Purpose

The purpose of this document is to provide licensees of long-term care homes, as defined in the Fixing Long-Term Care Act, 2021 (the Act), with general information on enforceable requirements set out by the Province of Ontario with respect to the COVID‑19 pandemic, including those set out in the Minister’s Directive issued by the Minister of Long-Term Care, and to help homes in developing approaches for operating safely while providing the greatest possible opportunities for maximizing resident quality of life.

This document is to be followed in conjunction with any applicable legislation, directives and orders, and is not intended as a substitute and does not constitute legal advice. This document should be followed unless there are reasonable health and safety reasons to exercise discretion as ordered by the local public health unit. Where homes are undertaking COVID‑19 measures that exceed the requirements in this document or the applicable legislation, directives and orders, it is expected that the home will consult with their local public health unit, their Residents’ Council and Family Council prior to implementation.

In the event of any conflict between this document and any applicable legislation, directive, or order, the legislation, directive or order prevails. Additionally, this document is not intended to take the place of medical advice, diagnosis or treatment.

SARS‑CoV‑2, the virus which causes COVID‑19, primarily spreads from one person to another when an infected person breathes, talks, coughs or sneezes and releases respiratory emissions of different sized virus-laden particles into the air. There is not one specific measure that will prevent SARS-CoV-2 transmission. However, the use of multiple layers of prevention provides the best protection, especially when people cannot avoid closed spaces, crowded places, and close contact.

COVID‑19 vaccination

Vaccination policies

With the high vaccine uptake among residents, the availability of safe and effective antivirals, and high immunity in the general community, the risk of severe outcomes to residents has significantly decreased.

Long-term care homes that have retained their proof-of-vaccination requirements are strongly recommended to revisit their policies, with consideration to the current context of the pandemic and the Residents’ Bill of Rights, including the residents’ right to receive visitors of their choice. Specifically, while continuing to promote the uptake of boosters, homes are encouraged to consider permitting entry to visitors and qualified staff, regardless of their vaccination status. Licensees should engage with their residents’ council, family council, and local public health unit to inform the review of their policies to ensure revisions are supported by the most current clinical evidence. Licensees are also encouraged to seek independent legal advice as appropriate.

Long-term care licensees continue to retain the ability to impose vaccination requirements for existing and new staff, students, volunteers, support workers, caregivers and general visitors provided they are consistent with the Fixing Long-Term Care Act, 2021, including the Residents’ Bill of Rights and section 5 (right to a safe and secure home), as well as O. Reg. 246/22 under the Act, and comply with all other applicable laws including the Human Rights Code.

However, vaccination requirements shall not apply to residents. For clarity, homes cannot deny admission to a resident due to their vaccination status. In addition, vaccination policies must not apply to outdoor visitors, children under the age of five, or to those visiting residents who are receiving end-of-life care.

To augment continued vaccination policies, long-term care homes are strongly encouraged to consider best practices regarding promoting awareness of the benefits of vaccination, ensuring up to date information regarding booster eligibility is available, and offering on site vaccination (including setting up for independent administration by the home).

Best practices

Promoting awareness of the benefits of vaccination

There continues to be a risk for severe outcomes as a result of COVID‑19 in the elderly population due to age and underlying medical conditions, particularly in shared living spaces like long-term care homes. Vaccination remains the best defense against COVID‑19.

Vaccination has been shown to be very effective against severe illness and outcomes. Staying up-to-date with recommended doses restores protection that wanes over time. More specifically, booster doses help increase protection against symptomatic infection and severe outcomes, such as hospitalization and ICU admission.

Regardless of a home’s specific vaccination policy, all individuals entering long-term care homes, including residents, staff, caregivers and visitors, are strongly encouraged to get vaccinated and stay up-to-date with recommended doses as per the Ministry of Health’s COVID‑19 Vaccine Guidance (PDF). All vaccines provided as part of Ontario’s vaccine rollout are safe and effective. Additional information about COVID‑19 vaccination can also be found at COVID‑19 vaccines for Ontario.

Onsite vaccination

Onsite vaccine administration by homes remains the preferred approach to ensure vaccines can get to residents, caregivers and staff as quickly as possible. Homes that are set up for independent administration of COVID‑19 vaccines should work with their local public health units to request vaccine and relevant ancillary supplies for administering vaccine doses to residents, staff and caregivers onsite.

Homes that are not yet set up for independent administration are asked to either take the necessary steps to onboard for independent administration, or consider other avenues for administering vaccines onsite, such as working with their local public health unit to arrange for a local pharmacy, community family physicians or Emergency Medical Services staff to administer boosters.

Onsite vaccine administration should include residents, staff and caregivers regardless of whether the home is administering or another partner. Notwithstanding the benefits of onsite administration, homes should also continue to strongly encourage staff and caregivers to leverage resources available in the community to get their booster dose as soon as they are eligible. Staff and caregivers can book booster appointments on the provincial COVID‑19 vaccination portal, by calling the Provincial Vaccine Contact Centre at 1-833-943-3900, or through select pharmacies and primary care settings. Homes are also encouraged to support staff and remove any barriers to getting a booster (such as, supporting paid time to go to a vaccine appointment).

Infection prevention and control (IPAC) practices

The importance of ongoing adherence to strong and consistent IPAC processes and practices cannot be overstated. It is critical that homes strive to prevent and limit the spread of COVID‑19 by ensuring that strong and consistent IPAC practices are implemented and continuously reviewed. Appropriate and effective IPAC practices must be carried out by all people attending or living in the home, at all times, regardless of whether there are cases of COVID‑19 in the home or not, and regardless of the vaccination status of an individual. Licensees are required to implement requirements of the Infection Prevention and Control Standard for Long-Term Care Homes for IPAC programming, in addition to the requirements outlined in this guidance document.

IPAC audits

Per section 1.1 of the Minister’s Directive, licensees, in consultation with their joint health and safety committees or health and safety representatives, if any, shall ensure measures are taken to prepare for and respond to a COVID‑19 outbreak, including ensuring the development and implementation of a COVID‑19 Outbreak Preparedness Plan. This plan must, among other things, include conducting regular IPAC audits in accordance with this guidance document.

Homes must complete IPAC audits every two weeks unless in outbreak. When a home is in outbreak, IPAC audits must be completed weekly.

Homes are reminded that IPAC audits should be rotated across shifts, including evenings and weekends.

At minimum, homes must include in their audit the PHO's COVID‑19: Self-Assessment Audit Tool for Long-Term Care Homes and Retirement Homes (PDF).

Results of the IPAC audit should be kept for at least 30 days and shared with inspectors from the public health unit, Ministry of Labour, Immigration, Training and Skills Development, and Ministry of Long-Term Care upon request.

General IPAC requirements

As a reminder, licensees are subject to section 23 of the Act, which requires that every home have an IPAC program. Details of IPAC program requirements can be found in the IPAC Standard for Long-Term Care Homes. Section 102 of O. Reg. 246/22 contains additional requirements, including that homes are to follow an interdisciplinary team approach in the coordination and implementation of the IPAC program and that every long-term care home must have a designated IPAC lead. The importance of ongoing adherence to strong IPAC processes and practices cannot be overstated.

Please see the Minister’s Directive for the full set of IPAC requirements including personal protective equipment (PPE) requirements.   

Everyone in a long-term care home, whether staff, student, volunteer, caregiver, support worker, general visitor or resident, has a responsibility to ensure the ongoing health and safety of all by practising these measures at all times.

Licensees should ensure that they have adequate stock levels of all supplies and materials required on a day-to-day basis regardless of outbreak status.

For further guidance on best practices related to IPAC, refer to the following Public Health Ontario websites:

Masking

Per section 1.2 of the Minister’s Directive, licensees are required to ensure that the masking requirements as set out in this guidance document are followed.

As the first defence against the transmission of respiratory viruses, masks are required for long-term care staff, as well as for visitors and others entering long-term care homes. The ministry recommends (but does not require) caregivers and visitors to wear masks when they are alone with a resident in their room. For residents living in shared rooms, homes should seek to designate a space that enables residents to interact with their visitors without masks. When not in a one-on-one setting with a resident in their room or a designated space within the home, visitors and caregivers are required to be masked.

Homes must ensure that all staff, students and volunteers wear a medical mask for the entire duration of their shift indoors regardless of their immunization status. These requirements also apply regardless of whether the home is in an outbreak or not.

Masks are not required outdoors for staff, residents, students, volunteers or visitors (general or essential); however, outdoor masking is still recommended for staff, students, and volunteers as an added layer of protection when in close proximity to a resident (for example, going for a walk with a resident).

Removal of masks for the purposes of eating should be restricted to areas designated by the home (which may include in a resident’s room).

For residents: homes are required to have policies regarding masking for residents. While there is no requirement for residents to wear a mask inside of the home, a home’s policies must set out that residents must be encouraged to wear or be assisted to wear a medical mask or non-medical mask when receiving direct care from staff, when in common areas with other residents (with the exception of mealtimes), and when receiving a visitor, as tolerated.

For staff: homes must ensure that all staff comply with masking requirements at all times, even when they are not delivering direct patient care, including in administrative areas. During their breaks, to prevent staff-to-staff transmission of COVID‑19, staff must remain two metres away from others at all times and be physically distanced before removing their medical mask for eating and drinking. Masks must not be removed when staff are interacting with residents or in designated resident areas.

Exceptions to the masking requirements are:

Homes must also have policies for individuals (staff, students, volunteers, support workers, caregivers, visitors or residents) who:

  • have a medical condition that inhibits their ability to wear a mask
  • are unable to put on or remove their mask without assistance from another person

Eye protection: from an occupational health and safety perspective, regardless of their COVID‑19 vaccination status, appropriate eye protection (for example, goggles or face shield) is required for all staff and essential visitors when providing care to residents with suspected or confirmed COVID‑19 and in the provision of direct care within two metres of residents in an outbreak area. In all other circumstances, the use of eye protection by staff is based on the point-of-care risk assessment when within two metres of a resident.

Areas for isolation

Per section 5.2 of the Minister’s Directive, licensees are required to ensure that the requirements regarding areas for isolation as set out in this guidance document are followed.

Note that per subsection 269(1) of O. Reg. 246/22 under the Act, licensees must ensure that their emergency plan related to COVID‑19 outbreaks identifies an area of the home to be used for isolating residents as required, among other requirements, however homes are no longer required to directly set aside beds for this purpose.

Individuals requiring isolation must be placed in a single room on Additional Precautions. Where this is not possible, individuals may be placed in a room with no more than one (1) other resident who must also be placed in isolation under Additional Precautions, and every effort must be made to allow for adequate space (minimum two metres) between beds. For the purposes of isolation, there should not be more than two (2) residents placed per room, regardless of the number of licensed beds in the room.

Activities

Communal dining

Communal dining is an important part of many homes’ social environment.

All long-term care homes may provide communal dining with the following precautions:

  • When not eating or drinking, residents should be encouraged to wear a mask where possible or tolerated.
  • Caregivers and general visitors may accompany a resident for meals to assist them with eating; however, caregivers or general visitors must remain masked at all times and not join in the meal.
  • Frequent hand hygiene of residents and staff, general visitors, caregivers and volunteers assisting residents with eating must be undertaken.

Unless otherwise directed by the local public health unit, homes may offer buffet or family-style service, including during regular daily meals and as part of special occasions or celebrations (for example, to celebrate a holiday).

Group activities: organized events and social gatherings

Homes are to provide opportunities for residents to gather for group activities including:

  • social purposes
  • physical activities
  • hobbies and crafts
  • celebrations such as for birthdays
  • religious ceremonies and practices consistent with licensees’ requirement to ensure that there is an organized program for the home to ensure that residents are given reasonable opportunity to practice their religious and spiritual beliefs, and to observe the requirements of those beliefs, pursuant to section 18 of the Act

Social group activities may consist of larger groups (more than 10). Infection prevention and control measures should continue to be followed by staff, residents and visitors to promote safety and wellbeing (for example, masking, good ventilation). General visitors and caregivers may join residents during the activities in all homes, both indoors and outdoors, unless otherwise directed by the local public health unit.

What happens in an outbreak?

Per section 3 of the Minister’s Directive, licensees are required to ensure that the cohorting requirements for staff, students, volunteers and residents as set out in this guidance document are followed.

In the event of a COVID‑19 outbreak, residents must be cohorted for all non-essential activities including communal dining, organized events and social gatherings. Different cohorts are not to be mixed, and residents from different cohorts should not visit one another. Homes must also follow the cohorting practices in the COVID‑19 Guidance: Long-Term Care Homes, Retirement Homes, and other Congregate Living Settings for Public Health Units (PDF).

What happens when a resident is isolating or fails screening?

Residents in isolation or who fail screening (such as, daily monitoring as per IPAC Standard section 3) are not to join in group organized events, activities, dining or social gatherings. However, homes should attempt to have these residents join in virtually where possible, to provide these residents with an alternative to in-person social interaction.

COVID‑19 screening

Per section 9 of the Minister’s Directive, licensees are required to ensure that the COVID‑19 screening requirements as set out in this guidance document are followed.

The purpose of screening is to provide another preventive layer to identify those who may be infectious, to reduce the potential entry and spread of COVID‑19 within long-term care homes.

Types of screening

Active screening means there is some form of attestation or confirmation of screening. This can be achieved through pre-arrival submission of online screening or in person.

Passive screening means that those entering the setting review screening questions themselves, and there is no verification of screening (for example, signage at entrances as a visual reminder not to enter if symptomatic).

Screening requirements

Long-term care home licensees must:

  • establish and communicate an operational plan including guidance for staff, students, volunteers, support workers, caregivers and general visitors to self-monitor for symptoms of COVID‑19 (passive screening)
  • provide individuals with information (for example, screening questions) to monitor their health at home for COVID‑19 symptoms and inform them that they are not permitted to enter the home if they are feeling ill or would otherwise fail screening
    • Homes are not required to request verification or an attestation upon entry to the home (nor are homes required to have staff conduct or verify screening at the door). 
  • post signage at entrances and throughout the home that lists the signs and symptoms of COVID‑19, for self-monitoring and steps that must be taken if COVID‑19 is suspected or confirmed in any individual

Homes are not to prohibit visitors for palliative end‑of‑life residents. If these individuals fail screening, they must be permitted entry, but homes must ensure that they wear a medical (surgical or procedural) mask and maintain physical distance from other residents and staff.

Staffing

To support long-term care homes that are experiencing staffing challenges, the ministry has put in place a number of measures to help homes in times of serious staffing shortages that cannot be filled by other means including staffing agencies. Homes not in outbreak have the ability to implement these measures based on their own assessment. When a home is in outbreak, it should work with the public health unit when implementing these measures.

Operational flexibility

To ensure operational continuity and maintain safety and security for residents, certain transitional provisions have been included in O. Reg. 246/22 under the Act as follows:

  • Provide that a licensee is not required to comply with a requirement set out in the Act or Regulation respecting qualifications for members of staff, subject to exceptions, until 12 months after the coming into force of the transitional section, as long as the person holding the position, in the reasonable opinion of the licensee, has the adequate skills, training and knowledge to perform the duties required of that position. This transitional provision does not apply to a number of staff positions, including physicians, registered nurses, registered nurses in the extended class and registered practical nurses.
  • Providing that a licensee is not required to comply with the requirements in subsection 140 (3) of the Regulation related to the administration of drugs until 12 months after the coming into force of the transitional section, as long as, where the administration involves the performance of a controlled act set out in subsection 27 (2) of the Regulated Health Professions Act, 1991, the person administering the drug is authorized to perform the controlled act under the relevant health profession Act.

Return-to-work risk-based framework

Please refer to the Ministry of Health’s Management of Cases and Contacts of COVID‑19 in Ontario (PDF).

Staffing resources available across the system are limited. Facilities must rely on their business continuity plans and system partners to support wherever possible. In the event that challenges continue after exhausting their contingency plans, staffing agency partnerships, community partners and corporate or municipal supports (where applicable), homes should escalate to Ontario Health.

Admissions and transfers

Per section 5.1 of the Minister’s Directive, for matters related to admissions and transfers as well as applicable isolation and testing requirements for long-term care homes, homes are to abide by requirements set out in the Ministry of Health COVID‑19 Guidance: Long-Term Care Homes, Retirement Homes, and other Congregate Living Settings for Public Health Units (PDF) (see in particular, Appendix E: Algorithm for Admissions and Transfers for Long-Term Care Homes and Retirement Homes).

Absences

Per section 6 of the Minister’s Directive, licensees are required to ensure that the resident absence requirements as set out in this guidance document are followed. 

Requirements

All long-term care homes must establish and implement policies and procedures in respect of resident absences, which, at a minimum, set out the definitions and requirements and conditions described below.

For all absences, residents must be:

  • provided with a medical mask when they are leaving the home
  • provided a handout that reminds residents and families to practice public health measures such as masking and hand hygiene when outside of the home

There are four types of absences:

  1. medical absences are absences to seek medical or health care and include:
    • outpatient medical visits and a single visit (less than or equal to 24 hours in duration) to the emergency department
    • all other medical visits (for example, admissions or transfers to other health care facilities, multi-night stays in the emergency department)
  1. compassionate and palliative absences include, but are not limited to, absences for the purposes of visiting a dying loved one
  1. short term (day) absences are absences that are less than or equal to 24 hours in duration. There are two types of short term (day) absences:
    • essential absences include absences for reasons of groceries, pharmacies, and outdoor physical activity
    • social absences include absences for all reasons not listed under medical, compassionate or palliative, or essential absences that do not include an overnight stay
  1. temporary absences include absences involving two or more days and one or more nights for non-medical reasons

Homes cannot restrict or deny absences for medical, palliative or compassionate reasons at any time. This includes when a resident is in isolation or when a home is in an outbreak.

Residents who are in isolation on Additional Precautions may not participate in essential, social or temporary absences. Homes should seek the advice of local public health unit if self-isolation must be broken for these reasons.

When a resident who is self-isolating on Additional Precautions is required to leave the home for a medical absence, homes should notify the health care facility so that care can be provided to the resident with the appropriate Additional Precautions in place.

Residents returning from absences

Homes are not required to actively screen, test or isolate residents upon return from an absence unless the resident is symptomatic. Any resident who is symptomatic must be permitted entry but isolated on Additional Precautions and tested for COVID‑19 as per the Management of Cases and Contacts of COVID‑19 in Ontario (PDF) and the COVID‑19 Guidance: Long-Term Care Homes, Retirement Homes, and other Congregate Living Settings for Public Health Units (PDF). 

Off-site excursions

Off-site group excursions (for example, to an attraction) are considered social absences and are permitted.

For all off-site group excursions, residents must be:

  • provided with a medical mask when they are leaving the home
  • reminded to practice public health measures such as masking and hand hygiene when outside of the home
  • following testing and isolation rules under isolation and testing requirements for residents when returning from absences, where applicable

Visitors

Per section 7 of the Minister’s Directive, licensees are required to ensure that the visitor requirements as set out in this guidance document are followed.

Homes are reminded that residents have a right under the Fixing Long-Term Care Act, 2021, to receive visitors and homes should not develop policies that unreasonably restrict this right.

Requirements

  1. Every long-term care home must have and implement a visitor policy that, at a minimum:
    • reflects the following guiding principles:
      • safety – any approach to visiting must balance the health and safety needs of residents, staff, and visitors, and ensure risks are mitigated
      • emotional well-being – welcoming visitors is intended to support the mental and emotional well-being of residents by reducing any potential negative impacts related to social isolation
      • equitable access – all residents must be given equitable access to receive visitors, consistent with their preferences and within reasonable restrictions that safeguard residents
      • flexibility – the physical and infrastructure characteristics of the home, its workforce or human resources availability, whether the home is in an outbreak and the current status of the home with respect to personal protective equipment (PPE) are all variables to consider when setting home-specific policies
      • equality – residents have the right to choose their visitors. In addition, residents or their substitute decision-makers, as applicable, have the authority to designate caregivers
    • sets out the parameters, requirements, and procedures prescribed in the current version of this document with respect to visitors, including but not limited to:
      • the definitions of the different types of visitors
      • the requirement to designate caregivers in accordance with the O. Reg. 246/22
      • restrictions with respect to visitors in the event of an outbreak or when a resident is isolating
      • non-compliance by visitors of the home’s visitor policy
    • includes provisions around the home’s implementation of all required public health measures as well as infection prevention and control practices
    • complies with all applicable laws, including the Act and O. Reg. 246/22
  1. In accordance with section 267(2) of O. Reg. 246/22, homes must maintain visitor logs of all visits to the home. The visitor log must include, at minimum:
    • the name and contact information of the visitor
    • time and date of the visit
    • the purpose of the visit (for example, name of resident visited)

These visitor logs or records must be kept for a period of at least 30 days and be readily available to the local public health unit for contact tracing purposes upon request.

  1. Homes must ensure that all visitors have access to the home’s visitor policy.
  1. Homes must provide education or training to all visitors about respiratory etiquette, hand hygiene, IPAC practices, and proper use of PPE.

The home’s visitor policy should include guidance from the following Public Health Ontario resources to support IPAC and PPE education and training:

Types of visitors

Not considered visitors

Long-term care home staff (as defined under the Act), volunteers and student placements are not considered visitors as their access to the home is determined by the licensee. Infants under the age of one are also not considered visitors.

Essential visitors

Essential visitors are the only type of visitors allowed when there is an outbreak in a home or area of a home or when a resident has failed screening, is symptomatic or in isolation.

As per O. Reg. 246/22 under the Fixing Long-Term Care Act, 2021, there are four types of essential visitors:

  • a caregiver, as defined under section 4 of O. Reg. 246/22
  • a support worker who visits a home to provide support to the critical operations of the home or to provide essential services to residents
  • a person visiting a very ill resident for compassionate reasons including, but not limited to, hospice services or end-of-life care
  • a government inspector with a statutory right to enter a long-term care home to carry out their duties

Caregivers – scheduling and length and frequency of visits

Homes may not require scheduling or restrict the length or frequency of visits by caregivers.

A caregiver should not visit any other home for 10 days after visiting:

  • an individual with a confirmed case of COVID‑19
  • an individual experiencing COVID‑19 symptoms

Recognizing there are caregivers who want to volunteer to support more than one resident, in the event of an outbreak, caregivers may support up to two residents who are COVID‑19 positive, provided the home obtains consent from all involved residents (or their substitute decision makers). Caregivers may also support more than one resident in non-outbreak situations, with the same expectation regarding resident consent.

General visitors

A general visitor is a person who is not an essential visitor and is visiting to provide non-essential services related to either the operations of the home or a particular resident or group of residents. General visitors include those persons visiting for social reasons as well as visitors providing non-essential services such as personal care services, entertainment, or individuals touring the home.

Homes should prioritize the mental and emotional well-being of residents and strive to be as accommodating as possible when scheduling visits with general visitors.

Access to homes

All general visitors, including children under the age of five, can enter the long-term care home. General visitors, with the exception of children under the age of five, will need to follow the vaccination policy of the individual long-term care home.

There are no ministry limits on the number of visitors (including caregivers) that a resident may visit with at a time for indoor or outdoor visits. Homes are to set their own visitor policy based on their available spaces and in accordance with applicable guidance and laws, including requirements under the Fixing Long-Term Care Act, 2021 and Regulation.

Restrictions during outbreaks or when a resident is isolating

Essential visitors

Essential visitors are the only type of visitors allowed when a resident is isolating or resides in a home or area of the home in an outbreak.

General visitors

General visitors are not permitted:

  • when a home or area of a home is in outbreak
  • to visit an isolating resident
  • when the local public health unit so directs

Direction from the local public health unit

In the case where a local public health unit directs a home in respect of the number of visitors allowed, the home must follow the direction of the local public health unit.

COVID‑19 asymptomatic screen testing

The requirement for asymptomatic screen testing has been removed for all staff, students, volunteers, support workers, caregivers and general visitors entering long-term care homes. While homes still have the option to implement their own asymptomatic screen testing policies, it is not recommended at this time. In addition, policies must not apply to outdoor visitors, those visiting residents who are receiving end-of-life care or to inspectors with a statutory right of entry.

The routine testing of asymptomatic staff, students, volunteers, caregivers, support workers and visitors who have not been exposed to COVID‑19 is different from COVID‑19 testing of individuals who are symptomatic, have had high risk exposure or are in an outbreak setting as directed by the local public health unit.

Prohibition on reselling or distributing to any other person

Antigen tests that have been provided by the Province of Ontario, either directly or indirectly (for example, through an agency of the government), must only be used for intended purposes and not be resold or distributed to any other person.

Residents’ councils

Residents’ councils play an important role in every long-term care home. As a reminder:

  • licensees are not to interfere with the meetings or operation of the residents’ council per section 71 under the Act
  • licensees are to co-operate with the residents’ council, appoint an assistant, and respond to council concerns and recommendations

All homes need to ensure that the residents’ council is provided an opportunity to meet. When in-person meetings of the residents’ council are possible, it is expected that the residents’ councils will be provided with the appropriate PPE and IPAC guidelines can be followed. Homes are to accommodate the continuation of residents’ council meetings when in-person meetings are not possible.

The Ontario Association of Residents’ Councils (OARC) has developed a number of resources to help homes facilitate resident council meetings; please visit OARC’s Tools webpage to access these important resources.

Case and outbreak management

Per section 4 of the Minister’s Directive, licensees are required to ensure that the requirements for case and outbreak management as set out in this document are followed.

Outbreak definition

For matters related to the definition of an outbreak in long-term care homes, refer directly to the Ministry of Health COVID‑19 Guidance: Long-Term Care Homes, Retirement Homes, and other Congregate Living Settings for Public Health Units (PDF).

Only the local public health unit can declare an outbreak and declare when it is over. It is not the long-term care home’s responsibility to determine whether cases have an epidemiological link. Local public health units will determine whether cases have an epidemiological link as part of their investigation, which will inform their decision as to whether or not they declare an outbreak.

Case and outbreak management

For COVID‑19 related case and outbreak management, homes are to abide by requirements under the Fixing Long-Term Care Act, 2021 and O. Reg. 246/22, and set out in:

Homes must follow direction from their local public health unit in the event of a suspect or confirmed outbreak. The local public health unit is responsible for managing the outbreak response. Local public health units have the authority and discretion as set out in the Health Protection and Promotion Act to coordinate outbreak investigation, declare an outbreak based on their investigation, and direct outbreak control measures.

For clarity, the local public health unit is responsible for defining the outbreak area (for example, a single affected unit vs. the whole home), directing outbreak testing, and leading all other aspects of outbreak management including isolation of residents and staff, as well as declaring the end of an outbreak.

Homes must follow any guidance provided by the local public health unit with respect to any additional measures that must be implemented to reduce the risk of COVID‑19 transmission in the setting.

Homes must ensure that any health system partners or external agencies that participate in any suspect or confirmed outbreak response inform the local public health unit and the Outbreak Management Team of their involvement. These external agencies must also follow any directions provided by the local public health unit to them pursuant to the Health Protection and Promotion Act.

Reporting outbreaks and cases

COVID‑19 is a designated disease of public health significance (O. Reg. 135/18) and thus confirmed and suspected cases of COVID‑19 are reportable to the local public health unit under the Health Protection and Promotion Act (HPPA). Homes must notify the local public health unit of all confirmed and probable resident cases of COVID‑19 as soon as possible, as well as outbreak-related staff and visitor cases, as per the outbreak definition found in the COVID‑19 Guidance: Long-Term Care Homes, Retirement Homes, and other Congregate Living Settings for Public Health Units (PDF).

The local public health unit is responsible for receiving and investigating all (reports of) cases and contacts of COVID‑19 in accordance with the COVID‑19 Guidance: Long-Term Care Homes, Retirement Homes, and other Congregate Living Settings for Public Health Units (PDF) and the Health Protection and Promotion Act.

Homes must follow the critical incident reporting requirements set out in section 115 of O. Reg. 246/22 made under the Act. Homes are required to immediately report any confirmed COVID‑19 outbreak to the Ministry of Long-Term Care using the Critical Incident System (CIS) report during business hours (Monday to Friday, 8:30 a.m. to 4:30 p.m) or calling the Service Ontario After-Hours line at 1-888-999-6973 outside of business hours or during a statutory holiday and submitting a CIS report the next business day.

Contact information

Questions regarding COVID‑19 related policies and guidance can be emailed to the Ministry of Long-Term Care at MLTCpandemicresponse@ontario.ca.

Contact your local public health unit.

Resources

General

Vaccination

Infection prevention and control

For information and guidance regarding general IPAC measures (for example, hand hygiene, environmental cleaning), please refer to the following documents:

Signage

Ventilation and air flow

Below is a list of Public Health Ontario resources related to the use of portable fans, air conditioning units, and portable air cleaners.