Ambulatory – ED/UCC|Hospital (Inpatient)|Continuing Care| End-of-Life|What to Expect |Screening & Orientation

Last Updated: July 8, 2020

In response to the COVID-19 pandemic, Alberta Health Services (AHS) has had to make the difficult decision to limit the interactions between patients/residents, families and visitors in order to ensure their safety, as well as physicians and staff providing their care. These decisions have not been taken lightly, and we understand it has been difficult for all involved.

Effective Thursday, July 2, AHS will implement enhanced Designated Family/Support Visitation Guidance for all patients in acute inpatient settings.

Based on feedback from patients, families and staff, we are expanding support and visitation to include outdoor visits in acute care, unaccompanied outdoor access for patients, and patient off-site passes, where safe and deemed suitable by sites and care teams.

Certain site-based services will also resume, including AHS site-based hairdresser/barber services, specific community support groups, in-person visits with legal services and a community faith/religious leader.

Existing guidelines for Designated Essential Visitors in continuing care environments will be maintained.

AHS recognizes that family/support persons directly contribute to patient safety, the healing process, and overall patient well-being. The enhanced guidelines welcome the involvement of a family member/support person, while maintaining specific criteria intended to protect all patients, residents, families, visitors, physicians and staff. These changes reflect the balance that we must continue to strike to address the ongoing risk of COVID-19, as well as the well-being of patients and residents.

We thank everyone for continuing to work together to support all of those in our care. Collaboration is vital to the health of all patients and residents.

View Family Support & Visitation Guidance - printable version (also available in most Translated Resources).

If it is not possible for the Designated Family/Support Person(s) to be physically present with a patient , AHS staff will provide support as needed for virtual connections through phone, video calls or chat apps.

For more information on how patients and their families can stay in contact virtually refer to: Using Technology to Stay Connected with your Loved Ones.

Thinking of Supporting or Visiting a Patient in a Hospital?

All Ambulatory Clinics (including Emergency Department/Urgent Care)

• Patients may identify one Designated Family/Support Person to accompany them while accessing ambulatory, emergency or urgent care services in AHS facilities.
• There may be circumstances where physical distancing with other patients within clinic areas will not allow for the Designated Family/Support Person to be present. In this case, staff will communicate this to the patient and their family/support person, and discuss options based on patient need.
• All support persons must be over the age of 14 for adult clinic visits. If visiting the Alberta Children’s Hospital or the Stollery Children’s Hospital, the Designated Family/Support Person must be 18 years of age or older.

All Inpatient Settings (Admission to Hospitals)

• Patients may identify two Designated Family/Support Persons while admitted to an inpatient unit in an acute care facility. If the room is large enough for physical distancing to be maintained, both Designated Family/Support Persons may be permitted at the same time. If not, they must attend one at a time.
• All facilities will have a screener greet Designated Family/Support Persons to conduct the health screening and verify if the person is authorized to enter the site.

Outdoor Visits in Acute Care

• Effective July 2, admitted inpatients may participate in outdoor visits with their Designated Family/Support Person(s) or others, where the site can support access to green spaces.
• A maximum group size of 3 people is permitted, including the patient.
• A child under the age of 14 is permitted at an outdoor visit but must be accompanied by an adult.
• No COVID-19-positive or COVID-19 suspected patients will be permitted to have an outdoor visit.

Patient Off-Site Passes

• Effective July 2, off-site pass may be granted if they are required as part of a patient’s treatment plan. This includes patients with an Alternate Level of Care designation, patients in dedicated rehabilitation programs and Addiction and Mental Health patients.
• If a pass is deemed an essential part of the patient’s treatment plan by their care team, weekend, overnight, and day passes must be ordered by a physician or designate.
• The facility, home environment and any destinations the patient plans to attend while out on pass, must not be on outbreak.

Maternity/Postpartum

• In consultation with the unit manager/charge nurse on a case-by-case basis, other support persons (e.g. surrogate parent or Doula) may be permitted in addition to the two Designated Family/Support Persons. Designated Support Persons on a maternity ward must be 14 years of age or older.
• Special consideration may be given to a symptom free Designated Family/Support Person who is under quarantine or isolation. See Obstetrical Screening and Visitation Guidance for more information.

Pediatrics/NICU

• Two individuals may be Designated Family/Support Persons.
• A child age 14 years and older can visit an admitted patient in addition to one designated family/support person.
• Children under 14 years of age are currently not permitted to visit. However, for compassionate reasons (such as at the end-of-life) and on a case by case basis, exceptions will be considered in consultation with the unit manager/charge nurse.
• Breastfed infants are able to accompany their mother.
• Parents/guardians under quarantine or isolation for COVID-19 may be permitted to visit. See Acute Care Guidance for Parents/Guardians Accompanying Children for more information.
• Ambulatory areas remain restricted to patients being accompanied by one Designated Family/Support Person 18 years of age or older.

Adults with Disabilities

• 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 Designated Family/Support Persons.
• A person quarantined or isolated because of COVID-19 who has an adult dependent requiring medical care may be permitted to accompany or visit the adult dependent. See Memo: Clarification: Exemption – Quarantined and isolated persons who have adult dependents that require medical care for more information.

End–of-Life Situations (See End-of-Life section below)

• Two Designated Family/Support Persons at a time can be present if the room is large enough for physical distancing to be maintained between individuals.
• The attending physician, in consultation with the unit manager/charge nurse, determines if the patient condition is considered end-of-life.

View Family Support & Visitation Guidance - printable version (also available in most Translated Resources).

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

Residents of these sites are at extreme risk if exposed to COVID-19, therefore strict restrictions are necessary.

Sites may allow one Essential Visitor to support either care needs that cannot be met without their assistance, or to support quality of life.

The Designated Essential Visitor may be a family member, friend, religious and spiritual advisors or paid caregiver 18 years of age or older.

A Designated Essential Visitor may visit in cases where:

• The resident’s quality of life and/or care needs cannot be met without the assistance of the Designated Essential Visitor.
• In end-of-life situations where there is a time sensitive need to be with a loved one.
• An outdoor visit may be arranged for a resident not on isolation. A Designated Essential Visitor and up to one additional person may visit as long as the additional person remains outside and does not enter the facility. While outside, all appropriate precautions must be taken to prevent exposure to COVID-19, including physical distancing and the requirement that all visitors wear a mask or face covering.

View Family Support & Visitation Guidance - printable version (also available in most Translated Resources).

Can I Visit a Friend or Loved One who is Dying While in Continuing Care?

A resident may have only one Designated Essential Visitor designated by the resident or guardian (or other alternate decision maker).

The Designated Essential Visitor determines who among a dying resident’s family/religious leader(s)/friends may also visit the resident.

Only one visitor at a time can visit a dying resident. A second visitor may be permitted if the room is large enough to accommodate social/physical distancing.

End-of-Life

There is no limit on the number of different individuals who can visit overall, but visits need to be coordinated with the care team and the site. However, up to two Designated Family/Support Persons at a time are allowed to visit a patient/resident at end of life within any AHS facility in these circumstances, as long as physical distancing can be maintained between the family/support persons.

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

• All persons considered to be at the end-of-life may have a Designated Family/Support Person (referred to in continuing care as a “Designated Essential Visitor”) 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 Family/Support Person.
• Children under age 14 (under age 18 in continuing care) may visit if accompanied by an adult.
• The length of time spent on the visit needs to reflect what both the patient and the Designated Family/Support Person need from the visit, as well as the ability of the dying patient to tolerate the visit.

There may be situations where some requested end-of-life visits cannot be accommodated. Based on individual patient/resident circumstances and/or operational considerations, sites may apply additional restrictions on a case-by-case basis that limit the length and frequency of in-person visits.

Recognizing the importance of connection with loved ones for the emotional well-being of patients/residents and families in end-of-life situations, wherever possible, units and sites will encourage and facilitate alternative means to connect with loved ones such as virtual visits.

The enhanced guidelines also recognize unique end-of-life considerations for Indigenous individuals.

View Family Support & Visitation Guidance - printable version (also available in most Translated Resources).

What to Expect

To support and visit a patient or resident you must:

• Ensure the patient has identified you as a Designated Family Support Person, and wear Designated Family Support identification.
• Be feeling well on the date/time of your visit
• Be 14 years of age and older OR accompanied by an adult. For pediatrics (Alberta Children’s Hospital and the Stollery Children’s Hospital) and continuing care, children under the age of 14 are not allowed to visit.
• Complete health screening prior to entering the facility, including a temperature check for fever over 38 degrees Celsius and a questionnaire.
• Sign in and out of all visits.
• Continuously wear a mask that covers the nose and mouth.
• Remain in the patient’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.
• Not bring animals to the visit except service dogs.

View Family Support & Visitation Guidance - printable version (also available in most Translated Resources).

Screening & Orientation

Facilities will have a screener greet each person to conduct the health screening and verify the Designated Family/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 Family/Support Persons including:

• Communicating the risks, requirements and responsibilities of being in the service area.
• Providing appropriate Personal Protective Equipment (PPE) to Designated Family/Support Person(s) and instructions on how to use PPE, hand hygiene and other infection prevention and control precautions for the service area.