COVID-19 OSHA Emergency Temporary Standard for Healthcare Employers: What Home Care Agencies Need to Know

In June 2021, the Occupational Safety and Health Administration issued a mandate to protect healthcare and health support workers: the Occupational Exposure to COVID-19 Emergency Temporary Standard. This six-month federal standard went into effect on June 21, and remains in place through Dec. 21, 2021—and potentially longer.

As a home care or home health agency administrator, here’s what you need to know to get—and remain—in compliance.*

What is the OSHA Emergency Temporary Standard? 

The standard requires healthcare employers to have specific policies and procedures in place to identify and control COVID-19 hazards in the workplace. These requirements range from training your staff on COVID-19 symptoms, transmission, and the proper use of personal protective equipment (PPE) to offering paid leave for your employees to get fully vaccinated and recover from vaccine side effects.

“The ETS is robust and covers a number of areas. There are many policies that agencies may have already adopted earlier in the pandemic,” says Erika Sessions, Compliance & Policy Development Manager at CareAcademy. “So you may already be compliant with some of the requirements. My advice to agencies is: Review the OSHA ETS, see where the gaps in your current policies and procedures are, and make a good faith effort to catch up on the additional requirements.”

If you have more than 10 employees, you must have a written plan for your workplace. Use OSHA’s COVID-19 Plan Template to make sure you have all areas covered.

OSHA offers a summary of the key requirements, which include:

  • Workplace-Specific Hazard Assessment
  • Patient Screening and Management 
  • Standard and Transmission-Based Precautions
  • Personal Protective Equipment (PPE)
  • Aerosol-Generating Procedures on a Person with Suspected or Confirmed COVID-19
  • Physical Distancing
  • Physical Barriers
  • Cleaning and Disinfection
  • Ventilation
  • Health Screening and Medical Management
  • Vaccination
  • Anti-Retaliation
  • No Cost to Employees
  • Recordkeeping
  • Reporting Fatalities
  • Training

What are the COVID training requirements?

As a healthcare employer, you need to ensure that each employee receives training on COVID-19 and your agency’s policies in a language and at a literacy level the employee understands. 

The ETS defines 21 topic areas that must be included in the training, including:

  • COVID-19 transmission (including pre-symptomatic and asymptomatic transmission)
  • Hand hygiene to reduce COVID-19 
  • Face coverings to reduce COVID-19
  • When PPE is required
  • Limitations of PPE
  • How to properly put on, wear, and take off PPE
  • Agency-specific COVID-19 protocols

You can rely on training completed before the ETS was in place, if the training meets OSHA’s requirements, including employer-specific policies and procedures regarding PPE.

Does the ETS apply to non-medical home care agencies?

Most likely, yes. The ETS was written broadly to cover “healthcare and health support services,” including home settings. There are narrow criteria by which a non-medical home care agency could claim exemption. Your agency could only be exempt if it meets ALL of these conditions:

  • Services provided are only non-medical home care, and
  • Services are provided only in the home, and
  • There are no state licensing, certification, or registration requirements for caregivers, and
  • The agency doesn’t offer licensing, certification, or registration credentials for caregivers.

For more coverage details, see OSHA’s workplace coverage flowchart.

If you’re unsure about your particular situation as it relates to coverage, talk with your attorney.

Is this a vaccine mandate? 

No; the OSHA ETS does not mandate COVID-19 vaccines, but it does encourage vaccination by relaxing some requirements if all employees are fully vaccinated. 

According to the ETS, in a home healthcare setting, workers are exempt from masking, distancing, and barrier requirements, if:

  • All employees are fully vaccinated
  • All non-employees are screened prior to entry
  • Work takes place in well-defined areas where there is no reasonable expectation that any person with suspected or confirmed COVID-19 will be present

However, the staff training and other ETS requirements still apply.

Does this replace state or CDC requirements?

No. The OSHA emergency temporary standard is a federal mandate, applicable to all states. Some state and local requirements go further than the ETS—for example, if you operate in California, Virginia, Oregon, Washington or New York, you may be ahead of the game. Agencies in these states should maintain compliance with their state standards and supplement as needed to meet the OSHA standards. The ETS is also not intended to replace recommendations from the CDC.

What happens if agencies don’t comply with the OSHA regulations?

OSHA enforces its regulations and standards by conducting inspections and issuing citations for noncompliance. OSHA has said it will use its discretion for healthcare employers who are making a good faith effort to comply with the ETS. 

How long is the ETS in effect?

The ETS went into effect June 21, 2021, and is effective for six months, until Dec. 21, 2021. During this time, OSHA will review public comments and evaluate what will become of the standard.

The agency says it will continue to monitor COVID-19 trends as the pandemic evolves and fully vaccinated workers increase, and update the ETS as appropriate.

What does this mean for home care agencies in the future?

Home care has had few regulations at a federal level—but the OSHA ETS signals a change, according to Sessions.

“While regulators have overlooked home care in the past, I think that the Biden administration and OSHA plan to seriously examine the healthcare continuum as it extends into the home,” she said. “The OSHA ETS specifically mentions in-home care, and that's a first—but it's part of a trend. I anticipate that home care will continue to get recognition through regulation.” 

How does CareAcademy help agencies meet COVID training requirements?

CareAcademy offers mobile-friendly online courses that meet OSHA’s COVID and infection control training requirements:

  • CARE0700 - Maintaining a Clean & Healthy Environment (Infection Control)

In this class, caregivers learn how to maintain a clean and healthy environment for the older adults in their lives. Topics discussed include standard precautions (also known as universal precautions), including hand hygiene and the use of personal protective equipment, and how to dispose of sharps and other contaminated materials and equipment. Also covered are methods of transmission, including bloodborne pathogens and airborne diseases, transmission-based precautions, and techniques for cleaning and disinfection for infection control.

  • CARE0706 - Overview of COVID-19

This class will provide caregivers with relevant information on the coronavirus disease 2019 (COVID-19). CaregiversDirect care workers will learn where to obtain reliable information about the virus, how to help prevent the virus from spreading, and how to care for themselves and their clients' care recipients.

For enhanced initial training or continued education, CareAcademy offers:

  • CARE0705 - Personal Protective Equipment for Home Care 

This class will provide caregivers with information on the use of PPE for home care. They will also learn about different types of PPE, and when and how to use them.

  • CARE0707 - Understanding the COVID-19 Vaccine

This class equips direct care workers to make an informed decision about the vaccine. The class provides direct care workers with relevant, reliable information about the vaccine and vaccination process.

CareAcademy’s platform makes it easy for agency administrators to assign all required courses to employees and to demonstrate proof of completion with certificates and easy-to-use compliance reports.

In addition, healthcare employers must also train employees on their agency-specific policies and procedures for full compliance with the ETS. Agency-specific training can also be delivered and tracked through CareAcademy’s platform.

For more details and insight on implementing the OSHA emergency temporary standard at your home care agency, watch CareAcademy’s informational OSHA COVID-19 ETS webinar.


*This blog post is intended as an overview of the OSHA ETS and CareAcademy’s interpretation of expectations based on its research. Please review the full ETS and consult with your business’s legal representation to ensure full compliance for your particular agency-specific needs.

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