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Evergreen Home for Special Care

Designated Caregiver Guidelines

September 11, 2020

Designated Caregiver Guidelines

Purpose: Provide opportunity for family to be actively involve in supporting resident's care, emotional well-being and quality of life in the midst of COVID-19 Pandemic.

Evergreen will strictly adhere to Infection Control Guidelines as per Department of Health and Wellness and Public Health protocols for Designated Caregiver.

Designated Caregivers in Long-Term Care:

• Designated Caregivers may visit to support the resident's physical care and mental well-being.

• Resident/SDM to identify up to a maximum of two (2) designated caregivers.

• Only one (1) designated caregiver per resident can be present in the faciliyt at a time (except for the cases of palliative/end-of-life care).

• If the designated caregiver is unable to perform their role for an extended period of time (i.e. Due to self-isolation requirements, other caregiving duties, or otherwise unable), the resident/SDM may identify a temporary replacement.

Criteria

• Family members and support individuals who have a clearly established pattern of involvement in providing the resident's care in the facility, supporting the resident's emotional well-being,health,and quality of life prior to pandemic.

• Residents who have been admitted since the facility closure will be reviewed on a case-by-case basis.

   

Requirements

• Maintain physical distancing of 6 feet, except when providing personal care

• Practice proper hand hygiene. Wash hands before and after entering the facility and after each care.

• Observe proper respiratory etiquette.

• Must wear medical-grade mask while inside the facility (facility to provide mask). Replace when soiled and discard properly after use.

• Must be knowledgeable on how to don and remove PPE. Facility to provide education.

• Must not provide care for more than one (1) resident.

• Must minimize movement throughout the facility as much as possible.

• Must wear an identification badge provided by the facility.

Tasks

Designated Caregivers may visit to support the resident's physical care and mental well-being. This must be for tasks such as:

• Assistance with feeding

• Assistance with mobility

• Assistance with personal care

• Communication assistance for persons with hearing, visual, speech, cognitive, intellectual or memory impairments

EHSC Protocol

• Designated Caregiver will be screened for COVID-19 upon entry to the facility.

• Caregiver's information (name, date and time of visit, duration of visit, telephone number or email) will be logged for tracing purpose.

• Provide copy of EHSC Designated Caregiver Guidelines.

• Evergreen to determine time of visitation.

• Family to call facility to book date and time.

• The role of designated caregivers within the facility will be assessed in a case by case basis in consultation with local Public Health when a lab confirmed COVID-19 outbreak is declared within the facility and/or there has been increased rate of community spread within the local community.

• Evergreen reserves the right to suspend for non-compliance to above guidelines.

   

Procedure

• Resident/SDM to identify up to a maximum of 2 designated caregivers

• Only 1 designated caregiver per resident may be present in the facility at a time

• Designated caregivers are permitted Monday-Friday, between the hours of 10:00am-2:00pm. Caregivers must arrive no later than 12:00pm for check-in and screening.

• An education session will be provided by Evergreen, this will include information on donning/doffing personal protective equipment as well as proper hand hygiene and respiratory etiquette.

• Caregivers must understand and agree to the written guidelines, as well as understand and agree to the information in the Designated Caregiver Waiver and Assumption of Risk. This will be formally reviewed and signed with caregivers during the education session.

• Family/Support person must identify their interest in being a designated caregiver by contacting DON/ADON.

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DESIGNATED CAREGIVER WAIVER AND ASSUMPTION OF RISK

Please note: Nursing home insurers have recently advised that they will not cover claims relating to COVID-19 and related diseases, illnesses, or viruses. We therefore require that designated caregivers sign this waiver and assumption of risk.

In this document, the term “Infectious Disease” means any contagious or infectious disease including, but not limited to COVID-19, SARS, MERS-CoV, or any other strain, derivative, mutation, or variation of such diseases, illnesses, or viruses, or any disease, illness or virus which is declared by any governmental or international organization to constitute an epidemic or pandemic.

I, ______________________________ [print name], the undersigned, on my own behalf and on behalf of my heirs, executors, administrators and assigns, do hereby agree that, as a condition of entry to the __________________________ (the “Facility”) now and in the future, and for good and valuable consideration, I hereby assume all risk of personal injury, death, property loss, and/or consequential damages resulting from an Infectious Disease (as defined above), and I do hereby release the Facility, its directors, officers, employees, agents, and staff from any and all claims, including in contract or negligence or any other tort, that I have or may have in the future relating to personal injury, death, property loss, and/or consequential damages relating to an Infectious Disease.

I, the undersigned, agree that the Facility, its directors, officers, employees, agents, and staff shall not be liable for any personal injury, death, property loss, and/or consequential damages relating to an Infectious Disease, and I hereby waive any and all claims against the Facility, its directors, officers, employees, agents, and staff with respect thereto including any claims in contract or negligence or any other tort in relation to an Infectious Disease and my visit.

Furthermore, I, the undersigned, accept and fully assume responsibility for any liability with respect to my personal injury, death, property loss, and/or consequential damages relating to an Infectious Disease and my visit to the Facility.

Furthermore, I, the undersigned, agree to indemnify the Facility, its directors, officers, employees, agents, and staff for all damages, costs, and expenses related to any claim brought by third parties for personal injury, death, property loss, and/or consequential damages relating to an Infectious Disease in connection or related to my visit to the Facility.

By signing below I acknowledge that:

• I am the legal age of majority and competent to sign this agreement;

• I have thoroughly read and understood the above;

• I recognize that the terms and conditions stated above are legally binding;

• I agree that I am freely executing this document without any inducement or assurances;

• I intend for this to be a complete and unconditional release of claims enumerated above to the greatest extent allowed by law;

• I agree that if any portion of the agreement is held to be invalid, the balance shall continue in full force and effect;