COVID-19: Congregate Living Settings

• Advise all staff and volunteers who are experiencing symptoms to stay home and call TBDHU at (807) 625-5900 or Toll-Free at 1 (888) 294-6630 for further instructions.
• All clients should be instructed to watch their health for symptoms of COVID-19 and immediately inform a designated staff person if they begin to feel unwell.
• If staff or volunteers develop symptoms while at work, they should immediately separate themselves from others, inform management, go home, if possible, to self-isolate and call TBDHU for further instructions.
• Put in place both active and passive screening measures for clients, staff and essential visitors.
  • Active screening involves having a designated staff person ask the screening questions at a designated entry point. Where possible, this should include no-touch temperature checks.
  • 1-2 screeners should be placed at the entrance to screen all individuals wanting to access the facility.
  • Staff conducting active screening should use appropriate personal protective equipment.  Staff asking questions should be behind a barrier (i.e. Plexiglass).  If a barrier is not available, the screener should wear a medical mask and eye protection (e.g. face shield, goggles) and stay 2 metres away from those entering the facility.
  • Alcohol-based hand sanitizer should be available at the entrance and anyone entering the facility is advised to perform hand hygiene.
  • Passive screening involves posting signage at every entry door and throughout the facility to prompt anyone to self-identify if they feel unwell or have symptoms consistent with COVID-19.
• All clients, staff and essential visitors should be actively screened daily:  
  • Clients - prior to entry/admission and twice during the day
  • Staff and essential visitors - at the start and end of each shift or visit
• Active screening should include reminders to self-monitor for COVID-19 symptoms and notify a designated individual if they start to feel unwell.
• Where possible, screening for new admissions should be done over the phone. 
• Keep a record or log of individuals (staff, volunteers, essential visitors, and clients) entering your facility and where in the facility they are working or staying. 
• A log of all essential visitors who are given entry, with whom they visit, and/or what areas of the residence they occupy should be maintained.
• Keep a line list of ill clients, staff and visitors including when they become ill, if tested for COVID-19 and if they remain at the facility or are transported elsewhere.
• Note that emergency responders should be permitted entry without screening. 
• See Congregate Living Settings for Vulnerable Populations (May 28, 2020) for further advice on adapting screening for long and short term stay settings. 

Visitors to Congregate Living Settings

• Guidance on visitors to congregate living settings can be found in the document Resuming Visits in Congregate Living Settings (June 2020).
• Congregate living settings should develop policies that limit non-essential visitors. An operational definition of “essential visitor” should be defined in policy, which could include “a person performing essential support services, such as health care services, a parent/guardian, a person visiting a very ill or palliative resident, or a maintenance worker”.

All visitors must adhere to the following: 

• Must pass active screening every time they are on the premises and attest that they are not experiencing any of the typical and atypical symptoms of COVID-19. They should not be allowed to visit if they do not pass the screening. 
• Attest to home staff that the visitor has tested negative for COVID-19 within the previous 2 weeks and subsequently not tested positive. The facility is not responsible for providing the testing. 
• Comply with the congregate setting’s infection prevention and control protocols, including proper use of face masks. 
  • Visitors should use a mask at all times. This may include a cloth mask even while maintaining a minimum of 2 metres (6 feet) physical distance. Visitors are responsible for bringing their own masks. Learn more by visiting our Masks page.
  • Visitors must maintain a minimum of 2 metres (6 feet) physical distance from the resident for the full duration of the visit. 
  • Visitors must adhere to protocols for hand hygiene and respiratory etiquette. 
• Gifts are permitted, only if in accordance with existing policies and procedures of the setting, and only if they can be easily cleaned and disinfected (e.g. hard surfaces, original packaging). 
• Outdoor visits may take place in a designated area, ensuring that physical distancing is maintained and masks are worn for source control. At no time may the non-essential visitor enter the congregate living setting.

Responding to a Positive Screen

• It is recommended that a shelter client who answers “yes” to any of the questions below, be isolated from the general population of the facility:
  • Does the individual have a fever (37.4^oC or higher), confirmed by temperature reading, if possible?
  • Does the individual have any of the following symptoms not related to an underlying medical condition: new or worsening cough, difficulty breathing, shortness of breath, difficulty swallowing, sore throat,  runny nose / nasal congestion, chills, unexplained fatigue / muscle aches, headache, nausea/vomiting, diarrhea, abdominal pain, decrease or loss of sense of taste or smell, pink eye (conjunctivitis)? 
  • Has the individual been tested (swabbed) for COVID-19 and are waiting for results?
  • In the last 14 days, has the individual had a confirmed case of COVID-19 or have been in close contact with a confirmed case of COVID-19?
  • Has the individual traveled outside of Canada in the last 14 days?
• Clients with severe symptoms should be transported to hospital via EMS. Severe symptoms include:  
  • Extremely difficult breathing (not being able to speak without gasping for air)
  • Bluish lips or face
  • Persistent pain or pressure in the chest
  • Severe persistent dizziness or light-headedness
  • New confusion, or inability to arouse
  • New seizure or seizures that won't stop
• See the Manage and Isolate Symptomatic Individuals section 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

a)    Hand Hygiene (including gloves):

• Advise staff, volunteers and clients to wash their hands frequently using soap and water for at least 20 seconds. If soap and water is not available, use alcohol-based hand sanitizer (minimum 60%).
• 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 or face covering
  • before touching the face (including before smoking)
  • after using the washroom
  • when dirty
• Install additional hand washing and/or sanitizing stations 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 health care workers. For non-health care workers, 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. Handle laundry gently without shaking, and in handling laundry 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 done, gloves must be removed properly and then hand hygiene performed.

For printable posters on proper handwashing 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.
• Non-medical masks are recommended as an additional measure for source control.  Non-medical masks help keep the wearer's droplets contained to protect others around them. Learn more about Masks.
• For staff and essential visitors, wear a non-medical mask for the duration of the shift or visit. Exceptions include when eating, when alone and in a private space, and when providing direct care using personal protective equipment.
• For clients, non-medical masks are recommended, if tolerated, when they cannot maintain a 2 metre distance from others.  Mask use may be encouraged in short-stay settings where clients leave and enter the facility or there is change in clientele.

For more information on mask use in congregate living settings, see provincial guidance documents linked above.  General information can also be found on the Masks page. 

Non-medical Masks

• Non-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 non-medical mask properly. Refer to How to Wear Masks Properly
• When not providing direct care or service, staff and essential visitors should wear a non-medical mask for source control at all times during their shift (except when eating, when they should stay 2 metres from others, or when alone in a private space).
• Residents should be offered a non-medical mask for use if tolerated when they cannot maintain a 2 metre distance from others. Residents who come and go from the facility are encouraged to wear the non-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.
• Information on non-medical mask use for staff and residents of congregate living settings can be found in the Public Health Ontario’s COVID-19: Personal Protective Equipment (PPE) and Non-Medical Masks in Congregate Living Settings.
• Do not share non-medical masks.
• Non-medical masks should be put in the laundry if worn that day, and also if dirty. Wash with laundry soap at the hottest temperature setting available and then dry well. Non-medical masks can be washed with other laundry.

Personal Protective Equipment (PPE)

• 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:
  • COVID-19: Personal Protective Equipment (PPE) and Non-Medical Masks in Congregate Living Settings (July 7, 2020)
  • Risk Algorithm to Guide PPE Use

• 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 least twice per day and when visibly dirty. For more information see the general messages on environmental cleaning.
• 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.
• 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 handwashing 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.

• 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.
• Clean and disinfect shared equipment after each use by each person. If phones are shared and cannot be appropriately disinfected, cover them with a new disposable plastic bag for each use.
• Remove shared items that cannot be cleaned, such as puzzles.
• 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 bunkbeds. 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 should don a medical mask, use hand sanitizer, inform their supervisor and go home immediately.
• If they cannot leave immediately, they should be isolated in a specific space until they are able to leave. Staff and volunteers who develop symptoms at home should notify their supervisor and stay home.
• Instruct staff and volunteers to immediately call TBDHU at (807) 625-5900 to Toll-Free at 1 (888) 294-6630 to be assessed for testing.

• 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, follow isolation protocols established for your local setting.

• 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 (mask and gloves at a minimum). 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 How to Cohort During an Outbreak of COVID-19 in a Congregate Living Setting (June 19, 2020).
• If a client experiences severe respiratory symptoms arrange for medical care immediately. 

• All congregate living settings should implement public health measures set out in Congregate Living for Vulnerable Populations - May 28, 2020 (Government of Ontario) 
• See also COVID-19 Resources for Congregate Living Settings provided by Public Health Ontario.
  • Frequently Asked Questions: Congregate Living Settings (posted June 29, 2020)
  • COVID-19: Personal Protective Equipment (PPE) and Non-Medical Masks in Congregate Living Settings (July 7, 2020)
  • Congregate Living Setting Resources Toolkit (June 23, 2020)
  • Checklist: COVID-19 Preparedness and Prevention in Congregate Living Settings - June 1, 2020 (Public Health Ontario) 
  • Checklist: Managing COVID-19 Outbreaks in Congregate Living Settings - June 1, 2020 (Public Health Ontario)
  • How to Cohort During an Outbreak of COVID-19 in a Congregate Living Setting - June 19, 2020 (Public Health Ontario)
  • COVID-19 Patient Screening Guidance Document - June 11, 2020 (Government of Ontario)
  • Foundations of COVID-19 Prevention and Control for Congregate Living Settings (May 7 2020, posted July 8, 2020) – Webcast
• The Ministry of Children Community and Social Services has provided guidance on Resuming Visits in Congregate Living Settings (June 2020)

• Coronavirus Resources for the Homelessness Sector (Canadian Alliance to End Homelessness)
• Cleaning and Disinfection for Public Settings (Public Health Ontario English)
• COVID-19 Shared Laundry Poster (TBDHU English)