A foster care company in Minnesota is under scrutiny after a memo to employees was shared online, revealing that workers may still be required to go to work even if they've tested positive for COVID-19 and have mild symptoms.
The memo was sent by North Branch-based Karcher Foster Services, which operates seven foster homes north of the Twin Cities, and describes the company's policies for employees in the time of COVID-19.
The excerpt that has attracted attention on social media says as follows: "Staff who test positive [for COVID-19] with no symptoms or minor symptoms will be required to work. A surgical mask will be required to be worn at all times while on shift."
This appears to fly in the face of national guidance on COVID-19, but in a statement to BMTN, Karcher said that the image above "lacks necessary context," saying that the sentence in question is part of a section called: "Quarantine Procedures for Locations with Multiple Ill Individuals."
"The protocols contained in that section apply in the worst case scenario, in which so many staff and clients are ill that there is no other viable option to ensure that our clients with disabilities receive the absolutely essential care and supports that they need," a spokesperson said.
"In this scenario, COVID-positive individuals would only interact with other COVID-positive individuals, whether staff or clients, meaning that no additional infection risk would be created. This worst-case scenario plan was carefully created with reference to and in compliance with DHS, MDH and CDC guidance."
Healthcare guidance suggests otherwise
The Minnesota Department of Human Services says that following the release of the memo, Karcher has been referred to its licensing staff "to gather more information and determine whether further action is needed."
MDH said the Karcher memo would "not be our recommended approach," saying it follows CDC guidelines when an employee tests positive for COVID-19 in a group home or congregate care setting.
Any worker in a group home setting in Minnesota is classed as "healthcare professional" (HCP) for the purposes of COVID-19 as they provide "close personal care" and work in congregate settings that could lead to rapid transmission.
The CDC guidance states that any HCP exhibiting mild or moderate symptoms of COVID-19 should only return to work when at least 10 days have passed before symptoms first appear, at least 24 hours have passed since the last fever without using fever-reducing medication, and symptoms have improved.
Even when they do return to work, MDH says staff should continue to wear procedure or surgical masks until "symptoms are completely resolved."
Those who have tested positive but who are asymptomatic should still stay off work for at least 10 days from the date their positive specimen was taken, and that this period would restart if they develop symptoms during this time.
However, Minnesota Department of Health guidelines do state that group home workers confirmed with COVID-19 but who are asymptomatic are allowed to return to work in the event of a staffing crisis. However, a staffing crisis can only be determined in consultation with the State Emergency Operations Center.
MDH's criteria for a staffing shortage in congregate care facilities is similar to the "worst-case scenario" described by Karcher Foster Services in that asymptomatic workers can return to work in a "non-direct resident care role" provided it has approval for the SEOC.
But this exception does not extend to anyone exhibiting "mild" symptoms of COVID-19, unlike what is stated in the Karcher policy.
In the event asymptomatic workers are required to provide direct care or supervision of group home residents, they should only do so for those who also have COVID-19, ideally in a separate setting.
They are also required to "practice diligent hand hygiene and wear a face shield and surgical face mask for source control at all times," including in non-resident care areas such as breakrooms, and must separate themselves from others if they have to remove their face mask.
The 'worst-case scenario' hasn't arrived
Karcher said that despite its preparations for the "worst-case scenario," it hasn't yet reached a staffing crisis that has required an employee with a positive COVID-19 test to return to work.
"We want to be clear that we have not yet and hope that we will never find ourselves in this worst-case scenario and that our community’s shared efforts to flatten the curve will continue to control the spread of COVID-19," the company said.
It went on to say that its COVID-19 preparedness plan has helped limit a widespread outbreak, and that thus far any staff who have tested positive for COVID-19 have only been allowed to return to work after the complete resolution of their symptoms or after a negative test.
"Even after these criteria are met, the returning staff member must take certain additional precautions in the workplace to make sure that other staff members and clients remain safe," the company added.