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

Long-term care licensees retain the ability to impose vaccination requirements for existing and new staff, students, and volunteers, provided they comply with all applicable laws, such as the Human Rights Code.

In addition, nothing prevents licensees from having proof-of-vaccination requirements for caregivers, general visitors and support workers provided the licensee’s requirements are consistent with the Fixing Long-Term Care Act, 2021, including the Residents’ Bill of Rights and section 5 of the Act (right to a safe and secure home), and O. Reg. 246/22: General, 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.

While licensees have the ability to develop their own proof-of-vaccination policies, to ensure that residents are not unreasonably restricted from having visitors in accordance with the Residents’ Bill of Rights, 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. Licensees should engage with their residents’ council, family council, and local public health unit to inform their policies, review their policies regularly to ensure they are supported by the most current clinical advice, and seek independent legal advice as needed regarding their ongoing policies.

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.

Best practices

Promoting awareness of the benefits of vaccination

There continues to be an increased 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 self-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 (PDF) 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 (PDF). 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:

Physical distancing

Per section 1.3 of the Minister’s Directive, licensees are required to ensure that the physical distancing requirements as set out in this guidance document are followed.

As much as possible, long-term care homes should continue to adjust activities to optimize and support physical distancing (PDF) (a minimum of two metres or six feet). This will also enable homes to adapt to enhanced precautions (for example, outbreak situations) as appropriate.

In general, all individuals should be encouraged to avoid situations where covid 19 can spread more easily, such as:

  • crowded places with many people nearby
  • close-contact settings
  • confined and enclosed spaces with poor ventilation

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.

Masks are required for long-term care staff, as well as for visitors and others entering long-term care homes. However, recognizing that long-term care residents miss seeing the faces of their loved ones, the ministry recommends (but no longer requires) 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 and encouraged where tolerated as an added layer of protection when in close proximity to others.

Removal of masks for the purposes of eating should be restricted to areas designated by the home (which may include 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). However, larger social group activities where potential crowding can occur should continue to be avoided, and IPAC measures should continue to be followed by staff, residents and visitors to promote safety and wellbeing (for example, masking, physical distancing, 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 symptom assessment, if applicable, active screening) 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

Long-term care homes are recommended to:

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.

Residents returning to the home following an absence must be actively screened by a staff member within the home using the Ministry of Health’s COVID-19 Screening Tool for Long-Term Care Homes and Retirement Homes. The active screening of residents returning from an absence must be done as soon as operationally feasible upon return to the home but is not required to be done prior to entry. Any resident who does not pass screening (for example, 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).

In addition, homes must ensure that all residents are assessed at least once daily for signs and symptoms of covid 19, including temperature checks.

Homes are strongly encouraged to conduct symptom assessments more frequently (for example, at every shift change), especially during an outbreak, to facilitate early identification and management of ill residents. This can take place at the same time as routine vital signs check, where applicable.

Homes should be aware that elderly individuals may present with subtle or atypical signs and symptoms of covid 19. As much as possible, it is important for homes to understand a resident’s baseline health and functioning and ensure routine monitoring of their status to facilitate early identification and management of ill residents.

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:

  • Exempt licensees from meeting the minimum staffing hours requirements in the Act and Regulation, for a period of six months from the date the transitional provision comes into effect, as long as all care requirements associated with the position are met. These exemptions would not apply to the direct hours of care targets referred to in sections 8 and 9 of the new Act.
  • 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
  • actively screened upon their return to 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

As noted in the Screening section above, residents returning from an absence must be actively screened using the Ministry of Health’s covid 19 Screening Tool for Long-Term Care Homes and Retirement Homes (PDF).

Homes are no longer required to test or isolate residents upon return from an absence unless the resident does not pass screening (for example, has covid 19 symptoms). Any resident who does not pass screening 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
  • actively screened upon their return to 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
    • reflects the requirements related to asymptomatic screen testing of visitors, consistent with this guidance document, as applicable
    • 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 physical distancing, 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. However, in the case where a resident resides in an area of the home in outbreak, is symptomatic or isolating under Additional Precautions, only one caregiver may visit at a time.

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 can return to their regular practices for setting 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.

Homes should not restrict individuals from outdoor visits based on vaccination status and should ensure physical distancing (a minimum of two metres or six feet) is maintained between groups.

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

Per section 8 of the Minister’s Directive, licensees are required to ensure that the covid 19 asymptomatic screen testing requirements as set out in this guidance document are followed.

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.

Every licensee shall ensure that no staff member, caregiver, student placement, volunteer, support worker or general visitor enters the long-term care home, unless the requirements contained in this section have been met.

Individuals who receive a positive test result for covid 19 as part of asymptomatic screen testing must follow further testing and isolation requirements as outlined in the Ministry of Health’s covid 19 Guidance: Long-Term Care Homes, Retirement Homes, and other Congregate Living Settings for Public Health Units (PDF) or as directed by the local public health unit.

Staff, caregivers, student placements and volunteers

Subject to the exceptions listed below, all staff, caregivers, student placements and volunteers working in or visiting a long-term care home must be tested for covid 19 according to one of the following:

  • an antigen test at least two times per week, on separate days, if they are up-to-date with recommended covid 19 vaccine doses according to the Ministry of Health’s covid 19 Vaccine Guidance (PDF)
  • an antigen test at least three times per week, on separate days, if they are not up-to-date with recommended covid 19 vaccine doses
  • one PCR and one antigen test per week, at a minimum, on separate days

For the purpose of meeting the asymptomatic screen testing requirements, “up-to-date” with covid 19 vaccines means having completed the primary series and received a covid 19 vaccine within the last 6 months.

Where a staff member, student or volunteer takes an antigen test at the long-term care home the test must be taken as soon as possible after beginning a shift, and the individual may enter the home with appropriate PPE and following IPAC practices while waiting for the test results. Staff, student placements and volunteers should not provide direct care to residents until a negative test result is received.

Where a caregiver takes an antigen test at the long-term care home, the test must be taken before granting them full entry. However, they may proceed to the resident’s room, with appropriate PPE and following IPAC practices while waiting for the test result. They must not enter any shared spaces (for example, dining room, activity room) until a negative test result is received.

General visitors and support workers

All general visitors and support workers entering a long-term care home must meet one of the following prior to entry:

  • receive and demonstrate a negative test result from an antigen test taken at the long-term care home on that day
  • demonstrate proof of a negative test result from an antigen test or PCR test taken on the same day or the day prior to the visit

Where a support worker who is a member of a regulated health profession takes an antigen test onsite, the test must be taken upon entry and the person may enter the home with appropriate PPE and following IPAC practices, while waiting for the test result.

Exceptions

Consecutive days

If a staff member, caregiver, student placement or volunteer only enters a long-term care home on two consecutive days within a seven day period and demonstrates a negative test result from an antigen test or from a PCR test taken on the first day, they may enter on the second consecutive day without requiring a negative test.

Occasional entry

No individual is required to attend the home for the sole purposes of meeting the testing requirements (for example, if they enter a home fewer than the number of times required to be tested per week).

Repeat false positives

If an individual receives three “false positive” antigen tests (takes an antigen test and the test result is positive for covid 19 and subsequently receives a negative confirmatory PCR test result), within a 30-day period, starting from the day the first preliminary positive antigen test was taken, the individual does not need to follow the above testing requirements. Instead, the individual must demonstrate proof of a negative PCR that was taken in the last seven days prior to entry.

Previous covid 19

If an individual has had a prior confirmed covid 19 infection in the past 90 days, they do not need to be asymptomatic screen tested, but must immediately resume asymptomatic screen testing after the 90th day from the date of their confirmed covid 19 infection.

Palliative and emergency situations

Asymptomatic screen testing for support workers, caregivers and general visitors is not required in an emergency situation or in situations where these individuals are visiting or attending to residents receiving end-of-life care.

Inspectors

The testing requirements of this guidance document do not apply to inspectors with a statutory right of entry. Rather, inspectors from the Ministry of Long-Term Care and the Ministry of Labour, Training and Skills Development have separate and specific testing protocols that have been established within their ministries.

Proof of negative test

Where an individual is being granted entry based on an antigen test or a PCR test not onsite at the long-term care home, as outlined in the sections above, they must provide proof of the negative test result in order to gain entry to the home or take a new antigen test. The licensee shall ensure that a log is maintained documenting that such proof has been demonstrated.

Statistical Information

Per section 10 of the Minister’s Directive, licensees are required to ensure that statistical information regarding covid 19 testing is collected, maintained and disclosed in accordance with this guidance document.

Every licensee shall collect, maintain and disclose statistical information on asymptomatic screen testing, including:

  • the number of staff, caregivers, student placements, volunteers, support workers and general visitors tested with an antigen test, and the number who received a positive test result from an antigen test
  • the number of staff, caregivers, student placements and volunteers screen tested with a PCR test, and the number who received a positive test result from a PCR test
  • the number of caregivers, support workers and general visitors who were permitted entry under an emergency or palliative situation
  • the number of staff, caregivers, student placements, volunteers, support workers and general visitors that provided proof of a negative test to gain entry

Upon request, the licensee must disclose the statistical information to the Ministry of Long-Term Care, Ministry of Health, Ministry of Government and Consumer Services, the public health unit for the area in which the long-term care home is located, or Ontario Health.

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 adequate space to meet so that physical distancing can be maintained 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 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 cases of covid 19 as soon as possible.

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 covid 19 outbreak (suspect or confirmed) to the Ministry of Long-Term Care using the Critical Incident System during regular working hours or calling the after-hours line at 1-888-999-6973 after hours and on weekends.

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.