Designated Support vs. Visitor

A designated support person:

• Is a consistent individual identified by the patient as an essential support
• Is someone the patient wants involved in their care and health matters
• Is at least 18 years of age for pediatric patients and 14 years of age for adult patients
• Can be a relative, close friend, or an informal or hired caregiver
• Should be included as much as the patient/alternate decision maker requests for palliative and end-of-life care, critical care, life threatening diagnosis disclosure or as requested by the care team
• Can support patients with suspected/confirmed COVID-19 but must pre-book access with the service area and their visitation be approved by and under the direction of the Infection Prevention and Control team
• Cannot be on isolation or quarantine, for suspected or confirmed COVID-19 unless meeting the criteria of an exemption (see below)
• Will need to work with the patient’s care team to determine when the best time is for them to come to the site

A visitor is anyone not identified as a designated support person and is currently limited in acute care settings to:

• Individuals that have received government approved compassionate exemptions
• Individuals visiting patients at end-of-life including faith/religious leaders, elders/helpers, traditional knowledge keeper or legal supports if requested by the patient/decision-maker

Exceptions & Exemptions for Designated Support Access at Acute Care Facilities

• Pediatric Ambulatory: On a case-by-case basis, exceptions for having two (2) designated support persons may be considered by the clinic (in consultation with the site leadership) for circumstances where they are required, and where physical distancing requirements can be maintained. Examples could include but are not limited to:
  • End-of-life or goals of care discussions;
  • Significant diagnosis/change in medical status leading to poor prognosis and patient implications;
  • Behavioural challenges requiring two caregivers;
  • Medical or equipment needs requiring two caregivers; or
  • Involvement of Children’s Services
• Pediatric Inpatient: In consultation with the unit manager/charge nurse on a case-by-case basis, other support persons (e.g. disability support worker) may be permitted in addition to the two (2) designated support persons. Parents/guardians under quarantine/isolation for COVID-19 may be able to be present with their child.
• Maternity Inpatient: To meet the care needs of some birthing circumstances, an additional designated support person may be considered by the unit manager/charge nurse if space is conducive to maintaining physical distancing requirements. For infants born via surrogate, and situations involving adoptive parents and guardians, the infant may have their own one (1) designated support person after birth.
  Maternity CMOH Exemption: a designated support person under quarantine/isolation may access in accordance with CMOH Exemption: Designated family & support person for obstetrical patients.
• Dependent Adults: Dependent adults can have one (1) designated support person. A person quarantined or isolated because of COVID-19 who has an adult-dependent may be eligible to accompany or visit the adult-dependent patient requiring medical care.
• End-of-Life: While it is difficult to be precise around when a patient/resident is at end-of-life, this generally refers to the last four to six weeks of life. All persons considered to be end-of-life can have one (1) designated support person who can be present as much as the patient/resident requests. End-of-life is the only circumstance when visitors are allowed as requested by a patient or their decision maker. Please see below for details on end-of-life.

This guidance will be adapted as the circumstances of COVID-19 change. Patients or family questions/concerns should be directed to the patient’s care team or Patient Relations at 1-855-550-2555.

View Designated Support Person & Visitor Access Guidance - printable version (also available in most Translated Resources).

Know Your Risk / Know Your Role

We are encouraging staff, patients/residents, and designated support persons to work together to reduce the amount of time spent in AHS facilities by considering what support needs to be provided in person and what can be provided virtually.

Designated support persons should assess their risk of exposure and transmission of COVID-19 before they enter an AHS site. To support this, we have created two brochures: Know Your Risk and Know Your Role.

Thinking of Supporting or Visiting a Resident in Long Term Care, Supportive Living or Congregate Living?

Continuing care facilities operate under an approach to family support and visitation based on CMOH Order 29-2020. All licensed supportive living, long-term care and hospice facilities will follow this Order.

Residents of these sites are at extreme risk if exposed to COVID-19, therefore a safe visitation approach is required.

• Each resident or alternate decision maker may designate up to two designated support persons (over the age of 18) who are essential to maintaining mental and physical health.
• Additional visitors may be given access in specific situations including end-of-life, change in health status or other pressing circumstances (e.g. financial or legal matters, family crisis).
• As announced by Alberta Health on Jan. 20, facility operators may use outdoor designated spaces onsite for outdoor visits with a maximum of five people, including the resident.
• If residents are able to go off-site, they can participate in an outdoor social gathering with up to nine other people.
• In doing so, residents may be asked to use additional safety precautions upon their return.
  • Physical distancing must be followed and additional precautions such as wearing a mask at all times during the outing are recommended to protect the resident who is more vulnerable to COVID-19.
• All visits must be pre-arranged. Please contact facility staff in advance to discuss the best option to safely visit your loved one.
• Use the Request a Visit tool to schedule a visit at a participating site. View the Scheduling a visit with your Loved One(s) in Continuing Care Sites infographic for help on booking a visit.

For more information please review CMOH Order 29-2020, Protecting Residents at Congregate Care Facilities and What to Expect, before your visit.

End-of-Life

While it is difficult to be precise around when a patient/resident is at end-of-life, this generally refers to the last four to six weeks of life.

The attending physician, in consultation with the unit manager/charge nurse, determines if the patient/resident condition is considered end-of-life. End-of-life guidance applies to individuals in hospice, from the time of admission. The enhanced guidelines also recognize unique end-of-life considerations for Indigenous individuals.

• All persons considered to be at the end-of-life can have a designated support person with them as much as required. Their presence should be coordinated with the care team and reflect the needs of both the patient and their designated support person.
• Other support persons/visitors may visit as long as the visits are pre-arranged with the site/unit.
• Children under age 14 may visit if accompanied by an adult.
• Up to three individuals may be permitted at the same time as long as there is room to maintain physical distancing.
• Members from the same household are not required to physically distance from each other.

For more information please review CMOH Order 29-2020 and Family Support & Visitation Guidance - printable version (also available in most Translated Resources).

Compassionate Exemptions from Quarantine

Alberta Health and Alberta Health Services have established a process for persons seeking exemption from either federal and/or provincial quarantine to visit a patient, client or resident who is receiving critical care for a life-threatening illness or imminent end-of-life care at an AHS, Covenant or continuing care facility or in a home setting.

To request a visit with a loved one in one of these settings, follow these steps.

What to Expect

To support and visit a patient or resident you must:

• Know your risk of exposure and transmission of COVID-19 and your role as a support person or visitor before you enter an AHS site.
• Ensure the patient/resident has identified you as a designated support person, and wear designated support identification.
• Be feeling well on the date/time of your visit.
• Follow all required site policies and public health measures.
• Complete health screening prior to entering the facility.
• Continuously wear a mask that covers the nose and mouth.
• Remain in the patient/resident’s room as much as possible and minimize movement within the facility.
• Perform hand hygiene (hand washing and/or use of hand sanitizer) when entering and leaving the facility and when entering and leaving the patient/resident’s room.

Screening & Orientation

Facilities will have a screener greet each person to conduct the health screening and verify the designated support person is authorized to attend as per the above. AHS units and teams will be responsible for providing an orientation to patients and their designated support persons including:

• Communicating the risks, requirements and responsibilities of being in the service area.
• Providing appropriate Personal Protective Equipment (PPE) to designated support person(s) and instructions on how to use PPE, hand hygiene and other infection prevention and control precautions for the service area.
• View Screening Questionnaires: Acute Care & Continuing Care

Virtual Visitation

We are encouraging virtual visitation at all healthcare facilities.

If it is not possible to have an in-person visit, staff will communicate this to the patient/resident and their designated support person, and discuss options based on need. Staff will do their best to support virtual visits by phone, video calls or chat apps. For more information on staying connected virtually, refer to our virtual visitation tools and resources.