A National State of Emergency remains in place due to COVID-19, and Tennessee Gov. Bill Lee recently extended the State of Emergency in Tennessee through the month of October. What, exactly, does that mean for Cornerstone of Recovery?
As a health care facility where the care of our patients is priority No. 1, we continue to evaluate the nebulous nature of the virus, as well as the evolution of the science designed to combat it. Many of our precautions have been in place since March, when COVID-19 began to spread widely across the country. Others are newer protocols put in place as additional information has been provided by scientists and physicians on a local, state and federal level.
But as we've said since the beginning: Addiction doesn't stop, and neither do we. While many non-essential businesses were forced to shutter because of the coronavirus, Cornerstone of Recovery wasn’t one of them.
“Cornerstone’s services and general operation are considered ‘essential’ under the state’s guidelines and under the guidelines put forth by the federal government under the Family First Act,” says Cornerstone Clinical Director Dr. Scott Anderson. “We fall under the exemption as health care providers. This is consistent with the licensure of most of our professional staff, who are considered health care providers and whose activities are licensed by health-related boards. It is also consistent with our facility license as a substance abuse treatment facility.
“Given that approximately 90,000 people per year die from Alcohol Use Disorder (the medical terminology for alcoholism) and another 70,000 from drug overdoses in the United States alone, we believe that our ongoing services are essential to the health and well-being of our patients.”
On Sept. 29, Tennessee Gov. Bill Lee signed Executive Order No. 63 , which removed "remaining restrictions on businesses and gathering sizes in the 89 counties with a state-run health department," but also extended "certain, targeted provisions of previous executive orders through October 30, including the authority of local governments to institute mask requirements."
“Tennessee’s response continues to be one of the most targeted in the country and a continued State of Emergency ensures we have access to additional federal funds, ensure our health care capacity is stable and loosen restrictions that would otherwise hinder our response time,” Gov. Lee said in a press release. “COVID-19 is still a serious problem and I encourage every Tennessean to continue social distancing and doing their part to make wise choices and help mitigate the spread of the virus.”
Nationally, the administration of President Donald Trump has put forth a plan called “Opening Up America Again,” , “a three-phased approach based on the advice of public health experts. These steps will help state and local officials when reopening their economies, getting people back to work, and continuing to protect American lives.”
While a national state of emergency is still in place, there are no federal restrictions that require an organization like Cornerstone of Recovery to follow certain mandated protocols. However, despite the lack of federal or state oversight, clinicians and administrators at Cornerstone continue to operate under a rigorous set of guidelines designed to keep COVID-19 from gaining a foothold in our patient population — individuals whose alcohol and drug problems may make them immuno-compromised, and for whom a lengthy battle with the coronavirus would be extremely detrimental to the drug and alcohol treatment they need to overcome addiction.
It's a fine line to walk, but it's one that administrators have treaded carefully since the beginning, when the scope of the pandemic became apparent, but so too did the need to continue to offer treatment to a population whose biggest health concerns had more to do with drugs and alcohol than COVID-19. The facility’s staff members worked quickly to implement stringent COVID-19 precautions shortly after the pandemic became widespread, and in order to minimize exposure, the following changes were made:
COVID-19 Precautions: Staff
- All employees in non-clinical positions, or positions that do not involve direct patient care, are allowed to work from home. As a result, a large number of Cornerstone’s support staff — employees in accounting, the business office, utilization review, marketing and more — are no longer traveling to and from campus each day.
- All staff and patients are temperature screened daily. Staff members are instructed to take their temperatures upon arrival for their work shift.
- All staff have been instructed to abide by state and Centers for Disease Control (CDC) recommendations regarding social distancing both at work and while away from work.
- Cornerstone staff members are now required to wear cloth masks when within 6 feet of patients, or giving direct patient care. Masks are not required while working 6 feet apart from one another or when staff members are working alone in their respective offices, but staff members are certainly encouraged to wear masks at all times, if they feel more comfortable doing so.
- Social distancing protocols remain in place between staff and patients whenever possible. Mask protocols are in addition to social distancing measures that encourage distance between staff members and patients whenever possible.
- Our Medical Services Director has worked diligently to locate additional PPE for use by both staff and patients if deemed necessary per CDC and State guidelines.
- Staff members who have been identified as “at risk” by their medical providers have been accommodated to the best of our ability and depending on their needs and job functions. Some staff members have been provided with telehealth technology so that they can conduct HIPAA-compliant Zoom sessions from home or engage in other essential work-related activities. Other staff members have been allowed to isolate in an office where they do not have contact with patients or other staff but have access to the technological resources that they need to continue working. Other staff members have been provided with alternative job duties in order to continue working in isolation.
- On a case by case basis, a few employees have utilized FMLA and taken medical leave upon the advice of the medical providers in order to minimize their exposure to COVID-19.
- Essentially, anyone who is not a patient or directly involved in patient care is prohibited from being on campus, unless his or her presence is critical to Cornerstone operations.
- Our medical and leadership staff constantly monitors information provided by the CDC and other government agencies as well as participate in numerous webinars intended to provide guidance on the risk mitigation of COVID-19 infection for both staff and patients. We have also participated in Zoom meetings, webinars and teleconference related to our specific industry to determine best practices for continuing to treat patients while protecting the welfare of staff and the existing patient population. To the best of our ability, we continue to abide by the guidance that we are receiving from all sources.
COVID-19 Precautions: Patients
- Before being admitted as patients to Cornerstone of Recovery, all potential admissions are screened using guidelines set forth by the Centers for Disease Control, in order to reduce the likelihood that an incoming patient has been exposed to COVID-19. This screening consists of questions specifically related to their recent travels, geographic location, contact with individuals known to have tested positive for COVID-19, any symptoms of COVID-19, etc.
Every admission is required to have a negative PRC or molecular test with results submitted to the Admissions Department before they arrive for admission.
- All new admissions are met in the parking lot upon arrival by staff members who conduct a temperature screening to ensure that the individual’s temperature is near normal and below 100.4 degrees. Family members or others accompanying the patient are not allowed into the building. The patient’s belongings are searched and are heat treated for a variety of reasons related to the safety of our facility.
- Cloth masks are distributed to patients upon their arrival, and at this time wearing those masks will be voluntary. That may change as the COVID-19 situation continues to evolve. Patients will be provided with one cloth mask — and only one cloth mask! — to keep and care for during their stay at Cornerstone of Recovery. IN ADDITION: Potential patients coming to Cornerstone for admission are encouraged to bring their own masks, if they have one and if they so wish.
- The first stages of the admissions process includes an assessment by our nursing staff, which involves a more thorough physical screening. Cornerstone of Recovery tests all patients during the admission process for COVID-19 antibodies. According to Travis Pyle, Cornerstone's Director of Medical Services, "While this type of test is not a definitive, it will give us good insight and guidance on how to proceed with the admission and will mitigate some level of risk to staff and other patients. If a patient has any signs or symptoms consistent with COVID-19 or a positive antibody, the individual is tested for COVID-19 using PCR/DNA testing on campus and isolated in a specifically designated quarantine room until a negative result is obtained from the external laboratory. Medical staff is provided with PPE as recommended by the CDC to ensure their safety. If a patient were to test positive for COVID-19 they would be referred to a hospital and would not be allowed back on our campus until it is confirmed that they were no longer contagious with COVID-19.
- All patients undergoing medical detoxification are monitored by nursing staff every two hours, including ongoing assessment of any symptoms that might indicate infection with COVID-19.
- HIPAA-compliant Zoom meetings have been implemented for patients living at home who are participating in Cornerstone’s Intensive Outpatient program. Clinical staff members working with these patients utilize Zoom and other technology in order to continue providing services without direct face-to-face contact.
- Within our residential programming, we have adjusted meal times for patients who are in the Medical Detoxification and Assessment and Orientation phase of treatment in order to minimize their contact with other patients. Essentially, these are patients who are newest to our campus and who may have been exposed to COVID-19 but present as asymptomatic.
- We have reorganized schedules and instructed staff to utilize larger group rooms or even to meet with groups of patients outdoors whenever possible in order to allow for greater social distancing.
- Larger groups of patients have been divided into smaller groups whenever feasible in order to allow for greater social distancing. The majority of our groups is less than 10 people and/or allow for at least a chair width between group members.
- We have even implemented telehealth within certain residential groups in order to divide groups into different rooms and reduce the number of patients in a given room. Our larger groups now utilize Zoom in various ways to provide lectures or other psychoeducational interventions.
- We have converted multiple Chromebook computers for Zoom use with our residential patients. These Chromebooks are used for Zoom meetings with certain employees who are deemed “high risk” due to age or underlying health concerns and who have special knowledge and skills which we deem essential to our patient population. For example, our psychiatrist and spiritual advisor are self-quarantined at home but are providing services to our residential patients via telehealth.
COVID-19 Precautions: The community
- No visitors or outside vendors are allowed on campus due to the COVID-19 pandemic, except for food and supply deliveries necessary for Cornerstone’s continued operations. In those cases, delivery representatives are met on the loading dock of the Caldwell Center, or in the event they are required to enter one of the buildings on campus, they are asked to wear masks and gloves. Any “drop off” of patient belongings is now conducted at an off-campus location. Any drug screens by outpatients are conducted at an off-site location.
- Patients are not taken off of campus for any reason other than a critical medical emergency.
- Numerous emails and pamphlets have been provided to staff and patients that detail information about COVID-19 and procedures to minimize the risk of contracting COVID-19, with a particular emphasis on social distancing and hand washing.
- Cornerstone’s Housekeeping Department has dramatically increased cleaning of all public areas and has changed its work priorities in order to ensure that public areas are cleaned multiple times per day. In addition, staff members have been provided with cleaning and disinfecting supplies in order to clean their work areas and have been encouraged to clean at least three times per day.
But Is It Enough?
No one can say, with any certainty, that the COVID-19 precautions being taken by Cornerstone of Recovery — and, by extension, every other business and individual in the United States — is “enough.” As of this writing, there are almost 7.7 million cases in the United States, and more than 215,000 Americans have lost their lives to COVID-19 .
However, addiction continues to claim roughly 130 lives a day due to overdoses alone . Alcohol is the third leading preventable cause of death in the United States, behind tobacco use and physical inactivity . The services that drug and alcohol treatment centers provide are medically necessary, and those who come to work daily at Cornerstone of Recovery are aware of the risks that their jobs pose.
“Certain aspects of treatment require intensive medical care, e.g. while a patient is undergoing detoxification,” Anderson says. “Other aspects of care require ongoing medical monitoring and medication management. Furthermore, many of our patients are not capable of maintaining abstinence in an outpatient setting during the early stages of their recovery, and these patients participate in our residential treatment program.
“We provide all housing, meals, medications, psychiatric care and substance abuse treatment facilities on our campus. Many of these services, activities and treatment procedures require face-to-face interaction with staff who are physically present. While it is possible to provide some substance abuse and mental health services through telehealth, this is not possible or practical within our residential programming where we have patients living in an intact community environment 24 hours per day, 7 days per week.
“Due to the critical nature of the problems being presented by these patients, the severity of their addictive disorders, the intensity of cravings and compulsions to return to alcohol/drug use, the presence of co-occurring psychiatric problems, and the challenges presented to provide for basic needs, it is imperative that we maintain sufficient staffing levels,” Anderson adds. “Without the skill, dedication and support of our essential staff, we would not be able to continue meeting the needs of our patients and would put their health and welfare at risk.”
In other words: Addiction doesn’t stop, and neither do we. That doesn’t mean we dismiss or even take lightly the concerns posed by the coronavirus, and regardless of various state and federal warnings and mandates, we will continue to take all necessary COVID-19 precautions until the tide turns in this pandemic.
Meanwhile, we’ll continue to do what we do best, because there’s a whole other pandemic that’s been raging for years, claiming lives and inflicting untold amounts of pain, misery and ruin — not just upon the individuals who suffer, but on their family members, their places of employment and the communities in which they live.
“Cornerstone provides intensive substance abuse and mental health services within a residential setting to individuals who are at high risk of severe medical complications or even death if their disease is left untreated,” Anderson says. “These services by their very nature require patients and staff to be in proximity to each other and make absolute adherence to social distancing virtually impossible. Cornerstone has gone to extraordinary lengths to ensure the safety of our staff and patients by isolating our therapeutic community to the greatest extent possible from the general population.
“Staff and patients are constantly reminded to practice social distancing and take other precautions in order to minimize risk to our community. Incoming patients are carefully screened for COVID-19 and are not allowed admission if there is any significant possibility that they are at risk. Numerous steps have been taken to encourage social distancing and allow patients to continue receiving care while protecting their safety and the safety of our staff.”