COVID-19

Updated May 29, 2020

The College of Massage Therapists of Ontario (CMTO) is monitoring the COVID-19 pandemic daily and we will be updating this page as information becomes available. We acknowledge this has been an unprecedented and challenging time for healthcare professionals and the healthcare system. The safety of the public, including Massage Therapists (RMTs), remains our top priority.

Guidance to RMTs on COVID-19 – Gradual Restart of Deferred Services

Ontario was previously in a situation where healthcare professionals were only allowed to provide emergency/urgent care through a government ordered closure of non-essential businesses. RMTs do not provide emergency/urgent healthcare in the context of the COVID-19 pandemic, so RMTs were directed to not practice in accordance with the government order.

The government’s order was recently updated. With the updated order (Ontario’s Chief Medical Officer of Health’s Directive #2 for Regulated Health Professionals) RMTs are now permitted to gradually restart Massage Therapy services. The Directive encourages healthcare providers to limit the number of in-person visits for the safety of healthcare providers and their patients.

Directive #2 allows for a gradual restart of services to be carried out with adherence to guidance from the health professional’s regulatory college. In the gradual restart of services, RMTs must:

  • Comply with requirements in the Ministry of Health’s COVID-19 Operational Requirements: Health Sector Restart (May 26, 2020 or as current), including, but not limited to, the hierarchy of hazard controls;
  • Prioritize clients with essential care needs while gradually resuming practice. Massage Therapy treatment is considered essential when the client’s overall health or function would considerably decline if treatment were not provided (i.e. lead to hospitalization or other serious health consequences);
  • Consider the principles of proportionality, minimizing harm to patients/clients, equity, and reciprocity (as defined in the CMOH’s Directive #2) in gradually returning to practice;
  • Adhere to COVID-19 Pandemic – Practice Guidance for Massage Therapists;
  • Restart Massage Therapy practice gradually, ensuring enough time between appointments to clean and disinfect the practice environment; and
  • Regularly look for updates on the Ministry of Health’s COVID-19 webpage and this webpage as the pandemic continues to evolve. Direction from the Ministry of Health and Chief Medical Officer of Health overrules anything that may be on this webpage.

CMTO is not expecting RMTs to return to practice if they do not feel it is appropriate or safe to do so.  This information is for RMTs who have assessed the risk associated with COVID-19 and choose to gradually return to practice. CMTO cannot comment on these individual decisions, including how they may impact eligibility for Canada Emergency Response Benefit (CERB) and other government financial benefits.

If I am to prioritize clients with essential care needs in gradually resuming practice, how can I identify essential care needs?

Massage Therapy treatment is considered essential when it can be demonstrated that the client’s overall health or function would considerably decline if treatment were not provided (i.e. lead to hospitalization or other serious health consequences). CMTO recommends prioritizing clients with essential care needs in gradually resuming practice.

RMTs must also consider the principle of minimizing harm, highlighted by both the Chief Medical Officer of Health and in CMTO’s Code of Ethics. In determining whether it is best to provide Massage Therapy treatment to a client, an RMT must always weigh the potential harm that could be done to the client (e.g. contracting COVID-19 and/or spreading it within their community) against the potential benefit of the treatment.

What do RMTs need to do to prepare for treatment?

Please refer to the Ministry of Health’s COVID-19 Operational Requirements: Health Sector Restart (May 26, 2020 or as current), including, but not limited to, the hierarchy of hazard controls; and CMTO’s COVID-19 Pandemic – Practice Guidance for Massage Therapists for full details about the requirements.

What happens if an RMT is found to be practicing contrary to government directives or CMTO guidance?

Contravening an order of the Chief Medical Officer of Health exposes one to significant financial penalties; and CMTO is following up on reports about RMTs providing treatment contrary to guidance, such as providing treatment without the appropriate Personal Protective Equipment (PPE). RMTs who are found to be practicing contrary to guidance may incur penalties, including suspension or revocation of their Certificate of Registration, penalties under the Health Protection and Promotion Act, the Occupational Health and Safety Act, as well as civil liability in court.

CMTO is receiving questions from RMTs and the public, and will continue to track and promptly respond to them. For more information, please contact CMTO’s Practice Specialist at practicespecialist@cmto.com or by phone at (416) 489-2626/1-800-465-1933 extension 4124. 

COVID-19 Resources

Along with CMTO’s COVID-19 Pandemic – Practice Guidance for Massage Therapists, RMTs should access the following websites for the most current information and guidance:

RMTs are required to follow infection prevention practices at all times, in all practice settings.

Resources for infection prevention and control:

For questions about this information, please contact CMTO’s Practice Specialist at practicespecialist@cmto.com or by phone at (416) 489-2626/1-800-465-1933 extension 4124. 

FAQs for RMTs

These FAQs provide answers to the questions that CMTO is receiving most often. We hope this information is helpful, and we will continue to provide updates.

Infection Prevention and Control/Personal Protective Equipment (PPE)
Client Care
Employment
Other

Infection Prevention and Control/Personal Protective Equipment (PPE)

Are RMTs required to wear masks while providing Massage Therapy treatment?

Yes, RMTs are required to wear surgical/procedure masks while within two metres of clients including while providing treatment.

CMTO requires that RMTs wear surgical/procedure masks due to the risk of COVID-19 transmission during Massage Therapy treatment.

RMTs and clients are not able to physically distance (stay two metres away from each other) during Massage Therapy treatment, and Massage Therapy treatment often involves the RMT working closely  with the client in a way that would allow smaller respiratory droplets to suspend and  accumulate in the air and larger droplets to fall onto the client (or vice versa) both of which create a higher risk of transmission. Government and public health organizations have indicated masks should be used when two metres of physical distance cannot be maintained, even if all parties have screened negative and do not have any COVID-19 symptoms.

Masks should be changed after each client (if available) and must be changed whenever wet, damaged or soiled. RMTs must wash their hands before and after touching, adjusting, putting on, or removing their mask.

Are clients required to wear masks during treatment? What if they refuse?

In accordance with the Ontario Ministry of Health’s recommendation to wear masks whenever physical distancing is not possible, the RMT must instruct the client to come to the appointment wearing a clean disposable or reusable mask to be worn throughout the treatment. RMTs may also (if PPE supplies permit) provide a surgical/procedure mask to be used by the client during treatment. In either case, the RMT should advise the client how to properly put on and take off the mask to limit possible transmission of COVID-19. Even if the client arrives wearing a mask the RMT, as a healthcare professional, should show the client proper procedures for future use.

The RMT may need to make practice modifications to accommodate and facilitate the ability of clients to wear masks throughout treatment. Client safety and comfort during treatment must be prioritized.  

If the client cannot wear a mask (e.g. due to a health condition or difficulty breathing), the RMT must use their professional judgement to assess the risk of providing or continuing treatment. If the RMT determines it is not safe to provide treatment without the client wearing a mask, the RMT can refuse to treat the client. The RMT must clearly document this in the client health record.

What types of masks are acceptable for RMTs to wear?

RMTs must wear surgical/procedure masks approved for medical use. These masks are manufactured using multiple layers and designed to prevent droplet contamination of the environment from the wearer in a medical setting. They also may provide some protection for the wearer from inhalation of droplets and particles. COVID-19 is spread primarily via droplets.

Masks should be changed after each client (if available) and must be changed whenever wet, damaged or soiled. RMTs must wash their hands before and after touching, adjusting, putting on, or removing their mask.

N95 respirators should not be used as they are in short supply and should be reserved for front-line healthcare workers in higher risk environments. Additionally, N95 respirators must be correctly fit to the wearer to provide protection.

What types of gloves are acceptable?

RMTs do not need to use gloves for most treatments. Glove use is not a substitute for proper hand washing. Hand washing is an extremely important measure in preventing the spread of COVID-19.

If gloves are used (for example, during treatments that pose a higher risk of transmission, such as intraoral treatments), the gloves should be single-use non-sterile nitrile or latex examination or medical gloves. These gloves are an effective barrier for disease transmission, are durable enough for manual work, and provide a fit that allows for high dexterity.

Latex gloves should only be used with water-based topical products and when the client and RMT do not have a latex allergy or sensitivity.

Nitrile gloves can be used for all clients with oil or water-based topical products.

Vinyl gloves are not recommended because they may not be durable enough for manual work.

Can RMTs wear cloth masks?                  

No, RMTs should not wear cloth masks when within two metres of a client or during treatment. COVID-19 is spread primarily via droplets. Cloth masks may be significantly less effective at containing droplets than surgical/procedure masks, particularly when damp or moist. They are also significantly less likely to protect the wearer against inhalation of droplets or particles.

I don’t have access to PPE supplies. Does that mean I cannot provide treatment to clients?

When an RMT encounters a situation where PPE is necessary but not available, the RMT must not provide treatment to the client at that time. RMTs must explain the reasons for cancelling the appointment to the client and document those reasons into the client health record. See Standard of Practice #15 for more information.

Please see the Government of Ontario’s dedicated website for PPE for more information on obtaining PPE.

Does CMTO know where I can find PPE supplies to purchase?

Please see the Government of Ontario’s dedicated website for PPE for more information on obtaining PPE.

Is CMTO going to purchase/organize PPE supplies for RMTs?

RMTs are responsible for ordering appropriate PPE supplies specific to their own practice needs.

Please see the Government of Ontario’s dedicated website for PPE for more information on obtaining PPE.

What type of cleaning and disinfecting agents should I be using?

RMTs must use products approved by Health Canada by cross-referencing the Drug Identification Number (DIN) on the product container with the list on the Health Canada website.

Public Health Ontario provides helpful guidance about cleaning detergents and disinfecting agents in Section 1.3 of the Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings document. 

Do I need to clean and disinfect pillows after each use? Can I just change the pillowcase/cover?  

To reduce the risks of contact and droplet transmission associated with COVID 19, RMTs must wash and dry all linens, blankets and pillows used in treatment in the highest heat possible after every client.

If the pillow is made of, or covered entirely by a plastic or otherwise non-porous material, it must be cleaned and disinfected between clients using products approved by Health Canada.

If both the pillow and pillowcase/cover are made of porous materials (like cotton, polyester, rayon, viscose, or linen), both the pillow and pillowcase/cover will need to be cleaned and disinfected after every client.

Items that cannot be cleaned and disinfected after every client should be removed from the treatment room.

What personal protective equipment (PPE) and infection prevention and control training do I need to complete?

Before returning to practice, RMTs must complete the training listed below (at a minimum). This training will help RMTs improve their knowledge about infection prevention and control. The goal is to decrease the risk of transmission of infection in your practice setting.

All training resources are free and available online. The IPAC modules are approximately 10-20 minutes in length. 

Client Care

Can I open my Massage Therapy practice?

Due to the rate and nature of how COVID-19 spreads, and the directive of Ontario’s Chief Medical Officer of Health, RMTs should be using their professional judgement to determine whether the benefit of treatment outweighs the risk of contracting or spreading COVID-19.

It remains important for RMTs to continue to monitor COVID-19 spread in their community and to carefully and gradually restart services. Examples of sources of data to use in monitoring local COVID-19 spread include, but are not limited to: Ontario.ca, Public Health Ontario, and local public health unit data dashboards.

CMTO is not expecting RMTs to return to practice if they do not feel it is appropriate or safe to do so.  This information is for RMTs who have assessed the risk associated with COVID-19 and choose to return to practice. CMTO cannot comment on these individual decisions, including how they may impact eligibility for Canada Emergency Response Benefit (CERB) and other government financial benefits.

When can I open my practice?

RMTs can resume practicing immediately, as long as they are able to meet the requirements (e.g. enhanced disinfecting, personal protective equipment, modifications to the practice setting, screening, training, scheduling considerations) of CMTO and the Ministry of Health.

What must I do to reopen my practice?

RMTs should review CMTO’s COVID-19 Pandemic – Practice Guidance for Massage Therapists and ensure they can meet the requirements.

RMTs are also responsible for following the direction of:

RMTs should not return to practice if they cannot meet the requirements set out in these documents.

Even if an RMT is able to meet these requirements, CMTO is not expecting RMTs to return to practice if they do not feel it is appropriate or safe to do so. CMTO cannot comment on the impact of these individual decisions, including how they may impact eligibility for Canada Emergency Response Benefit (CERB) and other government financial benefits.

Can I treat all clients? CMTO’s guidance said to prioritize clients with essential care needs.

Prioritize means treating clients with more serious needs first. All clients can be treated at this time, however, RMTs must always use their professional judgement to ensure the anticipated benefit of treatment outweighs the risk (including the risk of COVID-19).

Can I treat a client who cannot tolerate wearing a mask?

If the client cannot wear a mask (e.g. due to a health condition or difficulty breathing), the RMT must use their professional judgement to assess the risk of providing or continuing treatment.

A client has refused to participate in the infection prevention measures I have implemented (refuses to wash hands, wear a mask). Am I allowed to refuse to provide care?

The RMT is entitled to use their professional judgement to assess the risk of providing treatment. If a client refuses to participate in any reasonable infection prevention measures that have been implemented, the RMT can refuse to treat the client at that time. RMTs must clearly document this in the client health record.

What screening questions do I need to ask a client before booking an appointment and before providing treatment?

Please refer to the Ministry of Health’s COVID-19 Patient Screening Guidance document and COVID-19 Reference Document for Symptoms for screening questions.

A client has shown up for their appointment and has screened as potentially having COVID-19. Am I required to provide treatment?

If before an appointment (e.g. at the time of booking), the RMT screens the client as possibly being positive with COVID-19, the client may not enter the practice setting. RMTs cannot provide treatment to clients who do not pass a COVID-19 screening. The RMT must advise the client that they should self-isolate and complete the online self-assessment tool before calling their primary care provider or Telehealth Ontario at 1-866-797-0000.

If the client screens as possibly being positive for COVID-19 when they arrive for their appointment or symptoms develop during treatment, the RMT must:

  1. establish and maintain a safe physical distance of two metres;
  2. have the client complete hand hygiene;
  3. if the client is not wearing a mask, provide the client with a clean mask, if possible;
  4. segregate the client from others in the clinic;
  5. explain the concern that they are symptomatic, discontinue treatment and reschedule the appointment;
  6. advise the client that they should self-isolate and complete the online self-assessment tool and should then call their primary care provider or Telehealth at 1-866-797-0000;
  7. clean and disinfect the practice area and anywhere the client is likely to have touched immediately; and,
  8. ensure a record is kept of all close contacts of the symptomatic patient/client and other visitors and staff in the clinic at the time of the visit. This information will be necessary for contact tracing if the patient/client later tests positive symptomatic for COVID-19.

All client screening must be documented in the client health record.

Someone who was in my practice environment is confirmed to have COVID-19, what should I do?

If there are any confirmed cases of COVID-19 in a provider, staff, client or visitor of the practice, the RMT should report it to their local Public Health Unit and follow their directions.

Are there treatment techniques, skills, or modalities that are higher risk?

Certain techniques or modalities may present a higher risk of transmission or exposure to COVID-19. The RMT must determine whether it is appropriate to use these techniques/modalities given the increased risk of COVID-19 transmission/exposure. Some potential areas of risk may include:

  • Techniques requiring direct contact with areas close to the client’s mouth, nose, eyes, or ears.
  • Techniques that cause prolonged vibration, such as tapotement, as this may loosen phlegm or mucus leading to increased risk of coughing.
  • Intraoral massage which increases exposure to respiratory droplets and requires contact interaction with the client’s mucus membranes. This may also increase risk of coughing.
  • Hydrotherapy, due to the use of equipment and/or the increased risk of exposure to fluids that may be contaminated.

The RMT may only provide treatment if the benefit to the client outweighs the potential harm that could be done to the client (e.g. contracting COVID-19 and/or spreading it within their community). If these treatment modalities/techniques must be used, additional PPE may be required.

Do I still need to sign my receipts? Can I provide them electronically?

RMTs are required to sign receipts according to the CMTO Policy for Receipts. RMTs can choose to apply their signature in hand-written or electronic form. Clean and disinfect any equipment used during this process (e.g. pens, tablets).

Do I still need to obtain written consent from a client to treat sensitive areas?

RMTs must obtain written consent from clients to treat sensitive areas. During the pandemic, RMTs should consider additional precautions to safely obtain written consent when appropriate, including preparing any equipment used (e.g. pens and tablet devices) before and after treatment by cleaning and disinfecting. 

Are there any additional considerations for record keeping?

In addition to the routine requirements for record keeping, RMTs must record all new procedures related to the client in the client health record, including but not limited to:

  • screening dates and results;
  • PPE used during treatment;
  • modifications to treatment; and
  • details of infection prevention and control measures used to prepare for, during, and after each treatment.

In addition to the documentation in the client health record, RMTs must also maintain a general infection prevention and control record/log for the practice and roster of all people entering the space for contact tracing purposes. Documentation should be kept for 10 years.

Are there additional consent requirements or considerations during the COVID-19 pandemic?

There are no new consent requirements, but disclosing risk is a crucial part of obtaining informed consent. Disclosing risks specific to COVID-19 will be an important part of providing information required to obtain informed consent. The RMT must explain and document the measures taken to lessen risk of transmission of COVID-19, while highlighting that the risk is still present.

As a reminder, informed consent includes the client understanding all of the following:

  1. nature of the treatment;
  2. expected benefits of the treatment;
  3. material risks of the treatment;
  4. material side effects of the treatment;
  5. alternative courses of action; and
  6. likely consequence(s) of not having the treatment.

Can Massage Therapists provide treatment through telepractice* during the pandemic?

*telepractice is the use of telecommunications technology to provide Massage Therapy.

Offering Massage Therapy through a remote platform via telecommunications technology has a number of complexities that will need to be considered and should only be used in very few and unique situations. The RMT will need to consider the scope of practice of Massage Therapy in Ontario:

“The practice of Massage Therapy is the assessment of the soft tissue and joints of the body and the treatment and prevention of physical dysfunction and pain of the soft tissues and joints by manipulation to develop, maintain, rehabilitate or augment physical function, or relieve pain”.

The RMT must determine whether the Massage Therapy they are considering delivering through telepractice is within the scope of practice. There are very few situations where telepractice would fall within the scope of practice of Massage Therapy. Some examples of these rare situations may include:

  • When an RMT must provide guidance for client self-care; or
  • When an RMT would like to complete an intake process for a new client who will be receiving treatment when the RMT returns to practice (e.g. the RMT might receive health history information electronically and conduct an intake interview virtually).

If it is within the scope of practice, the RMT must be transparent in all documentation, including billing invoices, that the services were provided remotely and that, for example, only a partial assessment was performed (i.e. it does not constitute a full session of Massage Therapy and cannot be billed as such). RMTs must advise their clients that telepractice may not be covered by their insurance provider as Massage Therapy.

Prior to using any platform, the RMT must ensure the platform is confidential and secure and meets the requirements of the Personal Health Information Protection Act, 2014; and the RMT must obtain the consent required under the Health Care Consent Act, 1996 and CMTO’s written consent requirements for treating (or viewing) sensitive areas (if applicable). In addition, all applicable legislative and CMTO requirements would still need to be adhered to, such as maintaining client health records.

Employment

My employer refuses to complete telephone screening or implement infection prevention and control recommendations. What can I do?

If you have concerns about health and safety that your employer is not addressing, you can file a complaint with the Health and Safety Contact Centre at 1-877-202-0008.

CMTO is not ordering RMTs back to work. Each RMT will need to use their professional judgement to determine when they are comfortable returning to practice, including weighing whether the anticipated benefits of treatment outweigh the risks to the client and RMT. Ability to implement thorough infection control protocol, such as screenings and cleaning and disinfection measures, will play a key role in this determination.

What should I do if an employer/facility operator is pressuring me to provide Massage Therapy in a way that contradicts government or CMTO guidance?

CMTO expects RMTs to comply with government and public health directives to prevent and control the spread of COVID-19. RMTs who are found to be practicing contrary to guidance may face serious consequences, including suspension or revocation of their Certificate of Registration, penalties under the Health Protection and Promotion Act, the Occupational Health and Safety Act, as well as civil liability in court.

If an employer or facility operator attempts to encourage an RMT to practice in violation of government orders, or if you have concerns about health and safety that your employer is not addressing, you can file a complaint with the Health and Safety Contact Centre at 1-877-202-0008.

Other

What about my income? What financial relief is available to me?

CMTO suggests RMTs continue to follow the ongoing updates from the provincial and federal government regarding support for individuals and businesses financially impacted by the pandemic. Information about economic relief is available at: Canada’s COVID-19 Economic Response Plan.

The Registered Massage Therapists’ Association of Ontario (RMTAO) is also providing updates for RMTs on economic relief.

Ontario Ministry of Health – Workforce Matching Portal

The Ministry of Health is looking for healthcare providers who are not currently working, working part-time and want to and are prepared to increase their work hours, or former healthcare providers who are retired, or on inactive status with their regulatory college; and are prepared to return to employment.

If you are interested, please visit the Workforce Matching Portal for more information and to sign up.

If you have technical issues with the portal, you can find detailed instructions here.

For Students, Educators and Exam Candidates

Important Notice about the Certification Examinations

Due to the COVID-19 pandemic and the threat of community spread, the College of Massage Therapists of Ontario (CMTO) has had to make some difficult decisions regarding the delivery of the Certification Examinations.

The Multiple Choice Question (MCQ) examination scheduled to take place in April, 2020 has been cancelled. The Objectively Structured Clinical Evaluation (OSCE) administrations scheduled to take place in May and June have also been cancelled.

As of now, we do not know when the first MCQ or OSCE administrations of 2020 will be offered. We are monitoring the COVID-19 pandemic and all relevant government and public health recommendations. We will provide an update on the 2020 exam schedule as soon as we have more information to share. 

Please see the table below for a summary of exam cancellations so far:

Examination

Scheduled window

Decision

MCQ

April 1 – 30, 2020

Cancelled

MCQ

July 1- 31, 2020

TBD

MCQ

Sept 1 – 30, 2020

TBD

MCQ

Dec 1 – 20, 2020

TBD

OSCE

May 1 – 31, 2020

Cancelled

OSCE

June 1 – 30, 2020

Cancelled

OSCE

July 1 – 31, 2020

TBD

OSCE

Aug 1 – 31, 2020

TBD

OSCE

Sept 1 – 30, 2020

TBD

​OSCE

​Oct 1 – 31, 2020

TBD

​OSCE 

​Nov 1 – 30, 2020

TBD

OSCE

Dec 1 – 20, 2020

TBD

Thank you for your continued patience as we manage these changes. Please contact Certification Services at certificationservices@cmto.com if you have any questions.

CMTO Operations – Remote Office

Due to the COVID-19 pandemic and the threat of community spread, CMTO has been operating remotely as of March 17, 2020, until further notice.

CMTO expects to operate with few disruptions, none of which will affect our public protection mandate. The identified disruptions are as follows:  

  • There are no walk-in visits at CMTO. Please call us for information. 
  • Courier packages cannot be received at CMTO’s office.
  • Please use electronic mail whenever possible or use mail and registered mail, which will be received at an alternative location.