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COVID-19 FAQs for Hospice of Southern Maine These FAQs reflect agency policy and apply to all employees and volunteers.

Updated: 6/30/2020

EMPLOYEE RESOURCES Q: All of this is incredibly stressful, and I am afraid, where can I turn for help? (Updated 4/24) A: The following resources are available to you should you want someone to talk to during this unprecedented time (all calls are confidential):

• HSM’s Employee Assistance Program (EAP) 800-999-7222 • Optum’s (through United Healthcare) Emotional Support Help Line 866-342-6892 • Maine Crisis Hotline 888-568-1112 • Statewide Domestic Abuse Helpline 866-834-HELP (4357) • FrontLine WarmLine (new) for healthcare workers and first responders staffed voluntarily by licensed

psychiatrists, psychologists, therapists, social workers and other skilled professionals 207-221-8196 or 866-367-4440

Q: I’m worried I won’t be able to get my medications going forward, what should I do? A: Harvard Pilgrim said members are able to get a one-time early refill for maintenance medications. They also have a COVID-19 FAQ on their public website https://www.harvardpilgrim.org/public/frequently-asked-questions Q: What is the Coronavirus Aid, Relief and Economic Security Act (CARES Act)? (New 4/10) A. You’ve probably heard about the CARES Act, but you may not know about a provision within it related to your retirement benefit. The CARES Act provides expanded access to retirement plan accounts for distributions and loans during this unprecedented time. While taking a loan or withdrawing money from your retirement account early should be a last resort, we understand that sometimes unusual times call for unusual actions. While we encourage you to stay the course, remain invested and continue to save, we understand this is a challenging time. Before making decisions about taking money out of your retirement savings, please discuss your options with a tax professional. Q. Who does the CARES Act apply to? (New 4/10) A. Individuals who have been diagnosed with COVID-19 by a test approved by the Centers for Disease Control and Prevention; have a spouse or dependent who has been diagnosed; are experiencing adverse financial consequences due to being furloughed, quarantined or laid off; having their paid work hours reduced; being unable to work due to lack of childcare; or having to close or scale back a business due to coronavirus. Q. How can I get more details about the CARES Act? (New 4/10) A. For more details or if you have questions, visit empowermyretirement.com or call 1-833-301-9355 to speak to a representative who can provide guidance on your options. Q: I know people who have been laid off or furloughed even at essential businesses. What are HSM’s plans? (New 4/16) A: HSM has no intentions of laying off or furloughing employees, at this time. We are committed to paying our employees throughout this challenging time regardless of the situation. As you know, some employees are doing

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different jobs, or doing their jobs differently. We are grateful for their flexibility and patience. We are also grateful, that, at this time, we do not have any patients known to be COVID positive on our census. By adhering to Federal and State CDC guidance, and setting strict policy guidelines, HSM senior leadership is doing the best we can to safeguard employees and patients and reduce risk. We know this is difficult, and at times, distressing. Please know setting these new policies is distressing for us, too. All of these decisions are being made so that HSM can operate as normally as possible - safeguarding you, keeping you fully employed and paying you as we always have. Q: The census has begun decreasing in the Home Program and at Gosnell due to reduced referrals related to COVID-19. Will I need to use my EBT to be paid if I get called-off or sent home early for lack of work? (Updated 6/30) A: Not at this time. On April 24, HSM’s Board Executive Committee approved funding to pay employees who are called-off or are sent home early for lack of work due to low census related to the COVID-19 pandemic. Before being called-off or sent home early, your supervisor will work with you to be sure you have completed all of your Relias training, or if you are trained, that you and your supervisor determine whether you are able to help in other areas, such as the Tuck-in Program or assembling packets. Once all options for alternative work have been exhausted, HSM will call-off or send employees home with pay for the remainder of the shift. Pay will include any applicable shift differentials. Called-off hours paid will not be considered hours worked for overtime purposes. RNs and HAs at Gosnell will be called-off in the following order:

o Employees who have overtime o Employees next on the list to be called off (per diems will be added back to the list, temporarily)

This became effective April 26, 2020, and will continue through August 1, 2020, at which time it will be re-evaluated. If you have any questions, please contact Human Resources or your supervisor. Q: I am a per diem employee and was called-off for low census related to COVID-19, will I be paid for the shift? (New 4/24) A: Yes, you will during this temporary timeframe. Under normal circumstances you would not be paid for being called off, but HSM recognizes these are anything by normal circumstances. Q: I was called-off on a holiday, will I receive double-time pay? (New 5/18) A: No. Instead of employees using their EBT to be paid, HSM is paying employees who are called-off or who are sent home early for lack of work due to low census related to the COVID-19 pandemic (please see above). Employees would not be paid at the double-time rate if they used their EBT; therefore, the call-off pay will not be paid at the double-time rate. Q: How do I record my hours if I am called-off or sent home early for low census related to COVID-19? (New 4/24) A: If you work any part of the shift, you will punch in when you arrive and out when you leave. Your supervisor will update your timecard with any missing hours. If you are called off before your shift begins, your supervisor will update your timecard for the entire shift. Q: I am a nurse at Gosnell and was called-off with pay but was placed “on-call”, will I still receive the $50.00 on-call/call-back stipend? (New 4/24) A: Yes, you will still receive the $50.00 stipend for being on-call and remaining available to return to work if the need arises.

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Q: What if I reach the EBT cap due to a cancelled vacation or simply accruing EBT? (Updated 5/18) A: On March 18, 2020, HSM temporarily removed the EBT cap so that no one would “cap out” and lose EBT time. There are 3 options to avoid capping out, which are explained in greater detail below:

• Taking time off

• Cashing out

• Donating to the EBT Bank HSM is temporarily increasing the EBT Cap to 320 hours (pro-rated for part time employees – see chart below) through December 31, 2020. The regular EBT caps will resume effective January 1, 2021 (see chart below). If your EBT balance is above the regular cap on January 1 you will not lose those additional hours; however, you will not accrue EBT until your balance falls below the regular cap amount. Employees are highly encouraged to work with their supervisor to schedule time off. Employees will be offered the opportunity to elect a cash out of up to three weeks of EBT in January and July 2021. Elections for these cash out options must be made in August and December 2020, respectively. Employees also have the option to donate EBT to the shared EBT Bank at any time; you can find the form by clicking here.

Regular Weekly

Schedule

Regular

EBT Cap Amount

TEMPORARY

EBT Cap Amount

40 Hours 280 Hours 320 Hours

36 Hours 252 Hours 288 Hours

32 Hours 224 Hours 256 Hours

24 Hours 168 Hours 192 Hours

Q: Are we going to have any Town Hall Meetings? (Updated 6/1) A: Yes. In addition to the Town Hall Meetings held in April, meeting invites were recently sent for 2 employee Zoom meetings and 1 volunteer Zoom meeting. Employee Meetings (you can join either):

1. Tuesday, June 2 at 8:00a 2. Tuesday June 2 at 3:30p

Volunteer Meeting:

1. Thursday, June 4 at 2:30p Although you can ask questions during the meeting, it may be challenging with so many. If you would like, please feel free to email questions to me ahead of time dcady@hospiceofsouthernmaine.org Q: When this is over, can we somehow symbolize our journey together? (New 5/5) A: Yes. Much like recognizing a 3, 5, 10, or 15-year employment anniversary, we thought it would be symbolic to recognize the journey all of us have traveled together during this challenging time. I hope it doesn’t seem trite to any of you, because when we look back at this next year or in the years to come, what we have accomplished together, as a strong team, has been rather remarkable. Here is a photo of a pin and a quote written by Kyra:

A symbol of appreciation for bringing your whole self to this incredible journey—your integrity, resilience, humor, courage, and most of all, your heart.

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Because it may be some time before we are all back together again, we will be distributing the pins in your mailboxes or through postal mail. I have said so many times during this pandemic, if we have to go through this, there are no other people than you that I’d want to go through it with. I mean that about every single one of you. Thank you for bringing your incredible selves to this incredible journey. I am also including the song Good Job by Alicia Keys that I encourage all of you to listen to - it’s pretty amazing. I apologize for any ads that may pop up before or after. https://www.youtube.com/watch?v=N63tvQBwSSw Q: Where can I find prior communications regarding COVID-19? A: To help you easily find prior communications, and let you know if something has been replaced with newer guidance, we have revamped and categorized the previous emails into one FAQ. The link is still the same and can be accessed from anywhere. So, if you are off for a couple of days, and do not have access to a work computer, send this link to your personal phone or email, and check the link every couple of days to stay up-to date. https://www.hospiceofsouthernmaine.org/covid-19-updates-for-employees Q: Where can I find additional information about COVID-19? A: Please visit the following websites:

https://www.cdc.gov/ https://www.maine.gov/dhhs/mecdc/ https://www.who.int/ https://www.cdc.gov/coronavirus/2019-ncov/hcp/index.html https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus.shtml

Q: How can others find out about HSM’s Readiness? A: Please invite them to visit the COVID-19 banner at the top of our website.

EMPLOYEE & VOLUNTEER TRAVEL, SCREENING, REPORTING TO WORK, ALTERNATIVE WORK Q: Should I change any work travel plans? A: Effective March 12, we suspended all work-related international travel and suspended all work-related domestic travel to large gatherings, such as conferences and trade shows. Any requests for exceptions will need to be approved by the CEO.

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Q: The Governor issued an Executive Order on April 3 restricting travel into Maine and requiring those who do travel into Maine to self-quarantine. She then issued a new Executive Order on June 9 regarding travelers coming into Maine. How does this impact me? (Updated 6/25) A: On April 3, Governor Janet Mills issued additional orders to protect the health and safety of people living in Maine. The order required any person, resident or non-resident, traveling into Maine to immediately self-quarantine for 14 days or for the balance of 14 days dating from the day of arrival, except when travel was for purposes of an essential service. Beginning June 9, residents of New Hampshire and Vermont were allowed to travel into Maine without restrictions. Although the language was not clear, it seemed Mainers would be allowed to visit those states and return to Maine without restrictions. Further, Mainers traveling to other states would continue to be subject to the same restrictions as visitors coming to Maine from other states – a 14-day quarantine (in our case, before returning to work). Beginning June 26, if you travel outside of Maine, beyond New Hampshire or Vermont, the Executive Order states that you must obtain a COVID-19 test within 72 hours of entry into Maine or quarantine for 14 days upon arrival in Maine. Because HSM has established a relationship with Convenient MD, HSM has decided to vary from the Executive Order. If you travel outside of Maine, beyond New Hampshire or Vermont, you will be able to obtain a COVID-19 test within 24 hours of returning to Maine, thereby eliminating the need to quarantine for 14 days. You will need to provide a negative test to HSM prior to returning to work. Test results are usually available within 2 – 3 days. You will need to quarantine/work from home until test results indicate a negative result. At this time, HSM will cover the cost of one test for travel beyond New Hampshire or Vermont. HSM has established a relationship with Convenient MD with locations in Portland, Scarborough, Westbrook, Brunswick, and Bangor. All centers are open 7 days per week from 8am – 8pm. Prior to your travel, please coordinate with your manager, and upon return, please contact Stephanie Hutchins, Human Resources Director to obtain an authorization for the test. Q: I’ve been hearing conflicting information, when should I not report to work? (Updated 6/25) A: If you screen positive for ANY of the screening questions below, this includes those of you working remotely, follow the instructions below. These are the screening questions:

1. TRAVEL: In the past 14 days, have you been anywhere outside of the State of Maine except New Hampshire or Vermont?

2. TESTING: Have you or a member of your household been told that you or they have COVID-19, or are you/they currently being tested for COVID-19?

3. CONTACT: In the past 14 days, have you had close contact* outside of work with a person known to have COVID-19?

4. SYMPTOMS: In the past 14 days, have you had, or do you now have, a fever (a fever is 100.4 or greater) or symptoms of a lower respiratory illness such as cough and/or shortness of breath?

If you answer YES to question 1 (TRAVEL), contact Stephanie Hutchins, Human Resources Director (or Kathy Leddy, Volunteer Manager, if you are a volunteer) prior to your scheduled return to work to determine if there will be any restrictions about returning to work in your normal capacity. If you answer YES to questions 2 and/or 3 (TESTING and/or CONTACT), contact Stephanie Hutchins, Human Resources Director (or Kathy Leddy, Volunteer Manager, if you are a volunteer) for further instruction which may include a period of quarantine away from work and/or reporting of daily self-screening results.

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If you answer YES to question 4 (SYMPTOMS), regardless of your answers to questions 1, 2, and 3, contact your healthcare provider, follow the normal call-out process, and contact Stephanie Hutchins, Human Resources Director (or Kathy Leddy, Volunteer Manager, if you are a volunteer) for next steps. All employees and volunteers are asked to take their temperature prior to reporting to work each day. Beginning 5/21/2020, Gosnell employees will take their temperatures at the Employee Check-In Station upon entry to the building and prior to starting their shift. GMHH employees will also complete the HSM Employee Check-In Log before starting each shift. This does not take the place of employee self-screens prior to coming to work. Gosnell volunteers are screened through the Gosnell visitor protocols.

• GMHH Temperature Self-Check: If your temperature reads 100.4 F or greater, leave the building immediately, contact your healthcare provider, follow the normal call-out process, and contact Stephanie Hutchins, Human Resources Director for next steps.

*Close contact is defined by CDC as:

a) Being within approximately 6 feet (2 meters) of a COVID-19 case for > 15 minutes; close contact can occur while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case.

– or – b) Having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on).

With the exception of question 1, which is a violation of the Governor’s executive order, employees will be paid for scheduled shifts missed during any COVID-19 related quarantine period, with proper documentation from a qualified healthcare provider. On Monday morning, March 16, Mary and Kyra screened employees and volunteers at 180 US Rte. 1 who reported to work. At Gosnell, Keirsten screened employees and volunteers. At 136, Kathy screened employees and volunteers. We did this on that Monday only; each day thereafter, employees are responsible for a self-screening before reporting to work. Q: Will I know if HSM has a COVID-19 positive employee (or onsite volunteer)? (Updated 4/3) A: Just as with patients, safeguarding employee’s health information is taken very seriously. If an HSM employee tests positive for COVID-19, we will contact the CDC and the CDC will conduct an investigation with the employee. If you had close contact with the employee, you will be notified. We will work with the CDC to manage the process to the extent possible. Q: What does it mean to be quarantined in my home? (Updated 4/10) A: You are required to remain at your home (or other agreed upon place) for 14 days after your last potential exposure to COVID-19, or arrival in Maine per the Governor’s executive order, unless otherwise directed by the CDC or local health officials. During this time, you cannot go to work, school, the gym, grocery store, shopping or participate in any other activity where you will be sitting or standing less than 6 feet away from other people until the quarantine period is over. Do not have visitors to your home. Q: If I’m being told to self-quarantine, is the quarantine mandatory? A: Yes, the quarantine is mandatory and enforceable by the CDC and the State of Maine.

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Q: When can an employee (or volunteer) return to work after being out with an incident related to COVID-19, including a 14-day quarantine imposed by a physician? A: Based on the CDC guidance, if an employee is confirmed or suspected to have had COVID symptoms there are two return to work guidance options:

1. The first one is two negative tests (given the shortage of tests, that is likely not going to be an option) 2. The second option is:

• At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,

• At least 7 days have passed since symptoms first appeared If the employee was never tested for COVID-19 but had an alternate diagnosis (e.g., tested positive for influenza), criteria for return to work should be based on that diagnosis. Q: Will I know if an HSM patient tests positive for COVID-19? (Updated 4/7) A: If we are informed that a patient tests positive for COVID-19, we will contact the CDC and suspend visits until we receive further guidance. If you were determined to have had close contact with the patient, you will be notified. We will work with the CDC to manage the process to the extent possible. When HSM becomes aware of positive cases in facilities, we call the facility to determine if it is one of our patients, when symptoms started, where the patient is within the facility, which of our employees visited the facility and when. Q: We will begin practicing social distancing. What does that mean? A:

o We will be assessing who can work from home and many will begin to do so. Please coordinate with your Manager for further details.

o Clinicians do not need to report to the office. If they need medical supplies, contact the Team Assistants who will gather the needed supplies and bring them outside to your car. Call your Manager for other needs.

o Starting Wednesday, Home Program IDT will be done remotely. The details are not final, but it will begin at 8a, and most employees should plan to call in from home.

o We will be modifying or cancelling all in-person in-services o We will be limiting the number of individuals in conferences room at one time. The large conference room

maximum will be 8 and the small conference room will be 2. Please adjust any meetings you may have scheduled.

o The St. Patrick’s Day A Better Us event scheduled for tomorrow has been cancelled. Q: Our Thresholds Conference is in May. What are we going to do? A: At this time, we have decided to postpone this year’s Thresholds Conference until Spring 2021 and are communicating this to all registrants. Please see our website or Facebook page for more information. Q: I keep hearing the term essential and non-essential on the news. What does that mean for me? A: As an employee of a healthcare agency during this crisis, you are an essential employee. On a snow day, we often have some employees leave for the day, as being out for an afternoon doesn’t impact HSM or patients and families long-term. This is different. We are expected to operate as normally as possible, to the best of our ability. Many of you have been asked to work from home to minimize the risk of spread but working from home is not an option for everyone and not an individual decision. Further, those at home are still doing their jobs. For those in direct care roles, we have

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patients and families who need us to provide care, again, to the best of our ability. If we are unable to access them due to a facility’s request or other restriction, we need to be creative. And, if we can visit or see them, we will. Q: Will everyone be able to work from home? (Updated 3/20) A: Decisions regarding working from home are not an individual decision. Managers are assessing each situation to determine who is able to work from home based on job responsibilities. The goal is to make sure we are consistent in the way we deliver care and service across the agency. Q: I heard the NPs are working from home and they are essential. Why aren’t they in the office? A: Everyone is important at HSM. As you know, we have a very limited pool of NPs that we need to strategically preserve given their significant role with prescribing and offering clinical guidance and oversight to Home Program and Gosnell employees and patients. To be sure they remain available to meet your needs and those of HSM, we have asked them to work remotely during this unprecedented time. Q: Gosnell Social Services employees are essential. Why are they working from home? A: As has been indicated in previous email updates, an important aspect of our COVID-19 response is to assess the feasibility of work from home options for various roles across the agency to promote required physical distancing, allocate resources effectively, and preserve our ability to do our work without interruption during these very challenging times. As a reminder, these decisions are made carefully by leadership based on agency need—they are not individual decisions. In our ongoing assessment of functions throughout the agency, we have decided that the Gosnell Social Services Team will begin working remotely as of Friday, April 3, 2020 and until further notice. As a reminder, many HSM employees continue to work in their usual settings even if that work looks a little different. The senior team, clinical managers, team assistants, access, and triage folks are still at 180 with some remote rotations. The front desk at 180 is still staffed. The home program nurses, aides, social workers, and chaplains, while limiting in-person visits, continue to provide direct patient care every day in homes and facilities. Our community needs hospice now more than ever. Thank you for all you do, and for being present. Q: I haven’t seen Daryl or the rest of the senior team lately. Where are they? A: There are 6 members of the senior team working countless hours to manage this crisis. We have made the decision to separate ourselves – some at home, some at the office – so we can manage risk and continue to manage the crisis. Some are separating themselves from their families to try and avoid it. Some go only to their office and directly home every day avoiding everything and everyone else. We have each created a succession plan, so that if inevitably one of us contracts COVID-19, the team can continue to operate without the other(s). So, if you don’t see any of us for a while, it isn’t because we don’t care – it’s because we do! Q: What are HSM’s work from home meeting rules and etiquette? (New 4/21) A: Working from home may be new for many of you. Here are some simple do’s and don’ts. If you have any questions, please ask your supervisor. Here is a very funny conference call parody that I think you will enjoy: https://www.youtube.com/watch?v=DYu_bGbZiiQ

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DO DON’T Take phone and video calls in a quiet area where you can be alone (sounds dreamy). Prepare yourself and your environment before taking a videocall—your professional appearance still matters, and we are happy to see you. Mute yourself if there are things in your environment that could be distracting to your peers, like barking dogs or garbage trucks. If you need anything from your HSM workspace to make your home workspace efficient and comfortable, let your supervisor know right away!

Have your children on or about you while on a videocall with your peers or patients (they are super cute though). Allow others to hear either end of your work conversation, including:

• Patient information of any kind

• Business-related discussions Allow others to view what’s on the screen of your laptop, iPhone, or tablet, including:

• Patient information of any kind

• Business-related documents or emails

Q: I am working from home and my home office space is different than I am used to. Who should I call if I need ergonomic assistance? (New 4/16) A: Many employees are working hard at home. We want to be sure you are working safely and have what you need to do so. Here are some things to think about when assessing your space:

• Are your feet on the ground or fully supported? (If not, try a footrest)

• Are your arms comfortably at your side and elbows bent to 90 degrees when using your keyboard and/or mouse? (If not, try bringing your keyboard closer and adjusting your chair height)

• Does your chair support your body?

• Are your wrists and hands in line with your forearms? (Keep your mouse and keyboard at the same level and be sure they are not too far causing you to overreach/overextend to use them)

• Is your head in a neutral position looking straight ahead? (If not, try raising or lowering your screen) Please let your manager know if you need anything from your office workstation to help you be more ergonomic and/or more comfortable in your home office workspace. Q: As was communicated in the recent Town Hall meetings, our new building will be ready in mid-July. Many employees will remain at home at least until then, and many will work from home even after it is open. What will HSM do to assist employees at home? (Updated 6/9) A: Some who previously worked at 136, 180 or Gosnell and who have been working remotely may continue to work from home until it is safe to return to the office full-time. To ensure you have the home office set-up you need to be safe and comfortable, we are offering to reimburse those currently working remotely up to $500 for a desk and chair. We ask that before purchasing a new chair, you first take your chair from the office, if possible. We will have extra chairs in the large conference room at 180 on a first-come-first-serve basis. Reimbursements for new desks and chairs will be retroactive to March 16, 2020. The IT department will also be sending out a communication to ask if you are all set from a technology stand point, and to ask what your technology needs will be for the new building.

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Q: The Governor has issued multiple Executive Orders and Keep Maine Healthy directives aimed at physical/social distancing and working remotely. How do these impact me? (Updated 6/11) A: On March 31, Governor Janet Mills issued a series of substantial new mandates to protect public health and safety in the face of COVID-19, including a Stay Healthy at Home directive that required people living in Maine to stay at home at all times unless for an essential job or an essential personal reason, such as obtaining food, medicine, health care, or other necessary purposes. As an essential healthcare worker, the order did not apply to you traveling to work. Being at work does come with physical distancing restrictions. This isn’t a choice, but a mandate under the recent Executive Order. Physical distancing is defined as staying 6 feet from another individual. Now, clearly those providing direct care or working closely with another provider are unable to do this, which is one reason we have instituted the Universal Masking Protocol. You should also be practicing good hand hygiene especially when touching shared surfaces in different work spaces such as the med room, cabinets, drawers, desks, keyboards, and telephones. Other than those times, however, physical distancing must be observed. Page 3 after #7 When out of the home or when at work at an essential business, all individuals shall maintain a minimum distance of six feet from other persons. https://www.maine.gov/governor/mills/sites/maine.gov.governor.mills/files/inline-files/CORRECTED_An%20Order%20Regarding%20Further%20Restrictions%20on%20Public%20Contact%20and%20Movement%2C%20Schools%2C%20Vehicle%20Travel%20and%20Retail%20Business%20Operations.pdf On April 28, Governor Mills issued a new four stage Stay Safer at Home Executive Order through May 31. The Order continued to have Maine people stay at home with limited exceptions for already permitted activities, such as grocery shopping or exercising. The new Executive Order continued the prohibition on gatherings of 10 or more people and the 14-day quarantine period of all people entering or returning to Maine. It also newly required that Maine people wear cloth face coverings in public settings where physical distancing measures are difficult to maintain. Most significant for HSM, was that Stage 1 called for people who are able to work from home to continue to do so. With that, for those who are able to work from home, we will continue to maintain their work from home status for the foreseeable future. On a more positive note, Stage 1 allowed Maine people to now visit businesses or participate in activities that are deemed safe to open. Please click the link to learn more. https://www.maine.gov/governor/mills/news/governor-mills-presents-safe-gradual-plan-restart-maines-economy-2020-04-28 The state will move through the four stages based on: 1) a downward trajectory of influenza-like illnesses and COVID-like syndromic cases; 2) a downward trajectory of documented cases and newly hospitalized patients; and 3) the capacity of Maine’s hospital systems to treat all patients without crisis care and the ability of the state to engage in a robust testing program. On May 29, Governor Mills issued a Restarting Plan Executive Order, with phased-in actions, including the following:

• Effective June 1, the restriction on gatherings increased from 10 to 50 people.

• Until further notice, employers should continue to have employees work remotely, if able.

• People may access the increased business and personal activities that are being reopened. As senior leadership learns more about progressing through the stages, we will keep you updated. Safeguarding employees, patient, and families is our top priority.

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Q: With the new Stay Healthy at Home mandate, I’m worried I may be stopped by law enforcement on my way to work. What should I do if that happens? A: If that were to occur, showing them your Hospice of Southern Maine work badge will indicate that you are an essential employee traveling to and from an essential employer. Q: When might employees and volunteers be able to return? (New 4/21) A: The Federal government's plan/guidance for re-opening the country will likely happen in 3 Phases, and states will progress from one to two to three depending on the number of COVID-19 cases. In Maine, if we follow these guidelines, we would move to Phase 1 of reopening after the state has had a downward trajectory of cases for 14 days (there are various measures), hospitals could treat all patients without crisis care, and there is a robust testing program in place for at-risk healthcare workers, including emerging antibody testing. The Stay Healthy at Home executive order remains in effect through April 30. Maine is still seeing an increase in cases, and there is not yet a robust testing program. Governor Mills is working with the Governors of NH and VT, and it is possible the executive order could be extended. We will continue to keep you updated as new information becomes available. Safeguarding employees, patient, and families is our top priority. Below are some details of the plan:

• Phase 1 reopening would look very different from what life looked like just a couple of months ago. o ALL VULNERABLE INDIVIDUALS should continue to shelter in place. Members of households with

vulnerable residents should be aware that by returning to work or other environments where distancing is not practical, they could carry the virus back home. Precautions should be taken to isolate from vulnerable residents.

o All individuals, WHEN IN PUBLIC (e.g., parks, outdoor recreation areas, shopping areas), should maximize physical distance from others. Social settings of more than 10 people, where appropriate distancing may not be practical, should be avoided unless precautionary measures are observed.

o Avoid SOCIALIZING in groups of more than 10 people in circumstances that do not readily allow for appropriate physical distancing (e.g., receptions, trade shows)

o MINIMIZE NON-ESSENTIAL TRAVEL and adhere to CDC guidelines regarding isolation following travel. o Continue to ENCOURAGE TELEWORK, whenever possible and feasible with business operations. o If possible, RETURN TO WORK IN PHASES. o Close COMMON AREAS where personnel are likely to congregate and interact or enforce strict social

distancing protocols. o Strongly consider SPECIAL ACCOMMODATIONS for personnel who are members of a VULNERABLE

POPULATION. o SCHOOLS AND ORGANIZED YOUTH ACTIVITIES (e.g., daycare, camp) that are currently closed should

remain closed. o VISITS TO SENIOR LIVING FACILITIES AND HOSPITALS should be prohibited. Those who do interact with

residents and patients must adhere to strict protocols regarding hygiene. o LARGE VENUES (e.g., sit-down dining, movie theaters, sporting venues, places of worship) can operate

under strict physical distancing protocols. o ELECTIVE SURGERIES can resume, as clinically appropriate, on an outpatient basis at facilities that

adhere to CMS guidelines. o GYMS can open if they adhere to strict physical distancing and sanitation protocols. o BARS should remain closed.

• We would only move to Phase 2 if cases didn't jump up again. o During Phase 2, there are fewer restrictions, with groups of 50 allowed, with proper social distancing. o Non-essential travel would be allowed at this point for travelers living in states that meet this criteria.

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• Phase 3 takes us back closer to "normal," but keeps some social distancing in place, particularly for vulnerable individuals.

Q: Our new building has workstations versus offices for employees. Will we be able to practice physical distancing? (New 4/27) A: The workstations that have been selected are quite large and provide a lot of space between each person. They also have a glass divider between each workstation. However, they are open concept. We are working with our furniture company to determine whether we need to increase the height of the glass partitions and reconfigure some of the areas. Please stay tuned as more information about our new office space becomes available.

Q: Will employees and volunteers be returning to the office anytime soon? (New 5/14) A: The Governor’s Executive Order continues to recommend that, currently through June, employees work remotely whenever possible. Since this is possible for HSM, and with so many of you already established at home, and the new home hospice center building expected to be complete in July, we will not ask that anyone return to either 136 or 180 where physical distancing would be very difficult. The only time there will be a need to return, is to collect personal items or to pick up or drop off work related items. There is no rush to do this, and when you are ready, please arrange times to do either with your supervisor, so we can be sure to maintain physical distancing for all those involved. So…the new building. We are about 60 days away from substantial completion. Amazing! I wish I could say we will all move in there together and it will be just like we imagined, but that isn’t the case. Companies are dealing with COVID in a variety of ways. Some are permanently reducing their workforce. We are NOT doing that. Some are keeping employees home permanently, some are keeping employees home temporarily, but no one is bringing everyone back right away. It is unlikely everyone will come back permanently for quite a while. What are we doing? Within the next few weeks, we will hold virtual Town Halls to show you the inside of the building as it was designed. At that time, we can talk more fully about our new approach, but below are some details. Technology and Zoom will become our best friends while we work on a phased-in approach, with flexible rotating schedules. Again, as we get closer to the end of June, your supervisors will work with you to establish a schedule that meets everyone’s needs. We will make some modifications to the new building furniture plan. For example, the majority of the workstations had a 12” high clear glass divider between each person (each person is already 6’ from the person across from them). We increased that to 24” high. In addition, your monitors will be a barrier between you and the person across from you. In the clinical touch down space, there were privacy dividers in front of the workstations, there will now be moveable dividers between. We are installing plexiglass in the receptionist area, establishing capacity limits on conference rooms, installing hand sanitizer at all entrances and high use areas, marking the floor where necessary to maintain physical distancing, establishing masking protocols, among other protocols and modifications. We still have time to figure all of this out, but I wanted you to know we are working on it, and have your health, well-being and safety top of mind. And, even though not everyone will come back right away, we will provide tours to smaller groups (in line with the Executive Order) so you can see our beautiful new space. And finally, our ribbon cutting will have to wait, as well. The Executive Order does not allow more than 50 people to gather. But when we are able to celebrate, I hope to see every one of you there. Celebrating our new building, our resiliency and teamwork, and our amazing commitment to one another during these last few months.

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Q: What will happen if the public schools close? (Updated 3/15) A: One of the more significant developments has been the closing of many schools and daycares in Maine. Stephanie Hutchins is reaching out to managers who will be contacting many of you with respect to this situation. We want you to know that we will support you with flexible schedules, shift swapping, etc., as much as we can during this unprecedented time. Q: Might I be asked to do alternative work? A: Yes. Some of you may be asked to work in a different capacity, and we ask that you remain available to assist in other roles, as necessary. Rest assured your compensation will not be negatively affected.

PATIENT & VISITOR SCREENING & PROTOCOLS

GOSNELL HOUSE Q: Are we screening Gosnell patients? (Updated 6/11) A. Yes. We began screening patients according to CDC guidance and consistent with other healthcare providers in our community at time of referral and prior to home visits, and, beginning 3/20 daily at Gosnell. Protocols based on CDC guidelines to isolate, assess and inform will be distributed. (Screening protocols were implemented 3/10.) Our patient screening questions and protocols were updated on 6/11:

1. TESTING: Do you or a member of your household currently have or are you/they being tested for COVID-19? 2. TRAVEL: In the past 14 days, have you or a member of your household been anywhere outside of the State of

Maine except New Hampshire or Vermont? 3. CONTACT: In the past 14 days, have you or a member of your household had close contact with a person

known to have COVID-19? 4. SYMPTOMS: In the past 14 days, have you had a fever or symptoms of a lower respiratory illness such as

cough or shortness of breath?

Q: What is HSM doing about Respite Care? (Updated 6/9) A: At the advice of Dr. Moreno, we initially suspended respite care at Gosnell for 30 days and continued to evaluate periodically. After careful consideration of the risks and benefits in the current climate, and with support from Dr. Moreno, we have decided to re-instate limited respite care at Gosnell for new or emergent needs only. Please do not schedule pre-planned respite for caregiver vacations or other events, until further notice. If you have any questions, please contact a clinical manager. Q: Are we locking the doors at Gosnell and screening visitors? Has HSM updated its visitor policy at Gosnell? (Updated 6/25) A: Yes. We must follow guidelines and protect our employees, patients, and other visitors so while these precautions might cause stress or sadness, they are necessary. Beginning 3/14, the Gosnell visitor entry was locked and will remain locked 24/7 until further notice. Beginning the week of June 8, our contracted security firm, First Protection, will provide Gosnell with an unarmed security officer 7 days a week from 8am to 8pm to monitor the exterior grounds only. They will help enforce our window

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visitation policies and will ensure that people are not inappropriately congregating on Gosnell property. Our goals are to protect patient privacy, maintain Gosnell as a safe and peaceful place for patients and their approved visitors, and reduce the burden on employees so that they can focus on building therapeutic relationships so important at end of life. We continue to recognize the importance of loved ones being by patients’ sides at end of life. Effective 6/25, our visitor policy is as follows:

• Each patient may have 2 visitors at a time with a maximum of 4 visitors total (same 4 visitors) within each 24-hour period (8am-8am).

• Each visitor and vendor (except clergy, funeral home and authorized medical personnel) must be screened once daily—this includes Screening Questions and Temp Check.

o Funeral home and authorized medical personnel must wear appropriate PPE (minimum of mask and gloves) upon entry but are not subject to Screening Questions or Temp Check.

o Authorized clergy must wear mask and complete Temp Check upon entry but are not subject to Screening Questions.

• The screener will ask the following questions via the intercom while the visitor is in the vestibule (this applies to 180 visitors as well):

1. TESTING: Have you or a member of your household been told that you or they have COVID-19, or are you/they currently being tested for COVID-19?

2. TRAVEL: In the past 14 days, have you been anywhere outside of the State of Maine except New Hampshire or Vermont?

3. CONTACT: In the past 14 days, have you had close contact with a person known to have COVID-19? 4. SYMPTOMS: In the past 14 days, have you had, or do you currently have a fever or symptoms of a lower

respiratory illness such as cough or shortness of breath?

• Entry will be denied, at least conditionally, if the visitor answers yes to any of the screening questions above. o Those who have been outside of the states of Maine, New Hampshire, or Vermont in the previous 14

days will be restricted from visitation unless or until the individual provides HSM with proof of a negative result from a COVID-19 test performed within 72 hours of entry to Maine or at any time during their 14-day quarantine period. Upon receipt of proof of the negative test result, they will be permitted entry to Gosnell provided they are able to answer No to all other screening questions. Please note, daily screenings will continue for each visitation day and entry will be denied for any new Yes responses.

o The restriction based on SYMPTOMS only applies to people with fever and/or new onset cough indicative of respiratory infection. If needed, the screener will ask a member of the nursing staff to speak to the visitor (we do not want to deny entry to people with asthma or experiencing COPD flare ups not related to respiratory infection, for example).

• As a condition of permission to visit, each allowed visitor must have their temperature taken at the Temp Check Station upon first entry to Gosnell, and once per day thereafter.

o Anyone with a current temperature reading of 100.4 or greater will not be allowed entry to Gosnell o Anyone who had a temperature reading of 100.4 or greater in the previous 14 days will not be

permitted entry to Gosnell

• Screening answers and temp check will be documented by the screener in the log book which will be kept secure behind the front desk.

• Note that these screening questions are for visitors only. They do NOT apply to patients.

• The screener will ensure that the maximum of 2 visitors per room is maintained at all times. o Screener will coordinate with HSM Door Greeter, RN, or other member of the HSM team to ensure that

current visitor(s) leaves the building prior to allowing entry of additional visitor(s). o New visitors may wait in the vestibule until current visitors leave, however, groups of more than two

individuals may not congregate in the vestibule due to physical distancing requirements.

• Visitors will be advised upon entry of our visitor policy, and a copy of a policy summary will be available in each patient room:

o Maximum of 2 visitors at a time and no more than 4 visitors total per 24-hour period (8am to 8am)

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▪ There is no limit on the number of times each approved visitor may leave or enter the building. ▪ Visitors must coordinate with each other to uphold the 2 at a time maximum at all times. ▪ Visitors must agree to remain in the patient room while inside the building; no gathering in

hallways or common spaces currently closed to the public as indicated by signage. ▪ Each visitor must be observed washing their hands at the kitchen sink upon entry to Gosnell. ▪ Visitors must remain 6 feet from employees at all times, even while wearing a mask. ▪ Visitors are asked to wear their own facemask or face covering while in the building

− If a visitor does not have their own, HSM will provide the visitor with one washable, reusable cloth face covering (standardized facemasks may be reserved for employees and volunteers).

− Please note that wearing a face mask or face covering is not a replacement for physical distancing.

▪ HSM may authorize outdoor, closed-window visits for a maximum of 2 individuals at a time per patient window. See below for more details.

▪ All individuals on Gosnell property must abide by physical distancing rules as outlined in Governor Mills’ Executive Order, including but not limited to masking while in public spaces and maintaining at least 6 feet between people who do not share a household.

o Authorized Closed-Window Visits ▪ A maximum of 2 individuals per patient room may be present for window visits at the same time ▪ Window visitors do not count towards the 4 per day limit on in-person visitors ▪ “Window visitors” must go from their vehicle (or the vestibule) directly to the window and directly

back to their vehicle once the visit is over. They may not otherwise linger or gather anywhere on Gosnell grounds or in the building.

▪ Window visitors may initiate phone calls or video calls with patients or indoor visitors. Visitors must use their own devices for their end of the call; HSM employees may assist patients to receive these calls, to the extent possible.

• For visitors who answer YES to screening questions about SYMPTOMS or CONTACT: o Authorized closed-window visits only will be allowed for these restricted individuals. o These restricted individuals may not come into contact with approved visitor(s), HSM employees, or any

other individuals at any time while on Gosnell property.

• For visitors who answer YES to the screening question about TRAVEL: o Due to the State of Maine Executive Order on travel quarantines, window visits are not allowed, and the

individual may not remain on Gosnell property. o Once the individual has either satisfied the 14-day quarantine period or provided HSM with proof of a

negative result from a covid-19 test performed within 72 hours of arriving in Maine, they may be permitted entry to Gosnell provided they are able to answer No to all other screening questions.

• We have also restricted movement of ALL visitors within the house itself: o Visitors are to remain in the patient room except when entering or leaving the building o Visitors are not to gather in the hallways or other public areas o The kitchen, Sanctuary, and Family Room have been closed to visitor use o Visitors are being instructed to use the call bell for all needs o Visitors are not to use the public restrooms (they may use the bathroom in the patient room) o The Living Room will remain open for a maximum of two visitors to wait during the post-mortem period

• Post Mortem Allowances o During the post-mortem period of time, if a visitor is by themselves, they may have one additional visitor

wait with them in the patient room or in the Living Room, provided that visitor has been screened. o If requested by the patient’s primary caregiver and approved by the supervisor on duty, additional

visitors may be permitted a brief amount of time with the body outdoors, prior to transport by the funeral home.

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Q: I noticed Crow’s Nest employees still entering Gosnell and 180, is that okay? A: Yes. We have limited it to 2 individuals – Nate and Sean. Screening applies to them just as it does all others.

HOME PROGRAM

Q: Are we screening home program patients and everyone in the home during a visit? (Updated 6/11) A. Yes. We began screening patients according to CDC guidance and consistent with other healthcare providers in our community. Protocols based on CDC guidelines to isolate, assess and inform were implemented on 3/10. Our patient screening questions and protocols were updated on 6/11:

1. TESTING: Do you or a member of your household currently have or are you/they being tested for COVID-19? 2. TRAVEL: In the past 14 days, have you or a member of your household been anywhere outside of the State of

Maine except New Hampshire or Vermont? 3. CONTACT: In the past 14 days, have you or a member of your household had close contact with a person known

to have COVID-19? 4. SYMPTOMS: In the past 14 days, have you had a fever or symptoms of a lower respiratory illness such as cough

or shortness of breath?

180 & 136 US ROUTE 1

Q: Are we locking the doors at 180 and 136 and screening visitors? (Updated 6/11) A: Yes. Beginning 3/15, in addition to locked doors and screening at Gosnell, we began screening visitors at 180 and 136. We received notification that the building of our 136 location has closed, so there will already be limited access there. Effective 3/24, we made the decision to lock the outside doors at 180. We will accept deliveries to the vestibule. Other visitors will be permitted access to the building only after being screened with the same screening questions used for Gosnell visitors and updated on 6/11. Entry will be denied if the visitor answers yes to any of the screening questions. Answers will be documented in the log book which will be kept secure behind the front desk. A wireless doorbell is being installed to help the process. The door between clinical and admin will remain unlocked. Q: I noticed Crow’s Nest employees still entering Gosnell and 180, is that okay? A: Yes. We have limited it to 2 individuals – Nate and Sean. Screening applies to them just as it does all others.

REFERRALS & ADMISSIONS Q: Are we taking regular admissions during this pandemic? A: Yes. As you know, hospitals must make beds available for a potential influx of COVID-19 patients. I have reached out to the CEOs of all the major hospitals letting them know we are here and ready to serve them and hospice patients. They responded with gratitude for our willingness to support them during this challenging time. Q: Will we be admitting patients who have tested positive for COVID-19? (Updated 5/27) A: No. At this time, we will not be admitting patients who have tested positive for COVID-19. But please remember it is our responsibility, as a healthcare provider, to care for all patients. We have had examples of clinicians refusing to enter rooms and some are wondering whether they should be seeing patients. Specific questions of this nature should be directed to a Manager. Decisions and next steps will start there.

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As of 6/1, all patients admitted to Gosnell from a hospital or facility must test negative (not just screen negative) for COVID-19 prior to admission, following the guidelines below:

• New admissions who have had a hospital stay in previous 14 days: o This applies to patients who were admitted to any unit regardless of that unit’s COVID-19 status, and/or

who spent their entire hospital stay in the Emergency Department or urgent care unit o If the patient had multiple COVID-19 tests, the last one must be negative

• New admissions or current Home Program patients coming from a facility: o This applies to patients coming from any congregate living setting, including nursing homes, assisted

living facilities, memory care units, rehabilitation centers, group homes, etc. o The patient must have had a negative COVID-19 test (not just a screen) within 48 hours of admission to

Gosnell, and o if the patient had multiple COVID-19 tests, the last one must be negative

Q: Will we be admitting patients who have screened positive for COVID-19? A: No. Unless a patient has been tested and confirmed negative, they will not be admitted to HSM

HOME PROGRAM VISITS Q: Will we continue to make visits to patients in their homes and facilities? (Updated 4/7) A: Yes. We are mandated as a healthcare provider during this pandemic to continue to provide essential hospice services, while eliminating all non-essential contact with patients and their families. However, in-person visits are to be limited as follows beginning 3/16, and care plans adjusted accordingly:

• Essential Visits: Where there is a critical need that could not be met via phone, and/or where that critical need is not being otherwise met (i.e., by facility staff)

o Some examples include: Wound care, critical skin care, drains, Foley placement, CADD pumps, EOL or symptom crisis not able to be managed by phone, new caregiver education to promote independence in coming days

o Beginning 3/30, all in-person visits need to be approved by a manager.

• Hospice Aide Supervision: At least one RN visit every 14 days for aide supervision—this does not mean, in this time of emergency, that it has to be an in-person visit; it is a starting place for adjusting visit frequencies

• All Disciplines: may substitute in-person visits with expanded phone calls, this includes Face-to-Face Visits by Nurse Practitioners.

• Patient/Family/Facility Canceled Visits: If possible, attempt to conduct by via phone. Q: Can volunteers continue to see Home Program patients? A: No. In accordance with CMS and CDC guidance, for at least the next 30 days we are suspending hospice volunteer activity in the home program. This is effective immediately (3/15). Q: Are we limiting the number of people in the room for home program visits? A: Yes. Just like we limit the number of visitors at Gosnell, we will limit the number who can be present during a home visit. Clinical Managers are working on the details.

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Q: Will we continue to care for a home program patient if, after coming on service, they have a pending COVID-19 test or test positive? A: Yes, if there is an urgent visit need, and if the appropriate personal protective equipment (PPE) is available to our employees, and if the CDC allows. RNs may conduct essential visits only if they have been fit tested for N95 masks and have the appropriate PPE including N95 mask, gown, and gloves (eye shield is preferred but not required unless performing a procedure that results in increased secretions or exposure to secretions). Home Health Aides, Chaplains, and Social Workers are not allowed to visit these patients because they have not been fit tested for N95 masks. Q: I heard some facilities are locking their door, what are we doing about our patients in those facilities? A: Per CDC guidance hospice personnel are considered essential medical personnel, and many facilities have indicated they still want and need hospice care for patients and families. We have also received requests from some facilities to limit certain staff visitations. We are working with facilities to meet their needs. We sent a communication to all nursing homes, assisted living facilities, and group homes to let them know we are here for them and, if they have any needs, they can always reach us. Q: If we have patients in facilities where positive COVID-19 cases have been reported, will we continue to care for them? A: Beginning 3/20, if our patient screens negative, we will continue to provide care. If our patient screens positive for COVID-19, we will suspend visits until the patients receives a negative test. At that time, we will resume visits, based on facility protocols. If there is an urgent visit need while awaiting test results, and if the appropriate personal protective equipment is available to our employees, and if facility and CDC allow, we will conduct RN visits only. Q: I keep hearing about Ocean View on the news. What are we doing about our patients and employees? A: Beginning 3/24, in order to protect our home team, and due to the continuing CDC imposed shelter in place order at Ocean View and the growing community spread, we must make the difficult decision to forgo new admissions and in person visits to existing patients except for extenuating circumstances. I understand Ocean View is a large complex and it is difficult to know whether our patients are in the affected areas or not, and that is precisely why we are making this decision. If there is community spread in other facilities, it is highly likely the CDC’s actions would be the same - shelter in place. We will assess each scenario and update our policy accordingly. Q: We are forgoing home visits to some existing patients, except for extenuating circumstances. What are we doing instead to support our patients? A: We’re conducting in-depth phone assessments and caregiver education for symptom management and care planning. We’re making more frequent check-in calls to patients. We’re spending more time coordinating by phone with the inter-disciplinary teams at facilities, providing hospice consultation and identifying critical needs as they arise. We’re making more frequent calls to caregivers who cannot visit their loved ones, attempting to close the gaps created by social distancing, travel restrictions, and facility visitation policies. We’re expanding our inbound Triage Nurse phone team to ensure we can manage any potential increase in inbound calls. We continue to conduct one-on-one bereavement sessions, virtually. We’re doing all of this through agency cell phones, Zoom, and in the case of Bereavement, FaceTime. We’re also planning to use Zoom to conduct Bereavement groups, in the near future. We continue to make deliveries of medical supplies as usual. We have been offering quantity overrides and delivery for medication refills, thereby reducing the number of times the family has to pick up prescriptions. We continue to make in-person visits in the home program for needs that cannot be met via phone or otherwise. Some examples include: wound care; critical skin care; drain

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management; urinary catheter placement; medications pumps; end of life or symptom crisis that can’t be managed by phone.

ADDITIONAL PREVENTION, PERSONAL PROTECTIVE EQUIPMENT & SUPPLIES Q: I understand that some organizations are asking employees (and volunteers) to mask when going into other work “zones”. What is HSM doing? (New 5/21; reminder 6/1) A: In addition to universal masking that is currently in place at Gosnell and in the Home Program, beginning Tuesday, May 26, 2020, HSM is asking that all employees and volunteers mask if they move from their normal work zone into another work zone. For example, if Lisa goes into the clinical area from the admin area at 180, she would mask. If Cassie goes into the admin area from the clinical area, she would mask. If Jill visits 180 or 136 from Gosnell, she would mask, etc. The reason is so that we can further minimize exposure risk for everyone while at work, above and beyond our existing protocols for masking, distancing, and screening. As a reminder, any HSM employee or volunteer must wear a mask if, during the course of their work, they are unable to maintain a distance of at least 6 feet from other employees or volunteers. Q: The CDC is recommending the use of cloth face coverings in public settings to help slow the spread of COVID-19. Can HSM help us obtain one of these cloth face coverings? A: Yes. HSM has had many volunteers generously make cloth face coverings, which HSM is able to provide to employees. For those of you working at home, one will be mailed to your home. You should receive one within a couple of days with instructions on how to wear and care for the face covering. If you are in the office, please see your supervisor. Q: What steps can I take to prevent illness? A: Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60 percent alcohol.

• Always wash hands with soap and water if hands are visibly dirty

• Cough and sneeze into your sleeve, not your hands. Or use a tissue and then throw the tissue in the trash

• Stay home when sick

• Avoid close contact with people who are sick

• Avoid touching your eyes, nose, and mouth

• Clean and disinfect frequently touched objects (like your cell phone) and surfaces using a regular household cleaning spray or wipe

Q: I can’t find hand sanitizer in the stores, what can I do? A: The best way to prevent the spread of COVID-19 is with regular soap and water. Wash hands with soap and water for at least 20 seconds. Q: I heard we have suspended PawPrints. Does that mean families and employees cannot bring in their pets? A: That’s right. Based on CDC guidance, if someone is sick with COVID-19 (either suspected or confirmed), they should restrict contact with pets and other animals, just like they would around other people. Although there have not been reports of pets or other animals becoming sick with COVID-19, the role of pets in the transmission of the disease is not fully understood. While we’re screening all patients and visitors at Gosnell, we can’t be sure of who else the animal has come into contact with recently.

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Q: What is HSM doing to secure additional Personal Protective Equipment (PPE)? (Updated 3/24) A: We have requested an additional supply from McKesson, which is backordered, and we have ordered supplies from the Maine CDC. As you may know, PPE orders nationally are being filled for first responders and hospitals before any other healthcare providers. We have made the case with Maine CDC that HSM should be considered a priority as a mini-hospital, caring for patients at Gosnell and in their homes. In addition, we have volunteers making cloth masks, and once we have them in-hand, we will determine the best use for the supply pending CDC guidance. We were able to secure a limited number of N95s from our building contractor. Q: I’m worried about contracting COVID-19. What Personal Protective Equipment (PPE) should I be using at work? A: Please follow up with your manager on the specific PPE to use for working with and around confirmed COVID-19 patients, or those under monitoring. If you are not familiar with the use of this equipment, please make sure to speak with your manager to receive proper training. Q: I heard that some healthcare providers are implementing Universal Masking Protocols. Will HSM be doing this? (Updated 6/25) A: While Universal Masking for healthcare workers does not stem from specific CDC guidelines for COVID-19, healthcare organizations across the country have begun implementing it based on emerging evidence from other countries who have deployed Universal Masking with apparent good effect on reducing exposure and spread. Unlike healthcare workers at our local hospitals and urgent care settings, HSM employees do not experience the same level of risk due to our policy of not accepting admissions of Persons Under Investigation (PUI) or those known to have COVID-19. However, HSM will continue to care for patients who may develop COVID-19 while under our care. Therefore, we believe it prudent to add Universal Masking as a further safeguard for our patients, employees, and community. Beginning 4/2, HSM will begin issuing facemasks – that is, surgical/procedure masks – to those employees and volunteers who have close contact (defined as within 6 feet for > 15 minutes) with patients and visitors during the course of their work. Due to the expected ongoing facemask shortage, we will follow the US CDC’s published additional contingency and crisis strategies, including Extended Use and Limited Re-use of facemasks as outlined below. These protocols do not replace existing protocols for any RN caring for a patient who is a PUI or is known to have COVID-19, in which case an N95 should be worn.

Extended Use: Wearing the same facemask for repeated close contact encounters with several different patients, without removing the facemask between patient encounters.

• The facemask should be removed and discarded if soiled, damaged, or hard to breathe through. • Take care not to touch your facemask. If you do touch or adjust your facemask you must immediately perform

hand hygiene. • You should leave the patient care area when you need to remove the facemask.

Limited Re-use: Using the same facemask for multiple encounters with different patients but removing it after each encounter. Care should be taken to ensure that you do not touch outer surfaces of the mask during care, and that mask removal and replacement be done in a careful and deliberate manner.

• The facemask should be removed and discarded if soiled, damaged, or hard to breathe through. • Facemasks that fasten via ties may not be able to be undone without tearing and should be considered only for

extended use, rather than re-use. • Facemasks with elastic ear hooks may be more suitable for re-use. • You should leave the patient care area if you need to remove the facemask.

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• Facemasks should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage.

• The folded mask can be stored between uses in a clean sealable paper bag or breathable container. Gosnell RNs, Hospice Aides, House Assistants, and other employees or volunteers who have close contact with visitors or patients will follow the Extended Use protocol and utilize 1 mask per shift. Masks will be discarded at the end of your shift, unless it requires replacing sooner, per the protocol. Home Program RNs and Hospice Aides, as well as Admission Nurses and Transitional Care Nurses, will follow either the Extended Use or Limited Re-Use protocol and will utilize 1 mask per shift for each shift that they are seeing patients/families in person. Masks will be discarded at the end of your shift, unless it requires replacing sooner, per the protocol. Taking Mask Breaks During Extended Use Protocol: Employees can remove their masks during breaks or to eat or drink when in a location outside of the patient care area and when a distance of 6 feet can be maintained from other employees, patients, and visitors.

• Leave the patient care area and ensure you are 6 feet away from others before removing the mask

• Doffing the facemask o Perform hand hygiene o Remove mask by holding the ear loops

▪ For facemask with ties, untie the lower ties FIRST. Untie upper ties last. Ensure ties do not fall into clean interior side of mask

o Consider the front of the mask to be contaminated, so remove slowly and carefully o Visually inspect the mask after removing it:

▪ If visibly dirty or wet, discard the mask o If the facemask is not visibly dirty or wet, carefully place on a clean paper towel near you, exterior side

down, or place in a paper bag (see next bullet) o For extended breaks of more than 30 minutes or if you must leave the area, carefully fold the mask with

the exterior side inward and place into a paper bag with your name and date o Perform hand hygiene

• Donning the facemask o Perform hand hygiene o Grasp mask at the ear loops (or grasp upper ties) o Place over face o Secure ear loops behind the ears

▪ For masks with ties, secure upper ties first, behind head, then secure lower ties o Pinch mask at top and bottom to adjust to nose and chin, if needed o Perform hand hygiene

• A facemask can be worn for an entire shift if not wet or soiled (or, for shaped masks, distorted).

• Reminders of clean procedures and extended mask usage: o Do not touch the mask while delivering patient care o Perform hand hygiene before and after handling the mask (donning, doffing, or adjusting without

removing)

• If at any time during your shift the mask becomes wet, soiled, or difficult to breathe through, discard and get a new mask

If the COVID-19 crisis continues to the point where we have exhausted HSM’s supply of facemasks, we will implement CDC’s crisis strategy for the use of approved hand-sewn or alternative manufactured masks. More information about that will be provided in a future communication.

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Please note that hand-sewn or any other masks not provided or approved by HSM are not allowed for use during working hours at this time. In order to be issued your facemask, you must attest that you have read and understood these protocols. You may also be asked, or you may request, to demonstrate proper technique for Extended and Limited Re-Use protocols. Details about this will be issued to individuals shortly.

MEDIA INQUIRIES Q: What happens if I get a call from the press about HSM and COVID-19? A: All media inquiries should be directed to Heidi Farber, Development and Outreach Director, 289-3669.

GENERAL Q: Did I see Carol Schoneberg on the news? (New 5/5) A: Yes. Last week WGME and Good Day Maine reached out to HSM to ask our perspective on managing grief virtually during this time. Who better to answer that question than Carol? https://wgme.com/features/good-day-maine/hospice-of-southern-maine-offers-grieving-mainers-support Q: What is the sign on the lawn at 180? (New 5/5) A: A very appreciative son of a home program patient placed the sign and sent the following email: Greetings, though you are all top notch staff at HSM, I wanted to especially thank Janet, RN; Pam, CNA; Annette, LSW; Andrea, Chaplin; and Terry, Volunteer Companion. As the lawn sign states ... you are all the best, and I wanted everyone traveling Route One to know it. Thank you for all you do for others.

Q: I have heard that we are doing something special for many of the facilities we work with. What are we doing? (New 5/5) A: Last week, many of us wrote notes, which we sent to Kyra. She combined them into a letter that we sent to Maine Veterans Home. We will send others in the days ahead. Wednesday, we will kick off our luminaria heart project. What is that, you might ask? If you have ever been to Twilight in the Park – think smaller. We are going to a few of the facilities we work with to form lighted luminarias into a heart-shaped symbol to honor the employees and remember those who have been lost. In reaching out to the CEOs about this project, this is the first response I received:

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Oh Daryl, that would be lovely!!! It would mean so much to my team!! I will be here to escort you to the area that would be the best place for this. Thank you.

During this difficult time when it sometimes feels there is little we can do, this is something we can provide to bring us all a little closer together, while still at a distance. Q: The number of positive COVID-19 cases in Maine has been steadily increasing. How might that impact HSM? A: As you can imagine, HSM’s services may be needed now more than ever before. I’m sure you have all read or heard countless stories of people dying alone, without the opportunity to talk to anyone about their end-of-life needs or wishes. I’m sure you are also worried about yourself and your families if HSM were to care for COVID-19 patients. HSM has been working closely with MaineHealth/Maine Medical Center leadership to discuss how HSM might best assist in the event there is a dramatic rise in the number of positive patients at MMC and HSM is called upon to help support the increase. At this time, MMC and HSM feel the best way to support hospitalized patients and their families would be through virtual or telephonic visits, similar to the way we are supporting our home program patients and families now. Depending on the number of patients, HSM employees (in various disciplines) could be called upon to support COVID-19 positive patients and their families during this crisis and after, and to support hospital staff in managing the end of life process. Please understand this situation is evolving and subject to change on a nearly daily basis. Please know that we will want to support MMC, patients and families the best we can in a time of crisis. HSM leadership will continue to monitor the situation in southern Maine, and as information becomes available, we will provide you with updates on how this might impact HSM and you.