COVID-19: Impacts on DHS Programs

Additional funding providing by Congress through the CARES Act for the National Family Caregiver Support Program (NFCSP) should be used to expand the capacity and range of services available to help family caregivers provide support during the COVID-19 pandemic. Funds are being distributed to Wisconsin Counties for traditional NFCSP services with the understanding that funds should be used to promote innovative strategies for service delivery and the use of technology to provide caregiver counseling, respite, training, and connect people to information and caregiver support services.

• Agencies may begin charging expenses to CARES Act funding on April 1, 2020.
• The deadline to spent CARES Act funding is September 30, 2021.
• Agencies are encouraged to charge COVID-19-related expenditures to CARES Act funding first, before spending annually contracted Older Americans Act (OOA) funding.

Changes in Policy Related to Providing Caregiver Support Services

1. In the past, the State of Wisconsin has limited payments to in-home provider agencies, extended family members and friends of primary caregivers. In response to the paid caregiver shortage, social distancing advisories, and the reality that many family members are reluctant to invite outsiders into the home of older adults at-risk of contracting COVID-19, DHS is temporarily amending this policy. As of May 1, 2020, all caregivers, including primary caregivers, who are eligible to enroll in AFCSP and NFCSP may receive a stipend. If funding is running low, priority should be given to low-income caregivers who have been laid-off, furloughed or have lost a job.
   
   Time spent performing the following tasks may be eligible for an hourly stipend using the Title III-E or AFCSP when pre-approved by the county caregiver program coordinators:

   • Bathing and grooming
   • Meal preparation and feeding
   • Housekeeping chores, such as cleaning and doing laundry
   • Grocery shopping and other errands
   • Lawn care and home maintenance
   • Transportation to and from doctor appointments, scheduling appointments, or participating in appointments by phone or internet
   • Managing banking, household bills, and other financial transactions
   • Emergency preparation and planning for oneself or the care recipient
   • Purchasing technology, caregiver training, or internet services needed to maintain connections with medical and other care providers, friends, and family members while adhering to social distancing guidelines
   • Managing medications and coordinating with qualified health care professionals, including pharmacists
   • Grandparent and relative caregiver support
   • Any other activity currently reimbursable under Title III-E and the AFCSP

   Local agencies are responsible for setting the non-professional rate for stipends and for providing instructions to primary caregivers, extended family members, and friends on how caregiving hours should be documented and submitted for payment. The stipend rate should be less than hiring a professional agency, but may be higher than the minimum wage. In the past, stipends have generally ranged between $10 and $15 per hour. Agencies are also responsible for maintaining documentation to justify expenditures. Guidance for establishing a policy to provide stipends has been distributed to county and tribal AFCSP and NFCSP coordinators. It is also available on the Greater Wisconsin Agency on Aging Resources (GWAAR) website or by contacting Lynn Gall, Wisconsin Family and Caregiver Support Program Manager.

   Caregivers are personally responsible for determining the tax implications of receiving stipends, as well as for understanding how earning a stipend may impact their eligibility for unemployment and other public benefits. Caregiver program coordinators may assist caregivers in gathering information they need to make a determination about the impact stipends may have on tax liabilities and other benefits, but program coordinators may not advise or provide legal advice about these issues. However, NFCSP and AFCSP may be used to pay for caregivers to consult with a financial advisor or attorney to help make these determinations. Free benefits counseling is also available to caregivers age 60+ through the elder benefit specialist program or to caregivers of all ages through the GWAAR Guardianship Support Center.

2. The 20% cap on supplemental services expenditures for Title III-E is temporarily suspended until the end of 2020.
3. The 112 hour annual limit on NFCSP caregiver respite is temporarily suspended until December 31, 2020. Agencies may approve respite as needed based on results of the required AFCSP and NFCSP family caregiver needs assessment and available funds.
4. An online version of Powerful Tools for Caregivers (PTC) classes will be available in June 2020. To obtain the necessary training to host an online PTC class, contact Judy Rank at the Wisconsin Institute for Health Aging at 608-243-5690. 
5. Any policy for paying a non-professional stipend must be applied equally to all program participants.

Best Practices

Family caregivers face special challenges during this time of self-isolation. The person in their care needs them to be physically healthy and emotionally strong, which takes extra effort during a pandemic. Below are guidelines to help Family Caregiver Support Program coordinators and ADRC staff serve caregivers in days ahead. Providing information based on medical science with the goal of keeping caregivers connected to relatives, friends and advice from qualified professionals is the best way to help caregivers maintain peace of mind.

1. Emphasize prevention.
   Ensure that you and everyone in the household follows CDC guidelines:
   • Wash hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing one’s nose, coughing, or sneezing. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol.
   • Avoid close contact with others as much as possible (about 6 feet), and wear a face mask.
   • Stay home when sick, except to get needed medical care.
   • Cover coughs and sneezes with a tissue.
   • Clean frequently touched surfaces and objects daily. (e.g., tables, countertops, light switches, doorknobs, and cabinet, refrigerator and appliance handles)
   • For disinfection, a list of products with Environmental Protection Agency (EPA) approval is available at Disinfectants for Use Against SARS-CoV-2. Always follow the manufacturer’s instructions for all cleaning and disinfection products.
2. Know who is at greatest risk.
   According to the CDC, older adults and people of any age who have serious underlying medical conditions are at higher risk for more serious complications from COVID-19. If a caregiver or household member is at increased risk for COVID-19 complications, they should take extra precaution to minimize potential exposures and consult with their health care provider to monitor their health and symptoms.
3. Watch for COVID-19 symptoms.
   If a caregiver suspects they may have been exposed to COVID-19 and develops a fever, cough or other symptoms, or experiences difficulty breathing, advise them to immediately call their healthcare provider for medical advice.;
4. Designate a room at home that can be used to isolate sick household members.
   Identify a separate room and bathroom for a sick or potentially exposed person to use, if possible. Plan to clean these rooms regularly. Learn how to care for someone at home.
5. Create an emergency plan.
   Advise caregivers to speak with family and friends about what they and the care recipient are likely to need if the primary caregiver needs to self-isolate. Encourage caregivers to ask others to volunteer to ensure these needs are met, and make sure the caregiver creates an emergency contact list and instructions about medications and specific care needs in case the caregiver becomes ill. Remind them that their local aging and disability resource center (ADRC) can assist in creating an emergency plan.
6. Make a list of contacts and community resources.
   Advise caregivers to create a current list of contacts for family, friends, neighbors, carpool drivers, health care providers, teachers, employers, the local public health department and the Aging and Disability Resource Center. Include help lines such as:
   • Alzheimer's Association 24/7 Helpline: 800-272-3900, or live chat.
   • Caregiver Action Network Caregiver Help Desk: 855-227-3640, or live chat.
   • Institute on Aging Friendship Line—crisis intervention hotline and a "warmline" for non-emergency emotional support calls: 800-971-0016
   • Disaster Distress Helpline—free, 24/7 crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters (options for Deaf and hard of hearing and Spanish speakers): 800-985-5990, or text "TalkWithUs" to 66746.
7. Caregiver program coordinators should keep abreast of changes.
   Changes may occur in daily operations of ADRCs and other community support agencies in accordance with state orders and CDC recommendations. Please call to find out details, as the following guidelines are being enforced at varying degrees across the state. Changes may include:
   • Suspension of classes and support groups. Some are being transitioned to phone or online.
   • Suspension of in-home and in-office visits and offering visits by phone instead.
   • Closure of congregate dining sites with options for picking up meals or delivery of meals.
8. Take advantage of technology and virtual supports such as telephone support groups, webinars, tele-events, and message boards from the following organizations:
   • Alzheimer's Association offers a variety of online and virtual supports, in addition to a telephone support group for Wisconsin caregivers on Tuesdays from 5:30 to 7 p.m. and Thursdays from 1 to 2:30 p.m. Register by calling 800-272-3900 and ask for Wisconsin support group information.
   • ALZConnected is a free, online community for anyone affected by Alzheimer's or other dementia, that includes message boards and a caregivers forum.
   • Caregiver Teleconnection holds weekly live call-in events, as well as archived programs all relating to caring for someone who is older or disabled.
   • Alzheimer's Foundation of America hosts webinars that are accessible online.
9. Interactions with nursing homes, community-based residential facilities (CBRFs), and assisted living.
   Always call in advance to learn their most recent policies about visiting. The Department of Health Services has issued guidance restricting visits to all residential care facilities. Stay in touch by phone, email, and U.S. mail until restrictions are lifted.
10. Resources for grandparents and relative caregivers of a child.
    • Children and Coronavirus—information from the CDC
    • Tips for Families: Coronavirus
    • COVID-19 Fact Sheet for Grandfamilies and Multigenerational Families
    • If the child received free or reduced school meals, contact the school to find out how meals can be accessed during school closures.
11. Encourage caregivers to discuss their circumstances with their employer.
    Telework may be an option, as well as leave options. Remind them to emphasize that someone else's health is dependent on them remaining well.
12. Prioritize emotional health and stress management.
    Encourage them to make time to unwind, call a friend or spiritual advisor, listen to music or engage in other relaxing activities. Take breaks from watching, reading or listening to news about COVID-19. Connect with family and friends by phone or consider connecting via conference call or video conferencing. Free Conference Call, FreeConference, and Zoom are a few platforms that allow multiple people to talk or video chat.
13. Stay informed about the local COVID-19 situation.
    Get up-to-date information about local COVID-19 activity from the Wisconsin Department of Health Services website.

COVID-19 Patient Resources

Family Planning Services

• COVID-19: ForwardHealth Program updates (including Family Planning Services).

Pregnancy Testing

• Complete home pregnancy test.
• If you have questions, call your local provider or clinic with the date of your last menstrual period and last date of unprotected intercourse.
• Emergency contraception will not disrupt an implanted pregnancy or harm a pregnancy.

Birth Control during COVID-19

Reproductive Health Access Project: Birth Control Choices

Birth Control Refills during COVID-19

• Request a telephone visit from your clinic or provider.
• Call your clinic for refills by mail or curbside delivery.

Birth Control Methods (IUD and Nexplanon) about to expire during COVID-19

• Nexplanon: FDA approved for three years; based on current research, can be in place for five years
• Liletta: FDA approved for six years; based on current research, can be in place for seven years
• Mirena (same dose of levonorgestrel as Liletta): FDA approved for five years; based on current research, can be in place for seven years
• Skyla: FDA approved and evidence-based for three years
• Kyleena: FDA approved and evidence-based for five years
• Paragard: FDA approved for 10 years; based on current research, can be in place for 12 years

Birth Control Methods (IUD and Nexplanon) truly expired even by current research recommendations

• Use condoms.
• Use emergency contraception pills.
• Call your clinic and ask to talk about other possible options for contraception.

Depo-Provera (Depo shot) during COVID-19

Depo lasts for 15 weeks. If it's past 15 weeks, use condoms, or emergency contraception pills. Call your local provider or clinic to discuss options.

Emergency contraception during COVID-19

Paragard (IUD) is the most effective option but if the services are not available, then Ella is the next best option. Let your provider know if you are breastfeeding.

Sexual activity, sexually transmitted diseases during COVID-19

• NYC Department of Health: Sex and Coronavirus Disease 2019 (COVID-19)
• Mayo Clinic: Sexually transmitted disease (STD) symptoms
• Please call your provider or clinic if you develop any symptoms or have questions

Sexual assault, intimate partner violence, domestic violence

• Resources from End Domestic Abuse Wisconsin:
  • Contact information for tribal agencies
  • Contact information for Wisconsin Domestic Violence Programs
• Psychology Today: If You Are Locked Down With Someone Who May Become Violent

Additional educational resources

• Office on Women's Health: Emergency Contraception
• Reproductive Access Project: Non-Prescription Birth Control Methods

Contact your local health department.