Purpose
This document aims to provide licensees of long-term care homes, as defined in the Fixing Long-Term Care Act, 2021, with comprehensive information regarding the Province of Ontario’s enforceable requirements during the COVID-19 pandemic. This includes directives issued by the Minister of Long-Term Care, designed to assist homes in developing safe operational approaches while maximizing the quality of life for residents.
This guidance is intended to be used in conjunction with all applicable legislation, directives, and orders. It is not a substitute for legal advice and should be followed unless there are valid health and safety reasons to exercise discretion as directed by the local public health unit.
Long-term care facilities implementing COVID-19 measures exceeding the requirements outlined here or in applicable legislation are expected to consult with their local public health unit, Residents’ Council, and Family Council before implementation.
In case of any conflict between this document and any existing legislation, directive, or order, the legislation, directive, or order will take precedence. This document is not intended to replace professional medical advice, diagnosis, or treatment.
SARS-CoV-2, the virus causing COVID-19, primarily spreads through respiratory emissions when an infected person breathes, speaks, coughs, or sneezes. A layered approach to prevention is crucial for optimal protection, especially in enclosed, crowded, or close-contact settings.
COVID-19 Vaccination
Vaccination Policies
Considering the current moderate vaccine uptake among residents, the availability of effective antiviral treatments, and widespread community immunity, the risk of severe COVID-19 outcomes for residents has significantly decreased.
Long-term care homes maintaining proof-of-vaccination requirements are strongly advised to re-evaluate these policies. This review should consider the current pandemic context and the Residents’ Bill of Rights, especially residents’ rights to receive visitors of their choice. While promoting recommended vaccine doses remains important, homes are encouraged to permit entry to visitors and qualified staff regardless of vaccination status. Licensees should consult with residents’ councils, family councils, and local public health units to ensure policy revisions are based on the most current clinical evidence. Seeking independent legal advice is also recommended as needed.
Long-term care licensees retain the authority to implement vaccination requirements for staff, students, volunteers, support workers, caregivers, and general visitors, provided these are consistent with the Fixing Long-Term Care Act, 2021, including the Residents’ Bill of Rights (right to a safe and secure home), O. Reg. 246/22 under the Act, and all other applicable laws, including the Human Rights Code.
However, vaccination requirements are not applicable to residents. Homes cannot deny admission based on a resident’s vaccination status. Furthermore, vaccination policies must not apply to outdoor visitors, children under five, or those visiting residents receiving end-of-life care.
To enhance ongoing vaccination efforts, long-term care homes are strongly encouraged to adopt best practices in promoting vaccination benefits, providing up-to-date eligibility information, and offering onsite vaccination services.
Best Practices
Promoting Awareness of the Benefits of Vaccination
The elderly population, especially those in shared living spaces like long-term care homes, remains at risk for severe COVID-19 outcomes due to age and underlying health conditions. Vaccination and staying updated with COVID-19 vaccines are the most effective ways to protect against severe illness.
Vaccination is highly effective in preventing severe illness and adverse outcomes. Staying up-to-date with recommended doses maintains protection that can wane over time. Booster doses significantly enhance protection against symptomatic infection, hospitalization, and ICU admission.
Regardless of specific vaccination policies, all individuals living, working in, or visiting long-term care homes are strongly encouraged to get vaccinated and stay up-to-date according to the Ministry of Health’s COVID-19 Vaccine Guidance. All vaccines provided in Ontario’s rollout are safe and effective. More information is available at COVID-19 vaccines for Ontario.
Onsite Vaccination
Onsite vaccine administration remains the preferred method to ensure residents, caregivers, and staff can receive vaccines promptly. Homes equipped for independent vaccine administration should collaborate with local public health units to request vaccines and necessary supplies for onsite administration to residents, staff, and caregivers.
Homes not yet set up for independent administration are encouraged to take steps to onboard or explore alternative onsite vaccine administration options.
Onsite vaccination should be available to residents, staff, and caregivers, regardless of who administers the vaccine. Despite the advantages of onsite administration, homes should continue to encourage staff and caregivers to utilize community resources for vaccination as soon as they are eligible.
Staff and caregivers can book appointments through the provincial COVID-19 vaccination portal, by calling the Provincial Vaccine Contact Centre, or at select pharmacies and primary care settings. Homes should support staff by removing barriers to vaccination, such as providing paid time off for vaccine appointments.
Infection Prevention and Control (IPAC) Practices
Consistent adherence to robust IPAC practices is critically important. Homes must prioritize preventing and limiting COVID-19 spread by implementing and continuously reviewing strong IPAC practices.
Effective IPAC practices must be followed by everyone in long-term care homes at all times, regardless of COVID-19 case presence or vaccination status.
Licensees are required to implement the Infection Prevention and Control Standard for Long-Term Care Homes for IPAC programming, alongside the guidance provided in this document.
IPAC Audits
As per the Minister’s Directive, licensees, in consultation with their joint health and safety committees or representatives, must take measures to prepare for and respond to COVID-19 outbreaks. This includes developing and implementing a COVID-19 Outbreak Preparedness Plan, which must include regular IPAC audits as outlined in this guidance.
Homes must conduct IPAC audits at least quarterly, as required by the IPAC standard. During a COVID-19 outbreak, audits must be performed weekly.
IPAC audits should be conducted across different shifts, including evenings and weekends.
Audits must, at a minimum, include the PHO’s COVID-19: Self-Assessment Audit Tool for Long-Term Care Homes and Retirement Homes.
Audit results should be retained for at least 30 days and made available to inspectors from public health units, the Ministry of Labour, Immigration, Training and Skills Development, and the Ministry of Long-Term Care upon request.
General IPAC Requirements
Licensees are subject to section 23 of the Act, mandating every home to have an IPAC program. Details are in the Infection Prevention and Control Standard for Long-Term Care Homes. Section 102 of O. Reg. 246/22 includes further requirements, such as an interdisciplinary team approach for IPAC program coordination and implementation, and the designation of an IPAC lead in every long-term care home.
Everyone in a long-term care home—staff, students, volunteers, caregivers, support workers, general visitors, and residents—shares the responsibility for maintaining health and safety by consistently practicing these measures.
Licensees should maintain adequate stock levels of all necessary supplies and materials, regardless of outbreak status.
Masking
As per the Minister’s Directive, licensees must ensure compliance with masking requirements as detailed in this guidance.
Masking is a key defense against respiratory virus transmission. Homes must ensure all staff, students, volunteers, and support workers adhere to applicable masking requirements at all times.
Staff, Students, Volunteers, and Support Workers
- Masks are required based on a point of care risk assessment (PCRA).
- According to the COVID-19 Guidance Personal Protective Equipment (PPE) for Health Care Workers and Health care Entities, and existing Routine Practices, a PCRA must be completed by every healthcare worker before each interaction with a resident or patient and task. This assessment determines the risk of exposure to infectious agents, including COVID-19, and dictates appropriate IPAC measures.
- If a healthcare worker lacks PCRA expertise, a supervising healthcare worker should perform it. In some settings, resident room signage may indicate required precautions, determined by the infection prevention and control lead.
- Masks are required according to return-to-work protocols following COVID-19 infection, as outlined in the Infectious Disease Protocol Appendix 1.
- Staff may consider masking during prolonged direct resident care (one-on-one care within two meters for 15 minutes or longer).
- Masks are not required in administrative and staff-only areas (e.g., lunchrooms, breakrooms, offices, and gyms).
- Homes are encouraged to implement “mask-friendly” policies, accommodating:
- Staff who choose to continue masking beyond minimum requirements.
- Residents or substitute decision-makers who request staff to mask during care, in alignment with the Residents’ Bill of Rights, including the right to participate fully in care decisions.
Caregivers and Visitors
- Masks are recommended but not mandatory in all areas of the home.
Residents in Shared Rooms
- If a resident in a shared room is uncomfortable with roommates unmasked, homes should provide a designated space for visitors without masking requirements.
Exceptions
Masking exceptions include:
- Children under two years of age.
- Individuals (staff, students, volunteers, support workers, caregivers, visitors, or residents) accommodated under the Accessibility for Ontarians with Disabilities Act, 2005, or the Ontario Human Rights Code.
Eye Protection
From an occupational health and safety perspective, regardless of vaccination status, appropriate eye protection (e.g., goggles or face shield) is mandatory for all staff and essential visitors when caring for residents with suspected or confirmed COVID-19 and during direct care within two meters of residents in an outbreak area. In other situations, staff use of eye protection is based on PCRA when within two meters of a resident.
Physical Distancing and Cohorting
Currently, there are no specific COVID-19 related requirements or restrictions on physical distancing or cohorting outside of outbreak situations.
Areas for Isolation
Per the Minister’s Directive, licensees must adhere to requirements regarding isolation areas as outlined in this guidance.
While homes are no longer required to dedicate specific beds for isolation, emergency plans related to COVID-19 outbreaks must identify areas for resident isolation, as per O. Reg. 246/22.
Individuals needing isolation must be placed in a single room under Additional Precautions. If a single room is unavailable, they may share a room with at most one other resident also requiring isolation under Additional Precautions, ensuring at least two meters between beds. No more than two residents should be placed in isolation per room, regardless of the room’s licensed bed capacity.
Activities
Communal Dining
Shared meals are vital for the social environment in long-term care homes. Caregivers and general visitors can join residents for meals in communal spaces without masks.
There are no specific COVID-19 requirements or restrictions on communal dining. Standard IPAC practices, like hand hygiene, should be maintained in these settings.
Group Activities: Organized Events and Social Gatherings
Homes should provide opportunities for residents to participate in group activities, including:
- Social activities
- Physical exercises
- Hobbies and crafts
- Birthday celebrations
- Religious ceremonies and practices
No specific COVID-19 requirements or restrictions apply to group activities outside of outbreaks. IPAC practices should be followed in communal spaces to promote safety and well-being.
What Happens in an Outbreak?
During a COVID-19 outbreak, homes must follow directions from the local public health unit, including cohorting practices as outlined in the COVID-19 Guidance: Long-Term Care Homes, Retirement Homes, and other Congregate Living Settings for Public Health Units. Group activities and communal dining should separate the outbreak unit from unexposed individuals. Cohorted group activities and dining for exposed cohorts may resume. Continuing group activities for exposed cohorts is recommended to support resident mental health and well-being.
What Happens When a Resident Is Isolating or Fails Screening?
Residents in isolation or who fail screening (e.g., daily monitoring per IPAC Standard section 3) should not participate in group events, activities, dining, or social gatherings. However, homes should facilitate virtual participation where possible to provide alternatives to in-person social interaction.
COVID-19 Screening
As mandated by the Minister’s Directive, licensees must ensure adherence to COVID-19 screening requirements as detailed in this guidance.
The purpose of COVID-19 screening, a crucial preventative measure and Covid-19 Screening Tool For Long-term Care Homes And Retirement Homes, is to identify potentially infectious individuals, thereby minimizing the introduction and spread of COVID-19 within these facilities.
Types of Screening
Active screening involves attestation or confirmation of screening, achievable through pre-arrival online submissions or in-person checks.
Passive screening relies on individuals reviewing screening questions themselves without verification or reporting of results.
Screening Requirements
Long-term care home licensees must:
- Establish and communicate an operational plan that includes guidance for staff, students, volunteers, support workers, caregivers, and general visitors to self-monitor for COVID-19 symptoms (passive screening). This plan acts as a vital covid-19 screening tool for long-term care homes and retirement homes.
- Provide individuals with information (e.g., screening questions) to monitor their health at home for COVID-19 symptoms and inform them that entry is prohibited if they feel unwell or would fail screening.
- Homes are not required to request verification or attestation upon entry, nor are they required to have staff conduct or verify screening at the door.
- Post signage at entrances and throughout the home listing COVID-19 signs and symptoms for self-monitoring and outlining steps to take if COVID-19 is suspected or confirmed.
Homes must not prohibit visits for palliative end-of-life residents. If these visitors fail screening, they must be allowed entry but must wear a medical (surgical or procedural) mask and maintain physical distance from other residents and staff.
Staffing
To assist long-term care homes facing staffing challenges, the ministry has implemented measures to support homes during severe shortages that cannot be resolved through other means, including staffing agencies.
Homes not in outbreak can implement these measures based on their own assessment. Homes in outbreak should collaborate with the public health unit when implementing these measures.
Return-to-Work Following a COVID-19 Infection
Refer to the Ministry of Health’s Infectious Disease Protocol Appendix 1: Case Definitions and Disease Specific Information Disease: Diseases caused by a novel coronavirus for guidance on staff returning to work after infection.
Staffing resources across the system are limited. Facilities must utilize their business continuity plans and system partners for support. If challenges persist after exhausting contingency plans, staffing agency partnerships, community partners, and corporate or municipal supports, homes should escalate to Ontario Health.
Admissions and Transfers
For admissions and transfers, as well as related isolation and testing requirements, long-term care homes should follow the Ministry of Health COVID-19 Guidance: Long-Term Care Homes, Retirement Homes, and other Congregate Living Settings for Public Health Units (Appendix E: Algorithm for Admissions and Transfers).
Absences
As per the Minister’s Directive, licensees must ensure compliance with resident absence requirements as detailed in this guidance.
Currently, there are no specific COVID-19 related requirements or restrictions on absences.
Homes cannot restrict or deny absences for medical, palliative, or compassionate reasons, even during resident isolation or home outbreaks.
When a resident in isolation needs to leave for a medical absence, homes should notify the receiving healthcare facility to ensure appropriate Additional Precautions are in place.
Residents Returning from Absences
Homes are not required to actively screen, test, or isolate residents returning from absences unless they are symptomatic. Symptomatic residents must be permitted entry but isolated under Additional Precautions and tested for COVID-19 as per the Infectious Disease Protocol Appendix 1 and the COVID-19 Guidance for Public Health Units.
Visitors
As per the Minister’s Directive, licensees must ensure visitor requirements as outlined in this guidance are followed.
Visitors are recommended to wear masks in all indoor resident areas, except when in a resident’s room or while eating or drinking with a resident in communal spaces.
Homes are reminded of residents’ rights under the Fixing Long-Term Care Act, 2021, to receive visitors, and policies should not unreasonably restrict this right. Homes should establish their visitor policies in accordance with applicable guidance and laws, including the Fixing Long-Term Care Act, 2021, and Regulation.
Essential visitors, including caregivers, support workers, those visiting for compassionate reasons (including end-of-life care), and inspectors, must continue to have access to long-term care homes during outbreaks, as per O. Reg. 246/22.
During outbreaks, homes must follow directions from their local public health unit, which may include advising general visitors to postpone non-essential visits, as per the COVID-19 Guidance for Public Health Units.
COVID-19 Asymptomatic Screen Testing
As per the Minister’s Directive, licensees must ensure adherence to asymptomatic testing requirements as detailed in this guidance.
Currently, there are no asymptomatic screen testing requirements.
While homes may implement their own asymptomatic screen testing policies, it is not recommended at this time. If implemented, these policies must not apply to outdoor visitors, those visiting residents receiving end-of-life care, or inspectors with statutory rights of entry.
Routine asymptomatic testing of staff, students, volunteers, support workers, caregivers, and visitors not exposed to COVID-19 differs from testing symptomatic individuals, those with high-risk exposure, or those in outbreak settings as directed by public health units. Symptomatic resident testing will continue, and symptomatic staff, students, volunteers, general visitors, caregivers, and support workers are encouraged to get tested.
Prohibition on Reselling or Distributing to Any Other Person
Antigen tests provided by the Province of Ontario must be used only for their intended purpose and not resold or distributed to others.
Residents’ Councils
Residents’ councils are crucial in long-term care homes. Licensees must not interfere with their meetings or operations (section 71 of the Act) and must cooperate with the council, appoint an assistant, and address council concerns and recommendations.
All homes must ensure residents’ councils can meet. When in-person meetings are possible, councils should be provided with appropriate PPE and IPAC guidelines should be followed. Homes must accommodate the continuation of residents’ council meetings when in-person meetings are not possible.
The Ontario Association of Residents’ Councils (OARC) offers resources to help homes facilitate resident council meetings, available on OARC’s Tools webpage.
Case and Outbreak Management
As per the Minister’s Directive, licensees must ensure adherence to case and outbreak management requirements as detailed in this document.
Outbreak Definition
For the definition of a COVID-19 outbreak in long-term care homes, refer to the Ministry of Health COVID-19 Guidance: Long-Term Care Homes, Retirement Homes, and other Congregate Living Settings for Public Health Units.
Only the local public health unit can declare and declare the end of an outbreak. Long-term care homes are not responsible for determining epidemiological links between cases. Public health units will investigate and determine if cases are linked, informing their outbreak declaration decisions.
Case and Outbreak Management
For COVID-19 case and outbreak management, homes must comply with the Fixing Long-Term Care Act, 2021, O. Reg. 246/22, and the:
- Ministry of Health COVID-19 Guidance: Long-Term Care Homes, Retirement Homes, and other Congregate Living Settings for Public Health Units.
- Infectious Disease Protocol Appendix 1: Case Definitions and Disease Specific Information Disease: Diseases caused by a novel coronavirus.
Homes must follow directions from local public health units during suspected or confirmed outbreaks. Public health units manage outbreak responses, having the authority under the Health Protection and Promotion Act to coordinate investigations, declare outbreaks, and direct control measures.
Local public health units define the outbreak area, direct outbreak testing, and lead all outbreak management aspects, including resident and staff isolation, and declare the end of outbreaks.
Homes must adhere to any additional measures directed by the local public health unit to reduce COVID-19 transmission.
Health system partners or external agencies involved in outbreak responses must inform the local public health unit and the Outbreak Management Team of their involvement and follow all directions from the public health unit under the Health Protection and Promotion Act.
Reporting Outbreaks and Cases
COVID-19 is a designated disease of public health significance (O. Reg. 135/18). Confirmed and suspected cases are reportable to the local public health unit under the Health Protection and Promotion Act (HPPA). Homes must promptly notify the local public health unit of all confirmed and probable resident cases, as well as outbreak-related staff and visitor cases, as per the outbreak definition in the COVID-19 Guidance for Public Health Units.
Local public health units are responsible for receiving and investigating all reported cases and contacts in accordance with the COVID-19 Guidance for Public Health Units and the Health Protection and Promotion Act.
Homes must meet critical incident reporting requirements in section 115 of O. Reg. 246/22. Any confirmed COVID-19 outbreak must be immediately reported to the Ministry of Long-Term Care using the Critical Incident System (CIS) report during business hours or by calling Service Ontario After-Hours line outside business hours or on statutory holidays and submitting a CIS report the next business day.
Contact Information
For questions about COVID-19 related policies and guidance, email the Ministry of Long-Term Care at [email protected].
Resources
General
Vaccination
Infection Prevention and Control
For general IPAC measures information, refer to these documents:
Signage
Ventilation and Air Flow
Below are Public Health Ontario resources on portable fans, air conditioning units, and portable air cleaners.
