What emerging practices exist to safely re-open activities in non-residential settings for seniors?

Summary

The following is a short summary of the best available evidence from trusted sources that have been rated as providing high quality information on the emerging practices that exist to safely re-open activities in non-residential settings for seniors. Four guidance documents were found to answer this question and included in this summary. For additional information about each of the sources, see the Table below.

Several jurisdictions in Canada and the US have developed guidance on how to restart recreational and other services for seniors as outlined here. Manitoba guidance on Restoring Safe Services (June, 2020) outlined strategies including: 1) providing a single entry to the site and screening all staff, volunteers, and participants for symptoms of COVID-19; 2) maintaining physical distancing measures by practicing proper hygiene standards and structuring the furniture; 3) having adequate hygiene stations available; 4) discouraging drop-in sessions and limiting the size of groups to one-on-one interactions (where possible) or as small of a group as possible and preferably in outdoor settings; 5) maintaining a list of participants for 21 days to ensure public health follow-up for individuals exposed to COVID-19; 6) providing individually wrapped meals instead of family-style servings and serving beverages by a single staff to avoid continuous touching of items; and 7) using enhanced disinfection and cleaning measures frequently on all surfaces possible, including washrooms, if available. The guidance states that health clinics for seniors run by healthcare providers can resume if primary care guidelines are followed [1]. 
 
The Massachusetts Councils on Aging, Vermont Department of Health (September, 2020), and Pennsylvania Department of Aging (June, 2020) offer recommendations for re-opening senior activities in senior centres. These include: 1) creating a flexible schedule to ensure participants have access to programs, but alternating program start and end times to space out activities and stagger timing; 2) adhering to group size transportation requirements including spacing out participants within vehicles as much as possible and thoroughly clean and disinfect vehicles before and after transportation; 3) maintaining proper use of face coverings and practicing proper hygiene amongst all personnel within the centre; 4) operating with up to one person per 113 to 200 square feet, including staff, volunteers and participants; 5) installing plexiglass at the reception and other face-to-face interactions areas; 6) placing directional arrows to establish the flow of traffic; 7) setting-up and dividing supplies and/or equipment prior to programming; 8) creating and disseminating policies, procedures, and identify staff present who will serve as the Pandemic Response Person; 9) posting  information regarding policies and safety reminders for participants throughout the facility; and 11) following other general COVID-19 guidelines provided by the major organizations such as Centers for Disease Control and Prevention [2,3,4]. The Government of Alberta recommends in its Common Topics for Seniors’ Centres and Seniors-Serving Organizations (September, 2020) guidance that 1) a plan should exist on how to respond to symptoms (i.e., fever, sore throat, runny nose) when screening; and 2)  
consider who will be responsible for ensuring attendees are following precautions [5]. 

Evidence

What‘s Trending on Social Media and Media

Seniors’ centres provide services “essential to their health and well-being.” See this article from September 10th, 2020 by the Hamilton Spectator to learn more about the various programs available at specific locations. 
 
Local seniors from Saskatchewan look forward to the re-opening of seniors’ centres as the COVID-19 vaccine roll-out plan is announced. See this article from December 9th, 2020 by paNOW for more information. 
 
Ottawa seniors are encouraged to exercise and be mindful of their health through online services such as Good Companions. See this article from December 31st, 2020 by Capital Current for more information. 
 

Review of Evidence

Resource	Type/Source of Evidence	Last Updated
Province of Manitoba Restoring Safe Services – Senior Centres/Clubs — Province of Manitoba	Guidance	The province of Manitoba recommends the following strategies:1) providing a single entry to the site and screening everyone for COVID-19 symptoms; 2) maintaining physical distance measures; 3) having adequate hygiene stations available; 4) discouraging drop-in sessions and limiting group size to as small as possible and in outdoor settings; 5) maintaining a list of service participants for 21 days to ensure public health follow-up for individuals exposed; 6) providing individually wrapped meals and serving beverages by a single staff; and 7) using enhanced disinfection and cleaning measures frequently and on all surfaces possible.  The guidance states that health clinics for seniors run by health care providers can resume if guidelines for primary care are followed.  Last Updated: May 31, 2020
Massachusetts Recommendations for Reopening- Scaling Up Senior Centre Operations — Massachusetts Councils on Aging	Guidance	The following is recommended: 1) creating a flexible schedule to ensure participants have access to programs, but alternating program start and end times; 2) installing plexiglass in reception and other face-to-face interactions areas; 3) placing directional arrows to establish the flow of traffic; 4) requiring face coverings for all persons entering the center, and educating staff, volunteers and participants on how to properly use and take off masks; 5) setting-up and dividing supplies and/or equipment prior to programming; and 6) establishing a plan for employees or participants who are displaying symptoms, become ill from COVID-19 at the center or a return-to-work/programming plan.  Last Updated: August 24, 2020
Guidance for Senior Centres in Planning for Re-Opening — Vermont Department of Health	Guidance	The Vermont department of health states the following: 1) The center should track all people attending each day in case future contact tracing is needed (records should be kept for 30 days); 2) Hand hygiene facilities should be set-up at the entrance; 3) If the center is transporting participants, they should adhere to requirements of group size, participants should be spaced out in the vehicle and vehicles should be thoroughly cleaned and disinfected before and after transportation; 4) The center should operate with up to 1 person per 200 square feet, including staff, volunteers and participants; and 5) Assist participants with handwashing, if needed.   Last Updated: September 17, 2020
Guidance for Reopening & Operation of Older Adult Daily Living Centers — Pennsylvania Department of Aging	Guidance	This guidance outlines three steps on how to proceed with re-opening senior community centers (SCC):   1) determine how many participants the SCC can serve and include the area needed around the senior being served (i.e., 113 square footage per individual) 2) create and disseminate policies, procedures, and identify staff present who will serve as the Pandemic Response Person; and 3) post information about policies and safety throughout the facility.    It is also important to follow general COVID-19 guidelines provided by major organizations such as Centers for Disease Control and Prevention.  Last Updated: June 14, 2020
Common Topics for Seniors’ Centres and Seniors-Serving Organizations — Alberta Government	Provincial Guidance	Have a plan to respond to symptoms when screening such as fever, sore throat, runny nose or difficulty breathing.  Consider who will be responsible for ensuring attendees are following precautions.   Last Updated: September 29, 2020
Disclaimer: The summaries provided are distillations of reviews that have synthesized many individual studies. As such, summarized information may not always be applicable to every context. Each piece of evidence is hyperlinked to the original source.