A word from Dr David Lussier MD, FRCPC

COVID‑19 has shaken society all across the world, including here in Québec. Our habits have changed, requiring a very fast adaptation to the new reality. The elderly face even harsher difficulties due to their increased risk of catching the novel coronavirus and dying from a severe case of the COVID‑19 disease. As such, major efforts have been required of seniors.

Living environments for the elderly and vulnerable members of society, which include long-term care centres (CHSLD), intermediate resources (RI-RTF) in the “Soutien à l’autonomie des personnes âgées” program (SAPA) [Support for seniors’ autonomy program] and private seniors’ residences (RPA), have all been hit hard by COVID-19. The government decided to prohibit visits to these environments in order to limit the spread of COVID-19.

During this period of time, informal and family caregivers and visitors were unable to visit their loved ones or provide their usual assistance, support and/or companionship. It was a troubling time marked by great stress, as much for caregivers as for residents in care facilities for elderly or vulnerable persons.

Provided they comply with specific conditions, informal caregivers can provide assistance or significant support to a person who is living in a facility. Informal caregivers who will be authorized to do so are those who provide support to a loved one on a regular basis, every day or several times a week, to meet their needs and contribute to their integrity and well-being.

Visitors, i.e., people who do not meet the criteria to be defined as informal caregivers, are now allowed in facilities but only in those without a COVID-19 outbreak.

The relaxation of these emergency measures is subject to complying with precautions meant to ensure the benefits of the services and avoid COVID‑19 spreading, commencing or restarting in these environments.

As always, following instructions is vital to ensuring the safety of all concerned.

Recognizing the contributions of informal and family caregivers

In environments where elderly and vulnerable members of society live, informal and family caregivers that provide assistance, significant support (including moral support) and comfort, play a role that is essential, as much for the resident as for the members of the care team and other staff.

Their role is even more vital during a time like the present. Their considerable contributions, experience and knowledge need to be recognized in the context of a partnering approach.

This is why now is the right time to welcome back informal caregivers who provide assistance and support to their loved ones.

What to expect

It is very possible that the facility you knew prior to the COVID‑19 pandemic has considerably changed since your last visit. Environments lodging people infected by COVID‑19 may have been divided into various zones: a “hot” or “red” zone for infected residents and a “cold” or “green” zone for the others. Some facilities also have “warm” or “yellow” zones for residents at risk of infection or who have returned from hospitalization. Precautions may differ by the zone where your resident is lodged.

Learn more about the containment zones in residences This hyperlink will open in a new window..

You will probably meet new members of the care team for the first time that may be overwhelmed and unable to be as forthcoming as what you are used to. 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 weeks.

Your loved one may also have changed and have reduced mobility and memory loss, especially if they were sick with COVID‑19. 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.

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 This hyperlink will open in a new window.. 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

Support provided by informal and family caregivers and the presence of visitors amid the COVID-19 pandemic has to ensure that everyone they contact is safe, in the knowledge that the support and visits come with many risks. An informal caregiver who has COVID-19 or a visitor could, without knowing it, 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 to the resident’s room if needed. Feel free to ask them about your questions or concerns.

The following hygiene and protective measures are mandatory:

Hand hygiene

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.

Hand washing with soap and water
Hand hygiene using a hydroalcoholic solution

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 This hyperlink will open in a new window. 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.

Dressing and undressing procedure for droplet/contact precautions with eye protection

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).

Informal caregivers who provide significant assistance and support and visitors

Informal caregivers who are authorized to visit CHSLDs, intermediate or family-type resources (SAPA program) or RPA, whether or not there is an outbreak in the facility, are informal caregivers who provide or would like to provide significant assistance and support to a loved one to meet their needs and contribute to their integrity and well-being. Assistance and support may include:

  • helping with meals;
  • supervising and being attentive to the person’s overall condition;
  • providing support with various daily or recreational activities;
  • assistance with walking;
  • providing moral support or comfort.

Significant support is support that is provided on a regular basis to meet a loved one’s needs and contribute to their integrity and well-being.

Visitors are only allowed in CHSLDs, intermediate or family-type resources (SAPA program) or private seniors’ homes without a COVID-19 outbreak. A visitor is anyone who wants to visit the person in the facility and who does not meet the criteria to be identified as an informal caregiver.

More than one informal caregiver or visitor may be authorized to provide support to the same person in a facility.

  • CHSLDs: a maximum of two people may visit or provide support to one person at a time, while respecting the 2-metre rule. This rule must be respected at all times, without exception in CHSLDs, especially if two residents live in the same room.
  • Intermediate or family-type resources (SAPA program) with 10 places or less: a maximum of 10 people from three different households for the entire facility may visit users, while maintaining a physical distance of 2 metres.
  • Intermediate resources with more than 10 places: a maximum of two people from a single household may visit a user, while maintaining a physical distance of 2 metres.
  • Private seniors’ homes: a maximum of 10 people from three different households may visit a user, while maintaining a physical distance of 2 metres.

By respecting the usual visiting arrangements and certain particularities of the facility, informal caregivers and visitors should be able to determine the duration, time and frequency of visits themselves. However, you may be given an arrival and departure time in order to minimize contact with other people.

If you go into a facility where there are people with COVID-19, there is a risk that you might catch it, despite all the precautions taken. If you are at risk because of your age or a medical condition, it may be best not to go.

A manager or designated person in CHSLDs, intermediate or family-type resources (SAPA program) and RPA 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

Informal caregivers who would like to provide assistance and visitors will have to carefully follow the instructions given by the Ministère de la Santé et des Services sociaux to keep themselves and other people safe.

Monitoring your symptoms

  • 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 (SAPA program) before your quarantine is over.
  • You must have recovered from COVID 19 before entering a CHSLD, RI‑RTF or RPA (SAPA program). In order to be considered to have recovered from COVID 19, you must meet all the following conditions:
    • 10 days have passed since your symptoms started.
    • 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
  • Self-monitoring of symptoms is mandatory. Do not enter a CHSLD, RI‑RTF or RPA (SAPA program) if any of the symptoms of COVID‑19 appear.
  • If you would like to get tested for COVID 19, you can ask the establishment to arrange for a test.

Other conditions

Upon entering a CHSLD, RI-RTF (SAPA program) or RPA, you will sign a register to facilitate research by public health staff on contacts in the event of a COVID-19 outbreak.

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 (SAPA program) 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-TF (SAPA program) 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 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 (SAPA program) 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.
  • Follow the instructions as to 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 more details, read the Information sheet for informal and family caregivers whose loved one is institutionalized - Coronavirus (COVID-19) This hyperlink will open in a new window..

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;
    • videos;
    • text messages;
    • social media;
    • apps (WhatsApp, Skype, etc.);
    • prerecorded voice messages or videos;
    • letters;
    • postcards;
    • 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.

Don’t hesitate to call a helpline if you have questions or for support to deal with your grief: