Top Ways to Provide Safe & Effective Care in Residential Treatment Settings During COVID-19

June 11, 2020

Mitigating the risk of COVID-19 infection can be especially challenging for residential treatment facilities as the very nature of the facilities makes it difficult to follow guidelines for fighting the spread of the virus.

The facilities and the treatment that takes place within are designed to support group interaction and therapy.

These days, that’s dangerous.

“All you would need is one person who is infected and you could infect the entire patient population, all of the staff and shut the place down,” said Margaret Jarvis, MD, DFASAM, chief of addiction medicine for the Geisinger Health System and member of the ASAM Board. “At that point, you’ve lost access. So how do you balance that? Nobody has a perfect way of doing that at this point.”

There are, however, ways to continue providing treatment in safe, effective ways.

While screening for symptoms, such as cough, shortness of breath and fever, along with other recently described neurological, pulmonary, and gastrointestinal symptoms, it’s important to also consider whether the patient has potentially been exposed to the virus. Do they live or work in an area with high prevalence of the virus? Have they been following recommendations for social distancing?

“For instance, a person who has been doing child care in a community where there’s high penetrance of the virus could be at higher risk for having had an exposure as opposed to the person who has quite literally been sheltering in their house and has not left the house for two weeks,” Dr. Jarvis said. “Those things are considerations to make sense of who is at risk and who isn’t.”

Dr. Jarvis added that treatment providers should also wear masks and remain six feet apart, as much as possible, when seeing patients in the residential setting. Of course, telehealth and video conferencing platforms are incredibly helpful in mitigating coronavirus infection risk when in-person meetings are not required.

As our new reality continues to evolve as a result of COVID-19, Dr. Jarvis said it’s imperative that patients continue to have the same level of access that they had before the pandemic. It’s also important for providers to check on patients more frequently during this time of increased stress.

She said many who treat patients with substance use disorders are hearing of patients who are becoming unstable and have resumed addictive behaviors under the added stress associated with shelter-in-place orders and fears of contracting COVID-19.

“They are scared about trying to seek healthcare,” she said. “They’re not showing up in emergency rooms and places like that until they’re really, really sick. And some people are simply being found dead in their homes.”

Following up with patients after emergency department visits or just checking in to let them know you’re thinking of them during this time could save a life.

“Just a person taking the time to make contact somehow,” Dr. Jarvis said. “It’s a big deal.”


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