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Long-term Care Homes & Shelters

COVID-19 information and resources for Long-term Care Homes, Retirement Homes and Shelters

Visiting

  • General visitors, including children under age 5, can visit
    • Visitors under 14 years of age must be accompanied by an adult
    • Homes should ensure physical distancing (at least 2 metres) between groups
  • Mask use
    • Indoor visits – essential and general visitors must wear a medical mask
    • Outdoor visits – essential visitors must wear a medical mask; general visitors must wear a medical or non-medical mask
  • Number of visitors
    • Indoor visits – up to 4 visitors (including caregivers) per resident
    • Outdoor visits – no limit on number of visitors
  • Screening and testing requirements
    • Indoor visits – active screening prior to entering; testing is required (see Directive)
    • Outdoor visits – active screening prior to entering ; testing not required
  • There are no provincial directives requiring vaccination for visitors. However, visitors should always follow the vaccination policy of the individual long-term care home.

Note: Only essential visitors are allowed during outbreaks or when a resident is in isolation.

Additional Restrictions

  • Anyone who is required to quarantine by the Government of Canada AND anyone in the same household as a person required to quarantine is not permitted to enter a long-term care home.
  • Individuals who have travelled outside of Canada (including the US) must undergo rapid antigen testing prior to entering a LTC home, regardless of their vaccination status. Each test is valid for 48 hours.
  • Residents who travel outside of Canada (and therefore do not pass the screening requirements upon return) must be permitted entry as per Directive 3, isolated on Droplet and Contact Precautions and tested for COVID-19.

Reference:

COVID-19 Guidance Document for Long-Term Care Homes in Ontario

  • General and essential visitors can visit. All general visits should have the following measures:
    • Homes should ensure equitable visitor access for residents who are not isolating
    • Visits should be booked in advance
    • Visitors should wear a medical mask, maintain physical distancing, and perform hand hygiene
    • Residents should be strongly encouraged to wear a mask for the visit
    • Opening windows should be considered for indoor and in-suite visits
  • Number of visitors
    • Will be based on the capacity of the location where the visit will take place
    • Should allow for sufficient space for physical distancing
  • Screening and testing requirements
    • All visitors must be actively screened and demonstrate a negative antigen POCT result to be permitted entry for an indoor visit. This does not change based on vaccination status.
  • Vaccination requirements
    • Unvaccinated general and essential visitors are allowed, as long as they pass the screening
    • Only fully vaccinated general visitors may participate in home activities, gatherings, events, and resident dining

Note: Only essential visitors are allowed during outbreaks or when a resident is in isolation. At that time, essential visitors must also demonstrate a negative antigen POCT.

Reference:

Retirement Homes Policy to Implement Directive #3

  • General visitors are now permitted.
  • Number of visitors
    • Up to 2 visitors for indoor visits
  • Screening and testing requirements
    • Active screening prior to entering
    • Testing is not required
  • Additional protocols include:
    • Wearing of masks at all times for both indoor and outdoor visits
    • Visits must be scheduled in advance
    • Outdoor-only visits are encouraged, when possible
    • Facilities must keep a record of visitors and completion of screening
  • It is recommended to contact the facility directly prior to your visit, to confirm the protocols.

Note: this guidance applies to congregate living settings as defined in the COVID-19 Action Plan: Vulnerable People. Adult correctional institutions are not included in this guidance; separate guidance has been created for corrections.

For more information, read the Guidance for Congregate Care Settings.


Directives for Long-Term Care and Retirement Homes

For current COVID-19 orders, directives, memorandums and other resources from the Ministry of Health and Long-Term Care, please click here.

Screening and Testing Requirements

  • All individuals must be screened prior to entry into the home.
  • Symptom screening is required once per day for residents in the home, unless requirements related to return/admissions/transfers apply.
  • All fully vaccinated staff, students, volunteers and caregivers must be tested 2 times per week at a minimum.
  • General visitors and support workers require proof of negative test upon entry, taken on the day of the visit, regardless of vaccination status.
  • Testing is not required for infants under 1 year of age.
  • Individuals who show proof of a confirmed COVID-19 infection in the past 30 days should not be re-tested, except with the onset of symptoms or if they’ve travelled outside of Canada in the last 14 days.

Vaccination

  • There are no provincial directives requiring vaccination. However, staff and visitors should always follow the vaccination policy of the individual long-term care home.

Activities

  • Adult day programs, entertainers, and external personal care services are permitted in the home.
  • Cohorting is required for dining. Cohorting is no longer required for other social activities.
  • Larger social group activities where potential crowding can occur should continue to be avoided and IPAC measures should be followed by staff, residents, and visitors (e.g. masking, distancing, good ventilation).

Infection Prevention and Control (IPAC)

Absences/Admissions/Transfers

All long-term care homes must establish and implement policies and procedures for resident absences. At a minimum, the policies must set out the definitions, requirements, and conditions described below.

  • For all absences, residents must be:
    • Provided with a medical mask when they are leaving the home
    • Provided a handout that reminds residents and families to practice public health measures (e.g. physical distancing, hand hygiene) when outside of the home
    • Actively screened upon their return to the home
  • Homes cannot restrict or deny absences for medical or palliative or compassionate reasons at any time. This includes when a resident is in isolation or when a home is in an outbreak, as per Directive #3.
  • Return from day absences (medical, compassionate, or short-term)
    • Rapid antigen test and PCR test on day 5 following the absence
      • Or two rapid antigen tests 24hrs apart (days 5 & 6) if no PCR test is available
    • No isolation required (unless a positive test result)
    • Residents who go on daily/frequent absences must have a laboratory-based PCR test and rapid antigen test on the same day, two times per week
    • If a resident has a known exposure during an absence, they must be treated as a high risk contact:
      • Residents with 3+ doses of a COVID-19 vaccine – isolate until a PCR test on day 5 is negative
      • Residents who do not have 3 doses of a COVID-19 vaccine – isolate for 10 days with a PCR test on day 5
  • Return from overnight absences (temporary, medical, or compassionate)
  • Going on and return from off-site excursions
    •  Where an excursion involves transporting residents in a vehicle:
      • Residents should be cohorted
      • Physical distancing should be maintained to the maximum extent possible
      • Home should encourage consistent seating and maintain seating records
      • Residents must be actively screened upon their return to the home
    • The same testing and isolation rules as day absences apply.
      • Rapid antigen test and PCR test on day five following the absence
      • No isolation is required unless there is a positive test result
      • If a timely PCR test is not available, two rapid antigen tests 24 hours apart may be used as an alternative

References:
COVID-19 Guidance Document for Long-Term Care Homes in Ontario (sections 11 & 12).

Directive #3 for Long-Term Care Homes

Mask Use

  • Removal of masks for eating should be restricted to areas designated by the home.
  • All staff must wear surgical/procedure masks at all times, indoors and outdoors, regardless of their vaccination status.
  • Staff providing care or interacting with a suspected, probable, or confirmed case of COVID-19 must wear (reference: Directive #5):
    • A fit-tested, seal-checked N95 respirator (or approved equivalent)
    • Eye protection (face shield, safety glasses with side protection or goggles)
    • Gown
    • Gloves
  • General visitors
    • A medical mask is required for the entire duration of indoor visits.
    • A medical or non-medical mask is required for the entire duration of outdoor visits.
  • Residents
    • Homes are required to have policies regarding masking for residents.
    • There is no requirement for residents to wear a mask inside the home.
    • Homes’ policies must set out that residents are encouraged to wear or be assisted to wear a medical or non-medical mask when receiving direct care from staff, in common areas with other residents (except meal times), and when receiving visitors.
  • Exceptions to the masking requirements:
  • Homes must also have policies for individuals (staff, visitors, or residents) who:
    • Have a medical condition that inhibits their ability to wear a mask
    • Are unable to put on or remove their mask without assistance form another person

Protocols for Shelters, Group Homes, and Co-Living Settings

This guidance applies to congregate living settings as defined in the COVID-19 Action Plan: Vulnerable People and the Ministry of Health’s COVID-19 Guidance: Congregate Living for Vulnerable Populations document. Adult correctional institutions are not included in this guidance; separate guidance has been created for corrections.

Screening Requirements

  • Residents should be assessed at least once per day, including temperature checks if possible.
  • New resident admissions should be screened appropriately.
  • Staff should monitor residents who may not be able to self-monitor, such as children and adults with developmental disabilities.
  • Staff and visitors should be screened at the start and end of each shift/visit.
    • Only staff and visitors who pass COVID-19 screening should be allowed to enter.
  • All congregate living settings should use passive (using signage) and active (asking questions) screening for residents, staff, and visitors.
  • Signage should be posted on every entry door and throughout the setting to prompt anyone to self-identify if they feel unwell or screen positive.
  • If a resident/client has to self-isolate:
    • There should be a predetermined, designated room that is used solely for that purpose.
      • Should include a door that closes.
      • If feasible, includes access to a private bathroom.
    • If there is not enough space in the congregate living setting for the resident to self-isolate, the resident may be cohorted with others who are in the same situation, while maintaining as much distance as possible from other individuals/groups who are not ill.
    • If a resident’s symptoms get worse (severe difficulty breathing, severe chest pain, confusion, loss of consciousness), call 911. Inform EMH of symptoms/test result.

Mask Use

  • All staff and visitors must wear a mask when indoors. Staff should wear a mask at all times, indoors and outdoors.
  • Residents must wear a mask in common areas if physical distancing cannot be maintained.
  • Medical masks are preferred for staff, residents, and visitors.

Other Public Health Recommendations

  • All staff, volunteers, residents, and visitors should follow routine infection prevention and control practices (e.g. disinfecting surfaces, hand hygiene).
  • Physical distancing of 2 metres should be maintained as much as possible.
  • Wherever possible, employers should work with staff and unions (if applicable) to limit the number of work locations where staff work, in order to minimize risk.

Additional Resources

Long-Term Care Homes and Retirement Homes FAQs

Restrictions surrounding visitors to Long-Term Care and/or Retirement Homes change regularly based on current pandemic conditions. For the most up-to-date information, please visit our Visiting a Long-Term Care or Retirement Home webpage. General requirements and/or restrictions can be found below.

As of December 30th, 2021, general visits to Long-Term Care Homes have been paused. Only designated caregivers may continue to enter Long-Term Care Homes.

The following applies when a Long-Term Care home is NOT in Outbreak

Generally, visitors are permitted in a Long-Term Care home if they meet the following criteria:

  • Visitors must be fully vaccinated to have an indoor visit
    • Infants under 1 year of age are not considered visitors and are permitted
    • Children under the age of 5 are not permitted to visit indoors at this time as they are not currently eligible for vaccination.
    • Fully vaccinated children age 5 and up are permitted.
  • Visitors must be tested each time they attend a long-term care home unless they have a negative test from the previous day. Testing is required for both indoor and outdoor visits.
  • Up to 2 visitors are permitted at a time indoors. Up to 4 people are permitted at a time outdoors.

If a Long-Term Care home is in Outbreak

Essential visitors are the only type of visitors allowed when there is an outbreak or when a resident is in isolation. Essential visitors must wear a medical mask for the entire duration of their shift or visit, both indoors and outdoors, regardless of their immunization status, per Directive #3 unless exceptions in the directive or this document apply.

General visitors are not permitted:

  • when a home or area of a home is in outbreak
  • to visit an isolating resident
  • when the local public health unit so directs

Please read the “Visitors” section on the COVID-19 Guidance Document for Long-Term Caren Homes in Ontario for more details on the definitions of essential visitors and general visitors.

Yes. All staff, students, volunteers, and caregivers, (regardless of their vaccination status) are required at minimum to be tested 2 times per week, in addition to existing testing requirements for those not fully vaccinated.

  • General visitors and support workers (regardless of their vaccination status), require
    proof of negative test upon entry, taken the day of the visit, or on a previous day. Testing is also required for outdoor visits.
  • Testing not required for infants under one year of age.
  • Individuals who show proof of a confirmed COVID-19 infection in the past 30 days should not be re-tested except with the onset of symptoms or if they’ve travelled outside of Canada in the 14 days prior to entering a home.

At least once daily, residents must be assessed for signs and symptoms of COVID-19 including temperature checks as a way to quickly identify illness. If a resident has fever, cough or other symptoms of COVID-19 or mild respiratory and/or atypical symptoms they must be isolated and get tested as per the COVID-19: Provincial Testing Requirements Update.

Long-term care and retirement homes must implement active screening, including a temperature check of all staff, visitors, and anyone else entering the home (residents returning from a visit) for COVID-19 except emergency first responders, who should, in emergencies, be permitted entry without screening. Active screening is required regardless of vaccination status.

The COVID-19 Screening Tool for Long-Term Care Homes and Retirement Homes checks exposure and proper recent PPE usage. Active screening is required once per day at the beginning of a shift or visit and includes a temperature check after the questionnaire is passed.

According to this updated Ministry of Health COVID-19 Provincial Testing Guidance Update Document: In the event a resident living in a long-term care or retirement home develops symptoms of COVID-19, asymptomatic residents, regardless of immunization status, living in the same room should be tested immediately along with the symptomatic resident under the direction of local public health.

For asymptomatic residents who have been identified as a close contact of a known case, regardless of their vaccination status, a negative result should not change public health management as the individual may still be in their incubation period. Re-testing of asymptomatic individuals who initially test negative is recommended if they develop symptoms.

If a staff or visitor develops COVID-19 symptoms they are advised to go home immediately, to self-isolate and encouraged to be tested for COVID-19 using a lab-based PCR test.

The Health Unit may also, based on a risk assessment, determine if any additional testing is required and its frequency.  There maybe re-testing of asymptomatic individuals who initially tested negative if they develop symptoms.

As part of the updated Ministry of Health’s COVID-19 guidance document for long-term care homes, any single confirmed case of COVID-19 who is a resident of a long-term care home or retirement home is considered a suspect  outbreak for COVID-19. 

A confirmed outbreak in a home is defined as two or more lab-confirmed COVID-19 cases in residents and/or staff (or other visitors) with an epidemiological link, within a 14-day period.

An essential visitor prior to visiting a resident where the home is in an outbreak should provide have training on how to safely provide direct care, including putting on and taking off required PPE, and hand hygiene. If the home does not provide training it must direct caregivers and support workers to the appropriate resources from Public Health Ontario such as:

For homes not in outbreak every month the home’s visitor policy should ensure that visitors follow Public Health Ontario recommendations on IPAC and PPE training.

Surveillance testing is the proactive COVID-19 testing of individuals. Surveillance testing helps WECHU better understand the current state of COVID-19 infections in our region. The test results provide a snapshot of current infections and are used to track where the virus has spread. WECHU follows up immediately with homes and individuals (staff) if there is a positive test result.

Homeless Shelters & Group Homes/Co-Living Settings FAQs

Unless you are a healthcare facility, personal protective equipment should be ordered through your regular supplier. A list of PPE suppliers is available on the Ontario’s Workplace PPE Supplier Directory webpage.

  • Routine cleaning followed by disinfection is a best practice to prevent the spread of COVID-19. Facilities should follow their protocols for regular cleaning and disinfection.
  • Commonly used cleaners and disinfectants are effective against COVID-19. Check the expiry date before using cleaners and disinfectants, and always follow the manufacturer’s directions for use to ensure their effectiveness.
  • In addition to routine cleaning, high-touch surfaces should be cleaned and disinfected at least once per day, and when visibly dirty. Examples of high-touch surfaces include doorknobs, handrails, light switches, toilet handles, and faucet handles.
  • Recommend posting a cleaning and disinfecting schedule
  • Remove shared items that are difficult to clean.

For more information about cleaning and disinfecting for co-living settings:

If the facility is NOT in outbreak:

  • Staff and visitors should wear a non-medical mask (e.g. cloth mask) at all times except when eating or alone in a private space.
  • Residents should wear a non-medical mask (e.g. cloth mask) as all times if healthy and have no symptoms of COVID-19.
    • If resident has symptoms or has been directed to isolate, a medical mask should be worn.

If the facility is IN Outbreak:

  • Staff and visitors should wear a medical mask as all times except when eating or alone in a private space.
  • Eye protection and gowns should be worn when interacting with residents. Gloves should be worn when providing direct care to a resident (e.g. bathing, feeding).
  • Residents should wear a medical mask at all times.

For a helpful guidance document from Public Health Ontario that outlines PPE requirements in congregate living settings, please review “COVID-19: Personal Protective Equipment and Non-Medical Masks in Congregate Settings

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