At the time of writing, the situation in Victoria is thankfully improving, with levels of community transmission having significantly reduced along with outbreaks in aged care residential services. It has been a long journey and the risks of the pandemic continue, but it does seem that the dedicated efforts of everyone in that state in particular are paying dividends.
The Royal Commission’s special report on aged care and COVID-19 has been released by the Australian Government, which has accepted all six recommendations. In responding to the report, the Government announced legislation will be introduced into Parliament in the spring sitting for the Serious Incident Response Scheme (SIRS) to commence early in 2021. Information about SIRS was also included in last week’s 2020-2021 Federal Budget.
The Commission will be providing information and education for the sector about the new scheme in coming weeks and months. In this Quality Bulletin you can also read about our new webform which will make it easier for providers to submit compulsory reports.
Following the National Cabinet’s endorsement in August of the Plan to Boost Aged Care Preparedness for a Rapid Emergency Response to COVID-19, the Commission has been working alongside the Commonwealth Department of Health in engaging directly with each state and territory health authority to agree on how we will co-ordinate our efforts to support residential aged care services in each jurisdiction, and ensure that these services are well-prepared to prevent and respond to a COVID-19 outbreak.
The Commission is continuing to expand our program of unannounced infection control spot checks across the country, with over 950 conducted since March 2020. These spot checks ensure that staff, management and visitors are following all PPE protocols and that there are safe infection control arrangements in place. If issues or concerns are identified, the Commission will consider further regulatory activities to ensure that quality and safety obligations are met. You can read more about the Commission’s findings from these spot checks in this Quality Bulletin.
New resources and guides for both providers and consumers are being produced and published by the Commission on a regular basis, including posters and videos in many languages, as well as dedicated guides for providers of both residential and home care services. More of these are in the pipeline. Watch out for the Commission’s new practical guidance on outbreak management planning coming soon.
The ongoing announcements of limited, small-scale COVID-19 outbreaks in parts of the country are a constant reminder that, for the foreseeable future, we are all working towards a ‘COVID normal’ way of living and working which takes account of the viral risk. In aged care, this is being played out daily in arrangements for families to spend time with their loved ones in residential care. Keeping residents safe is obviously vitally important. Of equal importance is supporting the physical, social and emotional wellbeing of residents. Aged care providers can and must address both of these imperatives under the Aged Care Quality Standards. Some but not all providers are doing this now. Are you?
With a widely available vaccine still some way off, and noting the second waves of COVID-19 in many countries, there is no room for complacency. Everyone must remain alert and ready, and the Commission is continuing to use our full range of powers to promote the health, safety and wellbeing of Australians receiving aged care.
Provider responsibilities on infection control
On 31 August 2020, Minister Hunt and Minister Colbeck advised that the Australian Government will extend payments to provide a further $245 million injection into all residential aged care facilities to support the sector on COVID-19 response. The announcement included that this funding will be required to be used by providers to fund and support enhanced infection control capability, including through an on-site clinical lead.
The legal responsibilities of providers regarding infection prevention are contained in the Aged Care Act and the Quality Standards, as well as relevant jurisdictional public health orders. Standards 3 and 8 include requirements that relate explicitly to prevention and control of infection, and requirements in Standard 7 relate to the presence of skilled and qualified staff.
Assessment against the Quality Standards provides an opportunity to understand how services ensure they have the clinical support they need, including the presence of an onsite clinical lead.
New webform for compulsory reporting
To ensure the safety and help protect aged care residents, the Aged Care Act 1997 has compulsory reporting provisions that require approved providers of residential aged care services to report suspicions or allegations of reportable assaults at their services within 24 hours to local police and the Commission. The law also requires service providers to report when a resident is absent without explanation (also known as a missing resident).
These requirements ensure timely help and support for those affected and that providers work to put strategies in place to prevent the situation from occurring again. Such strategies help maintain a safe and secure environment for residents.
To facilitate the reporting of these incidents, the Commission has implemented a new way to submit compulsory reports using an online webform. The webform will not change the current responsibility of approved providers to submit compulsory reports under the Aged Care Act 1997. Instead, it is designed to make it easier to submit reports to the Commission and allow the Commission to process the information more efficiently.
The webform will be available shortly. Approved providers will be able to input the information about a reportable assault or unexplained absence directly into the webform which will feed into the Commission’s data system.
The webform will be the Commission’s preferred way to receive reports, however the compulsory reporting forms will still be available on the Commission’s website and can be submitted via email if approved providers are unable to access the webform.
Infection control spot checks – learnings so far
The Commission has expanded its infection control spot checks at residential aged care facilities across Australia. The spot checks are conducted to observe infection control defences to ensure that services are adhering to infection control arrangements, including safe PPE protocols.
What providers are doing well
Generally, the visits have found that Outbreak Management Plans (OMP) are in place, are reviewed regularly and, importantly, contain all relevant information in an easy-to-read format. A large proportion of providers have floor plans showing room configurations, highlighted alternative access points, don/doff stations and clearly marked command centres and staff break rooms.
Some providers have laminated floor plans that can be annotated and updated as often as required, and one had printed a table-sized floorplan with Velcro tabs with photographs of consumers for easy identification of placement within the service. Some providers have demonstrated a high level of preparedness by undertaking drills using the OMP including the allocation of staff to various lead roles and testing staff in their roles and responsibilities.
What could be improved
Our regulatory officials noted that several providers did not have sufficient PPE for the first 48 hours in the event of an outbreak.
While providers exhibited a good level of awareness about the COVID-19 status of staff and consumers and have strategies to use while waiting for test results, in some instances this was not well tested, with our regulatory officials identifying some consumers waiting for test results who were not isolated adequately.
While many providers have OMPs in place, there are some common issues being identified. For example, some services had an organisational OMP template that did not have service-specific information. Not all plans had clearly identified service cohorting zones/rooms where PPE donning and doffing stations are, or should be, located.
Additionally, some services did not have clear documentation of clinical handover or lockdown processes, or a centralised listing of consumer Medicare numbers readily available. Further it was noted that some services lacked prepared signage that could be used immediately to identify areas that are active COVID-19 zones.
In locations where PPE is a requirement (in accordance with state/territory directions), our officials observed some occasions where aged care staff were wearing masks incorrectly and/or frequently touching their face/mask and donning and doffing stations were not always clearly identified.
In terms of infection control, hand washing/alcohol-based hand sanitiser stations and disinfectant wipes are readily available in most, but not all, services. Shared equipment, such as phones or computers were not always wiped down between users, and although social distancing measures were in evidence in many services, some did not have clear signage to identify the permissible number of staff in common areas such as offices, break and changing rooms.
Good ideas and initiatives noted during our visits
Our regulatory officials have also identified good ideas and initiatives during spot check visits.
- Laundering of staff uniforms so the service can be assured that each staff member has a clean uniform every day
- Picking up staff who don’t drive and taking them to/from work in the service’s bus so they don’t have to take public transport
- Investing in tracking devices for onsite staff for the purposes of contact tracing. The device records when a staff member is in a room for more than 10-15 minutes and registers it on a database. In the event of an outbreak, the service is able to run a report about which staff members and residents may be impacted
- Investing in face scanner technology that recognises the forehead and scans faces for temperatures
- Relocating upper and middle managers out of the main aged care service into different buildings so that in the event of an outbreak, there are senior staff available who can step in and help if their senior onsite staff have to isolate
- Creating a song about the donning/doffing process so staff remember what to do
- Preparing and keeping handy an ID wristband for every resident that can be placed on their wrist in the event of an outbreak, to help incoming staff who are unfamiliar with the residents to identify them if a large number of the rostered staff have to go into isolation.
Home care services survey update
The Commission’s telephone survey of randomly selected consumers of home care packages has now exceeded 5,000 calls. The survey is part of our ongoing commitment to obtain consumer insights by conducting consumer experience interviews. While the survey was primarily intended to be conducted via telephone, some consumers were also offered the option of completing a paper-based or online version.
The response rate has been better than many comparable market-based telephone surveys, with approximately 2,500 consumers completing the survey so far. The process and results of the exercise are being independently evaluated, with one area for provider improvement already identified that relates to the amount, frequency and clarity of information provided to consumers, including the provision of monthly statements.
The survey questions were first tested using small pilot surveys. Additional questions relating to the impact of COVID-19 were included. The Commission’s staff, who conducted the survey, were also able to capture general comments or feedback alongside the survey questions to broaden the scope of results and to understand areas of risk. Once all results have been captured and evaluated, the Commission will publish a summary of results on our website.
Prudential targeted campaign - refundable accommodation payment responsibilities and compliance with the Liquidity Standard
Residential aged care approved providers who hold a refundable deposit (defined in Schedule 1 of the Aged Care Act 1997 (the Act) to mean ‘refundable accommodation deposits’ and ‘refundable accommodation contributions’), are required by section 52M-1 of the Act to comply with the Prudential Standards (Part 5 of the Fees and Payments Principles 2014 (No. 2) (the Fees and Payments Principles)). As part of refunding refundable deposit balances, providers are also required to comply with section 52P-1 of the Act (‘refunding refundable deposit balances’) and Part 7 of the Fees and Payments Principles.
One standard contained in the Prudential Standards mentioned above is the Liquidity Standard (Part 5, Division 2 of the Fees and Payments Principles). In order to meet their obligations under this standard, providers must maintain sufficient liquidity to ensure that they can refund any of the balances that can be expected to fall due in the following 12 months. An article on liquidity management and statutory obligations appeared in the March 2020 edition of the Aged Care Quality Bulletin.
An analysis of prudential information illustrates that some residential care providers are not meeting their refundable deposit refund obligations. This has led the Commission to embark on a campaign focussing on provider obligations with respect to refundable deposit refunds. The purpose of the campaign is to support providers to develop a better understanding of their obligations in refunding refundable deposits, including ensuring that providers comply with the Liquidity Standard when refunding refundable deposits.
The campaign will be conducted before the end of this calendar year and will involve a virtual assessment with a small sample of approved providers based on their previous Annual Prudential Compliance Statement (APCS) submissions. Providers selected to participate in the audit will be notified the week prior to the audit.
The assessment will determine if the providers are meeting their statutory obligations, including the timing of refunds, the amount of interest paid, and whether they complied with their minimum stated liquidity and their Liquidity Management Strategy. If the assessment identifies that a provider has not complied with their responsibilities, the Commission may take regulatory action.
Where it is clear that COVID-19 has affected a provider’s ability to meet its obligations, you may be referred to the Department or contact ACFM@health.gov.au to discuss available support options.
Detailed information on compliance with refundable deposit responsibilities is provided in the APCS Guidelines.
Information on managing refundable accommodation payments for residential aged care, including refundable deposits and accommodation bonds, is available on the Department of Health website.
Repatriation fact sheet now available
The Victorian Aged Care Response Centre (VACRC) has issued a fact sheet to assist residential aged care providers in managing the repatriation of multiple residents to a residential aged care service in Victoria after a COVID-19 outbreak.
The approach to returning residents focuses decision making on the preferences of residents and their families, good communication and information sharing, planning and logistics and reducing the risk of transmission for returning consumers and those on site.
The fact sheet details the responsibilities for hospitals involved in the repatriation process, as well as those of the residential aged care service. It also provides guidance on the coordination role that the VACRC will undertake before and during repatriation.
Please note that the fact sheet does not cover repatriation of individual residents to aged care facilities. Where there are individual residents (not admitted as part of a larger cohort) who may have been admitted to hospital for clinical reasons and meet the clearance criteria (if relevant) and are ready for discharge and the service can receive the resident, these transfers can occur as part of the health service’s discharge planning processes directly with the residential aged care service.
Checking in on home care recipients during COVID-19 – Watch Act Monitor
COVID isolation and social distancing mean that family and friends may not be checking in as often with older relatives who live in their own home. If other social supports have also diminished, the older person can feel lonely and isolated, which in turn can adversely affect their health and wellbeing. It might also mean that emerging problems can be missed.
Home care staff have a critical role in watching out for and responding to signs that people receiving home-based care are declining or not coping.
If you are a home care provider, you need to identify consumers most at risk, increase your staff’s regular check-ins and ensure that there is more than one carer checking in each week. Your staff need to:
Watch for warning signs that a person’s health or circumstances are deteriorating such as:
- Losing interest in activities or conversation
- Change in physical appearance, self-care or cleanliness of their home
- Lack of interest in food, uneaten meals and weight loss
- Lack of essential supplies: food in the home, continence aids, toilet paper
- Missed appointments or missed medicine
- Change in sleeping patterns
- Change in cognition, confusion, behaviour
- Evidence of falls, bruising, wounds
Act on warning signs
If staff are concerned, they need to know that they should alert home care management. Mechanisms should be in place to increase the care and support provided and discuss with the consumer, their family and GP.
All concerns, actions and plans must be documented. Safety issues must be addressed immediately.
Home care staff should continue to check in on home care consumers to ensure that concerns are addressed and circumstances are being stabilised.
For further guidance on how to reduce the risks for home care recipients, see the article on Provider management of risks to consumers who live at home.
COVID-19 resources – translated
As part of its ongoing role in providing guidance and resources for providers, consumers and their representatives, the Commission has translated some of its COVID-19 resources into 15 languages. The translated resources include the ‘How to stay safe from COVID-19’ video, which aims to help consumers understand the steps they can take to keep themselves safe during the current pandemic.
Also translated are the ‘What to expect during a COVID-19 outbreak’ A4 guide and A3 poster, which help consumers understand what to expect if someone has COVID-19 in a residential aged care service, including that a number of changes will take place.
Assessing the Standards – new workshops
Assessing the Standards – the Commission has scheduled a new round of our “Assessing the Standards” online workshops, running throughout October. Through active participation in this online workshop, participants will be able to:
- Understand the principles that inform the Commission's approach to performance assessment
- Understand and describe how they and other staff contribute to the achievement of quality outcomes for consumers
- Use the self-assessment tool to gather and analyse information to evidence performance against the Quality Standards and/or identify opportunities for improvement
- Contribute effectively to their organisation’s continuous improvement systems
Visit our website to find out more about the workshops and to register.
Website updates and resources
This template is used to refer key information, feedback or concerns to the Commission about care and services provided by Residential Aged Care Providers and Home Service Providers.
In the event of an outbreak of COVID-19 at a residential service, the service’s Outbreak Management Team and key personnel at the service will be working in close co-operation with public health authorities and other parties to ensure an effective emergency response. A key personnel template has been developed to assist providers in identifying key personnel of the service and their contact details to support this response.
Our COVID-19 information page is regularly updated with resources from the Commission, the Department of Health and other relevant stakeholders. The latest updates are announced at the top of the homepage of the Commission’s website.