Ontario to loosen LTC visitor rules as experts warn of deaths from 'loneliness and social isolation'

Ontario is loosening some of its restrictions on visitors to long-term care homes — a welcome change for residents and their loved ones.

But some experts who have been warning about the impact of social isolation on the vulnerable populations say the changes don't go far enough.

As first reported by the Toronto Sun, the new rules mean negative COVID-19 tests will no longer be required for outdoor visits as of July 15 and indoor visits will be permitted as of July 22.

News of the change comes just as a group of experts on aging released a report on Wednesday morning warning that without access to family caregivers, more long-term care residents will die — not from COVID-19, but because of it.

The report from the National Institute on Aging (NIA), a Ryerson University think-tank, called on provinces to loosen the restrictions preventing family caregivers from going into long-term care homes. It found the restrictions put in place across Canada early in the pandemic to prevent COVID-19 from entering long-term care homes now risk causing further damage to the residents they were meant to protect.

“If we don’t find the right balance, potentially more residents will end up dying from loneliness and social isolation than from COVID-19, due to the continued lack of access to their family caregivers that often were providing them with substantial assistance prior to the pandemic,” said Dr. Samir Sinha, director of health policy research at the NIA, in a press release.

Sinha, along with Dr. Nathan Stall, a geriatrician and researcher at Sinai Health System and NIA associate fellow, Dr. Allison McGeer, an infectious disease specialist at Sinai Health System, led the research into the restrictions in place in Canadian jursidictions.

“As Canadian LTC homes cautiously reopen, emerging provincial and territorial visitor policies are overly restrictive, inequitable and potentially harmful. These policies still largely exclude family caregivers from LTC homes, despite the fact that they are essential partners in care who help to ensure the health and wellbeing of many residents,” said Stall.

Their conclusions had been shared with the provincial government prior to the news that the restrictions would be loosened.

The researchers told QP Briefing that problems remain.

Sinha said the requirement that indoor visitors be tested offsite is "overly onerous" and instead homes should apply the same testing policies in place for staff — a recommendation that they are tested, with the testing done on-site, Sinha said.

That comment was echoed by Stall, who noted that elderly loved ones of residents have had challenges accessing testing sites and said he has heard, anecdotally, of older people waiting hours in the heat for a test, and fainting.

"Many families are also concerned that while the guidance says they will be welcome, too many homes still say they don’t have the staff or resources to enable them to welcome back caregivers and visitors in the way that would be most beneficial for LTC residents and them," Sinha said in an email. "Hopefully the guidance the NIA has released today with the input of national and international experts will allow Ontario and all provinces and territories to keep moving forward in reintegrating family caregivers and visitors in the most balanced way."

Stall also noted that restrictions remain strict in retirement homes and group homes for people with disabilities.

Ontario initially announced the resumption of visits to long-term care in June, but the restrictions were criticized as overly strict, particularly the requirements that visitors attest to having tested negative for COVID-19 in the previous two weeks, and that visits be held outdoors.

There is a narrow exception for essential visitors, which includes those visiting palliative patients and those providing necessary care.

The NIA report recommends provincial policies make a clear distinction between "family caregivers" and "general visitors," with the former considered "partners in care" who "support feeding, mobility, personal hygiene, cognitive stimulation, communication, meaningful connection, relational continuity, and assistance in decision-making." It recommends residents, or their substitute decision-makers, not the homes' administrations, have the authority to determine who are essential family caregivers. It proposes two different sets of recommendations, giving greater access to family caregivers than to social visitors.

The researchers said that Ontario's guidelines do go far enough in recognizing family caregivers.

The report also recommends homes prioritize equity when determining access to residents and that a system be put in place to clearly communicate these policies, report data on the reopening of homes and provide a mechanism for feedback and appeals from family members. It also recommends family caregivers be trained to follow the same infection control and personal protective equipment requirements and protocols as staff members of the home and remaining masked at all times.

Last week, Premier Doug Ford expressed concern about allowing more people into long-term care homes, saying at a press conference, "God forbid something breaks out" as a result.

Announcing the new rules at a press conference Wednesday, Long-Term Care Minster Merrilee Fullerton said the government recognizes the importance that friends and family members have in the well-being of the residents of long-term care, but said the province is still in a state of emergency.

Asked what the government will do if long-term care outbreaks increase again, she said the province will continue its testing regimen.

"So this is a process that we will be vigilant with, and we'll be monitoring and we're working with the chief medical officer of health and public health units to address any sparks, shall we say, that might be occurring in different regions," she said.