Reopening Process

Please see below for information regarding our reopening plan:

RE-OPENING PLAN – TRANSITIONS HEALTHCARE GETTYSBURG

Step 1 – Sept. 28-Oct.11

Step 2 – Oct. 12 – Oct. 25

Step 3 – Oct 26

If at any point there is a positive COVID-19 case that originates within the facility, the re-opening status will halt, communal dining will be discontinued, volunteer and all non-essential personnel will no longer be permitted within the building.  The re-opening process will resume at the beginning of the recommended incremental steps by the Pennsylvania Department of Health.

Baseline Universal Testing was initially completed with full results on July 31, 2020.

The facility is in a Green county per the Governor’s Reopening Plan.

Symptomatic COVID-19 Testing

Any resident found to have symptoms consistent with the symptoms of COVID-19 shall be tested within 24 hours after the first symptoms are observed.  There is a standing PRN order for all residents that permits testing as needed for symptoms.  All testing can be completed either by in house BD Veritor testing system, Wellspan Hospital, or Quest Diagnostics.

Outbreak Testing for Staff and Residents

In the event of a COVID-19 outbreak in the facility, we have secured the resources for resident and staff testing through Quest Diagnostics as well as additional testing through Wellspan Hospital.

Screening Testing

The level of COVID-19 activity in the community surrounding the facility has a direct impact on the risk of COVID-19 introduction into the facility.  When the facility is not experiencing an outbreak, the facility will test at a frequency based on the county positivity rate reported in the past week.  The facility will monitor the Adams County positivity rate every other week and will adjust the frequency of performing testing according to the table below.  This will only apply to testing of asymptomatic individuals.  Individuals with a prior confirmed diagnosis of COVID-19 will not be retested until at least 90 days from the positive diagnosis.

Routine testing of residents may be considered if the resident has “outside contact”.  This may include but is not limited to outpatient health care visits including dialysis treatments, social visits in the community, receiving visitors within the facility or on facility property, and after admission to another health care facility.

COVID-19 Testing of non-essential staff

• Prior to non-essential staff services beginning, baseline testing will be made available, and negative results will be obtained in order to participate in non-essential activities.
• On-going screening testing will be offered according to the Adams County positivity rate in the table above.

Refusal of COVID-19 testing by staff

All staff will be strongly encouraged to participate in mandatory testing and will be educated on the importance of testing for the wellbeing of our residents and our reopening plan.  Any employee of Transitions Healthcare LLC Gettysburg has the right to refuse COVID-19 testing.  After an employee refusal has been signed, the employee will be required to wear an N-95 mask at all times when in the building.  If at some point there is not an ample surplus of N-95 masks in the building, the employee may be placed on administrative leave without pay until either masks become available or testing is completed.

Refusal of COVID-19 testing by residents

All residents will be strongly encouraged to participate in mandatory testing and will be educated on the importance of testing for the wellbeing of our residents and our reopening plan.  Any resident at Transitions Healthcare LLC, Gettysburg has the right to refuse COVID-19 testing.  Any patient refusing testing will be placed in the yellow zone isolation for 14 days.  If at any time they become symptomatic and still refuse COVID-19 testing, they will be presumed positive and placed in red zone isolation for a duration of 10 days from the onset of symptoms.  In addition to the 10 day isolation period, the resident must remain symptom free for 72 hours before isolation can be discontinued.

Isolation and Co-horting of residents with confirmed COVID-19

Upon discovery of an active case of COVID-19 case, the resident will be moved to a RED zone isolation and will remain under isolation for at least 10 days and the resident is symptom free for 72 hours.  More critical residents or residents with a higher number of co-morbidities may remain in isolation for a period of 20 days.  Residents that are found to be COVID-19 positive may be co-horted with other positive residents in the Red zone.  When at all possible, an asymptomatic positive resident will not be co-horted with a symptomatic resident.

Screening of Staff

All employees are being screened prior to getting to patient care areas and at the end of their shift.  The temperature logs will be maintained by the ICP.  Any employee who hits the temperature threshold will be released from duty until they are asymptomatic for 72 hours.  Staff traveling outside of the area may be asked to wear an N-95 mask for a period of 14 days since return to area.

Screening of residents

All residents are to be screened a minimum of once daily for temperature and pulse oximetry.  If values are found to be out of the normal range, an immediate nursing assessment will be completed to determine if COVID-19 testing is indicated.

Visitor Screening

All visitors will be screened at the front lobby or at side entrance for vendors/contractors.  Visitors will be instructed to use the alcohol based hand sanitizer, will have their temperature screened and will be asked survey questions.  This process will assist in assessing the visitors’ potential risk prior to being given permission to enter the facility.

Volunteer Screening

All volunteers will be screened at the front lobby. Volunteers will be instructed to use the alcohol based hand sanitizer, will have their temperature screened and will be asked survey questions.  This process will assist in assessing the visitors’ potential risk prior to being given permission to enter the facility.

PPE supply management

Facility will monitor use of and procurement of PPE supplies.  A list of PPE is available from the ICP or Central Supply Manager.  Facility will make every attempt to ensure adequate supplies are available and will continue to monitor availability and proper use.  Completed inventory of essential PPE is reviewed at least weekly.  Burn rates are used to calculate estimated usage to project future needs and avoid PPE shortages.

Staffing Review

The scheduler and DON meet to review each days staffing to ensure that staffing is adequate to meet the needs of the residents.  At the present time this facility is not operating under its emergency staffing contingency plan.

Resumption of limited communal dining

Starting in step 1, limited communal dining will resume as long as the building remains COVID-19 free.  Communal dining is limited to residents unexposed to COVID-19.  No more than 10 residents will dine at one seating and residents will be spaced at least 6 feet apart.  Communal dining is the same for all steps of reopening.

Volunteer Services

Resumption of Volunteer services will resume in step 2 of the reopening phase.  In step 2, volunteers will be used exclusively for the purpose of assisting with visitation protocols.  Volunteer duties with visitation will only be with residents that are unexposed to COVID-19 and not under any isolation precautions.  Screening, social distancing, hand hygiene, and universal masking will be required.

In step 3 of the re-opening phase, volunteers are permitted but may only conduct volunteer activities with residents unexposed to COVID-19.  Screening, social distancing, hand hygiene, and universal masking will be required.

Non-essential Personnel

Non-essential personnel will resume in step 2 of the reopening phase as determined necessary by the facility.  Non-essential personnel services will only be with residents that are unexposed to COVID-19 and not under any isolation precautions.  Screening, social distancing, hand hygiene, and universal masking will be required.

Resident Activities

Under step 1 of the reopening process, communal activities can resume in groups of 5 or less.  Group activities must be held maintaining social distancing, frequent hand hygiene and universal masking.  Residents should be provided with Alcohol Based Hand Sanitizer at the completion of the activities.

Under step 2, the group can contain 10 or less participants with the same requirements.

Step 3 will not limit the number of participants, but all social distancing guidelines and universal masking are required.  All residents in all steps of reopening must not be residents that have potential COVID-19 exposure or in any isolation status.

Visitation Guidelines

• Visitors to include but not be limited to family, friends, clergy, and others during end of life situations and compassionate visit situations will be permitted regardless of re-opening plan as determined by the Interdisciplinary Care Team.
• Compassionate Caregiver Visitation – Residents who qualify for compassionate caregiver visitation as determined by the Interdisciplinary Care Team would be residents who have had a significant change in two areas or more that visitation may improve the impact.  A significant change would be a decline in a resident’s status that:
  • will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions; the decline is not considered “self-limiting”
  • impacts more than one area of the resident’s health status
  • requires interdisciplinary review and/or revision of the care plan
• In order to ensure the safety of all residents and staff, Compassionate Caregivers would need to adhere to the following steps and recommended safety precautions.
  • Caregivers are to show proof of a negative COVID-19 test that was administered within the prior 7 days, preferably 72 hours before initiating caregiver duties.
  • The caregiver is subject to all ongoing testing requirements that apply to facility staff pursuant to all guidance and orders.  Not completing testing will result in delay in entrance to facility until testing is performed.
  • Caregivers are responsible for arranging and covering the cost of testing.
  • All caregivers will be screened prior to entering the facility and will adhere to all PPE, hand sanitation, and social distancing requirements.
  • Caregivers would be limited to 2 hours visitation per day.
  • Only 1 caregiver per resident would be permitted per resident at a time.
  • The Interdisciplinary Care Plan team would determine who is needed and at what frequency a compassionate caregiver would visit to maintain or improve the resident’s health status without introducing unnecessary risk posed by an increased number of individuals entering the facility.
  • On a Compassionate Caregivers first visit they will need to go through an orientation process to ensure specific safety measures the caregiver needs to take to protect the residents and staff.
  • Staff will check in during visits to ensure safety measures are being followed.
  • The residents care plan will be updated to include the reason and plan for Compassionate Caregivers.
  • Caregivers not complying with requirements will be asked to leave facility and their caregiver status will be reassessed.
  • The Compassionate Caregiver will be required to provide the following information:  Name, Address, phone number, e-mail address.  A log will be kept with the date of entry to facility as well as the time in and out, in the event contact tracing is necessary.

Visitation Guidelines in Step 2 of Re-opening

• Established visiting hours will be Monday – Thursday 10A-11:15A & 2:30P-3:45P; Tuesday Evening 5:30P-6:45P; Sundays 10A-11:15A & 1P-2:30P.  Visitation appointments will be scheduled with the activity department.
• Visitation will not be permitted for residents that are in either RED or YELLOW isolation zones.
• Outdoor visitation will be weather permitting and as residents can tolerate as determined by nursing and will occur on the front porch.  If weather does not permit outdoor visitation or a resident is unable to tolerate outdoor visitation, indoor visitation will be permitted in the front Recreation Room.  Visitation zones will be clearly marked to provide adequate social distancing.  Each resident zone will accommodate 1 resident and each visitor zone will accommodate 2 visitors per resident.  The Recreation Room can accommodate no more than 3 resident visits at one time.  Each visitation zone will be no closer than 6 feet apart.
• Each visit will be no more than 30 minutes long to allow enough time for all residents desiring a visit and to allow for adequate time to decontaminate the zone for the next potential visitation.  When scheduling a visit only 1 visit per week will be scheduled in order to allow enough time for all residents desiring a visit.
• All surfaces in the visitation zones will be decontaminated with facility approved cleaner that meets CDC guidelines for killing the COVID-19 virus.
• All visitors will be screened at the front lobby.  Visitors will be instructed to use the alcohol based hand sanitizer, will have their temperature screened and will be asked survey questions.  This process will assist in assessing the visitors’ potential risk prior to being given permission to enter the facility.  Once the screening process is completed, the visitors will be escorted to the appropriate visitation zone.  Visitation will be denied for any visitor that does not meet the requirements of the screening checklist or has a fever.  Visitors who have tested positive for COVID-19 are asked to not visit for 20 days from diagnosis.
• Residents will be provided a facemask to wear during the visit (if they are able to comply).
• A 6 foot boundary will be clearly marked to separate the resident and the visitors.  It is vital that all visitors maintain a social distance of 6 feet from all residents and wear a mask at all times during the visit.  Visitors will be required to stay in the designated visiting area during visit.
• Children under the age of 10 will not yet be permitted to visit at this time.  Children 10 and older must be accompanied by an adult visitor and must adhere to the same requirements for visitation.
• Pets will be permitted for visitation in accordance with facilities pet policy.
• It is recommended that visits be scheduled at least 48 hours in advance and will be granted on availability and the residents’ condition.

• Visitors will be required to provide the following information: Name, Address, phone number, e-mail address.  A log will be kept with the date of entry to facility as well as the time in and out, in the event contact tracing is necessary.

Visitation Guidelines in Step 3 of Re-Opening

• Established visiting hours will be Monday – Thursday 10A-11:15A & 2:30P-3:45P; Tuesday Evening 5:30P-6:45P; Sundays 10A-11:15A & 1P-2:30P.  Visitation appointments will be scheduled with the activity department.
• Visitation will not be permitted for residents that are in either RED or YELLOW isolation zones.
• Indoor visitation will be permitted in the front Recreation Room.  Visitation zones will be clearly marked to provide adequate social distancing.  Each resident zone will accommodate 1 resident and each visitor zone will accommodate 2 visitors per resident.  The Recreation Room can accommodate no more than 3 resident visits at one time.  Each visitation zone will be no closer than 6 feet apart.

• Each visit will be no more than 30 minutes long to allow enough time for all residents desiring a visit and to allow for adequate time to decontaminate the zone for the next potential visitation.  When scheduling a visit only 1 visit per week will be scheduled in order to allow enough time for all residents desiring a visit.
• All surfaces in the visitation zones will be decontaminated with facility approved cleaner that meets CDC guidelines for killing the COIVD-19 virus.
• All visitors will be screened at the front lobby.  Visitors will be instructed to use the alcohol based hand sanitizer, will have their temperature screened and will be asked survey questions.  This process will assist in assessing the visitors’ potential risk prior to being given permission to enter the facility.  Once the screening process is completed, the visitors will be escorted to the appropriate visitation zone.  Visitation will be denied for any visitor that does not meet the requirements of the screening checklist or has a fever.  Visitors who have tested positive for COVID-19 are asked to not visit for 20 days from diagnosis.
• Residents will be provided a facemask to wear during the visit (if they are able to comply).
• A 6-foot boundary will be clearly marked to separate the resident and the visitors.  It is vital that all visitors maintain a social distance of 6 feet from all residents and wear a mask at all times during the visit.  Visitors will be required to stay in the designated visiting area during visit.
• Children of any age will be permitted to visit at this time.  All children must be accompanied by an adult visitor and must adhere to the same requirements for visitation.
• Pets will be permitted for visitation in accordance with facilities pet policy.
• It is recommended that visits be scheduled at least 48 hours in advance and will be granted on availability and the residents’ condition.
• Visiting in a resident’s room is permitted only if the resident is unable to be transported to the Recreation Room.
• Visitors will be required to provide the following information:  Name, Address, phone number, e-mail address.  A log will be kept with the date of entry to facility as well as the time in and out, in the event contact tracing is necessary.

Outside items

Visitors wishing to bring in personal items for residents should limit these items to items that can be decontaminated.  Items will be laundered or decontaminated with facility approved cleaner that meets CDC guidelines for killing the COVID-19 virus prior to giving to residents.  Any food items should be in a sealed package.  Arrangements should be made with the facility prior to dropping off items and to assure that they meet guidelines.  Items may be accepted by staff during visitation to be decontaminated prior to giving items to residents.