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Supports Coordinator (SC) Check-in
for Well-Being Tool

Issued: April 13, 2020


This tool is to be used by SCs as a guide when conducting individual well-being calls. It is the expectation of ODP that all SCs conduct weekly check-ins to all individuals especially, those who live alone. The only exception is for individuals residing in public ICFs. SCs should only ask questions that are applicable to the individual and the questions may be asked in any order.

The results of the conversation with the individual, caregivers and/or staff (if applicable) must be documented in a service note. The tool does not need to be completed or submitted to ODP. Again, it is intended to be used as a guide to help the SC facilitate the conversation.

Weekly well-being calls do not take the place of waiver and Targeted Services Management (TSM) individual monitoring requirements, however, the questions on this tool can be asked during the same time that the required monitoring takes place.

For individuals unable to engage in well-being calls, the SC should speak to the individual's caregiver or staff person.

Basic Needs

Ask the Individual

    • How are things going at home? How are you spending your day?
    • Do you need anything (food, housing, financial assistance, etc.)?
    • Are you receiving staffing support in your home? Do you need additional support? If so, what type of support do you need?

Ask the Caregiver

    • How are things going at home? How is "NAME OF INDIVIDUAL" spending their day?
    • Do you need anything (food, housing, financial assistance, etc.)?
    • Is "NAME OF INDIVIDUAL" receiving staffing support in your home? Do you need additional support? If so, what type of support is needed?

Ask Residential Staff

    • How are things going in the home? How is "NAME OF INDIVIDUAL" spending their day?
    • How are you helping the individual communicate with their family and/or loved ones?
    • Is additional support needed? If so, have you been in contact with the individual's SC to discuss?


This section is intended to ensure that the basic needs of the individual and caregiver are being met, and that there no concerns of neglect. In addition, it is intended to assess what services are currently being provided in the home and if there are any gaps.


Dial 211 (Call line to help connect with local resources):

Individual Wellness

    • How are you dealing with changes to your typical day, schedule and routines?
    • What type of physical activity are you doing?
    • What type of recreational activity are you doing?
    • Are you keeping in touch with family, friends, co-workers, church members, etc.?
    • Have your sleep patterns changed?
        • Sleeping more?  Less?  Disrupted sleep (waking in the night)?
    • Where are you getting your information about the coronavirus?
        • Technology – Do you have a:
        • Telephone (Landline, smartphone, cell phone)
        • Computer (Internet)?
        • Television (Cable)?


It is important to consider the impact that COVID-19 has had on everyone's daily routine and the importance of staying connected and active during a mandated stay-at-home order. Opportunities for wellness help maintain a sense of balance and control, especially in times of great uncertainty. Helping an individual think about these opportunities will be very beneficial during this difficult time.


Screening Questions for COVID-19 Symptoms

    • Have you or anyone in your household been tested for COVID-19? If so, what were the results of the test?
    • What is your back-up plan if your unable to care for "NAME OF INDIVIDUAL"? Do you have an alternative caregiver or place to go?
    • Do you have updated and accessible information/list of current medications and key medical information that someone may need to know, etc.?

PLEASE NOTE: SCs are required to report incidents in EIM related to the COVID-19 virus as per the following guidelines:

    • An individual was administered a COVID-19 virus test (awaiting results).
    • An individual was administered a COVID-19 virus test that indicated a positive result.
    • An individual was diagnosed with COVID-19 virus by a health care practitioner, regardless of testing.
    • Do you have any of the following?
        • Fever (100.0 or higher)?  If you do not own a thermometer, are you experiencing chills, muscle and joint aches which could indicate a fever?
        • Cough?
        • Shortness of Breath?
    • Do you have any of the following? (Associated symptoms):
        • Sore Throat?
        • Diarrhea?
        • Nausea?
        • Vomiting?
        • Abdominal Pain?


If the individual is experiencing any of these symptoms, the SC should encourage them to call their physician. Make sure the individual knows who and how contact their physician. Also, SC's should review social distancing and handwashing guidance. Mention that social distancing should not be mistaken for being out of contact with others. Discuss ways and strategies people can engage in meaningful interactions without physically being with them (phone calls, Skype, FaceTime, etc.) Give reminders on staying home unless for essential trips, wearing face masks when going out in public, and keeping appropriate distance between themselves and others in public places.


Physical Health

    • How do you feel physically?
    • Do you know what to do if you feel sick?
    • Do you have all your prescribed medicine?
        • Are you taking every day as directed?
        • Do you have refills available?
        • Do you have a way to get the medication from the pharmacy?
    • Are there any new or worsening symptoms of a physical illness (low or high blood sugar levels, headaches, body pains)?
    • Do you have a health care practitioner (aka family doctor)? Do you have their phone number? Have you had any difficulty contacting any of your health care practitioners?
    • If you use medical equipment, is it in good working condition?
    • Do you have any known swallowing difficulties?
        • If Yes:
            • Have there been any changes since the last health care appointment?
            • Are you following a special diet for aspiration/swallowing difficulty?
            • Are you following a special diet for any other reason, for example diabetic diet?
            • Do you have access to the food you need?
            • Do you have the proper equipment to modify the consistency of your food?
            • Do you need assistance to modify your food consistency and is that assistance available?
            • Do you have any questions about food consistency or liquid thickening if it is needed?
        • If No:
            • Any coughing or excessive drooling, especial during or after meals?
            • Any frequent clearing of throat, wheezing or complaining of food getting stuck.?
    • Any difficulties with constipation?
        • This is described as: infrequent, hard, dry stools that may be hard to pass or having a bowel movement less than every 3 days.
        • Sometimes people complain of bloating and stomach pain or have hard protruding abdomen
        • If you have loss of appetite, vomiting, or even a change in behavioral outbursts consider if constipation may be a cause.
        • It is important to make sure you are getting enough fluids.  Do you have any of these symptoms of dehydration?
            • Dry mouth or eyes
            • Increased thirst
            • Decrease in urine volume and dark concentrated urine
            • Headache, dizziness and/or muscle weakness
    • Do you have a seizure disorder?
        • If Yes, ask:
            • Any changes in the pattern or any recent seizures?
            • I know we spoke about medications already, but I want to double check that you have your seizure medication and that you are taking it as prescribed.
        • If No, state:
            • Contact your health care practitioner if you have any concerns for: Periods of unresponsiveness or staring
            • Fluttering of eyes or rolling eyes in a specific direction
            • Lip smacking
            • Muscle spasms
            • Loss of bladder or bowel


During this time when people are focused on COVID-19, it is important that other aspects of health are maintained. At a time when routines have been disrupted, it can be easier to forget things like taking medications daily or making sure that the medication supply is adequate. This is also an opportunity to remind individuals about the symptoms of the Fatal Four: aspiration, constipation, dehydration and seizure. These are all conditions that can lead to additional health problems if they are not recognized.

Please note, SCs should not diagnose or make medical recommendations. Individuals should contact their medical provider if they are having any non-emergency symptoms and call 911 if having emergency level symptoms.


Mental Health

    • Have you noticed any new or worsening symptoms that you think might be related to your mental health?
    • Have you had any difficulty reaching your mental health practitioner (psychiatrist, nurse practitioner, counselor)?
    • What is your mental health practitioner's plan regarding appointments during the COVID-19 pandemic?
      • Phone contact, telepsychiatry, emergency contact plan?
    • Do you have any concerns for your safety (self-harm or aggression)?


As with issues of physical health, mental health issues may receive less focus during the pandemic. Consider 2 important factors: 1) Individuals with existing mental health issues may experience changes due to changes in routine and access to the traditional modes of treatment, including face to face visits with prescribers and therapists. 2) Individuals with and without previous mental health issues may experience emotional difficulty associated with exposures to fear, anxiety, and uncertainty of this situation.


Behavioral Health

Ask the Individual

    • Have any problems come up at home that you did not know how to deal with? Do you feel prepared for a problem that might come up?
    • If the individual has a behavioral specialist: Is your behavior support staff still in contact (phone, Skype, etc.) with you?  Do you know how to reach your behavioral specialist if there are increased needs or a crisis?

Ask Caregiver/Staff

    • Have any problems come up at home that you did not know how to deal with?  Do you feel prepared for a problem that might come up?
    • Is the individual making any concerning statements or threats?
    • Have any previously known concerning behaviors increased?
    • Are there any new concerning behaviors that have developed?
    • Are there new situations that occur multiple times per week that have been challenging?
    • If the individual has a behavioral specialist: Is the behavior support staff still in contact (phone, Skype, etc.) with you (staff/supporters)? Do you (or caregiver) know how to reach the behavioral specialist if there are increased needs or a crisis?


It is important to recognize the impact the pandemic conditions may have on the individual's behavior. Increases in challenging behavior may occur as a result of heightened anxiety, disruptions to daily routine, increased social isolation, changes in support, etc. The intent of this section is to identify if individuals and/or caregivers need additional or new behavioral support to help cope with changes in behavior.


Individual Risk

    • Do you feel safe in your home?
    • Are you worried about anything?
    • Do you have the necessary contact numbers available in case of an emergency (SCOs 24-hour response system)?  Remind everyone, in the event of a real emergency, contact 911.
        • SC?
        • Behavior Support?
        • APS/OAPSA?


During this time, individuals may have less contact with professionals that are mandated reporters of abuse, neglect, and exploitation as a result of avoiding public spaces and staying in the home. For some people staying home may not be the safest option. In addition, external factors that add stress and financial strain can negatively impact survivors and create circumstances where safety is further compromised. Encourage individuals to try to maintain social connections online or over the phone, if it is safe to do so, and try to stick to daily routines as much as possible.

If an individual discloses that they are being abused or neglect, immediately report the situation to the appropriate protective service hotline and other appropriate authorities. Assist the individual with contacting resources so that a safety plan can be developed.


    • Adult and Older Adult Protective Services:  Call 1-800-490-8505
    • Child Protective Services CHILDLINE:   Call 1-800-932-0313
    • National Domestic Violence Hotline: 1-800-799-SAFE (7233) 
    • National Domestic Violence Hotline: website:
    • COVID-19 Support & Referral Helpline: 1-855-284-2494. For TTY, dial 724-631-5600.

Final Question

    • Is there anything else you want to talk about?
    • Guidance: This question is intended to be the final question so that the individual/caregiver or staff can discuss anything else they may need to talk about that they have not already discussed.