Twin Rivers Restructures for COVID-19

Restructuring-New Policies & Procedures

Policy & Procedure for Client Travel During COVID-19 Health Crisis


Twin Rivers has received approval from the South African Department of Social Development to continue with treatment operations for people suffering from addiction and mental health disorders during the COVID-19 health crisis. This includes admitting new International and South African Clients as long as the appropriate authorisation is obtained. This document serves as a basis for the procedure that must be followed in order to obtain the proper authorisation so that the regulations that are in place during the current health crisis are followed throughout the process of a client’s travel to Twin Rivers Rehab.


Dr Sam Botha is the consulting Medical Doctor for Twin Rivers Rehab. He will oversee the admission of each client to Twin Rivers rehab and assist in client monitoring with the assistance of Twin Rivers Registered Nurse.


  • A client will receive and fill the Preadmission Form that is sent to them from Twin Rivers. Accompanying the Preadmission Form will be an Essential Medical Needs Transfer document that must be filled out by the appropriate parties. There will also be some instructions for the potential client so that there is some idea of how to appropriately protect oneself while travelling as well as what must be done in order to obtain the authorisation for Travel. These documents may be sent to the client via a referring third party.
  • A consultation with a Medical Doctor must form part of the client’s preadmission process. During this consultation. The client must be assessed for symptoms of Covid-19. The Doctor must use a recognised assessment that measures potential exposure to COVID-19.
  • The Medical Doctor must also sign the Essential Medical Needs Transfer document that will accompany the Preadmission Form that the client receives.
  • The COVID-19 assessment information and the Essential Medical Needs Transfer document must be sent through to Twin Rivers’ consulting Medical Doctor for review.
  • If the recommendation is made by the consulting Medical Doctor, then the arrangements for transport can be made.

Transport Arrangements

  • A letter of motivation will be produced by Twin Rivers’ Medical consultant for a client to be admitted to the rehab for urgent treatment. This letter will be sent through to the client or the client’s referrer and will be accompanied by the ‘Essential Medical Needs Transfer’ document signed by Twin Rivers consultant GP.
  • Once the client has received the Letter of Motivation from Twin River’s consulting Medical Doctor and the client has received a completed ‘Essential Medical Needs Transfer’ document signed by the referrer, then these two documents will be sufficient for authorised travel and must be kept on-hand throughout travel.

Arrival in Plettenberg Bay

  • Before the client can go into Twin Rivers Rehab, they must have a medical consultation with Dr Sam Botha, Twin Rivers Medical Consultant.
  • Once Dr Botha has conducted a medical assessment, he will inform Twin Rivers nurse the client’s condition and advise accordingly.

Arrival at Twin Rivers

  • Upon arrival, the client will undergo sanitisation procedures and will immediately enter isolation and will be subject to the measures in place as described by Twin Rivers Policy and Procedure for Isolation of a Client During the COVID-19 Health Crisis.

Policy and Procedure for the Isolation of a Client During the COVID-19 Health Crisis


Twin Rivers has been granted permission to continue treatment operations for people suffering from addiction and mental illness. This includes the admission of new clients. In order to continue operations, the Rehab must uphold strict preventative measures in order to mitigate the risks posed by the current global epidemic of COVID-19.

One of these measures is the isolation of new clients from the rest of the community for a period of two weeks. Based on findings published by the World Health Organisation, two weeks is believed to be a sufficient amount of time for any symptoms of the virus to become apparent. It is believed that the measure of isolating clients that have recently arrived as well as clients that present any symptoms associated with COVID-19, combined with the other preventative measures that have been developed creates an acceptable level of safety for operations to be continued at the facility.


The client that is in isolation will not be allowed to interact with the other clients and staff for the duration of the isolated quarantine.

Sleeping Arrangements:

  • New clients and clients presenting symptoms must be housed separately from the rest of the recovery community for a safe period of time (14 days).
  • Twin Rivers has four bathrooms for clients. This means that initially, a maximum of four clients can be admitted to Twin Rivers and each will have their own bathroom. The clients must sleep in isolation for the total of 14 days.
  • After this period the client will be assessed by Twin Rivers’ consulting GP and may join the rest of the recovery community.
  • After the isolation period, clients will be moved into shared rooms with shared bathrooms. The shared rooms will be Rooms 2+3 for men and Rooms 5+6 for women.
  • Once there are four or more clients at the Rehab, the two bedrooms that have en-suite bathrooms (Rooms 1+4) will be used as the isolation rooms for new clients or clients that are presenting symptoms associated with COVID-19. After they have successfully undergone isolation and have been assessed by Twin Rivers’s GP, they can be moved to the shared rooms.

Meal-Time Arrangements

  • Clients that are in isolation will not be able to join the other clients for meals at the table.
  • Meals will be to be brought to their rooms if the weather is poor. If the weather is good, the meals will be brought to an area that only each particular clients uses at one time.
  • Each client in isolation will have his/her own area for meals. There will be strict sanitising of the area, utensils and condiments after each client has eaten.

Therapeutic Duty Arrangements

  • Clients that are in isolation will not be able to assist with the therapeutic duties that include the common areas, such as the kitchen, the coffee bar, the smoking area, the group room and the lounge
  • Due to the creation of separate areas for mealtimes, smoking, etc. the clients in isolation will be responsible for their own impact on the environment. They will sanitise the areas after every use. This will form the basis for their therapeutic duties.

Smoking Arrangements

  • If a client that is in isolation is a smoker, they will need to use a designated smoking area that is separate from other clients.
  • This area must be fully sanitised regularly.

Therapeutic Program Arrangements

  • Clients in isolation will not be able to attend Group Therapy or any other group activity while in isolation.
  • Individual therapy will be allowed as long as there are acceptable preventative measures in place.
  • According to the WHO, the most effective way to do this would be if both the client and staff member are wearing masks, there is a safe distance between the two, there is no physical contact between the two, materials shared are properly sterilised and if both parties appropriately clean their hands before and after the interaction. The area in which the session took place will also be sanitised afterwards.

External Activities Arrangements

  • Clients in isolation will not be able to leave the premises with the other clients.
  • If the client does need to leave for a doctor’s appointment, then a mask must be worn at all times and sanitisation must be done regularly.
  • Shopping will be done on behalf of the isolated clients by the staff member facilitating the shopping.

Exercise Arrangements

  • Clients in isolation will be given permission to exercise. It must fall into a specified time and it will be done in a specified area on-site. The area will be subject to strict sanitisation measures.

Medical Arrangements

  • All new clients will be assessed by Twin Rivers consulting GP, Dr Botha, before their arrival at TR. They will undergo a medical assessment that not only focusses on withdrawals and general health but includes the full assessment of symptoms associated with COVID-19.
  • There will be daily assessment of all clients by TR Registered Nurse for symptoms of the virus.
  • The clients in isolation will be seen by the Registered Nurse at a specified time that is apart from the other clients’ medication times.
  • The Medical office will subject to strict sanitisation measures.
  • There will be frequent advisory communication from a doctor.
  • Towards the end of the isolation period, it would be greatly beneficial if each client could be tested for the virus before joining the rest of the therapeutic community.
  • All the information from the assessments done by both the RN and GP (or any other relevant party) must be recorded for each individual client.