COVID-19: Guidance for Long-Term Care Facilities and Retirement Homes

Posted Tuesday March 24, 2020

Posted By: Emily Ngo

Category: General

To: Long Term Care Homes, Retirement Homes, Emergency Departments, HEPCO
Date: March 24, 2020
From: Dr. Brent Moloughney, Associate Medical Officer of Health, Ottawa Public Health

Dear Colleagues,

For COVID-19 information see OPH’s Physician and Health Care Professionals Coronavirus website, visit (www.ottawapublichealth.ca/ncov), or call 613-580-6744.

As per our March 16, 2020 Criteria for COVID-19 Laboratory Testing, Ottawa Public Health (OPH) recommends that individuals with acute respiratory illness who reside in Long-Term Care Homes (LTCH) and Retirement Homes, regardless of exposure or travel history, be tested for COVID-19.

Ontario guidance for LTCH and Retirement Homes includes:

  • Residents of LTCH and Retirement Homes should not be permitted to leave the home for any short-stay absences to visit family and friends.
  • Residents who wish to go outside of the home should remain on the home’s property, and maintain safe social distancing from any essential visitors.
  • Only essential visitors can enter an LTCF or Retirement Homes. Essential visitors are those who have a loved one in the home who is very ill or at end of life. Generic signage for visitors is available in English and French.
  • Initiating active screening for COVID-19 for all residents, staff, contracted staff, volunteers, and essential visitors. If a resident fails screening, they are to be placed in isolation and the institution should contact Public Health for further instructions.
  • Consulting Public Health if there is concern for exposure to or transmission of COVID-19 to determine necessary public health actions.

Residents returning to their LTCH or Retirement Home in the absence of an institutional outbreak

  • OPH is aware that some institutions have expressed concerns regarding the return of residents that have been tested for COVID-19 in hospitals prior to their test result being available.
  • Retirement Homes should review plans of care for returning residents according to the regulation, and include substitute decision makers as appropriate (by phone or electronic means). Homes are reminded that residents have rights under the Residential Tenancies Act to return to their home that need to be considered.
  • LTCHs must consult with Public Health unit if an incoming or returning resident has symptoms compatible with COVID-19, including being tested for COVID-19. Similarly, Retirement Homes are requested to inform Public Health if a returning resident has been tested for COVID-19.
  • Regardless of where a resident is tested for COVID-19, a resident with respiratory symptoms needs to be placed in isolation, pending the test result. A requirement for isolation is not a reason for refusing a resident re-admission. Public Health may be contacted for advice on isolation procedures.

Testing of residents for COVID raises broader outbreak-related considerations. Therefore, OPH is providing further information to guide LTCH and Retirement Homes in their management of their residents with respiratory symptoms:

  • If a single resident of a LTCH or Retirement Home has respiratory symptoms
    • OPH recognizes that many individuals in LTCH or Retirement Homes cannot go to an Assessment Centre, and they should NOT be sent to the Emergency Department if the only purpose is for COVID-19 testing.
    • OPH is able to provide a Nasopharyngeal (NP) swab test kit to a LTCH or Retirement Home to test a single resident with respiratory symptoms.
    • In order to obtain this kit please call 613-580-2424 ext. 26325. After a Public Health Nurse (PHN) or Public Health Inspector (PHI) has verified that only one resident has acute respiratory symptoms, they will deliver a NP swab test kit to the institution.
    • Collection of a COVID-19 specimen for testing, using appropriate Personal Protective Equipment, would be the responsibility a health care provider at the institution. An OPH staff member will pick up the specimen and deliver to the Public Health Ontario Laboratory (PHOL).
    • The symptomatic resident should be placed on isolation and droplet contact precautions pending COVID-19 testing results.
  • If two or more residents of a LTCH or Retirement Home have respiratory symptoms
    • This situation would constitute a suspect or confirmed respiratory outbreak, and OPH recommends following the normal protocol (e.g., notify Public Health, outbreak NP swab test kits would be sent to PHOL, outbreak control measures would be initiated at the LTCH or retirement home, etc.).
    • PHOL has announced that all specimens submitted from institutions for standard outbreak respiratory testing will be tested for COVID-19.
    • To report an outbreak in a LTCH or Retirement Home during regular business hours, or for more information, call 613-580-2424 ext. 26325, or in the evening, on weekends or holidays, call 3-1-1, and ask to speak with the Public Health Inspector on-call.
    • Please refer to the OPH Respiratory Outbreaks in Long-Term Care Facilities and Retirement Homes website for more information.

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