Long-term care homes and residential treatment centres started restricting visits on Saturday after Ontario’s chief medical officer of health recommended they only allow “essential visitors” in an effort to combat the threat posed by COVID-19.

The ministry defines essential visitors as those visiting residents who are dying or “very ill,” and the parents or guardians of an ill child or youth in a live-in treatment centre.

“These visitors must continue to be actively screened into these settings,” reads the memo sent by Dr. David Williams on Friday night. “Those who fail screening will not be permitted to enter. No other visitors should be permitted to enter these premises, instead they should be asked to keep in touch with loved ones by phone or other technologies, as available.”

Meanwhile, a staff member at the Tendercare Living Centre in Scarborough tested positive for the new coronavirus on Friday, forcing all residents living on the facility’s second floor to be quarantined in their rooms until March 25. A ministry official said the recommended ban on non-essential visitors was already planned before the Tendercare staff member tested positive.

COVID-19 is most deadly for older adults, who have a significantly higher fatality rate, according to data collected in China and Italy. Canada’s only death as a result of the new coronavirus occurred at a seniors’ residence in British Columbia, where a man in his 80s died March 8 at the Lynn Valley Care Centre in North Vancouver. The residence was home to Canada’s first outbreak of the virus with four confirmed cases.

Ontario’s Long-Term Care Association said they welcomed the decision to limit access to essential visitors. “There will now be increased screening of staff, essential visitors and new and returning long-term care residents, with additional efforts to keep families in touch with their loved ones through technology.”

On Wednesday, the ministry of health had instructed long-term care homes to begin proactively screening all staff, volunteers, visitors and residents for symptoms and asking about their recent travel history. Long-term care homes already had respiratory infection outbreak protocols in place for flu season, the ministry said. “When long-term care homes submit samples for standard respiratory testing, they will now also be tested for COVID-19 automatically to ensure the province identifies potentially unknown cases.”

Francis Martis, the executive director of the Tendercare Living Centre, said he learned on Friday night that a staff member had tested positive for the new coronavirus and they have been working closely with the local public health unit. Martis said staff are screening visitors at the door, many of whom were turned away on Saturday.

“We are trying to connect residents with their families by phone,” he said, adding that nurses have also been asked to communicate more with residents’ families. “I appreciate this is difficult for our residents and their family members, but we will work with them to make sure the restrictions are not very detrimental to them.”

Quarantined residents will be served meals in their rooms, according to a letter that was sent to the residents’ family members. “Our staff will continue to provide all necessary care and support to our residents while they are in quarantine, using full infection control precautions,” the letter reads. Staff who worked directly with the ill staff member are in quarantine at home.

Laura Tamblyn Watts, the president and CEO of CanAge, an advocacy group for seniors, said restricting visitors will be “incredibly difficult” for residents of long-term care homes.

“We know that social isolation is one of the most damaging experiences that an older person can have,” she said, adding it can be especially difficult for people with cognitive impairments, like dementia, who may not understand why they are being quarantined or are unable to have visitors.

She added that the presence of people in masks or protective suits may also be triggering for older people who have experienced trauma, like the Holocaust.

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“We need to be prepared not only for people experiencing loneliness and isolation, we also need to be ready for people who may be experiencing other reactions, which may be triggered due to their cognitive impairment.”

She suggested several ways to help an older person through a period of isolation, including setting up a regular schedule for video calls, exercising together on video, making plans to watch the same television show so you can discuss it later, doing an electronic crossword together on the internet or writing letters.

“To the greatest extent possible try to make sure your care workers know what types of things are important to the older person.”

Ontario’s confirmed number of positive cases climbed to 101 on Saturday, with five cases resolved. Across the country the total number of confirmed infections was 237, with 11 cases resolved.