Infection Prevention & Control

PURPOSE

This policy supports visitors while adhering to the current directives from the Ministry of Health, Ministry of Long-Term Care and Public Health Ontario Guidelines.
Visitors should consider their personal health and susceptibility to viruses in determining whether visiting a LTC home is appropriate.

Saint Luke’s Place recognizes that being able to connect with friends and family is essential to resident’s emotional health and well-being, so our visits are guided by the following 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: Allowing visitors is intended to support the emotional well-being of residents by reducing any potential negative impacts related to social isolation.

Equitable Access: All individuals seeking to visit a resident must be given equitable visitation access, consistent with resident preference and within reasonable restrictions that safeguard residents.

Flexibility: The physical/infrastructure characteristics of the long-term care home, its staffing availability, and the status of the home with respect to Personal Protective Equipment (PPE) are all variables to consider when setting home-specific policies.

General Guidelines for all types of visitors:

It is strongly encouraged that all visitors be up to date with all recommended COVID-19 vaccine doses. At this time, being up to date would mean having a 5th vaccine if you are 60 years of age or older or as prescribed by the ministry of health.
All visitors must participate in screening and will participate in rapid antigen testing as outlined.
If a visitor does not pass the screening and testing or do not comply with the homes protocols the visit will be cancelled.
Currently, visits must be in the resident’s room or a designated area of the Home, physical distanced from others. Visitors are not to visit other residents or other resident units.
Visitors will be provided with a medical grade mask and other PPE as deemed necessary upon entering the Home, while in the presence of other residents and staff and when exiting the home.
Visitors may remove their mask once alone inside the resident room or private area where no other resident is present other than the resident they are visiting. If the resident you are visiting is in a shared room, you must go to a designated private space if you want to interact without masks.
All visitors will sanitize hands upon entry and exit to the Home and as frequently as reasonable (especially after contact) during their visit.

Definitions of Visitors

Essential Visitor

Person performing essential support services (food delivery, inspectors, funeral directors, general contractors, or health care services (lab, x-ray) or a person visiting a very ill or end of life resident.
Government inspectors, however, they are not subject to this policy

Essential Care Giver (ECG)

A type of essential visitor who is designated by the resident or the resident’s substitute decision maker with authority to give that designation.
Visiting to provide direct care to the resident (e.g., supporting feeding, mobility, personal hygiene, cognitive stimulation, communication, meaningful connection, relational continuity, and assistance in decision making)
A caregiver could be a family member, a friend, a person of importance to the resident, a paid caregiver or companion or a translator
A caregiver must be able to comply with all applicable laws including any applicable directives, orders, guidance, advice, or recommendations issued by the Chief Medical Officer of Health or a Medical Officer of Health appointed under the Health Protection and Promotion Act.
In the case of an individual under 16 years of age, has approval from a parent or legal guardian to be designated as a caregiver
Visits do not need to be scheduled and there are no restrictions on length of visit
When a resident is self-isolating, symptomatic or during a confirmed and/or suspected outbreak, visits will be granted at the direction of Public Health regarding the number of visitors, but essential visitors will continue to have access to the home.

Support Worker

A type of essential visitor
Performing essential services in the Home or for a resident in the home. (i.e., physician, nurse practitioner, agency PSW, RN and RPN’s etc.)
Visitor is allowed when a resident is self-isolating or symptomatic, or the Home is in outbreak.

General Visitor

Is NOT an essential visitor
Individuals visiting to provide non-essential services, who may or may not be hired by the resident and/or SDM
Individuals visiting for social reasons
Individuals are not allowed to visit when a resident is self-isolating or symptomatic, or the Home is in confirmed and/or suspect outbreak

Essential Care Givers (ECGs)

It is strongly recommended that all ECG's be up to date with all recommended COVID-19 vaccine doses. At this time being up to date would mean having a 5th vaccine if you are 60 years of age or older or as prescribed by the ministry of health.
Regardless of vaccination status ECGs require an antigen test three times per week, on separate days, and they must wear a surgical mask and other appropriate PPE required
ECG’s will be provided with a medical grade mask and other PPE as deemed necessary upon entering the Home, while in the presence of other residents and staff and when exiting the home.
ECG’s may remove their mask once alone inside the resident room or private area where no other resident is present other than the resident they are visiting. If the resident you are visiting is in a shared room, you must go to a designated private space if you want to interact without masks.
ECGs are permitted to visit during outbreak or resident isolation, however visiting is restricted to 1 ECG at a time per resident.
If returning from travel outside Canada they do not require a pre-entry test but are required to be tested upon arrival for their first visit and wait for their results.
Those who have been deemed high-risk contact must be denied entry and cannot visit for 10 days post exposure.
Those who receive a positive rapid test, or they develop symptoms at home are deemed to be COVID Positive and must leave the facility and cannot visit for 10 days.
Those returning from having Covid-19 may resume testing after 90 days from their symptom onset or positive specimen collection.
A maximum of 4 ECP’s may be designated per resident
A process for documenting caregiver designation is in place by the Home (see process below).
The decision to designate an individual as a caregiver is entirely the remit of the resident and/or their substitute decision-maker and not the home.
The Resident or SDM may change caregiver in response to the resident’s care needs (as reflected in the plan of care) or based on the availability of the designated caregiver. (Changing a caregiver must be discussed with the Director of Nursing and Personal Care or designate).

General Visitor

It is strongly encouraged that all visitors be up to date with all recommended COVID-19 vaccine doses. At this time, being up to date would mean having a 5th vaccine if you are 60 years of age or older. All general visitors (GVs), including children under the age of 5, can visit the home.
Those younger than 14 years of age must be accompanied by an adult and must follow all applicable public health measures that are in place for Saint Luke’s Place (i.e., screening, physical distancing, hand hygiene, testing, and masking)
Regardless of vaccination status all general visitors require an antigen test three times per week, on separate days, and they must wear a surgical mask and other appropriate PPE required
Masks are required for children 5 years or older; children under 2 years of age are NOT required to wear masks.
General visitors will be provided with a medical grade mask and other PPE as deemed necessary upon entering the Home, while in the presence of other residents and staff and when exiting the home.
General visitors may remove their mask once alone inside the resident room or private area where no other resident is present other than the resident they are visiting. If the resident you are visiting is in a shared room, you must go to a designated private space if you want to interact without masks.
Those returning from travel outside Canada do not require a pre-entry test. All GV’s, regardless of vaccination status are required to be tested upon arrival for their first visit and wait for their results.
Those who have been deemed high-risk contact must be denied entry and cannot visit for 10 days post exposure.
Those who receive a positive rapid test, or they develop symptoms at home are deemed to be COVID Positive and must leave the facility and cannot visit for 10 days.
Those returning from having Covid-19 may resume testing after 90 days from their symptom onset or positive specimen collection.
Restricting time lengths or number of visits may be determined as per the home to ensure the safety of residents and staff

Support Worker

It is strongly encouraged that all support workers be up to date with their COVID-19 vaccine meaning they must have received all recommended COVID-19 vaccine doses, including any booster dose(s) when eligible.
Regardless of vaccination status all support workers require an antigen test three times per week, on separate days, and they must wear a surgical mask and other appropriate PPE required
Those returning from travel outside Canada do not require a pre-entry test. All Support Workers, regardless of vaccination status are required to be tested upon arrival for their first visit and wait for their results.
Those who have been deemed high-risk contact must be denied entry and cannot visit for 10 days postexposure.
Those who receive a positive rapid test, or they develop symptoms at home are deemed to be COVID Positive and must leave the facility and cannot visit for 10 days.
Those returning from having Covid-19 may resume testing after 90 days from their symptom onset or positive specimen collection.
If they are providing an essential service (i.e., X-Ray tech, oxygen company) and have been to another home in outbreak they must wear a surgical mask and shield, be tested upon entry, and wait for their results.

Contractors (including moving companies)

All visitors must participate in screening and will participate in rapid antigen testing as outlined
If a visitor does not pass the screening and testing or do not comply with the homes protocols the visit will be cancelled.
It is recommended that all contractors be up to date with their COVID-19 vaccine meaning they must have received all recommended COVID-19 vaccine doses, including any booster dose(s) when eligible
Regardless of vaccination status all contractors require an antigen test three times per week, on separate days, and they must wear a surgical mask and other appropriate PPE required
Contractors returning from travel outside Canada do not require a pre-entry test. Contractors are required to be tested upon arrival for their first visit and wait for their results.
Contractors who have been deemed high-risk contact must be denied entry and cannot visit for 10 days post-exposure.
Contractors who receive a positive rapid test or they develop symptoms at home are deemed to be COVID Positive and must leave the facility and cannot visit for 10 days.
Contractors returning from having Covid-19 may resume testing after 90 days from their symptom onset or positive specimen collection.

Visitor Logs

Visitor screening logs will be maintained for a minimum of 30 days via the testing consent form and visitor guest book and will include the following information:

the name and contact information of the visitor
the date and time of the visit
the name of the resident visited

Distribution of the Visitor Policy

a copy of the visitor policy will be given upon admission to the home within the admission package
updated versions of the policy will be distributed to resident and family council at the next scheduled meeting after the revisions have taken place
a copy is available on the home’s website under COVID19 Information

Screening

Screening is required for all individuals entering the facility

Signage will be posted throughout the home and at entrances relating to COVID-19 signs and symptoms
Everyone entering long term care must review the signs and symptoms of COVID-19 and determine honestly if they are experiencing any signs or symptoms
They must pass all screening questions. If they do not, they are denied entry.

Personal Protective Equipment (PPE) Requirements

Visitors are required to wear PPE as directed by the MLTC Directive #3 and Saint Luke’s Place Policy.

Process to Become an Essential Caregiver

It is strongly encouraged that all ECGs be up to date with all recommended COVID-19 vaccine doses. At this time, being up to date would mean having a 5th vaccine if you are 60 years of age or older or as prescribed by the ministry of health.
A verbal or written request (email) for designation should be made to the Director of Nursing and Personal Care or Long-Term Care Social Worker (the decision is entirely the remit of the resident and/or their SDM and not the Home).
Mirielle Tessier, DoN&PC- mtessier@stlp.ca or Paige Murtagh, Social Worker – pmurtagh@stlp.ca
An appointment is booked with the DoN&PC or designate (this usually occurs upon admission).
An information package will be provided to all designated caregivers.
The Essential Caregiver will sign a declaration. This declaration will be kept on file.
All Essential Caregivers may be given an identification badge that is to be always worn and visible during the visit as deemed necessary.

Education Requirements for Essential Caregivers

Prior to the first visit, the Home will provide training to essential visitors on how to safely provide direct care, including donning and doffing PPE and hand hygiene.
Prior to the first visit and monthly thereafter, the Home will ask all essential visitors to read the homes visiting policy and online training and verbally attest that they have done so.
Visiting policies are on the website – www.saintlukesplace.ca

Training Will Include the Following Resources

https://www.publichealthontario.ca/en/videos/ipac-fullppe-on

https://www.publichealthontario.ca/en/videos/ipac-fullppe-off

https://www.publichealthontario.ca/-/media/documents/ncov/factsheet/factsheet-covid-19-handhygiene.pdf?la=en

How We Will Respond to Non-Compliance of Visiting Policy

Saint Luke’s Place recognizes that connecting with family is essential to the emotional wellbeing of the residents. As such, the Home will strive to resolve issues or concerns that may arise from non-compliance with the visiting policy by ensuring:

Efforts have been made to ensure that the visitor understands the policy;
It is recognized that visits are critical to residents’ emotional well-being and the impact to the resident in discontinuing visits is considered;
The consequences of the action reflect the severity of the concern; and
Where visits have been suspended the Home will identify the training that would be needed before the visitor could return to the Home.

Ending a Visit

Saint Luke’s Place will end a visit with a visitor if they fail to adhere to the homes policy. The Home will consider this when:

The Home has explained the policy and its requirements to the visitor;
The Visitor has the resources to meet the requirements of the policy (i.e., there is enough space, the Home has provided PPE and training on its use); and
The Visitor has been given time to adhere to the requirements.

When a visit is ended due to non-adherence, the Home will document the concern and the actions taken.

Palliative/End of Live Visiting

Saint Luke’s Place will not restrict or deny any absences for medical and/or palliative/ compassionate reasons at any time. This includes when a resident is in isolation on additional precautions and/or when the home is in an outbreak; in these situations, Saint Luke’s Place will consult with the local public health for further advice.

References

COVID-19 Directive #3 for Long-Term Care Homes
FLTCA
Ministry of Long-Term Care; Resuming Visits in Long-Term Care, September 2, 2020
COVID-19: Visiting long-term care homes May 22, 2021
Minister’s Directive: COVID-19 Long-Term Care Home Surveillance Testing and Access to Homes.
COVID-19 Guidance for Long Term Care October 2022