Where to Find Ideas on Reopening - This Time?

Caregiving Resource | February 09, 2021 | by Dee Pekruhn

Now that an increasing number of older adults and staff in provider organizations have begun to receive the COVID-19 vaccine, members are starting to plan how to ‘reopen’ again to visitors, how to offer greater social interaction for older adults, and yet how to maintain all the needed safety protocols and infection control measures that will remain in place for the foreseeable future. While most state and federal agencies have yet to issue formal, post-vaccination guidelines, we review below a handful of reopening checklists, white papers and issue briefs from trusted sources. It is critical to note that nothing in this review applies to nursing homes that are certified to provide Medicare and Medicaid services. CMS has not made any changes in its visitation policies. 

Just a little over a month into the mass vaccination process for older adults and aging services providers, members are already deeply pondering – and fielding questions from families, staff, and older adults on – how and when we can ‘reopen’ and daily life can ‘return to normal.’ While the summer and early fall saw a flurry of “reopening guidelines” from states and federal agencies, as yet there aren’t many such agencies, if any, that have issued guidance for a post-vaccination reopening strategy for aging services providers. Although CDC and others have made it clear that, for the foreseeable future, we must continue to mask, be socially distant, and maintain enhanced infection control measures, what other protective measures may be slowly relaxed remains a significant question.

So, where can a provider look for ideas for crafting their own strategic plan for a safe, progressive post-vaccine ‘reopening’ that minimizes social isolation? Below, we offer you several resources that, while not all ‘brand new,’ may offer you a variety of perspectives and approaches that can be used to customize your strategic plan.

  1. American Seniors Housing Association: Special Issue Brief on Considerations for Balancing Seniors Housing Residents Safety as Communities Reopen.

Now being generously shared by ASHA with LeadingAge members at no charge, this June 2020 Issue Brief offers an important summary of issues faced by older adults and the providers who have tried to protect them from COVID-19. The heart of the brief can be found on pages 13-18, where are outlined “Strategic Considerations for Reopening Senior Housing Communities.” Of vital importance, the authors suggest, is the need to assess and manage risk, both internally and externally. External factors to be considered include: the rate of COVID transmission in the surrounding community; tracking local and state testing results; tracking the daily number of COVID deaths locally; and ensuring financial support is available for reopening efforts. Internal factors include: COVID transmission rates among residents and staff; preventive measures in place for programs, social engagement, visitation, new resident tours, and moves; testing of residents and staff; and enhanced infection control. These factors should be analyzed before, during and after two phases that each span at least a 14-day period: an “initial phase,” and a “maintenance phase.” Of course, to both the external and internal factors, vaccination-related acceptance rates and related local transmission rates could be easily added.

This key section then offers a handy, two-page checklist for evaluating internal and external considerations in each phase. Within each quadrant, example protocols are listed, such as allowing small groups (<10 people) for socially distanced group activities in an initial phase, and then expanding these groups to < 25 people in the maintenance phase of “Programs, Meals and Services.” This checklist would be a very useful tool for both planning and implementing safety protocols as restrictions are slowly lifted.

  1. Administration for Community Living: Phased Reopening Guidelines for Senior Nutrition Program Operations.

As nutrition and dining programs are central to the daily life and social engagement of older adults, this ACL resource offers many practical and poignant suggestions for addressing both safety and social isolation concerns at three phases of reopening. The guidelines within each phase are broken down into two distinct meal program categories: home-delivered meal programs, and congregate living meal programs. Each phase’s category offers a robust list of creative ideas to engage older adults in a setting-appropriate meal program that offers choice, variety, safe socialization, and connection with the greater community. Naturally, there is a heavy emphasis throughout on virtual media platforms to offer safe socialization; also suggested throughout is the mobilization of other older adults and volunteers to engage with each other over virtual meal gatherings. The guidelines also offer creative suggestions on the inclusion of local restaurants, grocery stores, community centers and even drive in theaters in the delivery of meals and entertainment; helpful links to other expert, food-service resources like the National Resource Center on Nutrition and Aging, the FDA and the CDC are provided throughout the guide.

  1. International Council on Active Aging: A Pathway to the Next Normal

This forward-thinking and provocative white paper, produced by the ICAA’s COVID-19 Task Force (including LeadingAge), offers a strategic framework for embarking on the next chapter of senior living and includes stepwise, helpful tools for the journey ahead. The white paper identifies two key areas of focus that “will position organizations for a successful future:” optimizing the health and wellbeing of residents and staff and developing a new value proposition for senior living. To achieve these areas of focus, the Task Force developed six strategic goals that organizations can use to build their own framework: 1) design, re-design and/or renovate exteriors and interiors of buildings; 2) develop purpose-driven, caring and passionate staff; 3) provide technology to increase connections, aid efficacy and optimize health; 4) develop the culture of positive aging, framed by all the dimensions of wellness; 5) establish trust by being prepared to respond to emergencies and unexpected events; 6) update perceptions to reinforce the new value proposition of each type of senior living.

As the reader works through each of the six strategies, the white paper breaks down each strategy into stepwise ‘tactics’ on a check list that can be filled in with short-, mid- and long-term goals. Each tactic then is delineated further into such goals that an organization can explicitly use to advance their work towards each strategy.

  1. FEMA: Exercise Starter Kit for Workshops on Reconstituting Operations.

FEMA has provided a very helpful Exercise Starter Kit and Facilitator’s Guide for organizations who are looking for a structural ‘workshop’ approach to strategic planning for reopening. The Kit includes talking points and PowerPoint slide decks that can be customized to each organization’s planning session. FEMA authors point out that the Kit and subsequent workshops can be planned in one contiguous session or broken down into workshops for a larger leadership team and smaller, task-focused workgroups. The Kit is optimally designed to be used virtually, or can be presented during a socially distanced, masked in-person exercise.

The Kit’s materials offer a structure of six core focal areas to strategic planning for resuming operations: assessing the current operating status; managing all aspects of people in the workplace; preparing facilities for reopening; developing clear and targeted messaging and communications; identifying needed resources and logistical concerns; and assigning action items and key takeaways for follow up. Similar to an Emergency Operating Plan Command Center, this Exercise Starter Kit provides all the materials and thought-work needed to get started on an organizational plan to resume operations. With some minor ‘tweaking,’ this Kit can easily be applied to the aging services provider’s setting.

  1. CDC: Resuming Business Toolkit.

Yet another helpful tool that can be easily applied to the aging services provider setting is this Toolkit from CDC. Most helpful within this Toolkit are two straightforward and prescriptive checklists that can be readily incorporated into the implementation phase of a strategic plan to reopen.

The first checklist is the Restart Readiness Checklist, designed to help organizations evaluate their current status and progress in three core areas: 1) prevent and reduce transmission among employees; 2) maintain healthy business operations; 3) maintain a healthy work environment. Each core area has a number of detailed items to prepare the organization to meet the requirements of the core area. For example, within core area one, an item is to “identify a coordinator who will be responsible for COVID-19 issues and their impact at the workplace,” and a task within that item is to “Inform employees who this person is and how to communicate with that person.” Evaluators can use the checklist to determine if an item within the core area has been completed, is ongoing, has not yet started, or is not applicable.

The second checklist is the Worker Protection Tool, designed to help employers identify measures for working with each other and “the public,” which can be interpreted here as any stakeholder, such as an older adult, staff member, business partner or family member. The Tool identifies engineering, administrative, and PPE related “worker protections” that should be addressed and/or assessed.

The overall Resuming Business Toolkit also offers an Employer Sheet, a Return to Work Infographic, and other Resources to help employers plan for resuming operations.

  1. Plante Moran: Your Guide to Starting Up or Restarting Operations.

Plante Moran’s COVID-19 Crisis Management Team developed this guide in April 2020 as a way to help businesses respond, restart and be ready for a transition back to ‘normal,’ post-COVID. The guide offers five core areas of focus with several critical action steps necessary to prepare within that area of focus. The four core areas are: 1) People: new safety protocols and workforce optimization; 2) Daily operating procedures: maintain daily operating process efficiencies; 3) Training, education and monitoring: changes are only effective if they are well communicated and adopted consistently; 4) Workplace readiness: an enhanced operating model; 5) Business continuity planning: manage your future risk. The guide points out that “how fast you respond to new circumstances and changing regulatory requirements will make the difference between maintaining an ongoing operation and being forced to shut down.” Plante Moran’s site also offers a COVID-19 Resource Center for Healthcare Providers, with current updates on relevant matters such as HHS Provider Relief Fund Guidance and CARES Act Reporting Requirements.

  1. OSHA: Guidance on Returning to Work

Drawing on the three-phased approach of the Trump Administration’s Guidelines for Opening Up American Again, OSHA’s guidance offers examples of how to implement nine guiding principles; several of these principles are then linked to other, extensive OSHA and CDC tools and checklists that can be easily applied during implementation: 1) Hazard Assessment; 2) Hygiene; 3) Social Distancing; 4) Identification and Isolation of Sick Employees; 5) Return to Work after Illness or Exposure; 6) Controls; 7) Workplace Retaliation; 8) Training; and 9) Anti-Retaliation. This section is followed by a detailed Employer FAQs section, which offers answers to questions such as, is there guidance on how to address the various health screening and medical issues associated with COVID-19 to avoid violating other labor, disability, and employment laws? (which links to the EEOC’s resource on COVID-19, and the ADA and Rehabilitation Act), and, what OSHA requirements must an employer follow when conducting health screening, temperature checking, or COVID-19 testing? The guide concludes with additional resources from OSHA, and how to contact regional offices for more information.

As new guides, toolkits and resources in this area are made available, we will share and post on the LeadingAge Coronavirus website.