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November 2020: Clients Declining to Wear a Mask

Q: What should I do if a client declines to wear a mask during a visit in their own home? Can in-person services be deferred?

A: As noted by federal, provincial and municipal authorities, some clients may not tolerate wearing a mask. The government of Canada recently updated its information on non-medical masks and face coverings . Clients who may not tolerate masking requirements may include:

  • People who suffer from illness or disabilities that make it difficult to wear a mask;
  • Individuals who have difficulty breathing; 
  • Children under the age of 2;

For clients who cannot tolerate a mask, you must determine the appropriate personal protective equipment (PPE) to wear based on your Point of Care Risk Assessment (PCRA) and COVID-19 screening results. It is strongly recommended that OTs implement all public health safety measures to prevent exposure to, and transmission of, COVID-19. Recognizing that community OTs work in multiple client homes, the client may be concerned about the risk to them, while the OT needs to be concerned about the risk to all clients and themselves. Balancing and addressing all these concerns is essential, as this will help clients feel more comfortable with the services they receive while helping to reduce community spread. 

When someone declines to wear a mask when you are in their home, you should explore the reasons for this, and discuss alternatives. Options may include virtual services, providing essential or urgent in-person care while wearing the appropriate PPE if you are with or within a 2-meter distance, or deferring the in-person home visit to a later date. OTs must document the options considered and discussed with the client, the decision made, and record the rationale for deferring if the OT service is non-essential.

If you are deferring clients who still require services, you have a responsibility to follow up with the client in a reasonable time frame to see if there are any changes in their status and complete another PCRA to determine how to proceed. 


Remember, our Practice team is here to help. Contact the Practice Resource Service at 416.214.1177 ext. 240 or email [email protected].



Adapted with permission from CASLPO.

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