The Registered Nurses’ Association of Ontario (RNAO) urges the Ontario government to immediately direct all nursing homes in Ontario to reunite residents with their loved ones, including those in nursing homes experiencing a COVID-19 outbreak. RNAO’s call is driven by the need to address a basic human right, and also to provide the foundational person- and family-centred care that is critical to quality of life for LTC residents and their families.
RNAO says the length of the COVID-19 pandemic, the likelihood of a second wave, and the lessons-learned from outbreaks in LTC necessitate a different approach, and one that is uniform across the province. All nursing home operators must be required to follow this approach.
“We have heard from families who have shared their hardships trying to connect with spouses, parents, grandparents and other relatives. It’s obvious that the lack of clear direction from Ontario’s chief medical officer of health is the reason we have a patchwork of protocols that is leaving families confused and some residents without the meaningful connections they need for their health and well-being,” says Dr. Doris Grinspun, RNAO’s CEO. Grinspun says the last few months have been excruciating for residents, their family members and friends, and staff. Grinspun says residents have paid a huge price in terms of their quality of life and their safety. “It’s heartbreaking and must change immediately.”
Grinspun says such change can come in the form of a five-step process RNAO developed in consensus with experts, including families of LTC homes. It lays out clearly defined steps that facilitate family (friend) visits that are vital, safe, meet people’s needs and prevent further suffering:
- Step 1: The LTC home invites families, including the resident (as appropriate) to identify up to three Essential Family Care Partners (EFCP) for each resident. During the EFCP identification process, every effort is made to achieve consensus, however in cases where consensus cannot be reached between the family and the LTC home, family members have access to the office of the patient ombudsman to help reach a mutually agreeable decision.
- Step 2: The LTC home utilizes and/or augments current internal policies related to COVID-19 screening, personal protective equipment (PPE) provision, and communication, specifically to staff and others related to the identified EFCPs and their role. For LTC homes in an active outbreak, the EFCP will be asked to sign a statement of understanding that they are placing themselves at an increased risk of contracting COVID-19 and accept all responsibility for it.
- Step 3: The LTC home provides the formally identified EFCPs with current and regularly updated information/education related to PPE, required infection prevention and control practices, and any directives in place because of COVID-19. To minimize risk, each EFCP is responsible to follow the guidance provided by the LTC home while attending to their loved one, and failure to do so may result in losing EFCP status.
- Step 4: The EFCP is provided with identification to be used for entry to the LTC home and to facilitate documenting their presence in the home should contact tracing be necessary. One EFCP is able to be present at a time in the home and in the company of the resident, without undue restriction on the number or length of visits.
- Step 5: Government facilitates access to PPE and the LTC home ensures there is adequate PPE for use by EFCPs, consistent with the requirements for staff, given the resident's care needs. The goal is a risk-tailored strategy that focuses on safety while simultaneously providing a humane and ethical approach to interaction between the resident and their family member. This approach can include touch, hugging, and close face-to-face interaction between the EFCP and the resident. However, the EFCP commits to keep two metres physical distance from LTC home staff, any other residents and other EFCPs.
RNAO President Morgan Hoffarth says the process addresses RNAO’s consultations with families and emerging evidence that restrictions on family visits in the name of safety have resulted in more harm than good. Such restrictions are now considered unethical, inhumane and unsafe.
“As nurses, we can no longer support the imposed restrictions most nursing homes have placed on family members. There is no evidence for it and the harm caused is significant. RNAO will continue to do everything in its power to ensure families and residents reunite in a meaningful and fulsome way. We will also urge that these rights not be taken away when COVID-19 outbreaks occur. Our process provides the necessary structure long-term care operators need, and gives residents and their families the respect and speedy attention they deserve,” Hoffarth says. “For families, this means being able to provide the emotional support their loved one yearns for, as well as assist with personal care, such as help with eating, hydration and toileting. Families and (friends) play a vital role in residents’ health and well-being. We want the government to honour these relationships by immediately heeding our advice.”
The Registered Nurses’ Association of Ontario (RNAO) is the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the health system, and influenced decisions that affect nurses and the public they serve. For more information about RNAO, visit our website at RNAO.ca or follow us on Facebook and Twitter.