COVID-19 (coronavirus) – Frequently Asked Questions (FAQs)
RETIREMENT HOME RESIDENTS AND THEIR FAMILIES
Current as of June 2021
(Please note our FAQs are in the process of being updated to reflect the latest changes. Please refer to Directive #3, Retirement Homes Policy to Implement Directive #3, and our Scenario Matrix for current information.)
VISITORS TO RETIREMENT HOMES AND ACTIVE SCREENING – updated June 2021
For visitation requirements and recommendations, please see the Retirement Homes Policy to Implement Directive #3.
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:
- 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: What rules will visitors have to follow?
A: Prior to each visit, the visitor must:
- Pass active screening every time they are on the premises of or enter the home. They should not be allowed to visit if they do not pass the screening
- The visitor will comply with the home’s infection and prevention control protocols (IPAC), including proper use of masks.
- Visitors should use a mask which covers their face at all times if the visit is outdoors. If the visit is indoors, a surgical/procedure mask is required. Visitors are responsible for bringing their own masks.
- Education on all required protocols will be provided by the home.
- Any non-adherence to these rules could be the basis for discontinuation of visits.
- The visitor must only visit the indoor/outdoor area or suite they are intending to visit, and no other resident.
Visitors do not need to attest (verbally or in writing) they have received a negative COVID-19 test.
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: Who is an essential visitor?
A: 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 testing), or a person visiting a resident who is very ill or requires end-of-life care.
- 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 CMOH directives
- Are the only type of visitors allowed when a resident is self-isolating or symptomatic, or a home is in an outbreak.
The essential visitor must visit only the one resident they are intending to visit, and only visit the designated indoor or outdoor area 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 mask at all times if the visit is outdoors, in a manner aligned with Directive #3. If the visit is indoors, a surgical/procedure mask for source control is required. 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.
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.
RESIDENTS LEAVING AND RETURNING TO THE HOME – updated December 2020
Q: Can my loved one leave their retirement home?
A: Retirement home residents who wish to go outside of the home (e.g., absences with friends or family, shopping, medical appointments, etc.) are permitted to do so if the following requirements are met, according to the Retirement Homes Policy to Implement Directive #3:
For an absence that does NOT include an overnight stay:
- Upon return to the home, residents must be actively screened and monitored for symptoms but are not required to be tested or self-isolate.
- 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, opt to supply face coverings/masks for absences.
- Education on all required protocols for short absences, such as IPAC and PPE, will be provided by the home
Homes in outbreak will put a hold on starting new absences. Short absences for essentials (e.g. groceries, medical appointments, filling prescriptions) may be continued.
For home in Alert and High Alert Areas, Retirement home residents may be permitted to leave the home to meet essential needs (e.g., groceries, medical appointments, filling prescriptions).
For an absence that includes at least one overnight stay:
For homes in outbreak, Overnight absences not allowed and there is a hold on new absences.
For homes in Alert and High Alert areas, overnight absences are not permitted. Retirement home residents may be permitted to leave the home for a few hours to meet essential needs (e.g., groceries, medical appointments, filling prescriptions).
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 been cleared of COVID-19 24-hours before move-in do not need to undergo 14-days of self-isolation (e.g., individual was positive and is no longer positive).
There are no restrictions on residents returning to the home from outpatient visits. 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.
ACTIVITIES IN THE HOME – updated February 2021
Q: Why hasn’t my/my loved one’s home stopped communal dining or group activities?
A: Retirement homes are required take all reasonable steps to follow the recommendations and directives from the Chief Medical Officer of Health. Retirement homes are to maintain physical distancing of two meters wherever possible. In smaller homes, where this is not possible, all residents and staff are to be managed as if they are potentially infected and wear appropriate PPE when around residents in such environments. Retirement homes are required to follow their infection prevention and control policies which may require further changes to communal activities in the event of an outbreak of an infectious disease. In the event of a confirmed COVID-19 case, homes are required to contact public health for additional instructions.
Social activities where public health measures can be maintained are permitted if they are:
- Consistent with CMOH Directives, provincial orders, including group size*, and any additional advice from the local PHU.
- Organized in such a way to maximize resident and staff safety. Home must ensure Participants and activity facilitators:
- Maintain physical distancing of at least 2 metres at all times;
- Adhere to IPAC measures;
- Conduct activities in designated areas;
- Ensure enhanced environmental cleaning of designated areas prior to and following activities; and
- Wear face coverings/masks (if tolerated).
Retirement Homes are subject to the Ontario government’s restrictions on social gatherings*:
- Max 10 people at an indoor event or gathering
- Max 25 people at an outdoor event or gathering (previous limit of 100).
*this does not apply to communal dining in Retirement Homes
Group activities are not permitted for homes in outbreak, Alert or High Alert areas.
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:
All new admissions from the community or from a hospital (including ALC patients) to a retirement home must be tested for COVID-19 and have a negative result and is transferred to the home within 24 hours of receiving the result or is confirmed infected and cleared of COVID-19. Residents being admitted who have been confirmed infected and then cleared of COVID-19 before move-in do not need to undergo 14-days of self-isolation.
A new admission still must isolate for 14 days and then be tested with negative result at the end of 14 days. A negative result does not rule out the potential for incubating illness and all new residents who have not been previously cleared of COVID-19 must remain in isolation under Droplet and Contact Precautions for a 14-day period following arrival.
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, and is tested again at the end of self-isolation, with a negative result. If the result is positive, the resident must complete another 14-days of self-isolation.
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.
ISOLATION OF RESIDENTS AND INFECTION PREVENTION AND CONTROL (IPAC) PROGRAM PROTOCOLS – updated June 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.
COVID-19 INFORMATION SOURCES – updated April 2020
Q: I’m overwhelmed by all of the information about COVID-19. Where do I get the best information?
A: The Ministry of Health website and your local public health unit website will have the most up-to-date information.
RHRA’s OPERATIONS DURING COVID-19 PANDEMIC – updated May 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 firstname.lastname@example.org. 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: 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 will be deferring our routine inspections on a temporary basis however continue to focus on complaint, mandatory report and compliance inspections. We will make every effort to limit the need to enter retirement homes for those inspections we do conduct and when it can’t be avoided, we will of course take every precaution in line with the recommendations of Public Health. We are also taking significant precautions with our inspections staff recognizing that they may visit multiple locations. RHRA Inspectors have completed Public Health Ontario’s Infection Prevention and Control Core Competencies training course and carry appropriate personal protective equipment (PPE).
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.