Who's allowed in? Plus 4 other things you should know about COVID-era nursing home visits in Saskatchewan
The rules allow for more than just palliative visits and have since mid-November
- Do you have a concern about visitation practices at your loved one's Saskatchewan care home? Contact Guy at [email protected]
B.C. resident Lynn Mathieson moved to Saskatchewan last year to be closer to her mother, Alice, a 94-year-old resident of the Extendicare Elmview home in Regina.
But she hasn't been in the same room with her mom since last fall.
Like hundreds of other children and relatives of people living in long-term care homes, Mathieson has been bound by the rules limiting the number and types of visitors allowed in Saskatchewan nursing homes as staff try to ward off COVID-19 outbreaks among vulnerable residents.
Premier Scott Moe's government initially locked down care homes last March, relaxed visitation rules over the summer and then, as of Nov. 19, suspended all visits province-wide "except for compassionate reasons."
Mathieson is a former nurse. "To me, compassionate care always meant end of life," she said.
But Saskatchewan's compassionate visitation rules during the pandemic are more complicated than that, and potential misuses of the system are causing concern.
Here's what you should know.
1. 'Compassionate reasons' covers more than just palliative/end-of-life visits
The provincial Ministry of Health breaks down compassionate care home visitation under two categories:
- "Family or support persons during end-of-life [palliative] care."
- "Long-term care or personal care home residents whose quality of life or care needs are unmet."
The first category is self-explanatory. When Shelley Dawn's mother Beth Elaine Sutherby was dying during the COVID-19 outbreak at Elmview's sister Extendicare Parkside home last December, Dawn was allowed inside to spend some final moments with her mother.
"The best 15 minutes of my life," Dawn said.
Two people can visit a dying resident "if physical distancing can be maintained," according to provincial guidelines.
The Saskatchewan Health Authority (SHA) fleshed out the criteria for the second, "unmet needs" category of compassionate visiting in an online FAQ dated Dec. 7 and a followup Dec. 17 handout.
"A quality of life need describes immediate and essential needs that are beyond care needs, such as helping someone eat or get dressed," according to the FAQ. "Residents may, in these settings, have cognitive impairments or other conditions and disabilities that create other kinds of needs."
The handout further outlines the unmet physical and mental health needs of a care home resident that might qualify a relative or support worker to be an essential visitor during the pandemic — everything from "assisting with stretching" to, "Is the resident not able to participate meaningfully in virtual visitation? (i.e. communication difficulties, in ability to learn how to use technology, hearing loss, dementia.)"
Residents who were receiving special care before the pandemic are singled out as having "immediate and essential needs."
Lynn Mathieson, whose mother Alice has dementia, said some of the criteria are too broad and that she would only visit her mom at Elmview "at that last moment if I was allowed."
"[It] makes me quite nervous to think that not everybody has the belief that I do: that I don't want to be the one to bring [COVID-19] in," Mathieson said. "So I think they are a bit on the broad side in terms of some people are abusing it and just wanting to get in."
Mathieson said she understands people are tired of being separated from their loved ones.
"There's certainly mental health issues, but I really want people to think hard about it because, of course, they're putting the other residents at risk," she said.
Matt Love, the Saskatchewan NDP critic on issues affecting seniors, said the criteria laid out by the health authority is a symptom of chronic understaffing in the province's long-term care system.
"This is a real admission that his government knows that without visitors entering the building, people who live there will have a very tough time managing daily needs with the staffing level that they currently have," Love said.
An SHA spokesperson said Tuesday that family members are also considered caregivers in long-term care. The help they provide can "reduce agitation or behaviours for residents when these supports are provided by a loved one."
2. Individual care homes seemingly decide who meets the criteria for compassionate visiting
People unclear about whether they meet the bar for compassionate visiting are encouraged by the SHA to talk to the unit or long-term care manager at their loved one's home, according to the FAQ. Quality of care co-ordinators — who help family members air questions or concerns about their relative's care — can help as well.
"Care teams collaborate with residents and/or families to determine if compassionate care family presence is needed to support care or quality of life needs unmet," the SHA spokesperson said.
Essential visitors can include a "healthy" spouse, common-law spouse, child, stepchild, parent, grandparent, grandchild, sibling or "a support person with whom the resident has had an equivalent relationship," according to the guidelines.
"The designated essential family/support person(s) should be consistent," although temporary replacements are allowed.
"Facilities keep screening records of designated family members/supports who attend the facility," the SHA spokesperson said.
3. Provincially-set levels determine how many compassionate visitors are allowed in at a given time
The level of visitation at a given time will vary per location because each home operates under one of three family presence levels set out by the province and moderated, if need be, by local medical health officers.
Generally speaking, Level 1 allows each resident to have two essential visitors (though only one at a time) while Level 2 restricts a resident to only one of those visitors.
Level 3 kicks in when a home is experiencing a COVID-19 outbreak. It means people can only visit if their loved one is dying or has suffered a quick turn in their health condition.
"There may be exceptions for care needs that are unmet and if family is needed to support," the SHA spokesperson said.
Whenever possible, "Restrictions to Level 3 should be at the unit or neighborhood level and not applied to an entire facility," according to a July 2020 policy note to SHA staff on family presence during a pandemic.
This chart shows a more detailed breakdown of the levels:
Two weeks after a level is changed, the local medical health officer will decide if the level of visitation can return to its prior, more permissive state.
At the private Providence Place care home in Moose Jaw, for example, the home recently reverted to Level 2 following a suspected outbreak, meaning "all residents are permitted one essential family/support person to provide in-person support for care and/or quality of life needs," as a note to family members last week stated.
Some care home's current compassionate visitation levels are listed on this provincial dashboard.
4. Visitors have to follow a long list of precautions
Nazeem Muhajarine, a professor of community health and epidemiology at the University of Saskatchewan, said the compassionate visitation system is reasonable, provided "care is taken to adhere to all the best practices of keeping oneself and others safe from getting the virus."
The FAQ and policy note set out a long list of precautions visitors must take before and while visiting care homes. These steps are required during all three restriction levels.
Visitors must complete a health screening before entering the building and, once inside, wear a mask.
If a resident requires more protection to be safe, "infection prevention and control processes will determine the type of PPE needed."
Visitors must wash their hands when entering or leaving the building or the resident's room — every time.
Since "it is likely that several residents and their designated essential family/support person will want to visit at the same time," homes need to stagger visits, the policy note stated.
Breaking the policy could cost SHA workers their jobs, the note added.
Providence Place went into even further specifics in its note to family members last week. The home requires visitors to bring ID, restrict themselves to their loved one's room (unless they want to go to the outdoor chapel courtyard) and show the results of their recent screening.
"[The] door attendant will review the date and time of completion and if it meets the criteria, you will be buzzed in to complete the check-in process," according to the home's note.
"Registered dogs/cats visitation may resume but can only visit your loved one."
5. The Saskatchewan NDP is concerned the rules aren't always being followed
Two days before Christmas, Matt Love, the NDP seniors critic, wrote the minister in charge of seniors, Everett Hindley, about concerns two Saskatchewan residents had about recent visitation practices at Tatagwa View Long Term Care Centre, a home operated by the SHA in Weyburn.
"Specifically, both individuals shared with me that managers at the facility are allowing anyone to visit residents and that visits are not being limited to compassionate end-of-life situations only," Love wrote. "If what has been shared with me is true, it must be brought to an end immediately."
As of Monday, Love had not heard back from Hindley, he said.
I think that seniors are very concerned when they see somebody or steady traffic or family members entering their building.- Matt Love, Saskatchewan NDP critic on issues affecting seniors
Love said his party has heard of other potential visitation breaches.
"That's a clear indication that the messaging is confusing," he said of the provincial government's communication of the rules. "We have had people write up and call us with these reports along with other MLAs. I think that seniors are very concerned when they see somebody or steady traffic or family members entering their building."
The SHA spokesperson said that no long-term care outbreaks from November onward have been linked to compassionate visitors.
Asked if the government has received complaints about the rules not being followed, the spokesperson said, "There have been questions received regarding the criteria for compassionate care family presence. Clarification has been provided that compassionate care family presence is not restricted to end of life family presence."
The Saskatchewan NDP's concern comes as 21 of the province's 35 long-term care outbreaks remain active, and after January proved to be the deadliest month overall for Saskatchewan COVID-19 deaths.
According to data shared by the province with CBC News, from the beginning of the pandemic in March 2020 to last Wednesday, one out of three COVID-19 deaths — 90 out of 274 — were among care home residents.
Muhajarine and Mathieson said compassionate visitors should be considered a priority vaccination group, as in other provinces. Saskatchewan's health ministry said last week that the province is reviewing its vaccine expansion plans.
In the meantime, Mathieson said she's making due with virtual visits with her mom. Elmview workers give Alice an iPad so that Mathieson can "prattle on and on about the old days."
"Sometimes you can see her reacting," Mathieson said of her mom. "It seems comforting to hear my voice."
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