Mount Hope Centre for Long Term Care

Mount Hope Centre for Long Term Care (Mount Hope) provides staff and families direction on visitor policies, and additional requirements that are required under the Fixing Long Term Care Act, (FLTCA), 2021.  These requirements are in accordance with current legislation, regulations, standards and best practice guidelines.  Mount Hope is responsible for implementing visiting practices that comply with 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.  Mount Hope is responsible for establishing and implementing visiting practices that comply with the Fixing Long Term Care Act, 2021 and O. Reg 246/22, Sec 267.

At Mount Hope Centre for Long Term Care, families are care partners and play an important role in resident wellbeing, including through the social connections and emotional support that are crucial for optimal quality of life.  

The options and responsibilities relating to each component of the Visitor Policy are outlined below.

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

Essential Caregivers

Essential caregivers can improve health outcomes, improve experience for residents, and team members, reduce risk of harm, and support culturally safe care. Including and supporting essential caregivers also benefits the care team by supporting team members in providing resident-centred care.

All residents (or their substitute decision-makers (SDM)) are empowered and encouraged to designate their essential caregivers.

Essential caregivers are provided education and training on key aspects of their role, including how they may choose to participate in care, and updated infection prevention and control protocols. The Essential Caregiver Program and Guidelines (Appendix C) will be shared with all designated essential caregivers. 

Essential caregivers are documented (e.g., in the electronic health record, including their contact information, timing, and level of participation in various aspects of care.

Infection Prevention and Control Visiting Guidelines

As of June 30, 2023, the Ministry of Long Term Care has transitioned guidance provided to long term care homes from a “pandemic response”, into routine operations.  Long-term care homes should anticipate that some pandemic response measures may be reinstated if the province enters a high-risk period of respiratory virus transmission, such as during the fall respiratory season.

• Masks are recommended, but not required, in all areas of the home. 
• Masks will continue to be available for visitors who wish to wear a mask.  
• If a resident or SDM request that a staff member wear a mask when providing care, the request will be adhered to in alignment with the Residents’ Bill of Rights.

• In the case where a resident resides in an area of a home that is in an outbreak, as declared by the local public health unit, Mount Hope continues to be subject to public health direction as it relates to visitors and any restrictions that may apply.
• In the case where Public Health Ontario, Middlesex-London Heath Unit or St. Joseph’s Infection Control directs the home in respect to the number of visitors allowed, the home is to follow this direction.

• ​​​​The decision to designate an individual as an essential caregiver is the responsibility of the resident/SDM, not the home. The designation of an essential caregiver should be made in writing to the home. 
• Refer to the Designated Essential Caregiver Program Information package (Appendix A)
• Homes should have a procedure for documenting caregiver designations.
• Essential caregivers must be designated and must be at least 16 years of age. 
• If there is a request to designate an individual as a caregiver under the age of 16, approval from a parent or legal guardian is required.  
  There are no limits on the number of designated essential caregivers a resident may have. 
• Note: During an outbreak, Public Health Ontario, Middlesex-London Health Unit, and/ or St. Joseph’s Infection Control will provide direction on essential visitors within the home, depending on the specific situation.
• All required education and Infection Prevention and Control education is required to maintain designated essential caregiver status.
  Essential caregivers must wear an approved badge/ sticker while on site to identify and formally recognize the essential caregiver across the care team.
• A resident/SDM may change a designation in response to a change in the:
  • resident’s care needs that is reflected in the plan of care.
  • availability of a designated essential caregiver, either temporary (for example, illness) or permanent.

• Homes may not require scheduling or restrict the length or frequency of visits by essential caregivers. However, in the case where a resident resides in an area of the home in outbreak, is symptomatic or isolating under additional precautions, restrictions may apply. Refer to section Restrictions during outbreaks or when resident is isolating.

As per O. Reg 246/22 Sec 267 (2), Mount Hope is required to maintain a visitor log for a minimum of 30 days, which include the following at a minimum:

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

All visitors to Mount Hope are required to sign in and sign out at the kiosk station located at the main entrance of the home when visiting.  The visitor log technology provides a sticker to indicate that the visitor has completed the required registration and screening to enter the home.  This information has the additional benefit that in the event of an emergency evacuation a list of visitors and locations would be available.

• Register upon arrival at the home using the electronic visitor log kiosk stations.
• Follow established infection control measures including wearing the provided personal protective equipment (PPE), performing hand hygiene as directed, practicing safe physical distancing from other residents and staff if required, and respiratory etiquette (coughing and sneezing safely).
• If an individual wants to be designated as an essential caregiver:
  • Prior to designation as an essential caregiver, it will be mandatory for all caregivers to complete educational training on the following: 
    • Infection Control practices, physical distancing, PPE use, respiratory etiquette, hand hygiene, etc.
    • Read, understand and agree to the Essential Caregiver Guidelines and Education Requirements (Appendix C).
    • Encouraged to remain up to date with all recommended dose guidelines for COVID-19 vaccinations and obtain seasonal Influenza vaccination to protect the vulnerable population we serve.
    • Agree to follow any asymptomatic testing (rapid testing) if directed by the home, ministry or public health officials.
    • Follow the symptom monitoring and management guidelines listed below.

• All individuals visiting Mount Hope must complete passive screening before visiting (review screening questions to ensure you are feeling well and not experiencing any signs or symptoms of illness).
• If you are displaying any signs or symptoms associated with a respiratory illness (i.e. fever, cough, runny nose, hoarse voice, sneezing) all visitors are encouraged to rule out COVID-19.  If unable to confirm the illness is not COVID-19, visitors must remain away from the home for 10 days (day of onset of symptoms or positive COVID test is considered day 0) to protect the vulnerable population that we serve.
• If a visitor can rule out COVID-19 for respiratory illness, visitors must stay away from the home until after 24 hours being symptom free.
• In the event a visitor has been experiencing gastrointestinal illness (vomiting and/ or diarrhea) you must remain away from the home for 48 hours after your last symptom was experienced.

• The home will provide ongoing strategies and communication related to understanding and adhering to the home’s visitor policy. 
• If a visitor is observed to be non-compliant with policy during a visit, the visitors will be approached by a staff member and expectations communicated, e.g. wearing PPE properly.
• Education and coaching will be provided to explain the rationale and consequences to the resident/ staff/visitor as a result of the action.
• If the violation is severe or ongoing, visits will be temporarily suspended and a meeting/ teleconference will be scheduled to discuss the concern.
• Re-education will be required by the visitor prior to any visits resuming in an effort to protect residents, staff and visitors in the home.
• If necessary, consultation with Residents’ Council and Family Council representatives will occur for input on addressing non-adherence by visitors while respecting privacy.

• The home has the discretion to end a visit by any visitor who repeatedly fails to adhere to the home’s visitor policy provided:
• The home has explained the applicable requirement(s) to the visitor;
• The visitor has the resources to adhere to the requirement(s) (e.g., there is sufficient space to visit, the home has supplied the PPE and demonstrated how to correctly put on PPE, etc.); and
• The visitor has been given sufficient time to adhere to the requirements.
• Homes should document when they have ended a visit due to non-adherence.

• Homes have the discretion to temporarily prohibit a visitor in response to repeated and flagrant non-adherence with the home’s visitor policy. In exercising this discretion, homes should consider whether the non-adherence:
  • Can be resolved successfully by explaining and demonstrating how the visitor can adhere to the requirements.
  • Is within requirements that align with instruction from the Ministry of Long-Term Care and guidance in this policy and negatively impacts the health and safety of residents, staff and other visitors in the home. 
  • Is demonstrated continuously by the visitor over multiple visits. 
  • Is by a visitor whose previous visits have been ended by the home. 
• Any decision to temporarily prohibit a visitor should:
  • Be made only after all other reasonable efforts to maintain safety during visits have been exhausted;
  • Stipulate a reasonable length of the prohibition;
  • Clearly identify what requirements the visitor should meet before visits may be resumed (e.g., reviewing the home’s visitor policy, reviewing specific Public Health Ontario resources, etc.) and 
  • Be documented by the home.
  • Where the home has temporarily prohibited visits, an essential caregiver, the resident/SDM may need to designate an alternate individual as an essential caregiver to help meet the resident’s care needs.​​​​

• In the event that a resident/SDM and/or essential caregiver disagree with a determination of the clinical team’s decision to remove or decline access the following process will be followed: 
  • Resident/SDM or essential caregiver to submit a written letter outlining the disagreement to a decision to any member of the leadership team or Patient Relations, Privacy and Risk who will provide guidance.
  • The notice will go to the Executive Director to review the details of the concern and make every attempt to rectify the concern. The Executive Director may include the Medical Director, Family Council representative, Resident Council representative as resources to support solution finding and decision making. 
  • If no resolution is found, the Vice President, Patient Care & Risk Management of St. Joseph’s Health Care London, will make the final determination regarding the concern and communicate to all the parties involved.

Essential Caregiver – An essential caregiver is a person identified and designated by the patient/resident – family member, friend, neighbour - who provides important personal, social, psychological and/or physical support, assistance and care, usually without pay, for people in need of support due to frailty, illness, degenerative disease, disability, or end of life circumstances. An essential caregiver does not have to be living with the person they are supporting. They do not have to be biologically related to the patient; can provide support and care for short periods of time (e.g., days) or for extended periods of time (e.g., years)

As outlined in the Fixing Long-Term Care Act, 2021 and O. Reg 246/22 section 267 (4), the types of essential visitors within long-term care are as follows:

“essential visitor” means,

(a)  a caregiver,

(b)  a support worker who visits a home to provide support to the critical operations of the home or to provide essential services to residents,

(c)  a person visiting a very ill resident for compassionate reasons including, but not limited to, hospice services or end-of-life care, or

(d)  a government inspector with a statutory right to enter a long-term care home to carry out their duties.

Not Considered Visitors:

• Long-term care home staff (as defined under the Act)
• Volunteers and student 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.

There are four types of essential visitors:

1. People visiting very ill or palliative residents who are receiving end-of-life care for compassionate reasons, hospice services, etc.
2. Government inspectors with a statutory right of entry. Government inspectors who have a statutory right to enter long-term care homes to carry out their duties must be granted access to a home in accordance with the applicable legislation. Examples of government inspectors include inspectors under the Fixing Long-Term Care Act, 2021 and O. Reg 246/22 section 267 (4) the Health Protection and Promotion Act, the Electricity Act, 1998, the Technical Standards and Safety Act, 2000, and the Occupational Health and Safety Act.
3. Support workers: support workers are persons who visit a home to provide support to the critical operations of the home or to provide essential services to residents. Essential services provided by support workers include but are not limited to:

• Assessment, diagnostic, intervention/rehabilitation, and counselling services for residents by regulated health professionals such as physicians and nurse practitioners
• Assistive Devices Program vendors –- for example, home oxygen therapy vendors
• Moving a resident in or out of a home
• Social work services
• Legal services
• Post-mortem services
• Emergency services (for example, such as those provided by first responders)
• Maintenance services such as those required to ensure the structural integrity of the home and the functionality of the home’s operational systems such as Heating, Cooling and Ventilation (HVAC), mechanical, electrical, plumbing and telecommunication systems, and services related to exterior grounds and winter property maintenance, including septic and well water system maintenance
• Food/nutrition and water/drink delivery
• Canada Post mail services and other courier services
• Election officials/workers

4. Caregivers: A caregiver is defined in the Fixing Long-Term Care Act, 2021, O. Reg 246/22 section (4) as follows: 

(a)  is a family member or friend of a resident or a person of importance to a resident,

(b)  is 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,

(c)  provides one or more forms of support or assistance to meet the needs of the resident, including providing direct physical support such as activities of daily living or providing social, spiritual or emotional support, whether on a paid or unpaid basis,

(d)  is designated by the resident or the resident’s substitute decision-maker with authority to give that designation, if any, and

(e)  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.

Examples of direct care provided by caregivers include but are not limited to the following:

• Supporting activities of daily living such as bathing, dressing, and eating assistance.
• Assisting with mobility
• Assisting with personal hygiene
• Providing cognitive stimulation
• Fostering successful communication
• Providing meaningful connection and emotional support
• Offering relational continuity assistance in decision-making

Whether a caregiver is paid for services is not a condition in meeting the criteria of the definition of caregiver as set out above. An important role of the caregiver is that of providing meaningful connection and emotional support. A person should not be excluded from being designated as a caregiver if they are unable to provide direct physical support.

General Visitors - means a person who is not an essential visitor and is visiting the home to provide non-essential services related to either the operations of the home or a particular resident or group of residents. This excludes children under the age of one.

There are two broad categories of general visitors:

• visitors providing non-essential services which include but are not limited to:
  • personal care service providers (for example, hairdressers, barbers, manicurists, etc.)
  • entertainers (singers, musicians, etc.)
  • recreational service providers
  • animal handlers (for example, as part of therapy animal program)
  • individuals who are touring the home to inform decisions regarding application for admission
• persons visiting for social reasons that the resident or their substitute decision-maker assess as different from “direct care” as described in the section on caregivers

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

General visitors younger than 14 years of age must be accompanied by an adult (someone who is 18 years of age or older) and must follow all applicable public health measures that are in place at the home (for example, active screening, physical distancing, hand hygiene, masking for source control).

Substitute Decision-Maker (SDM) – As defined by the Health Care Consent Act, 1996 (HCCA) is a person who is authorized to give or refuse consent to a treatment on behalf of a person who is incapable. The SDM must be capable, willing and available. The SDM must make a decision that is consistent with the patient/client/resident's previously expressed wishes and values. In the absence of previously expressed wishes the SDM must follow the principle of best interest. If a person is incapable with respect to a treatment, consent may be given or refused on his or her behalf by a person described in one of the following:

1. The incapable person’s guardian of the person, if the guardian has authority to give or refuse consent to the treatment.
2. The incapable person’s attorney for personal care, if the power of attorney confers authority to give or refuse consent to the treatment.
3. The incapable person’s representative appointed by the Board under section 33, if the representative has authority to give or refuse consent to the treatment.
4. The incapable person’s spouse or partner.
5. A child or parent of the incapable person, or a children’s aid society or other person who is lawfully entitled to give or refuse consent to the treatment in the place of the parent. This paragraph does not include a parent who has only a right of access. If a children’s aid society or other person is lawfully entitled to give or refuse consent to the treatment in the place of the parent, this paragraph does not include the parent.
6. A parent of the incapable person who has only a right of access.
7. A brother or sister of the incapable person.
8. Any other relative of the incapable person.
9. If two or more persons who are described above and who meet the requirements disagree about whether to give or refuse consent, and if their claims rank ahead of all others, the Public Guardian and Trustee (PGT) shall make the decision in their stead.
10. If no person described above meets the requirements, the PGT shall make the decision

Related Corporate Policies/Procedures

Essential Caregiver Presence and Visitor Restrictions

Legislation

Government of Ontario (1990) Health Protection and Promotion Act, 1990

Government of Ontario (1990) Occupational Health and Safety Act, 1990

Government of Ontario (1998) Electricity Act, 1998

Government of Ontario (2000) Technical Standards and Safety Act, 2000

Government of Ontario (2021) Fixing Long-Term Care Act, 2021

Government of Ontario (2021) Fixing Long-Term Care Act, 2021, O. Reg 246/22, Sec 267, 2022​​​​​​

Appendices

Appendix A

St. Joseph’s COVID-19 guidance document for long-term care homes in Ontario, April 2023

Designated Essential Caregiver Program Information Package

​​Appendix C

St. Joseph’s Essential Caregiver Guidelines and Education Requirements

Appendix D

St. Joseph’s Essential Caregiver Attestation Form