The NIA's Recommended 'Titanium Ring' for Protecting Older Canadians in Long-Term Care and Congregate Living Settings - Squarespace
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
The NIA’s Recommended
‘Titanium Ring’ for
Protecting Older
Canadians in Long-Term
Care and Congregate
Living Settings
March 2021The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
National Institute on Ageing
Guidance Document
Suggested Citation:
National Institute on Ageing. (2021). The
NIA’s Recommended ‘Titanium Ring’ for
Protecting Older Canadians in Long-Term
Care and Congregate Living Settings.
Toronto, ON: National Institute on Ageing
Guidance Document.
Mailing Address:
National Institute on Ageing
Ted Rogers School of Management
350 Victoria St.
Toronto, Ontario
M5B 2K3
CanadaThe NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings About the National Institute on Ageing The National Institute on Ageing (NIA) is a public policy and research centre based at Ryerson University in Toronto. The NIA is dedicated to enhancing successful ageing across the life course. It is unique in its mandate to consider ageing issues from a broad range of perspectives, including those of financial, physical, psychological, and social well-being. The NIA is focused on leading cross-disciplinary, evidence-based, and actionable research to provide a blueprint for better public policy and practices needed to address the multiple challenges and opportunities presented by Canada’s ageing population. The NIA is committed to providing national leadership and public education to productively and collaboratively work with all levels of government, private and public sector partners, academic institutions, ageing-related organizations, and Canadians. About the National Institute on Ageing 3
The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings Authors This report was researched and written by: Julie Dunning, MPH Senior Policy Advisor, National Institute on Ageing, Ryerson University Natalie Iciaszczyk, MA, JD Policy Analyst, National Institute on Ageing, Ryerson University Cameron Feil, MSc Policy Analyst, National Institute on Ageing, Ryerson University Misha Dhuper Research Assistant, National Institute on Ageing, Ryerson University Dr. Samir Sinha, MD, DPhil, FRCPC, AGSF Director of Geriatrics, Sinai Health System and the University Health Network Associate Professor of Medicine, Health Policy, Management and Evaluation, University of Toronto Director of Health Policy Research, National Institute on Ageing, Ryerson University Adjunct Professor of Management, Ted Rogers School of Management, Ryerson University Authors 4
The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
Background and Context
Older Canadians are more likely to die from accommodations. Activities are often
COVID-19. Their advanced ages and higher communal, and many residents receive
likelihood of living with multiple chronic care from providers who traditionally have
conditions, including dementia, frailty and been employed on a part-time basis across
weaker immune systems, all contribute to multiple LTC homes and other settings,
their greater risk of death. further increasing their ability to spread
infections like COVID-19 across settings.
There are close to 500,000 Canadians 1
Furthermore, the inability to maintain
who live in Long-Term Care (LTC) homes, strong Infection Prevention and Control
retirement homes and other congregate (IPAC) measures in these settings can only
living LTC settings, with 85% aged 65 years
2
encourage the transmission of COVID-19
and older. While 0.9% of Canadians live
3
into and throughout a home.
in LTC and congregate living settings, 7%,
32% and 67% of Canadians over 65, 85 and It has become well-understood
100 years of age also call these settings that COVID-19 can have both early
home. 4
asymptomatic and atypical presentations,
and is most likely to enter a home via
The presence of inherent systemic visitors and care providers infected in the
vulnerabilities in Canadian LTC settings, community or by transmitting the virus
such as living together in close proximity from one care setting to another. A CDC-
to others and chronic underfunding and led study comprehensively examining the
staffing issues, creates further risks for first COVID-19 outbreak in a US LTC home in
those living in these settings. As the NIA early 2020 reported a hospitalization rate of
has previously noted in its 2019 Enabling 55% and a case fatality rate of 34% amongst
the Future of Long-Term Care in Canada its residents, demonstrating early how
report, 5 Canada currently spends 30% less deadly COVID-19 can be in these settings. 7
of its GDP on the provision of publicly- An early Ontario, Canada study further
funded long-term care (home, community, demonstrated that LTC home residents 70
and residential care services) when years of age and older were 13 times more
compared with other OECD countries. 6 likely to die of COVID-19 than people in
the same age group living elsewhere in
Many older Canadian homes do not have Ontario. 8 In June 2020, CIHI in partnership
the space or ability to enforce proper with the NIA demonstrated that 81% of
physical distancing measures, especially Canada’s first wave deaths from COVID-19
when they may still be offering three and occurred in LTC and congregate settings,
four-bedded rooms and shared washroom nearly twice the international OECD average
Background and Context 5The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
of 38%. 9 Furthermore the NIA Long-Term COVID-19 evolves to further inform
Care COVID-19 Tracker Open Data Working expert interpretations. Furthermore, the
Group has shown that Canada’s COVID-19 NIA will continually provide updates on
Case Fatality Rate amongst residents in how Canada’s provincial, territorial and
these settings was 38% in July 2020, where federal governments and their respective
the risk of dying from COVID-19 is 74 times agencies like the Public Health Agency
greater than amongst older community- of Canada remain aligned with the NIA’s
dwelling Canadians 65 years of age and recommended best practices for the
older. 10 While Canada’s COVID-19 Case duration of this pandemic.
Fatality Rate amongst residents in these
settings has now come down to 26% in In late March 2020, the NIA released its
January 2021, deaths in these settings first edition of its ‘Iron Ring’ Guidance for
still represent 70% of Canada’s more than Protecting Older Canadians in Long-Term
20,000 COVID-19 deaths. Care and Congregate Living Settings. This
guidance synthesized rapidly emerging
The term ‘Iron Ring’ became popularized in international evidence at that time on how
Ontario during the first wave of COVID-19 to prevent and manage the introduction
infections to indicate the collective and spread of COVID-19 in LTC and
actions that the province would take to retirement settings.
protect residents of LTC and retirement
homes. Through the leadership of Dr. The NIA originally recommended five
Samir Sinha, the NIA’s Director of Health evidence-based measures to prevent and
Policy Research, the NIA has been keeping manage COVID-19 in these settings; a)
abreast of rapidly emerging international Restricting all Non-Essential Visitors, b)
evidence on how best to prevent and Limiting Care Providers from Working in
manage the introduction and spread Multiple Care Settings, c) All Care Providers
of COVID-19 amongst residents, care Should Wear Appropriate Protective
providers and family caregivers in these Equipment, d) Strong Infection Prevention
settings. This effort positioned the NIA and Control Procedures for Staff and
to quickly provide governments, LTC Residents, e) Flexible Admission and
providers, and the public evidence-based Discharge Policies. The NIA has continually
recommendations and advice that could monitored the uptake of its recommended
be swiftly and effectively implemented ‘Iron Ring’ guidance for LTC and
to better inform policies and strategies congregate living settings across Canada.
to address COVID-19. The NIA’s overall A second edition of the NIA’s updated
“Iron Ring” guidance is being continually ‘Iron Ring’ guidance was published in July
updated as the evidence-base around 2020 as evidence around the management
Background and Context 6The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
of COVID-19 in these settings evolved Finally, in anticipation of the arrival of
towards the conclusion of Canada’s first its first approved COVID-19 vaccines
wave of COVID-19 infections. in December 2020, Canada’s National
Advisory Committee on Immunization
This February 2021 update marks the third (NACI) issued guidance emphasizing the
edition of the NIA’s ‘Iron Ring’ guidance need to prioritize vaccinating Canada’s
around the peak of Canada’s current LTC and Congregate Setting Residents and
second wave of COVID-19 infections. This Staff.
third iteration has been greatly expanded
and to distinguish its stronger and more This document helps to outline the
fulsome guidance from that of its previous prioritization of LTC residents, staff, and
editions, we have decided to rename it our family caregivers in Canada’s provincial
“Titanium Ring” guidance for the duration and territorial COVID-19 vaccination
of this pandemic. In response to the rapidly strategies.
evolving evidence and policy landscape
across Canada, the NIA has identified a
number of additional evidence-based
measures to better manage COVID-19
within LTC settings. These additional
measures include implementing:
a. Enhanced Staffing Policies
b. Designated Onsite IPAC Support
c. De-Crowding Policies.
Furthermore, in alignment with the NIA’s
Finding the Right Balance: An Evidence-
Informed Guidance Document to Support
the Re-Opening of the Canadian LTC Homes
to Family Caregivers During the COVID-19
Pandemic, this ‘Titanium Ring’ update
includes an analysis of the evolving
provincial and territorial guidance related
to enabling the presence of Family
Caregivers and General Visitors in LTC
settings.
Background and Context 7The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
NIA Current Guidance Recommendations
as of February 2021
1. Enable Family Presence in a Safe actively screened for signs, symptoms
or for potentially being at high-risk of
and Effective Way While Restricting exposure. Anyone who does not pass
all Non-Essential Visits this level of screening should not be
permitted to enter the home. While
Given the growing prevalence and likely this early recommendation was seen as
persistence of community transmission critical to help stop the early spread of
in Canada, a key early way to prevent the COVID-19, staff and family members of
entry of COVID-19 into LTC settings was residents were being encouraged to look
to prohibit non-essential visitors from for safe ways of engaging with residents
entering a home. While it is arguable that to prevent undue social isolation that
most if not all visits from family and friends could result from a lack of on-site family
are important to the overall health and presences and visitors. Technology, such
well-being of residents, as community as tablets, can be used to communicate
transmission was rising quickly, the risk to residents. Homes and families quickly
that these visitors could inadvertently became creative in finding ways to visit
introduce the virus into a home became residents such as through the use of
greater as well. window-visits. However, it was soon
realized that lack of in-person contact was
Between March and April 2020 when having unintended consequences on the
outbreaks and deaths intensified in health and well-being of residents due to
Canadian LTC homes, homes across the increased loneliness and isolation.
country began to impose strict “no visitor”
policies as part of their IPAC strategies. 11,12 During the summer of 2020, as the
These policies still did allow visitors for community prevalence of COVID-19
residents but only when deemed to be continued to decrease in Canada, and
“essential”, which, in addition to paid care regions across the country progress
providers, could often include a family with phased re-openings, experts and
member visiting under only exceptional advocates grew increasingly concerned
circumstances, such as to visit a loved that visitation policies and family
one who is receiving end-of-life care or caregiver access to long-term care
needed other specific forms of care and settings remained overly restrictive and
support. Any care provider or other visitor may be causing harm to residents. 13 Thus,
being allowed to enter a home should be provinces and territories tried to develop
NIA Current Guidance Recommendations as of February 2021 8The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
and implement risk-mitigated guidance Quebec and the Northwest Territories.
to support the re-opening of Canadian Additionally, four provinces; New Brunswick,
long-term care and retirement homes to Ontario, Saskatchewan allowed general
essential family caregivers and visitors. 14
visits to take place outdoors only. While two
territories, Nunavut and the Yukon did not
The importance of implementing family permit general visitors during this period.
presence policies into LTC homes for
the health and well-being of residents During summer 2020, provinces and
cannot be overstated. Incorporating family territories began providing guidance
presence is recognized as a risk-based pertaining to family and essential caregivers
approach, and when implemented in a safe for residents. Differences arose in the
context where the necessary protections number of designated family or essential
such as strong IPAC, staff and visitor caregivers allowed per resident. Provinces
testing, and mandatory masking are in and territories allowing one family or
place, it can positively impact LTC home essential caregiver per resident included
residents. Many provinces and territories Alberta, Newfoundland, Nova Scotia,
have been enabling family caregivers and Northwest Territories, and Ontario. While
visitors to provide much needed contact, New Brunswick, Quebec, Saskatchewan, the
support, and care to residents in order to Yukon, and Manitoba allowed more than one
maintain their health and wellbeing as per resident.
the COVID-19 pandemic progressed. This
February 2021 edition of the ‘Titanium Entering the late summer and fall, many
Ring’ tracks provincial and territorial provinces and territories reintroduced
guidelines pertaining to family presence general visitor restrictions and limitations.
and general visitors in LTC homes. The Provinces and territories including Alberta,
family presence guidelines include the British Columbia, Manitoba, Ontario, Quebec,
number of designated caregivers allowed and the Yukon allow a limited number of
per resident, while the general visitor visitors depending on the COVID-19 risk
guidelines aim to capture the evolution level. Specifically, Ontario, Manitoba, and
of them over from the first wave (March Quebec impose more restrictive general
to August 31 st) and the second wave visitor policies depending on the current
September 1 onwards).
st
COVID-19 risk level specified in the LTC home
jurisdiction. During the same time period,
In late spring and early summer 2020, Prince Edward Island and the Yukon had no
provinces and territories began to loosen visitor restrictions to LTC homes.
general visitor restrictions across LTC
settings. Provinces and territories allowing As COVID-19 cases across Canada rapidly
normal general visitors during this time increased during the late fall and winter,
included Alberta, British Columbia, general visitor bans to LTC homes began to
Manitoba, Newfoundland, Nova Scotia, be implemented across Canada. Provinces
NIA Current Guidance Recommendations as of February 2021 9The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
and territories implementing general 2. Ensure Sufficient and Safe Staffing
in Care Settings to Enable Care
visitor bans during this time include
the Yukon, Saskatchewan, Quebec (risk
dependent), Ontario (risk dependant), Providers from Working in Multiple
Nunavut, Northwest Territories, Nova Care Settings
Scotia, Newfoundland, Manitoba (risk
dependant), and Alberta. While guidelines Staff working in more than one care setting
for British Columbia allow for one, Prince (i.e. another LTC or retirement home)
Edward Island allows for two general should be identified and efforts should
visitors per resident. be made to limit its occurrence. Limiting
staff to only working in one home can
In addition to greater visitor restrictions effectively limit the spread of COVID-19
across Canada in the late fall and winter between care settings. Implementing this
months, some provinces and territories recommendation, however, is easier said
changed the number of family and than done. Many care providers working in
essential visitors designated per resident. these settings have not traditionally been
Nova Scotia and the Northwest Territories offered full-time roles with comprehensive
increased the number of designated benefits such as sufficient paid sick leave.
family and essential visitors during this This incentivizes care providers to work
time period. While Prince Edward Island, multiple jobs across multiple homes
Saskatchewan, and the Yukon decreased (including through staffing agencies),
the number of designated family and in order to piece together a full-time
essential visitors from two to one per LTC wage. This sector has traditionally paid its
resident. care providers significantly lower wages
compared to their counterparts in hospital
settings. These are some of the reasons
why there is high staffing turnover in
this sector and why the majority of care
settings in this sector have struggled with
chronic staffing shortages pre-dating the
pandemic. Thus, effectively enabling staff
from working in multiple settings means
that several issues must be simultaneously
addressed, including top-ups on pay for
staff who would otherwise suffer a decline
in their income if they were limited to
working in one home that could not offer
them full-time employment.
NIA Current Guidance Recommendations as of February 2021 10The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
In response to the PHAC guidelines rates and benefits such as paid sick leave
suggesting that staff be limited to working as those in collective agreements with the
in a single care home, the NIA has tracked Public Health Authority. Furthermore, all
evolving provincial policies and efforts care providers would be offered full-time
to strengthen existing LTC workforces employment with their accompanying
and staffing supports. This includes, but benefits as well. Additionally, in
is not limited to, provincial and territorial September, British Columbia announced
policies aimed at recruiting more LTC staff, it would be hiring an additional 7,000
and increasing the wages and benefits for personal care workers to better staff its LTC
current and future LTC staff. homes.
In alignment with PHAC’s April 8th
In June 2020, Quebec announced a plan
Guidelines, all Canadian provinces and
to hire 10,000 LTC care providers by the
territories except for Nunavut and the
end of the fall. The plan offered successful
Yukon have issued an order to restrict staff
applicants a 12-week training program,
from working across multiple LTC homes.
with a $760 scholarship, and guaranteed a
However, this recommendation came with
minimum salary of $49,000 per year. As of
many external implications, as many LTC
October 2020, Quebec successfully trained
care providers have traditionally relied
and hired 7,100 new care providers for its
on staff working across multiple homes
LTC homes. 15
on a part-time basis to piece together a
full-time salary but with limited overall
In the Spring 2020, Ontario announced
benefits such as ample paid sick days. The
a $4 per hour pandemic pay wage
NIA has thus further examined provincial
enhancement for all of its frontline LTC
and territorial policy responses aimed at
workers that would last until July 2020. In
better addressing these issues.
September 2020, Ontario released a plan
to recruit, retain, and support additional
The NIA found three provinces; British
Personal Support Workers (PSWs). Its
Columbia, Quebec, and Ontario, have
plan included a $5,000 reimbursement
introduced specific staffing recruitment
for new PSW’s training costs in return
initiatives and pay increases aimed at
for a six-month working commitment. It
countering the issues caused by restricting
remains unclear how many new PSWs have
staff to work at a single LTC home as well
been recruited through this mechanism.
as chronic understaffing issues that were
Ontario followed this up with a $3 per
only exacerbated during the first wave of
hour temporary wage increase for PSWs in
the pandemic.
October 2020 that would last until March
2021. Finally, in December 2020, Ontario
British Columbia took the boldest step in
announced that it would spend up to $1.9B
announcing in March 2020 that all LTC care
a year to help raise the direct hours of care
workers would be paid the same wage
NIA Current Guidance Recommendations as of February 2021 11The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
being provided to residents in long-term 4. Ensure Strong Infection Prevention
care homes from 2 hours and 45 minutes
to 4 hours by 2024-25 by eventually hiring
and Control (IPAC) Policies and On-
an additional 27,000 frontline LTC workers, Site Practices, including Screening
although they only anticipated that they and Testing Procedures that are
Inclusive of Residents and Staff
would be able to increase the amount of
care being provided per resident per day
by 15 minutes by 2022. that May be Asymptomatic or Have
Atypical Presentations.
3. Ensure All Care Providers and
Strong Infection Prevention and Control
Visitors Have Access to and Are (IPAC) policies are necessary to protect
Wearing Appropriate Personal residents and staff in Canada’s LTC and
Protective Equipment congregate settings. Screening and testing
guidance for LTC needs to properly reflect
It is recommended that all care providers the emerging evidence of asymptomatic
and visitors in a LTC settings wear presentation of COVID-19, with a focus on
surgical masks and other appropriate the complications that arise with dementia.
protective equipment, given the high The CDC reports rates of asymptomatic
rates of community transmission, the presentations in upwards of 50% to 75% of
early asymptomatic spread that can occur residents who test positive for COVID-19
with COVID-19 between individuals, and a in these settings, 16,17, 18 along with similar
lower likelihood that older residents will rates of dementia that could further limit
display the typical signs and symptoms the ability of many residents to identify
of a COVID-19 infection. Wearing a mask and report symptoms. 19 As COVID-19
can particularly help to prevent or limit vaccination efforts are still underway, and
the early transmission of the virus from a growing number of cases and outbreaks
care providers to residents or to other care are being linked to new more contagious
providers. COVID-19 variants, there needs to be a
lower threshold than a typical symptomatic
The majority of provinces and territories
presentation to require testing for a
introduced mandatory masking for LTC
possible index case, or in the immediate
residents, staff and visitors in the Spring
testing of potential contacts related to an
2020. Both Saskatchewan and the North
index case. Moreover, as care providers
West Territories introduced mandatory
might enter a home being asymptomatic,
masking policies in December and
they should continuously self-monitor for
September 2020 respectively. Meanwhile,
any symptoms, while LTC home residents
Nunavut and the Yukon have not specified
should be screened twice daily.
masking requirements for its staff.
NIA Current Guidance Recommendations as of February 2021 12The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
Also, standard hygiene practices should and team responsible for coordinating
continue, including regular hand washing and implementing an IPAC program.
and physical distancing, where possible. However, there is no requirement for
the IPAC lead or staff to hold a full-time
Since the NIA’s July 2020 ‘Iron Ring’ position dedicated to performing IPAC
Guidance, a number of provinces have duties, to be on-site every day, or to have
either introduced or updated their IPAC formal IPAC training. Thus, despite calls
policies to better prevent and limit the for providing enhanced IPAC staffing from
spread of COVID-19 in LTC and other several Ontario LTC associations as well as
congregate settings. Every jurisdiction Ontario’s own Long-Term Care COVID-19
other than the Yukon now provides detailed Commission, 20 dedicated home-based IPAC
guidance on IPAC policies for LTC settings. specialists and teams who can provide
In addition, more than half of Canada’s continuous training and compliance
provinces (B.C., Alberta, Manitoba, New support remain not as readily available
Brunswick, Nova Scotia, and Ontario) across the province’s LTC homes.
now require testing for atypical or mild
presentations of COVID-19. On the other hand, in Quebec, every
CHSLD is now required to have an IPAC
Overall, however, there remain manager and trained IPAC staff on site
significant deficiencies in the provision who are responsible for ensuring IPAC best
of IPAC expertise and accountability for practices are complied with at all times.
maintaining IPAC standards across LTC Quebec’s Ministry of Health and Social
settings. Adherence to evidence-based Services released a directive outlining
IPAC measures depends on there being these guidelines in October 2020. 21
sufficient support for effective training Retirement homes in Quebec are also
and compliance monitoring. Yet, currently, subject to new IPAC guidelines, albeit ones
inadequate time and resources are often that are less strict. Every RPA in Quebec
devoted to IPAC measures in LTC homes. must have employees identified for IPAC
The NIA found only two provinces - purposes, but the guidelines only specify
Ontario and Quebec - with requirements that there must be either an IPAC Manager
for having designated IPAC staff in LTC or IPAC staff, rather than both like in the
settings. Moreover, Quebec appears to be case of its CHSLDs, and there is no mention
the only province that has taken additional of a requirement that they must be on-site.
steps after the first wave to ensure homes Quebec’s IPAC guidelines for retirement
are both proactively implementing IPAC homes were also issued later than those
measures and continuously monitoring for its LTC homes, with the Ministry
their compliance with proper protocols. releasing its directive in December 2020. 22
In Ontario, all LTC homes are required by
provincial legislation to have an IPAC lead
NIA Current Guidance Recommendations as of February 2021 13The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
5. Develop Supportive and Flexible 6. Consider Frequent LTC Staff and
Admission and Discharge Policies for Visitor Testing to Reduce the Risk
LTC Settings of COVID-19 Exposure Amongst LTC
Residents
In some regions, traditional admission and
discharge policies penalize residents and Sufficient and frequent testing for COVID-19
families who decline a placement offer is one of the most effective strategies for
or seek to return to a former care setting mitigating and controlling risk in LTC homes.
after a prolonged absence. Residents and Ensuring that individuals who frequently
families should be given the flexibility to come into contact with LTC home residents,
defer a placement offer, or leave and return both LTC staff and designated essential family
quickly to their care setting if they feel that caregivers are required to regularly test for
would be the best to support their overall COVID-19 greatly reduces the probability of
health and well-being. As the COVID-19 transmission of COVID-19 into LTC facilities.
pandemic required that in-person visits This not only helps to ensure the safety of
be prohibited for at least four months in care provided to residents, but also enables
some cases at the outset of the pandemic, improved resident well-being and health by
and with some families at home now more ensuring continuous care and family presence
able to provide for the care needs of their in LTC homes.
loved one, and the growing concern that
living in these care settings confers a higher Quebec has explicitly prohibited its LTC
risk of contracting COVID-19, more flexible and retirement homes from imposing
admission and discharge policies should requirements for presenting a negative
be implemented. Researchers at the NIA, COVID-19 test as a precondition for essential
the Ottawa Hospital, and the University of family caregivers to visit residents in these
Ottawa created guides for families to use homes.
to help determine if they can safely remove
a loved one from a home, and what they Ontario is the only province or territory
need to consider in order to provide care at specifying staff, visitor and family caregiver
home. The guides are accessible here. asymptomatic testing requirements. In
June 2020, Ontario announced that it
would introduce (non-mandatory) twice-
monthly asymptomatic testing for all LTC
staff. Essential workers, agency staff and
LTC inspectors were exempted from this
requirement.
NIA Current Guidance Recommendations as of February 2021 14The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
Furthermore, all visitors and family
7. Mandate De-Crowding Policies in
caregivers would need to present a
negative COVID-19 test result from within
LTC Setting to Limit the Number of
the preceding 14 days upon entry to an LTC Residents Per Room and Minimize the
home. In July, general visitors no longer Exposure and Spread of COVID-19
needed to present negative COVID-19
tests. However, mandatory testing was The de-crowding of LTC homes has
continued for all staff and residents, and also been recommended as a potential
is currently still in place but on a weekly mechanism to reduce the transmission
basis in orange, red and grey (lockdown) between LTC home residents, staff, and
regions. In January 2021, to enhance essential caregivers. In May 2020, the
its overall testing capacity, Ontario Science Advisory Table for COVID-19 in
announced that it plans to implement Ontario recommended that LTC homes
three times weekly antigen testing for its be de-crowded by disallowing three and
LTC staff and family caregivers beginning four person rooms, and only allowing two
in February 2021. This method aligns
23
residents in a shared room at a time. This
with recent federal government expert strategy would significantly reduce contact
guidance suggesting that more frequent among LTC residents, staff, caregivers, and
antigen testing in these settings may be a visitors, reducing the potential for COVID-19
better way to identify possible infections infection and spread. Ontario adopted this
early among staff. Many LTC homes are
24
recommendation, in June 2020, stating “at
raising concerns about the feasibility any time, there should not be more than
for them to implement this new testing two (2) residents placed per room, including
method when many indicate that it will 3 or 4 bed ward rooms”. 25 So far Ontario
require even more frontline staffing is the only province or territory that has
resources that they currently do not have formally adopted this recommendation.
to lead this level of on-site testing.
While other provinces are considering
asymptomatic testing strategies in their
LTC settings, the NIA remains of the view
that essential family caregivers should not
face more stringent testing requirements
than staff.
NIA Current Guidance Recommendations as of February 2021 15The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings
8. Prioritize LTC Residents, Staff, The NIA agrees that residents and
staff in LTC and retirement homes
and Essential Caregivers for should undoubtedly be prioritized for
Immunization Against COVID-19 early vaccination. COVID-19 has had a
Will Greatly Reduce Virus-Related devastating impact on Canada’s LTC and
Deaths. COVID-19 Immunization will
retirement homes, accounting for over
14,000 of Canada’s deaths reported since
greatly reduce the transmission and the onset of the pandemic.
deaths from the virus.
Residents in LTC and Retirement homes
The federal government has approved settings should be receiving initial vaccine
COVID-19 vaccines and negotiated doses as soon as they become available
agreements to secure vaccine doses for given that they are more susceptible
Canadians. The provincial and territorial to serious infection once exposed to
governments are responsible for deciding COVID-19, and the congregate nature of
who gets vaccinated and when. As of these settings facilitates rapid spread of
January 2021, each province and territory the virus.
has released a vaccine implementation
strategy. The National Advisory Committee Staff should also be prioritized to
on Immunization (NACI) released COVID-19 potentially lower their risk of inadvertently
vaccination prioritization guidelines as introducing COVID-19 into LTC homes and
early as November 2020 which outlined minimize the disproportionate burden
its suggested priority populations for faced by LTC staff who have become
vaccination. The guidelines include sick and died from COVID-19 during the
both LTC residents and staff, but do not pandemic.
specifically include family caregivers. The
majority of provinces and territories have Finally, while residents and staff in LTC
adopted the NACI recommendations, homes have been identified as a priority in
thus not including essential and family most provinces and territories, vaccination
caregivers of LTC residents in their ‘priority efforts could have been quicker in
populations’. However, five provinces; jurisdictions such as Ontario given the
British Columbia, Newfoundland, Nova slow speed of their vaccine rollouts thus
Scotia, Ontario and Prince Edward Island far. In other provinces, retirement home
do include essential/family caregivers in populations have not been given the same
their priority vaccination populations. All level of priority and will have to wait until
provinces/territories are trying to vaccinate the general population is invited to be
their defined long-term care populations vaccinated.
by February 2021.
NIA Current Guidance Recommendations as of February 2021 16The NIA’s Recommended ‘Titanium Ring’ for Protecting Older Canadians in Long-Term Care and Congregate Living Settings In addition to LTC and retirement home residents and staff, the NIA strongly supports that essential family caregivers are included as a priority population for COVID-19 vaccination. Family and essential caregivers provide critical support to residents of LTC homes, playing an important role in their overall health and well-being. Vaccinating essential family caregivers will not only help better balance resident safety and well-being, but may also reduce the enormous burden placed on LTC staff during the remainder pandemic. NIA Current Guidance Recommendations as of February 2021 17
Finding the Right Balance: An Evidence-Informed Guidance Document to Support the Re-Opening of Canadian
Long-Term Care Homes to Family Caregivers and Visitors during the COVID-19 Pandemic
First Wave vs. Second Wave: Where are We Now?
Throughout the pandemic, the NIA has This represents 7,470 deaths being added
been tracking the spread of COVID-19 in during the second wave thus far.
long-term homes across Canada. Our data
as presented in Table 1 below, show that Certain provinces dealt with a relatively
during the first wave between March 2020 minor number of outbreaks during
and August 2020, we saw 1,225 or 21% of the first wave, including Manitoba and
Canada’s 5,801 LTC and retirement homes Saskatchewan, due to their low rates of
experience outbreaks. We are now in the community transmission. From March
second wave, which is proving to be even to August 2020, 6 Manitoba and 4
deadlier than the first. As of February 15, Saskatchewan LTC and retirement homes
2021, 2,564 (44%) of Canada’s 5,801 LTC had experienced COVID-19 outbreaks,
and retirement homes have experienced respectively. As of February 15, 2021, 86
outbreaks. This represents 1,339 (23%) Manitoba and 100 Saskatchewan LTC and
new homes experiencing outbreaks during retirement homes have now experienced
the second wave between September outbreaks, representing a large increase in
2020 to February 15, 2021. While Table the number of outbreaks occurring in these
1, shows the first Wave vs second Wave provinces during their second wave.
data, Table 2 presents the cumulative
data on COVID-19 outbreaks, cases and On the other hand, 588 Quebec homes
deaths amongst residents and staff in LTC experienced outbreaks during the first wave
and retirement homes across Canada as from March to August 2020. But during its
of February 15, 2021. The increase in LTC second wave, it fared better relative to the
home related COVID-19 outbreaks, cases first wave with 451 additional outbreaks
and deaths during Canada’s second wave as of February 15, 2021 and fewer deaths
further emphasizes the importance of overall. Overall, Quebec, which had the
comprehensively implementing the NIA’s worst performance of any province during
‘Titanium Ring’ guidance. the first wave, has done far better than
provinces like Alberta, BC, Manitoba,
During the first wave between March and Ontario and Saskatchewan whose LTC and
August 2020, there were a total of 7,022 retirement homes experienced much worse
resident deaths, with a resident case outcomes during their second waves. In
fatality rate of approximately 38%. As of provinces such as Ontario, Alberta and BC,
February 15, 2021 there have been a total which were hit hard during the first wave,
14,492 deaths, with a resident case fatality the second wave of COVID-19 has again
rate of around 27%. had a devastating impact on its LTC and
First Wave vs. Second Wave: Where are We Now? 18Finding the Right Balance: An Evidence-Informed Guidance Document to Support the Re-Opening of Canadian Long-Term Care Homes to Family Caregivers and Visitors during the COVID-19 Pandemic retirement homes. From March to August 2020, 479 Ontario, 85 Alberta, and 46 BC LTC and retirement homes experienced outbreaks. As of February 15, 2021, 408 Ontario, 183 Alberta and 110 BC additional LTC and retirement homes have faced new COVID-19 outbreaks, where total deaths due to COVID-19 have also been higher in these jurisdictions than during their second waves. Finally, Newfoundland, Nova Scotia and PEI have stood out as provinces that have not experienced a single LTC outbreak during the second wave, especially Nova Scotia which had a devastating first wave that affected 13 of its LTC and retirement homes and led to 57 total resident deaths and 88% of that province’s deaths to date. First Wave vs. Second Wave: Where are We Now? 19
Table 1. The NIA’s Long-Term COVID-19 Tracker First Wave and Second Wave Data on LTC and Retirement Home Outbreaks as of February 15, 2021
Canadian Total Number Total Number of Homes Total Number of Residents Deaths Total Number of Resident Total Number of Staff
Total Number of Staff Cases
Jurisdiction of Homes Affected (Resident Case Fatality Rate %) Cases Deaths
First Second First Second First Second First Second
First Wave Second Wave*
Wave Wave* Wave Wave* Wave Wave* Wave Wave*
QC 2,215 588 451 4,613 (44%) 3,103 (23%) 10,493 13,535 7,850** Unknown** 8 4
ON 1,396 479 408 2,072 (31%) 2,225 (21%) 6,716 10,380 3,445 7,925 8 3
AB 350 85 183 153 (24%) 1,013 (14%) 641 7,057 503 2,037 0 4
BC 392 46 110 120 (34%) 567 (28%) 357 2,041 226 1,259 0 0
NS 134 13 0 57 (22%) 0 259 0 133 0 0 0
SK 402 4 96 2 (50%) 84 (21%) 4 402 4 230 0 0
MB 261 6 80 3 (50%) 465 (28%) 6 1,653 8 805 0 0
NL 125 1 0 0 0 1 0 0 0 0 0
NB 468 2 11 2 (13%) 13 (12%) 16 109 10 73 0 0
PEI 39 1 0 0 0 0 0 1 0 0 0
YT 5 0 0 0 0 0 0 0 0 0 0
NWT 9 0 0 0 0 0 0 0 0 0 0
NU 5 0 0 0 0 0 0 0 0 0 0
CANADA 5,801 1,225 1339 7,022 (38%) 7,470 (21%) 18,493 35,177 10,409** 14,101** 16 11
Disclaimer: This table was generated with raw data that has not undergone cleaning at this point. Any future analysis with this data may result in different conclusions or results.
* Second Wave began September 1, 2020 and was not concluded as of February 15, 2021
** Quebec’s staff case numbers are not readily reported and therefore what is presented are likely significant underestimates of their actual staff case counts. First wave
counts are estimated based on a recent report from INSPQ 26 and second wave counts are currently unavailable.
The NIA’s Long-Term COVID-19 Tracker First Wave and Second Wave Data on LTC and Retirement Home Outbreaks as of February 15, 2021 20Table 2. The NIA’s Long-Term Care COVID-19 Tracker Data* on LTC and Retirement Home Outbreaks as of February 15, 2021
Total % Staff + % Staff +
Total Total Total Total Resident
Total Total Number % of Total Resident Resident
Canadian Number Number of Number of Number Case
Number of Number of of LTC and Homes Number of Cases out Deaths out
Jurisdiction of Homes Resident Resident of Staff Fatality
Cases Deaths Retirement Affected Staff Cases of Total of Total
Affected Cases Deaths Deaths Rate %
Homes Cases Deaths
QC 278,187 10,246 2,215 1,039 47% 24,028 7,850** 12% 7,716 12 75% 32%
ON 290,965 6,679 1,396 887 64% 17,096 11,370 10% 4,297 11 65% 25%
AB 129,075 1,782 350 268 77% 7,698 2,540 8% 1,166 4 66% 15%
BC 72,750 1,288 392 156 40% 2,398 1,485 5% 687 0 53% 29%
NS 1,594 65 134 13 10% 259 133 25% 57 0 88% 22%
SK 26,693 354 402 100 25% 406 234 2% 86 0 24% 21%
MB 30,766 872 261 86 33% 1,659 813 8% 468 0 54% 28%
NL 704 4 125 1 1% 1 0Monitoring the Uptake of the NIA’s ‘Titanium Ring’ Guidance for LTC and Congregate Care Settings Across Canada
First Issued March 27, 2020 and Updated as of February 1, 2021 Legend:✔ = Implemented R = Recommended
Province/ Family and General Policies to Universal Appropriate LTC Staff/ Supportive Additional Vaccination Dates and link(s)
Territory Designated Visitor Enable Care Masking Infection Visitor Testing and Flexible Measures – Policies to guideline(s)/
Caregiver Policies Providers Policies Prevention Policies Admission with Initial directive(s) or
Policies from Working and Control and De-Crowding Prioritization for: source(s)
in Multiple (IPAC) Discharge Policies 1. LTC Home
Care Settings Policies Policies Residents
Enhanced
2. LTC Home Staff
On-Site Staffing Policies
Designated 3. Designated/
IPAC Staff Essential Family
Caregivers
April 8, 2020:
https://www.canada.ca/
en/public-health/services/
diseases/2019-novel-
coronavirus-infection/prevent-
control-covid-19-long-term-care-
homes.html#a
Federal R R R R R R
April 8, 2020 Not Specified April 8, 2020 April 8, 2020 April 8, 2020 January 27, 2021 Not Specified Not Specified November 3, 2020 January 27, 2021:
Guidelines https://www.canada.ca/en/
health-canada/services/
drugs-health-products/covid19-
industry/medical-devices/
testing-screening-advisory-
panel/reports-summaries/
priority-strategies.html
Monitoring the Uptake of the NIA’s ‘Titanium Ring’ Guidance for LTC and Congregate Care Settings Across Canada 22Alberta ✔ ✔ ✔ ✔ ✔ Not Specified ✔ ✔ March 20, 2020:
https://open.alberta.ca/
June 29, 2020 April 28, 2020 Announced Announced on Announced Announced December 2, 2020 dataset/96e5aad9-9981-
on April 10, April 10, 2020 April 28, 2020 April 28, 2020 4593-b015-74484f967a4e/
Alberta allows General Visitor 2020 All LTC staff and resource/1b1f9b7b-57fa-4f9f-
8256-ee223d5878fd/download/
LTC residents Ban is Lifted To be effective If there is a ✔ residents of LTC, health-cmoh-record-fof-
to designate To be as of April 15, new confirmed July 3, 2020 regardless of decision-cmoh-03-2020.pdf
one family November 25, effective as of 2020 outbreak, all age are to be
April 10, 2020:
support 2020 April 23, 2020 residents and People will vaccinated in https://open.alberta.ca/
person. ✔ staff must continue to PHASE 1A: January dataset/b0483d64-254e-
Access to ✔ July 3, 2020 be tested for move into 2021 4d55-895a-1c1d9127c906/
resource/76b47c6e-4ac9-
✔ outdoor visits July 3, 2020 COVID-19 and transfer 41e1-ad7b-244fe1e149ee/
Designated or download/health-cmoh-record-
November 25, permitted. between
Essential Family of-decision-cmoh-10-2020.
2020 Indoors When an ✔ facilities in pdf#page=4
Caregivers not
visits are outbreak is July 3, 2020 the usual included in initial April 28, 2020:
Each Resident determined confirmed, way. If the vaccination priority https://open.alberta.ca/
may designate by sites’ risk staff are Anyone site is under populations. dataset/63fd3100-c64c-
up to two tolerance. limited to entering the investigation, 492e-9be0-cf62d83ad10f/
resource/21817ec1-2daa-4d84-
designated working at site must be the operator 9171-c1132cb70963/download/
support single facility. screened should health-cmoh-record-of-
decision-cmoh-12-2020.pdf
workers December 14, each time consult with
who are 2020 they enter, AHS Zone April 28, 2020:
essential for including a) Medical https://open.alberta.ca/
dataset/1a2011e5-fc79-
maintaining General Visitor Temperature Officer of 43b4-aab0-1c276b16b99b/
the resident’s Ban is re- screening, and Health. resource/35ab8044-8c19-480a-
9799-ef4f9b95c376/download/
health and implemented. b) COVID-19 health-cmoh-record-of-
well-being. questionnaire decision-cmoh-14-2020.pdf
✔ July 3, 2020:
https://open.alberta.ca/
December 14, dataset/89b38756-f89b-4eef-
2020 b9a5-670be5927b20/resource/
d6023ca1-066a-4280-8e69-
4fa84a40c406/download/
Designated health-cmoh-record-of-decision-
support cmoh-27-2020.pdf#page=2
person may November 25, 2020:
continue https://www.
to visit LTC albertahealthservices.ca/assets/
healthinfo/ipc/hi-ipc-covid19-
residents infosht-visiting-pts-pandemic.
despite pdf
General Visitor
December 2, 2020:
Ban. https://www.alberta.ca/covid19-
vaccine.aspx
December 14, 2020:
https://www.
albertahealthservices.ca/topics/
Page17001.aspx
Monitoring the Uptake of the NIA’s ‘Titanium Ring’ Guidance for LTC and Congregate Care Settings Across Canada 23British Essential ✔ ✔ ✔ ✔ Not Specified ✔ ✔ ✔ March 17, 2020:
Original Source No Longer
Columbia and Family June 30, 2020 March 27, March 25, 2020 Testing if October 5, April 1, 2020 December 14, 2020 Available*
Caregivers 2020 exhibiting mild 2020
allowances per LTC Residents and atypical All workers will Residents, Staff, and March 27, 2020:
Essential Visitors https://www2.gov.bc.ca/assets/
resident are may visit with symptoms be paid the same gov/health/about-bc-s-health-
not specified one general ✔ wage as those to LTC will be in care-system/office-of-the-pro-
in British visitor at a time. Effective April 10, 2020 in collective the first groups vincial-health-officer/
Columbia. April 10, 2020 agreements with to get vaccinated reports-publications/covid-19-
pho-order-movement-health-
✔ the Public Health between December care-staff.pdf
October 5, Authority and February
March 25, 2020:
2020 https://www2.gov.bc.ca/assets/
gov/health/about-bc-s-health-
LTC and ✔ care-system/office-of-the-pro-
vincial-health-officer/covid-19/
Assisted September 9, ppe_allocation_framework_
Living facilities 2020 march_25_2020.pdf
advised to
April 1, 2020:
restrict visitors. Announced https://docs.google.com/doc-
they will hire ument/d/10P1EO7TRqT5nnuo-
Under these an addition p4AM3yQ-iMemW22IqORBImk-
cr3GA/edit?usp=sharing
new guidelines, 7,000 healthcare
residents are workers for LTC April 10, 2020:
allowed to visit homes http://www.bccdc.ca/Health-Pro-
fessionals-Site/Documents/
with one family BCCDC_PHL_Updated_nCoV_
member or Lab_Guidance.pdf
friend.
June 30, 2020:
http://www.bccdc.ca/Health-
Info-Site/Documents/COVID19_
. LongTermCareAssistedLiving.pdf
September 29, 2020:
https://www.cbc.ca/news/cana-
da/british-columbia/bc-fall-pan-
demic-plan-1.5717466
October 5, 2020:
http://www.bccdc.ca/health-pro-
fessionals/clinical-resources/
covid-19-care/clinical-care/
long-term-care-facilities-assist-
ed-livin
December 31, 2020:
https://www2.gov.bc.ca/gov/
content/safety/emergency-pre-
paredness-response-recovery/
covid-19-provincial-support/
vaccines
Monitoring the Uptake of the NIA’s ‘Titanium Ring’ Guidance for LTC and Congregate Care Settings Across Canada 24Manitoba ✔ ✔ ✔ ✔ ✔ Not Specified ✔ Dependent on ✔ March 17, 2020:
https://sharedhealthmb.ca/files/
June 22, 2020 June 22, 2020 Announced on Announced on Announced December 9, level of risk: December 23, 2020 covid-19-family-ltc.pdf
April 26, 2020 April 1, 2020 May 13, 2020 2020
Residents may Up to two Red/Orange: Long Term Care April 26, 2020:
designate a visitors may To be To be ✔ Asymptomatic May visit at any workers and LTC https://sharedhealthmb.ca/files/
residents to be covid-19-single-site-staffing-
reasonable visit residents implemented implemented December 9, admission/ time, buy only model-for-licensed-pchs.pdf
number of at a time. beginning by April 13, 2020 re-admissions one at a time if in vaccinated in
friends and May 1, 2020 2020 do not require residents’ room December and April 1, 2020:
family for visits. ✔ Expanded isolation after January. Original Source No Longer
Available*
November 27, testing arrival in the Yellow: May visit
Designated or Source updated May 7th, 2020:
✔ 2020 for those facility at any time, up to
Essential Family https://sharedhealthmb.ca/files/
November 27, exhibiting two in the same covid-19-provincial-ppe-require-
Caregivers not
2020 Residents may atypical Those room if social ments.pdf
included in initial
identify general symptoms admitted from is distancing vaccination priority May 13, 2020:
LTC residents visitors for community maintained. populations. https://sharedhealthmb.ca/files/
may have up to social reasons. should isolate covid-19-updated-testing-crite-
two designated in room for ria-may-13.pdf
family Visitor 14 days upon June 22, 2020:
caregivers. limitations arrival https://sharedhealthmb.ca/files/
are directly covid-19-pch-visitation-princi-
ples .pdf
related the
presence and November 27, 2020:
https://sharedhealthmb.ca/files/
transmission
covid-19-pch-visitation-princi-
of COVID-19 as ples.pdf
determined by
the Chief Public December 9, 2020:
https://sharedhealthmb.ca/files/
Health Officer covid-19-ipc-guidance-for-pch.
pdf
December 23, 2020:
https://news.gov.mb.ca/news/
index.html?item=50101&post-
ed=2020-12-23
Monitoring the Uptake of the NIA’s ‘Titanium Ring’ Guidance for LTC and Congregate Care Settings Across Canada 25New ✔ ✔ R ✔ ✔ Not Specified ✔ ✔ April 14, 2020:
https://www2.gnb.ca/content/
Brunswick August 28, June 5, 2020 Should avoid April 14, 2020 May 4, 2020 May 4, 2020 December 8, 2020 dam/gnb/Departments/h-s/pdf/
2020 working in LTCF-E.pdf
LTC facilities different In addition Stage 1 includes
vaccination of all May 4, 2020:
Residents may were closed facilities if to mild https://www2.gnb.ca/content/
have up to two to visitors possible symptoms, LTC residents and dam/gnb/Departments/h-s/pdf/
Designated except for DSPs are to look staff. covid-19_ltcf_guidance-e.pdf
Support and palliative April 14, 2020 for atypical June 4, 2020:
People (DSP). situations. symptoms Designated or https://www2.gnb.ca/content/
DSPs have no Outdoor visits Essential Family gnb/en/news/news_re-
Caregivers not lease.2020.06.0324.html
limitations on are permitted
included in initial
visitation. with physical August 28, 2020:
vaccination priority
distancing if https://www2.gnb.ca/content/
populations. gnb/en/news/news_re-
the facilities
lease.2020.08.0465.html
allow.
December 8, 2020:
✔ https://www2.gnb.ca/content/
gnb/en/corporate/promo/
August 28, covid-19/vaccine.html
2020
Any visitors
who are not:
palliative
resident
visitors,
designated
support
persons,
volunteers or
non-essential
service
providers,
these visitors
are subject to
a maximum
visitation
capacity of 20%
(e.g. 20% of
residents can
have visitation
per day).
Monitoring the Uptake of the NIA’s ‘Titanium Ring’ Guidance for LTC and Congregate Care Settings Across Canada 26Newfoundland ✔ ✔ ✔ Refers to PHAC Refers to PHAC Not Specified ✔ Up to two visitors ✔ March 23, 2020:
Original Source No Longer
and Labrador June 10, 2020 June 10, 2020 April 14, 2020 Guidelines Guidelines March 23, can attend at the Date Not Specified Available*
General 2020 same time.
Residents may Visitation Phase One includes April 14, 2020:
priority vaccination Original Source No Longer
assign one permitted. Residents can Available*
designated temporarily for all residents,
support ✔ move in with staff, and essential March 23, 2020:
person. July 13, 2020 family, but visitors. https://www.gov.nl.ca/
covid-19/files/Key-Messages-
will need to Personal-Care-Homes-
✔ Each resident continue to Community-Care-Homes-and-
COVID-19-03-23-2020.pdf
November 25, can designate pay their client https://www.gov.nl.ca/
2020 up to five contribution covid-19/files/Long-Term-Care-
visitors. Homes-Temporary-Discharges.
pdf
Residents may
continue to ✔ June 10, 2020:
assign one November 25, https://www.cbc.ca/news/
canada/newfoundland-
designated 2020 labrador/new-visitor-changes-
support mothers-birth-partners-
person. Continuation of hospital-1.5606167
five designated
July 13, 2020:
visitors. https://www.gov.nl.ca/
covid-19/ guidelines-for-
support-persondesignated-
✔
visitors/
December 11,
2020 November 25, 2020:
https://www.gov.nl.ca/
covid-19/guidelines-for-
General support-person-designated-
Visitation visitors/#Long-Term-Personal
suspended
(Alert Level 2). December 11, 2020:
https://www.gov.nl.ca/
covid-19/guidelines-for-
support-person-designated-
visitors/
Monitoring the Uptake of the NIA’s ‘Titanium Ring’ Guidance for LTC and Congregate Care Settings Across Canada 27Nova Scotia ✔ ✔ R ✔ ✔ Not Specified ✔ ✔ July 3, 2020:
https://novascotia.ca/coronavirus/
June 8, 2020 March 15, 2020 Public Health April 12, 2020 Testing for Nova Scotia’s December 8, 2020 docs/health-protection-act-order-
Residents may to determine atypical normal 30-day by-the-medical-officer-of-health.pdf
designate a General visits whether staff symptoms bed holding During the first March 15, 2020:
caregiver. banned. from facility policy is in three months, Nova https://novascotia.ca/news/
in outbreak April 11, 2020 place Scotia will focus on release/?id=20200610004
✔ ✔ can work in immunizing LTC April 12, 2020:
September 8, June 15, 2020 non-outbreak Effective Effective residents, staff and https://www.cbc.ca/news/canada/
nova-scotia/masks-now-mandatory-
2020 General facilities December 21, December 21, essential caregivers. for-workers-at-n-s-long-term-care-
homes-1.5530953
outdoor visits 2020 2020
Each resident permitted. April 17, 2020 April 11, 2020:
may assign two https://novascotia.ca/coronavirus/
docs/health-protection-act-order-
designated ✔ ✔ by-the-medical-officer-of-health.pdf
caregivers. September 22, December 21,
April 4, 2020:
Only one may 2020 2020 https://www.cbc.ca/news/canada/
visit at a time. nova-scotia/resident-removal-long-
term-care-1.5522052
Residents may Staff are
have offsite restricted to June 8th, 2020:
https://novascotia.ca/dhw/
day visits with one home if ccs/ documents/COVID-19-
family in their no outbreak Management-inLong-Term-Care-
Facilities-Directive.pdf
homes. has occurred,
June 10, 2020:
https://novascotia.ca/news/
✔ release/?id=20200610004
November 26,
June 15, 2020:
2020, https://novascotia.ca/news/
general visits release/?id=20200610004
cancelled September 8, 2020:
https://novascotia.ca/news/
se/?id=20200908003#:~:text=
Designated%20caregivers%20
can%20be%20family,resident%20
prior%20to%20COVID%2D19
September 22, 2020:
https://novascotia.ca/news/
release/?id=20200922004
December 8, 2020:
https://novascotia.ca/coronavirus/
docs/COVID-19-immunization-
plan-overview-poster-en.pdf” to
the sources.
December 14: 2020:
https://novascotia.ca/coronavirus/
docs/health-protection-act-order-
by-the-medical-officer-of-health.pdf
December 21, 2020:
https://novascotia.ca/dhw/
ccs/documents/COVID-19-
Management-in-Long-Term-Care-
Facilities-Directive.pdf
Monitoring the Uptake of the NIA’s ‘Titanium Ring’ Guidance for LTC and Congregate Care Settings Across Canada 28You can also read
