Congregate Living Settings and COVID-19

• COVID-19 vaccination is one of the most effective public health measures to prevent severe illness and death due to COVID-19.
• Encourage all clients/residents, staff and visitors to get vaccinated against COVID-19 and to remain up-to-date with their vaccinations.
• Offer all new admissions who have not yet received a COVID-19 vaccine or are not up-to-date with booster dose(s) a complete series of COVID-19 vaccinations as soon as possible, and booster dose(s), when eligible.
• For more information, visit the Ministry of Health’s COVID-19 Vaccine Relevant Information and Planning Resources webpage.

• Both active and passive screening are important measures that can be utilized are to be in place to prevent those who may be infectious from entering the facility and/or spreading the infection within the congregate living setting (CLS).
• During passive screening those entering the CLS monitor their own health and may review screening questions themselves; there is no verification or attestation of screening (e.g. signage at entrances as a visual reminder to not enter if symptomatic).
• During active screening there is some form of attestation/confirmation of screening. This can be achieved through in-person or pre-arrival submission of online screening or in-person.
• At minimum, CLSs should utilize passive screening at entrances and throughout the setting, advising individuals of symptoms and provide next step actions if the staff, visitor or client is experiencing symptoms.
• Clients/residents must be assessed at least once daily to identify any new or worsening symptoms of COVID-19  if they have tested positive, have symptoms or are a close-contact
• A copy of a screening poster is available to download .
• Post signage throughout the CLS to encourage all persons in the CLS to wear their masks, perform hand hygiene, and follow practice respiratory etiquette and monitor for symptoms to practice layers of protection during respiratory season.

There are two types of visitors, essential and general.  

• Essential visitors provide support to the ongoing operation of a congregate living setting and/or are considered necessary to maintain the health, wellness and safety, or any applicable legal rights, of a congregate living client. Essential visitors are permitted to enter the facility even when clients are in self isolation and/or the facility is in an outbreak.
• General visitors comprise all other types of visitors who are not considered essential visitors as per above. They are not permitted to visit client(s) who are self-isolating and/or when the facility is in an outbreak.
• Prior to visiting any congregate living setting, contact them for additional site specific visitor information.

• It is recommended that a client who answers “yes” to any of the screening questions, be isolated from the general population of the facility. Implement additional IPAC precautions.
• Do not allow staff or a visitor that is showing symptoms of COVID-19 during screening or has not passed the screening for other reasons, entry into the CLS. Instructed them to self-isolate immediately and encourage COVID-19 PCR testing (as applicable).
• Do not allow staff or a visitor that is showing symptoms of COVID-19 during screening or has not passed the screening for other reasons, entry into the CLS. Instructed them to self-isolate immediately and encourage COVID-19 PCR testing (as applicable).
• Have options in place for individuals that fail screening that consider the type of visitor and the client’s circumstances (i.e., there may be instances where CLSs may need to consider permitting the entry of an individual who has failed active screening for compassionate and/or palliative reasons). Ensure that individual wears a well-fitted medical mask, maintains physical distance from other individuals, and performs hand hygiene.
• See the "Managing and Isolating Symptomatic Individuals" tab below for advice on how to manage and isolate clients who screen positive at intake or become unwell with COVID-19 symptoms while at the facility.  

• Medical masks are used to protect others by containing respiratory droplets of the wearer so that they do not spread to others. This is referred to as source control.
• It’s important to wear a medical mask properly. Ensure the mask covers the nose and the chin and fits well.  There are more than one type of mask that may provide a better fit.
• All staff and essential visitors should complete a personal risk assessment before every client interaction. Staff are required to wear a mask (along with other appropriate PPE) based on their personal risk assessment and in consideration of Occupational Health and Safety.
• Children younger than 2 years of age should not wear a mask.
• Staff may consider wearing a mask for source control when providing prolonged direct (< 2 metres and > 15 minutes) care indoors and outdoors, for clients at high risk of severe outcomes (e.g., immunocompromised). 
• See COVID-19 Guidance: Personal Protective Equipment (PPE) for Health Care Workers and Health Care Entities and Public Health Ontario’s COVID-19: Personal Protective Equipment and Non-Medical Masks in Congregate Living Settings for additional details.

• Personal Protective Equipment (PPE) is intended to protect the wearer and to minimize their risk of exposure to COVID-19 and other potential hazards. The effectiveness of PPE depends on using it correctly and consistently.
• Minimal requirements may be set out by facility policies and procedures and Occupational Health and Safety, however all staff should complete a Personal/Point of Care Risk Assessment (PCRA) before every client or client environmental interaction. 
• See the IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID‑19

• Hand hygiene continues to be the number one way to stop transmission of infectious disease, including respiratory viruses and COVID-19.  Continue to promote hand hygiene within your CLS with numerous educational material (i.e. posters, signage, emails, newsletters, huddles etc.)
• Instruct staff, volunteers and clients to wash their hands often, especially:
  • upon entering the facility
  • before and after using shared equipment
  • before  and after eating
  • before and after preparing food
  • before touching clean PPE
  • after removing or touching dirty PPE
  • before and after touching the face (including smoking)
• To promote frequent hand hygiene, ensure  hand washing and/or sanitizing stations are available and well stocked at multiple, prominent locations throughout the CLS, and includes locations such as entrances,  common areas and at elevators/stairwells. Staff or volunteers may also administer hand sanitizer to clients before/after meals or activities). 
•  Always remember gloves do NOT replace hand hygiene.  Hand hygiene is required prior to wearing gloves and always after removing dirty gloves.  Gloves should be worn for short periods of time and only for a  one specific task. 
• For printable posters on proper hand washing practices, visit the Hand Hygiene page under Additional Resources.

• Increase environmental cleaning and disinfection especially in high use/common areas and for high touch surfaces (e.g. doorknobs, light switches, phones). Clean and disinfect frequently touched surfaces at regularly scheduled intervals (e.g., at least once daily) and when visibly dirty.  For more information and guidance on environmental cleaning, please refer to PHO’s Fact Sheet on Cleaning and Disinfection for Public Settings.
• During an outbreak, clean and disinfect common areas and high-touch surfaces at more frequent intervals (e.g., at least twice daily).
• Cleaning should also be extended to the exterior of the facility if there is a concern that clients may come into contact with high-touch surfaces outside the building. Clear away cigarette butts and debris regularly.

• Encourage all individuals to avoid the 3 C’s where COVID-19 can spread more easily:
  • Avoid crowded places with many people nearby;
  • Avoid close-contact settings; and
  • Avoid confined and enclosed spaces with poor ventilation.
• Whenever possible, make use of outdoor or larger well-ventilated spaces where people can maintain a 2 metre (6 feet) distance from each other.
• Where common spaces are used, consider how to increase physical distancing in that space (e.g. staggering start/end times, decreasing room capacity, placing furnishings further apart).
• Activities/programming that require close contact should be discontinued.

Ventilation with fresh air and filtration can improve indoor air quality and are layers of protection in a comprehensive COVID-19 strategy.

• Encourage outdoor activities over indoor activities where possible.
• Ventilate indoor spaces through a combination of strategies: natural ventilation (e.g., by opening windows), local exhaust fans, or centrally by a heating, ventilation, and air conditioning (HVAC) system.
• If using portable fans and portable air conditioning units place the fan at bed level or higher and never place the portable fan on the floor. Portable fans can disperse dust particles and microorganisms, change the airflow pattern, and potentially increase the dispersion of aerosols.
• Regularly inspect and maintain HVAC, air filtration units, humidifiers and de-humidifier systems to ensure proper functioning.

Staff and Volunteers

• Follow guidance and any relevant workplace guidance on return to work protocols.   Staff and volunteers who screen positive or develop symptoms while at work must immediately don a medical mask, use hand sanitizer, inform their supervisor and go home immediately to self-isolate and follow the direction provided by the employer and/or the guidance found on Ontario's website Protection from COVID‑19 and other respiratory illnesses.
• If testing is advised, contact the nearest Assessment Centre or Health811 by dialing “811” (previously know as Health Connect Ontario, which replaced Telehealth Ontario) 
• If staff or volunteers cannot leave immediately, they must be isolated in a specific designated space away from others, until they are able to leave.

Clients/ Residents

• Put in place procedures for how clients who screen positive will be safely isolated either at the facility or at an alternate location and make arrangements for transportation (if needed), clinical assessment and testing.
• Positive clients within the setting should follow the most recent guidance
  • At least 5 days after the onset of symptoms or date of test (whichever is applicable/earlier), and until the case has no fever and symptoms are improving for 24 hours (48 hours for gastrointestinal symptoms. When outside the setting: follow community guidance.
  • For a total of 10 days after date of testing or symptom onset (whichever is earlier/applicable): Wear a well-fitted mask, if tolerated, and physically distance from others as much as possible while in the setting
• If close contact is required, staff should wear appropriate personal protective equipment. See Public Health Ontario recommendations on the use of personal protective equipment when caring for individuals with suspected or confirmed COVID-19. 
• Designate areas of the facility for cohorting well and unwell clients. See Cohorting in Outbreaks in Congregate Living Settings (February 2022) from Public Health Ontario.

• Have an outbreak management plan in place for detecting and managing a potential COVID-19 outbreak in your facility.
• Visit TBDHU's Outbreak Management webpage for more information
• CLS can utilize PHOs checklist when navigating an outbreak.
• Outbreaks are declared by the local medical officer of health, or their designate while working with your facility.
• Contact TBDHU as soon as you suspect an outbreak. Guidance will be provided. Once an outbreak has been declared, TBDHU will provide direction to help manage the outbreak.

• COVID-19 Guidance: Congregate Living for Vulnerable Populations - Government of Ontario, Ministry of Health
• Cohorting in Outbreaks in Congregate Living Settings - Public Health Ontario
• Planning for Respiratory Virus Outbreaks in Congregate Living Settings - Public Health Ontario
• Personal Protective Equipment (PPE) and Non-Medical Masks in Congregate Living Settings - Public Health Ontario
• COVID-19 Preparedness and Prevention in Congregate Living Settings - Public Health Ontario
• Managing COVID-19 Outbreaks in Congregate Living Settings - Public Health Ontario
• COVID-19 IPAC Fundamentals Training - Public Health Ontario
• NEW Respiratory Season Posters for Shelters
• NEW COVID-19 Letter to provide clients that access shelters and transitional housing