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Directives

Directives have been issued by Ontario’s Chief Medical Officer of Health for Long-Term Care and Retirement Homes.

These directives provide detailed information on the following:

  • Active screening
  • New admission and re-admission
  • Repatriation
  • Short-stay absences - UPDATED August 28, 2020 for Long-Term Care Residents
  • PPE
  • Visitor Restrictions and Testing Requirements
  • Work locations
  • Staff and resident co-horting
  • Outbreak guidance
  • Case management
  • COVID-19 Testing
  • Communications
  • Food and product deliveries

Long-Term Care and Retirement Homes

Long-term care facilities are regularly monitored and supported by Public Health Inspectors. Outbreaks are managed through mandated outbreak management protocols under the guidance of the Ministry of Health. For a list of current outbreaks, please visit the WECHU Outbreak Information Page or for Outbreaks related to COVID-19 only visit here

Visiting Long-Term Care and Retirement Home Residents

NEW: For answers to frequently asked questions about visiting Long-Term Care Homes, please review the COVID-19 Visiting Policy document from the Ministry of Long-Term Care. Effective September 9, 2020.

Topics covered include:

  • Types of Visitors
  • Number of Visitors
  • Requirements for Visitors
  • Accessibility
  • Organizing Visits
  • Safety During Visits
  • Resident Requirements for Visiting
  • Home Capacity
  • Co-Located Homes

Beginning June 18, 2020, the Ministry announced that family visits in Long-Term Care Homes, Retirement Homes, and Other Residential Care Settings can resume.  

Homes are subject to strict health and safety protocols, including:

  • Requiring visitors to pass active screening every time they visit,
  • Long-Term Care Home Visitors only – For indoor visits, visitors must confirm with staff that they have tested negative for COVID-19 within the previous two weeks. Proof of a negative COVID-19 test is not required for outdoor visits
    • Retirement Home Visitors do not need to attest (verbally or written) to a negative COVID-19 test for indoor or outdoor visits.
  • complying with the infection prevention and control protocols. This includes bringing and wearing a face covering during visits and maintaining physical distancing during the visit.

Additionally, long-term care and retirement homes, as well as other residential care settings, must meet the following conditions before they welcome visitors:

  • Homes must not be in outbreak;
  • Homes must have an established process for communicating visitor protocols and safety procedures; and
  • Homes must maintain the highest infection prevention and control standards.

For retirement homes, visitor admissions will vary from home to home depending upon their individual circumstances.

The Ministry of Long-Term Care has published information guides for “Update to Visits at Long-Term Care Homes – July 15, 2020 - FR” and “Reopening Retirement Homes – July 22, 2020” that outline:

  • Requirements for the Home including new admission and re-admissions
  • Visitor requirements including COVID-19 testing results and types of visits (outdoor, indoor)

NEW – August 28, 2020: Update to LTCH Resident Short-Term Absences and Overnight Stays

Starting August 28, 2020, as stated in the updated Directive #3 LTCH residents are now permitted to spend time away from their long-term care homes for day trips or overnight absences. For 'short-stay' absences — those that do not include an overnight stay — homes must provide residents with a medical mask to be worn at all times when outside of the home, if tolerated, and remind them of the importance of public health measures, including physical distancing. When they return, residents must be actively screened but are not required to be tested or to self-isolate.

LTCH residents may also leave for 'temporary' absences of one or more nights. Temporary absences will be at the discretion of the home and decided on a case-by-case basis based on safety factors like the risk associated with the absence (e.g., for a family weekend vs. a large gathering) and ability of the home to help residents self-isolate upon return. For the protection of their neighbours, residents who leave on a temporary absence will be required to self-isolate for 14 days when they return to the home. If a home makes the decision to deny a temporary absence request, they must communicate their rationale in writing.

Please note that day trips and overnight absences for residents of Retirement Homes continue to be permitted as stated in the Ontario document Reopening Retirement Homes Document, July 22, 2020.

Mask Use in Long-Term Care Homes and Retirement Homes

Long-term care homes and retirement homes are directed by the Ministry to ensure that all staff wear surgical/procedure masks at all times. This is a requirement for all homes regardless of outbreak status.

For full guidance on mask use requirements for long-term care and retirement homes review the Ministry of Health Guidance Document dated April 15th, 2020.

COVID-19 Testing

As the COVID-19 outbreak continues to evolve and laboratory testing capacity has increased, Ontario’s provincial testing guidance is also being updated. Please review the COVID-19 Provincial Testing Guidance Update, June 2, 2020 for information on testing in Long-Term Care and Retirement Homes.

Screening in Long-term Care and Retirement Homes (LTCH)

LTCHs must conduct active screening (when possible, over-the-phone screening) for ALL resident admissions, returning residents, readmissions, staff and anyone else entering the home for COVID-19. First responders reporting an emergency do not need to be screened and are permitted to enter. Screening must be done twice daily at entry and exit (beginning of shift and end).

Active Screening of Staff and Essential Visitors:

Screening must be done twice daily and include symptom check and temperature reading. Please refer to the Ministry of Health document ”COVID-19 Screening Tool for Long-Term Care and Retirement Homes – Version 3, May 6, 2020” .

Essential visitors who fail the screening will not be permitted to enter. Advise them to contact their health care provider, Telehealth Ontario, or visit wechu.org/coronavirus [2] for more information. Staff who fail the screening process should be sent to the assessment centre for testing and public health should be notified.

Consider the following when implementing an active screening process:

All LTCHs should instruct staff to continuously self-monitor [4] for symptoms of COVID-19. All LTCH staff should be aware of the early signs and symptoms of acute respiratory infection (such as fever, cough, shortness of breath). If a staff member is required to self-isolate they must NOT come to work and must report their symptoms to the LTCH

Daily Health Monitoring of Residents

Long-Term care homes must conduct active screening of all residents, at minimum twice daily (at the beginning and end of day). If any resident has typical or atypical symptoms of COVID-19. This regular check must include temperature checks.

Shelters, Group Homes & Co-Living Settings

Persons experiencing homelessness, those with underlying medical conditions and those living in congregate settings may be at heightened risk for infection during the COVID-19 -pandemic. This information is intended for staff and volunteers who work in these settings to support response planning and the prevention and management of COVID-19 in their environments. The following information is based on the guidance and recommendations provided by the Ministry of Health.

Screening and monitoring clients/residents

Failed Screening/ Positive Test for COVID-19:

If a resident/client fails the screening procedure and/or tests positive for COVID-19 and will be required to self-isolate, there should be a designated room that has been predetermined and is used solely for that purpose. Ensure the room at the following amenities:

If the residents’ symptoms get worse (e.g., severe difficulty breathing, severe chest pain, confusion, loss of consciousness), call 911. Inform EMS of symptoms.

All staff, volunteers, residents and shelter guests should follow routine infection prevention and control practices to prevent and control the spread of germs.

Training Resources

Long-Term Care and Retirement Homes

Public Health Ontario (PHO) has a series of free infection prevention and control (IPAC) educational resources for those who work or visit LTCH and RH facilities.

These resources are intended to strengthen IPAC practices and provide an opportunity for staff to review and refresh their training. There are also resources for families and caregivers to help increase their understanding of important IPAC practices.

COVID-19 IPAC Fundamentals Training is free and available on PHO’s website. The training is tailored to four specific roles:

  • Clinical staff (e.g., registered nurses, registered practical nurses, personal support workers, physicians, therapists and social workers)
  • Non-clinical staff (e.g., environmental cleaning, dietary, maintenance, and administrative staff)
  • Family/visitors/ other caregivers (e.g., volunteers, faith leaders)
  • Inspectors (e.g., public health inspectors, LTC and RH inspectors)

The following is a FREE presentation offered for long-term care homes pertaining to outbreak management and infection control practices, in light of COVID-19.

Please note that the information in this presentation is current as of March 27, 2020. For the most up-to-date Ministry guidance documents and directives, please review the Restrictions & Guidance page.

You can also watch this video on Youtube 

Guidance Documents and Resources

Shelters/Group Homes/Co-living Settings

COVID-19 Guidance for Homeless Shelters Presentation

The following is a FREE presentation offered for staff and volunteers at homeless shelters that provides education about infection control practices and best practices to reduce the risk of COVID-19.

You can also watch this video on Youtube 

COVID-19 Guidance for Group Homes/Co-living Settings

The following is a FREE presentation offered for staff and volunteers at group homes/co-living settings that provides education about infection control practices and best practices to reduce the risk of COVID-19.

You can also watch this video on Youtube 

Guidance Documents:

  • Requirements for the Home including new admission and re-admissions
  • Visitor requirements including COVID-19 testing results and types of visits (outdoor, indoor)
    • Active screening
    • New Admission and re-admission
    • Repatriation
    • Short-stay absences
    • PPE
    • Visitor Restrictions and Testing Requirements
    • Essential visitors
    • Work locations
    • Staff and resident co-horting
    • Outbreak guidance
    • Case management
    • COVID-19 Testing
    • Communications
    • Food and product deliveries
    • Determine the entrance where a table and a staff member(s) will set up a screening station for all incoming individuals
    • Provide a script for screening that includes a process for handling visitors or staff who fail the screening
    • Post up signage [3] to alert all patients, staff, residents, and visitors of the active screening process
    • Ensure that alcohol-based hand rub (ABHR) with 70 – 90% alcohol, facial tissues, and procedure masks are available at the active screening desk
    • State clear rules at the entrance to allow or prohibit entry
    • Provide a handout to visitors explaining the changes
    • Immediately isolate any residents with respiratory illness or fever.
    • Ensure that staff Personal Protective Equipment (PPE) is available near the point of care for all residents and that staff do not have to walk far to access it.
      • PPE includes disposable gowns, gloves, procedural masks and eye protection.
      • Garbage bins and ABHR should be available immediately outside the room.
    • If needed, signage for additional precautions should be posted immediately outside the room.
    • All symptomatic residents must be tested for COVID-19
    1. Do you have a fever, new or existing cough, or difficulty breathing?
    2. Have you travelled outside Canada in the last 14 days?
    3. Have you been in close contact with someone who has been tested positive or awaiting results for COVID-19?
    4. Have you been in close contact with a person with acute respiratory illness who has travelled outside Canada in the last 14 days?
    5. Take temperature reading (if 37.8 degrees Celsius or more fail test)
    • Post signage on the entry door and throughout the residence to prompt anyone to self-identify to staff if they feel unwell or screen positive for COVID-19 symptoms.
    • Staff should keep a log of residents and include names and times of entry/exit.
    • Those that are conducting screening should do so at the main entrance (all other entrances should be restricted) and maintain a physical distance of 2-metres – consider placing markings on the floor indicating how individuals are expected to distance themselves
    • Anyone exhibiting signs of illness (e.g., coughing, sneezing) or indicate that they are not feeling well should be given a surgical/procedure mask and be required to put it on.
    • All staff, volunteers and returning residents/clients must be actively screened upon entry for COVID-19 and/or respiratory illness using the COVID-19 Self-Assessment Screening Tool, and monitored for COVID-19 symptoms daily.
    • If the individual being screened answers ‘no’ to all questions, they have passed the screening and can enter the building. They should be reminded of hygiene and distancing requirements.
    • If the individual answers ‘yes’ to any of the screening questions or refuses to answer, they have failed the screening. Give the individual a surgical/procedure mask if they have symptoms and hand sanitizer.
      • If it is a staff member or volunteer, let them know they cannot enter and should go home, self-isolate and contact their healthcare provider, the WECHU (519-258-2146 ext. 1420), or Telehealth.
      • If it is a resident, immediately isolate the individual into a separate room that has been predetermined and is used solely for that purpose, and call the WECHU (519-258-2146 ext. 1420) to arrange for testing.
    • A door that can be closed
    • Access to a private bathroom for the unwell resident to use. If this is not available, develop a schedule for the shared bathroom, ensuring the unwell person uses it last, and it is followed by thorough cleaning and disinfection.
    • If a private room for isolation is unavailable, and the room will need to be shared by both well and unwell individuals, ensure:
      • There is good airflow in the room (open windows if the weather permits)
      • Residents are kept 2-metres away from each other
      • Unwell person should wear a mask
      • Individuals should be provided with hand sanitizer
    • If a room must be shared by more than one unwell individual with confirmed COVID-19, these individuals do not need to wear a mask.
    • Avoid housing people with underlying conditions in the same room as people with symptoms.
    • Individuals in isolation should be provided a boxed meal so they can eat in the room they are isolated to.
    • Provide these individuals with a plastic lined garbage, hand sanitizer and tissues at their bed/beside them to cover coughs, easily clean hands and dispose of materials.
    • Symptoms should be monitored several times per day.
    1. Engage in regular and frequent hand hygiene practices:
      • Hands should be washed with soap and water or hand sanitizer (with a concentration between 70% & 90%) for 15-20 seconds.
      • It is recommended to use disposable paper towels when drying hands.
      • Group homes and shelters should post hand-washing posters in visible locations around the setting (e.g., washrooms, kitchen, above sinks and near hand sanitizer dispensers).
      • If wall-mounted hand sanitizers are not possible, consider providing portable hand sanitizers to staff, residents, and clients.
    2. Engage in proper respiratory etiquette:
      • Everyone should cover their nose/ mouth with a tissue, or into the bend of the arm when coughing and sneezing (do not sneeze or cough into hands). Any used tissues should be disposed of in the garbage, and hands should be washed immediately after.
      • Post Proper Cough & Sneeze Practice Poster in visible locations around the setting and staff/volunteers should frequently remind residents about good respiratory etiquette.
      • Staff/volunteers should ensure that cleaning and disinfection in the facility is performed on a routine and consistent basis. Special attention should be paid to high-touch surfaces (e.g., doorknobs, light switches), common areas (e.g., dining rooms, bathrooms) and shared equipment (e.g., telephone, keyboards).
    3. Practice physical distancing (maintaining at least 2 metres of distance) to limit the number of people that individuals come into close contact with.  
      • Consider re-arranging furniture to assist with promoting physical distancing.
      • Educate residents and staff/volunteers to maintain a 2 metre distance from each other.
      • Create visual cues, such as tape on the floor to remind individuals about maintaining their distance.
    4. Avoid Sharing of Personal/ Household Items:
      • Residents should not share personal items with others (e.g., food, drinks, personal hygienic items).
      • Where possible, personal items should be kept separately for each resident.
      • Clean all items that may be used by multiple people between uses (e.g., toys, telephone, computer).
    5. Follow proper cleaning and disinfection protocol
      • Public Health Ontario Resource on Cleaning and Disinfection for Public Settings

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Last modified: 
Wednesday, September 9, 2020 - 3:15pm