COVID-19 at our Long Term Care Centres

A general visitor is someone who is not an essential visitor. They are visiting:

• To provide non-essential services, who may or may not be hired by the centre or the resident and/or their substitute decision maker.
• For social reasons that the resident or their substitute decision maker assess as different from direct care. This includes care related to cognitive stimulation, meaningful connection, and relational continuity.

Examples of general visitors include entertainers, hairdressers, sales representatives, families, and friends.

General visitors younger than 14 years must be accompanied by an adult and must follow all applicable public health measures that are in place at the centre.

Visitors who fail active screening will not be allowed into the centre. You will be advised to go home immediately to self-isolate, and will be encouraged to complete COVID-19 testing.

Exceptions: Visitors for ill, palliative or end of life care residents must be screened before entering. If you fail screening, you will be allowed entry but will be required to wear appropriate PPE and maintain physical distance from other residents and staff.

General visitors are not allowed to enter the centre or unit area during an outbreak. However, general visitors may be allowed to visit in visit in areas of the centre that are not in outbreak.

Outdoor visits

There is no limit on the number of people visiting outdoors, space permitting. Please contact the centre in advance of your visit to check if outdoors space is available.

Outdoor visits may occur as long as:

• A resident is not self-isolating or symptomatic.
• The centre is not in a full facility outbreak.
• The visit works with the centre’s schedule.
• Space is available to allow for physical distancing.

Outdoor visits infection prevention and control measures:

• Masking is not a requirement for outdoor visits, but it’s strongly recommended to prevent infection transmission. A medical or non-medical mask that covers the mouth, nose, and chin at all times during the visit is recommended.
• Practice regular hand hygiene.
• Maintain physical distancing of 2 metres or 6 feet to the resident.
• Maintain physical distancing of 2 metres or 6 feet to all others such as other groups of visitors.
• Follow all infection prevention and control guidance in place.

Indoor visits

• All visitors must be screened for COVID-19.
• All visitors visiting indoors must be tested for COVID-19.
• General visitors over the age of 5 must be fully vaccinated (completed their primary series of COVID-19 vaccines), or have a valid medical exemption, to enter the centre, unless they are visiting a resident receiving end-of-life care. Infants under 1 year of age are not considered visitors and may enter the centre without COVID-19 surveillance testing. Virtual visits are preferred for infants and young children who are not vaccinated.
• General visitors younger than 14 years of age must be accompanied by an adult.
• "Day of" COVID-19 Rapid Antigen Testing is required unless tested for the previous day. Previous day’s negative test result must be shown prior to entry to the centre.
• Must wear a medical mask when in the centre. These will be provided when you pass screening.
• Must perform regular hand hygiene when entering and exiting the centre.

Scheduling your visit

Call the centre to schedule your visit. We’ll do our best to make it happen, taking into account the following:

• The physical space we have available.
• The staff we have available to accompany residents to entry points or visiting spaces.

Outdoor visits can also take place in the neighbourhood if a centre doesn’t have enough outdoor space.

Essential visitors are people who perform essential support services. Examples include:

• Support workers
• People who deliver food 
• Government inspectors
• Maintenance workers
• Healthcare service workers, such as those who provide x-ray and lab services
• Essential caregivers
• A person visiting a very sick or palliative resident

Visiting requirements for essential visitors visiting a very sick or palliative resident:

• Essential visitors who are visiting a very sick or palliative resident do not need to be vaccinated, have a COVID-19 test or attest to a negative result. However, if you have not completed your primary series of the COVID-19 vaccines, we encourage you to be tested for your safety and for the safety of residents and staff.
• If you fail screening, you will be permitted entry but must wear the appropriate PPE. You must also maintain physical distance from other residents and staff.

Essential caregivers are chosen by the resident or substitute decision maker. They give direct care to the resident.

Examples of essential caregivers:

• Family member who provides meaningful connection
• Private caregiver
• Paid companion
• Translator

Examples of things essential caregivers help with:

• Feeding
• Mobility
• Personal hygiene
• Cognitive stimulation
• Communication
• Help with decision-making
• Meaningful connection

Designating an essential caregiver

If your loved one wants to designate an essential caregiver, complete the caregiver support form. Once you submit the form, we’ll review it to ensure it meets the needs of the resident, and the safety needs of residents and staff. We’ll notify you when the review is complete.

Refer to the information package on hiring a private caregiver for a resident or Substitute Decision Maker for more information.

You can request a copy of the information package and the caregiver support form from the Long Term Care centre screener or receptionist.

Caregivers must be at least 16 years of age. The decision to designate a caregiver is up to the resident or their substitute decision maker, not the centre. The centre will document caregiver designations in the resident’s Electronic Health Record.

A person may be an essential caregiver for multiple residents in the same centre. However, the residents should be of the same cohort, i.e., they should reside in the same unit or floor. It’s not recommended that a person be a designated caregiver for residents in different long term care centres, although it is permitted.

A resident or their substitute decision maker may change the designation in response to a change in the following:

• Resident’s care needs that are reflected in the plan of care.
• Availability of a designated caregiver either temporary (e.g., illness) or permanent.

Caregiver visiting during COVID-19

• Always wear a mask during your visit to the centre.
• Fully vaccinated caregivers (primary series and a booster dose), who complete the required surveillance testing, can join residents for communal dining or family-style meals, while wearing a mask at all times.
• There is no limit on the number of visitors a resident may have for indoor visits, space permitting. If the resident is symptomatic or isolating, 1 caregiver per resident at a time can visit indoors.
• Please contact the centre before your visit to ensure the centre has the space/capacity and PPE required.
• You must verbally attest that you’ve read or re-read the centre’s visitor policy and education/information package.

Material to review before your visit

• Private caregiver education package
• Caregiver information package
• Managing visitors
• Putting on full PPE
• Taking off full PPE
• How to hand wash
• How to hand rub

You can request a copy of the private caregiver education package, the caregiver information package and the visitors policy from your Long Term Care centre screener or receptionist.

Physical distancing and exceptions

The long term care centres continues to adjust activities to optimize and support the requirements of physical distancing to enhance precautions against COVID-19.

It’s recommended that all individuals avoid situations where COVID-19 can spread more easily:

• Crowded places with many people nearby.
• Close contact settings.
• Confined and enclosed spaces with poor ventilation.

You must maintain physical distancing of 2 metres or 6 feet at all times from residents, staff, and other visitors.

The following are exceptions to physical distancing:

• When providing direct care to a resident.
• Between residents and their visitors.
• Between residents in one on one or small group settings.
• For the purpose of a compassionate or end of life visit.
• During the provision of a personal care service (e.g., haircutting).
• Between staff and clients of Adult Day Service programs that take place on the site of a LTC home.

Visiting a resident with symptoms

• If the resident has symptoms of COVID-19 or self-isolating, 1 caregiver per resident may visit at a time.
• You may not visit any other resident or long term care centre for 10 days after visiting a resident who is self-isolating or symptomatic, or a home in an outbreak.

Self-isolation means that the resident is staying in a room away from other people under droplet and contact precautions and can only see essential visitors. The visitor must be provided with and wear appropriate PPE.

• All general visitors must be actively screened and have a rapid antigen test for COVID-19 prior to entering the long term care centre.
• "Day of" COVID-19 Rapid Antigen Testing is required unless tested for the previous day. Previous day’s negative test result must be shown prior to entry to the centre. Infants under 1 year of age are not considered visitors and may enter the centre without COVID-19 surveillance testing.
• General visitors over the age of 5 are required to complete their primary series of COVID-19 vaccines, or have a valid medical exemption, to enter the centre, unless they are visiting a very ill resident, resident receiving palliative or end-of-life care or their visits are approved by the Administrator or Director of Care.
• To maintain optimal level of protection, visitors are strongly recommended to stay up-to-date with their COVID-19 vaccines. This means you have completed your primary series and you have received a booster dose in the last 6 months.
• Virtual visits are preferred for infants and young children who are not vaccinated.
• General visitors should postpone non-essential visits to the centre for 10 days after developing symptoms, regardless of the results of their COVID-19 test results, to reduce the risk of introduction of any respiratory infections into the centre.

Screening

• All essential visitors and caregivers will be actively screened for symptoms and exposure history for COVID-19 before entering the centre or visiting outdoors.
• All visitors must verbally attest that, in the last 10 days, you have not visited another:
• Resident who is self-isolating or who has signs and symptoms of COVID-19.
• Home in an outbreak.
• Exception: First responders must be permitted entry without screening in emergency situations.

Vaccination and testing of support workers

• Support workers are required to complete their primary series plus one booster dose of COVID-19 vaccines before entry into the centre. Proof of vaccination must be shown.
• "Day of" COVID-19 Rapid Antigen Testing is required unless tested the previous day. Testing must be complete before you enter the centre. If tested the previous day, you must show the previous day’s negative antigen test before you enter.

Support workers who are regulated health professionals

• Must demonstrate proof of a negative test result from a test taken on the day of the visit or taken on the previous day before entry into the centre.
• Require testing before entry but may have contact with residents if wearing appropriate PPE and following infection prevention and control guidelines while awaiting results.
• If you visit more than once in a day, testing is only required at the first centre visited either on the same day or the previous day. Proof of the negative antigen test result must be provided.
• When a centre is in outbreak, testing must be completed as instructed by Peel Public Health.

Caregivers

• All eligible designated caregivers are required to complete their primary series plus one booster dose of COVID-19 vaccines.
• To maintain optimal level of protection, caregivers are strongly recommended to stay up-to-date with their COVID-19 vaccines. This means you have completed your primary series and have received a booster dose in the last 6 months.
• Caregivers who are not up to date (booster dose within the past 6 months) with their COVID-19 vaccines must have a rapid antigen test a minimum of 3 times per week.
• Testing must be completed before gaining entry to the centre. Visitors who refuse to take the test or who have a positive test result will not be allowed entry into the centre.
• Caregivers with valid medical exemptions or visiting residents receiving palliative or end of life care, or have approval form the Administrator or Director of Care, will continue to be allowed to enter the centre regardless of their vaccination status. Appropriate PPE and precautions must be followed.
• Caregivers who completed their primary series plus one booster dose of COVID-19 vaccines and who have completed the necessary surveillance testing may continue to join residents for communal dining or family-style meals, while wearing a mask at all times.
• Caregivers are the only type of visitors allowed to enter the centre or unit during an outbreak.
• Unvaccinated or partially vaccinated caregivers may be allowed entry as per approval from the Administrator or Director of Care.

We're following all government directives and guidelines, public health recommendations, and infection prevention and control measures to stop the spread of COVID-19.

Current safety measures

• Everyone visiting the centres, whether for indoor or outdoors visits, when permitted, is screened either when entering the centre or when visiting residents outdoors, to ensure they have no symptoms, or had contact with COVID-19 cases.
• All staff, students and volunteers must complete their primary series plus one booster dose of COVID-19 vaccines, unless they have a valid medical exemption, to enter the centre.
• All staff, students and volunteers have rapid antigen testing a minimum of 3 times per week.
• Anyone with a positive rapid antigen or PCR test are not allowed into the centre. They will be asked to go home and follow Public Health instructions.
• All residents are offered and provided with COVID-19 vaccination onsite including a COVID-19 booster dose when eligible.
• Residents are screened upon return from any absences, are tested when they have symptoms or were in high-risk situations where they were unable to follow infection prevention and control practices.  
• All residents are screened daily for symptoms.
• All staff who interact with residents or enter resident home areas wear surgical masks, and other personal protective equipment (PPE), as appropriate.
• There is enhanced cleaning and disinfecting, especially on high touch surfaces.
• Staff have completed additional training on COVID-19, infection prevention, and control, and PPE.

Maintaining staffing

• Additional staff have been brought into our centres to support the pandemic response.
• We're accepting pre-graduation students from nursing and other programs.
• Our Human Resources department is continuously hiring and recruiting to meet the changing demands of staff due to the COVID-19 pandemic.

Personal protective equipment

• Personal protective equipment (PPE) is used to protect staff and residents.
• All staff who interact with residents or enter resident home areas wear surgical masks, eye protection, and other PPE as appropriate.
• Staff who work with residents who have tested positive for COVID-19 or close contacts wear additional PPE to protect themselves and others.

New admissions, readmissions, and return to the centres

• We’re accepting new admissions.
• When residents are admitted, readmitted or return to the home, they are screened for signs and symptoms. Residents with symptoms are tested, and placed in isolation until a negative test result is confirmed.
• When a centre is in a declared outbreak or under investigation of an infectious disease, we can only accept new admissions or re-admissions that are reviewed and approved by Peel Public Health.

Dropping off items to residents

• If residents need more or different clothing, we are accepting clothing drop offs from families and key contacts. Contact the centre for details.
• Other items, including food, are being accepted at this time.

Types of testing

There are 2 types COVID-19 testing in Peel long term care centres:

• A polymerase chain reaction (PCR) assay laboratory test. This test is performed onsite for staff, students, and volunteers only.
• A point-of-care rapid antigen screening test. This test is performed onsite for staff, students, volunteers, caregivers, support workers and general visitors.

Rapid antigen testing

A rapid antigen test is a quick way to see if someone might have COVID-19. It is performed by conducting a nasal swab. The swab is then tested onsite and the result is available in 15 to 20 minutes.

PCR testing

PCR testing is used:

• Sometimes as part of regular COVID-19 surveillance testing.
• When someone has a positive rapid antigen test result.
• When someone has been in contact with a confirmed COVID-19 case.
• When someone is symptomatic.
• When a centre is in outbreak.
• When directed by local public health.

Outbreaks

• During an outbreak, we work closely with Peel Public Health to protect everyone.
• Residents who test positive for COVID-19 or are identified as a close contact of a known case are isolated and closely monitored.
• Staff who test positive for COVID-19 are sent home to self-isolate and follow Public Health instructions.
• Staff who work with residents who have tested positive or close contacts wear additional PPE to protect themselves and others.
• We provide regular status updates when a centre is in outbreak.

Declaration of an outbreak

Peel Public Health can declare an outbreak based on their investigation. This includes defining the outbreak area and where outbreak measures should be applied, such as a single affected unit or the whole centre.

Confirmed outbreak management will include the following steps:

• Defining the outbreak area of the Home (floor or unit) and cohorting based on COVID-19 status (infected or exposed).
• Initiating additional precautions for all symptomatic residents and those with suspect or confirmed COVID-19.
• Posting appropriate signage outside the resident's room.
• Resident close contacts who remain asymptomatic do not need to be placed on additional precautions, unless residing in the same room. A close contact is defined as an individual who has a high-risk exposure to a confirmed positive COVID-19 case, an individual with COVID-19 symptoms, or an individual with a positive rapid antigen test result.
• Centres should conduct enhanced symptom assessment (minimum twice daily) of all residents in the outbreak area to facilitate early identification and management of ill residents.

We use the following outbreak definitions:

A suspect outbreak

• One positive molecular test in a resident, where source is thought to be from within the centre (including a potential epidemiological link to a staff or visitor case) or cannot be determined.

A confirmed outbreak in a centre

• 2 or more residents with a common epidemiological link (e.g., same unit, floor, etc.), each with a positive molecular or rapid antigen test, within a 7-day period, where both cases have reasonably acquired their infection in the home.

Epidemiological link

• 1 case has either been exposed to a confirmed case or has had the same high-risk exposure as a confirmed case (e.g., both were exposed to a known cluster or outbreak).
• Local Public Health units will determine this as part of their investigation, which informs their decision on declaring an outbreak.

Reporting positive tests

All positive PCR test or rapid antigen test results in residents, staff, or visitors associated with a suspect or confirmed outbreak in the centre must be reported to the Peel Public Health and Outbreak Management Team.

Confirmed COVID-19 cases in our centres

Visit the COVID-19 in Peel dashboard to learn about long term care and retirement home outbreaks in Peel.

While safety is our top priority, staff also focus on quality of life for residents to keep their minds and spirits healthy. Long Term Care and Adult Day Services staff are working to prevent social isolation.

Staff are also using technology to connect residents with families and friends. Window visits are allowed when the weather is nice. Outdoor and indoor visits can also occur with loved ones if the home is not in an outbreak or isolation.

If you have questions, call the family information line at the centre your loved one is located.

• Davis Centre 905-857-0977 ext. 5419
• Malton Village 905-791-1179 ext. 5416
• Peel Manor 905-453-4140 ext. 5417
• Sheridan Village 905-791-8668 ext. 5418
• Tall Pines 905-791-2449 ext. 5415