Reopening a human services facility after a closure

Human Services organizations are diverse and have a lot of moving parts. These are a wide range of considerations when reopening.

The thought of reopening in the wake of the COVID-19 pandemic can seem daunting. The outbreak has caused us to reevaluate the ways employees interact with people we support and adds new challenges to otherwise routine activities. As your organization considers reopening, it’s important to do it in a manner that reduces the likelihood for exposure to the public, employees and the persons you support.

Human Services organizations are diverse and have a lot of moving parts. Below are a wide range of considerations when reopening. While this list is not comprehensive, these are items meant to spur conversations amongst your leadership team.

Review and update infectious disease/pandemic influenza preparedness plans. The Centers For Disease Control and Prevention (CDC) has developed a sample for Long-Term Care facilities, found here. As your team goes through COVID-19 protocols, be aware of CDC, state and local community guidelines that may impact reopening. There are links to many of the guidelines shared at the end of this article. As you create a reopening plan, always address your response through best practice hierarchy of controls:

Always eliminate the hazard/exposure when possible. Even if temporary, eliminating a high-risk practice eliminates the exposure to COVID-19. Eliminate higher hazard activities (touching multiple surfaces) or reduce on-site guests

1. Substitute in-person meetings for virtual meetings or allow employees to work from home as able.
2. Use safety engineering practices to isolate people from the COVID-19 exposure. Examples: Social distancing, isolate specific high-risk wings, limit staff sharing, barriers/partitions.
3. Administrative Controls to change the way in which the work is completed. Examples, use training to change/reinforce safety protocols, stagger shifts to reduce exposure levels, etc.
4. Personal Protective Equipment

Questions for Consideration — Workforce

• Are you able to reduce overall exposure potential and implement flexible work operations (telework, limit on-site to essential) for any staff?
• Will employees return in stages, or at the same time? Will you consider flexible work hours like staggering shifts, breaks, and start times?
• Could you use virtual training for staff, and be more flexible with virtual meetings or conduct more meetings with smaller groups?
• What testing and/or screening will be conducted of employees? At what frequency will this occur?
• How will you train staff to meet the challenges of providing services in this climate? Are there new operating procedures that they need training on?
• How will you accommodate staff who may be immunocompromised?
• Is there a way to create separation between employees and visitors by the use of barriers, signs, or floor markings?
• Have staff been adequately trained on practices and procedures if their duties or positions have been changed?
• How will you protect employees using CDC-recommended Personal Protective Equipment (PPE) and social distancing guidelines? How will you train them in the proper use, disposal, and care of PPE?
• If childcare is a concern for employees with children, are you considering opening a temporary daycare? If so, please refer to Nationwide’s Article on Temporary Child Daycare.
• If the pandemic has caused a reduction in workforce, please refer to Using Temporary Employees and Independent Contractors During the COVID-19 Pandemic.

Questions for Consideration — Facilities

• Have you identified high traffic areas and readily contacted surfaces, such as lobbies, elevators, stairs and handrails, waiting areas, program rooms, for regular sanitation?
• Are cleaning agents consistent with CDC, World Health Organization (WHO), and Environmental Protection Agency (EPA) guidance?
• Do the cleaning agents require employee training or certification?
• In an effort to reduce exposure to employees, can this process be contracted out to a qualified contractor?
• If using janitorial staff from a vocational workshop, will you continue to update protocols and training in-line with CDC guidance?
• Have ongoing maintenance and inspection items been performed before reopening idle or unoccupied buildings and spaces?
• Does the frequency of cleaning sweeps and documentation efforts need to be increased?
• Please refer also refer to Nationwide’s Articles Prepare Your Facility For Reopening After a COVID-19 Closure and Maintaining Closed or Idle Facilities.

Questions for Consideration — Visitor Policies and Screening

• Do you need to consider a single point of entry for visitors to eliminate the number of access points into the facility?
• Can non-essential visits be reduced by conducting them virtually or with less regularity?
• Will you conduct temperature checks and ask visitors about symptoms related to COVID-19? How will you record their responses?
• Could you implement a visitor sign-in log to assist with future contact tracing?
• Can a short video or posters be made to highlight your pandemic response plan, such as handwashing instructions, PPE usage and social distancing?
• How will you handle clients who are unwilling or unable to comprehend your safety guidelines?
• Can your facility require visitors to wear face coverings in line with CDC guidance?
• How will facility maintenance service contractors be screened? Has their company implemented screening measures to reduce exposure?

Questions for Consideration — Sanitation

• Are instructions on handwashing clearly posted throughout your programs?
• Could portable handwashing and/or hand sanitation stations be used to reduce exposure? If so, how are you following CDC guidelines and keeping the stations properly stocked?
• How will you sanitize common areas, offices, program rooms, and other high traffic areas?
• Please refer to CDC guidance on cleaning and disinfection for community facilities

Questions for Consideration — Residential

• For more information on residential response, please refer to the Nationwide article COVID-19 Guidelines for Senior Living and Human Services Organizations

Questions for Consideration — Retail

• Will you make one-way paths down aisles and around the facility to limit interactions between customers?
• To reduce exposure at registers, can a clear barrier be placed between the employee and customer?
• Will store hours be adjusted to allow employees time to stock shelves without interacting with shoppers?
• Can the donation process be altered to make it contactless? Are there donations that need to be quarantined and or sanitized before stocking?
• Can curbside pickup be offered as an alternative to entering the facility?
• Can on-site dining be eliminated or are you able to reduce the number of seats to increase social distance in the restaurant or dining areas?

• Should your organization consider cancelling or rescheduling sporting events due to the high rate of infection?
• Since pools, whirlpools, and saunas present a challenge for social distancing, can these be temporarily closed?
• Can low- and no-contact sports be safely conducted with the use of PPE and social distancing principals?
• How frequently is shared sporting equipment properly sanitized?
• For sporting events, can they be livestreamed to reduce the need for fans to attend?

Questions for Consideration — Fitness Centers

• How will social distancing be enforced in the workout facility?
• Can you stagger or limit the number of visits members can make a week to decrease capacity?
• Can you create distance between members by strategically shutting down certain equipment or machines?
• Can you lower the number of class attendees to maintain social distancing?
• Do you have equipment and free weight sanitation protocols in place that meets CDC guidelines? How will equipment be sanitized between each use?

Questions for Consideration — Summer Camps

• Should your organization consider cancelling or rescheduling camps due to the high rate of infection?
• Can Day Camp hours be reduced, and campers’ arrivals be staggered to reduce exposure?
• Can activities be done remotely via video conference to still engage campers yet keep them separated?
• How will you adequately sanitize living quarters, dining areas, and bathrooms to meet CDC guidance?
• How will you clean and sanitize safety gear, equipment, and apparel between uses by campers?

Questions for Consideration — Therapeutic Settings

• If your State allows it, can telehealth options be utilized to hold sessions with individual clients or group discussions?
• Can office furniture be rearranged to allow therapists to conduct sessions with proper separation from clients?
• Could larger group sessions be broken down into several smaller groups to decrease the risk of exposure?
• Can appointments be staggered so that it decreases the number of people in an office or waiting area?

Questions for Consideration — Vocational Supports and Workshops

• How can 3^rd party entry into the facility (delivery drivers, etc.) be eliminated or limited during the shipping and receiving process?
• How can production areas be adjusted to accommodate social distancing guidelines through space or the addition of barriers?
• Do incoming goods require additional sanitization steps before moving to production areas?

Remember, whether it’s training of staff or clients, or putting a pandemic response plan in place, it’s important to document the challenges your organization faces and efforts to mitigate the risk. While not guaranteed, documentation may assist if questioned by referral or funding sources about changes in procedure. For more information about documentation, refer to the Nationwide article Documentation Journaling During COVID-19. Since response to COVID-19 can change as we learn more, it’s important to rely on sources from Federal, State, and local officials for guidance on how to respond.

Resources

Nationwide Loss Control Services
The Insurance Institute for Business & Home Safety (IBHS): An easy-to-use guide to business continuity planning
CDC Coronavirus Disease
CDC: Cleaning and Disinfection for Community Facilities
CDC: Business and Workplaces: Plan, Prepare, and Respond
CMS Coronavirus Toolkit
EPA Disinfectants for use Against COVID-19
America’s Small Business Development Center: COVID-19 Small Business Resources
OSHA: COVID-19 eTools
OSHA: COVID-19 News and Updates