The province has announced a phased approach for the resumption of visits in LTC and Retirement Homes.

To facilitate this Directive #3 has been updated, and two guidance documents have been created. The updated Directive also lays out the requirements for admissions into both LTC and Retirement Homes.

We should recognize the value of visits being able to take place to support the general health and well-being of the residents, but it’s essential that appropriate planning takes place before the visits commence that ensures they can happen safely. We want to ensure that risk is minimized as much as possible with early assessment and planning.  There is some guidance below on how what JHSCs and Locals should be looking for as homes prepare for these visits.

For Long-Term Care

There are strict conditions that have to be met by both the home and visitors. These are outlined in the attached reference document from the Ministry – where there is a conflict between the document and Directive #3, the Directive prevails.

The first phase will begin on June 18th and only applies to outdoor visits limited to one visitor subject to the conditions outlined below.

Additional phases, including expanded outdoor visits and limited indoor visits, roll out beginning one week after the lifting of the provincial emergency under the EMCPA.

Requirements for the home:

•  LTC home must NOT be in an outbreak (has never been in an outbreak, or has had an outbreak declared resolved by Public Health)
• LTC has developed procedures for the resumption of visits and a process for communicating these procedures with residents, families, visitors, and staff – including infection-prevention and control and masking. See the notes below related to planning.
• Home needs to create and maintain a list of visitors that will be available for relevant/appropriate staff members to access.

 Requirements for visitors prior to each visit:

•  Must pass an active screening questionnaire administered by home staff
• Attest to having tested negative for COVID-19 in the last two weeks, and have not since tested positive
• Must comply with LTC infection, prevention, and control protocols – including use of face or surgical/procedure masks
  • Nonadherence to these rules will be the basis for discontinuation of visits

 In Phase 1:

• Outdoor visits only – homes create a dedicated area outside the building for visits
• Only 1 visitor per resident is allowed at a time
• Visits must be scheduled to allow for appropriate physical distancing and staffing coverage

 For Retirement Homes

Retirement Homes will be allowed to have both indoor and outdoor visits – but physical distancing MUST be maintained. Visitors must abide by the restrictions below. Residents will also be allowed to leave the homes for short absences, subject to certain restrictions.

 Requirements for the home:

• Retirement Home must NOT be in an outbreak (has never been in an outbreak or has had an outbreak declared resolved by Public Health). If the home has relaxed visitor restrictions and an outbreak occurs all non-essential visitations must cease immediately.
• Retirement Home has developed procedures for the resumption of visits and a process for communicating these procedures with residents, families, visitors and staff – including infection prevention and control, masking and limiting movement around the home. See the notes below related to planning.
• Retirement Homes must have dedicated areas for both indoor and outdoor visits – those areas must be cleaned and disinfected between visits.
• Home needs to create and maintain a list of visitors that will be available for relevant/appropriate staff members to access.

 Requirements for visitors prior to each visit:

•  Must pass an active screening questionnaire administered by home staff
• Attest to having tested negative for COVID-19 in the last two weeks, and have not since tested positive
• Must comply with the Home’s infection, prevention, and control protocols – including the use of masks outdoors and surgical/procedure masks indoors. Visitors should be expected to provide their own masks.
• Education on all required protocols is the responsibility of the Home
• Nonadherence to these rules will be the basis for discontinuation of visits

 Short Absences:

The home cannot be in an outbreak – and in the event of an outbreak all short absences must end

• The resident must pass screening every time they re-enter the home and attest that they are not experiencing any typical or atypical symptoms.
• Absence is limited to 12 hours, and cannot be overnight
• The resident must wear a cloth mask while outside the home.
• Education on these protocols is the responsibility of the home.

Recommendations for JHSCs and Locals

 General  

1. Directive #3 prevails over any internal program for visitation

a) The home must not be in an outbreak. That means the entire facility.

b) If a resident develops symptoms, visitation should be halted for that resident until tests return negative. The resident remains under isolation while awaiting tests.

c) In the document, consider a “should” as a “must”. No discretion.

d) Visitation is denied if the visitor does not bring a face mask for outside visits. Visitors should only access mask supply for indoor visits.

Duties 

2. Employers must develop a written program (measures and procedures) to safety conduct indoor and outdoor visits based on risk assessment.  The written program is developed and implemented in consultation with the JHSC. All workers are given information and instruction on the written program.

 

Risk Assessment 

3.  A risk assessment should take into account the following:

a) The floor area capacity to hold indoor/outdoor visits while maintaining social/physical distancing.

b) Job tasks, classifications, and individual workers

c) The stockpile of hand sanitizer/cleaning products and the expected use as visitations increase.

d) The stockpile of PPE available and the expected use as visitations increase.

e) Determining if workers will be placed at a greater risk of workplace violence.

f) Determining if additional engineering/administrative control are required.

g) Determining if appropriate staffing levels can be maintained during visits that do add additional workload and task load

h) Evaluating the ergonomic load of assisting several residents inside and outside in a shift.

f) Determine if additional training and instruction are required.

 NOTE: The risk assessment is developed and implemented in consultation with the JHSC.

 

Written Program for Occupational Health and Safety

4. The written program must set out:

a) The screening protocols, including how the employer will ensure a visitor has tested negative in the last two weeks prior to the visit

b) How the employer will communicate the written visitation policy to families and caregivers.

c) How families/caregivers can communicate with the home if they test positive within 14 days of their last visit.

d) Identify the roles for each classification and the tasks to carry out: RPN, PSWs, activities, etc.

e) How the employer will ensure visitors are adhering to the visitation policy

f) How the employer will deal with visitors who do not adhere to visitation policy.

g) How workers will signal to a supervisor where a resident or visitor does not adhere to the policy.

h) The increased environmental cleaning of indoor/outside furniture between visits.

i) Visitors/residents must disinfectant hands before and after visits.

j) Signage to indicate how a visitor and resident can maintain physical distancing from other visitors and residents.

k) Layout and spacing of furniture to ensure physical distancing from other visitors and residents. (Similar to chalk circles in the park)

l) The minimum age of visitors.

m) Limit the number of visits per day per resident.

n) Who is responsible for scheduling?

o) The threshold at which visitation will be cancelled due to a low supply of masks.

p) Who will carry out the assessment?

q) How often the home will re-assess (evaluate) the visitation program

Download PDF Resuming Visits in Long-Term Care Homes 

Download PDF Reopening Retirement Homes