Excerpt from Pages 6 – 9,
Infection Prevention and Control Requirements for COVID-19 in Long Term Care and Seniors Assisted Living
BC Centre for Disease Control | Ministry of Health, British Columbia
Updated June 30, 2020
Health authorities and facility operators shall continue to support visitors for essential visits and allow family/social visits within established criteria, supported by a detailed plan and process as outlined below. The Ministry of Health acknowledges the need to support operators to ensure safe visitation with adequate staffing.
A written plan must be developed in accordance with the practice requirements. The plan must be available for Licensing or the Assisted Living Registry if requested. A visitor list, with contact information, will be maintained as per BC CDC IPC COVID-19 Guidance for LTC and Seniors AL.
Essential visits include:
- Visits for compassionate care, including critical illness, palliative care, hospice care, end of life, and Medical Assistance in Dying;
- Visits paramount to the patient/client’s physical care and mental well-being, including as follows:
- Assistance with feeding;
- Assistance with mobility;
- Assistance with personal care;
- Communication assistance for persons with hearing, visual, speech, cognitive, intellectual or memory impairments;
- Assistance by designated representatives for persons with disabilities, including provision of emotional support;
- Visits for supported decision making; and
- Police, correctional officers and peace officers accompanying a patient/client for security reasons.
Essential visits shall be limited to one visitor per patient/client within the facility at a time (except in the case of palliative/end of life care). A visitor who is a child may be accompanied by one parent, guardian or family member.
Health Authority or Facility staff will determine if a visit is essential.
Family and visitors can request an immediate review of the decision and shall be provided the ability to speak with an administrator or administrator on call; or a formal review of a decision through the health authority Patient Care Quality Office (PCQO).
As part of their ongoing efforts to keep residents safe, operators will complete an initial and then monthly review of their current practices to ensure for themselves, residents, and families that there is full compliance against the current practice requirements set out below. Any gaps identified should be addressed.
As part of implementing additional measures to allow family/social visits, operators will engage with residents, their families, and care providers on both the current status of IPC practice in the home and the proposed next steps that will now include processes for visitors. There will be ongoing engagement to ensure residents and families understand the individual and collective risks and their collective accountability and commitment to adhere to agreed guidelines to minimize those risks for both residents and visitors who may be older and/or have underlying health conditions. This engagement will strive to ensure an ongoing shared approach to establishing and then maintaining the challenging balance of safety and quality of life that will require the continued collaboration and mutual accountability of residents, families and their care givers through the coming 12 plus months.
These practice requirements are intended to support residents, families, staff, administrators and managers, boards or owners of LTC homes and Seniors AL residences to provide the opportunity for social visits and to provide guidance about how they can collectively work together to minimize the risk of COIVD-19 transmission in these facilities.
These practice requirements may be updated as required with renewed direction from the Ministry of Health and Provincial Health Officer. This document replaces earlier infection prevention and control guidance that was set out in the following documents:
- Infection Prevention and Control Novel Coronavirus (COVID-19): Interim Guidance for Long-Term Care and Seniors Assisted Living (BC CDC IPC COVID-19 Guidance for LTC and Seniors AL, May 19,2020).
- Infection Prevention and Control Novel Coronavirus (COVID-19): policy communique providing updated guidance for essential visits (Ministry of Health May 12,2020)
Family/social visits are intended to support the emotional well-being of clients/residents and are limited to a
designated visitor per client and must be booked in advance according to the practice requirements below.
The shared approach to establishing and maintaining the balance of benefits and risks will be informed by the following core practices:
1.Social visits will only be allowed if there is no active COVID-19 outbreak at the care home/residence and will cease immediately if an outbreak is declared, and the facility goes into active outbreak management. Visits will resume immediately when the outbreak is declared over with lessons learned applied to ongoing practice.
2.Social visits will be scheduled in advance between the visitor and facility. The number of visitors within a visiting group should be limited to effectively support physical distancing practices while supporting meaningful social connection with the resident. As part of the engagement the facility will establish a family friendly process for scheduling and facilitating visits.
3.Care homes/residences will safely provide the location(s) for visits as soon as possible. Residents will meet their visitors in the designated location(s). The location(s) of social visits occurring at LTC home or seniors AL residence should be introduced as soon as possible but once the preparation at a site level is completed. The three key locations are as follows:
- Outdoor location(s) dedicated to visiting (seasonally when the weather permits)
- Indoor designated location(s) (summer and especially fall/winter)
- Individual single-client room (focused on limited mobility of an individual resident)
4.If individuals residing in multi-bed rooms are unable to attend in the settings outlined above, appropriate visitation requires careful consideration. Visitation in multi-bed rooms would be an exceptional circumstance based on, and taking into consideration, the needs and requirements of everyone in the shared room. This circumstance requires careful planning and facilitation with the care team, families and residents.
5. Visitors should receive advance guidance on the process and guidelines for social visits. Operators will identify details about the location(s) and processes for visiting on their websites, inform residents and families in writing/by email. For outside and designated facility visits, operators will ensure adequate signage and mark suitable locations as required to help families and residents to have a safe and successful visit.
7. Visitors shall be instructed when to perform hand hygiene, respiratory etiquette and safe physical distancing. All visitors are required to bring and wear a mask. When visiting with a client on ‘Droplet & Contact Precautions’ all visitors shall be instructed on how to put on and remove any required PPE. If the visitor is unable to adhere to appropriate precautions, the visitor shall be excluded from visiting.
8. Care homes/residences must be able to safely provide oversight for these visits, including adequate staffing to provide pre-screening, screening on arrival, providing information on IPC for the visit, monitoring the visit, monitoring leaving of the residence. Visitors shall go directly to the patient/client they are visiting and exit the facility directly after their visit.
9. Any furniture and surfaces in the visit area will be sanitized as per BC CDC IPC COVID-19 Guidance for LTC and Seniors AL at the end of each visit. Time should be allowed for sanitizing visitor areas and supporting residents to move to and from the visiting area between visits.
Social Activities & Outside Appointments
LONG-TERM CARE FACILITIES:
- Residents are advised to limit their external activities and outside appointments to essential only (i.e., medically necessary).
- If clients must leave the facility for medically necessary care or treatment (e.g., hemodialysis treatment):
- Call the medical facility and the transportation service (e.g., HandyDART, taxi or SNT hospital transfer service) ahead of the appointment to discuss necessary precautions.
- Clients with confirmed or suspected COVID-19 who need urgent medical attention should wear a surgical or procedure mask when leaving their room or space. Droplet and contact precautions must be maintained during client transport. See Client Transfer of this document for further information.
- Clients returning from an outpatient medical appointment (e.g., hemodialysis and cancer treatment) do not require 14-day isolation upon arrival at the facility. Staff must complete a PCRA to assess the risk posed by returning clients and determine appropriate control measures. See Point of Care Risk Assessment for more information.
- When possible, clean mobility aids, such as wheelchairs, canes and walkers before exiting the client’s room/space and upon returning from the appointment.
ASSISTED LIVING RESIDENCES
- Assisted Living clients can engage in social and external activities that are aligned with general public health guidance.
- Current information suggests that older people with chronic health conditions are at higher risk of developing more severe illness or complications and should take the measures to protect themselves including avoiding large gatherings and stay away from other people who are ill. They should maintain safe physical distance at all times and wear a non-medical mask when in enclosed spaces such as transit or stores where safe physical distances cannot be maintained.
Hairdressing and Other Personal Services
All service providers must follow the WorkSafeBC protocols for personal services returning to operation, including mask use for both service providers and clients, excellent hand hygiene and the cancellation of services if the service provider or client has symptoms. Additionally, all operators or facilities are asked to retain a list of every resident who has received services and when these services are provided.
Hairdressers and other personal services providers working onsite will develop and submit safety plans to the director of the facility, who will confirm the feasibility of the plan and work to determine the starting date. These plans will need to follow the guidelines within this document and should be posted in the service area prior to services being resumed.