Visitors Policy (LTC)

Origination: 10/2023

Last Approved: 10/2023

Last Revised: 10/2023

Next Review: 10/2024

Owner: Maria Cherbel

Manual: LTC- IPAC

Category: COVID-19 Pandemic Management

POLICY

The home has established and implemented a written visitor policy as required under Ontario Regulation 246/22 made under the Fixing Long-Term Care Act, 2021 (s. 267. (1) and Directive #3. This policy is periodically updated to meet requirements of all applicable legislation.

See last page for UniversalCare Memo Letter to residents, staff and visitors.

PROCEDURE

This policy is effective June 26, 2023. All previous versions of the visiting policy are revoked and replaced with this version.

VISITORS’ ACCESS TO THE HOME’S VISITOR POLICY

The Long-Term Care Home must:

Provide a copy of Visitors Policy to Residents’ Council and Family Council (if any)

A copy of Visitors Policy must be included with Resident Information Package

Post Visitors Policy in the Home

Communicate Visitors Policy to residents, families, and staff

Post Visitors Policy on LTC home’s website

COVID-19 VACCINATION

COVID-19 vaccination continues to be recommended; however, the requirement is removed.

REQUIREMENTS

Residents have a right under the Fixing Long-Term Care Act, 2021 (https://www.ontario.ca/laws/statute/21f39), to receive visitors and homes should not develop policies that unreasonably restrict this right.

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

2. In accordance with section 267(2) of O. Reg. 246/22, homes must maintain visitor logs of all visits to the home. 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. The visitor log must include, at a minimum:

  • the name and contact information of the visitor
  • time and date of the visit
  • the purpose of the visit (for example, the name of resident visited)
  • Homes must ensure that all visitors have access to the home’s visitor policy.
  • Homes must provide education or training to all visitors about physical distancing, respiratory etiquette, hand hygiene, IPAC practices, and proper use of PPE.

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 and are excluded from testing requirements.

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 ON 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 ON 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

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.

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 should not restrict individuals from outdoor visits based on vaccination status.

RESTRICTIONS DURING OUTBREAKS OR WHEN A RESIDENT IS ISOLATING

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 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

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 PASSIVESCREENING OF VISITORS

Passive Screening:

All visitors regardless of vaccination status, must conduct passive screening for COVID-19 upon entry of the Long-Term Care Home. Passive screening means that all individuals entering the long-term care home or retirement home should self-monitor for COVID-19 symptoms at home and review the COVID-19 screening themselves. Passive screening should be continuous (e.g., before entering and while working/visiting the LTC/RH). Please refer to the Passive Screening poster and the Ministry of Health Appendix 1: Case Definitions and Disease-Specific Information Disease: Diseases caused by a novel coronavirus, including Coronavirus Disease 2019 (COVID-19), Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) Effective: May 2023 for more information: https://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/2019_case_definition.pdf

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.

Asymptomatic Screen Testing:

Per the Minister’s Directive, 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 for indoor and outdoor visits.

EDUCATION/TRAINING REQUIREMENTS FOR ALL VISITORS

Education package will be provided to all visitors via contact information annually and must be reviewed by all visitors prior to the first visit and annually.

The following IPAC topics included but not limited to in the Education Package to visitors are:

  • visitor policy
  • physical distancing
  • respiratory etiquette
  • hand hygiene
  • masking
  • IPAC practices
  • proper use of PPE

In addition, Essential Caregivers will complete the following Education Package on IPAC on an annual basis:

  • Chain of Transmission
  • Routine Practices
  • Risk Assessment
  • Additional Precautions
  • Steps for Donning and Doffing Personal Protective Equipment (PPE)
  • Assess Signs and Symptoms of Infection for Staff, Residents, and Visitors
  • Cleaning and Disinfection Procedures and Policies
  • Disposal of Solid Non-infectious Waste from Resident Care Areas and Biomedical and Biohazardous Waste routine practices, additional precautions
  • Prevention strategies for COVID-19

PROVISIONS REGARDING HOME’S IMPLEMENTATION OF ALL REQUIRED PUBLIC HEALTH MEASURES AND INFECTION PREVENTION AND CONTROL PRACTICES (IPAC)

The importance of ongoing adherence to strong and consistent IPAC processes and practices cannot be overstated. The home strives 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.

IPAC audits

  • Homes required to complete IPAC audits at least quarterly unless in outbreak.
  • When the Home is in outbreak the IPAC audits are completed at least weekly.
  • IPAC audits are 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. Results of the IPAC audit should be kept for at least 30 days and shared with inspectors upon request

UNIVERSAL MASKING AND EYE PROTECTION

The Universal Mask and Eye Protection Policy During COVID-19 has been archived.

As per the Ministry of Long-Term Care COVID-19 guidance document for LTC homes in Ontario (effective as of June 26, 2023):

  • masks are required based on PCRA and return-to work protocol, for staff, students, volunteers, and support workers.
  • If the health care worker, regulated or unregulated, does not have the knowledge, skill and training to perform PCRA, the PCRA should be performed by a supervising health care worker that does.
  • Staff to consider wearing mask during prolonged direct (<2 metres for > 15 minutes) care indoors and outdoors

Caregivers and visitors:

  • Masks are recommended but not required in all areas of the home
  • This means that caregivers and visitors may now join in sharing a meal with their loved one(s) in communal dining areas

Home to implement “mask friendly” practices including accommodating:

  • staff who prefer to continue to wear a mask beyond minimum requirements residents (or substitute decision-makers) who request that a staff member wear a mask when providing care, in alignment with the Residents’ Bill of Rights.

Exception to the masking requirements are:

  • children who are younger than two years of age
  • any individual (staff, student, volunteer, support worker, caregiver, visitor, or resident) who is being accommodated in accordance with the Accessibility for Ontarians with Disabilities Act, 2005 or the Ontario Human Rights Code.

REFERENCES:

  • Fixing Long-Term Care Act, 2021 https://www.ontario.ca/laws/statute/21f39
  • Regulations under the Act: O. Reg. 246/22 https://www.ontario.ca/laws/statute/21f39
  • Minister’s Directive https://www.ontario.ca/page/ministers-directive-covid-19-response-measures-for-long-term-care-homes
  • COVID-19 Guidance document for long term care homes in Ontario
    \https://ltchomes.net/LTCHPORTAL/Content/2023-06-23-2-EN-MLTC-Guidance_Pandemic-Response-Updates_2023-06-23-FV.pdf

RELATED POLICIES AND FORMS

Policies

  • “Zero Tolerance to Resident Abuse and Neglect
  • OHS Section – Workplace Violence and Harassment Prevention
  • “Universal Mask and Eye Protection Policy”

Forms

  • “Visitors Education Roaster”
  • General Visitors Education Package
  • “UC Mask Friendly Poster”

Please click on file to view document.

Coronavirus Disease 2019 (COVID-19) How to Self-Isolate

Cover Your Cough

COVID-19 Pandemic Response Update

LTC Visitors Sign in Record V4

LTC Education Package - Visitors

Policy Acknowledgement

UC COVID-19 Passive Screening Poster

UC Mask Friendly Poster

UC-Mask Strongly Recommended Poster

Visitors Education Roaster

Get in Touch

Have questions? We can help. Contact us and we’ll be in touch as soon as possible.