The goal of COVID-19 Management in the Disability Support Program is to, as much as possible, prevent the introduction of the virus into the home and/or prevent transmission to participants and staff within the home.
All residential service providers must follow the orders and directives made by the Chief Medical Officer of Health under the Health Protection Act (HPA) (see link in Section 6). We are also recommending compliance with the guidelines contained in this document.
These guidelines are based on the latest available scientific evidence about this emerging disease and may change as new information becomes available. The Public Health Agency of Canada will be posting regular updates and related documents at https://www.phac- aspc.gc.ca/.
These guidelines use the term participant to include individuals residing in a licensed DSP home.
These guidelines use the term home to include all licensed DSP facilities, including Regional Rehabilitation Centres (RRCs), Adult Residential Centres (ARCs), Residential Care Facilities (RCFs) Development Residences (DI, DII, DIII), Small Option Homes (SOH) and Group Homes (GH).
These guidelines use the term staff to include compensated employees of licensed service providers.
These guidelines use the term essential visitors to include health care workers not employed by the service provider, such as but not limited to:
- Paramedics, occupational therapists, physiotherapists, nurses and primary care.
Essential visitors will also include support service vendors such as but not limited to:
- Canada Post, supply deliveries, essential maintenance, IT, regulator authorities (Office of the Fire Marshal, Nova Scotia Environment, Licensing, Care Coordinators).
If your organization has any questions about these guidelines, please contact Nancy Neil, DSP Residential Coordinator at email@example.com.
2 PREPARING YOUR ORGANIZATION FOR COVID-19
2.1 Central point of contact
In the event of a COVID outbreak the organization should have one point person assigned who is physically on-site or available by phone during an outbreak who will serve as the central point of contact for DSP and Public Health.
2.2 Collection and storage of Heath Card Numbers (HSN)
Staff, including casuals should be invited to provide their HCN and date of birth so that a centralized list could be compiled by the organization. This list will aid in expediating the screening and testing process in the event of an outbreak. Employees should be told there is no obligation to provide their HCN and if they choose not to do so they should be asked to ensure they have their HCN on them whenever they are working.
3 PREVENTING THE INTRODUCTION OF COVID-19 INTO THE DSP HOME
3.1 Screening, Monitoring and Active Surveillance
- Active screening of all staff, essential visitors and anyone else entering the home:
- Enact, and if possible document, active daily symptom screening of all staff (including temperature checks once per shift, at the beginning of shift) and if they become symptomatic in the workplace, individuals are to immediately go home to isolate. Possible symptoms include fever (signs of fever), new or worsening cough, sore throat, runny nose, headache or difficulty breathing/shortness of breath.
- Active screening of all participants:
- Enact, and if possible document, active screening (at least daily, and twice per day if operationally feasible, including temperature checks) for early identification of any participant with fever or symptoms compatible with COVID-19 (such fever (signs of fever), new or worsening cough, sore throat, runny nose, or headache, difficulty breathing/shortness of breath) that should prompt management of the participants, and consideration of testing for COVID-19.
3.2 New Admissions and Re-Admissions
New admissions and re-admissions should be screened for symptoms and potential exposure to COVID-19.
- During COVID, DSP will only be seeking emergency placements (i.e. participants from hospital and/or under an Adult Protection order) and re-admissions of existing participants from hospital.
- Prior to a participant returning from a healthcare facility the service provider should make every effort to determine if the participant has been suspected, tested, or diagnosed for COVID-19 and if so, what measures may be required, per the guidelines in Section 5.0 of this document.
- New placements represent a potential introduction pathway to a home. Quarantine/self- isolation for 14 days is recommended to the extent possible. More information on these measures can be found here:
3.3 Managing Essential Visitors
- As DSP homes are now closed to visitors, accommodation should only be considered for essential visitors who are visiting very ill or palliative participants (compassionate exception), or those who are performing essential support care services for the participant (i.e., similar to a personal support worker). If an essential visitor is traveling from out of province, they need to contact local Public Health to discuss an exemption to self-isolate and instructions on how to self-isolate for the remainder of their time in Nova Scotia.
- Essential visitors should be screened on entry for illness including temperature checks
- Essential visitors should only visit the one participant and not have contact with other participants, as much as possible.
3.4 Social Distancing
As per the Order by the Medical Officer of Health (March 24, 2020):
- All efforts to maintain social distancing should be made. Examples of social distancing include, but are not limited to; staggering mealtimes, maintaining physical distance of two metres or six feet, limiting group activities to less than 5 people total inclusive of staff supporting activity.
- Staff while working within the home providing participant care are exempt from social distancing requirements.
3.5 Environmental Management
- Enhanced environmental cleaning and disinfection regimens are recommended. This includes frequent (twice daily) cleaning and disinfection of high-touch surfaces.
- Disinfectants should be used in accordance to the manufacturers’ instructions.
- Laundry and waste disposal protocols are as per routine practices.
3.6 Participant Care Equipment
Any equipment that is shared between participants should be cleaned and disinfected, as per routine practices, before use on or by another participant.
Identification of COVID-19
3.7 Suspect Influenza Like Illness (ILI) Outbreak
In the context of the pandemic, a single case of ILI in a DSP home, in a participant or staff member, meets the definition for a ‘suspect outbreak’ and should prompt outbreak control measures associated with a suspect respiratory infection outbreak.
The definition of ILI in the context of COVID is two or more of the following symptoms: fever (signs of fever), cough (new or worsening), sore throat, runny nose, or headache.
Notification of the following agencies should occur immediately:
- Participants who are exhibiting potential symptoms should first be supported to completethe online assessment tool found at: https://when-to-call-about-covid19.novascotia.ca/en
- DSP Specialist for their region:
- Western Region – Donna McNeil
- Central Region – Lynn Ann Power or Tricia Murray
- Northern Region – Adam Fraser
- Eastern Region – Cynthia Boutilier
- Medical Director of facility (for ARC/RRCs only)
- During contact tracing discussions with Public Health, staff should report all homes they haveworked in during the 14 days preceding symptom onset.
- During contact tracing discussions Public Health should be notified of participant transfersduring the 14 days preceding symptom onset.
- Public Health will be notified through standard processes if a participant or staff membertest positive through a test administered at a provincial assessment centre.
- Participants who are exhibiting potential symptoms should first be supported to complete the online assessment tool found at: https://when-to-call-about-covid19.novascotia.ca/en
- The assessment tool will provide direction on whether 811 should be called for further assessment by a nurse.
- 811 will provide direction on how to receive a COVID-19 test at an assessment centre. You should notify 811 of any mobility challenges associated with participants accessing testing.
- An alternate phone line for COVID-19 initial assessments has been set up to ensure front- line workers are virus-free and able to safely provide care, reducing the demand on 811.
- Staff in DSP facilities/homes should use this line as an alternative to calling 811 for assessments. This screening tool aligns with that of 811.
- Access the screening service by calling: 1-833-547-0059. Please note that the alternate assessment line is intended for screening purposes only.
4 OUTBREAK CONTROL MEASURES
Use the measures outlined below as soon as a participant or staff exhibits COVID-19 symptoms. Implement additional precautions upon symptom onset and continue using them until advised by Public Health. Do not wait for lab results to begin additional precautions.
- Signage should be posted at all entrances and exits throughout the home to advise staff and essential visitors, that an outbreak (or potential outbreak) has been declared in the home.
- Signage should include instruction for cleaning hands when entering and exiting the home, reminders that ill visitors should not visit, and that visitor restrictions are in effect e.g. non- essential visits should be postponed
4.2 Cohorting of Staff and Participants
Cohorting of staff and participants is a very important measure to reduce transmission and should be applied to the best of a home’s ability.
For symptomatic participants, asymptomatic lab-confirmed cases and their close contacts, restrict contact as much as possible until the isolation measures can be lifted as per Public Health direction. This includes:
- Placing participants in private rooms, or if that is not possible, placing symptomatic participants/lab-confirmed cases with other symptomatic participants/lab-confirmed cases. If this is not possible, maintain a two-meter distance between participants with ILI/lab- confirmed cases and others. Use of partitions, like curtains, may help.
- Serving meals in the participant’s room.
- Further restricting participation in any group activities.
- Droplet and contact precautions should be used when providing direct care to the participant or when within 2 metres of the participant.
- A sign should be visible on the participant’s door or in the participant’s bed space that indicates the participant requires droplet and contact precautions. The sign should not disclose the participant’s confirmed or suspect diagnosis.
- Wearing a mask and gloves when staff or essential visitor is in the room.
For all participants:
- Minimize contact between participants on affected floors/units/wards with unaffected areas.
- Remind participants to wash hands thoroughly and immediately report any symptoms.
- Cancel or reschedule appointments that do not risk the health or well-being of the participant until the outbreak is declared over.
- Reinforce hand hygiene and respiratory hygiene practices.
- Cohort staff as strictly as possible e.g. staff working with symptomatic participants should avoid working with participants who are well.
- Practice strict hand hygiene between participants at all times.
- Whether staff can work between outbreak and non-outbreak facilities/homes will be at the determination of Public Health.
- In the event of critical staff shortages, and under the direction of Public Health, staff from non-outbreak facilities may work in outbreak facilities. They may continue to work in their home facilities/homes. This exception will not apply to those who have been identified as a close contact by Public Health. Staff should confirm at the beginning of each shift that they are asymptomatic and are able to self-isolate as soon as symptoms develop.
- In the event of a forecasted critical staff shortage, contact the DSP Specialist in your region.
- Staff who have recovered from COVID-19 may work in all facilities and should be prioritized to work in outbreak facilities.
- If dedicated staff for sick participants is not available, staff should first work with the well/asymptomatic and then move on to care for the ill/symptomatic and avoid movement between floors and units where possible.
4.3 During a COVID Outbreak: Admissions and Transfers
- There should be no new admissions, transfers or outside medical appointments during an outbreak; however, this may not always be feasible.
- For those residents returning from a medical appointment, staff must perform a risk assessment to determine exposure risks during transport and while at the appointment (clinic/hospital/office).
- The return of a hospitalized participant should be discussed with Public Health to consider the participant’s past COVID exposure, testing history and disease status. This information will determine if and where within a home the participant should be placed and the public health measures to be implemented.
If transfer to the hospital or another facility/home is necessary, notify the hospital/other facility/home and Emergency Health Services (EHS) of the outbreak situation. If the participant requiring transfer is symptomatic, EHS should be notified prior to pick-up that the participant will require droplet/ contact precautions.
5 Other Links
- Health Protection Act Order:
- NSHA COVID-19 updates and resources:
- This document provides direction to health care workers (HCWs) for the prevention and control of novel coronavirus (COVID-19) in LTCFs. The foundational documents used in the development of this guidance include the 2019-2020 Guide to Influenza Like Illness and Influenza Outbreak Control for LTCFs and Coronavirus Disease 2019 Infection Prevention and Control Guidelines for Long Term Care Settings.
- Hand Hygiene Practices in Healthcare Settings
- IPAC guidelines for home and community care:
- IPAC guidelines for LTC