Guidance for Providing In-person Community Care During COVID-19
The following guidance has been developed collaboratively by BC Health Regulators, with expertise and direction provided by the Provincial Health Officer (PHO), the BC Centre for Disease Control (BCCDC), and WorkSafeBC. It is intended for all registrants of the College of Speech and Hearing Health Professionals of BC (CSHBC) in community practice. The guidance, which is applicable for the duration of the COVID-19 pandemic, reflects the best evidence available at this time and will change as required to reflect updates in our understanding of the virus and its transmission. Resources that are linked to in the guidance are also subject to change – CSHBC will monitor changes and update the guidance. As this guidance will be regularly updated, registrants are advised to check this page frequently.
During the COVID-19 pandemic, CSHBC recommended:
- All Registered Audiologists (RAUDs), Registered Hearing Instrument Practitioners (RHIPs), and Registered Speech-Language Pathologists (RSLPs) who work in private practice should suspend in-person elective and non-essential services, and only provide urgent and emergent services.
- RAUDs, RHIPs, and RSLPs who work in public health clinics, hospitals, health agencies, long-term care facilities, school districts, and other public sector settings should follow the direction of their employers and public health officials.
With announcements from Premier John Horgan and PHO Dr. Bonnie Henry about BC’s Restart Plan, registrants can begin to resume in-person practice in a way that promotes safe care to clients and prevents the spread of the virus. As a new normal is being defined, registrants will have to adjust how they deliver care, conduct business, and attend to physical environments to ensure best infection prevention and control practices. In some cases, the ongoing use of digital technology to provide virtual care may still be the best option.
This guidance to registrants will assist in determining which services are reasonable to resume in the coming weeks. The goal is to gradually resume services while adhering, wherever possible, to physical distancing and following other guidelines and best practices outlined in this guidance. CSHBC recognizes that registrants would like very clear and specific direction on what is considered reasonable; however, it is not possible to address all scenarios.
As health professionals, the College expects registrants to collaborate with colleagues in similar practices when making decisions about providing care and to use professional judgement to determine what is in the client’s interest. CSHBC expects registrants to read this guidance and follow guidelines for infection prevention and control as they resume work in community settings.
CSHBC encourages all registrants to take the time required to review this guidance, and web pages/documents that are linked, and make the necessary adjustments to ensure safe community practice. While in-person services may resume on May 19, 2020, as confirmed in an update from the PHO to health professionals (PDF), there is no requirement to re-open by this date.
Guiding principles and assumptions
The following guiding principles and assumptions are foundational for reintroducing health care services in the context of COVID-19:
- All CSHBC registrants will follow the guidance, expectations, and direction provided by the PHO.
- Registrants employed by hospitals, health authorities, and long-term care facilities should refer to guidance provided by their employers and the PHO.
- The direction in this document pertains to the delivery of care outside of these settings. These include, but are not limited to, private practice clinics, private mobile or community-based practices, and school-based practices.
- Some services can be safely and effectively provided virtually. Other services require in-person visits including direct client care. CSHBC standards of practice apply, regardless of whether services are provided virtually or in-person.
- Wherever possible, physical distancing will be maintained during the delivery of care.
- In-person services must only proceed when the anticipated benefits of such services outweigh the risks to the client and the registrant.
- The registrant is accountable and is the person best positioned to determine the need for, urgency, and appropriateness of in-person services.
- Appropriate personal protective equipment (PPE) must be used for the safe delivery of in-person services. However, all registrants must also act to conserve PPE through its judicious use.
- Registrants must consider if they are the most appropriate health professional to address the client’s needs, referring clients to other members of the health care team when in the client’s interest.
- Registrants must not recommend unproven therapies for treating COVID-19.
- Registrants must not prescribe or offer any COVID-19 treatments or therapies if infectious diseases if not within their scope of practice.
- Registrants are accountable to provide clear, honest, and transparent communication regarding their policies and procedures related to COVID-19.
Prioritization of client care services
It is anticipated that when services resume, CSHBC registrants may face difficult decisions regarding which clients to see and the prioritization of service provision. Registrants are accountable for prioritizing access to in-person services based on clinical judgment and with consideration given to the client perspective and the referral source. When determining priority for in-person care, registrants should reflect upon the following considerations:
- Acuity and severity of the client’s condition.
- Functional impairment or impact of the condition on health-related quality of life.
- The impact of not receiving services, including deteriorating condition if the client is not seen; potential need for an emergency visit; risk of increased social isolation; and inability to communicate with external or virtual resources.
- Appropriateness of service provision via virtual care.
- Necessity of services that can only be provided in-person.
- Duration of client wait times for care.
Ongoing pandemic best practices
Public health officials have indicated that COVID-19 is expected to continue to circulate in the general population for an extended period. As such, ongoing measures to control the spread of the disease are needed. They include requirements to practice physical distancing of at least 2 metres (6 feet), increased screening for signs, symptoms, and risk factors for COVID-19, and other important measures:
- Above all, registrants must adhere to BCCDC’s Infection Prevention and Control Guidance for Community-Based Allied Health Care Providers in Clinic Settings (PDF) regarding measures applicable to the practice environment, including PPE use and environmental cleaning best practices to enable safe practice.
- Registrants must adhere to all BCCDC and WorkSafeBC guidance regarding occupational health and safety exposure control plans to ensure a safe work environment for staff. This includes robust policies, procedures, and organizational cultures that ensure that no one (employees or contractors) associated with the practice attend work when they have symptoms of illness.
- Registrants are reminded that if they are exhibiting signs of COVID-19 or respiratory illness, including cough, runny nose, or fever, they must not provide in-person care and should not be in attendance at clinics or other practice settings where other staff and clients are present.
- Registrants must follow BCCDC and WorkSafeBC guidelines for self-isolation when an employee is sick with any respiratory illness, support access to primary care provider assessment and testing, and provide sick-leave support where possible until advised by their health care provider that it is safe to return to work.
- Registrants must implement COVID-19 screening practices for clients:
- If client screening reveals risk factors for COVID-19, or symptoms of COVID-19, registrants should refer the client to a COVID-19 testing centre and defer treatment until signs and symptoms have resolved.
- The College does not expect any registrant to provide treatment unless, in their professional opinion, it is safe to do so for both clients and staff.
BCCDC: Infection prevention and control, including personal protective equipment (PPE)
BCCDC has issued comprehensive new guidance on infection prevention and control, including information on PPE, cleaning and disinfection, and other measures: Infection Prevention and Control Guidance for Community-Based Allied Health Care Providers in Clinic Settings (PDF).
WorkSafeBC: Protocols for returning to operation
WorkSafeBC has developed protocols for returning to operation for health professionals.
PHO order: Developing and posting your COVID-19 safety plan
On May 15, 2020, the PHO issued an order on workplace COVID-19 safety plans (PDF). The order states that employers, which includes sole practitioners, must:
- Post a copy of their COVID-19 Safety Plan on their website, if there is one, and at their
workplace so that it is readily available for review.
- Provide a copy of their safety plan to a health officer or a WorkSafeBC officer on request.
It is not necessary for registrants to submit their plans to CSHBC for approval.
CSHBC Notices to the Professions and Standards of Practice
Ensure the reintroduction of health services aligns with CSHBC Notices to the Professions and Standards of Practice, including but not limited to:
Notices to the Professions
- Information about personal protective equipment (PPE) and routine precautions
- Providing Virtual Care during COVID-19 Pandemic
- CSHBC statement on hearing aids dispensed directly from manufacturers to clients
Standards of Practice
See all COVID-19 CSHBC news stories and Notices to the Professions on the COVID-19 Information for Registrants page.
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