Table 2.

Recommended Visitor Policy and Access for “General Visitors”

Domain	Recommended Policy
1. Number of allowable visitors at one time	• Outdoors: similar to guidance from the Saskatchewan Health Authority, outdoor visits can include more than one visitor at a time, provided that physical distancing can be maintained. Additionally, family members from the same household and/or bubble should not have to physically distance from one another.
	• Indoors: one visitor per resident in the home at a time. Similar to guidance from the British Columbia Centre for Disease Control, a visitor who is a child may be accompanied by one parent, guardian or family member.37
2. Allowable locations of visits and access during an outbreak	• Outdoor visits should be prioritized, when possible and feasible, to both minimize the risk of COVID-19 transmission and to maximize the number of possible visitors. Provinces like Manitoba plan to construct outdoor, all-season visiting shelters.38 • When outdoor visits are not feasible for either the resident or the visitor (e.g. for cognitive, psychiatric or physical reasons), the home must provide an indoor alternative which provides ample open space for physical distancing and adequate ventilation. • Exceptional circumstances may sometimes necessitate the visitor meeting the resident in their room, but this should be a last resort if none of the previously noted alternative options are deemed feasible.
3. Allowable access during a COVID-19 outbreak	• If the home goes into COVID-19 outbreak status, general visits may need to be temporarily suspended (if advised by the local public health authority), but if the outbreak does not involve the entire home, consideration should be given to suspending visits only on the floor or unit under outbreak. Virtual visits must be upscaled during suspensions of in-persons visits.
4. Allowable frequency and length of time for visits	• As per the Ontario Ministry of Long-Term Care, visits should be at least 60 minutes/visit and residents should have access to visitors at a minimum of once per week.39
5. Screening and testing requirements	• Visitors must pass an active screening questionnaire (which may include an on-site temperature check) but there should be no requirement for COVID-19 testing for outdoor and physically distanced visits. If exceptional circumstances necessitate a visitor entering the resident’s room, they should be subject to the same screening and testing requirements as family caregivers.
6. IPAC and PPE requirements	• Visitors must remain masked (cloth or surgical/procedure for outdoor visits and surgical/procedure for indoor visits) at all times and maintain at least 2 metres of physical distance from the resident they are visiting. Visitors should be encouraged to bring their own cloth masks for outdoor visits, but appearing without a mask should not be a barrier to visiting.
	• If masking of visitors causes distress to the resident (e.g. for cognitive or mental health reasons) or poses difficulties with either recognizing (e.g. cognitive impairment) or understanding the resident (e.g. hearing-impaired residents who rely on lipreading) a face shield which wraps around the chin or a transparent mask can be considered as alternatives.
	• Consideration may be given to allowing brief hugs and handholding while maintaining as much distance as possible between the faces of the resident and visitor, and ensuring the availability of alcohol-based hand sanitizer for prompt and effective hand hygiene both immediately before and after these encounters.40
	• Homes must maintain ample PPE supply to enable resident visits.
	• Failure of visitors to comply with procedures could be grounds for a loss of visiting rights, which should be appealable.
7. Accommodations for visitors while on-site at the nursing home	• Visitors must have access to bathrooms (an accessible outdoor sheltered bathroom or designated indoor bathroom). • Outdoor visiting must occur in weather protected settings (e.g. a shaded area with hydration for hot weather, a sheltered area for rain, or a heated area for colder weather).
8. End-of-life considerations	• Residents designated as being “critically ill” or at “end-of-life” (<14-day life expectancy) should be provided with the same level of access that would be rendered to a family caregiver. If visitors need to enter the home under these circumstances, they should be subject to the same conditions and procedures as “family caregivers”.