Background
From the beginning of the pandemic, the long-term care industry was headed for trouble. Before Covid-19 came to Canada we saw outbreaks in nursing homes in the United States. It seemed inevitable we would fare the same here. And then, to make matters worse, family caregivers were locked out of homes. Of course, none of us understood much about the virus and major precautions were required. But locking family caregivers out meant residents would be neglected. It was the equivalent of terminating, and not replacing, a major part of the long-term care workforce. Because that is the reality: family caregivers are the unpaid backbone of our health care system. The current staffing models do not allow staff at the homes to do it all on their own.
Family caregivers feed their loved ones. They administer medication. They do laundry. They change diapers. They brush teeth. They advocate for residents - their loved ones and those who do not have regular visitors. They plan social and fundraising programs. They catch mistakes. They notify the government when something is not right. They hold homes accountable. Sometimes they face the ultimate consequence - getting banned from visiting because they advocated in a way the home disliked (with little recourse to challenge such decisions).
It was clear to virtually every family that removing family caregivers from the equation would result in major problems. We have fielded calls from several families whose loved one lost a significant amount of weight, and died (not from Covid-19), in the months following the lockdown. We have seen the military have to step in - and the horror they have found.
The importance of family caregivers to the health and safety of long-term care residents cannot be overstated. This is why it is important that at least some family caregivers be permitted to enter long-term care facilities throughout the pandemic (while adhering to safety protocols, of course).
New Policy
On October 7, 2020 the Ministry of Long-Term Care released a COVID-19 Visiting Policy (referred to herein as "the Policy"), to supplement existing laws and directives.
It is clear the Ministry of Long-Term Care is turning its attention to the important role of family caregivers in the long-term care environment, and striving to create greater consistency across homes.
The policy states that "Under Directive #3 [released in September], a home’s visitor policy must specify that the definition of "essential visitors" include "a person visiting a very ill or palliative resident." It is also stated that "a home’s visitor policy should specify that essential visitors include support workers and caregivers". (emphasis added).
So, who is considered a caregiver? According to the Policy:
A caregiver is a type of essential visitor who is designated by the resident and/or their substitute decision-maker and is visiting to provide direct care to the resident (e.g. supporting feeding, mobility, personal hygiene, cognitive stimulation, communication, meaningful connection, relational continuity and assistance in decision-making).
• Caregivers must be at least 18 years of age.
• A maximum of 2 caregivers may be designated per resident at a time. The designation should be made in writing to the home. Homes should have a procedure for documenting caregiver designations. The decision to designate an individual as a caregiver is entirely the remit of the resident and/or their substitute decision-maker and not the home.
• A resident and/or their substitute decision-maker may change a designation in response to a change in the:
o Resident’s care needs that is reflected in the plan of care.
o Availability of a designated caregiver, either temporary (e.g. illness) or permanent.
• Examples of caregivers include family members who provide meaningful connection, a privately hired caregiver, paid companions and translators.
Caregivers are distinguished from "general visitors". The Ministry of Long-Term Care stated in the Policy that if the home is experiencing an outbreak, only one caregiver per resident can visit at a time. The government has also stated that general visitors are not permitted when an area has been identified as having high community spread. Therefore, visitation by general visitors is likely to fluctuate as the pandemic progresses.
Visitors, including caregivers, are required to wear PPE. Homes are responsible for providing caregivers with PPE, while "general visitors" must bring their own.
In order to protect residents, homes are required to provide training to caregivers:
Prior to visiting any resident for the first time after this policy is released, the home should provide training to caregivers that addresses how to safely provide direct care, including putting on and taking off required PPE, and hand hygiene. The home should also provide retraining to caregivers, with the frequency of retraining indicated in the home's visitor policy.
One of the most important sentences in the Policy is that "homes may not require scheduling, or restrict the length or frequency, of visits by caregivers". This is quite useful guidance because certain tasks, such as spoon-feeding a person with dementia, can take a long time.
The Policy also states that homes are not required to supervise visits; however, it does not prohibit supervision. Where supervision does occur, the home must still respect the resident's right to speak privately with their visitor.
We are pleased to see the government actively take steps to consider how family caregivers can resume the important role they plan in keeping seniors as physically and mentally well as possible.
Photo by Karolina Grabowska from Pexels
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