While many states still have restrictions in activities in place for the most vulnerable populations, we realize that the re-opening of Evergreen Life Services (ELS) will:

• Not resemble the previous operation of ELS for many months, if not years. We will endeavor to serve our individuals as fully as possible given the continued need for vigilance and ongoing protective actions
•  Be individualized by State, Division, homes, and persons served
• Be monitored closely with ongoing prophylactic measures and the continuation of the Centers for Disease Control and Prevention (CDC) best practices
• Be withdrawn if there is an increase in the incidence of positive Covid-19 exposures whether they are in individuals or staff; or if they are asymptomatic and realized after testing

Evergreen Life Services will open in phases by services provided, by ELS and State phases and by assessments of the risk/benefit factor for our individuals. While our individuals and their families are becoming frustrated with the sheltering in place and reduction in activities procedures, ELS will continue to fully explain that our primary concern centers on the interest of the whole of ELS.

This phased plan presents a pathway for re-opening that relies on Five Core Actions that we must all consistently abide by to reduce the spread of Covid-19. These core actions also reduce individual and community risk. The Five Core Actions are as follows:

1. Physical distancing
2. Wearing cloth face coverings
3. Handwashing
4. Disinfecting surfaces
5. And, staying home if you are sick or instructed to isolate and/or quarantine

We will be able to safely maintain our re-opening efforts only if everyone commits to maintaining these Five Core Actions.

We are also aware of some States opening more fully than other States and the ensuing pressure that this exerts upon ELS to comply. The strategies here are measured in such a manner that they can be reversed or modified at any time. We endeavor to fulfill the services that our individuals deserve, the State demands, and that we believe are prudent for the safety of not only the individuals served but for our staff as well.

Divisional and Administrative Offices

It was determined by the Re-Opening Strategy Task Force that all administrative offices will maintain the agreed upon and reduced level of staffing and operations until further notice. All current practices will continue until further notice and these include:

• Reduced and agreed upon level of staffing pattern
• Temperature/symptom logs before entering
• Only ELS staff and visitors who are approved by the Executive Director will be allowed to enter the facilities
• Doors will remain locked to the public
• Masks are to be worn by all staff
• Social distancing
• Staff will be quarantined for at 14 days if they are living with or have been in contact with any other consumer, family member, or caregiver who is suspected (tested but not yet received results) or confirmed COVID-19 positive
• And staff who are exhibiting signs and symptoms of Covid19 must not have symptoms for 72 hours without a fever reducing medication or have a negative Covid19 test.

The re-opening strategies are proposed for community outings, visitation, day services programs, and vocational/employment programs.

Community Outings

Community activities and outings will be considered after each State has reached its Phase 2 level of opening and after the shelter in place orders or the precautions for vulnerable populations orders expire.

Phase 1 – Open Air

• Is comprised of groupings of no more than 10 of our individuals at a time from the same home
• Individuals and staff will wear masks at all times. Proper infection control procedures will continue to be followed such as washing hands, social distancing, monitoring of temperatures/symptoms upon departure and return
• These activities will include picnics outside, visits to low-density parks and such areas
• These activities will take place out of doors, in open spaces away from other groups of people, will occur only with other members of the same home and will not include any restaurants except to drive through to obtain take-out food

Phase 2 – Direct Contact

• Is comprised of activities where there is direct contact with other people who are not housemates of our individuals. These interactions will take place in hair salons, small restaurants that are following the correct percentage of opening, convenience stores, smaller venues that are following the correct percentage of opening and social distancing, sporting events that follow the correct social distancing standards
• Individuals and staff will wear masks at all times. Proper infection control procedures will continue to be followed such as washing hands, social distancing, monitoring of temperatures/symptoms upon departure and return
• There should be limited to direct interaction and would not include waiting in lines or large groups of people such as church
• The correct infection control measures will be followed in the transportation vehicles including the number of people in the vehicle, social distancing, disinfection of the vehicle before and after the outing and contact disinfection
• In addition, after direct contact of this type, the individuals will follow the protocol of removing their shoes upon return to the home, changing clothes, bagging and/or laundering the clothes they were wearing and taking a shower

Phase 3

• Is comprised of open access to all community activities as prescribed by the conditions in the State and any level of infection concern
• The correct infection control measures will be followed in the transportation vehicles including the number of people in the vehicle, social distancing, disinfection of the vehicle before and after the outing and contact disinfection
• This will be the “new normal”.

Visitation

Visitation is considered after each State has reached its Phase 2 level of opening or after the shelter in place and precautions for vulnerable populations orders expire.

Phase 1 – Visitation is for essential visitors only in the home

• This includes medical emergency personnel, ELS staff, and approved contractors only for critical repairs of infrastructure and end of life needs. Masks must be worn at all times.
• All CDC guidelines will be followed for visitation to vulnerable individuals including the use of PPEs, the logging of temperatures and symptoms upon entry and departure and proper infection control procedures
• Proper infection control procedures will continue to be followed such as washing hands, social distancing, monitoring of temperatures/symptoms upon departure and return
• Visitation will not occur for at least 14 days if the visitor is living with or has been in contact with any other consumer, family member or caregiver who is suspected (tested but not yet received results) or confirmed Covid-19 positive

Phase 2 – Is for immediate family or supports who wish to visit the individuals served

• This visitation will occur only in open areas such as on the porch of the homes or in an open area where the individuals can practice physical distancing and there are limited communal surfaces
• All infection control measures will be followed including the use of masks by family members and the individual, no physical contact, social distancing, hand sanitizing, and
  the logging of temperatures and symptoms upon beginning the visit and upon ending the visit
• Visitation will not occur for at least 14 days if the visitor is living with or has been in contact with any other consumer, family member, or caregiver who is suspected (tested but not yet received results) or confirmed Covid-19 positive

Phase 3 – Is comprised of open access for visitation as it follows the policies and procedures of ELS

• Visitation will not occur for at least 14 days if the visitor is living with or has been in contact with any other consumer, family member or caregiver who is suspected (tested but not yet received results) or confirmed Covid-19 positive
• All infection control measures will be followed including the use of masks by family members and the individual, no physical contact, social distancing, hand sanitizing, and
  the logging of temperatures and symptoms upon beginning the visit and upon ending the visit
• This will be the “new normal”

Day Services Programs

Day services are considered after each State has reached its Phase 2 level of opening or after the shelter in place or the precautions for vulnerable populations orders expire.

Phase 1 – This is day services that ELS provides only to individuals who are served by ELS and those services are provided in the homes where they live.

• This includes services that ELS is currently providing in alternative sites or virtually as a result of the health crisis brought on by Covid-19
• This is primarily provided in ICF homes in Texas and Louisiana where services are part of the daily per diem rate and are provided by staff in the homes where the individuals live
• This does not include independent living or waiver served individuals

Phase 2 – This is the day service programming for individuals who are served by ELS and would go to an ELS day service program location.

•  A risk/benefit assessment will be completed on each individual. The tool is attached. This is not a validated tool and is intended only to be a total score that is communicated to the facility to assist in the assessment of risk/benefit to the individual who is participating in the day services program
• This assessment will be completed by a team of individuals which may include the person served, the staff of the facility, family or supports and/or a circle of supports
  • The setting would only serve 10 people at a time
•  Individuals and staff will wear masks at all times. Proper infection control procedures will continue to be followed such as washing hands, social distancing, monitoring of temperatures/symptoms upon departure and return, disinfecting of hard surfaces during the course of the program
• Times of service will be staggered so to only have 10 persons and only the required and designated staff in the service area at a time. This may entail a split shift of services such as 9:00 am to 12:00 pm and then 1:00 pm to 4:00 pm.
• No essential personnel or consumer can enter the day services program for at least 14 days if they are living with or have been in contact with any other consumer, family
  member, or caregiver who is suspected (tested but not yet received results) or confirmed Covid-19 positive. If a suspected case does not end up testing positive for Covid-19, they can return to the day services program before the end of the 14 days. Day services programs are required to inform the consumers’ family if any personnel test positive for Covid-19.
• Consumers and family members are required to notify the day services program if the consumer, family member, or any direct care worker or staff serving the consumer in their living arrangement test positive for Covid-19. Any consumer or essential personnel who tests positive for Covid-19 must follow current CDC guidance regarding when it is safe for them to return to the day services program.

Phase 3 – This includes people served by ELS going to other providers’ day services programming.

• This component of day programming is currently on hold. There are ongoing and unknown concerns about the infection control measures undertaken by other providers and the potential cross-contamination of ELS individuals and their housemates

Phase 4 – This includes other individuals from other providers coming to ELS’ day programming services.

•  This will only be allowed if ELS staff are able to work with the staff of the other providers along with the supports in order to complete the risk/benefit assessment tool (Please see the attached document.)
• Individuals and staff will wear masks at all times. Proper infection control procedures will continue to be followed such as washing hands, social distancing, monitoring of temperatures/symptoms upon departure and return, disinfecting of hard surfaces during the course of the program
•  There is a limit on the number of individuals to ten
• Individuals from the same provider will be grouped together and provided services as a group. No other individuals from other providers or ELS will be comingled and served together in the same day program setting at the same time
• The day services area will be thoroughly cleaned after each group of individuals is served
• No essential personnel or consumer can enter the day services program for at least 14 days if they are living with or have been in contact with any other consumer, family member, or caregiver who is suspected (tested but not yet received results) or confirmed Covid-19 positive. If a suspected case does not end up testing positive for Covid-19, they can return to the day services program before the end of the 14 days.
• Day program services are required to inform consumers, family members, and providers who have consumers attending the day program if any consumer or essential personnel test positive for Covid-19. Any consumer or essential personnel who tests positive for Covid-19 must follow current CDC guidance regarding when it is safe for them to return to the day services program.
• This will be the new “normal”.

Vocational/Employment Programs

Vocational/employment programs are considered after each State has reached its Phase 2 level of opening or after the shelter in place or the precautions for vulnerable populations orders expire.

Phase 1– These services include contracts for cleaning and other services in buildings where there is little direct contact with other people.

•  Individuals and staff will wear masks at all times. Proper infection control procedures will continue to be followed such as washing hands, social distancing, monitoring of temperatures/symptoms upon departure and return
• The correct infection control measures will be followed in the transportation vehicles including the number of people in the vehicle, social distancing, disinfection of the vehicle before and after the outing and contact disinfection
• This Phase 1 is allowed only if there is documented concern about the possible cancellation of the employment contract if services are not provided
• This Phase 1 will follow all CDC, State guidelines and is allowed if the shelter in place orders have expired

Phase 2 – Vocational workshops will resume only after the shelter in place orders have expired and the State has phased in openings for persons who are especially vulnerable.

• Individuals and staff will wear masks at all times. Proper infection control procedures will continue to be followed such as washing hands, social distancing, monitoring of temperatures/symptoms upon departure and return
• The correct infection control measures will be followed in the transportation vehicles including the number of people in the vehicle, social distancing, disinfection of the vehicle before and after the outing and contact disinfection
• Persons served at employment sites who exhibit symptoms of Covid-19: Fever of 100.4 degrees or higher; new and persistent dry coughs; unable to hold their breath for 20-30 seconds; or unusual fatigue will immediately report to their supervisor. The person will be isolated and their emergency contact or residential support organization will be called and transportation services, to return the person home, will be arranged or provided
• Employees and persons served will be strongly reminded to keep 6-feet distances while engaged in branch-based and community activities including during lunches
• Physical environments will be adapted to limit group sizes in individual rooms throughout the service area
• Production spaces for persons served will be adapted to create more space between workstations
• Communal food and the sharing of food will not be permitted until further notice. There is to be no use of water fountains
• Shaking hands, hugging, fist bumps, high fives and other physical forms of greetings or celebrations will not be allowed
• Employees will be required to sanitize tables, other surfaces, door handles, light switches, and other common touchpoints throughout the day using a sanitizer/disinfectant. Tables will be cleaned before and after lunch
• Employees shall clean restrooms at least once per day
• Shared computers and mobile devices will be sanitized using a sanitizer composed of at least 70% alcohol, at the end of each day
• This will be the new “normal”.