COVID-19: Congregate Living Settings

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 are to be in place to prevent those who may be infectious from spreading the infection within the 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 pre-arrival submission of online screening or in-person.
  • For staff and volunteers, active screening may be done through completing and submitting an online screening tool prior to the start of a shift without the need for interaction with an in-person screener for confirmation, unless asked/requested by the CLS or advised by the PHU.
  • For visitor, an established process for conducting active screening for COVID-19 symptoms and exposures for visitors entering the home must be in place.  CLSs may incorporate options for how active screening will be conducted (e.g., prearrival submission of online screening or in person on arrival) and it should be clearly communicated to those entering the CLS. CLSs may use mobile apps or other tools to facilitate the active screening process.
  • For clients/residents being admitted, transferred or returning to a CLS from an extended absence active screening must take place. The General COVID-19 Self-Assessment can be used as a tool to guide screening activities and can be adapted as needed.
• Clients/residents must be assessed at least once daily to identify any new or worsening symptoms of COVID-19. CLSs are strongly encouraged to conduct symptom assessment more frequently (e.g., at every shift change), especially during an outbreak, to facilitate early identification and management of ill clients.
• Post signage that list the signs and symptoms of COVID-19 for self-monitoring and provide steps that are to be taken if COVID-19 is suspected or confirmed in a staff member, visitor, or a client.
• Post signage throughout the CLS to encourage all persons in the CLS to wear their masks, perform hand hygiene, and follow respiratory etiquette as per routine measures for respiratory season.

Emergency first responders must be permitted entry without screening.

Visitors to Congregate Living Settings

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.  
• All visitors are required to bring and wear a mask and physical distance.

Responding to a Positive Screen

• It is recommended that a client who answers “yes” to any of the screening questions, be isolated from the general population of the facility.
• Clients with severe symptoms should be immediately transported to hospital via EMS.
  • 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).
  • Put in place options for allowances 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.  

Printable Resources

• Shelter Client Screening Tool
• Shelter Client Screening Log

Asymptomatic testing for staff  is only recommended in outbreak situations on the advice of public health.

• Instruct staff, volunteers and clients to wash their hands often, especially:
  • upon entering the facility
  • before and after touching surfaces or using common areas or equipment
  • before eating
  • before and after preparing food
  • before and after putting on a mask, and before and after taking off a mask
  • before touching the face (including before smoking)
  • after using the washroom
  • when dirty
• To promote frequent hand hygiene, make available Install additional hand washing and/or sanitizing stations at multiple, prominent locations throughout the CLS, including entrances and in common areas and keep hand soap, hand sanitizer and paper towel dispensers filled.
• Offer supervised hand hygiene for clients (e.g. have a staff member pump hand sanitizer into participants hands as they enter an area).
• Generally, gloves are only recommended for individuals providing direct care. For those not providing direct care, gloves are recommended when cleaning and disinfecting with products that may be absorbed through the skin.
• Gloves are worn when handling dirty laundry if likely to touch items contaminated with blood or body fluid. Gowns can be added if likely to contaminate your clothing. All laundry must be handled using the same precautions: gently without shaking, regardless if the laundry is for someone who has or is suspected to have COVID-19.
• Gloves should be worn for short periods of time for a specific task. Once the task is completed, gloves must be removed properly and then hand hygiene performed. 

For printable posters on proper hand washing practices, visit the Hand Hygiene page under Additional Resources.

• Use good cough etiquette: turn your head away from others, cover your nose and mouth with a tissue, or your sleeve when you cough or sneeze. Throw used tissues away immediately in a lined wastebasket then wash or sanitize your hands.
• Display posters promoting respiratory hygiene. For printable posters on cough etiquette, visit the Cover Your Coughs page under Additional Resources.

Medical Masks

• Staff should practice universal masking in the congregate living setting. Universal masking means wearing a mask at all times, both indoors and outdoors, whether or not the facility is in an outbreak and regardless of one’s COVID-19 vaccination status. This means that in addition to the indoor masking requirement, staff should also wear a mask at all times while they are outdoors. 
  • Well-fitted medical (surgical/procedural) masks are strongly recommended.
• 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. 
• When not providing direct care or service, staff and essential visitors should wear a medical mask at all times during their shift (except when eating, when they should stay 2 metres from others, or when alone in a private space).
• Visitors should wear a well-fitted mask at all times while indoors at the CLS (subject to very limited exceptions). Given the frequency, duration, and/or the intimate nature of interaction between essential visitors and clients, essential visitors are strongly encouraged to practice universal masking in the CLS, while indoors, at all times regardless of their COVID-19 vaccination status.
• Clients/residents should be offered a medical mask for use if tolerated when they cannot maintain a 2 metre distance from others, unless otherwise cohorted. Residents who come and go from the facility are encouraged to wear a medical mask when they may be near other residents or staff if tolerated.
• Children younger than 2 years of age should not wear a mask.
• Further information can be found in Public Health Ontario’s COVID-19: Personal Protective Equipment and Non-Medical Masks in Congregate Living Settings. 

• When providing direct care or service to residents, staff and essential visitors should wear appropriate PPE. PPE protects the wearer from being infected by others.
• PPE can include surgical/procedural mask (medical mask), eye protection (i.e. face shield, goggles, mask with visor attached), gown and gloves.
• The choice of PPE is based on the type of care being provided and the health status of the resident and whether or not there is an outbreak in the facility.
• Staff should be trained on the use of PPE.
• Information on appropriate PPE can be found in Public Health Ontario’s documents:
  • New Interim IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19
  • Risk Algorithm to Guide PPE Use
• See also national guidance on Harm reduction worker safety during the COVID-19 pandemic  provided by the Canadian Initiative on Substance Misuse.

• 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).
• Commonly used cleaners and disinfectants are effective against COVID-19.  Disinfectants should have a Drug Identification Number (DIN) given by Health Canada to confirm it is approved for use in Canada.
• For waiting and dining areas, and public and staff washrooms, increase environmental disinfection routines, concentrating on high contact areas, such as toilet handles, faucets, doors, etc.
• Apply cleaning and disinfection routines to vehicles used to transport clients.
• Reduce the sharing of objects by having personal or single-use items on hand (e.g. harm reduction equipment, personal grooming items). Items or equipment that are shared should be thoroughly cleaned between users.
  • If phones are shared and cannot be appropriately disinfected, cover them with a new disposable plastic bag for each use.
• Continue normal dishwashing practices. Do not share dishes, drinking glasses, cups or utensils.
• Laundry precautions to take can include:
  • Place possibly contaminated laundry into a container with a plastic liner and do not shake.
  • Wash with regular laundry soap and hot water (60-90°C) and dry well.
  • Clothing and linens belonging to any ill person can be washed with other laundry.
  • Gloves should be used to handle laundry if likely to touch items contaminated with blood or bodily fluids. Gowns can be worn as an added precaution.
  • Towels and bedding should be changed on a regular schedule for longer stay clients.
  • A printable poster is available for shared laundry areas.
• Be careful when touching waste. All waste can go into regular garbage bins; however, no-touch garbage bins (e.g. with a foot pedal) are preferred. When emptying, be careful not to touch any used tissues with your hands. Always perform proper hand washing after emptying garbage.
• Clients' sleeping items and spaces should be cleaned and disinfected between clients. Bedding should be cleaned on a regular schedule.
• 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.
• Promote physical distancing in your facility. A minimum of 2 metres (6 feet) should be kept between all individuals. Remind residents and staff of physical distancing using verbal reminders and posters.
• 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). Mark floors to help residents and staff maintain physical distancing.
• Activities/programming that require close contact should be discontinued.
• Support activities that can be done with physical distancing.
• In overnight shelter settings, increase distancing between beds/cots to 2 meters. Consider the use of curtains or other partitions. Arrange beds alternative head and feet. Avoid the use of bunk beds. Use additional rooms in the facility for sleeping spaces to increase physical distancing. 
• Limit visitors or volunteer access to decrease in-person contacts.

• 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 Ministry of Health's guidance at Ontario.ca/EXPOSED. If testing is advised, call the nearest Assessment Centre or Telehealth Ontario at 1-866-797-0000.
• If staff or volunteers cannot leave immediately, they must be isolated in a specific space until they are able to leave.

• 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. 
• If a client screens positive, instruct the client to wear a mask (if it is safe for them to wear one) and use hand sanitizer. Place the client in a separate room with a door that closes to avoid contact with others. 
• If a separate room is not feasible, they may be placed in an area away from others.
• Staff should try to maintain physical distance (2 metres or more) while monitoring and providing assistance to these clients.
• 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. 
• Clients requiring self-isolation should have a private room and bathroom. 
• Put in place supports to help individuals remain in their room including meals and daily wellness checks. If strict self-isolation is not feasible, a medical mask should be provided to the client for use outside of their room and physical distancing maintained. Everyone should perform hand hygiene before and after putting on and before and after taking off masks.
• If you are unable to provide isolation rooms within your facility or have a very limited number of private rooms, and an alternate isolation location has not been established, contact your public health unit to help determine how best to cohort residents within the facility. 
• 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.