COVID-19 Some Thoughts & Strategies

March 15, 2020

You should have received a second “Dear Providers” letter from DBHDS dated Saturday, 14 March.  It is attached here for reference.  While we continue to expand our list of issues to be discussed with DMAS and DBHDS on Monday, we are also receiving updates from members about what they are doing to protect the individuals they support, protect and preserve their staff and try to mitigate the long term effects on their ability to continue.  A common thread is that many residential providers have made the decision to assist their individuals with “social distancing” by keeping them at home.

  • Both the Guidance Letter and the FAQs reference the steps to be taken to document.

  • As we are very aware, for most if not all providers, there are no longer supervisory, managerial or administrative personal who are performing only those tasks assigned in the position description – sometime within the past two weeks that luxury disappeared.

  • One option to ensure that complete and accurate information about decisions made, reasons why and what is to be done in lieu of the previous plan is fully documented in each individual’s record is to create and maintain a chronological file of the communication being sent to staff and families.

  • If you keep the communication generic (no PHI) those memoranda can become a part of each individual’s record without the burden of doing individual documentation.


 

The other issue that stood out in the “Dear Providers” letter was the conclusion that “technically, isolation meets the definition of ‘seclusion.’”  The definition of seclusion is found in 12VAC35-155-20:

  • “Seclusion” means the involuntary placement of an individual alone in an area secured by a door that is locked or held shut by a staff person, by physically blocking the door, or by any other physical or verbal means, so that the individual cannot leave it.



  • Though there may be a circumstance where this might be the “isolation” methodology – we can not conceive of a DD Waiver Residential setting where this would be true.  Our conversations, to date, have been with providers who are making preparation to “isolate” entire residences and either include staff in the “isolated setting” or develop a protocol which is sufficient to allow staff to continue to work a restricted shift schedule.

  • An individual who continues to be supported by staff in all activities of daily living and has free movement around their home does not appear to meet the definition of being secluded.  Precautions against leaving and “mingling” in a crowded area will be no different than the normal safety precautions.

  • DBHDS licensed community providers are not equipped to strictly “quarantine” anyone; should absolute security be required, the individual will need the facilities of a hospital which is not subject to the regulation cited.


 

Last, for the moment – we are trying to work with DBHDS to streamline/expedite the process by which staff who are facing a layoff from a Day Program can rapidly become “Relief” staff for a residential provider.  Note: We have also asked about the possibility of day services being provided in or from a residential site.

  • This option may not be a good “fit” for staff of a TDT provider – we are expecting guidance from DMAS early in the week.



  • However, while waiting for some additional permissions, we have reviewed the requirements for unemployment and have established a contact at the VEC who shared the following:

  • “Workers who are separated from their employment because their employer is shut down or reducing staff due to the coronavirus, or who are otherwise unable to report to work because of those effects, should file a claim for UI benefits and indicate “lack of work/laid off” as the reason for their separation.  At this time we are not waiving the work search requirement; however, we are continuing to monitor and evaluate the circumstances.”

  • Keep in mind that depending on your pay cycle, assistance may not be critical for the first week or two – so any lag time in getting benefits may not be as much of an issue.

  • We hope that the costs associated for employers in future Unemployment Tax Rates will be one of the items which can be addressed in future actions.