COVID-19 – 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. Licensees with questions or concerns about their legal obligations are encouraged to obtain legal advice.

TESTING, DETECTION, MANAGEMENT & CARE – Updated October 2020

 

Please see the Ministry of Health’s Testing Guidance and this additional direction on testing.

 

Q: What is an outbreak?

A: An outbreak is one laboratory confirmed test of COVID-19 in a resident or staff member.

Q: What triggers an outbreak assessment?

A: Once at least one resident or staff has presented with new symptoms compatible with COVID-19 including atypical symptoms, the retirement home should immediately trigger an outbreak assessment and take the following steps:

  • Place the symptomatic resident under Droplet and Contact
  • Test the symptomatic resident or staff (if still in the home)
  • Contact the local public health unit to notify them of the suspected
  • Test those residents who were in close contact (i.e. shared room) with the symptomatic resident and anyone else deemed high risk by the local public health unit, including staff; test residents and staff in close contact with a symptomatic staff member per risk exposure and local public health unit advice.
  • Ensure adherence to cohorting of staff and residents to limit the potential spread of COVIF-19.
  • Enforce enhanced screening measures among residents and staff.

If the retirement home receives negative test results on the initial person who was tested, the retirement home can consider ending the suspect outbreak assessment related steps in consideration of other testing completed and in consultation with the local public health unit.

Q: Does my home have to perform surveillance testing?

A: On June 9th, Ontario Health recommended testing of all retirement home staff every two weeks, and of residents of retirement homes at risk of outbreak. Ontario Health has developed this COVID-19 Surveillance Testing guidance document with more details.

Q: When should a resident be tested?

A: On June 25, the Ministry of Health issued updated testing guidance for retirement homes residents. The guidance states that any residents with the following should be tested as soon as possible:

  • Fever (Temperature of 37.8°C or greater)
  • Any new/worsening symptom (e.g. cough, shortness of breath (dyspnea), sore throat, runny nose or sneezing, nasal congestion, hoarse voice, difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain)
  • Clinical or radiological evidence of pneumonia.

Note: in people presenting with ONLY runny nose/sneezing or congestion, consideration should be given to other underlying reasons for these symptoms such as seasonal allergies and post-nasal drip.

Atypical presentations of COVID-19 should be considered, particularly in older persons and people living with a developmental disability. For a list of potential atypical symptoms, please see testing guidance appendix.

In the event of an outbreak of COVID-19 in a retirement home, asymptomatic contacts of a confirmed case, determined in consultation with the local public health unit, should be tested including:

  • All residents living in adjacent rooms
  • All staff working on the unit/care hub
  • All essential visitors that attended at the unit/care hub
  • Any other contacts deemed appropriate for testing based on a risk assessment by local public health

Local public health may also, based on a risk assessment, determine whether any of the above-mentioned individuals do not require testing (e.g. a resident that has been in self-isolation during the period of communicability).

Q: What if there is an outbreak at my home?

A: If an outbreak is declared at the retirement home, the following measures must be taken:

  • New resident admissions are not allowed until the outbreak is over;
  • No re-admission of residents in the home or outbreak area, per the specific outbreak, until the outbreak is over.
  • If residents are taken by family out of the home, they may not be readmitted until the outbreak is over;
  • For residents that leave the home for an out-patient visit, the home must provide a mask and the resident, if tolerated, wear a mask while out and screened upon their return, but does not need to self-isolate; and
  • Discontinue all non-essential activities

The Licensee should consult with their local public health unit if the Licensee believes any of these measures are not reasonably possible.

Licensees must report any COVID-19 outbreak to RHRA. The report must include the name of the home, licence number, number of positive resident cases, number of positive staff cases and identification of public health contact. Licensees must send to info@rhra.ca. Homes must consider one laboratory confirmed case of COVID-19 in a resident or staff as an outbreak.

Public health may declare an outbreak over when there are no new cases in residents or staff after 14 days from placing the resident or staff member in isolation.

Q: What if the home has just one resident case of COVID-19?

A: The home must isolate the resident, in a single room, if possible and take appropriate contact and droplet precautions. Staff who have had a high-risk exposure to COVID-19 without appropriate PPE must self-isolate for 14 days. In exceptional circumstances staff working in homes may be deemed critical, by all parties, to continue operations. If staff must continue to work, they must undergo regular screening, use appropriate PPE, and undertake self-monitoring for 14 days. Staff who have had contact with medium risk exposure to COVID-19 should be self-monitoring for 14 days.

Q:  What if the home has just one staff case of COVID-19?

A: Even if the staff exposure was to a specific area of the retirement home, consideration must be given to applying outbreak control measures to the entire home.  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: 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: How are COVID-19 tests done and how do I get results?

A: The Ministry of Health has produced testing guidance FAQs specifically for the retirement home community. 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 or shift) symptom screening, including temperature checks, and must test residents who have symptoms compatible with COVID-19. Residents with symptoms (including mild respiratory and/or atypical symptoms) must be isolated and tested for COVID-19. Homes must not wait for additional cases of respiratory infection before testing.

Symptoms for COVID-19 commonly present as:

  • Fever (temperature of 37.8°C or greater)
  • Any new/worsening acute respiratory illness symptoms (e.g. cough, shortness of breath, sore throat, runny nose or sneezing, nasal congestion, hoarse voice or difficulty swallowing, new olfactory or taste disorder(s), nausea/vomiting, diarrhea, abdominal pain)
  • Clinical or radiological evidence of pneumonia

Atypical presentations of COVID-19 should be considered, particularly in elderly persons. Atypical Symptoms/Signs of COVID-19:

Symptoms:

  • Unexplained fatigue/malaise
  • Delirium (acutely altered mental status and inattention)
  • Falls
  • Acute functional decline
  • Exacerbation of chronic conditions
  • Digestive symptoms, including nausea/vomiting, diarrhea, abdominal pain
  • Chills
  • Headaches
  • Croup
  • Conjunctivitis
  • Multi-system inflammatory vasculitis in children
    • Presentation may include persistent fever, abdominal pain, conjunctivitis, gastrointestinal symptoms (nausea, vomiting and diarrhea) and rash

Signs:

  • Unexplained tachycardia, including age specific tachycardia for children
  • Decrease in blood pressure
  • Unexplained hypoxia (even if mild i.e. O2 sat <90%)
  • Lethargy, difficulty feeding in infants (if no other diagnosis)

Q: What if residents or staff are asymptomatic?

A: New admissions or re-admissions to a retirement home should be tested within the first 14 days under the direction of the overseeing clinician.

Asymptomatic residents living in the same room as a symptomatic resident should also be tested immediately. A negative result does not rule out the potential for incubating illness and all close contacts should remain under a 14-day self-isolation period following contact.

Q: What if a resident or staff member tests positive for COVID-19?

A: 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. In the event of an outbreak of COVID-19, asymptomatic contacts of a confirmed case, determined in consultation with the local public health unit, should be tested including:

  • All residents living in adjacent rooms
  • All staff working on the unit/care hub
  • All essential visitors that attended at the unit/care hub
  • Any other contacts deemed appropriate for testing based on a risk assessment by local public health

Staff who have tested positive and symptomatic cannot attend work. In exceptional circumstances when a staff member has been deemed critical, the staff member who tested positive and whose symptoms have resolved, or they remain asymptomatic may return to work under work self-isolation after a certain number of days. For details refer to the COVID-19 Quick Reference Public Health Guidance on Testing and Clearance.

Q: How do I prepare for an outbreak?

A: The home should take measures to prepare for a COV19 utbrek including:

  • ensuring outbreak swab kits are available
  • ensuring sufficient personal protective equipment (PPE) is available
  • training of staff on the use of PPE
  • reviewing advanced directives for all residents
  • reviewing communications protocols
  • reviewing staffing schedules
  • reviewing internal activities to ensure social distancing
  • reviewing environmental cleaning protocols
  • develop polices to manage staff who may have been exposed to COVID-19

In addition, homes must permit an organization completing an infection prevention and control (IPAC) assessment and report to share it with public health units, local public hospitals, LHINs and the Retirement Homes Regulatory Authority as may be required to respond to COVID-19 in the home.

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.

Q: If a resident passes away in the home, is the home required to test them for COVID-19 or does this only apply if the home was in outbreak or the resident had symptoms?

A: RHRA expects homes to work with their local public health unit should this situation occur.

 

ADVANCED DIRECTIVES – Updated April 15

 

Q: Are licensees required to review advanced directives with each retirement home resident?

A: Licensees are not obligated to review advanced directives. Where advanced directives exist and the retirement home has completed advanced directives, this could be implemented if possible. If a retirement home is approached by resident or family to update their advanced directives, then the home should do so.

 

ISOLATION OF RESIDENTS AND IPAC PROGRAM PROTOCOLS – October 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.

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.

Q: Can RHRA advise what the RHRA’s expectation is for this component of Directive #5? 

“The public hospital’s or long-term care home’s Organizational Risk Assessment must be continuously updated to ensure that it assesses the appropriate health and safety control measures to mitigate the transmission of infections, including engineering, administrative and PPE measures. This must be communicated to the Joint Health and Safety Committee including the review of the hospital or long-term care environment when a material change occurs.”

A: Retirement homes are required to take all reasonable steps to ensure COVID-19 preparedness as set out in Directive #3. For example, from Directive #3:

Ensure LTC Home’s COVID-19 Preparedness. Long-term care homes and retirement homes, in consultation with their Joint Health and Safety Committees or Health and Safety Representatives, if any, must ensure measures are taken to prepare the home for a COVID-19 outbreak including: ensuring swab kits are available and plans are in place for taking specimens, ensuring sufficient PPE is available, ensuring appropriate stewardship and conservation of PPE is followed, training of staff on the use of PPE, discuss with each resident and their substitute decision-maker an advanced care plan for the resident, and document the plan as part of community planning with local acute care facilities and EMS, 6. Communicate with local acute care hospitals regarding outbreak, including number of residents in the facility, and number who may potentially be transferred to hospital if ill based on the expressed wishes of the residents, 7. Develop policies to manage staff who may have been exposed to COVID-19 and must permit an organization completing an IPAC assessment and report to share the report with any or all of the following: public health units, local public hospitals, LHINs, the Ministry of Long-Term Care in the case of long-term care homes and the Retirement Homes Regulatory Authority in the case of retirement homes, as may be required to respond to COVID-19 at the home.

Other required precautions and procedures are outlined in Directive #3. IPAC checklists and other materials are available here on the RHRA website. ORCA and AdvantAge will also have resources available.

Q: Where can I find IPAC support and resources?

A: Public Health Ontario has an IPAC Checklist available here. While directed at Long-Term Care Homes, the checklist also applies to retirement homes. Please see here for further guidance from RHRA specific to retirement homes. PHO also has Regional IPAC Support Teams available should you have any questions. ORCA and AdvantAge will also have resources available.

 

ACTIVITIES IN THE HOME – Updated October 2020

 

Q: Can my home now offer group activities?

A: 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.

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.

 

RESIDENT/STAFF COHORTING – Updated April 17

 

Q: Must I use resident/staff cohorting to prevent the spread of COVID-19?

A: Homes must use resident/staff cohorting as a strategy to prevent the spread of COVID-19 in the home. For residents, this could include alternative accommodation to maintain physical distancing of 2 metres, resident cohorting of the well and unwell and utilizing other rooms as available to help maintain isolation of affected residents.

For staff, this could include ensuring a staff member does not provide care for the well and unwell at the same time and having staff work under “work-isolation” due to high risk exposures. In smaller homes where physical distancing is not possible all residents or staff should be managed as if they are potentially infected, and staff should use droplet and contact precautions when in an area infected by COVID-19.

Q: What additional steps can I take to prevent the spread of COVID-19 in my home?

A: Additional environmental cleaning is recommended for frequently touched surfaces, including trolleys and other equipment that move around the home, and consideration given to increasing the frequency of cleaning.  Policies and procedures regarding staffing in Environmental Services (ES) departments should allow for surge capacity (e.g., additional staff, supervision, supplies, equipment)

PERSONAL PROTECTIVE EQUIPMENT IN HOMES – Updated October 2020

 

Please see Ministry of Health’s Guidance for Mask Use in Retirement Homes

 

Q: Do staff have to wear masks at all times?

A: All staff and essential visitors must wear surgical/procedure masks at all times  for the duration of full shifts or visits in the home. During breaks, staff may remove their surgical/procedure mask but must remain 2 metres away from other staff to prevent staff to staff transmission of COVID-19. This is required regardless if the home is in outbreak or not.

Q: What PPE do staff have to wear in the home?

A: At a minimum, for health care workers and other employees in a home, contact and droplet precautions must be used by health care workers and other employees for all interactions with suspected, presumed or confirmed COVID-19 patients or residents. Contact and droplet precautions includes gloves, face shields or goggles, gowns, and surgical/procedure masks.

Q: What type of mask/face covering can be worn by residents in the retirement home?

A: Please consult with your local public health unit for recommendations on mask/face covering specifications.

Q: My home is running out of Personal Protective Equipment (PPE). Where can I get more?

A: Once a supply shortage of personal protective equipment (PPE) has been identified, take the following steps:

  • Work with your regular supplier to determine when you will get regular shipments of PPE
  • Work with other local health care providers to determine if others in your local area have supplies they can provide you
  • Submit your request online through the Personal Protective Equipment Intake Form. Your Regional Table Lead will work with you to see if they can address the request within the region
  • If the need can not be addressed regionally, the Regional Table Lead will escalate your request to the Ministry Emergency Operations Centre (MEOC)

Q: Do I need to report my PPE inventory in my home?

A: Yes. As of June 9, all retirement homes are required to report twice weekly (Monday and Thursday) on their PPE supplies through Ontario Public Health’s website here. The information received from will be used to help the province identify current inventory status, forecast demand, inform procurement and allocation decisions, and respond to emergency requests.

If you have questions, please email COVIDsupplies@ontariohealth.ca.

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: How else can I procure PPE for my home?

A: The Ontario Government has developed an online workplace PPE supplier directory to assist in the procurement of PPE. Retirement homes can now review a list of companies that sell PPE and other supplies to help keep staff and residents safe from COVID-19.

Q: Is there anything I can do to reasonably conserve PPE?

A: Retirement homes must take steps to conserve and provide stewardship of PPE. 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.

Q: What are my responsibilities for ensuring staff have proper PPE?

A: Homes must ensure all staff are appropriately trained safely don and doff all PPE, and provide them with information on how to safely use PPE. All staff who are within 2 metres of suspected, presumed or confirmed COVID-19 residents are to have access to PPE. This includes: masks, N-95 respirators or approved equivalent, gloves, face shields and isolation gowns. The home cannot unreasonably deny access to appropriate PPE.

Q: What responsibilities do staff have for ensuring they wear proper PPE?

A: Health care workers must perform a risk assessment before every resident interaction. If the worker determines they need PPE to deliver care, then the home must provide the worker with access to the appropriate safety control measures, including an N95 mask. The home cannot unreasonably deny access to appropriate PPE.

HEALTH WORKERS AND RETURN TO WORK – Updated October 2020

 

Q: Do I need to screen my staff for COVID-19?

A: Anyone entering the home must be actively screened, including staff and volunteers. Homes should be conducting active screening of staff and volunteers twice daily, including temperature checks. Anyone showing symptoms of COVID-19 should not enter the premises and should return home to self-isolate. Every symptomatic staff member and volunteer must be tested. Staff responsible for occupational health at the home must follow-up with staff who are self-isolating. Staff must be reminded to monitor themselves for COVID-19 symptoms at all times.

Q: When can Health Care Workers return to work after travel?

A: Anyone who has travelled outside of Canada within the last 14 days must 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 does this apply to?

A: This applies to all employees of a retirement home, third-party care providers and any conducting activities in the home (i.e. volunteers).

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 return to work if they are confirmed or presumed to have COVID-19, or are showing symptoms or signs of COVID-19?

A: The Ministry of Health has updated its Quick Reference document on Testing and Clearance. which includes additional detail around clearing health care workers to return to work.

  • Health care workers should follow isolation and clearance with a non-test based approach unless they have required hospitalization during the course of their illness, in which case a test based approach is preferred. Some health care workers may be directed to have test based clearance by their employer/Occupational Health and Safety
  • Symptomatic health care workers awaiting test results must be off work
  • Asymptomatic health care workers awaiting test results may continue to work using the appropriate precautions recommended by the facility, which will depend on the reason for testing

In exceptional circumstances where care would be severely compromised without additional staffing, an earlier return to work of a COVID-19 positive health care worker may be considered under work self-isolation recognizing the staff may still be infectious.

Please see here for further details on work self-isolation and instructions related to symptoms and test results.

Q: What if staff in my home work at multiple locations or health care settings?

A: Orders currently in force under the Reopening Ontario (A Flexible Response to COVID-19) Act have been extended until October 22, 2020.

This includes O. Reg. 158/20: LIMITING WORK TO A SINGLE RETIREMENT HOME that limits employees of retirement homes to working in a single location. This applies to anyone employed by a retirement home licensee who also works in another retirement home or with a health service provider as defined by the Connecting Care Act, 2019. It also applies to employees who work in multiple retirement homes operated by the same licensee.

Wherever possible, the home should work with contractors and volunteers to limit the number of work locations that contractors and volunteers are working at in order to minimize risk to residents of exposure to COVID-19.

Please see the Ontario government’s emergency information pages here for more information

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 who are deemed essential 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 or shift) 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 or volunteers begin to feel ill at work?

A: All retirement homes must actively screen for signs of illness. Retirement home staff and volunteers 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 or volunteer 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.

 

NEW HIRES – Updated October 2020

 

Q: Are TB tests still required for new residents and staff?

A: The regulatory requirement to test new residents and employees remains under the Retirement Homes Act. If you have difficulty with resources related to TB tests, please contact your local public health unit.

 

PANDEMIC PAY – Updated May 31

 

Q: How do I access pandemic pay?

A: On April 25, 2020, the government announced that eligible frontline staff working to contain the COVID-19 outbreak in licensed retirement homes would receive a temporary pandemic pay of $4/hour worked on top of existing hourly wages, effective for 16 weeks from April 24, 2020 until August 13, 2020.

All non-management employees working on-site in licensed retirement homes (full-time, part-time and casual) are eligible for the pandemic pay. This includes agency staff contracted by the retirement home.

The Ministry for Seniors and Accessibility is administering the pandemic pay for retirement homes licensed by the RHRA.

Retirement homes will receive the temporary pandemic pay from the government’s transfer payment system, Transfer Payment Ontario and you will need to provide MSAA with your home’s information to be set up for Direct Deposit/Electronic Funds Transfer. Retirement homes are then required to administer the pandemic pay directly to employees.

Please contact msaapandemicpay@ontario.ca with any questions.

VISITORS TO RETIREMENT HOMES AND ACTIVE SCREENING – Updated October 2020

 

For visitation requirements and recommendations, please see the Retirement Home COVID-19 Visiting Policy

Q: Who are non-essential visitors and what are the rules for non-essential visitors in retirement homes?

A: As of June 18, the Chief Medical Officer of Health has directed that retirement homes can allow visits for retirement home residents. Please see this chart as a reference tool for visiting requirements. 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 Home COVID-19 Visiting Policy.

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. The Retirement Home COVID-19 Visiting Policy 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

Please see this chart for essential visitor requirements for homes not in outbreak, in outbreak and in Alert and High Alert geographic locations. 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.

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.

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

Q: How will the RHRA respond if there is a disagreement between a retirement home or a resident (or their SDM) about whether a caregiver is necessary?

A: If a resident or their substitute decision-maker designate a caregiver, the home is to allow that caregiver in the home to provide care, as long as the caregiver has performed their Safety Review as set out in the Retirement Home COVID-19 Visiting Policy. The caregiver must perform their Safety Review on a monthly basis. As long as the home is not in outbreak, caregivers should generally be allowed in the home for as long as is required to provide care for the resident. The RHRA encourages licensees to speak with residents if they have concerns about the duration of a caregiver’s visit. There must be compelling and demonstrable safety concerns to justify limiting the length of caregiver visits, absent an outbreak in the home.

If a retirement home sees or suspects that a caregiver is abusing or neglecting a resident, providing improper or incompetent treatment or care of a resident, misusing or misappropriating a resident’s money or any other unlawful conduct, the home must follow their abuse and neglect policy. The retirement home must protect residents from harm and must report any instance of harm or risk of harm to a resident to the RHRA.

Q: What are the visiting requirements for a home in outbreak?

A: Where the home is in an outbreak:

  • General visitors are not permitted
  • Any number of support workers may visit a home
  • A maximum of 1 caregiver per resident may visit at a time; and
  • Personal Care Service Providers are not permitted

Please see this chart for further details on visiting requirements for homes in Alert and High Alert areas. If a home is in outbreak, the local PHU may further limit visiting hours, the number of essential visitors in the home, and the number of residents with whom an essential visitor has contact based on their assessment of the situation.

Q: What is the visitor policy for retirement homes co-located with long-term care homes?

A: On September 2, the Ministry for Long-Term Care released updated guidelines for visitors to long-term care homes that will impact all co-located retirement homes. These guidelines come into effect on September 9, 2020.

A retirement home co-located with a long-term care home must implement the long-term care home’s visitor policy if the visit is occurring on the long-term care home floor/space. If the visits are occurring within the retirement home, visitors must follow the policy of the retirement home.

Q: When creating my homes visitor policy, what criteria should I follow?

A: Before your home can allow visitors, you must:

  • Develop procedures for the resumption of visits and associated procedures, 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. This process must include sharing an information package with visitors on IPAC, masking, physical distancing and other operational procedures such as limiting movement around the home, if applicable, and ensuring visitors’ agree to comply. Materials must include an approach to dealing with non-adherence to home policies and procedures, including the discontinuation of visits.
  • Have dedicated areas for both indoor and outdoor visits to support physical distancing between resident and visitors.
  • Protocols to maintain the highest of IPAC standards prior to, during and after visits.
  • Ensure adequate staffing within the home to implement the protocols related to visitors and a testing plan is in place in the event of a suspected outbreak.
  • Have a screening policy for all visitors on entry for symptoms or exposures to COVID-19, temperature checks, and attest to not experiencing symptoms.
  • Create and maintain a list of visitors that is available for relevant/appropriate staff members to access.
  • Protocols for record keeping of visitations for contact tracing purposes

Retirement homes co-located with facilities other than long-term care homes should, in the event of conflicting visitation policies, engage the local Public Health Unit (PHU) to determine the best path forward.

Q: I’m concerned we won’t be ready in time for visitors on June 18.

A: The guidelines for creating a visitors policy are outlined on page 3 and 4 of MSAA’s reopening retirement homes guidance document. As a requirement for allowing visitors it states:

The home has developed procedures for the resumption of visits and associated procedures, 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.

  • This process must include sharing an information package with visitors on IPAC, masking 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.
  • Protocols to maintain the highest of IPAC standards prior to, during and after visits.
  • Each home should create and maintain a list of visitors. The list will be available for relevant/appropriate staff members 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.

It may be a good idea to let families know that you are working on a policy to ensure everyone’s safety during visits, that you are trying your best to be ready for visitors and that you will communicate your visitors policy as soon as you can. ORCA or Advantage will also have resources available for creating a visitors policy.

Q: Do visits need to be scheduled in advance?

A: Yes. Visits should be pre-arranged. This will allow for appropriate physical distancing and staffing coverage.

Visits could be time-limited to allow the home to accommodate all residents. A sufficient block of time should be made available by homes to allow for at least one meaningful weekly visit per resident at a minimum (i.e., an appropriate length of time for a visit with your older adult).

Q: Can my home stop non-essential visitors from holding indoor visits?

A: Retirement homes can only facilitate indoor visits if the home has sufficient space to allow for physically distanced visits, which may include in-suite visits under appropriate circumstances. Homes must have dedicated areas for both indoor and outdoor visits and must share their visiting policies with residents and families.

 Q: Can my home stop a non-essential visitor who hasn’t been tested in the last 48 hours?

A: All retirement home non-essential visitors must be actively screened for COVID-19 every time they are on the premises of or enter the home. Visitors who do not pass active screening should not be allowed to visit. Visitors do not need to attest (verbally or written) to a negative COVID-19 test to visit a resident.

 Q: Can my home’s visitor policies be stricter than the government’s guidance regarding visits (e.g. only allow visits for 15 minutes at a time, keep visitors eight feet apart rather than six, etc.)?

A: Homes must consider the rights of their residents when implementing measures that are not in Directive #3 and the Retirement Home COVID-19 Visiting Policy. Allowing visits is intended to support the well-being and health of residents. Visits are expected to be an appropriate length of time for a meaningful visit. Physical distancing is dependent on space limitations. If your home can accommodate six feet distances, visits should be allowed both inside and outside.

Q: What kind of masks are visitors expected to wear?

A: Visitors should use a face covering mask at all times if the visit is outdoors. If the visit is indoors, a surgical/procedure mask for source control is required. Visitors are responsible for bringing their own masks. If visitors do not bring their own masks, they cannot visit.

Q: Can my home ask to see a visitor’s COVID-19 test results?

A: All retirement home visitors must be actively screened for COVID-19. Visits do not need to attest (verbally or written) to a negative COVID-19 test to visit a resident. Retirement homes are not permitted to request a visitor’s personal medical files.

Q: Do I need to actively screen residents?

A: 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. Residents with symptoms (including mild respiratory and/or atypical symptoms) must be isolated and tested for COVID-19. Homes must not wait for additional cases of respiratory infection before testing. For a list of COVID-19 symptoms, please see refer to the guidance document appendix.

Q: Do essential visitors need to wear masks and PPE?

All essential visitors must wear a face-covering mask at all times while visiting a resident. This is required regardless if the home is in outbreak or not. For any essential visitor in contact with a resident who has COVID-19, appropriate PPE should be worn.

Q: What screening resources are available?

A: The Ministry of Health has an active screening checklist available here.

Q: Are external care providers considered “visitors”?

A: Paid caregivers/companions who have been deemed essential 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: Non-essential visitors are insisting on seeing residents even after we’ve explained our outbreak protocols. What can we tell them?

A: If a home is in outbreak, in a High Alert area, or the resident is self-isolating or symptomatic, general visitors are not allowed. If the home is an Alert area, a resident may have 1 general visitor. Personal Care providers are not allowed in homes that are in outbreak, Alert or High Alert areas. Please see this chart for reference.

Please communicate with your residents and their families/loved ones the visitation policies and procedures as soon as possible to increase awareness prior to these situations occurring. Assure your residents and their families that staff are working hard to maintain the health of your loved one during the outbreak/Alert/High Alert situation, and we need to take these steps for the safety and well-being of everyone in this community during this difficult time. Accommodating interactions between residents and family through phone calls or video technology is encouraged.

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 kind of information do I have to provide the staff and residents/families re: COVID-19?

A: Retirement homes must keep staff and residents informed about COVID-19. Signage in the home must be clear about COVID-19, including signs and symptoms of COVID-19, and steps that must be taken if COVID-19 is suspected or confirmed in staff or a resident. Issuing a media release to the public is the responsibility of the institution but should be done in collaboration with the public health unit.

Homes must also share an information package with visitors on IPAC, face covering/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.

Q: Can I give in-person tours in the retirement home?

A: In-person tours should be reduced as much as possible and replaced with virtual tours.

All tour participants are subject to the general visitor requirements. The tour route must be restricted in a manner that avoids contact with residents.

Homes should keep the number of tours in the home to a minimum

In person tours are not permitted for homes in outbreak, Alert and High Alert areas.

Q: What is the expectation regarding extended family visits in a retirement home at this time? Can a family member stay overnight in a resident’s suite in some circumstances, e.g. visiting from out of town, helping the resident post-surgery, etc.?

A: While there are no restrictions on the duration of a visit outlined in the Retirement Home COVID-19 Visiting Policy or Directive #3, if the visitor is complying with all visitation rules and guidelines, e.g. avoiding communal areas, staying in the resident’s suite, wearing PPE at all times when indoors, the home can determine the length of visit it will accommodate within the its visitor policy.

Q: What are the accessibility requirements for visits to retirement homes?

A: Homes are required to meet all applicable laws such as the Accessibility for Ontarians with Disabilities Act, 2005.

SERVICES IN THE HOME – Updated October 2020

 

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 include a person performing essential support services (e.g. food delivery, phlebotomy testing, maintenance, family or volunteers providing care services and other health care services required to maintain good health of residents) or a person visiting a very ill or palliative resident. These essential visitors must continue to be actively screened into these settings.

Q: We have “service providers” such as hairdressers come into the home. Are they allowed to visit?

A: Any person that visits a resident must adhere to requirements outlined in the CMOH’s Directive #3 and Retirement Home COVID-19 Visiting Policy Visitors must only visit the indoor/outdoor area or suite they are intending to visit, and no other resident, and visits must allow for proper social distancing.

Personal Care Service Providers must follow the same active screening, IPAC, PPE, masking and testing requirements that apply to retirement home staff as outlined in CMOH Directive #3.

Q: Are homes required to monitor visits?

A: While homes are not required to supervise visits, homes must ensure that visitors and residents are adhering to the homes’ visitation policy, and that Directive #3 and the Retirement Home COVID-19 Visiting Policy are followed.

NEW RESIDENT ADMISSIONS – Updated October 2020

 

For new resident admissions requirements and recommendations, please see the Retirement Home COVID-19 Visiting Policy

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: What if a new or re-admitted resident tests positive for COVID-19?

A: If test results are positive, then report as a confirmed case and follow case management protocol; however, in consultation with the local public health unit, in a new admission or re-admission who tests positive it may not be necessary to declare an outbreak if they have been in isolation under contact and droplet precautions since entering the home.

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.

 

RESIDENT ABSENCES, LEAVING AND RETURNING TO THE HOME – Updated October 2020

 

Q: How do we manage residents who are returning from the hospital?

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 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, 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.

Q: Are homes allowed to admit new residents from hospitals, or only re-admissions?

A: As per the Ministry of Health’s updated directives on May 21, homes can now accept returning and new residents to the home who are being transferred from a hospital, as long as the home is not in a COVID-19 outbreak. The resident must be tested for COVID-19 and receive negative results not more than 24 hours before entering/being transferred to the home.

Q: Can retirement home residents leave the 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 Home COVID-19 Visiting Policy:

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:

  • 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 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 absences or for overnight stays

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: Can my home stop residents from leaving for absences? If they leave the premise, can my home isolate the resident for 14 days afterwards?

A: It is important for retirement homes to ensure resident’s rights are maintained during the COVID-19 pandemic. This includes the freedom to leave the premise. Residents who leave the home for short absences are required to wear a cloth face mask and pass active screening upon their return. Residents are not required to self-isolate for 14-days as a condition for an absence.

For details on absences, please refer to this chart.

Q: A resident has returned from an absence; 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. If test results are positive, then report as a confirmed case and follow case management protocol. The home should contact Public Health for further instruction.

RHRA’s OPERATIONS DURING THE COVID-19 PANDEMIC – Updated November 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, or any infectious disease 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 all 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.

As a result of a temporary emergency order issued on May 29, 2020, the Registrar has the authority to issue a Section 91 Management Order appointing a manager to manage a retirement home in the event of a COVID-19 outbreak in the home.  The Registrar’s authority under the emergency order exists regardless of whether the grounds for a Management Order set out in section 91 of the Retirement Homes Act are satisfied.

The Registrar can issue this order when the RHRA finds there is a risk of harm to residents related to COVID-19. While a home may appeal the order, it is not subject to a stay of proceedings and therefore is implemented immediately.

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. 

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. During the most recent phase of the pandemic, RHRA communicated in this March 15 RHRA special advisory a  list of the ways RHRA is altered our approach during this time. Now that Ontario has entered stage three of reopening, RHRA is preparing to reinstitute its regulatory expectations and standard business operations.

Q: When do homes need to complete RHRA requirements/activities that were suspended by the pandemic? 

A: Please refer to the chart below:

 

RHRA Practices Affected during Declaration of State of Emergency What RHRA Communicated

Date RHRA will expect homes to demonstrate that requirement have been met

Annual Retraining Requirements

Annual retraining that expires during  COVID-19 will have a grace period of one month following the return to normal operations

Annual retraining requirements must be completed by Monday, September 28.

Plan of Care Reassessments

Homes will be given four weeks to complete six-month reassessments following the return to normal operations Six-month reassessments must be completed by Monday, September 28.
Emergency Plan Completion Homes would have an additional eight weeks to complete requirements related to Emergency Plans following the return to normal operations

 

Emergency plan requirements must be complete by Monday, October 26.

If a home cannot maintain physical distancing during an evacuation exercise, a tabletop exercise is acceptable. Homes must document tabletop exercise has occurred and outcome of exercise. RHRA considers this acceptable until the CMOH’s physical distancing requirements change. Once physical distancing requirements no longer impact a home’s ability to conduct an evacuation, homes will have 12 months to complete an evacuation exercise.

Abuse Policy Evaluation

Homes have an additional four weeks to complete evaluation of the policy following return to normal operations per Chief Medical Officer of Health.

Abuse policy evaluations must be complete by Monday, September 28.

Individual Complaints Homes have an additional two weeks to complete records for individual complaints

Records for individual complaints must be completed by Wednesday, September 9.

Quarterly Evaluation of Complaints

Homes have an additional four weeks to complete quarterly evaluations following the return to normal operations

Quarterly evaluations of complaints must be completed by Monday, September 28.

Deferring Routine Inspections

 

Beginning in November 2020, RHRA will resume routine inspections.

 

RHRA will prioritize ongoing compliance inspections and minimizing the routine inspection backlog.

 

Transactional Survey paused (satisfaction survey of homes and complainants post-inspection/complaint)

 

No date communicated. The survey will be back in field at a date to be determined later.

Starting September 1.

Behaviour Management Training

Have all staff trained on behaviour management as soon as possible and no later than within four weeks of hire.

Homes should endeavour to have all staff fully trained as soon as possible.

 

All staff must be trained on behaviour management by Monday, September 28.

Vulnerable Sector Checks

VSCs to be completed within six weeks following the return to normal operations per Chief Medical Officer of Health (may be extended based on backlogs)

VSCs must be completed by Friday October 9.

 

Q: How many retirement homes in Ontario currently have a COVID-19 outbreak?

A: The RHRA’s COVID-19 dashboard provides data on licensed retirement homes with reported outbreaks. The dashboard is updated daily at 11 a.m. Monday to Friday (excluding statutory holidays). The information presented is current as of 5:00 p.m. the previous day.

Q: What is RHRA’s Emergency Fund and how does it work?

A: The Registrar of the RHRA can allocate up to $3,500 from the RHRA’s Emergency Fund to individual retirement home residents in crisis. The emergency fund is only available to residents of retirement homes in certain prescribed circumstances, for example an abrupt closure of a home due to COVID-19. In the event of an emergency, such as an outbreak, this funding can be used to support residents to cover costs for transportation, alternative accommodation or temporary care.

 

MAY 29 EMERGENCY ORDER: EMERGENCY MANAGEMENT AND CIVIL PROTECTIONS ACT: SUBSECTION 7.0.2 Management of Retirement Homes in Outbreak – updated May 31

 

Q: What has been changed under the Emergency order re: Management of Retirement Homes in Outbreak?

A: The Registrar has the authority to issue a Management Order pursuant to Section 91 of the Retirement Homes Act appointing a manager to manage a retirement home in the event of a COVID-19 outbreak in the home. The Registrar’s authority under the emergency order exists regardless of whether the grounds for a Management Order set out in section 91 of the Retirement Homes Act are satisfied.

The Registrar can issue this order when the RHRA finds there is a risk of harm to residents related to COVID-19. While a home may appeal the order, it is not subject to a stay of proceedings and therefore is implemented immediately.

 

MAY 29 AMENDMENTS TO THE RETIREMENT HOMES ACT ONTARIO REGULATION 166/11 – updated May 31

 

Q: What has been changed under Ontario Regulation 166/11?

A: Ontario Regulation 166/11 under the Retirement Homes Act has been permanently amended in the following ways:

Retirement home licensees must report any infectious disease outbreak to the Retirement Homes Regulatory Authority (RHRA) on the same day it is reported to the local medical officer of health.

The Registrar of the RHRA can allocate up to $3,500 from the RHRA’s Emergency Fund to retirement home residents in crisis; previously the amount was $2,000 per resident. Financial assistance is available at the Registrar’s discretion and assessment of specific circumstances, for example an abrupt closure of a home due to COVID-19.

 

MARCH 20 AMENDMENTS TO THE RETIREMENT HOMES ACT REGULATION 166/11 – updated March 22

 

Q: What is Ontario Regulation 118/20 under the Reopening Ontario Act?

A: Ontario Regulation 118/20 allows retirement homes more flexibility to plan for staffing resources during the COVID-19 emergency. RHRA guidance on the regulation is available here. This has been extended until at least October 22, 2020. Please see the Ontario government’s emergency information pages here for more information

 

MARCH 20 AMENDMENTS TO THE RETIREMENT HOMES ACT REGULATION 166/11 – 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) (effective March 20, 2020)
  • 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 (effective March 20, 2020)
  • 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) (effective March 20, 2020)

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: 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.

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Steps to getting a licence

Get started on the licensing process and find out what you will need to submit an application.


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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Process

To assist you with the application process, the RHRA has put together an Applicant Guide. The Guide introduces you to the forms, supporting documents and fees that must be submitted.

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Fees

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

Find out what constitutes harm and what you need to do if you see or suspect harm.

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RHRA Process

Find out what happens after the report has been made.

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Mandatory Reporting

What must you report and why.

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More information about RHRA

Understand our role, what we stand for and how we enforce ‘the Act’.


How we help

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Our Vision, Mission and Values

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Understanding the Legislature

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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.

Read More
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