COVID-19 Updates and Resources for Residents and Families

The Retirement Homes Policy to Implement Directive #3 is available here

Current as of May 2021.

The RHRA is closely monitoring developments related to COVID-19 and is ready to assist local health authorities should an outbreak at a retirement home occur.

The RHRA’s primary concern is the health and safety of seniors living in Ontario retirement homes.

Please see RHRA’s COVID-19 FAQ for Residents and Families

VISITORS TO RETIREMENT HOMES AND ACTIVE SCREENING – updated April 2021

 

Q: What is the current Retirement Home Visitors Policy?

A: As of June 18, the Chief Medical Officer of Health has directed that retirement homes can allow visits for retirement home residents. There are two types of non-essential visitors:

A general visitor is a person who is not an essential visitor and visits:

  • To provide non-essential services (may or may not be hired by the home or the resident and/or their substitute decision maker);
  • For social reasons (e.g., family members or friends); and/or
  • A prospective resident taking a tour of the home.

If not in outbreak, a maximum of 2 general visitors per resident at a time may visit that resident.

If in an Alert area, as maximum of 1 general visitor per resident at a time may visit that resident

If in outbreak, in a High Alert area, or the resident is self-isolating or symptomatic, general visitors are not allowed.

A personal care service provider is a person who is not an essential visitor and visits to provide personal services to residents such as hair dressing and nail care.

If not in outbreak, A maximum of 1 personal care service provider per resident at a time

If in outbreak, in an Alert or High Alert area, or the resident is self-isolating or symptomatic, personal care service providers are not allowed.

The home must also first meet baseline requirements to allow any visitors:

  • The home has developed procedures for the resumption of visits and a process for communicating these procedures with residents, families and staff, including but not limited to infection prevention and control (IPAC), scheduling and any setting-specific policies. Dedicated areas for both indoor and outdoor visits to support physical distancing between residents and visitors.
  • Protocols to maintain the highest of IPAC standards prior to, during and after visits.
  • A list of visitors available for relevant staff to access
  • Protocols for record keeping of visitations for contact tracing purposes

Homes are required to develop visitor policies that reflect their unique circumstances, comply with CMOH Directive #3 and the Retirement Homes Policy to Implement Directive #3.

Q: Who is an essential visitor and what are the rules for essential visitors in retirement homes?

A: An essential visitor is a person performing essential support services (e.g., food delivery, inspector, maintenance, or health care services (e.g., phlebotomy)) or a person visiting a very ill or palliative resident. In addition to a person visiting a very ill or palliative resident, the Retirement Homes Policy to Implement Directive #3 provides for two additional categories of essential visitors:

Support Workers (essential visitor)

An essential visitor who is brought into the home when there are gaps in services to perform essential services for the home or for a resident in the home.

Caregiver (essential visitor)

An essential visitor who is designated by the resident and/or their substitute decision-maker and visits to provide direct care to the resident

According to direction from the Chief Medical Officer of Health, essential visitors:

  • Are defined as including a person performing essential support services (e.g., food delivery, inspector, maintenance, or health care services (e.g., phlebotomy) or a person visiting a very ill or palliative resident.
  • Providing direct care to a resident must use a surgical/procedure mask while in the home, including while visiting the resident that does not have COVID-19 in their room.
  • Who are in contact with a resident who is suspect or confirmed with COVID-19, must wear appropriate PPE in accordance with Directive #5 and Directive #1.
  • Are the only type of visitors allowed when a resident is self-isolating or symptomatic, or a home is in an outbreak or in an Orange, Red or Grey level.

The essential visitor must visit only the one resident they are intending to visit. Essential visitors are required to follow CMOH guidance when visiting, including physical distancing and the use of a face-covering at all times if the visit is outdoors, in a manner aligned with Directive #3. If the visit is indoors, a surgical/procedure mask must be worn at all times. Visitors are responsible for bringing their own masks. These visitors must continue to be actively screened on entry for symptoms of COVID-19. The essential visitor must also attest to not be experiencing any of the typical and atypical symptoms. Those who fail screening will not be permitted to enter.

In emergency situations, emergency first responders should be permitted entry without screening.

Q: What do homes have to do to prepare for visitors?

A: The following baseline requirements must be met prior to the home being able to accept any visitors:

  • The retirement home must NOT be currently in outbreak. In the event that a home has relaxed visitor restrictions and enters into an outbreak, all non-essential visitations must end.
  • The home has developed procedures for the resumption of visits and a process for communicating these procedures with residents, families and staff.
    • This process must include sharing an information package with visitors on Infection Prevention and Control (IPAC), masking, physical distancing and other operational procedures such as limiting movement around the home, if applicable, and ensuring visitors’ agreement to comply. Home materials must include an approach to dealing with non-adherence to home policies and procedures, including the discontinuation of visits.
  • Dedicated areas for both indoor and outdoor visits to support physical distancing between residents and visitors.
  • Protocols to maintain the highest of IPAC standards prior to, during and after visits.
  • Each home should create and maintain a list of visitors available for staff to access.

Additional factors that will inform decisions about visitations in retirement homes include:

  • Access to adequate testing: Home has a testing plan in place, based on contingencies informed by local and provincial health officials, for testing in the event of a suspected outbreak.
  • Access to adequate Personal Protective Equipment (PPE): Home has adequate supplies of relevant PPE.
  • Infection Prevention and Control (IPAC) standards: Home has essential cleaning and disinfection supplies and adheres to IPAC standards, including enhanced cleaning.
  • Physical Distancing: Where appropriate, home is able to facilitate visits in a manner aligned with physical distancing protocols.

Q: Are external care providers considered “visitors”?

A: Paid caregivers/companions are not visitors. They will be screened according to protocols set out for staff in the Chief Medical Officer of Health’s direction.

Q: What can I do if I can’t visit with my family or loved one?

A: Homes in outbreak cannot allow non-essential visitors. Family members and loved ones are strongly encouraged to follow the instructions given by the public health unit. It’s important to protect seniors during this time of uncertainty while not leaving them feeling isolated. The RHRA encourages you to use all means available to connect with loved ones, including by telephone or by using technology like Facetime or Skype. Families can speak with the retirement home to see what can be facilitated. Effective and frequent communication between the home, residents and families is imperative for the well-being of residents, and to alleviate concerns during this stressful time.

ISOLATION OF RESIDENTS AND INFECTION PREVENTION AND CONTROL (IPAC) PROGRAM PROTOCOLS – updated December 2020

 

Q: In what situations would residents be isolated/quarantined in the home/rooms?

A: If a home is instructed by the local public health unit to isolate a resident, the retirement home must adhere to the Public Health Unit’s instructions. All new admissions must be placed in self-isolation for 14 days. Any resident exhibiting symptoms of COVID-19 must be placed in isolation and tested. Maintaining the health of all residents is paramount.

Q: What is a retirement home required to do if they suspect a resident may have COVID-19 or has come into contact with someone with COVID-19?

A: A retirement home must immediately contact their local public health unit if they suspect a resident has COVID-19 or has come into contact with COVID-19. Any resident exhibiting symptoms of COVID-19 (including mild respiratory symptoms) must be placed in isolation and tested.

RESIDENTS LEAVING AND RETURNING TO THE HOME – updated December 2020

 

Q: Can my loved one leave their retirement home?

A: Retirement homes residents in Green and Yellow Level are permitted to leave the home for an absence that does not include an overnight stay (e.g., absences with friends or family, shopping, medical appointments, filling prescriptions, taking walks, etc.), with the exception of single-night emergency room visits, provided the following requirements are met:

  • The retirement home is NOT in an outbreak in or in a PHU under Orange (Restrict), Red (Control) or Grey (Lockdown) at the time the absence is to commence.
  • If a home allows absences but enters into an outbreak there should be a hold on starting new absences until the home is no longer in outbreak.
  • The local PHU has not directed the home to cease all short absences.
  • The home is compliant with all CMOH Directives and follow directions from the local PHU.
  • Upon return to the home, residents are actively screened and monitored for symptoms but are not required to be tested or self-isolate.
  • Residents must always wear a mask when outside of the home (if tolerated) and be reminded about the importance of public health measures including physical distancing. The resident is responsible for supplying a face covering/mask while they are on absences. The home may, at its discretion, supply face covering/masks for absences.
  • The home provides education on all required protocols for short absences, such as IPAC and PPE.

Retirement home residents in a home in a PHU under Orange (Restrict), Red (Control) or Grey (Lockdown) may be permitted to leave the home for walks or essentials (e.g., groceries, medical appointments, filling prescriptions), with the exception of also being permitted to leave for single-night emergency room visits. They must also meet the screening, face covering/masking, physical distancing and education requirements outlined above.

Homes in outbreak will put a hold on starting new absences.

For an absence that includes at least one overnight stay:

Retirement homes residents in Green and Yellow Level are permitted to leave the home for an absence that includes an overnight stay provided the following requirements are met:

·       The retirement home is NOT in an outbreak.o   Homes must establish compliance with all CMOH Directives for homes in outbreak and follow directions from the local PHU.

·       Residents must wear a face covering/mask at all times when outside of the home (if tolerated) and be reminded about the importance of public health measures including physical distancing. The resident is responsible for supplying a face covering/mask while they are on absences. The home may, at its discretion, supply face coverings/masks for absences.

·       Education on all required protocols for short-term absences, such as IPAC and PPE, will be provided by the home to the resident prior to their absence.

·       Upon return to the home, residents must self-isolate for 14 days under Droplet and Contact Precautions but are not required to be tested upon re-entry to the home.

·       Residents who are self-isolating for 14-days following an overnight stay may not receive general visitors, leave the home for short-term absences or for overnight stays.

For homes in outbreak, Orange, Red and Grey level, overnight absences not allowed and there is a hold on new absences.

Q: I/my loved one has gone to the hospital. Can the Retirement Home refuse take me/my loved one back to manage the risk of COVID-19 transmission in the home?

A: Hospitals may discharge patients to retirement homes where:

  • The receiving home is NOT in a COVID-19 outbreak
  • The resident has been tested for COVID-19 at point of discharge, has a negative test result and is transferred to the home not more than 24 hours of receiving the result
  • The receiving home has sufficient staffing and a plan to ensure that the resident being readmitted can complete 14-days of self-isolation and continue with other COVID-19 preparedness measures

Residents being admitted who have previously has lab-confirmed COVID-19 and have been cleared by the local PHU within the last 90 days prior to admission do not need to be re-tested and are exempted from self-isolation.

There are no restrictions on residents returning to the home from outpatient visits, but the home is encouraged to consult with the hospital about whether a more appropriate arrangement may be to keep residents with frequent hospital visits in hospital. Residents returning from outpatient visits to hospitals (e.g. visit for broken bone, medical appointment within the hospital, dialysis appointment) should undergo the required screening and monitoring when returning to the retirement home. Further, a COVID-19 test is not required in these circumstances.

For example, there may be a resident going to hospital for dialysis three times a week. Upon returning to the home, the resident must be screened. The retirement home would continue to actively screen the resident for signs and symptoms of COVID-19 twice daily, including the atypical signs and ensuring the home has a very high suspicion for the development of any signs in the resident. The home could also have good dialogue with the dialysis unit to see if there are any concerns on their end. The home would also want to ensure that the resident is performing hand hygiene, and the resident could wear a mask when going to appointments.

NEW RESIDENT ADMISSIONS – updated December 2020

 

For new resident admissions requirements and recommendations, please see the Retirement Homes Policy to Implement Directive #3

Q: Are homes allowed to admit new residents?

A: Homes currently in outbreak are NOT allowed to admit new residents. Under exceptional circumstances admissions may take place during an outbreak if it is approved by the local public health unit and there is concurrence between the home, public health and hospital.

For homes not in an outbreak, Alert or High Alert areas:

For homes not in an outbreak, Green*, Yellow, Orange and Red level:

  • The home must have a plan to ensure the resident being admitted (except for those who have cleared COVID-19) can complete 14 days of self-isolation, under Droplet and Contact Precautions and is tested again at the end of self-isolation, with a negative result.
  • Individuals must be placed in a single room on admission to complete their 14-day self-isolation
  • Other COVID-19 preparedness measures

*If in Green, an admission from the hospital may occur without the required 14-day self-isolation period provided that neither the hospital and the home are experiencing an outbreak and both the hospital and the home are located in Green (Prevent) areas. This transfer may occur if the individual has had a negative COVID-19 test within 24 hours of transfer. In the event that the test result is not available within the 24-hour period, the transfer can occur but the individual must remain in isolation at home until a negative test result is received. If this test result is positive, the individual must continue their self-isolation and the home must contact their local public health unit.

A new admission still must isolate for 14 days but are not required be tested with negative result at the end of 14 days. A negative result does not rule out the potential for incubating illness.  Residents being admitted who have previously has lab-confirmed COVID-19 and have been cleared by the local PHU within the last 90 days prior to admission do not need to be re-tested and are exempted from self-isolation.

Under all circumstances, the home must have sufficient staffing and a plan to ensure the resident being admitted (except for those who have been cleared of COVID-19) can complete 14-days of self-isolation under Droplet and Contact Precautions.

The resident must be placed in a room with no more than one other resident after self-isolation.

Q: Can family members help with move-in of new residents?

A:The Chief Medical Officer of Health has directed that retirement homes can allow visits for retirement home residents. The home must NOT be in outbreak.

RHRA understands that there are varying circumstances that surround moving resident’s belongings. In these cases, the home should consult with the local public health unit. Public health can provide guidance that considers factors specific to the situation, such as location and amount of the individual’s belongings, the risk of outbreak in the home and the community, etc.

RHRA’S OPERATIONS DURING COVID-19 PANDEMIC – updated December 2020

 

Q: What is the RHRA’s role in the event of an outbreak at a retirement home?

A: Homes are required by the Retirement Homes Act to have an Infection Prevention and Control (“IPAC”) program and are required to conduct active screening for signs and symptoms of illness. Retirement homes must contact their local Public Health Unit (“PHU”) if there are residents (and staff) with symptoms. Homes must report any COVID-19 outbreak to RHRA (in addition to reporting to Public Health). The report to RHRA must include the name of the home, licence number, number of positive resident cases, number of positive staff cases and public health contact. Licensees must send to info@rhra.ca. Homes must consider one laboratory confirmed case of COVID-19 in either a resident or staff member as an outbreak.

RHRA is proactively reaching out to homes and requires them to actively screen essential visitors, staff, residents, and anyone else entering the home (with the exception of first responders in emergencies) and take other precautions in response to the COVID-19 outbreaks.

The RHRA will take swift action if there is evidence that homes do not report or manage outbreaks in accordance with public health direction.

RHRA has regular communication to ensure retirement home sector issues are identified and raised with Ministry of Health through multiple levels/channels. RHRA also has a web page available here that is updated regularly with information and resources on COVID-19.

Q: Are RHRA inspectors still doing inspections? If so, what precautions do they take not to spread the virus?

A: Starting in November 2020the RHRA will resume routine inspections to ensure that homes comply with the Retirement Homes Act and regulations. Routine inspections will continue to focus on implementation of practices including IPAC protocols to protect residents and improve outcomes during the pandemic. Consistent with our regulatory modernization initiative to place greater emphasis on assessing the implementation of important policies and strategies in retirement homes, all routine inspections are unannounced.

RHRA inspectors will be taking every precaution in line with the recommendations of public health to ensure the safety of residents and staff. All inspectors have completed Public Health Ontario’s Infection Prevention and Control Core Competencies training course and carry appropriate PPE. Consistent with our current practice, RHRA will not be conducting routine inspections for homes in outbreak. 

Q: Is RHRA changing the approach to the implementation of the legislation and regulation during the COVID-19 situation? Are inspectors able to show more flexibility during this time?

A: We will take a pragmatic and flexible approach to how we regulate and take the evolving situation into account. Please refer to this March 15 RHRA special advisory for list of the ways RHRA is altering our approach during this time.

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Guidelines

As of July 1, 2012, homes that meet the definition of “retirement home” in the Act must have a licence from the RHRA to operate.

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Review the 2018 Fee Schedule before submitting your application.

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Complaints & reporting harm

Reporting harm is a shared duty. Certain situations involving harm or risk of harm to any resident must be reported immediately by law. Here’s how to report harm or potential harm.


How to File a Report

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RHRA Process

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A retirement home

A retirement home 1

There are over 700 licensed retirement homes in Ontario. Let us help you find the one that’s right for you.


#ICON

Status of home

Search the Retirement Home Database for a complete history of a retirement home's compliance with the Act.

Read More
#ICON

Types of homes

If you've never lived in a retirement home or haven’t needed long-term care, you may not be aware of the difference between the two. Here is what you need to know.

Read More
#ICON

I’m not sure how to start

Here, we’ll provide tools to help support your research.

Read More

A retirement home 1

There are over 700 licensed retirement homes in Ontario. Let us help you find the one that’s right for you.


#ICON

Status of home

Search the Retirement Home Database for a complete history of a retirement home's compliance with the Act.

Read More
#ICON

Types of homes

If you've never lived in a retirement home or haven’t needed long-term care, you may not be aware of the difference between the two. Here is what you need to know.

Read More
#ICON

I’m not sure how to start

Here, we’ll provide tools to help support your research.

Read More

A retirement home 1

There are over 700 licensed retirement homes in Ontario. Let us help you find the one that’s right for you.


#ICON

Status of home

Search the Retirement Home Database for a complete history of a retirement home's compliance with the Act.

Read More
#ICON

Types of homes

If you've never lived in a retirement home or haven’t needed long-term care, you may not be aware of the difference between the two. Here is what you need to know.

Read More
#ICON

I’m not sure how to start

Here, we’ll provide tools to help support your research.

Read More

A retirement home 1

There are over 700 licensed retirement homes in Ontario. Let us help you find the one that’s right for you.


#ICON

Status of home

Search the Retirement Home Database for a complete history of a retirement home's compliance with the Act.

Read More
#ICON

Types of homes

If you've never lived in a retirement home or haven’t needed long-term care, you may not be aware of the difference between the two. Here is what you need to know.

Read More
#ICON

I’m not sure how to start

Here, we’ll provide tools to help support your research.

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