in  getting rid of the virus on surfaces.
  • If an HCP is in a client’s home and suspects the client or a member of the household has COVID-19 infection, they should follow CDC guidance for PPE and safe working procedures to minimize the risk of transmission.
  • If the individual being cared for and their HCP can remain at a safe distance from other members of the household that are symptomatic and isolating, then care can be provided without additional precautions. This would apply, for example, where the living arrangements will allow the symptomatic family member to remain in their own room, use a separate bathroom facility, and observe robust isolation procedures, including staying 6 feet away from other family members. If this is not possible, then the same procedures should be adopted as if the client being cared for did have symptoms of COVID-19. Care should continue to be taken to limit contact with any household member with symptoms.
  • Coordinate with your physicians and local health department; inform them of COVID-19 cases that have had contact with the medically fragile child or anyone in the home.

Preventative actions for vulnerable populations

Social distancing actions are taken to restrict when and where people can gather to stop or slow the spread of COVID‐19 or other infectious diseases. Social distancing actions include limiting large groups of people coming together, closing buildings, and canceling events. Staff, parents/guardians, and children with medical conditions may wish to avoid a congregate setting, such as a child care or day care center.

Contingency planning

  • Work with home health agencies for “Just in Time Training” on medical equipment, treatment pathways, and emergency interventions.
  • Work with home health agencies to determine what medical equipment can be cleaned and reused if there is difficulty securing supplies.
  • Contact your health care provider to ask about obtaining extra necessary medications to have on hand in case there is an outbreak of COVID-19 in your community and you need to stay home for a prolonged period.
  • If you cannot leave the home to obtain extra medications, consider other options (pharmacy delivery or using mail-order ).
  • Be sure you have over the counter medicines and medical supplies (e.g., tissues, oral syringes, humidifiers) to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home.
  • Have sufficient household items and groceries so you will be  prepared to stay at home for a period of time.
  • You can make a do it yourself (DIY) hand sanitizer using over the counter ingredients . Mix isopropyl or rubbing alcohol (99% alcohol volume) with aloe vera gel to make a gel that keeps the alcohol content close to the recommended concentration of at least 60 percent. Maintaining a 2:1 proportion of alcohol to gel will assure the recommended alcohol percentage. A few drops of essential oil or lemon juice can be added for scent. This can be poured into any pump-equipped bottle like a gel dispenser. The bottle should be labeled to make sure it is not misidentified. NOTE: This is not a substitute for hand washing. There should be a warning that this is kept away from children and not ingested.

Last Updated:  7/2/2020

Guidance Document: