Guidance for health care providers, long-term care homes, and retirement homes (COVID-19)

On this page:

• Health care workers
• Long-term care homes and retirement homes
  • Symptoms in staff
  • Symptoms in residents
  • Outbreaks
  • Masks
  • Personal protective equipment (PPE)
• Frequently asked questions – Long-term care home or retirement home
• Direct communications from Public Health Sudbury & Districts
• Helpful links

Health care workers

COVID-19 testing is available to all health care workers whether they have symptoms or not. If you are a health care worker and have symptoms of COVID-19, immediately self-isolate (learn how) and notify your employer or occupational health and safety department.

Staff presenting with new symptoms compatible with COVID-19, including atypical symptoms, must be rapidly identified, investigated and managed, including ensuring access to testing. Symptomatic staff awaiting test results must be off work and on isolation. Learn more about who is eligible for testing.

There are also a number of Ministry of Health guidance documents for health and other sectors available below for further information.

Long-term care homes and retirement homes

On April 24, 2020, Public Health Sudbury & Districts announced COVID-19 targeted surveillance testing for all residents and staff in the 13 long-term care homes in its jurisdiction. On May 22, 2020, Public Health announced the coordination of COVID-19 testing of all residents and staff in the 12 retirement homes in its service area as part of the next step in targeted surveillance. The testing is part of the provincial surveillance initiative to get a point-in-time picture of COVID-19 in congregate care settings such as long-term care homes and retirement homes. Additional targeted testing campaigns are ongoing under the direction of Ontario Health.

In the context of these surveillance initiatives, the following information provides Public Health Sudbury & Districts guidance related to Directive #3 of the Chief Medical Officer of Health (dated June 10, 2020) and the COVID-19 Outbreak Guidance for Long-Term Care Homes (dated April 15, 2020), particularly as it relates to the management of close contacts of symptomatic staff and residents and the declaration of outbreaks. Long-term care homes must ensure that all measures outlined in the directives are in place. This includes, but is not limited to staff masking, screening, and management of visitors (non-essential visitations may resume effective June 18, 2020). Retirement homes are required to take all reasonable steps to follow these directives. Though it is acknowledged that certain measures are more intense than would be implemented for other respiratory diseases, the provincial directives are developed to be proportional to the risk and ensure that we are providing the best protection we can to vulnerable residents and to staff.

Symptoms in staff

• Staff presenting with new symptoms compatible with COVID-19, including atypical symptoms, must be rapidly identified, added to the facility line list which is shared daily with Public Health, investigated and managed, including ensuring access to testing.
• Symptomatic staff awaiting test results must be off work and on self-isolation.
• Close resident and staff contacts of ill staff are to be identified and tested. This includes those who were in close contact with the symptomatic staff for the 48 hours prior to onset of symptoms in the ill staff.
• Asymptomatic staff who are close contacts can be on work self-isolation pending results.
• Asymptomatic residents who are close contacts must be on isolation under contact and droplet precautions pending results.
• If the symptomatic staff tests negative, the home can immediately cease the measures above in consultation with Public Health.

Symptoms in residents

• Residents presenting with new symptoms compatible with COVID-19, including atypical symptoms, must be rapidly identified, added to the facility line list which is shared daily with Public Health, investigated and managed, including ensuring access to testing.
• Symptomatic residents must be on isolation under contact and droplet precautions pending test results.
• Close resident and staff contacts of the ill residents are to be identified and tested. This includes those who were in close contact with the ill resident for the 48 hours prior to symptom onset.
• Asymptomatic residents who are close contacts must be on isolation under contact and droplet precautions pending results.
• Asymptomatic staff who are close contacts can be on work self-isolation pending results.
• If the symptomatic resident tests negative, the home can immediately cease the measures above in consultation with Public Health.

Please note that if the facility has recently undergone surveillance testing, it is possible that residents and staff who are close contacts of the symptomatic staff do not have to be retested. This depends on a number of factors and is determined in consultation with Public Health.

If the symptomatic staff or resident tests positive, an outbreak is declared based on Public Health assessment in accordance with Ministry guidance. Note that per the June 10, 2020 Directive #3 of the Chief Medical Officer of Health, when only asymptomatic residents and/or staff with positive results are found as part of the enhanced surveillance testing, it may not be necessary to declare an outbreak. This is assessed in consultation with the Public Health.

Outbreaks

If the symptomatic staff or resident tests positive, an outbreak is declared based on Public Health assessment in accordance with Ministry guidance. Outbreaks of COVID-19 are not automatically declared in long-term care homes, retirement homes, and other congregate settings with the confirmation of one case. Per the June 10, 2020 Directive #3 of the Chief Medical Officer of Health, when only asymptomatic residents and/or staff with positive results are found as part of the enhanced surveillance testing, it may not be necessary to declare an outbreak. Public Health assesses each unique situation in determining if an outbreak should be declared, including, for example, occupation, exposures in the home, symptoms of the case, specific risk factors, and local epidemiology

Close contacts

A close contact is defined as a person who provided care for the patient including Health Care Workers, family member or other caregivers, or who had other similar close physical contact or who lived with or otherwise had close contact with a probable or confirmed case while the case was ill. In the context of long-term care homes and retirement homes, it is important to apply these definitions conservatively in order to protect vulnerable residents. Although exceptions may apply, in general the following applies in these setting:

• When the resident is the probable or confirmed case:
  • staff is considered a close contact if proximity to resident is 2 metres or less for any duration of time
  • resident is considered a close contact when in the same patient care area or when in a common area when proximity is 2 metres or less for any duration of time
• When the staff is the probable or confirmed case:
  • resident is considered a close contact if proximity is 2 metres or less for any duration of time
  • staff is considered a close contact if proximity is 2 metres or less in an enclosed area for a duration of 15 minutes or more

Close contacts are assessed as having a high risk exposure to a case or to a patient/resident or staff presenting with symptoms compatible with COVID-19.  Health Care Workers may reduce their risk of exposure to pre-symptomatic (up to 48 hours) and symptomatic individuals by following contact and droplet precautions while providing direct patient care/within 2 meters of the individual. If based on employer assessment, Health Care Workers are determined to not have had high risk exposure because of their consistent and appropriate use of contact and droplet precautions (without error), this should be discussed with Public Health and these Health Care Workers may not need to be tested pending results of the symptomatic individual, and provided that they practice work self-isolation during this time.

Masks

Mask use for source control is required for all staff and visitors in all long-term care homes across the province. Retirement homes are required to take all reasonable steps to follow this directive. This is an additional protective measure, however, due to the extreme vulnerability of residents in Homes, universal masking does not negate the need for other control measures to protect close contacts of symptomatic staff. Therefore, close contacts are required to be identified, isolated, and tested even when symptomatic staff are wearing surgical/procedure masks for source control.

Personal protective equipment (PPE)

If you anticipate that your facility will face challenges regarding personal protective equipment, please ensure that these concerns are highlighted with the appropriate contacts.

COVID-19 in long-term care homes and retirement homes has presented a very real risk with tragic consequences across Ontario and elsewhere. Please note that the above information is in accordance with current Ministry guidance documents and subject to change as provincial guidance is updated to reflect the evolving science of COVID-19.

Should you have questions or require any further information, please do not hesitate to contact Public Health Sudbury & Districts at 705.522.9200, ext. 301.

Frequently Asked Questions – Long-term care home or retirement home

What requirements are in place for a resident who attends an essential outpatient visit?

In line with the Directive #3 of the Chief Medical Officer of Health (dated June 10, 2020) and the COVID-19 Outbreak Guidance for Long-Term Care Homes (dated April 15, 2020), in the event that a resident or their substitute decision maker deems an outpatient medical visit to be essential, the home must provide a mask for the resident to wear and should encourage the resident to wear the mask out of the home if tolerated. Upon return to the home, the resident should be screened but if asymptomatic, they are not required to be tested for COVID-19 or to self-isolate. Per Directive #3 of the Chief Medical Officer of Health, the home must conduct active screening and assessment of all residents, at least twice daily.

What requirements are in place for short absences from retirement homes?

In line with the Directive #3 of the Chief Medical Officer of Health (dated June 10, 2020) and the Reopening Retirement Homes guidance document, effective June 18, 2020, retirement home residents who wish to go outside of the home (e.g., short absences with friends/family, shopping, medical appointments, etc.) are permitted to do so provided that the home is not currently in outbreak. The short absence is limited to a maximum of 12 hours (cannot be overnight), and the resident is to wear their own cloth mask. The home may, at its discretion, opt to supply masks to residents for short absences. Upon return to the home, the resident should be screened but if asymptomatic, they are not required to be tested for COVID-19 or to self-isolate. Per Directive #3 of the Chief Medical Officer of Health, the home must conduct active screening and assessment of all residents, at least twice daily.

Direct communications from Public Health Sudbury & Districts

• Medical Officer of Health COVID-19 Data presentation to the Sudbury Medical Society, April 9, 2020 (PDF, 2 MB)
• Advisory Alerts and clinical guidance issued by Public Health Sudbury & Districts

Helpful links

Public Health Sudbury & Districts

• Diseases of Public Health Significance
• Daily Surveillance Line Listings (resident & staff)

Public Health Agency of Canada

• Coronavirus disease (COVID-19): For health professionals
  • What health professionals need to know
  • Spectrum of illness
  • Transmission
  • Detecting and reporting
  • Infection prevention and control
  • Treatment

Ontario Ministry of Health

• Guidance for the health sector
  • Case definition
  • Guidance documents for:
    • Primary care providers in a community setting
    • Acute care
    • Home and community care providers
    • Long-term care/Retirement homes
    • Paramedic services
    • Independent health facilities
    • Labs and specimen collection centres
    • Community pharmacies
    • Occupational health and safety
    • Consumption and treatment services
    • Public Health guidance on testing and clearance
• Symptoms, Screening, and Testing Resources
  • COVID-19 Provincial Testing Guidance Update (PDF)
  • Quick Reference Public Health Guidance on Testing and Clearance (PDF)
  • Coronavirus Disease 2018 (COVID-19) Testing – PHO
  • COVID-19 Reference Document for Symptoms (PDF)
  • COVID-19 Patient Screening Guidance Document  (PDF)
• Signage
• Related Ministry information

Public Health Ontario

• Coronavirus Disease 2019 (COVID-19)

Learn more about symptoms and how to protect yourself from COVID-19.

This item was last modified on September 22, 2020