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FAQs: RMTs’ return to practice, interim guidelines (COVID-19)

CMTBC posts Interim Guidelines for RMTs’ Return to Practice in the context of COVID-19.

RMTs’ requests for interpretation of the Guidelines are summarized here, in “Frequently Asked Questions” (FAQs). CMTBC updates this webpage on a regular basis.

RMTs can contact [email protected] with questions about the FAQs below, or with other questions related to the Interim Guidelines for Return to Practice.

Reminder: please call 8-1-1 for health-related questions. The phone number for non-medical information about COVID-19 is 1-888-COVID19 (1-888-268-4319) 7.30 am-8pm, 7 days a week. Please consider book-marking BCCDC resources at a glance in your browser. 

FAQs POSTED ON JULY 9, 2021, related to revised Interim Guidelines (COVID-19) posted June 30, 2021 re: Step 3, BC’s Restart Plan

May RMTs ask patients if they have been fully vaccinated?

An RMT can ask a patient for their vaccination status but must also tell the patient they’re not obliged to answer. An appropriate way to present this question would be to ask whether the patient is comfortable revealing their vaccination status.

If the patient chooses not to answer, it is at the RMT’s discretion how to proceed. A possible protocol may be to require that the patient and RMT both wear a mask during treatment.

Public health guidance is that masks are recommended in public indoor settings (including RMT practice settings) for all individuals aged 12 years and older who are not fully vaccinated. Full vaccination is considered two vaccinations, with a minimum of two weeks after the second vaccination for the vaccine to take effect.

It may be reasonable to assume that if a patient – or a potential patient – chooses not to disclose their vaccination status, that they are not fully vaccinated. Given the careful and gradual nature of Step 3’s return to interaction with others, it may be prudent to err on the side of caution, and wear masks.

Can an RMT ask for proof of vaccination status?

Under the revised Interim Guidelines (COVID-19), June 30, 2021, nobody is obliged to provide proof of vaccination for the purpose of receiving massage therapy. People may choose to provide proof if they have it.

Trust is a foundation piece of the therapeutic relationship. If an RMT doesn’t trust a patient – for instance, if an RMT needs to ask for proof of vaccination when a potential patient says they’re fully vaccinated – the College recommends that the RMT wear a mask and ask the patient to do so as well. 

Please consider what it would be like if the question was turned the other way: Can the patient ask the RMT for proof of full vaccination? Remember that the therapeutic relationship is the RMT’s responsibility. Open, honest communication is the responsibility of the RMT. Setting the tone for the patient to provide informed consent might look/sound like this (and there are many alternatives to this example).

  • RMT: BC is in Step 3 of a four-step Restart Plan; it’s a careful and gradual return to being together. The new public health guidelines provide the option of not wearing masks indoors when both of us are fully vaccinated. For the time being, I’m wearing a mask and ask that patients wear a mask during treatment as well.
  • Patient: I’m fully vaccinated, though, and I don’t want to wear a mask.
  • RMT: I understand and appreciate that. I have decided that a consistent standard of care is the best standard of care I can provide to all my patients, their families, and others in our community. I’m asking that we all continue to wear masks during the hour we spend in the treatment room.

Can you recommend a good way to discuss vaccination status that is consistent with practice standards?

This discussion is best in person, because it’s about building trust and that’s hard to do via an online form with check boxes. The RMT and the patient – especially if it’s a new patient with whom you don’t yet have a mutual trust relationship – need to be able to assess each other’s attitudes toward reducing risk of communicable disease transmission.

In Step 3 of BC’s Restart, we all need to consider each other’s situation – matters are rarely black and white. Each patient – and each RMT – has different variables to consider. Some RMTs may choose to only treat fully vaccinated people; the question then is, how do they determine that patients are fully vaccinated? Other RMTs may decide it’s risky to assume that when an individual says they’re fully vaccinated, they’re telling the truth. In such an environment, the best strategy may be to continue to wear masks and follow previous protocols.

An RMT might choose to disclose their own vaccination status (assuming they are fully vaccinated), and then ask, Are you comfortable disclosing your own vaccination status to me? I’m asking because public health guidelines relate mask use to vaccination status.

Remember that vaccination status is private, personal information. RMTs are not required to disclose their status, nor are patients.

The current challenge is that mask use is related to vaccination status. Some RMTs may choose to continue wearing masks and ask patients to do the same. It is at the RMT’s discretion.

I have chosen not to be vaccinated. I don’t want to discuss my decision with colleagues or with patients, so I always wear a mask indoors. My colleagues are not wearing masks; I know they’re fully vaccinated but I want them to wear masks so we’re all following the same standard of care. Can you help?

The short answer is no. CMTBC doesn’t regulate clinics; CMTBC regulates RMTs. CMTBC cannot mandate that all practitioners at a clinic wear masks. Not everyone can be expected to do the same thing all the time unless you make it a clinic policy.

It’s important to remember that not everyone is able to wear a mask. BC’s Human Rights Commissioner published useful context and guidance related to mask-wearing. It’s helpful to remember that BC is in Step 3 – we’re transitioning; risk of transmission still exists. There are many reasons to wear masks, and it is not always necessary to discuss personal choices and personal health details.

It is understandable that there will be variation in mask use. Public health guidance about the use of masks is currently based on vaccination status, and as discussed in these FAQs, personal and private information need not be shared.

All of us, worldwide, are in a new conversation about safety precautions. CMTBC is aware that some registrants – and some members of the public – have stated they will continue to wear masks in the future to avoid flu, colds, and other communicable diseases.

The revised Interim Guidelines state that “no one should enter the clinic if they show signs of communicable disease; they should be tested for COVID-19.” What signs of communicable disease should I screen for, in myself and others?

The Interim Guidelines state: “If they have signs of COVID-19, they are to contact public health at 8-1-1 and arrange to be tested.”

We have all learned over the last year and a half of pandemic management that COVID-19 has both typical and atypical signs, and is sometimes asymptomatic. None of us are communicable disease experts; all of us are asked to apply common sense to the question, do you feel sick, or have you been with people who are sick? If the answer to either question is “yes”, stay at home, and if COVID-19 symptoms are present, call 8-1-1 to arrange testing. The BC Centre for Disease Control provides information about where to get COVID-19 tests.

All I can see that is different going forward is that we (our patients and ourselves) will not have to wear a mask if fully vaccinated, if both of us are comfortable with that. That seems to be it. Otherwise, continue with all other COVID-19 safety practices. Correct?

No, there are other changes. Pre-screening is less restrictive. Focus has shifted from COVID-19 (including the BC COVID-19 Self-Assessment Tool, which is no longer a required component of pre-screening) to prevention of communicable disease. The message is simpler: if you’re sick, or have been with someone who is sick (with possible signs of COVID-19), stay home, call 8-1-1, and get tested for COVID-19.

In the previous version of Interim Guidelines (COVID-19) (PDF), Section 5 on “enhanced cleaning” was prescriptive and lengthy. It’s shorter in the June 30 revision, and one could argue that it’s no longer necessary because thorough cleaning is best practice in health care settings.

CMTBC’s Practice Environment Standard requires that RMTs promote and maintain a safe treatment space within the practice environment for patients, colleagues, themselves, and others, and ensure the cleanliness of all spaces, equipment, tools and other resources. The standard of cleanliness – defined in the Standard – is set by BC Centre for Disease Control, the Provincial Infection Control Network of BC, and the Government of Canada. Those public health authorities continue to stress cleaning protocols in the context of COVID-19. For this reason, cleaning protocols specific to COVID-19 considerations are still included in the Interim Guidelines (COVID-19).

Step 3’s approach in BC’s Restart Plan is more conceptual, compared to the restrictions and prescriptive guidance offered earlier. There is room for discretion and choices, while following the guidelines.

For example, people are no longer restricted to gathering in safe “bubbles”. But that doesn’t mean that all gatherings are safe. At a news conference on June 29, 2021, BC’s Provincial Health Officer introduced the Golden Rules for gathering safely, reprinted here for guidance:

Do I have to provide treatment to a patient who refuses to wear a mask? The patient wore a mask while the mandate was in effect, but now refuses to wear one. I am asking all patients to continue to wear masks.

No, you don’t have to provide treatment to a patient who refuses to wear a mask.

The Code of Ethics provides guidance in Section 17, in the category of “Terminating the Therapeutic Relationship”. In effect, refusing treatment terminates the therapeutic relationship. An RMT may do so “with any patient who …threatens the RMT or otherwise endangers the RMT.”

The ethical obligation, particularly for an existing patient with whom you’ve established a good therapeutic relationship, is to explain that you provide treatment under revised guidelines that stress the importance of controlling the spread of communicable diseases. That said, the Code of Ethics provides the option of immediate termination if you feel endangered.

CMTBC has heard from some RMTs who are considering not offering treatment to patients who won’t get vaccinated.

Is pre-screening still required?

The short answer is yes, but it’s different from before.

RMTs must clearly explain what patients will experience when they arrive at the practice setting. For example, does the RMT have a mask-use policy? Are patients invited to use the waiting room, or should they wait outside the practice setting to avoid physical crowding? And of course, patients are asked to rebook at a later date if they are sick, or have been with someone who was sick, and to get tested for COVID-19.

The first pillar in the revised Interim Guidelines (June 30, 2021) reads: “Prior to the appointment: Communicate with patients and all who enter the practice environment.” Compare this to the previous version of the Interim Guidelines (PDF), which itemized prescriptive pre-screening steps (including use of the BC COVID-19 Symptom Self-Assessment tool within 24-48 hours prior to a patient’s appointment).

The language of “screening” has changed to “communicate with patients”, which reflects the shared commitment in Step 3 of BC’s Restart Plan following the Golden Rules for Everybody (see graphic, above).

Prior to COVID-19, RMTs didn’t ask patients – or potential patients – if they were free of communicable diseases that can be transmitted in shared space, for example in a treatment room. RMTs may choose to maintain this practice not only during the final steps of BC’s Restart Plan, but into the future. The message – “If you’re sick or have been with someone who is sick, please stay home and get tested for COVID-19” – is a reasonable precaution right now.

Is discussion of mask-use part of Section 1 of the Interim Guidelines, the pre-appointment message?

Yes. Section 1 reads that RMTs will “Advise patients of available options regarding the use of personal protective equipment, including masks. Public health authorities recommend the use of masks in public indoor settings for individuals aged 12+ who are not fully vaccinated.”

RMTs are reminded that compliance with public health guidance is compulsory. Mask use (as discussed in other questions on this webpage) depends on other variables including vaccination status. RMTs are advised to communicate what to expect, prior to patients arriving for an appointment.

FAQs POSTED ON MARCH 17, 2021, RELATED TO COVID-19 IMMUNIZATION [updated April 7, 2021]

Current information is available at the following websites:

I received the email about vaccination clinics in my area; do I have to get vaccinated to maintain my registration, even though my family has chosen not to get vaccinated?

Immunization against COVID-19 is a global effort. In BC, the provincial government is providing immunization to all citizens through the health authorities. Please reflect on this question in the context of your professional Code of Ethics.

Consider as well that Section 7 of CMTBC’s Interim Guidelines for Return to Practice (COVID-19) addresses professional obligations, including your insurer’s requirements and the requirement to obtain informed consent from your patient. Consider that your decision about immunization may impact those with whom you come into contact, including your patients.

I was unable to book a vaccine appointment when initially offered in my regional health authority.  Can I still book an appointment?

Information regarding eligibility and booking a COVID-19 vaccination appointment is rapidly changing. 

RMTs who have questions regarding vaccine eligibility and/or the registration process for an appointment are advised to review their regional health authority webpage for the most up to date information and/or contact their regional health authority for further information.

Health Authorities’ COVID-19 vaccine information:

FAQ POSTED ON OCTOBER 6, 2020:

A member of my family is sick. Can I still go to work?

Where a member of the RMT’s family (or close connections who share the home with the RMT) becomes sick, the RMT should contact public health at 8-1-1 for guidance related to the need to self-isolate, get tested or monitor symptoms.

My patients have requested heat during treatments. Am I able to use a thermophore, table warmer or other thermal agents during treatment? [updated November 2, 2020]

Short answer, yes. Regular cleaning and disinfection minimize the risk of transmission of the novel coronavirus.

The College understands that many RMTs have successfully incorporated vinyl covers for heating devices. This is acceptable, where the vinyl (or other) cover of the heating devices (such as a thermophore) provides a surface that can be thoroughly cleaned after each use. RMTs need to consider if the heating (or cooling) agent and any high-touch surfaces associated with its use can be properly sanitized between patients. This includes not only coverings, like pillowcases and towels (e.g., some RMTs use multiple layers of towels around a heating device, and launder the towels after each use), but the thermal agent itself. A thermal agent that cannot be properly sanitized must not be used.

FAQs POSTED ON MAY 29, 2020:

Do I have to get written consent to treat every time my subsequent patient receives massage therapy in the new COVID-19 environment, or just the first time?

Written consent must be renewed in your presence when your patient first returns to massage therapy in the COVID-19 environment. This is consistent with CMTBC’s Consent Standard of Practice which states in Section 10: “An RMT renews consent when the treatment approach changes for any reason, and revises the treatment plan or creates a new one.”

The treatment approach has changed to include risk mitigation measures for transmission of COVID-19. Take the opportunity to invite your patient to ask questions and engage with your new protocols for everyone’s safety.

For subsequent treatments, ongoing consent is verbal (and charted by you), as before, until such time as there is a significant change in your treatment approach or treatment plan.

I would like to provide massage therapy to front-line health care workers who have been in COVID-19 wards, but I’m not sure what to do. What are the requirements? [updated November 2, 2020]

RMTs must apply the assessment tool provided by the BC Centre for Disease Control, Exposures and return to work for health care workers, in consultation with the health care worker. Spend time on the BCCDC webpage and read the fine print of the assessment tool (the diagram with green, yellow, red risk indicators), and ask your patients questions to help you determine the risk level.

FAQs POSTED ON MAY 20, 2020 [updated November 4, 2020]

Please clarify the consent requirement – there are a lot of new consents required, is that right?

Fundamentally, the consent process, and the reasons for it, have not changed.

If you previously had an informed consent process in your practice that conformed with requirements set by CMTBC’s Consent Standard of Practice, it probably looked something like this:

  • On initial intake, you would describe your practice framework to a new patient, explaining that you will take a clinical history (question/answer about the patient’s medical history) initially and ask from time to time if anything has changed.
  • You would explain that at every session, prior to providing massage therapy, you will conduct an assessment to clearly focus on the patient’s presenting complaint, or to monitor improvement over time.
  • Further, you would explain that following treatment, you might re-assess, and you would provide home care – activities that the patient will do at home to improve their condition, including stretches, strengthening exercises, and possible adaptations to daily activities.
  • You would also describe potential benefits and risks of receiving massage therapy, and point to alternatives for care.
  • You would then request signed consent, demonstrating that the patient understood your framework for clinical care, understood the benefits and potential risks, and consented to your approach.

Sections 9 and 10 of the Consent Standard of Practice state that “before the delivery of a subsequent treatment, an RMT renews consent if appropriate” and that “[an] RMT renews consent when the treatment approach changes for any reason” [emphasis added].

What is new as a result of COVID-19 is that the context of care for every RMT and for every patient has changed, which means that RMTs are now required to renew written consent with each patient returning for massage therapy. Specifically, RMTs must include the risk of transmission of the COVID-19 virus, and the steps taken by the RMT to reduce the risk.

RMTs are not required to create a new form – they are required to obtain informed consent in the new context of care, including the risk of transmission of COVID-19 virus, and the patient must sign the consent.

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