A word from Dr David Lussier MD, FRCPC
COVID‑19 has shaken the whole world, including our society. Our lifestyles have changed and we have all had to adapt very quickly to this new reality. The challenges have been even greater for older adults and people who are vulnerable, as they are more likely to have a severe illness and die if they become infected. The efforts these people have been asked to make have been and still are demanding.
As a result of the COVID‑19 pandemic, visitor guidelines have been issued in living and health care facilities for informal caregivers and visitors.
Thus, while taking the necessary measures to ensure the rigorous application of infection prevention and control (IPC) measures, living and health care facilities must allow visits by informal caregivers. Efforts to facilitate means of communication with relatives must also continue.
Among other things, these measures are designed to prevent the physical or psychological deconditioning of older adults and people who are vulnerable. Maintaining emotional and social ties is essential in the context we are living in.
An informal caregiver is someone who, on a continuous or occasional basis, provides support to a loved one who has a disability and with whom they share an emotional bond, whether or not they are close and immediate family. Support can take a variety of forms, such as providing assistance with activities of daily living, instrumental activities of daily living, care as well as a presence and moral or psychological support.
A visitor is anyone who wishes to visit the user who is not a close or immediate family member and who does not fall under the definition of an informal caregiver. This may be someone the person knows with whom they have contact from time to time that is not essential to their physical and psychological well-being. It may also be someone the person does not know.
Informal caregivers and visitors in living and health care facilities must also follow the IPC instructions put in place at all times, such as washing hands, observing physical distancing of 2 metres and wearing a surgical mask. Everyone’s safety is at stake. I invite you to consult all the resources on this page and hope you will be able to have a safe and enjoyable time with your loved ones.
Recognizing the contributions of informal and family caregivers
In a facility where older adults and vulnerable people live, an informal caregiver, like yourself, provides assistance with activities of daily living, instrumental activities of daily living and care, but also a presence and moral support and comfort.
You play an essential role, both for your loved one and for the health care team or staff.
Your role is even more important at a time like this. We acknowledge your considerable contribution, experience and knowledge. You are part of the partnership-based approach.
This is why you are welcome in the various living and health care facilities.
What to expect in a facility where there is an outbreak
Informal caregivers are allowed to visit facilities where there is an outbreak but must follow specific infection prevention and control instructions. Don't be surprised if changes have been made to the facility. Various zones have been established in facilities where people with COVID‑19 live. A "hot” or “red” zone includes people who are infected, while a "cold” or “green” zone includes those who are not infected or who have recovered. There is also a "warm” or “yellow” zone for people at risk of infection or who are returning from a hospital stay, for example. The precautions are different depending on the zone where the person being visited is located.
To learn more about these different zones, watch the capsule Containment zones in residences for seniors and vulnerable individuals in the context of COVID‑19 .
Health care team members may be overwhelmed and may not be able to be there for you as much as they usually are. Please remember that it isn’t due to lack of good will but stems from their heavy work load and the difficult conditions on the job in recent months.
If your loved one has COVID‑19, they may have changed, their mobility or memory may not be as good as they were. They may have lost a lot of weight or been moved to a different room, the latter necessitated to control the infection. It could even be the case that their personal effects were not transferred, especially if the change of room is only temporary. You can be sure, however, that facility staff members are doing everything they can to make it possible for your family member to live under optimal conditions in these particularly difficult times, and they will keep doing it.
Your first visit after a weeks-long separation and all the apprehension that came with it will certainly be rich in emotions. The visit, which may be comforting, could also be quite nerve-wracking.
If you have concerns, feel free to speak up. Info‑Aidant advisers are available to listen to you and refer you to programs and resources that are likely to improve your daily life. Call 1‑855‑852‑7784 or go to the Info‑Aidant website . Equally useful are the following web pages: Protecting your well-being in the COVID‑19 pandemic or Stress, anxiety and depression associated with the coronavirus COVID‑19 disease.
Making sure that everyone is safe
During the COVID‑19 pandemic, the presence of informal caregivers and visitors in the facility must be made safe for everyone. There are many risks associated with this support and with visits. An informal caregiver or visitor who has COVID‑19, without knowing it, can infect their family member or other people in the facility and facility staff. Extremely serious consequences for people in the facility may result.
As soon as you enter the care facility, you will be welcomed by an attendant who will provide instructions on current rules and accompany you if needed. Feel free to ask them about your questions or concerns.
The following hygiene and protective measures are mandatory:
The best way to prevent transmission of COVID-19 is to observe good hand hygiene and keep at a minimum physical distance of two metres from others. You need to wash your hands as soon as you enter the facility, several times during your visit and when you leave.
Personal Protective Equipment (PPE)
Wear a procedure mask as soon as you enter the CHSLD, RI-RTF or RPA and keep it on for the duration of your visit. Procedure masks can only be used once before being discarded prior to any subsequent visit.
PPE should be used appropriately, based on the resident’s condition.
- Full PPE that includes a gown, gloves and eye protection is required when visiting someone that either has COVID-19 or is in a unit that houses infected persons. The PPE must be removed before exiting the hot zone, except for the procedure mask.
- A procedure mask suffices for visits with uninfected residents with no COVID-19 symptoms.
Wear the procedure mask throughout your visit without ever touching it and remove it only when you leave.
Refer to How to put on a mask for instructions on the correct method.
When wearing full PPE (gown, gloves and eye protection), carefully follow the instructions for putting it on and removing it to avoid contamination, which you will receive when you enter. You may be supervised when putting on and taking off some types of personal protective equipment.
Content of the following sections: Recognizing the contributions of informal and family caregivers; What to expect; and Making sure that everyone is safe, was developed with the participation of Dr. David Lussier, Geriatrician at the Institut universitaire de gériatrie de Montréal (CIUSSS du Centre-Sud-de-l’Île-de-Montréal), Director of the Clinique de gestion de la douleur chronique (Institut universitaire de gériatrie de Montréal) and Associate Clinical Professor (Université de Montréal).
Instructions for informal caregivers and visitors in CHSLDs, adult RI-RTFs and RPAs
Access to the facility for informal caregivers and visitors varies depending on the alert level where the residential centre and long-term care centre (CHSLD), the intermediate or family-type resource (RI‑RTF) for adults or the private seniors' home (RPA) is located. The alert level, that is, 1 (green), 2 (yellow), 3 (orange) and 4 (red), for a given territory is established based on the recommendations of the public health authorities who regularly analyze the situation taking into account the epidemiological situation, the control of transmission and the capacity of the health care system.
To find out the alert level in force as well as the applicable interventions or measures, you can refer to the Map of COVID‑19 alert levels by region.
In addition to alert levels, additional measures are taken when there is an outbreak in a facility.
By following the usual visitor guidelines and any specific requirements in the facility, informal caregivers should generally be able to determine the length, time and frequency of visits to the facility themselves. In addition, while respecting the informal caregiver’s wishes, an arrival time may be allocated in order to minimize contact between informal caregivers and visitors. Sleeping over is allowed insofar as they are providing support to the person they are helping.
Specific procedures depending on the alert level in a CHSLD, an RI-RTF for adults or an RPA that does not have an outbreak
- In territories where the alert level is level 1 (green) or 2 (yellow), visits to CHSLDs, RI‑RTFs and RPAs that do not have an outbreak are allowed, provided visitors and informal caregivers comply with specific infection protection and control requirements. The number of people allowed varies depending on the facility in question.
- In territories where the alert level is level 3 (orange), visitors are not allowed in CHSLDs; only informal caregivers are allowed. However, visitors are allowed inside an RI‑RTF, a rental unit in an RPA or on the grounds outside these facilities, provided they comply with specific requirements. The number of people allowed varies depending on the facility in question.
- In territories where the alert level is level 4 (red), only informal caregivers are allowed in CHSLDs, RI‑RTFs and RPAs. Visitors are not allowed in CHSLDs, RI‑RTFs and RPAs at this alert level.
- Regardless of the type of facility, visitors and informal caregivers are allowed to visit people who are in palliative and end-of-life care.
Specific procedures in CHSLDs, RI-RTFs for adults or RPAs where there is an outbreak or that are in preventive isolation
- Informal caregivers may continue to visit the facility provided they comply with specific requirements.
- In the event of an outbreak (more than two cases reported in the facility) where the resident is in isolation or if they are in preventive isolation in a CHSLD, an RI or an RPA, visitors are not allowed, However, if the outbreak is localized, they may, under certain conditions, be allowed to visit units that are not affected with the authorization of the infection prevention and control (IPC) team.
- Regardless of the type of facility, visitors and informal caregivers are allowed to visit people who are in palliative and end-of-life care.
Dissatisfaction or disagreement regarding the interpretation and application of ministerial directives
A manager or designated person in CHSLDs, RI‑RTFs and RPAs will be able to answer your questions and respond to your concerns if you are not satisfied with how the ministerial directives are being interpreted and applied. Contact the facility to find out who the manager or designated person is. If you are still not satisfied, you will be asked to contact the service quality and complaints commissioner. We assure you that the entire procedure will be conducted with tact, sensitivity and impartiality.
Ministère de la Santé et des Services sociaux directives
Monitoring your symptoms
- At all times, self-monitoring of symptoms is mandatory. Do not enter a CHSLD, RI‑RTF or RPA if any of the symptoms of COVID‑19 appear.
- If you are under preventive quarantine (e.g., due to close contact with a case of COVID‑19), you are not allowed to enter any CHSLD, RI‑RTF or RPA before your quarantine is over.
- If you have received a positive COVID‑19 result, you will be allowed to visit a CHSLD, RI-RTF or RPA only when you are considered to have recovered. In order to be considered to have recovered from COVID‑19, you must meet all the following conditions:
- 10 days have passed since the onset of acute illness, 21 days if you were admitted to intensive care or 28 days if you are on corticosteroids or immunosuppressed, provided that you meet the clinical criteria already recommended for lifting isolation measures.
- You have not had a fever for at least 48 hours, without using fever medication.
- Your symptoms have improved for at least 24 hours, except for cough and loss of smell, which can last longer
- When you have recovered, you can, if you want, get tested so that you have a negative result before visiting a CHSLD, RI‑RTF, RPA or a unit in facilities where there are no confirmed COVID‑19 cases.
- You must be asymptomatic to visit a facility.
- If you would like to get tested for COVID‑19, you can ask the establishment to arrange for a test.
- A CHSLD, RI‑RTF or RPA may not, under any circumstances, require an informal caregiver to have a negative test to be allowed to visit the facility.
- Upon entering a CHSLD, RI‑RTF or RPA, you will sign a register to facilitate research by public health staff on contacts in the event of a COVID‑19 outbreak. The minimum amount of personal information needed to facilitate epidemiological surveys by public health authorities must be entered in the register (name, telephone number or email address, date and time of visit, place visited).
- You will visit only one person at a time. This is mandatory and no exceptions will be made in CHSLDs, especially when two residents share the same room. However, the directive may be adjusted in RPA and RI‑RTF facilities if two people in the same unit receive regular, significant support from the same informal caregiver.
- You must wear clean clothes when you go to the facility and change and wash your clothes when you get home (regular wash).
- Make sure you eat and drink well before visiting a loved one.
- Minimize travel outside your home to help prevent the virus from spreading.
- Do not bring clothes or other items from home such as purses, lunch bags, documents, etc. to a CHSLD, RI‑RTF or RPA. If you forget and bring them, you will be prevented from taking them back home as they will be required to remain in the facility.
Inside the facility:
- Only circulate to and from the loved one’s or resident’s room or unit.
- Avoid approaching other people who live in the facility, visitors, staff and informal caregivers at a distance of less than two metres.
- Do not enter CHSLD, RI‑RTF or RPA common areas.
- Do not enter equipment storerooms.
- Leave the room if a staff member asks you to when a medical procedure is about to take place, and only go back in when instructed to.
- Ask which bathrooms you can use and the health and safety precautions and instructions. For example, using bathrooms in a hot zone is not recommended for informal caregivers and visitors.
For more details, read the Information sheet for informal and family caregivers whose loved one is institutionalized - Coronavirus (COVID‑19) .
Stay connected from a distance
Physical distancing does not mean social isolation. To stay connected with your loved ones, we suggest that you use distance socializing strategies. Don’t minimize the positive effects of distance socializing, since continuing to socialize has a positive impact on your health and on the health of the person you are helping. Here are a few tips to help you feel closer to your loved ones despite physical distancing and visitor restrictions:
- Keep in touch and even increase communication with your loved ones. There are various ways you can do this:
- telephone calls;
- text messages;
- social media;
- apps (WhatsApp, Skype, etc.);
- prerecorded voice messages or videos;
- digital photos.
- Plan regular times to get in touch with your loved ones to create a reassuring routine.
- Find out which types of communication you and your loved ones like best and decide how often you will use them.
- Get creative and find original ways to distance socialize that you like (e.g., drawings, crafts, photo collages, distance reading, arranging a time to say hello from your balcony or the street, dinner for two by Skype).
- Get connected and see the lockdown as an opportunity to learn how to use the variety of technology options that are available more. Do not hesitate to ask family and friends for help.
Dealing with grief during the pandemic
While most people who have COVID‑19 recover on their own, in some cases, the disease can lead to the death of someone you care about. It is important for you to:
- know that losing a loved one is certainly one of the hardest things we may have to face in life;
- give yourself plenty of time to recover from the ordeal, since the healing process can take months, even years;
- be proactive about your recovery, since it will speed up the grieving process despite the challenge involved;
- ask for help from your family and friends, community organizations or the health and social services network without hesitation if you feel the need to talk to someone or if you feel overwhelmed by the situation.
The death of a loved one is a distressing event and the pandemic affects how we grieve. The following tools describe common reactions to grief and what you can do to cope and help yourself feel better.
- Bereavement during the pandemic (COVID‑19)
- Guide for Bereaved People During a Pandemic
Formations Montbourquette sur le deuil
Don’t hesitate to call a helpline if you have questions or for support to deal with your grief:
- Measures that apply to CHSLDs, RIs for seniors with 20 or more residents and RPAs (COVID-19)
- Questions and answers on caregivers
- Information sheet for informal and family caregivers whose loved one is institutionalized
- Preventing deconditioning in seniors during the pandemic
- Measures for families, informal and family caregivers, and visitors with a loved one in a residential care facility
Last update: November 3, 2020