Recovery Housing and Coronavirus:

Frequently Asked Questions

Last Updated: September 30, 2020

Introduction

The global coronavirus pandemic has raised unique questions from recovery housing operators.  There is much information out there, but questions remain on exactly how recovery housing operators should adjust their policies and practices in response.  This document includes frequently asked questions and responses, based on the most recent best practice advice from national, state and local experts.  We will do our best to update this guidance as needed as the situation develops.

We are in unprecedented and uncertain times.  The situation changes rapidly, and it is possible that new recommendations and resources may become available.  Operators must examine information provided by trusted sources, including the Centers for Disease Control and Prevention (CDC), Indiana State of Department of Health (ISDH), Department of Mental Health and Addiction (DMHA), along with this document and consider the individual needs of their residents. 

FAQ

If you have questions about the coronavirus itself, you should call the Indiana State Department of Health at 877-826-0011.
If a resident becomes ill and starts to show symptoms of possible COVID-19, the resident should call their primary care provider and follow the instructions provided. If they do not have a primary care provider, you can call a federally qualified health center, or contact your local health department. If they are having trouble breathing call 911 and inform the operator of the resident’s symptoms if they are symptoms of possible COVID-19.In some instances, the resident may be asked to go to the hospital, in other cases the resident may be asked to self-isolate. It is important that you help support the resident in completing the instructions provided by their health care professional.
  • Assist the resident getting to the hospital if that is the recommendation of the health care provider
  • Be sure to call ahead if you are visiting a health care provider
  • If the resident is asked to stay at home and self-isolate, begin isolation protocols
It is important to remember that many people living in recovery housing often do not have anywhere else to go. Hospitals and other health care systems are overwhelmed with critical cases. It is unlikely that a resident will be able to go to a hospital unless they are in need of immediate medical attention. Treatment centers, shelters and other housing options are also unlikely to be an option.The following recommendations are provided as ways that recovery housing operators can allow the resident who is ill to have the support they need to get better, keep moving forward in their recovery as well as reducing the risk of illness for the other residents living in the home.
  • Provide the resident their own bedroom and single bathroom for their own use
  • Ask the resident to clean high-touch surfaces of the bathroom each time it is used
  • Have staff, house manager or other residents bring the resident meals and other supplies to their room for them
  • Leave any meals, items, or other needs outside the bedroom door. The resident should only open the bedroom door and retrieve items after the person dropping off items has left
  • Allow the resident to participate in house meetings and other activities virtually. There are many apps and other tools that can be used to help residents keep in connection with others in the home.
  • Allow resident to participate in outside activities virtually. There are more online and virtual resources becoming available like IntheRooms and the Connections App. Check the INARR Resources Page for the most up to date information about these tools.
  • If the resident needs to go outside, have them notify other residents. Other residents should go to their rooms while the resident walks through the house and outside to ensure appropriate physical distancing. The resident should wear a face mask when around other people (including before entering a health care provider’s office). They may have to improvise a face mask using a scarf or bandanna if surgical masks are not available. The resident should clean any doorknobs, light switches or other surfaces touched
  • If you need personal protective equipment, supplies are limited. Contact your local Emergency management agency for guidance.
  • You can reference an example policy for a Level II recovery home provided by Erin Helms, Executive Director of The Woodrow Project and board member for the National Alliance of Recovery Residences and Ohio Recovery Housing. These procedures are currently in place and working well in the recovery home.
Everyone is being asked to reduce visits to our friends and family. This is difficult for everyone, but it is clear this distancing is a critical strategy for reducing the spread of disease. Even with this consideration, essential activities and visits do need to continue.
  • If a resident would like to have a visitor, discuss if it is at all possible to have the visit virtually. Residents may have limited minutes on their cell phones. Offer to allow residents to use an organization phone or computer to conduct the visit virtually
  • Discuss Indiana's Stay at Home order with your residents. Allow them to read the order and understand why it is in place. This order explains what types of activities are considered essential. If a visit meets the definition of an essential activity in that order, it is appropriate to allow that visit to happen.
  • If the visit is for peer support or a health care service, many providers are now offering tele-health services. Contact the provider to see if this is an option.
If it is determined that the visit is essential and it cannot be done virtually, steps can be taken to still allow the resident to have their essential visitor and reduce risk of spread of disease.
  • Visitors should be screened for symptoms of COVID-19, including fever (100.4 or higher), dry cough, sore throat, or shortness of breath. Visitors should also be asked if they have been around anyone who has tested positive or has shown symptoms of COVID-19 in the past 14 days.
  • At all times, everyone should practice appropriate physical distancing of being six feet apart from any other person
  • If at all possible, conduct the visit outside, on the porch or in the backyard
  • If it is not possible to have the visit outside, set aside a single room for the resident to have the visitor.
  • Clean this room before and after the visitor leaves
  • Do not allow other residents in this room while the visitor is present
All Hoosiers are being asked to reduce our interaction with others. That means that we are being asked to stay at home, and only leave the home if it is essential to do so. While many businesses are closed, essential businesses are still open and operating, also it is essential that people have food, supplies, and health care services that they need.
  • Work with residents to reduce trips outside of the home.
    • Contact any health care, treatment or peer support providers and see if services can be received via telehealth.
    • Work with residents to create weekly shopping lists to reduce trips to the grocery store
    • Allow resident with limited minutes on their phones to use the organization phone or computer to connect with others virtually
  • Discuss Indiana's Stay at Home order with your residents. Allow them to read the order and understand why it is in place. The order explains what types of travel are considered essential.
  • If a trip outside the house meets the definition of essential travel in the order, the resident should travel and practice appropriate distancing and other recommendations in the order
  • Remind the resident that they are still required to practice appropriate physical distancing whenever they leave the home.
  • When the resident returns to the home they should wash their hands and clean any high touch surfaces.
As businesses are forced to close to reduce the spread of disease, many people are losing their jobs, including recovery housing residents. There are resources available. Residents can apply for unemployment online at https://www.in.gov/dwd/2362.htm. If you are calling about unemployment insurance, DWD is requesting that individuals only reach out with questions on the day corresponding with the first letter of their last name to assist with wait times. Here is the schedule:
  • Monday: Letters A-E
  • Tuesday: Letters F-I
  • Wednesday: Letters J-M
  • Thursday: Letters N-T
  • Friday: Letters U-Z
  • Friday: If You Missed Your Day
• There are many people applying for unemployment at this time. You are encouraged to use the website as wait times on the phone are very long.
As of the publication of this document, we are starting to see basic supplies such as toilet paper and cleaning products be restocked in stores. However, be prepared that stores may have placed limits on the amount that you can buy at one time to reduce hoarding. Each store is managed differently, and these strategies might not work at all stores, but some operators have had success using the following strategies.
  • Call ahead, if possible, and ask to speak to the store manager or business account manager.
  • Explain that you are a housing provider, and that you need to purchase supplies for all the residents in your home.
  • Ask how many supplies you will be permitted to purchase.
  • Bring your INARR Associate certificate or other documentation with you to demonstrate that you are purchasing supplies as an organization. The capacity of your home is printed on the certificate.
  • Contact your local Emergency management agency for guidance on supplies such as masks.
  • Contact your local health department for direction and support if all other sources for obtaining needed supplies have been attempted and exhausted.
  • The Department of Mental Health and Addiction (DMHA) has provided information regarding Recovery Residences COVID-19
This is a stressful time for all people, and it is not uncommon for people to be overwhelmed and experience anxiety and sadness. The CDC has provided resources on managing stress and anxiety during this time.
  • Everyone should continue with any existing mental health treatment plans. Many providers are offering services via telehealth, contact the provider to learn more about how to continue to receive any treatment services.
  • If a resident needs help immediately, you can contact the Disaster Distress Hotline at 1-800-985-5990
  • They can also use the Crisis Lines.
General best practice strategies include
  • Taking breaks from watching or reading news stories or social media
  • Encouraging everyone to stick to a routine as much as possible
  • Engaging in physical activity, such as taking a walk (remember physical distancing!)
  • Connecting with others virtually, talking to friends and family about how you are feeling
  • Engaging in enjoyable activities
  • Talking to other recovery housing operators to get ideas about group activities and projects for residents to do
Relapse is always a concern in recovery homes. This concern is raised during this time of crisis as residents experience increased anxiety, sadness and disruption in routine. Suggestions for creating an environment that is supportive of recovery and decreases relapse include
  • Connect with your local treatment providers to learn about available services, including telehealth options, in case they are needed.
  • Be sure to talk to your local treatment providers about any resources that may be available to you should a resident experience a relapse.
  • Have any residents who are currently engaged in treatment contact their treatment provider to make arrangements so they can continue with any existing treatment plans under telehealth or other options.
  • Go over the recovery and relapse prevention plans with each resident. Make changes and updates to adapt for a new schedule, goals, and options.
  • In-person recovery meetings have been cancelled, but residents can still engage in virtual recovery meetings using online tools and apps like IntheRooms and the Connections App. Check the INARR Resources Page. Please also see resources listed by the Office of National Drug Control Policy. As we learn about new tools and resources, we will post them there.
  • Many residents may not be able to engage in regular work and volunteering. Help provide residents resources for virtual job training so they can remain engaged in these activities.
  • Residents may have limited minutes on their phone, allow them to use the organization’s phone or computer to connect with peers, family and friends.
  • If a resident were to experience a relapse, and treatment services or other options are not available, connect the resident to their primary care provider or to a federally qualified health center.
As with any other household, residents may be looking for positive activities to do, especially residents who normally would engage in work, school or volunteer activities that have been cancelled. Suggestions to reduce boredom include:

Conclusion

These are challenging times, and the decisions that recovery housing operators need to make are difficult.  It is normal to feel stress, anxiety and sadness during this time.  Recovery homes are critical parts of the continuums of care for people with substance use disorders, they are also critical parts of or neighborhoods and communities.  By being thoughtful, supportive and reasonable during these times, you will be demonstrating to your residents and your communities the core values of recovery housing, and further demonstrating how recovery housing is a critical asset for any neighborhood or community.

Disclaimer

This frequently asked questions guide is not intended to replace the advice of legal counsel or serve as medical recommendations or clinical guidance for substance abuse disorder treatment professionals.  It is based on best practice guidance that has been provided up to the date of publication.  The exact implementation of these responses will vary depending on the exact structure of your home and the Level of Support available in your home.