Lakeshore

HOME HEALTH CARE SERVICES, Inc.

 COVID-19 Preparedness & Response Plan

The Following Covid-19 Preparedness and response plan has been established for Lakeshore Home Health Care Services, Inc. (“Lakeshore”) as part of its ongoing response to the Covid-19 Public Health Emergency and CDC recommendations. The safety and wellbeing of Lakeshore’s employees and clients is of the utmost importance. Managers and employees are responsible to become familiar with this plan and to enforce each guideline. Lakeshore’s goal is to reduce the risk of exposure and transmission.

Lakeshore’s Program Director will be responsible for keeping up to date on COVID-19 guidelines issued by MDHHS, CDC and/or any other state or federal health authorities. The Program Director may update this plan accordingly.

Lakeshore has appointed the Program Director and Regional Managers as worksite supervisors to implement, monitor, and report on the COVID-19 guidelines developed in this plan. The supervisors will always be available.

Lakeshore will keep a record of screening results and trainings offered to employees. The Program Director will be responsible for filing reports to the appropriate health departments regarding confirmed Covid-19 infections.

LAKESHORE OFFICES

During the pandemic or public health emergency, when Covid numbers are up,  Lakeshore will reduce the number of individuals on worksite locations as much as possible. When there must be multiple individuals at a worksite, social distancing will be enforced. Lakeshore will encourage employees that are able to work from home to do so when recommended by the CDC or MDHHS when COVID-19 numbers are high. Field employees are critical to Lakeshore’s basic operations and will remain working at client homes.

As Covid numbers decrease, office employees will be allowed to remain on site with social distancing. Lakeshore provides services 24 hrs a day/7 days a week so field employees are critical to the everyday operations.

 LAKESHORE ENVIORNMENT AND CONTROLS TO MINIMIZE THE TRANSMISSION OF COVID

SCREENING

Daily Covid 19 assessments are not required for asymptomatic employees. Any employee that has any symptoms of Covid 19 will be required to take a Covid test. If numbers increase and CDC advises, daily assessments will be reinstated.

SAFE WORK PRACTICES

Handwashing, social distancing, and masks are a critical step in preventing the spread of COVID 19. All employees must adhere to the following protocols to help decrease the spread of COVID-19.

• All employees should wash their hands with soap and water, scrubbing for at least 20 seconds. Employees should wash their hands at the start of their shift, before and after meals and after using the restroom. Employees that provide direct care to clients should also wash their hands before and after providing care, meds, feedings, treatments, etc.
• When water and/or soap is not available, all employees should use hand sanitizer. The hand sanitizer should contain a minimum of 60% alcohol.
• All employees should cough and sneeze into their elbow and then wash their hands
• All employees should avoid touching equipment or objects after other employees without disinfecting the equipment/object. A Clorox wipe may be used to clean equipment and objects between employees.
• Company vehicles should be disinfected after each use. Lysol and Clorox wipes can be used to disinfect areas that touched such as the steering wheel, keys, door handles, locks, shifter, seat belts, etc.
•  Office employees and field employees that only provide care to 1 client a day (or 2 siblings) will no longer be required to wear masks when community levels are low or moderate. If community levels become high in your area, you will be notified to always wear a mask. It is still highly recommended to wear a mask when providing patient care. If a client or their family member requires a mask, the employee must wear a mask. Employees that are seeing more than one patient in a day, should continue to wear a mask during all visits. If disposable masks are unavailable, cloth masks may be used in accordance with CDC guidelines. N 95 masks should be worn when caring for a client that test positive for COVID-19 or their family member tests positive or as instructed by management. Hands should be washed after touching a mask. If you tested negative for covid, but have any symptoms, you will be required to wear a mask during your entire shift. Masks requirements may change as CDC changes their guidelines.
• PPE will be available for all staff. Staff can arrange to pick up in person or notify Regional Managers can drop off or mail to client home
• All employees should keep a distance of at least 6 ft from other employees, clients or their family members when possible.
• During the pandemic or public health emergency or until advised to do so by MDHHS, all supervisory visits will be conducted by video using Doxy.me or telephone unless otherwise requested by client. When the public emergency ends, visits will resume in person unless otherwise directed.
• All office meetings conducted by video or phone
• Breaks and lunches should be taken separately and not in common areas.
• All employees will receive training on COVID and the prevention of spreading the virus.
• Office meetings will be conducted through phone, email, or web conferencing.
• Sick leave policies will be flexible and consistent with public health guidance, so employees do not go to work sick. Employees will not be penalized for staying home to care for a family member that is sick.
• Cleaning supplies will be made available for all offices.
• Only cleaning supplies that are approved by the Environmental Protection Agency (EPA)
• Doorknobs, workspaces, bathrooms, and kitchens will be disinfected daily.
• Lakeshore will provide enhanced cleaning and disinfection after a person with confirmed COVID-19 has been in a work area and the area will be closed for at least 3 hours.

ILLNESS/TESTING

All employees will be directed to promptly report any sign or symptoms of COVID-19 (cough, runny nose, fever, sore throat, headache, etc.) to their office administrator, supervising nurse or the Program Director by phone. Employees that exhibit any symptoms will be required to get a Covid test. At home tests are allowed but a picture must be sent to the office. If the test is negative, you are allowed to report to your assignment with a mask and parent/client approval. All reports will be reported to the program director.

Per the CDC, when testing a person with symptoms of COVID-19, negative results from at least one viral test indicate that the person most likely does not have an active SARS-CoV-2 infection at the time the sample was collected.

• If using NAAT (molecular), a single negative test is sufficient in most circumstances. If a higher level of clinical suspicion for SARS-CoV-2 infection exists, consider maintaining work restrictions and confirming with a second negative NAAT.
• If using an antigen test, a negative result should be confirmed by either a negative NAAT (molecular) or second negative antigen test taken 48 hours after the first negative test.

For HCP who were initially suspected of having COVID-19 but, following evaluation, another diagnosis is suspected or confirmed, return-to-work decisions should be based on their other suspected or confirmed diagnoses.

Employees who must isolate, may return to work after they meet the current CDC return to work guidelines. Lakeshore will continue to check the guidelines by the health department and CDC and amend this policy as necessary to promote public health.

Any Lakeshore employees that begin to develop symptoms while at work will be asked to leave the workplace at once. Any employees that experience any symptoms of COVID-19 should follow the recommendations of their health departments and the CDC.

SUSPECTED OR CONFIRMED POSITVE COVID-19 EMPLOYEES

All exposures and positive cases will be kept confidential unless permission is given by the employee to notify the client and/or their family members. Lakeshore will inform other employees that may have been exposed to the sick employee without identifying who the positive employee is. All field employees who may have been exposed to a positive employee, will be instructed to abide by CDC guidelines.

If an employee has an exposure they will be instructed to follow current CDC criteria:

For the purposes of this guidance, higher-risk exposures are classified as HCP who had prolonged¹ close contact² with a patient, visitor, or HCP with confirmed SARS-CoV-2 infection³ and:

• HCP was not wearing a respirator (or if wearing a facemask, the person with SARS-CoV-2 infection was not wearing a cloth mask or facemask)⁴
• HCP was not wearing eye protection if the person with SARS-CoV-2 infection was not wearing a cloth mask or facemask
• HCP was not wearing all recommended PPE (i.e., gown, gloves, eye protection, respirator) while present in the room for an aerosol-generating procedure

Following a higher-risk exposure, HCP should:

• Have a series of three viral tests for SARS-CoV-2 infection.
  • Testing is recommended immediately (but not earlier than 24 hours after the exposure) and, if negative, again 48 hours after the first negative test and, if negative, again 48 hours after the second negative test.  This will typically be at day 1 (where day of exposure is day 0), day 3, and day 5.
  • Due to challenges in interpreting the result, testing is generally not recommended for asymptomatic people who have recovered from SARS-CoV-2 infection in the prior 30 days.  Testing should be considered for those who have recovered in the prior 31-90 days; however, an antigen test instead of NAAT is recommended.  This is because some people may remain NAAT positive but not be infectious during this period.

• Follow all recommended infection prevention and control practices, including wearing well-fitting source control, monitoring themselves for fever or symptoms consistent with COVID-19, and not reporting to work when ill or if testing positive for SARS-CoV-2 infection.
• Any HCP who develop fever or symptoms consistent with COVID-19 should immediately self-isolate and contact their established point of contact (e.g., occupational health program) to arrange for medical evaluation and testing.

Work restriction is not necessary for most asymptomatic HCP following a higher-risk exposure, regardless of vaccination status.  Examples of when work restriction may be considered include:

• HCP is unable to be tested or wear source control as recommended for the 10 days following their exposure;
• HCP is moderately to severely immunocompromised;
• HCP cares for or works on a unit with patients who are moderately to severely immunocompromised;
• HCP works on a unit experiencing ongoing SARS-CoV-2 transmission that is not controlled with initial interventions;

If work restriction is recommended, HCP could return to work after either of the following time periods:

• HCP can return to work after day 7 following the exposure (day 0) if they do not develop symptoms and all viral testing as described for asymptomatic HCP following a higher-risk exposure is negative.
• If viral testing is not performed, HCP can return to work after day 10 following the exposure (day 0) if they do not develop symptoms.

In addition to above:

• HCP should follow all recommended infection prevention and control practices, including wearing well-fitting source control, monitoring themselves for fever or symptoms consistent with COVID-19, and not reporting to work when ill or if testing positive for SARS-CoV-2 infection.
• Any HCP who develop fever or symptoms consistent with COVID-19 should immediately contact their established point of contact (e.g., occupational health program) to arrange for medical evaluation and testing.

When an employee has recovered form COVID-19, they will be instructed to return to work based on the current CDC criteria:

HCP with mild to moderate illness who are not  moderately to severely immunocompromised could return to work after the following criteria have been met:

• At least 7 days have passed since symptoms first appeared if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7), and
• At least 24 hours have passed since last fever without the use of fever-reducing medications, and
• Symptoms (e.g., cough, shortness of breath) have improved.

*Either a NAAT (molecular) or antigen test may be used.  If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later

HCP who were asymptomatic throughout their infection and are not moderately to severely immunocompromised could return to work after the following criteria have been met:

• At least 7 days have passed since the date of their first positive viral test if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7).

*Either a NAAT (molecular) or antigen test may be used.  If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later

HCP with severe to critical illness who are not moderately to severely immunocompromised could return to work after the following criteria have been met:

• At least 10 days and up to 20 days have passed since symptoms first appeared, and
• At least 24 hours have passed since last fever without the use of fever-reducing medications, and
• Symptoms (e.g., cough, shortness of breath) have improved.
• The test-based strategy as described below for moderately to severely immunocompromised HCP can be used to inform the duration of work restriction.

The exact criteria that determine which HCP will shed replication-competent virus for longer periods are not known. Disease severity factors and the presence of immunocompromising conditions should be considered when determining the appropriate duration for specific HCP. For a summary of the literature,  refer to Ending Isolation and Precautions for People with COVID-19: Interim Guidance (cdc.gov)

HCP who are moderately to severely immunocompromised may produce replication-competent virus beyond 20 days after symptom onset or, for those who were asymptomatic throughout their infection, the date of their first positive viral test.

• Use of a test-based strategy (as described below) and consultation with an infectious disease specialist or other expert and an occupational health specialist is recommended to determine when these HCP may return to work.

Test-based strategy

HCP who are symptomatic could return to work after the following criteria are met:

• Resolution of fever without the use of fever-reducing medications, and
• Improvement in symptoms (e.g., cough, shortness of breath), and
• Results are negative from at least two consecutive respiratory specimens collected 48 hours apart (total of two negative specimens) tested using an antigen test or NAAT.

HCP who are not symptomatic could return to work after the following criteria are met:

• Results are negative from at least two consecutive respiratory specimens collected 48 hours apart (total of two negative specimens) tested using an antigen test or NAAT.

TRAINING

The Program Director will be responsible for providing COVID-19 training and ensuring compliance. In addition to annual Infection Control training, Lakeshore will train employees on, at a minimum

• How COVID-19 is spread from person to person
• Symptoms of COVID-19
• The proper use of PPE
• Steps the employee must take to notify Lakeshore of any symptoms of COVID-19 or a suspected or confirmed diagnosis of COVID-19
• Measures Lakeshore is taking to decrease the spread of the virus in the workplace.
• How to report unsafe working conditions.