Last week I appeared before the Senate’s Select Committee on COVID-19 to answer questions on the Commission’s role and activities during the current pandemic. In my opening address to the committee, I highlighted the Commission’s proportionate, risk-based regulatory response while underlining the important commitment of providers to continue delivering safe and quality care. You can watch my opening statement.
As the Australian community continues to navigate our way to a post-pandemic world, with easing restrictions in some jurisdictions, we in the aged care sector necessarily remain vigilant.
The Commission's regulatory activities are ongoing, including undertaking risk-based site visits, telephone contacts and surveys to assess risks and monitor the quality of care being delivered by individual providers and across the sector, and resolving complaints received about providers. Through these and other means, we are closely monitoring issues to inform our ongoing regulatory responses.
In this edition, we outline a new initiative by the Commission commencing this month - to undertake a consumer survey of recipients of home care packages. Consumer experience interviews are being conducted via telephone, with a participation target of over 5,000 consumers. All providers of home services packages are encouraged to notify consumers of the survey to assist with its successful completion.
You may have seen the series of storyboards published on the Commission’s website in December last year that provide a pictorial representation of the application of the Quality Standards. As described in this bulletin, three more storyboards have been created that are directly relevant to COVID-19 and illustrate key behaviours and priority issues in an aged care setting.
Finally, it is pleasing to see so many examples of providers taking the opportunity to try new approaches to keeping consumers engaged. If your service has put innovative ideas in place please share them via the details at the end of this newsletter.
Home Care Consumer Engagement Survey
The Commission has designed a consumer engagement activity tailored for COVID-19 circumstances, in which we will be conducting direct interviews with home care consumers in receipt of a Home Care Package or their representatives throughout June and July.
The survey aims to better understand the quality of care being provided to aged care consumers by service providers. The responses will provide valuable intelligence to further inform our regulatory activities.
Consumer experience interviews will be conducted over the telephone, with a target of approximately 5,000 respondents. Aged care consumers, or their representatives, will be reminded that taking part in the survey is voluntary and they can choose not to participate.
The survey will cover aspects of the Aged Care Quality Standards, such as whether consumers are treated with respect, to staff follow up when issues are raised, the frequency that services are updated, and how services could be improved.
The Commission had input from Dementia Australia in designing this approach and has built on the initial findings of La Trobe University which highlighted that the telephone interview is the preferred mode for consumers.
Outcomes will be evaluated and information on the survey findings will be published on the Commission’s website.
The Commission continues to respond to all complaints and concerns received about aged care services during the COVID-19 pandemic.
The Commission has seen a significant increase in complaints over recent months including complaints and concerns related to COVID-19 issues. Preliminary analysis of data indicates key issues raised associated with the COVID-19 pandemic include:
- visitor restrictions, including where they exceed jurisdictional legal directions
- concerns about preparedness and prevention
- impact on the quality of care
- concerns about flu vaccinations
- concerns about social isolation
- concerns about possible confirmed cases of COVID-19
- impact on staff numbers and safety.
In addition to continuing to work with aged care consumers and providers to resolve individual complaints, we are also using information provided through our complaints function to inform our proportionate risk-based regulatory approach to COVID-19.
Risk assessment for site visits in a COVID-19 safe Australia
As the Commission continues to undertake risk based regulatory activities in the context of a COVID safe Australia, we remain committed to minimising infection risks to aged care consumers, residential staff and to our regulatory officials when entering a service.
The Commission is reassuring providers and consumers that we conduct a thorough risk assessment prior to and on entry to a service. The application of our risk assessment process is flexible enough to apply to visits which are unannounced, as well as those where short notice is given. When assessing risk, the Commission considers a range of factors including any symptomatic consumers or staff at the service, current cases or suspected cases of COVID-19, infection control procedures and management of an existing influenza program. Where the visit is unannounced, the regulatory official will complete the risk assessment with the approved provider immediately at entry.
The Commission also implements strategies to further minimise the risks for regulatory officials when undertaking site visits. These include a specialised briefing session, guidance on how to safely engage with staff, consumers and others as well as reinforcing advice on hygiene and social distancing measures. All regulatory officials undertake a risk assessment with their supervisor prior to entering a service. Officials are also equipped with personal sanitiser and will adopt local processes implemented by the provider on entry to a service. We are also committed to the government directions on influenza vaccinations and any regulatory official who enters a service will have received a 2020 influenza vaccination.
Our approach ensures that regulatory officials pose no additional risk to consumers of the service visited, and are not placed at avoidable risk themselves. The Commission will continue to conduct these risk assessments prior to and on entry to a service for the foreseeable future.
New COVID-19 storyboard resources
To support the aged care sector during the COVID-19 pandemic, the Commission has developed a range of new storyboards that are designed to illustrate key behaviours and priority issues.
The storyboards aim to support people whose English or literacy levels may be a barrier when it comes to accessing content relating to COVID-19. They are relevant to all providers and consumers, their families and representatives.
The first three new storyboards deal with the following topics:
- working safely in community care
- social and physical distancing
We hope that aged care providers will use the storyboards to explain various scenarios to their staff, their consumers and their families. Providers are encouraged to display the posters within their services, as well as share them online for staff and consumers.
The storyboards have been developed in consultation with a wide range of stakeholders from the aged care sector, including providers, consumers and community organisations. Initial feedback indicates that the storyboards are successful in breaking down often complex issues in a clear, understandable way that will aid understanding and promote best practice across the aged care sector.
Using Personal Protective Equipment when a resident is awaiting a COVID swab or result
If an aged care consumer is suspected of having COVID-19 and is waiting to either have a swab test or receive a swab result, then staff caring for that consumer (and/or for others in close contact or the same area), must wear personal protective equipment (PPE). This is necessary to help keep staff and consumers healthy and safe during the pandemic. Services will need to have sufficient PPE available so that staff can access it immediately if a consumer is suspected of having COVID-19.
It is important that staff use PPE correctly to prevent the spread of COVID-19. This includes washing hands before putting on PPE and removing PPE without touching the front of the mask.
The Department of Health has released a simple guide on when and how to use PPE in aged care. We recommend that this guide is provided to all staff to help stop the spread of COVID-19.
What’s on: Department of Health training webinars
The Department of Health has a number of useful training webinars on their website.
- Learn more about the COVIDSafe app: Deputy Chief Medical Officer Dr Nick Coatsworth explains how the COVIDSafe app works and why it is important to help stop the spread of coronavirus.
- Find out how and when to wear personal protective equipment (PPE). Alison McMillan, Australia’s Chief Nursing and Midwifery Officer, demonstrates how to wear personal protective equipment (PPE) for aged care workers during the Coronavirus (COVID-19) pandemic.
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 check out our examples of the great things providers are doing.
You can send an email with details of your idea, program or initiative to firstname.lastname@example.org. 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 been conducting interviews with a number of providers to share, in more detail, examples of the successful activities they have implemented and what they have learned from the experience.
We sat down with Head of Aged Care with OzCare, Lanna Ramsay to learn more about what her facilities are doing to keep residents connected and support their wellbeing.
What has been the most challenging aspect for your service in implementing visitor restrictions?
I think we've adapted quite well. We haven't closed at all, so keeping visiting open with restrictions has made it easier for the clients, families and the services.
Our visiting hours have worked really well, and we've been screening everybody since early March and they’re all used to it now.
Having the screening process in place is confirmation of trying to keep everyone as safe as possible. Should the Department of Health or the Aged Care Quality and Safety Commission come in to check, it shows we have systems and processes in place, that we’re following and everyone is adhering to, in order to keep everybody safe and that’s what this is all about. Our staff are very comfortable with what we have in place and are coping well with any challenges as they arise.
The biggest challenge we're confronted with is people not wanting to be vaccinated and helping families to understand the importance of the influenza vaccination. We have put strategies in place for those with medical reasons that meet the exemption criteria and can’t be vaccinated, but it's the people who say, “I’m just not having it” but still want to come in who pose a challenge.
The majority of our volunteers haven’t been coming because many are in the vulnerable group so we've been trying to do everything within our staffing levels, keep all the measures in place, and some days this is tough.
We all miss the “sense of community” due to social distancing, limited visits and the presence of children in the facility. We’re trying to keep as much normality as we can.
We have had two special events in the time of restrictions – Easter and Mother’s Day which is traditionally a very busy time with families. Because of limitations on visitor numbers and no under 16-year olds allowed to visit some families were very creative.
We have a lovely video of a lady with her daughter on her balcony, her son-in-law and grandchildren serenading her on Mother’s Day from the park below. This shows you that you can find ways to demonstrate to people how great it is that they are a part of their lives.
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?
Because we can't do large group activities, we're doing similar things in smaller groups. We’ve changed barbecues in the facilities to small picnics in the grounds. Walking groups are now done in the grounds of the facilities.
One of the lifestyle team’s ideas which has been taken up well by the residents is a bird watching group, which is something we hadn't done before. At Noosa they’re very lucky as they’ve got a big national park that borders on to the facility.
It is also a point of discussion: Nobody knows what that bird is, so they say, ‘okay let's take a picture, let's look it up and then tomorrow when we come out we'll be able to say this is what it is and where the bird comes from’, so it's become an educational thing, as well.
For consumers in secure care it is difficult to manage social distancing and isolation. We had a client we needed to isolate in special care who liked to wander. And it was purely because they’d come out of hospital; they weren't COVID positive, but they had respiratory symptoms, so we just needed to keep them away from others, so we contacted Dementia Australia for advice and we were able to access a range of resources.
One of the things they suggested was to keep pushing the hand washing, so we created what's known as “fun hand washing”. We found out everybody's favourite song and they wash their hands while we're singing their song or just any song. It’s a good 20 second hand wash and it’s working really well.
A group activity we've taken a different stance on is some of the quizzes. Now it becomes a competition quiz with one area versus another. Doesn't matter how old you are, we always keep our competitive streak and offer prizes.
Some of the things we’ve done to adapt is using Zoom entertainment and Zoom singing groups.
We’ve been trying to allay any client’s fears because some of them have retreated and gone into self-isolation just because of all the media around COVID-19 and with some of them, we may need to encourage them to get them to feeling safe enough to come out for a bit and participate.
One of the biggest things missed is the intergenerational programs, because we had quite a few of them happening with childcare centres, and primary and secondary school students. But it was one of the first things we had to stop.
It was a challenge for the residents and their happiness…it’s a joy to see little people coming in and interacting so beautifully. So, what we’ve done with a number of them is letter exchanges, or pen-pal activities, so making and writing cards to each other. We’ve been using email with secondary school students.
In Port Douglas, the childcare centre is doing cards and our residents make their cards during the week and send them off in little packages for them.
We are trying to keep them interested but also keep those connections going for them.
What activity do you believe has had the most positive/beneficial impact on consumers’ quality of life during the restrictions? In what ways?
Probably all the activities to do with nature: creating new gardens and the bird watching.
Although we already had gardens some of them have created new gardens, but they’re doing it in more earnest and seeing what can go to the kitchen, and it also gets them outdoors.
Also, the “fun hand washing” because it doesn't have to be just for the secure unit, you can do it anywhere - it’s just making sure they're doing it well.
What we’ve noticed is with the exercise classes, because they are now smaller, more people are inclined to participate. We’re capturing a greater audience in some of the smaller group activities.
There has been an increase in engagement from the people who are a little bit shy or have been a bit reclusive in their life, or where their health conditions and illnesses over the years have kept them more confined to home. They find [on entering the residential service] that all of a sudden, they’re back into communal-type living and they’re a little bit uneasy about it.
They’ve found that they’re happier in a small group, rather than sitting in a big room with 30 other people. They’re actively joining in.
What has been the most positive feedback from the consumers and their families?
The most positive feedback is from the residents: ‘Thank you for letting relatives come and see me’. Thank you’s from a couple of people who we’ve made some exemptions for, around time, and other things. I have one lady who spends all day every weekday with her husband who isn’t very well. They have been married for 68 years so with strategies we agreed she could still do this, after having the conversation that 'this is what I need you to do, this is how we can do it, are you okay with that'? She is fine with that, so we've allowed that to continue.
I think probably the best feedback we've had is families telling us, “We know this is tough, and we know we've got to do things that we don’t like, but thank you for everything you're doing to keep everybody safe and that's the thing that's most important”.
With the possibility of the visitor restrictions lasting several more months, what other ideas have you got planned to implement?
I think, in the toughness of it all, you try and keep as much normality happening as possible. Normally our lifestyle program is driven by clients' likes, dislikes and interests. So we keep talking with them, finding and researching new ideas and learning from what others are doing.
Can you tell us what you have learned/taken away from implementing these activities?
One good thing to come out of it is that our lifestyle and leisure teams have had to think very laterally about things you can do; sometimes it is pretty easy to fall into a bit of a rut with programs.
I think this has allowed them to be more creative in their thinking: it's not just about adapting what we've always done and doing it “less”, it’s about what's new and what's different and not underestimating the capacity of the people who are living with us to change and do different things and to enjoy investigating and learning new things.
Just like the bird watching - it's just that sort of different thing that creates that curiosity.
Are there any activities your facility has introduced that you will continue post visitor restrictions?
The smaller group activities are certainly something we’re going to try and keep on the agenda, continuing to foster some of those friendships and relationships in an easier way. As well as the onsite picnics versus barbecues; we will put that more into the mix.
We will definitely continue the birdwatching group as well as more gardening for them; because as I said, gardening is good for them; and the routine stuff on fun hand washing.
Also, sometimes thinking differently and applying different ways to get people to do something, when they have challenges that prevent them from understanding or following guidance you know, how to sneeze hygienically, or to cough, or giving them coloured tissues or whatever, to help them with those sorts of things.
I think keeping the facilities open to visitors has been a lot of additional work but it’s been worth every minute of doing it because it has kept these connections happening and, as I said, the majority of visitors are well aware of their obligations and requirements and are being very responsible, because the last thing they want is be the one responsible for making their family member sick.
On a last note I would like to say what a fantastic job all our employees and the aged care industry has done in what is a tough time for the nation. They willingly come to work and give everything to ensure our clients are well cared for and, importantly, kept safe. I am proud of them all and very proud to be a part of this great service to the elders of the nation.
If you would like to be involved in our Q and A, email email@example.com.