Our collective response to the pandemic remains front-of-mind across the sector, and for good reason. Nationally, the trends in new cases of COVID-19 are broadly reassuring, but at a local level, we are reminded of the experts’ advice that even under a successful suppression strategy, there will continue to be a risk of positive cases being identified.
The current situation underscores the importance of providers incorporating sensible precautionary measures into the ongoing delivery of care and services for older Australians as the country moves towards becoming COVID Safe. Guidance on appropriate measures for use by residential services is provided in the statement released by the Australian Health Protection Principal Committee (AHPPC) on 19 June. This statement underscores the importance of supporting and promoting each residents’ mental and emotional wellbeing, and ensuring that this receives as much attention as efforts to mitigate the risks posed by COVID-19. (Remember also that each State and Territory Government has issued and is regularly updating its own legal directions/orders about visitor access to residential aged care services, so providers should keep an eye on their own jurisdiction’s orders to ensure that they remain compliant.)
We are continuing to closely monitor and support those services with confirmed or suspected outbreaks. A feature of our approach is to work alongside and complement the efforts of the Commonwealth Department of Health and state-based public health units.
We also continue to closely monitor the impact of visitor restrictions and complaints from consumers and their representatives to ensure the safety and wellbeing of aged care consumers.
The Commission has now recommenced unannounced site visits as one of our regulatory activities, and information is provided in this edition about the precautionary measures in place to minimise any COVID-related risks in undertaking such visits.
The successful launch of Alis, our online learning platform, in February this year has garnered positive feedback and high ratings from those who have signed up. Some providers who expressed interest are yet to take up our offer of four free registrations and we encourage you to do so to evaluate how it could benefit your workforce.
In this edition we also feature information from our Chief Clinical Advisor on minimising physical restraints in relation to beds positioned against the wall and the use of bed rails.
Finally, we are still inviting providers to get in touch to share the creative ways you are keeping consumers engaged, healthy and happy. More examples are in this newsletter – and remember, it’s not too late to share your innovative ideas.
Resuming unannounced visits
In line with a COVIDSafe Australia guidance, the Commission has re-commenced conducting unannounced visits to aged care services.
While we have undertaken risk-based site visits throughout the pandemic, as a temporary measure from 16 March 2020 we introduced a short period of notice (less than 48 hours) prior to visiting a site to minimise infection risks to aged care consumers, aged care staff and our own employees. We have also undertaken a range of off-site monitoring activities on the basis of the Commission’s assessment of risk.
All Commission staff entering an aged care service will provide evidence of having received a 2020 influenza vaccination. We will continue to undertake pre-screening of our staff before entering an aged care service as well as take steps to ensure our practices on site are compliant with infection control requirements.
Further advice will be provided shortly on the next steps in relation to reaccreditation site audits at residential services.
Have you accessed your free registrations yet?
The Commission’s new Aged Care Learning Information Solution, Alis, was made available to the sector in February 2020.
Alis supports people across the aged care sector to access educational content anywhere and at any time.
Alis includes learning modules which focus on the Aged Care Quality Standards. Additional modules are being created and new content continues to be made available.
The Alis modules support learners to understand the intent and application of the Quality Standards; some of the key concepts within the Quality Standards; the importance of working with consumers; and how to demonstrate compliance with the Quality Standards.
Learners who have completed the Alis modules have provided feedback including:
- A good course with some thought-provoking scenarios
- Good course – clear explanations
- Enjoyed the scenarios.
If you are a Commonwealth-funded aged care service, don’t forget your organisation can access four free registrations until the end of March 2021.
If you have not yet accessed your free licences we encourage you to contact the Commission so that you can evaluate the benefits the Alis system for your staff. To register for Alis, visit https://learning.agedcarequality.gov.au/
NDIS registration requirement deferred
The NDIS Quality and Safeguards Commission has recently written to all affected providers and NDIS participants to explain that due to the COVID-19 pandemic, the NDIS has deferred commencement of mandatory NDIS registration for residential aged care providers supporting NDIS participants. This deferment, expected to be extended until 30 November 2020, followed consultation with stakeholders including organisations representing NDIS participants. Previously this exemption was due to expire on 30 June 2020.
You can read more about the arrangements on the NDIS Quality and Safeguards Commission website.
Some tips on minimising physical restraints
From the Chief Clinical Advisor, Dr Melanie Wroth
Is a bed against a wall a restraint?
The Commission often receives queries about whether pushing a bed against a wall is a restraint. There is no black and white answer as it depends on the consumer and their individual circumstance.
As a guide, a bed against a wall is considered a restraint if:
- The wall prevents the consumer from getting in and out of the bed: The consumer may have a health condition, mobility issue or injury that means they can only get out of one side of the bed. If the wall is on the only side of the bed that the consumer can get in and out of, then the wall is a restraint. If the consumer can freely get out of the other side of the bed, then the wall is not a restraint.
- The bed is against the wall and furniture is on the other side: Furniture, heaters and other beds that are close to the bed may stop the consumer getting in and out of the bed. This means both the wall and the furniture are a restraint.
- The bed is against a wall and there is a bedrail on the other side: This is restraint as both sides prevent consumer movement.
If you determine the wall is a restraint for that individual consumer, you need to engage a health practitioner to assess the risks the wall restraint poses to that consumer. This includes the risk of entrapment, body parts being stuck between the wall and the bed, trauma from accidently hitting the wall, and suffocation from bedding being trapped against the wall.
If the wall is a restraint, you will need to put in place appropriate measures to manage the risks and support the consumer. These measures will need to be based on what is reasonable for that consumer’s individual circumstance.
Regardless of whether the bed pushed against a wall is restraint or not, the most important thing is to respect the consumer’s privacy, dignity and independence.
Bedrails are a physical restraint
Bedrails are a restraint and can only be used as a last resort as they restrict free movement. The following steps must take place before bedrails are used.
- Document the reason for bedrails: Document why they have been requested and what harm they seek to address
- Consider alternatives to bedrails: Document all the alternatives that have been considered or unsuccessfully implemented. This includes lowering beds, concave mattresses, better lighting, pressure alarms, recliner lounge chairs and assistance to mobilise out of bed. Partial bedrails or bedrails that can be operated by the consumer and do not restrict movement are unlikely to be considered a restraint. Partial bedrails that restrict movement and prevent the consumer getting out of bed therefore would be a restraint.
- Assess the risks: Unless a restraint is used in an emergency, a health practitioner with knowledge of the consumer must conduct a comprehensive individual assessment of the consumer based on their current behavioural, physical and emotional factors. This includes assessing any risk of harm to the consumer or others, the alternatives used or considered and ensuring the restraint is the least restrictive possible. A new risk assessment will need to be completed regularly and when there are any changes to the consumer’s clinical presentation
- Make an informed decision: The consumer and/or their representative must provide informed consent to use bedrails based on the documented assessment of potential risks, benefits and alternatives to bedrails. Their decision must stipulate any conditions such as whether the bedrails are a temporary use or only used at night. If used in an emergency, the provider must inform the consumers’ representative as soon as practicable after use.
- Monitor, review and readjust: Closely monitor the consumer for distress, harm and whether the bedrails continue to be necessary to address the consumer’s care needs. The bedrails should be used for the minimum time necessary. All these requirements must be met and must be documented prior to use.
If bedrails are used, you must be able to demonstrate that you are meeting your responsibilities under Part 4, s 56-1 of the Aged Care Act 1997, and the Aged Care Quality Standards. This includes having systems in place to manage how the restraint is being used and organisational policies on reporting the use of restraint – Standard 8 (3)(e).
Bedrails can be a risk to consumers health and safety. Bedrails can cause:
- Suffocation if pillows, bumpers and bedding are against the bedrail
- Injury and wounds if consumers scrape or are caught on the bedrails
- Falls if consumers climb over rails, forget or do not recognise the bedrails
- Safety risks if bedrails prevent consumers from summoning help or reaching the buzzer
- Pressure injury if bedrails restrict movement
- Reduced independence, seclusion and social isolation if bedrails prevent consumers from being able to leave the bed and participate in activities and social interactions
- Decline in health and muscle function if bedrails restrict movement and activity.
Innovative consumer engagement
We continue to have a great response to our call out for innovative ways that providers are using to keep consumers engaged and connected during COVID-19 and we welcome more examples.
The Commission has been collecting examples of successful practice from residential aged care services about how they are supporting residents to stay in touch with their families and friends and supporting wellbeing and quality of life during the visitor and other restrictions associated with the COVID-19 pandemic. Please head over to our page on success stories to see more about the great things that providers are doing.
You can send an email with details of your idea, program or initiative to email@example.com. Please send any supporting videos, photos or other visual material (ensuring first that you have secured the permission of any people featured in videos and photos to share their image).
Q and A – Talking success stories!
The Commission has enjoyed conducting interviews with providers as they share, in more detail, examples of the successful activities they have implemented during visitor restrictions and what they have learned from the experience.
In this Bulletin we learned from Saviour Buhagiar – Director of Ageing at Uniting NSW/ACT, what his facilities are doing to keep residents and families connected.
What are some of the activities you have introduced in your facility to keep residents connected and engaged with families and friends during the visitor restrictions?
Very early on we created a group called ‘Staying Connected and Engaged’ and we've kept that running right throughout. ‘Staying Connected and Engaged’ is a working group to drive activity or try to create activities around staying connected and engaged. It involves our key lifestyle specialists convening various groups and various people from across the organisation; across residential, across home care, across disability services - to think of ways of keeping people connected and engaged. There is also an online chat group on our Yammer site that people have been using to share ideas.
Stopping activities and services altogether was not an option. Finding creative ways to adapt became the main objective. Ideas and offerings which emerged through this work included:
- Weekly activity packs sent out to clients living in their own homes.
- Welfare checks for all our Independent Living residents, conducted by volunteers from the corporate employee group.
- Boredom Buster Packs sent out to residents in Independent Living.
- Pen Pals with Purpose launched - project partnering Independent Living residents with kids from local Rovers groups.
- Weekly gym sessions delivered by Zoom.
- Art classes, book groups, Tai Chi & trivia afternoon delivered online for community clients.
- ‘Pop up’ corner stores in our RACs and some of our ILUs - often better stocked than our supermarkets!
- Window, balcony and virtual visits with family and loved ones.
- Entertainers and concerts via social media or from the car park/garden.
- Many of our sites also continued weekly contact with playgroups and school kids via Zoom and the sharing of letters and pictures.
- Art while we’re apart - Competition launched which will culminate in an exhibition in October 2020, followed by a roadshow of the exhibits around the state.
We’ve put a big investment into software called Move and Groove and we’ve engaged a company that helps with Music Therapy. We had started that just before COVID within our dementia support units so we're launching that more widely. We’ve just seen some real benefits in that program in terms of music therapy in particular, but also some of the other resources that it gives you access to.
We have done all the basics too, in terms of communicating with families; we've written to our families every fortnight since mid-February in terms of letting people know what we're doing.
With the possibility of the visitor restrictions lasting several more months, what other ideas have you got planned to implement?
The Stay Connected and Engaged working group will continue to meet each week. One of the benefits of being in a larger organisation is that you keep hearing those new ideas popping up, so people keep sharing them. We've got to keep coming up with new ideas, because clearly loneliness and boredom are a critical issue for us to deal with and address. I think it's important that we keep that momentum going.
People are taking up the visiting options and if we can find a good balance between the need to be cautious whilst also ensuring people are able to meet with their loved ones and keep our programs as vital as they can, I think that's the key.
Are there any activities your facility has introduced that you will continue post visitor restrictions?
Clearly the use of technology with rolling out of things like Move and Groove; we want to keep the use of Skype and various technology pieces.
As I said previously, the Stay Connected and Engaged working group will keep going. In a recent leadership meeting we talked about keeping our leisure and wellness coordinators meeting each month, so they can share ideas and keep going. That's certainly something that we hadn't done before that we'll keep doing.
I believe the use of tech is really, really critical. Our residents in particular, in many cases, have adapted to that. Some of them are into ringing people overseas and Facetiming overseas already. But to do it on a much broader scale, given that people are dispersed these days, it makes a difference. They can still at least connect and see somebody's face and see someone smile. The sort of excuses that they won't adapt to technology - well, they do like it.