Current Vaccination Rates and Policies as well as Essential Family Caregiver and Visitor Policies across Canadian Long-Term Care Homes

Cameron Feil, MSc, Research Coordinator, National Institute on Ageing

Natalie Iciaszczyk, MA, JD, Policy Analyst, National Institute on Ageing 

Samir Sinha, MD, DPhil, Director of Health Policy, National Institute on Ageing

Since the start of the COVID-19 pandemic – Canada’s Long-Term Care (LTC) and Retirement Homes have represented 55% of Canada’s COVID-19 deaths that mostly occurred during its first two waves.[1] Residents, staff, and in a select province’s essential family caregiver (EFCs) were among the first groups to be offered a COVID-19 vaccine. Since beginning to vaccinate these groups on December 14, 2021, COVID-19 outbreaks, infections, and deaths have rapidly declined in LTC settings during Canada’s third and fourth pandemic waves. For example, 2601 (43%) of Canada’s 6029 LTC and retirement homes had experienced a COVID-19 outbreak during the first two pandemic waves (March 2020 to February 2021). Since then, only an additional 353 (5.8%) LTC homes have experienced outbreaks as of October 18, 2021. Currently 52% of Canada’s LTC outbreaks are in the province of Alberta. Regardless, the significant drop off of outbreaks, cases and deaths between the first and fourth waves can be primarily attributed to the profound impact of COVID-19 vaccines in these settings. 

LTC vaccination, essential family caregiver and general visitor policies have continued to evolve over the past few months since the National Institute on Ageing published its After the Shot: Guidance Supporting the Re-opening of Canada’s LTC Homes Following COVID-19 Vaccination in June 2021. This report identified several enabling characteristics and guiding principles LTC homes could adopt to enable their safe re-opening. This analysis builds on the release of the After the Shot report by conducting an updated scan of Canadian jurisdictions for their most recent LTC vaccination, essential family caregiver and visitor policies and guidelines that continue to properly balance the risks of COVID-19 with the overall health and well-being of Canadian LTC residents. 

Current Vaccination Rates and Policies

Canada currently has achieved some of the highest population vaccination rates in the world, as 87% of its eligible population has received at least one dose of a COVID-19 vaccine, while 82% are fully vaccinated against COVID-19, as of data from October 9 2021.[2] Long term care homes have been the epicenter of the impacts of COVID-19, with a large number of deaths occurring amongst residents in these settings. However, COVID-19 vaccinations have had a great impact on reducing hospitalizations and deaths amongst these populations. As of April 24, 2021, more than 96.68% of LTC residents had received at least one dose of a COVID-19 vaccine.[3] More recently it has been reported that in Ontario and other jurisdictions, that 99% of residents have been fully vaccinated against COVID-19.

While residents have shown little hesitancy towards getting the vaccines, staff vaccination uptake has varied across provinces.[4] For example, the Ontario government noted that 90% of staff have received at least one dose of a COVID-19 vaccine. However, 44% of LTC homes have staff vaccination rates below 90%, and that approximately one in every six homes have rates below 80%.[5],[6] The persistence of low staff vaccination rates in a minority of LTC homes across Canada has led several provinces to introducing vaccination mandates for their LTC staff, including British Columbia, Alberta, Manitoba, Quebec, and Nova Scotia.[7],[8],[9],[10] Meanwhile, Ontario and Prince Edward Island have adopted a ‘vaccinate or test’ approach, which requires that LTC staff either be fully vaccinated or take a COVID-19 test before every working day.[11],[12] Moreover, British Columbia and Nova Scotia also recently mandated that all visitors, including EFCs, must be fully vaccinated before entering a LTC home.[13],[14] Thesedecisions have largely been prompted by a growing number of homes that are now experiencing COVID-19 outbreaks during a fourth wave driven principally by the more transmissible and virulent delta variant of the SARS-Cov-2 virus.

On September 28, 2021, he National Advisory Community on Immunization (NACI) determined that there was now a need to recommend booster shots as emerging evidence has demonstrated that LTC residents and older adults living in other congregate care settings may experience both waning antibodies and vaccine protection over time.[15] It also cited LTC residents’ frequent interactions with visitors and staff as key reasons behind this recommendation.[16] As of October 19, 2021, ten of Canada’s 13 provinces and territories have announced that they plan to administer a third dose of COVID-19 vaccines to their LTC residents, with only Manitoba, Newfoundland and Labrador, and Nunavut having yet to announce such plans.[17], [18], [19], [20], [21],[22], [23], [24], [25],[26]

Current Essential Family Caregiver and Visitor Policies

With respect to essential family caregivers (EFCs) in LTC settings, Alberta, Saskatchewan, Ontario, Newfoundland, and Nova Scotia currently no longer restrict  visiting frequency or duration for EFCs. Two provinces, New Brunswick and Prince Edward Island (PEI) only impose restrictions based on vaccination rates. New Brunswick restricts EFC visits if they are unvaccinated. PEI restricts EFC visits if less than 85% of the residents in a LTC home are not fully vaccinated. 

British Columbia, Manitoba, the Yukon, Northwest Territories, and Quebec permit EFCs to visit LTC residents with certain limitations. British Columbia and Manitoba do not restrict EFCs from visiting LTC homes, however,only one may visit at a time. Yukon follows a similar approach, allowing residents to identify up to four EFCss, up to two of which can visit at a time.  Similarly, the Northwest Territories allows residents to designate two EFCs, one of which may visit at a time. Quebec currently allows EFCs to visit depending on a resident’s vaccination status. Fully vaccinated residents may visit EFCs indoors and are not required to remain physically distant and wear a mask.  While unvaccinated residents are only permitted to visit their EFCs outdoors, and must maintain physical distance and wear masks during their visits. 

With respect to visitors in LTC settings, all 13 of Canada’s provinces and territories, with the exception of the Northwest Territories, currently permit general visitors to visit with residents in their LTC homes. However, of the 12 jurisdictions permitting general visitors, only two provinces—Manitoba and New Brunswick—have implemented mandatory vaccination policies for general visitors. The ten remaining jurisdictions either strongly recommend vaccination for general visitors or make no mention of it in their directives. 

Many provinces across Canada have also lifted restrictions on the number of general visitors permitted to visit with a resident at a given time. Specifically, six jurisdictions—Alberta, British Columbia, Saskatchewan, Ontario, Newfoundland and Labrador, and Nova Scotia—no longer impose any specific limits on the number of general visitors permitted to visit with a resident at a time, while Prince Edward Island also does not limit the number of general visitors if a home has achieved and maintains an 85% vaccination rate amongst its residents. On the other hand, Manitoba, New Brunswick, Nunavut, Yukon, and Quebec, continue to limit the number of general visitors permitted to visit with a resident at a given time. Among these jurisdictions, Quebec and Yukon have the least restrictive policies, allowing up to 9 or 6 general visitors at once, respectively. Manitoba permits up to two general visitors if the resident is vaccinated, while New Brunswick permits one general visitor at a time, and in both provinces, general visitors must show proof of vaccination. In Nunavut, each resident can have two visitors at a time, but they must be members of their immediate family.

In terms of safety precautions for visitors, Manitoba, Nova Scotia, New Brunswick, Newfoundland and Labrador, Nunavut, Ontario, and Yukon require general visitors to wear masks when inside a LTC home, regardless of their vaccination status. On the other hand, in Saskatchewan and Alberta, even if unvaccinated, general visitors are not required to wear a mask or when around the resident. British Columbia, Prince Edward Island, and Quebec have loosened their masking requirements depending on a resident’s vaccination status. Specifically, in British Columbia, fully vaccinated general visitors are permitted to remove their masks when in direct contact with the resident, while in Quebec, fully vaccinated general visitors are allowed to remove their masks when inside the room of the resident they are visiting with. In Prince Edward Island, if both the resident and visitor are fully vaccinated, then masks are not required when in the resident’s room and physical distance can be maintained from others. On the other hand, if either the visitor or resident are not vaccinated, then masks must be worn at all times during indoor visits.

References to Canadian Provincial and Territorial Directives: 

[1] National Institute on Ageing. (2021). Long-Term Care COVID-19 Tracker. Retrieved: https://ltc-covid19-tracker.ca/

[2] Government of Canada. (2021). Canada COVID-19 Vaccination Rates. Retrieved: https://health-infobase.canada.ca/covid-19/vaccination-coverage/

[3] Ibid. 

[4] Sinha S, Feil C and Iciaszczyk N. (2021). The rollout of the COVID-19 vaccines in care homes in Canada as of March 19, 2021. Article in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE.

[5] Ontario. (2021). Ontario Taking Additional Steps to Protect Long-Term Care Home Residents. Retrieved: Ontario Taking Additional Steps to Protect Long-Term Care Home Residents. Retrieved: https://news.ontario.ca/en/release/1000917/ontario-taking-additional-steps-to-protect-long-term-care-home-residents

[6] DeCleq, Katherine. (2021). Ontario makes it mandatory for long-term care staff, volunteers to be fully vaccinated against COVID-19 by Nov. 15. Retrieved: https://toronto.ctvnews.ca/ontario-makes-it-mandatory-for-long-term-care-staff-volunteers-to-be-fully-vaccinated-against-covid-19-by-nov-15-1.5607655

[7] British Columbia. (2021).Plans further protect people living, working in long-term care. Retrieved: https://news.gov.bc.ca/releases/2021HLTH0150-001598

[8] Alberta. (2021). Alberta Health Services implementing immunization policy for physicians, staff and contracted providers. Retrieved: https://www.albertahealthservices.ca/news/Page16165.aspx

[9] Arsenault, Mike. (2021). Manitoba’s COVID-19 vaccine mandate for teachers and school staff raising questions. Retrieved: https://winnipeg.ctvnews.ca/manitoba-s-covid-19-vaccine-mandate-for-teachers-and-school-staff-raising-questions-1.5578177

[10] Nova Scotia. (2021). Vaccination Mandates. Retrieved: ??https://novascotia.ca/news/release/?id=20210929007

[11] CBC News. (2021).  P.E.I. to implement ‘vaccinate-or-test’ policy, introduce ‘Vax Pass’

Social Sharing. Retrieved: https://www.cbc.ca/news/canada/prince-edward-island/pei-covid-update-september-21-1.6183698#:~:text=A%20vaccinate%2Dor%2Dtest%20policy,public%20spaces%20in%20early%20October .

[12]The Canadian Press. (2021). Ontario LTC minister defends shot-or-test policy as companies mandate COVID. Retrieved: vaccines https://www.cbc.ca/news/canada/toronto/ontario-long-term-care-covid-vaccines-1.6156039   

[13] British Columbia Centers for Disease Control.(2021).  Long-term Care Facilities and Assisted Living. Retrieved: http://www.bccdc.ca/health-professionals/clinical-resources/covid-19-care/clinical-care/long-term-care-facilities-assisted-living

[14] April, Allan. (2021). Nova Scotia Health to require proof of vaccine for hospital visitors. Retrieved: https://atlantic.ctvnews.ca/nova-scotia-health-to-require-proof-of-vaccine-for-hospital-visitors-1.5614578

[15] NACI. NACI rapid response: Booster dose in long-term care residents and seniors living in other congregate settings. September 28, 2021. Retrieved from: https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/statement-september-28-2021-booster-dose-long-term-care-residents-seniors-living-other-congregate-settings.html

[16] NACI. (2021). NACI rapid response: Booster dose in long-term care residents and seniors living in other congregate settings. Retrieved: https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/statement-september-28-2021-booster-dose-long-term-care-residents-seniors-living-other-congregate-settings.html

[17] Yukon. (2021). COVID-19 booster doses being provided to long-term care residents. Yukon News release #: 21-371. Retrieved from: https://yukon.ca/en/news/covid-19-booster-doses-being-provided-long-term-care-residents

[18] CBC News. (2021). N.S. reveals plans for 3rd COVID-19 doses, mask mandate to continue under Phase 5. Retrieved from: https://www.cbc.ca/news/canada/nova-scotia/covid-19-update-september-29-2021-1.6193466

[19] CTV News. (2021). P.E.I. reports one new COVID-10 case Tuesday; first day of Vax Pass. Retrieved from: https://atlantic.ctvnews.ca/p-e-i-reports-one-new-covid-19-case-tuesday-first-day-of-vax-pass-1.5611583

[20] Cook, Stephen. (2021). Bookings for COVID-19 boosters jump as seniors in Alberta eligible for 3rd dose. Retrieved from: https://www.cbc.ca/news/canada/edmonton/alberta-covid-19-vaccine-booster-1.6203829

[21] Wong, Denise. (2021). COVID-19 vaccine booster doses coming to British Columbians in long-term care. Retrieved: https://www.citynews1130.com/2021/09/28/bc-covid-19-vaccine-doses/

[22] Pruys, Sarah. (2021).Third doses for the NWT’s immunocompromised starting soon. Retrieved from: https://cabinradio.ca/73048/news/health/third-doses-for-the-nwts-immunocompromised-starting-soon/

[23] Saskatchewan. (2021). COVID-19 Vaccination Boosters Starting September 7. Retrieved from: https://www.saskatchewan.ca/government/news-and-media/2021/august/30/covid-19-vaccination-boosters-starting-september-7

[24] Government of Ontario. (2021). Expanded Eligibility for Third Doses of the COVID-19 Vaccine. Retrieved from: https://news.ontario.ca/en/backgrounder/1000805/expanded-eligibility-for-third-doses-of-the-covid-19-vaccine

[25] Caruso-Moro, Luca. (2021). Quebecers with compromised immune systems can now get a third dose of a COVID-19 vaccine. Retrieved from: https://montreal.ctvnews.ca/quebecers-with-compromised-immune-systems-can-now-get-a-third-dose-of-a-covid-19-vaccine-1.5566890

[26] Van Horne, Ryan. (2021). N.B. to offer booster shots to seniors in nursing homes; reports 84 new COVID-19 cases and one. Retrieved from: https://atlantic.ctvnews.ca/n-b-to-offer-booster-shots-to-seniors-in-nursing-homes-reports-84-new-covid-19-cases-and-one-death-1.5605398  

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