This tip sheet is for employers and workers in long-term care including retirement homes and long-term care facilities. It provides an overview of potential hazards and risks due to COVID-19 and guidance regarding control measures.
COVID-19 is a contagious disease caused by the SARS-CoV-2 coronavirus. Infected individuals can spread the virus through respiratory particles when they cough, sneeze, breathe, etc. People can become infected when they inhale particles that contain the virus or by touching contaminated surfaces and then touching their face with unwashed hands.
Communicate (e.g., using posters, by email, or verbally) to all workers, including students and volunteers, and visitors that people who are sick (or may be sick) with COVID-19 should not enter the facility.
Review and comply with the vaccination requirements of your local jurisdiction (i.e., some jurisdictions may require vaccination of all workers and visitors in long-term care).
Require all workers to continuously self-monitor for COVID-19 symptoms. If symptoms are present, ask the worker to isolate according to workplace policy or their local public health authority isolation requirements.
Comply with any legislative requirements that apply to long-term care operators in your jurisdiction. Requirements may include:
Creating and implementing a disease outbreak preparedness plan
Actively screening all workers and visitors who enter the facility
Putting effective infection prevention and control practices in place
Maintaining adequate levels of supplies and materials such as personal protective equipment (PPE) or hand sanitizer
Having all workers and visitors, in specific areas or situations, wear non-medical masks indoors
Reporting resident and worker illnesses to the local public health authority
Preparing areas for isolation
Restricting the number of visitors each resident can have at one time
Maintaining visitation records
Have workers work at only one worksite or department, if possible.
Consider forming work cohorts (groups of workers that have the same work schedule, work in the same areas, and take breaks at the same times). Keep work cohorts separated as much as possible.
Implement measures that promote physical distancing and reduce indoor crowds:
Remind workers and visitors to maximize the distance between themselves and others (e.g., during training sessions, providing resident care, while in hallways or elevators, in communal areas, in changerooms, during mealtimes, etc.).
Stagger workers’ meal and break times.
Rearrange or remove furniture in dining areas, meeting rooms, entrances, activity rooms, etc. to create more space.
Evaluate job tasks and modify as many as possible to be single person tasks, if safe to do so.
Consider implementing protocols for the intake of new residents or those returning after a long absence. Protocols can include requiring a negative COVID-19 test result 24 to 48 hours before arrival, monitoring for symptoms, and limiting interactions with other residents for the first 14 days.
When caring for a COVID-19 positive (or suspected positive) resident:
Conduct a point of care risk assessment before any interaction with the resident.
Isolate the resident in their room until they fully recover. Follow your provincial or territorial isolation requirements.
Post signs outside their room to make sure workers know to take precautions before having close contact with the resident.
Set up a personal protective equipment (PPE) station or cart outside the resident’s room.
Require all workers and visitors who enter the room to wear appropriate PPE.
Require the resident to eat all meals in their room (i.e., have meals delivered).
Transport the resident’s laundry in a sealed bag to the laundry facility. Keep the bag sealed until the contents are loaded into the washing machine. Wash using the warmest appropriate temperature and detergent, then thoroughly dry all laundry.
During a facility COVID-19 outbreak:
Post information at entrances and other key areas detailing outbreak specific protocols and procedures that are to be followed by all workers, residents, and visitors.
Monitor residents for COVID-19 symptoms daily.
Increase the frequency of cleaning and disinfecting high-touch surfaces and items.
Implement and enforce physical distancing requirements for all workers, volunteers, residents, and visitors.
Require mask wearing for everyone in the facility, including residents, unless they are eating or drinking.
Implement droplet and contact precautions (i.e., requiring additional PPE to prevent disease transmission) where appropriate (e.g., in residents’ rooms, when a resident begins showing symptoms, or when providing care to residents who are sick or were exposed).
Restrict facility access to essential personnel and visitors only (e.g., religious leaders, healthcare providers, immediate family).
Suspend ongoing non-essential external services such as animal therapy, entertainment, personal services, etc. for the duration of the outbreak.
Establish cohorts of residents that stay apart. Assign different caregivers to each cohort, if possible.
Consider pausing new resident admissions.
Work with your local public health authority who will declare the beginning and end of a COVID-19 outbreak.
Install hand sanitizer dispensers in high-traffic areas (e.g., main entrance, at entrances to lounges and dining rooms, outside washrooms, break rooms, cafeterias, etc.).
As an additional precaution or if it is required by law, require mask wearing for workers, residents, and visitors whenever they are in common indoor spaces. Mask can be optional in the privacy of a resident’s room and while outdoors.
Reduce the amount of paper documentation or other items being exchanged between workers. Consider exchanging documents electronically. If this exchange cannot be avoided have workers wash or sanitize their hands after handling items.
Remove magazines, newspapers, and other shared items from common areas (e.g., break rooms, meeting rooms, libraries, lounges, lobby, etc.).
Consider limiting the use of equipment (e.g., computers, tools, wheelchairs, lift assist device, etc.) to one worker or resident, especially when the equipment is difficult to clean and disinfect. If equipment must be shared, clean and disinfect it between users. Make sure all workers are trained on proper cleaning and disinfecting techniques.
Consider the Risks
The risk of COVID-19 transmission is increased when individuals are exposed to several risks at once, such as:
When person-to-person interactions are longer and more frequent.
In crowded spaces, especially when people cough, sneeze, or exhale forcefully.
In poorly ventilated spaces with other people.
When people have inadequate hand hygiene, respiratory etiquette, or do not have access to cleaning facilities and products.
When shared surfaces and objects are touched frequently.
When community COVID-19 hospitalizations or cases are high or increasing.
When sick individuals are allowed to stay in the workplace.
When individuals are exposed to several risks at once.
When other risks are high and workplace health measures are relaxed (e.g., dropping indoor mask wearing requirements, requiring all workers to return to the workplace, etc.).
Consider all possible COVID-19 exposure scenarios in your setting and perform COVID-19 risk assessments. Develop or use an existing risk assessment form to document and evaluate all work setting characteristics, activities, and job roles. It is good practice to review your assessment on a regular basis to make sure your control methods are effective.
Sample questions to ask during a COVID-19 risk assessment:
Are indoor spaces properly ventilated?
Where do individuals gather?
What activities require interactions, communication, or touching shared objects?
How long, frequent, and physically close are interactions between people?
Are people able to maintain adequate physical distance from each other?
Which workers are at higher risk?
What are the high-touch surfaces and shared objects?
Do individuals normally participate in activities that create respiratory droplets (e.g., singing, shouting, etc.).
Are people expected to stay in an enclosed space for an extended duration?
Meet your legal occupational health and safety obligations by doing everything reasonably possible in the circumstances to protect the workers and ensure the health and safety the workplace.
To provide the highest level of protection to workers, use multiple public health measures and workplace controls in a layered approach. No single measure is completely effective alone. Be careful not to create new hazards or negatively impact existing safety controls. Review and adjust measures as necessary in consultation with the health and safety committee or representative.
Create and implement a written workplace COVID-19 safety plan supported by the risk assessment. A written plan may be legally required by the jurisdiction in which you operate. Refer to local authorities for details on what must be included in the plan, if it needs to be posted, etc.
Implement policies and programs to accommodate workers, particularly those who are at high risk of severe disease or outcomes (i.e., immunocompromised, have chronic medical conditions, or are older) from a COVID-19 infection.
Communication and Training
Communicate new and updated workplace controls and applicable public health measures to all workers in languages they understand. Specific training requirements and recommendations may vary depending on your jurisdiction. Allow workers the opportunity to ask questions and share concerns. Respond to questions and provide feedback within a reasonable time.
Train workers on COVID-19 specific topics such as:
Screening: keeping individuals who may be infected with COVID-19 out of the workplace.
Contact tracing: identifying and notifying people exposed to the virus and offering advice.
Screen individuals who enter the workplace, if required by your local jurisdiction. Consider having a screening program even when it is not required as an additional measure to protect your workers.
Determine which type of screening your worksite requires: passive or active.
Passive screening requires individuals to self-monitor and self-report possible illness or exposure to COVID-19.
Active screening requires individuals to respond to questions about signs or symptoms of infection, recent possible
COVID-19 exposures, or recent travel outside of Canada.
Allow individuals that pass the screening to access the workplace. Deny access to anyone who does not pass the screening.
Have workers who do not pass the screening contact their supervisor. The supervisor should instruct them to return (or stay) home and follow local public health guidance which may include isolation, testing for COVID-19, or contacting their healthcare provider or public health authority.
Determine if you are required to implement contact tracing. If so, maintain a list of all individuals (for which contact tracing applies) entering the workplace, including their names, contact information, and time spent in the workplace. This information should be provided to the local public health authority if requested for the purpose of contact tracing. All information must be safely stored and destroyed as required by privacy legislation.
For additional information on screening and contact tracing, refer to:
Ventilate indoor spaces appropriately according to the number of occupants and types of activities.
Open windows and doors to the outside, if possible.
Maintain ventilation systems and seek advice from a ventilation specialist on possible improvements (e.g., increasing air exchanges per hour, reducing or eliminating recirculated air, or upgrading to air filtration and disinfection).
If possible, run ventilation systems continuously or for two hours before and after buildings are occupied.
Run local exhaust fans that vent to the outside to help remove contaminated air.
Make sure that air circulation or cooling fans do not direct air flow from person to person.
If ventilation cannot be improved, consider using portable air filtration units with high-efficiency particulate (HEPA) filters.
Keep indoor humidity between 30% and 50%.
For additional information on indoor ventilation, refer to:
PPE includes such items as respirators, medical masks, eye protection, gloves, and safety footwear.
Eye protection (safety glasses, goggles, or face shields) may be worn in addition to a mask when in close physical contact with others. Note: face shields do not provide respiratory protection and cannot replace masks.
COVID-19 PPE policies must not interfere when a higher level of protection is needed for a task.
Workers may need PPE for COVID-19 protection if they are:
Performing tasks that require them to be less than 2 metres from another person.
Using cleaning and disinfecting products (refer to the manufacturers’ safe handling instructions).
Follow the mask wearing requirements of your local jurisdiction. If not required, mask wearing should be encouraged as an additional measure when there is a high risk for COVID-19 spread, or when physical distancing is not possible.
Masks should be comfortable, well-constructed and well-fitting, covering the nose, mouth, and chin.
Consider using masks with a transparent window when communicating with people who are deaf or hard of hearing.
Masks should not be worn by anyone who is unable to remove it without assistance (e.g., due to their age, ability, or developmental status).
Allow workers to wear masks, even if not required, based on their discretion (e.g., being at risk of more severe disease, working in crowded setting, etc.).
Immediately have them wear a mask (preferably a respirator or medical mask, or if neither is available, a well-constructed and well-fitting non-medical mask). A respirator used in this way (i.e., as source control) may not need to be fit tested.
Have them leave as soon as possible.
If they cannot immediately leave, have them isolate in a designated area, away from others, until they can leave.
Call 911 for medical assistance if symptoms are life threatening. If it is a worker, notify their emergency contact.
Complete an incident report and begin an investigation.
Refer to guidance from your local public health authority to determine when the worker can return to work.
Consider updating your sick leave policy to provide support to workers who are or may be sick. Support may include paid or unpaid sick leave, long-term disability, and information on government programs, if available.
Note that this guidance is just some of the adjustments organizations can make during a pandemic. Adapt this list by adding your own good practices and policies to meet your organization’s specific needs.
For further information on respiratory infectious diseases, including COVID-19, refer to the Public Health Agency of Canada.
Disclaimer: As public and occupational health and safety information may continue to change, local public health authorities should be consulted for specific, regional guidance. This information is not intended to replace medical advice or legislated health and safety obligations. Although every effort is made to ensure the accuracy, currency, and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. CCOHS is not liable for any loss, claim, or demand arising directly or indirectly from any use or reliance upon the information.