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Reopening Guidelines for Behavioral Health and Homelessness Care Providers

 
Please Note – Information below is subject to change as content is updated frequently. (Last Update: June 15, 2020)
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The following guidelines are based on recommendations from state and federal sources and are meant to serve as resources for providers. Agencies should develop their policies and procedures that fit best with their scope of practice. Additional updates are forthcoming as more is learned about best practice guidelines.

General Considerations

  • Behavioral health and homelessness services should continue to be offered to patients as clinically appropriate. Providers might consider talking with clients about their preferences about how to best continue services, given the dynamic nature of the COVID-19 pandemic.
    • As an alternative, would clients prefer continuing telehealth for a while?
  • Consider establishing Grey Zones that would screen all patients for symptoms of COVID-19, including temperature checks. Staff would be routinely screened as would others who will work in the facility.
  • It is recommended that facilities prepare resources across phases of care to ensure capacity.

Personal Protective Equipment

  • Consistent with CDC’s recommendations for universal source control, CMS recommends that health care providers and staff wear surgical face masks at all times.
  • Patients should wear a cloth face covering that can be bought or made at home if they do not already possess surgical masks. If they do not have access to cloth face coverings, consider having spare masks available and/or maintaining at least 6-foot separation. If you need additional PPE, please complete a supply and request form.
  • Those working in congregate settings including shelters and prisons should also wear masks at all times.
  • The risk of infection is increased with not only face to face time, but the length of interaction, whether in a closed room, with more crowding and people in the room, and potential for human touch or aerosolizing procedures. Staff should be mindful of the three Cs of Contact, Closed Spaces, and Crowds. As a result, it is recommended that community-wide mass gatherings be canceled if more than suggested by state leadership (currently advised no more than 10 people) or have smaller groupings. Also, it is advised to cancel gatherings more than 10 for organizations with high-risk individuals. Check the latest CDC guidelines for more information regarding large events.
  • Check for the latest CDC guidelines on PPE including how to don and doff PPE.
  • Check for the latest CDC guidelines for extended use and limited reuse of N95 filtering facepiece respirators in healthcare settings.
  • Check the latest CDC guidelines for strategies for optimizing supplies of facemasks.

Workforce Availability

  • Staff should be routinely screened for symptoms of COVID-19 using the current DOH testing criteria (insert a link to BHHSURG screening tool) and if symptomatic, they should be tested and quarantined.
  • Staff who will be working in grey zones should be limited to working in these areas and those working in a “COVID-19 Care zone” should limit contacting grey zones unless they have gone through a two-week quarantine.

Testing Capacity

  • All patients must be screened for potential symptoms of COVID-19 before entering the facility, and staff must be routinely screened for potential symptoms as noted above.

Supplies

  • Adequate supplies of equipment, medication, and supplies must be ensured, and not detract for the community’s ability to respond to a potential surge.

Facility Considerations

  • With a relatively low incidence rate of COVID-19 in Hawaii, when a facility determines to provide in-person, non-emergent care, the facility should create grey zones which have in place steps to reduce risk of COVID-19 exposure and transmission; these areas should be separate from other facilities to the degrees possible (i.e., separate building, or designated rooms or floor with a separate entrance and minimal crossover with COVID-19 areas).
  • Visitors should be prohibited but if they are necessary for an aspect of patient care, they should be pre-screened in the same way as the patients.

Source: Centers for Medicare & Medicaid Services (CMS) Recommendations Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare: Phase I

The Hawaiʻi Path Beyond Recovery- Continued Care and Adaptability

The following section details specific guidance on reopening from the state of Hawaiʻi.

Phase 1: Stabilization focuses on Healing Hawaiʻi by saving lives and flattening the curve in the communities. In the last few weeks, Hawaiʻi has stabilized by reopening low-risk businesses, such as floral shops, pet grooming services, and car washes. Because of the success, Hawaiʻi is preparing to transition from the Stabilization Phase to Healing Hawaiʻi into the Reopening of the Kamaʻāina Economy.

Phase 2: Reopening celebrates Hawaii’s Kamaʻāina Economy and is informed by “Acting with Care.” In this phase, Hawaiʻi starts to reconnect local activities by, first, reopening medium-risk businesses and activities; and, later on, reopening high-risk businesses and activities.

Phase 3: Long-term Recovery is where Hawaiʻi Renews and Rebuilds its economy through a planning and policy discussion to incorporate transitional workforce modernization opportunities, support economic diversification initiatives, target the development of emerging industries, and advance long-term resiliency planning.

Phase 4: Resilience is Hawaii’s intended outcome. United, Hawaiʻi will emerge stronger and more resilient as a result of learning from and overcoming this challenge.

Source: Governor David Ige’s Memo & Presentation Slides (May 18, 2020)

Phase 1: Stabilization-Reopening-Guidelines: Healing Hawaii

Healthcare & Social Assistance: Elective surgery, Non-emergent services, etc. (LOW RISK)

  • Open with health and safety precautions for employees, visitors, and patients, including physical distancing of 6 feet or greater between workstations/desks, enhanced sanitation measures and appropriate PPE
  • Facilities should frequently conduct thorough and detailed cleaning and disinfecting with focus on high-touch areas (e.g., door handles)
  • Visitors and patients by appointment only and should wait outside the facility (e.g., in cars) until employees are ready to work with them
  • Either disposable equipment or appropriate equipment disinfection protocols should be used
    Employees should wash hands before and after every appointment, and wear disposable gloves at all times that are changed frequently
  • Train all employees on the importance of frequent handwashing with soap and water, the use of hand sanitizers with at least 60% alcohol content, and give them clear instruction to avoid touching hands to face
  • Patients should fill out paperwork digitally in advance, where possible
  • Employees, visitors, and patients should wear face coverings at all times when on the premises
  • Employees should also wear face shields if possible when near others
  • Employees who develop symptoms of COVID-19 at work should be dismissed as soon as possible to self-isolate at home or seek medical attention as appropriate
  • Anyone visibly displaying symptoms of COVID-19 should not be allowed in the facility

Source: Phase 1 Stabilization-Reopening Guidelines

CMS Recommendations for Reopening Healthcare Facilities

If states or regions have passed the Gating Criteria (symptoms, cases, and hospitals) announced on April 16, 2020, then they may proceed to Phase I.

COVID-19 Employer Information for Office Buildings

Before resuming business operations, check the building to see if it is ready for occupancy

  • Check if ventilation systems in your facility operate properly.
  • Increase the circulation of outdoor air as much as possible.
  • Evaluate the building and its mechanical and life safety systems.

Identify where and how workers might be exposed to COVID-19 at work

  • Conduct a thorough hazard assessment of the workplace to identify potential workplace hazards that could increase risks for COVID-19 transmission.
  • Identify work and common areas where employees could have close contact (within 6 feet) with others.
  • Include employees and contractors in communication plans.

Engineering controls: Isolate workers from the hazard

  • Modify workspace (e.g., install transparent shields or other physical barriers).
  • Use methods to separate employees in all facilities (e.g., use signs, tape marks, or other visual cues to indicate where to stand when physical barriers are not possible).
  • Take steps to improve ventilation in the building, consider using portable high-efficiency particulate air (HEPA) fan/filtration systems.
  • Consider using ultraviolet germicidal irradiation (UVGI).
  • Ensure exhaust fans in restroom facilities are functional and operating at full capacity.

Administrative controls: Change the way people work

  • Employees who have symptoms of COVID-19 should notify the supervisor and stay home.
  • Consider conducting daily in-person or virtual health checks (e.g., symptoms and/or temperature screening) of employees before they enter the worksite.
  • Stagger shifts start times and break times.
  • Consider posting signs in parking areas and entrances that ask guests and visitors to phone from their cars to inform the administration or security when they reach the facility.
  • Consider signs in the parking area and entrance that ask guests or visitors to wear cloth face coverings, to not enter the building if they are sick, and to stay 6 feet away from employees, if possible.
  • Clean and disinfect high-touch surfaces, provide employees with disposable wipes and other cleaning materials.
  • Provide employees adequate time to wash their hands and access to soap, clean water, and single-use paper towels.
  • Establish policies and practices for social distancing.
  • Offer employees incentives to use forms of transportation that minimize close contact with others.
  • Allow employees to shift their hours so they can commute during less busy times.
  • Post signs and reminders at entrances and in strategic places providing instruction on hand hygiene, COVID-19 symptoms, and cough and sneeze etiquette.
  • Use no-touch waste receptacles when possible.
  • Wear a cloth face covering to cover their nose and mouth in all areas of the business.

Source: CDC COVID-19 Employer Information for Office Buildings

Governor Ige’s Reopening Plans:

Additional Mitigation Resources provided by Governor Ige:

If you have a question that is not addressed above, please complete this form or send us an email.

 
Last reviewed on June 16, 2020