phased reopening at luther oaks

On October 21, 2020, the Illinois Department of Public Health (IDPH) updated its interim guidance for residential healthcare and assisted living communities. This interim guidance provides guidelines for communities like ours to implement a phased reopening of our campus.

The guidance from IDPH follows the same numbering convention outlined in the Centers for Medicare and Medicaid Services (CMS) guidance. There are three phases. There are seven eligibility criteria that must be met to advance through the three phases. There are also three tiers of mitigation strategies that may be implemented within each phase, based on resurgence of COVID-19 in our region.

Communities must spend a minimum of 14 days in a given phase, with no new, facility-onset COVID-19 cases or facility-associated COVID-19 infections in a staff member, before advancing to the next phase. Facility-onset case is defined as a COVID-19 case that originated in the facility, and not a case where the facility admitted an individual from a hospital with known COVID-19 positive status, or an individual with unknown COVID-19 status that became COVID-19 positive within 14 days after admission. Facility-associated case of COVID-19 infection in a staff member is defined as a staff member who worked at the facility for any length of time two calendar days before the onset of symptoms (for a symptomatic person) or two calendar days before the positive sample was obtained (for an asymptomatic person) until the day that the positive staff member was excluded from work.  Residents, their families, the Long-Term Care Ombudsman, and the local health department will be notified when we move to a new phase, and of the relevant operational changes.

If Luther Oaks identifies a new, facility-onset case of COVID-19 or there is a case of facility-associated COVID-19 infection in a staff member in any phase of reopening, we will immediately revert back to the highest level of mitigation and start over in the phases of reopening. If any other of the criterion for the current phase is no longer fulfilled, then Luther Oaks will revert to the previous phase until the criterion is fulfilled. Phase regression will also be communicated to residents, families, the Long-Term Care Ombudsman, and the local health department, along with the relevant operational changes.

 

The seven criteria are as follows:

1. Case status in the community. The state of Illinois is divided into eleven geographic Illinois COVID Regions for the purpose of monitoring and mitigating resurgence of COVID-19. Both of the calculated indicators for our region must have been within their target ranges for at least 14 days, before we can advance to the next Phase. The two indicators are: (a) test positivity rate; and (b) a composite metric of COVID-19 hospital admissions and hospital resource capacity.

2. Case status in the facility. Luther Oaks must spend a minimum of 14 days in a given phase, with no new facility-onset COVID-19 cases and no facility-associated COVID-19 infections in a staff member, before advancing to the next phase. Local health department may require an interval longer than 14 days. If a resident develops facility-onset COVID-19 or there is a case of facility-associated COVID-19 infection in a staff member, Luther Oaks will immediately revert to the highest level of mitigation.

3. Staffing level. Luther Oaks must have sufficient staffing that it is not operating with a contingency or crisis staffing strategy, as defined by CDC.

4. PPE supply and usage and essential cleaning and disinfection supplies to care for residents. Luther Oaks must have sufficient PPE, and not be operating at crisis capacity. All staff must wear appropriate PPE when indicated.

5. Universal Screening. Luther Oaks must screen each person entering the community, including all staff, visitors, and other persons. Access must be denied if the person does not pass the screening. All residents must be screened at least daily.

6. Universal Source control and hand hygiene. Luther Oaks must train all staff in proper hand hygiene. Everyone entering the community must perform hand hygiene upon entry. Everyone entering the community must wear facemasks or respirators, as appropriate, and additional PPE as appropriate, except during breaks in designated break areas.  All residents must wear a cloth face covering or facemask when outside of their rooms and when staff enter their rooms.

7. Testing plan and response strategy. Luther Oaks must have a COVID-19 testing plan and response strategy in place, based on contingencies informed by the CDC. The testing plan includes: initial (baseline) facility-wide testing: routine periodic retesting of staff; testing and repeated retesting of residents and staff in response to an outbreak or a single new, facility-onset COVID-19 case in a resident or a single new case of COVID-19 infection in a staff member and immediate testing of residents or staff with signs/symptoms of COVID-19.

The guidance under each phase is extensive and very detailed. Luther Oaks has reviewed this guidance to ensure the new activities introduced meet that guidance. If Luther Oaks moves to a new phase, or has to introduce any tier of mitigation, this will be communicated to all. The current phase of opening and of tiered mitigation, along with what that means for our residents and families, will be posted on Luther Oaks COVID-19 webpage for you to reference. (LutherOaks.org/covid19)

Highlighted below are some of the most important changes that phased reopening will allow for our residents and their families. The key changes within each phase are broken out into four of the most important categories of engagement: small group activities, visitation, communal dining and beauty/barber shop. The summary below is a high-level summary of these areas of engagement and does not cover every detail of the phased reopening, additional details to each phase and each category will be shared as needed.  We will continue to update our policies and practices in accordance with guidance from CMS, IDPH and our local health department.  Accordingly, the information contained in this communication is subject to change in accordance with guidance from CMS, IDPH and our local health department as well as changes we deem operationally necessary.

We recognize that this communication includes a lot of information. Please know that we will be communicating frequently, and in detail, as we move through the phases of reopening, so that our residents and their families understand what is allowed, and what is not allowed.

Small Group Activities

Phase 1: Virtual engagement is preferred to minimize opportunity for exposure.

Phase 2: Virtual engagement continues.

Small group activities may take place, with a maximum of 10 residents per activity. No activities that require strenuous activity or exertion will be conducted. No activities will involve any shared items among residents. Activities will preferably take place outdoors, but can be moved indoors due to weather. All residents will wear a mask.

Phase 3: Virtual engagement continues.

Small group activities may take place, and can exceed 10 participants. Participation will be limited to the maximum number of persons that can be accommodated in the designated space while maintaining at least a six-foot distance. All residents will wear a mask.

Visitation

Phase 1:  Virtual visitation and indoor compassionate care visitation (when outdoor visitation is not practicable) is allowed. Additionally, outdoor visitation is permitted in Phase 1.

Outdoor visitation must comply with the following:

  • Visitation will take place at the designated outdoor visitation pavilion.

  • Signage indicating the maximum occupancy in the designated outdoor area, and cues for six-feet of separation will be provided.

  • Residents and visitors will wear a face covering throughout the visit.

  • Visits must be scheduled by appointment only, with a specific start time, end time and
    location.

  • Visitors may not enter the facility at any time.

  • Visitors are limited to two visitors at a time per resident. The visitors, if two, must be
    from the same household. An exception to this limitation may be made for compassionate care situations, at Luther Oaks’s discretion.

  • Visitors will be pre-screened by phone less than 24 hours in advance of their visit. They
    will be screened upon arriving at the visit as well. If a visitor develops symptoms of
    COVID-19 within 3 days after visiting, they must notify Luther Oaks.

  • Visits will be supervised.

 

Phase 2: Virtual visitation, indoor compassionate care visitation & outdoor visitation continues. Additionally, indoor visitation is permitted in Phase 2.

Indoor and outdoor visitation is permitted. Outdoor visitation is strongly preferable, as a result, weather permitting, visits will take place in the outdoor visitation pavilion.

Indoor visitation must comply with the following:

  • In room visits will be allowed if the visitor can maintain 6 feet separation from the resident.

  • Visits must be scheduled by appointment only, with a specific start time, end time and
    location.

  • Residents and visitors will wear a face covering throughout the visit.

  • Visitors are limited to two visitors at a time per resident. The visitors, if two, must be
    from the same household. An exception to this limitation may be made for
    compassionate care situations, at Luther Oak’s discretion.

  • Visitors will be pre-screened by phone less than 24 hours in advance of their visit. They
    will be screened upon arriving at the visit as well. If a visitor develops symptoms of
    COVID-19 within 3 days after visiting, they must notify Luther Oaks.

  • Visits will be supervised.

  • Resident and visitor need to wear a face covering throughout the visit.

 

Phase 3:  Virtual visitation, compassionate care visitation, outdoor visitation continues & indoor visitation continues as in previous phases.

Trips That Are Not Medically Necessary

Phase 1:  Trips that are not medically necessary must be avoided.

Phase 2:  Trips that are not medically necessary must be avoided.

Phase 3:  Trips off campus for non-medical purposes are permitted; provided that a decision on making a non-medically necessary trip shall be made collaboratively with the resident, the resident’s family or health care surrogate, a Luther Oaks representative, and, where appropriate, the resident’s physician. Residents with symptoms consistent with COVID-19, or a confirmed case, must not make trips that are not medically necessary.  Residents with high-risk comorbidities should avoid trips that are not medically necessary.  Residents should avoid use of public transportation or ride-hailing services.

 

All trips off-campus must comply with the following expectations.

  • Resident and those assisting them are to perform frequent hand-hygiene

  • Resident and those with whom they come in contact will continuously wear a face covering

  • Resident is to maintain six feet of separation from other individuals at all times during the trip

 

The resident will be evaluated upon return from the outing. If the resident shows any signs or symptoms of COVID-19 or if any of the above conditions were not maintained, the resident may be placed on quarantine precautions for 14 days upon return.

Communal Dining

Phase 1: There will be no communal dining, except as deemed necessary for resident safety for
those resident who cannot eat safely in their rooms.

 

Phase 2: Communal dining may take place for all residents; provided the maximum number of residents who will participate in any one sitting will be based on 25% of seating capacity in the applicable dining area. Tables and chairs will be set up in a configuration so that each resident is at least 6 feet apart.

 

Phase 3: Communal dining may take place for all residents; provided that the maximum number of residents who will participate in any one sitting will be based on the number of residents that the applicable dining room can accommodate with each resident maintaining at least 6 feet of social distance. During Phase 3, all of the other requirements of Phase 2 shall be followed.

Beauty/Barber Shop

Phase 1: Salons will remain closed.

Phase 2: Salons may operate, provided that the following rules are followed:

  • Resident must wear a mask during the entire service.

  • Hand-held blow dryers are not allowed.

  • The salons must also observe restrictions and precautions in Personal Care Services Guidelines for Restore Illinois. Where IDPH guidelines are more stringent, IDPH guidelines apply.

 

Phase 3: Salons will continue to operate in accordance with Phase 2 guidance.

Tiered Mitigation. If health metrics indicate a resurgence in our region, IDPH will consider mitigation options for our community from a tiered menu.

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