Mount Hope Centre for Long Term Care
Our rich history of care
Mount Hope Centre for Long Term Care can trace its rich history of caring back to 1869 when the Sisters of St. Joseph founded the original Mount Hope. Today, the Centre (formerly St. Mary’s and Marian Villa) is a 394-bed home with residents representing a variety of cultures, beliefs, and ages. While creating a home-like environment, Mount Hope is known for providing comprehensive long term care. There is a personalized program for each resident, encouraging participation in varied activities such as art therapy, gardening, local trips and sports activities.
Due to direction from the Ontario Ministry of Health and Long-Term Care regarding ward rooms and resident capacity, our home is currently operating with a 375 bed capacity.
Philosophy of care
The philosophy of care is centered on the needs of the individual and focused on enhancing independence, choice and personal wellness for the residents who live at Mount Hope. Interdisciplinary teams work with residents to promote both individual well-being and positive group dynamics in this shared living environment.
Mount Hope's philosophy of care is built on the following principles:
- resident-focused care: emphasizing privacy and maximizing resident independence and choice;
- creating a home-like environment;
- providing opportunities for residents to enjoy activities they engaged in prior to moving to Mount Hope;
- encouraging residents to enjoy the out-of-doors and be involved in the community
*please note that the visiting guidelines outlined below also apply for visitors to our Veterans Care Program.
Mount Hope Centre for Long Term Care is responsible for supporting residents to safely receive visitors while mitigating the risk of exposure to infectious illnesses. Mount Hope Centre for Long Term Care will balance the need to promote safety and mitigate risks to residents, staff and visitors, with the mental, physical and spiritual needs of residents for their overall quality of life.
This policy was created with reference to the Guiding Principles (Appendix B) and provides guidance on facilitating access to essential caregivers as partners in care.
Essential caregivers are welcome at any time during the day. Quiet hours are from 10 pm to 7 am to promote a restful environment for the residents' well-being. Essential caregivers must consult with the registered staff for visiting arrangements during designated quiet hours.
The leadership team is responsible for outlining the specifics for essential caregiver presence based on the needs of the resident, space, and types of services being offered.
During declared outbreaks within the home, all visitors should consider their personal health and susceptibility to the virus in determining whether visiting the home is appropriate.
Purpose of policy
Mount Hope Centre for Long Term Care (Mount Hope) provides staff and families direction on visitor policies, and additional requirements that are required under the Fixing Long Term Care Act, (FLTCA), 2021. These requirements are in accordance with current legislation, regulations, standards and best practice guidelines. Mount Hope is responsible for implementing visiting practices that comply with any applicable directives, orders, guidance, advice or recommendations issued by the Chief Medical Officer of Health or a medical officer of health appointed under the Health Protection and Promotion Act. Mount Hope is responsible for establishing and implementing visiting practices that comply with the Fixing Long Term Care Act, 2021 and O. Reg 246/22, Sec 267.
At Mount Hope Centre for Long Term Care, families are care partners and play an important role in resident wellbeing, including through the social connections and emotional support that are crucial for optimal quality of life.
The options and responsibilities relating to each component of the Visitor Policy during the COVID pandemic are outlined below. These include social visits (virtual, indoor/outdoor, General visitors and care visits (support workers, caregivers, and essential visitors).
General visitors younger than 14 years of age must be accompanied by an adult and must follow all applicable public health measures that are in place at the home (for example, active screening, physical distancing, hand hygiene, masking for source control).
Essential caregivers can improve health outcomes, improve experience for residents, and team members, reduce risk of harm, and support culturally safe care. Including and supporting essential caregivers also benefits the care team by supporting team members in providing resident-centred care.
All residents (or their substitute decision-makers (SDM)) are empowered and encouraged to designate their essential caregivers.
Essential caregivers are provided education and training on key aspects of their role, including how they may choose to participate in care, and updated infection prevention and control protocols. The Essential Caregiver Program and Guidelines (Appendix C) will be shared with all designated essential caregivers.
Essential caregivers are documented (e.g., in the electronic health record, including their contact information, timing, and level of participation in various aspects of care.
Infection Prevention and Control Visiting Guidelines
Effective March 31, 2023, as outlined in the COVID-19 guidance document for long-term care homes in Ontario, the current visiting guidelines must be adhered to.
1. Outdoor visits
- Masking is not required when outdoors for residents, caregivers, or visitors, but remains encouraged as an added layer of protection against COVID-19. Staff, students and volunteers are required to wear a mask outdoors when in close proximity to a resident.
2. Indoor visits
- All visitors are required to wear a well-fitted medical mask, provided by the home, when visiting regardless of their COVID-19 vaccination status. These requirements also apply regardless of whether the home is in an outbreak or not. Children 2 and under are not required to wear a mask.
- The ministry continues to recommend, but does not require, essential caregivers and visitors to wear masks when they are alone with a resident in their room. When not in a one-on-one setting with a resident in their room visitors and essential caregivers are required to be masked.
- Indoor visitors are required to complete passive screening for any signs or symptoms of illness.
Note: Removal of masks for the purposes of eating or drinking should be restricted to areas designated by the home, which may include a resident’s room.
3. Restrictions during outbreaks or when resident is isolating
- In the case where a resident is symptomatic or isolating under droplet and contact precautions, essential visitors are the only type of visitor allowed. An essential visitor is defined in the FLTCA, 2021 as a caregiver, a support worker who visits a home to provide support to the critical operations of the home or to provide essential services to residents, a person visiting a very ill resident for compassionate reasons including, but not limited to, hospice services or end-of-life care, or a government inspector with a statutory right to enter a long-term care home to carry out their duties.
- In the case where a resident resides in an area of a home that is in an outbreak, as declared by the local public health unit, permitted Mount Hope continues to be subject to public health direction as it relates to visitors and any restrictions that may apply.
- In the case where Public Health Ontario, Middlesex-London Heath Unit or St. Joseph’s Infection Control directs the home in respect to the number of visitors allowed, the home is to follow this direction.
4. Designating an Essential Caregiver
- The decision to designate an individual as an essential caregiver is the responsibility of the resident/SDM, not the home. The designation of an essential caregiver should be made in writing to the home.
- Refer to the Designated Essential Caregiver Program Information package(Appendix A)
- Homes should have a procedure for documenting caregiver designations.
- Essential caregivers must be designated and must be at least 16 years of age.
- If there is a request to designate an individual as a caregiver under the age of 16, approval from a parent or legal guardian is required.
- There are no limits on the number of designated essential care partners a resident may have.
- Note: During an outbreak, Public Health Ontario, Middlesex-London Health Unit, and/ or St. Joseph’s Infection Control will provide direction on essential visitors within the home, depending on the specific situation.
- All required education and Infection Prevention and Control education is required to maintain designated essential caregiver status.
- Essential caregivers must wear an approved badge/ sticker while on site to identify and formally recognize the essential caregiver across the care team.
- A resident/SDM may change a designation in response to a change in the:
- resident’s care needs that is reflected in the plan of care.
- availability of a designated essential caregiver, either temporary (for example, illness) or permanent.
5. Essential Caregivers – scheduling, length and frequency of visits
- Homes may not require scheduling or restrict the length or frequency of visits by essential caregivers. However, in the case where a resident resides in an area of the home in outbreak, is symptomatic or isolating under additional precautions, restrictions may apply. Refer to section Restrictions during outbreaks or when resident is isolating.
6. Visitor Log Requirements
- As per O. Reg 246/22 Sec 267 (2), Mount Hope is required to maintain a visitor log for a minimum of 30 days, which include the following at a minimum:
- the name and contact information of the visitor
- the time and date of the visit
- the name of the resident visited
- All visitors to Mount Hope are required to sign in and sign out of the log book located at the main entrance of the home when visiting. This information has the additional benefit that in the event of an emergency evacuation a list of visitors and locations would be available.
7. Visitor expectations
- Register upon arrival at the home by filling out the visitor log.
- Follow established infection control measures including wearing the provided personal protective equipment (PPE), performing hand hygiene as directed, practicing safe physical distancing from other residents and staff if required, and respiratory etiquette (coughing and sneezing safely).
- If an individual wants to be designated as an essential caregiver, prior to designation, it will be mandatory for all essential caregivers to complete educational training on the following:
- Prior to designation as an essential caregiver, it will be mandatory for all caregivers to complete educational training on the following:
- Infection Control practices, physical distancing, PPE use, respiratory etiquette, hand hygiene, etc.
- Read, understand and agree to the Essential Caregiver Guidelines and Education Requirements (Appendix C).
- Encouraged to remain up to date with all recommended dose guidelines for COVID-19 vaccinations and obtain seasonal Influenza vaccination to protect the vulnerable population we serve.
- Agree to follow any asymptomatic testing (rapid testing) if directed by the home, ministry or public health officials.
- Follow the symptom monitoring and management guidelines listed below.
8. Symptom Monitoring and Management
- All individuals visiting Mount Hope must complete passive screening before visiting (review screening questions to ensure you are feeling well and not experiencing any signs or symptoms of illness.
- If you are displaying any signs or symptoms associated with a respiratory illness (i.e. fever, cough, runny nose, hoarse voice, sneezing) all visitors are encouraged to rule out COVID-19. If unable to confirm the illness is not COVID-19, visitors must remain away from the home for 10 days (day of onset of symptoms or positive COVID test is considered day 0) to protect the vulnerable population that we server.
- If a visitor can rule out COVID-19 for respiratory illness, visitors must stay away from the home until after 24 hours being symptom free.
- In the event a visitor has been experiencing gastrointestinal illness (vomiting and/ or diarrhea) you must remain away from the home for 48 hours after your last symptom was experienced.
9. Responding to Non-Adherence by Visitors:
- The home will provide ongoing strategies and communication related to understanding and adhering to the home’s visitor policy.
- If a visitor is observed to be non-compliant with policy during a visit, the visitors will be approached by a staff member and expectations communicated, e.g. wearing PPE properly.
- Education and coaching will be provided to explain the rationale and consequences to the resident/ staff/visitor as a result of the action.
- If the violation is severe or ongoing, visits will be temporarily suspended and a meeting/ teleconference will be scheduled to discuss the concern.
- Re-education will be required by the visitor prior to any visits resuming in an effort to protect residents, staff and visitors in the home.
- If necessary, consultation with Residents’ Council and Family Council representatives will occur for input on addressing non-adherence by visitors while respecting privacy.
10. Ending a Visit
- The home has the discretion to end a visit by any visitor who repeatedly fails to adhere to the home’s visitor policy provided:
- The home has explained the applicable requirement(s) to the visitor;
- The visitor has the resources to adhere to the requirement(s) (e.g., there is sufficient space to visit, the home has supplied the PPE and demonstrated how to correctly put on PPE, etc.); and
- The visitor has been given sufficient time to adhere to the requirements.
- Homes should document when they have ended a visit due to non-adherence.
11. Temporarily Prohibiting a Visitor
- Homes have the discretion to temporarily prohibit a visitor in response to repeated and flagrant non-adherence with the home’s visitor policy. In exercising this discretion, homes should consider whether the non-adherence:
- Can be resolved successfully by explaining and demonstrating how the visitor can adhere to the requirements.
- Is within requirements that align with instruction from the Ministry of Long-Term Care and guidance in this policy and negatively impacts the health and safety of residents, staff and other visitors in the home.
- Is demonstrated continuously by the visitor over multiple visits.
- Is by a visitor whose previous visits have been ended by the home.
- Any decision to temporarily prohibit a visitor should:
- Be made only after all other reasonable efforts to maintain safety during visits have been exhausted;
- Stipulate a reasonable length of the prohibition;
- Clearly identify what requirements the visitor should meet before visits may be resumed (e.g., reviewing the home’s visitor policy, reviewing specific Public Health Ontario resources, etc.) and
- Be documented by the home.
- Where the home has temporarily prohibited visits, an essential caregiver, the resident/SDM may need to designate an alternate individual as an essential caregiver to help meet the resident’s care needs.
12. Appeal Process for Residents, Families and Caregivers:
- In the event that a resident/SDM and/or essential caregiver disagree with a determination of the clinical team’s decision to remove or decline access the following process will be followed:
- Resident/SDM or essential caregiver to submit a written letter outlining the disagreement to a decision to any member of the leadership team or Patient Relations, Privacy and Risk who will provide guidance.
- The notice will go to the Executive Director to review the details of the concern and make every attempt to rectify the concern. The Executive Director may include the Medical Director, Family Council representative, Resident Council representative as resources to support solution finding and decision making.
- If no resolution is found, the Vice President, Patient Care & Risk Management of St. Joseph’s Health Care London, will make the final determination regarding the concern and communicate to all the parties involved.
Essential Caregiver – An essential caregiver is a person identified and designated by the patient/resident – family member, friend, neighbour - who provides important personal, social, psychological and/or physical support, assistance and care, usually without pay, for people in need of support due to frailty, illness, degenerative disease, disability, or end of life circumstances. An essential caregiver does not have to be living with the person they are supporting. They do not have to be biologically related to the patient; can provide support and care for short periods of time (e.g., days) or for extended periods of time (e.g., years)
As outlined in the Fixing Long-Term Care Act, 2021 and O. Reg 246/22 section 267 (4), the types of essential visitors within long-term care are as follows:
“essential visitor” means,
(a) a caregiver,
(b) a support worker who visits a home to provide support to the critical operations of the home or to provide essential services to residents,
(c) a person visiting a very ill resident for compassionate reasons including, but not limited to, hospice services or end-of-life care, or
(d) a government inspector with a statutory right to enter a long-term care home to carry out their duties.
Not Considered Visitors:
- Long-term care home staff (as defined under the Act)
- Volunteers and student as their access to the home is determined by the licensee.
- Infants under the age of one are also not considered visitors and are excluded from testing requirements.
There are four types of essential visitors:
- People visiting very ill or palliative residents who are receiving end-of-life care for compassionate reasons, hospice services, etc.
- Government inspectors with a statutory right of entry. Government inspectors who have a statutory right to enter long-term care homes to carry out their duties must be granted access to a home in accordance with the applicable legislation. Examples of government inspectors include inspectors under the Fixing Long-Term Care Act, 2021 and O. Reg 246/22 section 267 (4) the Health Protection and Promotion Act, the Electricity Act, 1998, the Technical Standards and Safety Act, 2000, and the Occupational Health and Safety Act.
- Support workers: support workers are persons who visit a home to provide support to the critical operations of the home or to provide essential services to residents. Essential services provided by support workers include but are not limited to:
- Assessment, diagnostic, intervention/rehabilitation, and counselling services for residents by regulated health professionals such as physicians and nurse practitioners
- Assistive Devices Program vendors –- for example, home oxygen therapy vendors
- Moving a resident in or out of a home
- Social work services
- Legal services
- Post-mortem services
- Emergency services (for example, such as those provided by first responders)
- Maintenance services such as those required to ensure the structural integrity of the home and the functionality of the home’s operational systems such as Heating, Cooling and Ventilation (HVAC), mechanical, electrical, plumbing and telecommunication systems, and services related to exterior grounds and winter property maintenance, including septic and well water system maintenance
- Food/nutrition and water/drink delivery
- Canada Post mail services and other courier services
- Election officials/workers
- Caregivers: A caregiver is defined in the Fixing Long-Term Care Act, 2021, O. Reg 246/22 section (4) as follows:
(a) is a family member or friend of a resident or a person of importance to a resident,
(b) is able to comply with all applicable laws including any applicable directives, orders, guidance, advice or recommendations issued by the Chief Medical Officer of Health or a medical officer of health appointed under the Health Protection and Promotion Act,
(c) provides one or more forms of support or assistance to meet the needs of the resident, including providing direct physical support such as activities of daily living or providing social, spiritual or emotional support, whether on a paid or unpaid basis,
(d) is designated by the resident or the resident’s substitute decision-maker with authority to give that designation, if any, and
(e) in the case of an individual under 16 years of age, has approval from a parent or legal guardian to be designated as a caregiver.
Examples of direct care provided by caregivers include but are not limited to the following:
- Supporting activities of daily living such as bathing, dressing, and eating assistance.
- Assisting with mobility
- Assisting with personal hygiene
- Providing cognitive stimulation
- Fostering successful communication
- Providing meaningful connection and emotional support
- Offering relational continuity assistance in decision-making
Whether a caregiver is paid for services is not a condition in meeting the criteria of the definition of caregiver as set out above. An important role of the caregiver is that of providing meaningful connection and emotional support. A person should not be excluded from being designated as a caregiver if they are unable to provide direct physical support.
General Visitors - means a person who is not an essential visitor and is visiting the home to provide non-essential services related to either the operations of the home or a particular resident or group of residents. This excludes children under the age of one.
There are two broad categories of general visitors:
- visitors providing non-essential services which include but are not limited to:
- personal care service providers (for example, hairdressers, barbers, manicurists, etc.)
- entertainers (singers, musicians, etc.)
- recreational service providers
- animal handlers (for example, as part of therapy animal program)
- individuals who are touring the home to inform decisions regarding application for admission
- persons visiting for social reasons that the resident or their substitute decision-maker assess as different from “direct care” as described in the section on caregivers
General visitors are not permitted:
- when a home or area of a home is in outbreak
- to visit an isolating resident
- when the local public health unit so directs
General visitors younger than 14 years of age must be accompanied by an adult (someone who is 18 years of age or older) and must follow all applicable public health measures that are in place at the home (for example, active screening, physical distancing, hand hygiene, masking for source control).
Substitute Decision-Maker (SDM) – As defined by the Health Care Consent Act, 1996 (HCCA) is a person who is authorized to give or refuse consent to a treatment on behalf of a person who is incapable. The SDM must be capable, willing and available. The SDM must make a decision that is consistent with the patient/client/resident's previously expressed wishes and values. In the absence of previously expressed wishes the SDM must follow the principle of best interest. If a person is incapable with respect to a treatment, consent may be given or refused on his or her behalf by a person described in one of the following:
- The incapable person’s guardian of the person, if the guardian has authority to give or refuse consent to the treatment.
- The incapable person’s attorney for personal care, if the power of attorney confers authority to give or refuse consent to the treatment.
- The incapable person’s representative appointed by the Board under section 33, if the representative has authority to give or refuse consent to the treatment.
- The incapable person’s spouse or partner.
- A child or parent of the incapable person, or a children’s aid society or other person who is lawfully entitled to give or refuse consent to the treatment in the place of the parent. This paragraph does not include a parent who has only a right of access. If a children’s aid society or other person is lawfully entitled to give or refuse consent to the treatment in the place of the parent, this paragraph does not include the parent.
- A parent of the incapable person who has only a right of access.
- A brother or sister of the incapable person.
- Any other relative of the incapable person.
- If two or more persons who are described above and who meet the requirements disagree about whether to give or refuse consent, and if their claims rank ahead of all others, the Public Guardian and Trustee (PGT) shall make the decision in their stead.
- If no person described above meets the requirements, the PGT shall make the decision
Related Corporate Policies/Procedures
Essential Caregiver Presence and Visitor Restrictions
Government of Ontario (1990) Health Protection and Promotion Act, 1990
Government of Ontario (1990) Occupational Health and Safety Act, 1990
Government of Ontario (1998) Electricity Act, 1998
Government of Ontario (2000) Technical Standards and Safety Act, 2000
Government of Ontario (2021) Fixing Long-Term Care Act, 2021
Government of Ontario (2021) Fixing Long-Term Care Act, 2021, O. Reg 246/22, Sec 267, 2022
St. Joseph’s COVID-19 guidance document for long-term care homes in Ontario, April 2023
Designated Essential Caregiver Program Information Package
St. Joseph’s Guiding Principles for Visitor Policy
Under the Fixing Long-Term Care Act, 2021, residents have a right to receive visitors.
There is an ongoing need to protect long-term care home residents and staff from the risk of infections, including COVID-19, particularly as residents are more susceptible to infection from COVID-19 than the general population due to their age and medical conditions.
At Mount Hope we prioritize the mental and emotional well-being of residents and strive to be as accommodating as possible when scheduling visits with general visitors. The following guiding principles will inform decision making:
Safety - Any approach to visiting a long-term care home must consider, balance, and meet the health and safety needs of residents, staff, and visitors to ensure risks are mitigated.
Emotional Well-Being - Welcoming visitors is intended to support the mental and emotional well-being of residents by reducing any potential negative impacts related to social isolation.
Equitable Access - All residents must be given equitable access to receive visitors, consistent with their preferences and within reasonable restrictions that safeguard residents.
Flexibility -The physical/infrastructure characteristics of the home, its workforce/human resources availability, whether the home is in an outbreak and the current status of the home with respect to personal protective equipment (PPE) are all variables to consider when setting home-specific policies.
Equality - Residents have the right to choose their visitors. In addition, residents and/or substitute decision makers have the right to designate essential caregivers.
Alignment with St. Joseph’s Healthcare London (St. Joseph’s) Guiding Principles
- Mission, vision and values of St. Joseph’s
- Safety and well-being are top priorities for patients/residents, essential caregivers and staff
- Recognition of the value and importance of care partnership with essential caregivers
- Equitable treatment for all patients, residents, visitors and essential caregivers
- Respect and adherence to local/regional guidance and government directives
- Proactive, transparent, and accessible communication with patients/residents, staff, visitors and essential caregivers -Ongoing monitoring and evaluation of essential caregiver presence and visitor restrictions policy as COVID-19 evolves and modify accordingly
- Ongoing support for patients/residents to maintain meaningful connections with family and caregivers using virtual technology, telephone calls, window visits, etc.
- Consistent and collaborative process and procedures
St. Joseph’s Essential Caregiver Guidelines and Education Requirements
St. Joseph’s Essential Caregiver Attestation Form
Review our Caregiver and Visitor Presence information.
Emergency Preparedness Plans
We have emergency plans in place that comply with regulatory requirements at St. Joseph’s Health Care London which includes Mount Hope Centre for Long Term Care. This includes measures for preparing and managing emergencies such as pandemics, and procedures for evacuation and relocation of residents and staff in the event of an emergency.
View our Emergency Preparedness resources.
Mount Hope Centre for Long Term Care is fully air conditioned in both the St. Mary’s building and the Marian Villa building.
Continuous Quality Improvement Initiative
Mount Hope Centre for Long Term Care values and strives for continuous quality improvement. Our team works collaboratively with residents, families and caregivers to improve our quality of care and services for those we serve.
View our Continuous Quality Initiative Report - Interim