Long-term care homes in Ontario are facing unprecedented tragedy.

The Ontario government is committed to using every resource we have to support the province’s long-term care homes as we work to stop the spread of COVID-19.

This plan outlines the actions that the government is taking to protect residents and staff in long-term care homes.

Long-term care homes have become the front-line of the fight against COVID-19 around the globe. Ontario is no different, and in our grief, we must fight back fiercely.

The COVID-19 Action Plan for Protecting Long-Term Care Homes consolidates actions taken to date, starting in February 2020, and adds aggressive new measures to prevent further outbreaks and deaths from COVID-19 in our long-term care homes.

Actions to date

April 13

  • Providing same-day deliveries of supplies and equipment to hospitals, long-term care and retirement homes and other facilities to support essential workers in all settings and ensure supplies are expedited to those most in need.

April 8

  • The Chief Medical Officer of Health issued an updated directive (#3) for long-term care homes to immediately implement that all staff and essential visitors wear surgical/procedure masks at all times for the duration of full shifts or visits in the long-term care home as well as to ask long-term care homes to save and securely store used PPE, including masks. The directive includes rigorous direction for staff and resident cohorting, the limitation of staff workplaces, COVID-19 testing and the latest protocol for outbreak management, among other critical guidance.
  • The Chief Medical Officer of Health issued an updated directive (#3) for long-term care homes to immediately begin more aggressive screening – upgraded to twice daily – of staff, essential visitors and residents.

March 27

  • Issued a second temporary order for long-term care homes to provide further flexibility for long-term care homes and allow homes to redirect their staffing and financial resources to essential tasks during the COVID-19 crisis.

March 25

  • Launched Ontario’s Action Plan: Responding to COVID-19, a $17 billion emergency relief package to provide relief to families and certainty to businesses. This includes $3.3 billion in additional resources for the health care system, specifically $243 million for long-term care.

March 24

  • Amended regulations to allow for a streamlined long-term care admissions, discharge and re-admissions process, freeing up much-needed capacity in hospitals and ensuring residents who leave their long-term care home during the COVID-19 pandemic are prioritized for re-admission, giving them peace of mind.

March 23

  • Issued a temporary order for long-term care homes to support increased staffing flexibility, enabling homes to be able to respond to, prevent and alleviate an outbreak of COVID-19.
  • Suspended short-stays in long-term care homes and provided guidance to homes on how to use short-stay beds to maximize capacity for applicants waiting for admission to a long-stay bed in a long-term care.

March 22

  • The Chief Medical Officer of Health issued a directive (#3) to long-term care homes to immediately implement the following:
    • To not permit residents to leave the home for short-stay absences to visit family and friends
    • To wherever possible limit the number of work locations that employees are working at

March 20

  • Amended regulations to allow for increased flexibility in staffing at long-term care homes, making it easier for qualified staff to be hired and for homes to prioritize skills where they are needed most. These measures allowed for homes to quickly bring in more and new staff, to prevent potential staffing shortages, and to allow staff to spend more time on direct care to residents.

March 17

  • Enhanced the province’s response to COVID-19 with up to $304 million in funding including building additional hospital capacity, supporting public health units with testing and screening, purchasing additional personal protective equipment for frontline workers and ventilators, providing 24/7 screening at long-term care homes, and dedicated supports for rural, remote, Northern, and Indigenous communities.

March 13

  • The Chief Medical Officer of Health recommended that long-term care homes only allow essential visitors, such as those visiting the very ill or end-of-life visits. A guidance document to this effect was issued on March 17.

March 11

  • Instructed long-term care homes to begin active screening of visitors, volunteers, staff and new residents for symptoms of COVID-19.
  • Long-term care home respiratory tests will now be additionally screened for COVID-19.

March 9

  • Issued guidance to all long-term care operators via a memo to actively screen all visitors, residents, re-admissions and returning residents to long-term care homes. (Memo was subsequently amended on March 11 to also include staff and volunteers.)

February 11

  • Released updated guidance on COVID-19 prevention and screening in long-term care.

February 3

  • Released guidance on COVID-19 prevention and screening in long-term care.

Next actions

  1. Aggressive Testing, Screening, and Surveillance
  2. Managing Outbreaks and Spread of the Disease
  3. Growing our Heroic Long-Term Care Workforce

1. Aggressive testing, screening, and surveillance

Goal:

  • Increased testing of LTC home residents and staff

Actions:

  1. Testing: To protect people, enhanced testing that will include:
    • For all homes: test all symptomatic residents and staff in accordance with expanded symptom list (ongoing)
    • For long-term care homes in outbreak, also include asymptomatic residents and staff who have been in contact with cases (ongoing)
    • For all cases in long-term care, public health units conduct contact tracing to ensure all contacts are aware of their potential exposure and to understand origins of the exposure
    • Plan to expand LTC testing for residents and staff. Public health units plus additional health sector resources including hospital staff and paramedics are being deployed to support additional testing
  2. Surveillance: To proactively stop the spread, undertake broader surveillance activities.
    • Testing of asymptomatic residents and staff in select homes across the province. This will help to inform understanding of spread in long-term care homes and inform future adjustments to the plan This testing is underway in select homes.
    • A sample of homes not in outbreak will be tested to determine presence of COVID-19, as part of surveillance. Public health unit assessments will inform an expanded plan for surveillance of homes not in outbreak, which will be implemented in the next 48 hours.

2. Managing outbreaks and spread of the disease

Goals:

  • Reduce the number of outbreaks in LTC homes
  • Contain outbreaks in LTC homes, so they do not affect as many residents

Actions:

  1. Support LTC homes with public health and infection control expertise to contain existing outbreaks and prevent future outbreaks. This will include:
    1. Risk assessment:
      • Public Health Unit assess risks for all homes to determine homes for priority focus on outbreak management and other homes for prevention supports (assessment underway).
      • Capacity assessment of public health units to determine how additional health system resources (e.g., hospital infection and control experts) can support public health units to address long-term care home outbreaks.
    2. Support teams
      • Infection prevention and control expertise from across health sector staged and ready to go in 24-48 hours
        • Ontario Health working with Public Health Units will assemble regional teams to support individual homes
        • Public health units to supplement one another is underway
        • Infection prevention and control teams will be deployed to highest risk homes starting within 48 hours
  2. Personal Protective Equipment
    • Enhanced guidance to support homes on usage of PPE, including on what PPE to use in what circumstances, will be released shortly
    • Continue to prioritize distribution of PPE to homes that are in need. The Ministry of Health’s Emergency Operations Centre is responding to every escalated request for PPE from LTC homes and retirement homes within 24 hours. This resulted in 102 LTC homes and 16 retirement homes receiving supplies over the April 11th weekend.
  3. New emergency order to limit work sites for long-term care employees
    • Directing long-term care employers to ensure their employees including registered nurses, registered practical nurses, personal support workers, kitchen and cleaning staff only work in one long-term care home. This means that employees cannot work in multiple locations such as a retirement home, or other health care setting.
    • Long-term care workers who must temporarily give up a job in another care setting as a result of this order are protected from losing that job because they are entitled to an unpaid leave of absence.
    • Long-term care homes are encouraged to use emergency funds to bring part-time staff to full-time hours to meet staffing needs
  4. Training and education to support staff working in outbreak situations, including supporting staff with IPAC education for homes in outbreak on use of PPE (underway)

3. Growing our heroic long-term care workforce

Goals:

  • Fewer long-term care homes reporting critical staffing challenges
  • Limiting long-term care employees to work in only one location

Actions:

  1. Supplement long-term care home capacity by:
    • Redeploying health care workers from areas in the health sector experiencing fewer patient volumes, including hospital and home care resources, into long-term care homes
    • Utilizing the job matching portal to identify available resources for homes experiencing shortages (more than 190 homes have used it to date). Supplement with the Federal government HR portal when it goes live
    • Providing emergency funding for infection prevention and containment to homes. This funding can be used for hiring additional or replacement staff, or for topping up part-time workers to full-time hours, along with other options.
    • Working with the federal government to determine how their recently announced initiative to top-up wages for essential health care workers can be used in Ontario to support our long-term care staff.

Additional measures

  • Every option is on the table and additional measures will be taken as we address this fast-changing outbreak.
  • To augment current planned actions additional measures are under development, including approaches to help older homes with challenging facilities better isolate sick residents
  • Ministry of Health, Ministry of Long-Term Care, Public Health and Public Health Ontario are working together to assess options
    • This could include movement of patients to other facilities to improve isolation capacity
Updated: August 25, 2021
Published: April 15, 2020