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

Vaccine planning and rollout
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

Vaccine planning and rollout

The Province of Ontario has announced that the COVID-19 vaccine distribution implementation plan (Government of Ontario) will rollout in three phases. Phase 1 will begin with identified priority groups including health care workers in hospitals; staff, residents, and essential caregivers in long-term care home and retirement homes; other congregate care settings; and remote Indigenous communities.

Locally, Public Health Sudbury & Districts is actively planning and preparing for the arrival of COVID-19 vaccine in area communities including through engagement with local stakeholders.

For more information on COVID-19 vaccine planning and rollout, review planning resources and guidance documents from the Ministry of Health and the Ministry of Long-Term care. Stay up to date with Advisory Alerts and clinical guidance, and the COVID-19 Vaccine Bulletin issued by Public Health. Additionally read our frequently asked COVID-19 vaccine questions.

For a complete list of resources to support planning and implementation of a COVID-19 vaccination, please review our COVID-19 Vaccine Clinic Communications in a Box.

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

The following information provides Public Health Sudbury & Districts’ guidance related to Directive #3 of the Chief Medical Officer of Health and the COVID-19 Outbreak Guidance for Long-Term Care Homes, 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 Directive are in place. This includes but is not limited to staff masking, active screening of all residents, staff and visitors, management of visitors, and cohorting of residents and staff. Retirement homes are required to take all reasonable steps to follow these directives. Although 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.

As per Directive #3 of the Chief Medical Officer of Health, long-term care homes must have a plan for and use, to the extent possible, staff and resident cohorting as part of their approach to preparedness, as well as to prevent the spread of COVID-19 once identified in the home. For more information on cohorting, please see the Frequently Asked Questions section below or consult the following Public Health Ontario resources:

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. This would trigger an outbreak assessment and require the following steps:
1. Place the symptomatic staff off work and on self-isolation.
2. Test the symptomatic staff immediately.
3. Identify any close contacts (defined below) of the symptomatic staff.
4. Cohort and test those residents who were in close contact with the symptomatic staff in the 48 hours prior to symptom onset without appropriate precautions in place.
5. Cohort and test any asymptomatic staff identified as close contacts (defined below).
6. Test anyone else deemed high-risk by public health. Refer to the Public Health Ontario Cohorting During an Outbreak of COVID-19 in LTCH, for further information.
7. Enforce enhanced screening measures among residents and staff.

Receiving Negative Results

If the symptomatic staff member tests negative, the home can consider ending the suspect outbreak assessment related steps in consideration of other testing completed and in consultation with Public Health.

Receiving Positive Results

Staff who test positive will trigger an outbreak declaration in most cases. Refer to the Outbreak section below for further information.

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.
Symptomatic residents must be isolated under contact and droplet precautions immediately and pending test results.
Test the symptomatic resident immediately.
Identify any close contacts (defined below) of the symptomatic resident.
Cohort and test those residents who were in close contact (i.e. shared a room) with the symptomatic resident in the 48 hours prior to symptom onset without appropriate precautions in place.
Test anyone else deemed high-risk by public health, including staff.
Cohort and test any asymptomatic staff identified as close contacts. Refer to the Public Health Ontario Cohorting During an Outbreak of COVID-19 in LTCH, for further information.
Enforce enhanced screening measures among residents and staff.

Receiving Negative Results

If the symptomatic resident tests negative, the home can consider ending the suspect outbreak assessment related steps in consideration of other testing completed and in consultation with Public Health.

Receiving Positive Results

Residents who test positive will trigger an outbreak declaration in most cases, refer to the section below for further information.

Outbreaks

A single laboratory confirmed cases of COVID-19 in a resident or staff member must be considered as a confirmed respiratory outbreak with the following exceptional considerations:

When only asymptomatic residents/staff with positive results are found as a result of surveillance testing it may not be necessary to declare an outbreak. This is assessed in consultation with the Public Health.
If a resident who was admitted or transferred to the LTCH is tested during the 14-day isolation period and results are positive and the resident has been under Droplet and Contact Precautions during the entirety of the 14-day period, declaring an outbreak may not be necessary.

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.

Declaring an Outbreak

In the event an outbreak of COVID-19 is declared in the LTCH, all staff in the entire LTCH AND all residents in the LTCH must be offered testing.

Management of Resident Cases

Resident(s) cases must be in isolation under appropriate Droplet and Contact Precautions, in a single room if possible.

Management of Staff Cases

Symptomatic staff cases cannot attend work and must be in self-isolation. In exceptionally rare circumstances where clinical care would be severely compromised without addition staffing, the staff member who has tested positive and whose symptoms have resolved, or in the case that the staff member has always been asymptomatic, may be considered to return to work under work self-isolation in accordance with provincial criteria and in consultation with public health. Refer to the COVID-19 Quick Reference public Health Guidance on Testing and Clearance.

Close contacts

A close contact is defined as an individual with a high-risk exposure to a confirmed or probable case (or in the case of Directive #3 a symptomatic resident or staff awaiting test results) in the 48 hours before symptom onset. The following are considered close contacts:

When the resident is the case (or is symptomatic with test results pending):

HCW and/or support staff who provided direct care* for the case, or who had other similar close physical contact (i.e., < 2 metres from patient for any duration of time) without consistent and appropriate use of personal protective equipment (PPE) in relation to the care provided.
Other patients in the same room when the case was not on Droplet and Contact precautions.
Other patients in waiting room/common areas (i.e., < 2 metres from case for any duration of time) when either the case OR the contact was not wearing a mask (medical or non-medical).

When the HCW is the case (or is symptomatic with test results pending):

All patients for whom the HCW provided direct care*, or who had other similar close physical contact (i.e., patient was < 2 metres away from HCW for any duration of time), UNLESS BOTH the HCW and the patient were wearing a mask (medical or non-medical).
All co-workers who had close prolonged unprotected contact with the HCW (e.g., within 2 metres in an enclosed common area) UNLESS both the HCW AND the co-worker were wearing a mask (medical or non-medical) OR the co-worker was wearing a surgical/procedure mask** and eye protection.

*Direct care is defined as: Providing hands-on care, such as bathing, washing, turning the resident, changing clothing, continence care, dressing changes, care of open wounds/lesions or toileting.

** Surgical/procedure masks are made to comply with certain performance standards. Not all masks that you can purchase meet this standard. Check with your supplier.

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, cohorted, 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. 267.

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

What requirements are in place for a resident who leaves the home for a medical visit/reason?

In line with Directive #3 of the Chief Medical Officer of Health and the COVID-19 Outbreak Guidance for Long-Term Care Homes, in the event that a resident or their substitute decision maker requests to leave the LTCH for medical visits, 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. The resident should be reminded about the importance of public health measures including maintaining a safe distance of at least two metres from others and hand hygiene. 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. As 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 Directive #3 of the Chief Medical Officer of Health and the Retirement Home COVID-19 Visiting Policy, 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 face covering/mask. The home may, at its discretion, opt to supply masks to residents for short absences. The resident is to be reminded about the importance of public health measures including physical distancing. 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. As 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 is resident and staff cohorting?

According to the Public Health Ontario: Cohorting During an Outbreak of COVID-19 in Long-term Care Homes fact sheet, cohorting means grouping residents based on their risk of infection or whether they have tested positive for COVID-19 during an outbreak. Cohorting may also mean assigning staff to work with only ill or well residents. Residents are to remain physically separate (at least 2 meters) from one another as much as possible, including those within the same cohort. Staff should work with only a single cohort per shift, if possible. If staff must work with more than one cohort during a single shift, then staff are ideally to work with well residents first and COVID-19 positive residents last.

For more information on cohorting, please see the Cohorting During an Outbreak of COVID-19 in Long-Term Care Homes.