Assisted Living (AL) Communities (Fleischman Residence and Coville Apartments)

According to the CDC, in general, long term care settings whose staff provide non-skilled care such as assisted living communities, should follow community prevention strategies based on COVID-19 hospital admission levels (Hospital Admission Level/Community Levels), similar to independent living, retirement communities or other non-healthcare settings. However, according to the MDHHS Infection Prevention Resource and Assessment Team (IPRAT) best practice is if COVID-19 is present in the facility, the facility should follow recommended infection prevention control practices for nursing homes to protect themselves and others from potential exposures.

Infection Prevention Control

· Visitors with confirmed COVID-19 infection or similar symptoms should defer non-urgent in-person visitation until they are 5 days past the CDC criteria to end isolation (day 10).

o If the visit is still to occur, see Visitation section.

· For visitors who have had close contact with someone with COVID-19 infection, it is safest to defer non-urgent in-person visitation until 10 days after their close contact.

· Hand hygiene practices are to be followed (alcohol-based hand rub preferred unless hands are visibly soiled and then soap and water should be used).

· A face covering or mask (covering the mouth and nose) should be used in accordance with CDC guidance.

· Instructional signage throughout the facility and proper visitor education on COVID-19 signs and symptoms, infection control precautions, and other applicable facility practices will be maintained.

· Cleaning and disinfection of highly touched surfaces in the facility will take place regularly.

· Staff will adhere to the appropriate use of personal protective equipment (PPE) per CDC guidance.

· The facility will conduct resident and staff testing, at a minimum, per current CDC guidance during outbreak (a single case of COVID-19 in the building).

· Residents will be monitored for signs and symptoms of COVID-19 daily.

· Couples to be offered option for separate apartments/suites, if available.

Hospital Admission Level/Community Levels – JSL will inform its residents of the following CDC recommendations:

• At all COVID-19 Community Levels:

• • Maintain ventilation improvements.
  • Avoid contact with people who have suspected or confirmed COVID-19.
  • Follow recommendations for isolation if you have suspected or confirmed COVID-19.
  • Follow the recommendations for what to do if you are exposed to someone with COVID-19.
  • If you are at high risk of getting very sick, talk with a healthcare provider about additional prevention actions.

• When the COVID-19 Hospital Admission Level/Community Level is Medium or High:

• •  If you are at high risk of getting very sick, wear a high-quality mask or respirator (e.g., KN95) when indoors in public
  • If you have household or social contact with someone at high risk for getting very sick, consider self-testing to detect infection before contact, and consider wearing a high-quality mask when indoors with them.
  • See above.
• When the COVID-19 Hospital Admission Level/Community Level is High:

• •  If you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.
  • See above.

Source Control (Masks) and Physical Distancing

• · JSL will follow the masking guidelines as described above for counties in high, medium or low Hospital Admission Level/Community Levels.CDC Hospital Admission Level/Community Level Masking RequirementLOW · Not required unless * below.MEDIUM · Wear masks if you are at high risk of getting very sick or * below.HIGH · Masking always required.

  * Masking will be required in all CDC Hospital Admission Level/Community Levels if:

  · the community is in outbreak mode (a single case of COVID-19 in the building);

  · the resident has COVID-19 or a visitor is on day 6 post COVID-19; or

  · the resident or visitor has had a close exposure to COVID-19 in the last 10 days (less than 6 feet for more than 15 minutes in a 24-hour period).

   

  · While JSL is not required to provide PPE for visitors, we have chosen to offer surgical masks as a source control option for visitors, but we will allow the use of a mask or respirator with higher level protection that is not visibly soiled. · If you are at high risk of getting very sick, wear a high-quality mask or respirator (e.g., KN95) when indoors in public at medium and high Hospital Admission Level/Community Levels.

  · When Hospital Admission Level/Community Levels are high, masks are recommended for everyone.

  · Physical distancing and wearing well-fitting masks (if tolerated) is recommended when electing indoor visitation when the community is in outbreak mode (i.e. when there has been one or more resident or staff cases of COVID-19 within the prior 10 days).

  · The safest approach is for everyone, regardless of vaccination status, to wear a face covering or mask while in communal areas of the facility (except when eating) and to practice social distancing.

Visits

• Visitors are allowed at all levels and will adhere to infection prevention controls as listed above. Visits will be person-centered and will consider the residents’ physical, mental, and psychosocial well-being, and support their quality of life. The following protocols will be observed:
  • Visits are allowed indoors and outside.
  • Visitors must enter the community at permitted entrances only.
  • All visitors will be screened as currently practiced. Those with symptoms or exposures must wear a KN-95 mask, at a minimum, if the visit must occur.
  • Regardless of Hospital Admission Level/Community Level, residents and their visitors when alone in their apartment, may choose not to wear face coverings or masks and may choose to have close contact.
  • Although there is no limit on the number of visitors that a resident can have at one time, visits will be conducted in a manner that adheres to infection control practices and that do not increase risk to other residents.
  • Visits are preferred to take place in the resident’s apartment.
  • When in outbreak mode, visitors must go directly to the resident’s apartment and limit movement within the building.
  • Visits are permitted during dining. Guests may dine with residents in the dining room.
  • Large gatherings (e.g., parties, events) may be permitted indoors in accordance with community rules regarding pre-scheduling and availability of indoor/outdoor space. Where large numbers of visitors are in the same space at the same time, physical distancing is advised.
  • While not recommended, residents who are on isolation protocols due to COVID-19 or other illness, can still receive visitors. In these cases, visits should occur in the resident’s apartment and the resident and visitor should wear a well-fitting facemask (if tolerated), the visitor should don PPE which can be found outside the apartment, and infection prevention controls should be followed.
  • Physical distancing during visits is recommended to be maintained.

Visitor Testing and Vaccination

• JSL strongly encourages all visitors to receive all COVID-19 vaccines including the most recent bivalent vaccine as well as the flu vaccine.
• While not required, JSL encourages visitors to test prior to visiting their loved ones while Oakland County is in high or medium Hospital Admission Level/Community Levels.

Screening and Testing Protocols

• All visitors entering the facility will continue to be screened.
• Visitors with symptoms or signs of COVID-19 will not be prohibited from entry, however, they are encouraged either to defer their visit for 10 days since symptom onset or first positive test, or to enter only after day 5 and in any event with a well-fitting mask.
• Staff with signs or symptoms of COVID-19 must test immediately and will not be permitted to work if they test positive for COVID-19.
• Routine testing of asymptomatic staff is no longer required but may be performed at the discretion of the facility. JSL reserves the right to require asymptomatic staff to be tested routinely.
• Residents with signs or symptoms of COVID-19, regardless of vaccination status, must be tested as soon as possible.
• Residents with signs or symptoms of COVID-19 will be isolated until a nucleic acid amplification test (PCR) or an antigen (POC) test is completed and a negative result is obtained.
• Residents or their responsible party are required to consent to testing and must sign and return the consent form.  All new admissions must sign the consent to testing form.
• Residents who decline testing, if symptomatic, will be placed on isolation protocols for COVID-19 per the Centers for Disease Control (CDC) guidelines.  This means that the resident would not be able to participate in communal dining or programming until a minimum of 5 days have passed and a negative POC or PCR test result is obtained or 10 days have passed.
• Residents who decline testing and are asymptomatic will have additional monitoring, to ensure the resident maintains appropriate distance from other residents, wears a face covering, and practices effective hand hygiene until the procedures for outbreak testing have been completed.
• Staff who are asymptomatic and decline to participate in testing will not be permitted to have contact with residents and will be redeployed to other duties, if available.

Outbreak Testing Protocol

• Upon identification of a single new case (outbreak) of COVID-19 infection in any staff or resident, outbreak testing will begin immediately, but not earlier than 24 hours after the exposure, if known.
• Testing will be conducted of all staff and residents regardless of vaccination status.  If supplies are available, POC testing will be conducted.
  • Confirmatory testing will be done with a PCR, if possible.
  • If POC tests are not available PCR testing will be conducted.
• 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.
• If no additional cases are identified during contact tracing or the broad-based testing, no further testing is indicated.
• If additional cases are identified, testing will continue on affected unit(s) or facility-wide every 3-7 days until there are no new cases for 14 days.
• If antigen testing is used, more frequent testing (every 3 days), will be considered.
• In general, testing is not necessary for asymptomatic people who have recovered from COVID-19 infection in the prior 90 days or due to challenges in interpreting the result.
• If JSL has the ability to identify close contacts of the individual with COVID-19, JSL can choose to conduct focused testing based on known close contacts.  If JSL does not have the expertise, resources, or ability to identify all close contacts, JSL will instead investigate the outbreak at a facility-wide or group-level (e.g. unit, floor, or other specific area of the community).
• During outbreak periods, JSL may continue communal dining and programming.  During the testing period, if a concern is found, JSL may close dining and programming as deemed necessary by management.
• High risk exposures that involve material contact with the eyes, nose or mouth or were with aerosol generating procedures will test at day 1, day 3 and day 5 and will be repeated until no new cases are identified for 14 days.

Notification of COVID-19 Positive Cases

• Although not required, all residents, guardians and healthcare proxies will be notified when there are any staff or resident cases of COVID-19 identified in the community. This notification will be transmitted via Voice Friend text messaging or email.
• A notice will be posted in a visible and obvious place near the main entrance of the facility indicating the presence of a confirmed COVID-19 positive employee or resident.  The notice will continue to be displayed for 14 days after the last positive COVID-19 test result for an employee or resident in the facility.
• Anyone with a known close contact with an individual diagnosed with COVID-19 will be notified per CDC guidelines.
• All notifications required per MDHHS memo, CDC or other officials will be

made (local health department, electronic reporting system).

Visits During Outbreak Mode

• An outbreak investigation is initiated when an onset of COVID-19 occurs (i.e., a new COVID-19 case among residents or staff).
• While it is safer for visitors not to enter during an outbreak investigation, visitors are permitted.  Visitors should adhere to all infection prevention controls.
• Visitors should wear face coverings or masks during outbreak mode visits, regardless of vaccination status, and visits will occur in the resident’s apartment.

New Resident Admission

• JSL will antigen test all new admissions on day 1, 3 and 5.
• New admissions may be required to wear a mask when in common areas for their first 5 days in the facility.
• If resident tests positive at any time, see Management of Residents with Confirmed COVID-19 section.
• Residents who leave the community for more than 24 hours will be managed as a new admission.

Volunteer and Service Provider Testing

• Testing of service providers such as consultants, contractors, volunteers, and caregivers who provide care and services to residents on behalf of the facility must participate in outbreak mode testing pursuant to protocols for staff.
• JSL prefers that all volunteers be fully vaccinated.
• Visiting or shared healthcare personnel who enter the setting to provide healthcare to one or more residents (e.g. physical therapy, wound care, IV injections or catheter are provided by home health agency nurses) should follow the healthcare infection prevention control recommendations in the CDC guidance for healthcare workers.

Dining, Programming and Resident Outings

• While adhering to infection prevention controls, communal activities and dining are permitted to occur.
• Residents and families will be notified if dining or programming is suspended during a surge in COVID-19 cases in either the community at large or within the AL community staff and/or residents.
• While in high and medium Hospital Admission Level/Community Levels JSL requires the wearing of masks in programming and activities.

COVID-19 Exposures

• In general, asymptomatic residents do not require isolation while being evaluated for COVID-19 following close contact with someone with COVID-19 infection.
• Residents should wear a mask as soon as they find out they were exposed.  Mask wearing should continue for 10 full days.
• Those who have not recovered from COVID-19 infection in the prior 30 days should be tested as described in the testing section.
• Day 0 is the day of last exposure to someone with COVID-19
• Day 1 is the first full day after the last exposure
• For 10 Full Days residents who have had close contact with someone with COVID-19 will:
  • Wear a high-quality mask or respirator (e.g., KN95) any time around others inside the community.
  • Be instructed to not go places where unable to wear a mask.
  • Take extra precautions around people who are more likely to get very sick from COVID-19.
  • be monitored for symptoms by staff daily.
• After 5 full days after the last exposure, residents will be tested even if they do not develop symptoms.
• If a resident develops symptoms before testing day, they will isolate immediately and be tested.
• If the test result is positive, CDC guidelines on isolation will be followed.   https://www.cdc.gov/coronavirus/2019-ncov/your-health/isolation.html.
• If test is negative
  • precautions should continue through day 10.
  • Resident must wear a high-quality mask or respirator (e.g., KN95) any time around others inside the community.

Management of Residents with Confirmed COVID-19

• Residents who test positive for COVID-19 will be placed on isolation/transmission based precautions.
• Staff will use full PPE (gowns, gloves, eye protection, and a NIOSH-approved KN95 or equivalent or higher-level respirator) while in the resident’s apartment.
• Residents should continue to wear masks, if capable, until symptoms resolve or, for those who never developed symptoms, until they meet the criteria to end isolation below.
• Residents who had mild to moderate illness throughout their infection and are not immunocompromised may end isolation when:
• At least 10 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.
• Residents who were asymptomatic throughout their infection and are not moderately to severely immunocompromised may end isolation when:
  • At least 10 days have passed since the date of their first positive viral test.
• Residents with moderate to severe illness (see CDC definition) who are not moderately to severely immunocompromised may end isolation when :
  • At least 10 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.
• Residents will be monitored closely while in isolation.
• Medically unstable residents will be transferred to the hospital for evaluation.
• Medically stable residents will be isolated in their apartments and will be monitored closely for changes in condition.  Should their medical condition change, residents will be transferred to the hospital.   
• Residents will be evaluated by nursing staff who will consult the resident’s primary care physician.
  • JSL will coordinate transportation for resident to be taken to the hospital for treatment, if needed and follow 911 protocols.
  • JSL will assist with tracking any contact between an impacted resident and those with whom they may have interacted.
  • JSL will work with hospital to track resident’s results and progress as appropriate and permitted and discharge plan accordingly.

Recordkeeping

• Records of vaccination will be maintained for staff and residents and can consist of the AL community’s electronic medical record system reflecting a resident’s receipt of the vaccine and bivalent booster, Michigan Care Improvement Registry (MCIR) or other official immunization record from a doctor, local health department, hospital, pharmacy or health system or a copy of a valid CDC vaccination card.
• All MDHHS and CDC reporting regarding positive cases and testing shall be completed as required.

Independent Living (Meer, Hechtman, Prentis and Teitel Apartments)

Independent Living COVID-19 practices are determined based on the CDC COVID-19 Hospitalization Level/Hospital Admission Level/Community Levels and per the CDC are as follows:

• At all COVID-19Hospital Admission Level/Community Levels:
  • Stay up to date on vaccination, including recommended booster doses.
  • Maintain ventilation improvements.
  • Avoid contact with people who have suspected or confirmed COVID-19.
  • Follow recommendations for isolation if you have suspected or confirmed COVID-19.
  • Follow the recommendations for what to do if you are exposed to someone with COVID-19.
  • If you are at high risk of getting very sick, talk with a healthcare provider about additional prevention actions.

• When the COVID-19 Hospital Admission Level/Community Level is Medium or High:

• • If you are at high risk of getting very sick, wear a high-quality mask or respirator (e.g., KN95) when indoors in public
  • If you have household or social contact with someone at high risk for getting very sick, consider self-testing to detect infection before contact, and consider wearing a high-quality mask when indoors with them.
  • See above.

• When the COVID-19 Hospital Admission Level/Community Level is High:

• • Wear a high-quality mask or respirator.
  • If you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.
  • See above.

If the level in Oakland County rises, JSL may resume more cautious guidelines.

Masking and Social Distance

• Although masks are not mandatory in the CDC green and yellow Hospital Admission Level/Community Levels, we strongly recommend wearing a mask in public places, within and outside your JSL community as older adults are the most vulnerable to the virus.  However, based on CDC recommendations, you will no longer be required to mask nor will staff.  If you would like a staff member to wear a mask when in close proximity to you, please request that they do so.  We will continue to supply masks and have advised staff to keep them on hand for this purpose.
• Social distancing is no longer required but is advised.

Screening and Testing Protocols

• All residents and persons entering the facility will continue to be screened.
• Staff with symptoms or signs of COVID-19, must report their illness to Human Resources, leave the building immediately and have a PCR test regardless of vaccination status. Staff will be excluded from work until they are clear to return to work by Human Resources.
• Residents are not required to test if they have signs or symptoms of COVID-19 but are urged to obtain a POC or PCR test per CDC guidelines regardless of vaccination status.
• Visitors with confirmed COVID-19 infection or similar symptoms should defer non-urgent in-person visitation until they meet CDC criteria to end isolation (after day 5 has passed, and it is preferred that visits be delayed past day 10).
• Visitors should consider testing themselves for infection before a visit with a resident who might be at high risk for severe illness.
• Staff are no longer subject to routine testing.

Notifications of COVID-19 Cases

• Although no longer required, JSL will notify all residents, guardians, and healthcare proxies when there are any staff or resident cases of COVID-19 in the community as soon as possible via Voice Friend.  Notices of positive cases will be posted in a conspicuous place in all communities as per JSL protocol.  Anyone with a direct exposure will be notified.  Although not required, the Oakland County Health Department has requested to be notified will be notified of any COVID-19 cases among staff or residents.

Visitors

• Visits are permitted at any time.
• All visitors must enter and be screened and logged in at permitted entrances only.
• Those with symptoms or exposures are recommended not to visit.  If the visit must occur, it is highly recommended to wear a well-fitting mask while in the facility.

COVID-19 Exposures

• Asymptomatic residents do not require isolation while being evaluated for COVID-19 following close contact with someone with COVID-19 infection.
• These residents should still wear a mask and those who have not recovered from COVID-19 infection in the prior 30 days should be tested as described in the testing section.
• Residents will be instructed to wear a high quality mask as soon as they find out they were exposed.
• Day 0 is the day of last exposure to someone with COVID-19
• Day 1 is the first full day after last exposure
• For 10 Full Days residents will:
  • Wear a high-quality mask or respirator (e.g. KN95) any time you are around others inside an apartment or indoors in public.
  • Be instructed to not go places where unable to wear a mask.
  • Take extra precautions around people who are more likely to get very sick from COVID-19.
• After 5 full days after the last exposure, residents should test per CDC recommendations, even if they do not develop symptoms.
• If a resident develops symptoms, they should isolate immediately and should be tested.  Residents have been advised how to obtain free tests from the Federal distribution program and local free distribution options.  Tests can also be purchased at local stores and are now readily available.
• If the test result is positive, isolation recommendations should be followed.
• If test is negative
  • Residents should continue taking precautions through day 10.
  • Residents should wear a high-quality mask when around others at home and indoors in public through day 10.

Management of Residents with Confirmed COVID-19 (Isolation)

• We request if you test positive for COVID-19 that you inform the office as soon as possible so that contact tracing may occur.
• People who are confirmed to have COVID-19 or are showing symptoms of COVID-19 need to isolate regardless of their vaccination status.
• Residents who have a positive viral (PCR) test or Point of Care (POC) test for COVID-19, regardless of whether or not they have symptoms are considered confirmed for COVID-19.
• Residents confirmed with COVID-19 will be instructed to isolate per the CDC recommendation.
• Current CDC guidelines for isolation will be followed (day 0-day 5).
• Day 0 is the day a resident tests positive or when symptoms begin.
• If symptoms are improving, a resident can leave isolation at day 6 but must wear a high quality mask through day 10.
• If a resident cannot wear a mask, they should remain isolated through day 10.
• If symptoms are not improving by day 5, resident must remain isolated until 24 hours after fever resolves without using fever reducing medication or until symptoms improve.
• Residents participating in the meal program will have their meals delivered to their apartment and the fee for delivery will be waived during the period of isolation.
• Staff will use full PPE (gowns, gloves, eye protection, and a NIOSH-approved KN95 or equivalent or higher-level respirator) if the need arises to enter the apartment.
• Resident will be encouraged to be evaluated and seek medical treatment with their own primary care physician.
• Residents should also isolate if sick and suspect that they have COVID-19 but do not yet have test results. 

Volunteers

• JSL prefers that all volunteers be fully vaccinated.

Dining and Activities

• Communal dining and group activities will be permitted.
• While in high and medium Hospital Admission Level/Community Levels JSL will require the wearing of masks in programming and activities.
• Access to hand hygiene will be available.
• Residents who wish to continue to receive meals in their apartment will be charged the customary delivery fee.
• During an increase in the County Hospital Admission Level/Community Level, JSL will determine when it is appropriate to temporarily suspend dining or programming.  Residents and families will be notified when a temporary suspension occurs.

Salon and Wellness Center

• Currently open.
• During an increase in the County Hospital Admission Level/Community Level, JSL will determine when it is appropriate to temporarily suspend the use of the salon and/or wellness center.  Residents and families will be notified when a temporary suspension occurs.

Transportation

• Transportation will be offered for medical appointments, essential appointments, and social appointments where and as available. Masking required per masking protocol.
• During an increase in the County Hospital Admission Level/Community Level, JSL will determine when it is appropriate to temporarily suspend the use of transportation.  Residents and families will be notified when a temporary suspension occurs.

All JSL Communities

Miscellaneous

• JSL staff are required to follow our MIOSHA/OSHA work plan.  If you would like to see a copy of our plan or any other staff protocols, please speak with your building Administrator.  Topics covered in this plan include the following:
  • Engineering controls – barriers between the worker and exposure to the virus including masks and facial coverings.
  • Administrative controls – policies, procedures and practices such as staggered work schedule, teleworking and increased social distancing measures.
  • Basic infection prevention measures – handwashing and facility cleaning, in accordance with CDC guidance.
  • Health surveillance – screening protocols to identify known or suspected COVID-19 cases at the start of work shifts, employees should report any signs or symptoms of COVID-19.
• Marvin’s Bistro and the Krolik Café are currently open.  If there is an increase in local cases, JSL will determine when it is appropriate to temporarily suspend the use of the Bistro or Krolik café.  Residents and families will be notified when a temporary suspension occurs.
• Boutiques, where provided, are currently open.  If there is a COVID-19 surge in the County, JSL will determine when it is appropriate to temporarily suspend the use of the boutique. Residents and families will be notified when a temporary suspension occurs.
• Tours available.
• Move-ins and move-outs are permitted and subject to protocols and policies for the same.
• Continued vigilant sanitation building-wide.
• Congregating in common areas of the buildings is permitted.  Although masking and social distancing is not required, they are recommended and requested.

Plan of action in the event of an outbreak of multiple cases of COVID-19 at a JSL Community:

• Take instruction from the Oakland County Health Department and follow recommendations.

If you have questions about any of the above information, or require additional information or clarification please contact your building administrator.