COVID-19 (Coronavirus) – Frequently Asked Questions (FAQs)
RETIREMENT HOME OPERATORS
These FAQs are for informational purposes only. They do not constitute legal advice and are not a substitute for the applicable directives, recommendations, guidance or advice of the Chief Medical Officer of Health, or the other legal obligations of licensees, which licensees must know and follow.
Current as of April 3, 2020
RHRA’s OPERATIONS DURING COVID-19 PANDEMIC – updated March 31
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.
RHRA is proactively reaching out to homes and requires them to actively screen 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: 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.
Q: The latest RHRA Update said we have to do Behaviour Management training sooner for new hires than usual. What’s the rationale behind this?
A: Evidence collected shows that behaviour management is a high risk of harm area. Also considering that this is a stressful time for residents and their visitors have been severely limited, having all staff trained on behaviour management as soon as possible and no later than within 4 weeks of hire is designed to mitigate the risk. Licensees are reminded that these timeframes are the maximum allowable given the circumstances and take into account some staff may not have immediate contact with residents. Homes should endeavour to have all staff fully trained as soon as possible in the priority order set out in the March 15 communication.
Q: How many homes are currently under quarantine? How many retirement home residents in Ontario currently have COVID-19?
A: Public Health Ontario is responsible for receiving reports of outbreaks from retirement homes, including influenza and coronavirus. Please visit the Ministry of Health website or your local public health unit website for the most up-to-date information.
VISITORS TO RETIREMENT HOMES AND ACTIVE SCREENING – updated March 31
Q: What is the current Public Health Retirement Home Visitors Policy?
A: In order to ensure a safe and secure environment for residents, the Chief Medical Officer of Health and RHRA have mandated that Retirement Homes are closed to visitors with the exception of essential visitors until further notice. No other visitors will be permitted at this time.
Q: Who is an essential visitor? What are the criteria for establishing an essential visitor?
A: According to the recommendation from the Chief Medical Officer of Health, essential visitors include a person performing essential support services (e.g. food delivery, maintenance, and other health care) or a person visiting a resident who is very ill or requires end-of-life care. The essential visitor must visit only the one resident they are intending to visit, and no other resident. They must wear a mask while visiting a resident without COVID-19 and if the resident does have COVID-19, appropriate PPE must be worn. These visitors must continue to be actively screened on entry for symptoms of COVID-19. Those who fail screening will not be permitted to enter. No other visitors should be permitted to enter these premises, instead they should be asked to keep in touch with loved ones by phone or other technologies, as available.
Q: Do I need to actively screen residents?
A: As per the Chief Medical Officer of Health’s directive, retirement homes must take all reasonable steps to conduct active screening of all residents at least twice daily (at the beginning and end of the day) to identify if any resident has fever, cough or other symptoms of COVID-19. Residents with symptoms (including mild respiratory symptoms) must be isolated and tested for COVID-19.
Q: Does RHRA have active screening resources available?
A: The Ministry of Health has an active screening checklist available here on the RHRA website.
Q: Are external care providers considered “visitors”?
A: Paid caregivers/companions are not visitors. The home should screen them according to protocols set out for staff in the Chief Medical Officer of Health’s direction.
Q: Visitors are insisting on seeing residents even after we’ve explained our outbreak protocols. What can we tell them?
A: The province of Ontario has declared a state of emergency and has adopted significant social distancing measures to help prevent the spread of COVID-19, including the Chief Medical Officer of Health’s requirement that only essential visitors be allowed into retirement homes. Please post this signage in your home. You can also provide the message from RHRA and this memo from Ontario’s Chief Medical Officer of Health. Accommodating interactions between residents and family through phone calls or video technology is encouraged.
Q: Many families are very upset about the policy re: essential visitors. What can we tell them?
A: The health and safety of all residents is our top priority. Staff are working hard to maintain the health of your loved one, and those in their community. The province of Ontario has declared a state of emergency, this is an unprecedented situation, and we need to take these steps to make sure COVID-19 doesn’t make its way into this home and that this situation is over as soon as possible.
Q: What can we do if residents and families refuse to follow public health directives?
A: RHRA takes seriously any contraventions of the public health directives, and RHRA will support retirement homes in complying with these directives. If a resident or family member is not following them, homes should consider all reasonable measures to persuade residents to comply. When deciding what measures to take to get residents to follow public health directives, the home should also consider the potential impacts these measures may have on individual residents.
Q: What can family members or loved ones do if they can’t visit?
A: Should a resident be isolated or quarantined, 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. For non-essential visitors, the RHRA encourages you to use other means to connect with loved ones, such as 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, their residents and families is imperative for the well-being of residents, and to alleviate concerns and reduce complaints.
SERVICES IN THE HOME – updated March 27
Q: Can a business that is deemed essential come into the home and offer their services?
A: No, Ontario’s list of essential businesses does not impact the Chief Medical of Health’s guidance that non-essential visitors are not permitted into retirement homes. A business that has been deemed “essential” is not considered an “essential visitor”. Essential visitors are defined by the Ministry of Health as those who have a resident who is very ill or requires end-of-life care. These essential visitors must continue to be actively screened into these settings.
Q: We have “service providers” such as hairdressers and entertainers come into the home. We don’t consider them visitors. Are they allowed to enter?
A: Service providers, such as entertainers or hairdressers who do not provide care, should be treated as visitors. If they do not meet the definition of an essential visitor they should not be permitted into the home.
EMERGENCY CHILDCARE CENTRES – Updated March 30
Q: Are retirement home staff eligible for emergency childcare?
A: Yes, emergency childcare centres are available for frontline workers, which include regulated health care professionals and unregulated health care providers working in health care delivery. A full list is available here.
Q: How can retirement home staff apply for emergency childcare?
A: Many of the emergency childcare centres operate on a first-come, first-serve basis and municipalities have the ability to set priority access for the list of eligible workers.
NEW RESIDENT ADMISSIONS – updated March 31
Q: Are homes allowed to admit new residents?
A: New residents must be screened according to the directive from the Chief Medical Officer of Health and placed in self-isolation for 14 days. If they fail the screening, homes should contact public health immediately for further instruction. If a home has declared an outbreak, no new residents are to be admitted.
Q: Can family members help with move-in of new residents?
A: Only essential visitors are permitted as per the Chief Medical Officer of Health. Essential visitors include a person performing essential support services (e.g. food delivery, maintenance, and other health care) or a person visiting a resident who is very ill or requires end-of-life care.
ISOLATION OF RESIDENTS AND IPAC PROGRAM PROTOCOLS – updated March 31
Q: In what situations would residents be isolated/quarantined in the home/rooms? Can a retirement home require a resident be isolated/quarantined, and if so, under what circumstances?
A: If a home is instructed by the local public health unit to isolate a resident, by law 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 is required by law to 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.
Q: Is an IPAC policy specific to COVID-19 needed if a policy is already in place at our Retirement home for infection control related to our obligations under the Retirement Homes Act?
A. There is no requirement to have specific IPAC policy for Coronavirus – all Retirement Homes must have an infection prevention and control program for all infectious diseases and viruses.
COMMUNAL DINING – updated March 31
Q: What communal dining directives must my home follow?
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.
COVID-19 INFORMATION SOURCES – updated March 17
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. If you belong to an association, they will have resources that can help you with your operations, but the Ministry of health and public health are primary sources for information about COVID-19.
NEW HIRES – updated March 17
Q: We are hiring additional staff. Do they need a vulnerable sector check? Have you relaxed the training requirements? What about TB tests – do they still need a two-step test?
A: Please refer to this March 15 RHRA special advisory for information on VSCs and required training. RHRA is seeking further clarification on TB tests from Public Health via the Ministry for Seniors and Accessibility. We will provide more information when it is available.
HEALTH WORKERS AND RETURN TO WORK – updated March 28
Q: When can Health Care Workers return to work after travel?
A: Ontario’s Chief Medical Officer of Health (CMOH) recommends that Health Care Workers who have travelled outside of Canada within the last 14 days self-isolate for a period of 14 days starting from their arrival in Ontario. Health Care Workers should not attend work if they are sick.
Q: Who is considered a “Health Care Worker”?
A: This applies to all employees of a retirement home and third-party care providers.
Q: Can Health Care Workers who are deemed critical return to work?
A: If there are particular workers who are deemed critical by all parties, to continued operations, the Chief Medical Office of Health recommends that these workers:
- Undergo regular screening;
- Use appropriate Personal Protective Equipment (PPE) for the 14 days;
- Undertake active self-monitoring, including taking their temperature twice daily to monitor for fever; and
- Immediately self-isolate and get tested if symptoms develop and self-identify to their occupational health and safety department.
Q: When can health care workers with positive tests return to work?
A: The Quick Reference document on Testing and Clearance has been updated and is available on the Ministry of Health website. This updated version includes additional detail around clearing health care workers to return to work. Pursuant to the directive of the Chief Medical Officer of Health, staff who have tested positive and symptomatic cannot attend work. Staff who have tested positive and have symptom resolution and are deemed critical may return to work under work isolation.
Q: What if staff in my home work at multiple locations or health care settings?
A: Employees who work in multiple locations should identify themselves to their managers and develop an individualized plan to manage their employment across these settings over the course of the pandemic. Wherever possible, employers should work with employees to limit the number of work locations that employees are working at, to minimize risk to residents of exposure to COVID-19.
In some high-risk settings, it may be possible to coordinate arrangements for staff to work only in one institution. In the event of an outbreak, the public health unit will provide instruction on where staff are permitted to work.
Q: How do we screen external care providers?
A: The home should screen them according to protocols set out for staff in the Chief Medical Officer of Health’s direction. Paid caregivers/companions are not considered visitors and should be screened as staff. They should only visit the resident that they are there to provide services to and no other residents.
Screening must include twice daily (at the beginning and end of the day) symptom screening, including temperature checks. Anyone showing symptoms of COVID-19 should not be allowed to enter the home and should go home immediately to self-isolate and seek testing. External care providers interacting with residents who do not have COVID-19 are required to wear a mask. Any external care providers providing services to residents who have COVID-19 must wear appropriate PPE, as provided in the Chief Medical Officer of Health’s directives.
Q: What about employees that are not Health Care Workers?
A: This applies to all employees of a retirement home and third-party care providers. In addition, everyone in Ontario should be practicing physical distancing of two meters to reduce their exposure to other people. Retirement Homes should facilitate arrangements to ensure that this is practiced in the workplace to every extent possible. The CMOH has also asked that where there is opportunity, for all employers to facilitate work arrangements that enable appropriate employees to work from home or to work virtually, if not re-deployable.
Retirement homes should also consider a review of their services and practices to identify how they can provide services to residents and their families virtually or remotely.
Q: What if one of our employees begin to feel ill at work?
A: All retirement homes must actively screen for signs of illness. Retirement home staff should diligently monitor themselves for signs of illness over the course of the pandemic and identify themselves to their manager and/or occupational health and safety departments if they feel unwell. If a retirement home worker begins to show symptoms while at work, they should immediately don a surgical mask and go home to self-isolate. Homes must test staff who have symptoms compatible with COVID-19. Retirement home workers who show symptoms of COVID-19 should not be allowed into the home and should be tested. Staff responsible for occupational health at the home must follow up on all staff who have been advised to self-isolate based on exposure risk.
Q: What if I don’t have enough staff to cover my home’s operations?
A: All Retirement homes should have a Continuity of Operations plan to redeploy resources, whether human resources, equipment or space, to protect critical services. This may include cross training, cross credentialing or formal redeployment to different functions. As part of these plans, organizations should also have minimum thresholds of staffing in place to ensure that critical services continue to operate.
Q: What if one of my staff is in a high-risk group for the effects of COVID-19?
A: Employees with comorbidities should also identify themselves to you and consider ways to redeploy them away from duties associated with COVID-19.
Q: I have a staff member that has been off sick. When can they return to work?
A: Staff who have tested positive and are symptomatic cannot return to work. Employees should consult their local public health unit and their manager/occupational health and safety department to plan their safe return to work.
REGULATION CHANGE: 118/20 – updated April 3
Q: What is Ontario Regulation 118/20 under the Emergency Management and Civil Protection Act?
A: Ontario Regulation 118/20 is effective April 3, 2020 and allows retirement homes more flexibility to plan for staffing resources during the COVID-19 emergency. RHRA guidance on the regulation is available here.
EMERGENCY AMENDMENTS TO THE RETIREMENT HOMES ACT REGULATION – updated March 22
Q: What changed in the Act?
A: Ontario Regulation 166/11 has been amended to make it clear that retirement homes must:
- Ensure its infection prevention and control program follows guidance and recommendations given to retirement homes by the Chief Medical Officer of Health (CMOH).
- Take all reasonable steps to follow any directive respecting COVID-19 that has been issued to a long-term care home by the CMOH under section 77.7 of the Health Protection and Promotion Act
- Take all reasonable steps to follow any directive respecting COVID-19 that has been issued to a long-term care home by the CMOH and made available on the Government of Ontario’s website respecting coronavirus (COVID-19)
Please refer to the March 22 RHRA special advisory sent to operators for more information.
Q: Why was this change made?
A: These amendments were necessary to make the Chief Medical Officer of Health’s recommendations related to both retirement and long-term care homes binding on retirement homes for the protection of retirement home residents in Ontario.
Q: When was the change made? When does this take effect?
A: The change was made on March 19, 2020 during an emergency session of the Ontario parliament. The regulation took effect on March 20.
Q: Does this change the way RHRA will do inspections?
A: These amendments will give the RHRA formal power under the Retirement Homes Act, 2010 to cite and possibly take enforcement action against a home for not appropriately following the guidance, advice or recommendations of the Chief Medical Officer of Health.
RESIDENTS LEAVING AND RETURNING TO THE HOME – updated March 31
Q: Are residents able to go outside for walks? Can we restrict them from leaving the building?
A: The Chief Medical Officer of Health has directed that residents not be permitted to leave the home for short stay absences to visit family or friends. Residents who wish to go outside of the home must remain on the home’s property. While outside, they should maintain safe physical distancing by staying at least two metres apart from any individual.
Q: What can we tell a family who wants to take their senior relative out of building for a medical appointment?
A: If family needs to take a resident to an outside appointment which is essential to the resident’s health, then they should do so. The resident would then be subject to screening upon their return. Prior to starting any outside appointment, families should be encouraged to call ahead to make sure the medical professional is still taking appointments.
Q: What can we tell a family member who wants to take their senior relative out of the building?
A: Residents who wish to go outside of the home must remain on the home’s property and maintain safe physical distancing (at least two metres) from anyone else. The health and safety of all residents is our top priority. Staff are working hard to maintain the health of your loved one, and those in their community. The province of Ontario has declared a state of emergency, this is an unprecedented situation and we need to take these steps to make sure COVID-19 doesn’t make its way into this home and that this situation is over as soon as possible.
Q: What can we tell a resident who wants to leave to stay with family and friends?
A: Residents of retirement homes are not permitted to leave the home for short stay absences to visit family and friends as per the Chief Medical Officer of Health’s direction.
Q: If a resident has gone to hospital, can I refuse them re-entry to manage the risk of COVID-19 transmission in the home?
A: All returning residents are to be screened as per the Chief Medical Officer of Health. If a resident fails the screening, they are to be placed in isolation and the home should contact Public Health for further instructions. Homes should also review plans of care for returning residents according to the regulation and include substitute decision makers as appropriate (by phone or electronic means). Homes are reminded that residents have rights under the Residential Tenancies Act to return to their home that need to be considered.
For residents that leave the home for an out-patient visit during an outbreak, the home must provide a mask and the resident, if tolerated, must wear a mask while out and screened upon their return.
Q: A resident has returned from an absence from the home (any duration). Upon returning, they’ve failed the screening test. Now what?
A: According to the Chief Medical Officer of Health, returning residents who fail screening should be placed in isolation following current Public Health protocols. Any resident who shows symptoms of COVID-19 must be isolated and undergo testing for COVID-19. The home should contact Public Health for further instruction.
PERSONAL PROTECTIVE EQUIPMENT IN HOMES – updated March 31
Q: My home is running out of Personal Protective Equipment (PPE). Where can I get more?
A: The province is taking action to procure PPE supplies in bulk. The Ministry of Health is conducting a survey of all retirement homes to understand their current PPE inventory, which was distributed to all homes by ORCA.
Due to the rapidly evolving situation, homes are asked to complete the survey on a daily basis. This will give the Ministry a better understanding of your home’s immediate needs. A link to the survey and instructions are available here.
The province will soon be communicating how PPE will be distributed along with guidance on how to place an order. We understand that PPE supplies will be distributed through five regional tables, with direction from the Ministry of Health’s recent PPE survey.
If you are currently struggling with immediate access to PPE, please contact your Regional Leads – PPE and Critical Supplies. It is our understanding that there is retirement community sector representation on all five regional PPE tables.
Q: How will the government determine who receives additional PPE?
A: The government will make allocation decisions that adhere to principles of procedural fairness, including transparency and consistency. Please refer to Priority Setting of Personal Protective Equipment – Provincial – Regional Distribution and Priority Setting of Personal Protective Equipment – Within Health Care Institutions and Community Support Services
Q: Is there anything I can do to reasonably conserve PPE?
A: Recommendations on the use and conservation of PPE can be found in Ontario Health’s Personal Protective Equipment (PPE) use during the COVID-19 Pandemic.
Q: Can we use expired N95 masks?
A: This fact sheet provides information for Retirement Homes about the use of N95 masks beyond the manufacturer-designated shelf life.
COVID-19 TESTING, DETECTION, MANAGEMENT AND CARE – Updated March 31
Q: Do retirement home residents get priority for COVID-19 testing?
A: Public Health Ontario has confirmed that COVID-19 tests for retirement home residents are to be prioritized by laboratories, as is the case for residents of long-term care homes.
When completing a requisition form to request testing, it is important that you clearly indicate that the individual is a resident of a retirement home to ensure priority processing.
Q: What if I have questions about testing?
A: Questions about testing should be directed to Public Health Ontario.
Q: How do I detect cases of COVID-19 in my home?
A: To identify potential cases of COVID-19, homes must actively screen residents including twice daily (at the beginning and end of the day) symptom screening, including temperature checks, and must test residents who have symptoms compatible with COVID-19. Homes must not wait for additional cases of respiratory infection before testing.
Q: What if a resident or staff member tests positive for COVID-19?
A: If a resident tests positive for COVID-19, homes must isolate them in a single room if possible and take appropriate contact and droplet precautions.
Staff who have tested positive and symptomatic cannot attend work. Staff who have tested positive and have symptom resolution and are deemed critical may return to work under work isolation.
Retirement homes must consider a single, laboratory confirmed case of COVID-19 in a resident or staff member as a confirmed respiratory outbreak in the home, and take actions as indicated for influenza.
Q: What if there is an outbreak at my home?
A: If an outbreak has been declared at your home, no new resident admissions will be permitted. For residents that leave the home for an out-patient visit, the home must provide a mask for the resident, if tolerated, wear a mask while out and screened upon their return. Your home must also discontinue all non-essential activities.
Q: How do I provide routine care for residents with suspected or confirmed cases of COVID-19?
A: The Chief Medical Officer of Health has directed health care workers to perform a point-of-care risk assessments before interaction with the resident and at a minimum, contact and droplet precautions must be used by workers for all interactions with suspected, presumed or confirmed COVID-19 patients.
Airborne precautions when aerosol generating medical procedures are planned or anticipated to be performed on patients with suspected or confirmed COVID-19, based on a point of care risk assessment and clinical and professional judgement.
Retirement home staff who are interacting with residents must review and adopt the Updated IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19 dated March 25, 2020 which has been prepared by Public Health Ontario.