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How Might We Bring Them Back

MYTH - Presence of Essential Care Partners increases infectious disease transmission.^[1]

FACT - Essential Care Partners often learn to conduct medical procedures at home such as suctioning and administering medications. They also learn to carry out infection prevention and control procedures. Essential Care Partners are often eager to participate in safety training ^[2,3] as they are invested in the health and safety of their loved ones and for themselves. Essential Care Partners do not play a significant role in transmission. ^[4,5] They can safely be present if infection prevention and control protocols such as masking and screening are in place.^[6-9]

Hôtel-Dieu Grace Hospital in Windsor has welcomed essential care partners since March 2020. More than750 people have gone through the orientation. Lisa is a Patient Advocate at HDGH and involved in setting up and running their Designated Care Partner program. Read Lisa’s story.

How Might We Bring Them Back

I wasn’t sure if I could even imagine it – no family presence or visitation.  How would this work? How will families trust their loved ones would be okay?  How will patients know they haven’t been abandoned?

How might we bring them back?

I placed myself in their shoes and all I could think about was the emotional distress this would create.

I began to frantically search for research, evidence and the “how to” for  supporting essential care partners to come into hospital, despite the pandemic. This was important.

I found white papers that spoke about the emotional harm people had experienced after the first SARS pandemic. This couldn’t happen again.

I phoned a friend who is an epidemiologist, asking for any information that would support the importance of care partners supporting their loved ones in hospital during the pandemic.

At the same time, my phone was ringing off the hook; family members were missing their loved ones, they were concerned and they were feeling left out. They repeatedly expressed how unfair they believed the restrictions were. They were concerned about their loved one not understanding the separation and feeling abandoned; worried about their loved one being alone; concerned about their care needs being unmet as they (care partners) had been assisting with care. They were feeling anxious and it was difficult not being present – feeling in the dark. I empathized. I provided encouragement as much as possible, to comfort and put their minds at ease. Despite my efforts, I don’t believe their minds were ever at rest.

I had read the term, “essential care provider” and used it whenever I could. One day, I must have said it to the right person at the right time. “Essential care provider”, they said. “I like that”. The door was open and I stepped inside. I further explained the role and how critical it was for essential care providers to be supporting their loved ones.

A few days later, I was part of a team that was writing a guidance document for visitation during COVID-19. We were on our way.

Our family presence policy, written before COVID-19 used the term “Designated Care Partner.”  This was chosen to reflect the patient’s choice as well as leaving the care and support provided, up to the patient and their care partner.

“How might we reintegrate designated care partners?” Asking staff and patients, both were equally afraid. How could we do this safely and without additional risk?

The answers included:

• Guidelines for health and safety, to ensure everyone was following all related site policies and public health measures
• Education and training for Designated Care Partners (DCPs)
• ID badge for DCPs
• Infection Prevention and Control (IPAC) education for DCPs
• Screening for safe entry and minimizing risk.

The DCP program was out of recognition that family and friends are integral to the patient’s care and healing. Family is defined by the patient and DCPs are trusted and valued members of the care team. DCPs are distinct from casual visitors because they know their loved one best and are uniquely familiar to subtle changes in their health or the way they feel.

The patient or substitute decision maker chooses the DCP. Once selected and the DCP commits to this role, they attend a 90 minute orientation.  This session includes a review of the DCP roles and responsibilities, guidelines for safe entry and IPAC education. DCPs learn about the value of their partnership and their role as a member of the care team; they are informed that their responsibilities mirror some of the same responsibilities as staff, and understand the risk of exposure to COVID-19 and are asked to be mindful of this risk when at home or in community.

The IPAC portion includes information and interactive activities on proper hand hygiene, virus transmission, how to wear a mask and face shield, donning and doffing personal protective equipment.

Unit social workers meet the DCPs at the end of the session as a warm welcome to the unit.

The in-person orientation sessions offer DCPs a chance to ask questions and is foundational to establishing an on-going relationship.

DCPS are partners in the journey with their loved one and the vision is for the DCP program to continue beyond the pandemic.

1. Guzzetta, Cathie. “Family presence during resuscitation and invasive procedures.” Critical Care Nurse 36, no. 1 (2016).
2. Toronto Region COVID-19 Hospital Operations Table. “Access to Hospitals for Visitors (Essential Care Partners): Guidance for Toronto Region Hospitals (Acute, Rehab, CCC) During the COVID-19 Pandemic.’ October 2020. https://www.oha.com/Documents/Access%20to%20Hospitals%20for%20Visitors%20-%20 Oct%206.pdf.
3. Alberta Health Service. “Community-based Service Resource Manual.” (2020), https://www. albertahealthservices.ca/assets/healthinfo/ipc/hi-ipc-community-based-services-resource-manual.pdf.
4. Munshi et al. 2021. The case for relaxing no-visitor policies in hospitals during the ongoing COVID-19 pandemic. CMAJ. The case for relaxing no-visitor policies in hospitals during the ongoing COVID-19 pandemic | CMAJ
5. Ontario Science Table. 2021. Impact of hospital visitor restrictions during the COVID-19 pandemic. Impact of Hospital Visitor Restrictions during the COVID-19 Pandemic - Ontario COVID-19 Science Advisory Table (covid19-sciencetable.ca)
6. Wee et al. 2021. Containment of COVID-19 and reduction in healthcare-associated respiratory viral infections through a multi-tiered infection control strategy. Containment of COVID-19 and reduction in healthcare-associated respiratory viral infections through a multi-tiered infection control strategy - ScienceDirect
7. Nguyen et al. 2021. IMPACT OF VISITATION AND COHORTING POLICIES TO SHIELD RESIDENTS FROM COVID-19 SPREAD IN CARE HOMES: AN AGENT-BASED MODEL: Controlling COVID-19 in care homes. IMPACT OF VISITATION AND COHORTING POLICIES TO SHIELD RESIDENTS FROM COVID-19 SPREAD IN CARE HOMES: AN AGENT-BASED MODEL: Controlling COVID-19 in care homes - ScienceDirect
8. Wee et al. 2020. The impact of visitor restrictions on health care-associated respiratory viral infections during the COVID-19 pandemic: Experience of a tertiary hospital in Singapore. The impact of visitor restrictions on health care-associated respiratory viral infections during the COVID-19 pandemic: Experience of a tertiary hospital in Singapore - American Journal of Infection Control (ajicjournal.org)
9. Passerelli et al. 2021. Asymptomatic COVID-19 in hospital visitors: The underestimated potential of viral shedding. Asymptomatic COVID-19 in hospital visitors: The underestimated potential of viral shedding - International Journal of Infectious Diseases (ijidonline.com)