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Long-Term Care Homes and ‘Directive 3’ ~ A Hopeful Sign for Caregivers & Families

Posted: February 10, 2021

(February 9, 2021)

By: Lynne Brown, SaultOnline

Natalie Mehra (top left) is Ontario Health Coalition Executive Director. OHC has been holding zoom meetings with families, caregivers, health professionals and more since the outset of the pandemic. Long-Term Care has been a priority for OHC advocacy. (source: OHC on twitter)

The COVID-19 pandemic continues to be top-of-mind for Ontario citizens, health-care professionals, politicians, and each and every family member/caregiver with a loved one living in one of Ontario’s long-term care homes. With ever-evolving strains becoming of grave concern, especially as it relates to our elderly population, families and caregivers are awaiting an opportunity to go into a long-term care home to support the critical work of PSW’s, nurses and front-line staff. Since the outset of the pandemic, volunteers who provide an enhanced quality of life for residents in long-term care have been unable to offer programming, including music sing-a-longs and more. The reasons are obvious, however it doesn’t change the fact that residents living in LTC have been missing out on events that provide meaningful experiences for them. They have also been missing the daily contact they have with their loved ones, friends and family. Many families make daily visits to an LTC home where their loved one is living.

The Ontario Health Coalition is calling on the Ontario government to stop for-profit long-term care chain companies from banning essential caregivers. The Ontario Health Coalition (OHC) is reporting that they have been hearing from family members of loved ones in long-term care homes who are being stopped from getting into the homes to provide support and care for their loved ones. This is happening in a range of long-term care homes across Ontario, and the Coalition is hearing it much more frequently from families with loved ones in for-profit homes. The Ontario Health Coalition cited ‘one particularly egregious example, Jarlette, a for-profit chain with 14 long-term care homes across the province, has suspended all access for essential caregivers except for compassionate and end-of-life care.’

According to ‘Directive 3’, LTC homes can set policies to provide better protection and PPE to essential caregivers to allow them to safely provide care for their loved ones.

Under Directive #3 Ontario’s Chief Medical Officer of Health, Dr. David Williams, has issued directions regarding visitors/essential caregivers. All LTC homes have to have a policy that is compliant with the Directive.This directive will be effective as of January 8, 2021. This directive updates and replaces the previous version of this directive dated November 23, 2020.

‘This Minister’s directive is issued pursuant to s. 174.1 of the Long-Term Care Homes Act, 2007 (Act), which authorizes the Minister of Long-Term Care to issue operational or policy directives respecting long-term care homes where the Minister considers it in the public interest to do so. Every licensee shall carry out every operational or policy directive that applies to the long-term care home. This directive relates to surveillance testing and access to long-term care homes that are not experiencing an outbreak of COVID-19. Additional measures apply in an outbreak situation, including measures as per local public health direction and measures contained in directive #3 for long-term care homes issued by the Chief Medical Officer of Health.’

Under Directive #3, a home’s visitor policy must specify that essential visitors be defined as including a person performing essential support services (e.g., food delivery, inspector, maintenance, or health care services (e.g., phlebotomy) or a person visiting a very ill or palliative resident.

There are a total of 626 long-term care homes in Ontario. According to The Ontario Government’s COVID-19 data, Long-term care homes, from April 24, 2020 to Feb. 8, 2021, account for 21,234 COVID positive cases in long-term care homes.


Public Health Ontario data from January 15, 2020 to June 1, 2020 states that there were 5,158 confirmed cases of COVID-19 in LTCH residents.There were 1,465 deaths reported in that same time-frame with 308 LTC homes listed as having experienced COVID-19 outbreaks.

The Minister of LTC’s COVID-19 Visiting Policy, December 26, is to assist LTC homes with implementing Directive #3. In it, it is clear that essential caregivers are designated by the resident or their substitute decision-maker. Each resident can have up to two essential caregivers. In areas of high COVID prevalence or in homes with COVID-19 outbreaks, the homes can limit essential caregivers to one at a time. Essential caregivers must follow the homes’ policies for infection control and safety, including testing, PPE and training. But LTC homes cannot simply ban all essential caregivers. (Note: Visitors, who are not essential caregivers, can be stopped in homes in outbreak or in areas with high COVID prevalence.)

‘The Minister of Long-Term Care’s Directive: COVID-19: Long-Term Care Home Surveillance Testing and Access to Homes (Minister’s Directive) establishes requirements for long-term care homes pertaining to testing of certain visitors. This COVID-19 Visiting Policy (policy) is provided to support homes in implementing the requirements in Directive #3 and the Minister’s Directive to safely receive visitors while protecting residents, staff and visitors from the risk of COVID-19.’

“At this difficult time, it is more important than ever that residents have access to essential caregivers for assistance and support,” said Jane Meadus LL.B Laywer and Institutional Advocate at the Advocacy Centre for the Elderly. “Under the Resident’s Bill of Rights in the LTC Homes Act it is unlawful for homes to interfere with this right.”

For clarity, in addition to the Directive #3 requirement, an LTC home visitor policy should also specify that essential visitors include support workers and caregivers as defined in the policy. However, an essential visitor does not need to be a support worker or caregiver, as long as they meet the definition under Directive #3.

At a ‘Science Media Centre’ briefing on 25 January,2021, Peter Horby, Professor of emerging infectious diseases at the University of Oxford (UK) and chair of NERVTAG (New and Emerging Respiratory Virus Threats Advisory Group) said, “What the analysis so far shows is that the rates of death when you link community testing to death is higher in those with the B.1.1.7 variant than matched people with the other virus variant.” a more highly transmissible variant of SARS-CoV-2. In Ontario, as of Feb.7, 2021, there are 174 confirmed cases of the B117 variant (UK) and 1 confirmed case of the B1351 variant (S. Africa).

Closer to home here in Algoma, the UK COVID-19 variant B.1.1.7 has been confirmed in the Simcoe Muskoka District Health Unit (SMDH), As of January 26, 2021, 106 individuals have had a positive test for the UK variant.

“While we understand the fear of the spread of the U.K. variant, the fact is that long-term care homes can set a policy of requiring and providing a stronger level of protection and PPE for essential caregivers,” said Natalie Mehra, Executive Director of the Ontario Health Coalition. “We all know the suffering and death of residents resulting from isolation and inadequate care. Locking out all essential caregivers is not a solution; it causes harm, and in some cases, irreparable harm. The Ford government must intervene.”

“The Elizabeth Centre Friends and Family Council sent a letter to Jarlette Health Services regarding the order to suspend all essential family caregivers, stating that we are concerned with it because of the effect it will have on the emotional well-being of our loved ones,” said Roma Smith, Chair of the Elizabeth Centre Friends and Family Council and member of the Ontario Health Coalition Long-Term Care Committee. During the first wave of this pandemic we saw the negative impact of social isolation on our loved ones. We asked Jarlette to reconsider their decision.”

The OHC in partnership with lawyers from the Advocacy Centre for the Elderly held a video briefing and has provided all the resources for families with questions about access to their loved ones in long-term care. It is available here.

Since January 15, 2020, there has been a total of 280,494 cases of COVID-19 cases confirmed in the province of Ontario, and 6,555 deaths. In Canada, a total of  people have died from COVID-19. Last updated Feb.9, 2021.

Superior Media has reached out to LTC homes in our region and will share updates with our readers in the coming days.

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