As of September 9, the Ontario government is allowing up to two “essential” caregivers to visit each resident of a long-term care home. The government describes this step as a clarification of the rules that it established in March, which prohibited visitors other than these caregivers. The details of the current rules are as follows:
- An “essential” caregiver is a person who provides direct care to a resident who is seriously ill or requires end-of-life care. Examples of direct care include “helping with feeding, mobility, hygiene, or cognitive stimulation”.
- A resident, or a resident’s substitute decision-maker, may designate up to two essential caregivers. These caregivers can be family members, friends, hired caregivers, or translators.
- A designated caregiver is permitted to visit the resident at any time, and with no time limit, even when the home is experiencing a COVID-19 outbreak, subject to direction from the local public health unit.
- Both caregivers are permitted visit together if the home is not experiencing an outbreak, and the resident in question is not self-isolating or symptomatic. If the home is experiencing an outbreak, or the resident is self-isolating or symptomatic, then only one caregiver may visit at a time.
- All visitors should be screened before entering a home, and must wear appropriate protective equipment while inside.
- Long-term care homes previously had discretion in allowing essential caregivers to visit, and some chose not to implement the government’s recommendation that the visits be allowed. The government has now stated that the above points represent a uniform standard to be applied across Ontario.
- Homes retain some discretion on the scheduling of visits, as long as a resident is allowed at least one visit, of at least 30 minutes, per week. The 30 minutes do not begin until the resident and visitor[s] are seated in the visiting area.
In addition, the government has recently permitted residents of long-term care homes to leave for temporary absences, including day trips and overnight departures. For day trips, residents must be provided with medical masks to be worn at all times “if tolerated,” and must be screened when they return. They are not required to self-isolate or be tested for the COVID-19 virus.
Overnight absences are left to the discretion of the homes, which must evaluate requests on a case-by-case basis, and provide written reasons when they deny requests. Residents who return from overnight absences are required to self-isolate for 14 days. The home’s ability to help the resident self-isolate is a valid “safety factor” for a home to consider when evaluating an overnight absence request.
It is well-established that people other than long-term care workers are often important to a resident’s care. Supportive family members and other people often provide direct care in various areas, including the examples listed by the government. Their relationships with a resident can grant them a valuable perspective on the resident’s needs, and they have filled gaps left by understaffing in some homes – one of the various problems with the long-term care system that have been exposed by the pandemic.
But the government’s statements go further, and recognize the importance of access to others in the emotional well-being of long-term care residents. Research has long indicated that isolation is dangerous to the mental health of vulnerable seniors, and that regular access to supportive family members and friends is itself an important component of care. The dangers of isolation existed before the pandemic, but have been exacerbated by the restrictions that have come with it.
Access between vulnerable seniors and their support systems is also important in many areas of elder law. For example, an attorney acting under a power of attorney is required to consult with the incapable grantor, and determine the grantor’s wishes to extent that they can. Such consultation is much more difficult when face-to-face interaction is not available. Isolation from support systems can also expose vulnerable seniors to greater risk of financial exploitation and other forms of elder abuse. Substitute decision-making, elder abuse, and other critical seniors’ issues are discussed in much more depth in WEL Partners’ recent book on elder law, available at: https://welpartners.com/resources/WEL-on-elder-law.pdf.
As the government works to balance the care needs of seniors against the importance of preventing yet more COVID-19 outbreaks in the long-term care system, we can expect the rules to continue to adapt to changing circumstances over time.