Sunnyside Home Caregiver Designation Form

On September 2, the Ministry of Long-Term Care announced that in addition to general visitors, residents living in Long-Term Care may also choose to have up to two “Caregiver” visitors.

Caregivers are considered essential visitors and provide direct care and support to a resident (e.g., supporting assistance with meals, mobility, personal hygiene, cognitive stimulation, emotional support etc). Caregiver visits do not need to be scheduled.

We welcome the opportunity to support you in continuing to reconnect with friends and family in a meaningful way. Sunnyside Home has developed a plan to support these changes that meets the provincial guidelines and maintains the safety and well-being of Sunnyside residents and staff.

Under the new policy, a caregiver visitor is defined as:

• Someone that is 18 years of age or older
• designated in writing by the resident or substitute decision maker (SDM)
• Visiting to provide direct care to the resident (e.g. assisting with a meal, personal hygiene, emotional support etc.)

Caregivers must:

• Be willing to provide direct care (e.g. assisting with a meal, personal hygiene, emotional support etc.)
• Provide proof of a negative COVID-19 test completed within the previous 7 days of each visit. The Security Guard will ask to see proof of your test results as you enter the building.
• Complete mandatory training on personal protective equipment
• Screen in at the main entrance with security
• Commit to following the infection control guidelines and requirements

Designating caregivers is optional; the purpose of this form is to determine your wishes. The Security Guards will use the information from this form as part of the screening process when Caregivers arrive at Sunnyside Home to visit.

Contact Information for the person completing this form (Residents may skip this question):

We are required by the Ministry of Long-Term Care to provide education to each Caregiver Visitor on the proper use of Personal Protective Equipment before their first visit. Our preferred method of meeting this requirement is to email links to videos to watch on your computer or smart phone before you visit Sunnyside.  If applicable, please provide an email address for both Caregivers.  If a Caregiver does not have access to a computer, we will contact you to make alternate arrangements for the training before the first visit. 

To avoid delays, please review the email addresses carefully to ensure that they are entered correctly.  

Important things to note about Caregiver Visits:

•  The Caregivers listed on this form may be updated in response to changes in a resident’s care needs and/or based on the availability of the designated caregivers by completing and submitting a new form. Please allow for one full business day for the changes to be processed (this does not include the day on which the form was submitted).
•  The electronic version of the form can be found on the Region of Waterloo website or by typing the address (url) into your computer browser: tinyurl.com/sunnysidevisitor
•  Blank copies of the paper version of this form can be found in a folder that is attached to the Caregiver Designation Form return box located in the vestibule to the main entrance of Sunnyside Home.
•  Please allow for 1-2 full business days for us to process paper and electronic forms. This does not include the day that you submitted your form.  

If you provided an email address we will email you the information listed in this section along with the links to the educational videos.  If you have any questions about this form or about visits to Sunnyside Home, please call the COVID hotline at 519 893 8494 extension 6868.