The tragic COVID-19 situation affecting a number of aged care services and residents in Victoria underscores for everyone involved in the aged care sector the importance of meticulous planning and well-rehearsed preparations to minimise the risk of an outbreak and optimise the response to an outbreak.
During July, we conducted over 1,000 assessment contacts by telephone with all residential aged care service providers operating in Victoria and Western Sydney to gather information about each service’s COVID preparedness. We have also engaged with all services (residential and home services) operating along the NSW/VIC and SA/VIC borders regarding management of risk and workforce supply.
We also recently deployed a new self-assessment tool for all residential aged care providers to use in assessing their readiness for a COVID-19 outbreak. All services across Australia (except those with an outbreak) were required to complete the online assessment and submit their results to the Commission. This assessment included consideration of their outbreak management plan and their readiness to enact it immediately if an outbreak occurs. We will share high-level findings from the survey with the sector shortly.
In early August, the Commission started undertaking unannounced spot checks of residential aged care services to observe infection control practices and ensure that staff are adhering to safe personal protective equipment (PPE) protocols and infection control arrangements. Priority is being given initially to aged care homes in the areas of greatest cluster transmission (in the restricted zones in Victoria and in parts of Sydney).
All providers are reminded of their responsibilities under the Quality Standards to ensure that staff have the necessary training, including in infection control practices and procedures, and in the appropriate use of PPE including gloves, masks, face shields and gowns.
The Commission continues to publish new resources to support aged care services during the pandemic. With support from our Chief Clinical Advisor we have developed and published two new resources specifically for Victorian aged care providers in preparing for a COVID-19 outbreak called ‘Are you alert and ready?’, which can be found in the Resources section of our website. These resources have now been updated with relevant links for all States and Territories.
In July, we published new consumer resources including a new video resource to support consumers in services experiencing a COVID-19 outbreak. You can find the resources on our website and a link to the video under the Consumer tab.
The Commission continues to work together with the Commonwealth Department of Health and the Victorian Department of Health and Human Services, including infectious disease and clinical experts, to closely support and monitor services experiencing an outbreak in Victoria.
We acknowledge the ongoing efforts of all aged care services to protect older Australians at this critical time.
Online self-assessment survey
The recent online Self-assessment Survey conducted by the Commission was designed to support residential aged care services to undertake a critical check of their Outbreak Management Plan (OMP) and ensure that they are ready to immediately activate the Plan if an outbreak occurs.
The information submitted to the Commission in response to the survey was sought as an assurance that providers are not underestimating the scale of likely impact of an outbreak at their service, that they have a good understanding of the risks the service faces, and have ensured that these risks are addressed in the service’s Outbreak Management Plan.
You can read more about the survey online. The Commission will share high-level findings from the survey to the sector shortly.
Identifying key personnel and roles during an outbreak
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.
The template is intended for a service to use in the event of an outbreak to communicate with multiple other parties who may be involved with the service during an outbreak. Services can modify and tailor the template to suit their needs and it is recommended that the completed template is provided to all involved parties and updated as required, with updates also printed out for use on site.
Wearing of face shields
In addition to the requirement for all Victorian aged care workers to wear face masks, aged care workers in Victorian residential aged care facilities are now advised to wear face shields as a precautionary measure.
Single use face shields are being distributed from the National Medical Stockpile to all residential aged care facilities in Victoria. Facilities will be directly contacted by delivery providers to receive the allocated face shields, with priority distribution to Greater Melbourne and Mitchell Shire.
Guidance on the use of face masks and shields by health care workers in areas with significant community transmission of COVID-19 can be found on the Department of Health’s website.
Cohorting Consumers with COVID-19
Cohorting may be a fairly unfamiliar term for some residential aged care services. In the context of an infectious disease like COVID-19, it refers to separating consumers with a confirmed or suspected case of COVID-19 from those who do not have COVID-19 in residential care. This may involve temporarily moving a resident with COVID-19 to another room or area within the facility to create distance from other residents who have tested negative to the virus. Alternatively or in addition, it may involve temporarily moving a resident or residents to another facility such as a public or private hospital.
As indicated in the document “First 24 hours”, early decisions and actions are required regarding cohorting of residents as a critical component of infection control practice in response to COVID-19.
You need to act quickly if a consumer or staff member in your facility tests positive to COVID-19. Your primary concerns will be:
- stopping the spread of the virus within your facility,
- safely delivering care to any COVID positive residents, and
- continuing to deliver essential care to other residents.
Depending on the particular circumstances, options for separating COVID-positive resident/s from other residents can include offsite and/or onsite cohorting. Offsite cohorting involves relocating one or a group of residents to another care setting. Onsite cohorting involves immediately isolating a COVID-positive resident, preferably in a single room with their own ensuite facilities. If this is not possible at your service, then there are medical grounds to move residents within your facility to control the spread of the virus.
Principles to apply when moving residents within a facility
The Commission acknowledges that if you need to temporarily move a resident within your facility, you may not have the time or capacity to follow the security of place provisions in the User Rights Principles 2014. In these instances, it is essential that you prepare ahead, including your communication with residents and families, so that you are ready to implement moves if necessary.
The following principles should be applied either prior to or as soon after the move as you reasonably can:
- Explain to the affected resident/s (or their representative) the reason for the move, that it is temporary and how safe, quality care will continue to be delivered.
- Notify the affected resident/s (or their representative) of the timing of the move.
- Ensure residents have access to their belongings.
- Regularly update the affected resident/s (or their representative) about any ongoing need for them to stay in a different part of the facility.
- Support residents to adjust to their changed environment. The Older Persons Advocacy Network can help – opan.com.au
- Continue to deliver essential care to the resident in the changed setting.
- Effectively and promptly manage any complaints about the move.
- Document the reason for the move and your communications with the resident/s (or their representative).
- Continue to act on advice provided by the Public Health Unit and treating health professionals.
Plan ahead to consider how you would implement cohorting arrangements if there were a positive case at the service. Use your floor plan to identify risks your service may face and consider how these risks could be managed.
Your planning should test multiple scenarios and options.
Considerations for implementing cohorting
- Suspected cases and known COVID positive residents not being in a shared or communal area, such as a dining room
- Suspected cases and known COVID positive residents not sharing a room or bathroom with other consumers
- Positive residents can share a room with other COVID-19 positive residents
- Designating a particular wing or floor for COVID positive residents
- Consideration of alternatives such as repurposing an office for a COVID positive residents or repurposing a common area for COVID positive residents
The Commission has prepared FAQs on cohorting, which you can read here.
The Commission’s regulatory activities
The Commission continues to take a proportionate risk-based approach in responding to the evolving COVID-19 (coronavirus) situation.
With restrictions lifting in some states, the Commission will resume conducting reaccreditation site audits for residential aged care services from August in some states and territories. This step is being taken in line with advice from the Commission’s Chief Clinical Advisor and we have in place a comprehensive risk screening process relating to the Quality Assessment Team. We are also risk assessing circumstances at the aged care service prior to entry. In line with the return to site audits in some states, the Commission will also resume its weekend monitoring program in August. Residential aged care providers can expect that Quality Assessors may attend after hours and on weekends to conduct unannounced assessment and monitoring activities.
These arrangements will be carefully monitored, and if required, the Commission will make further adjustments in line with the COVID situation in each state and territory.
New COVID-19 resources for consumers
The Commission has developed resources to support consumers during the COVID-19 pandemic. The resources relate to the following topics:
- How to stay safe from COVID-19
- Staying connected with your loved ones during COVID-19
- How to stay active and enjoy yourself during COVID-19
- What to expect during a COVID-19 outbreak
For each topic there is a poster, how-to guide and short video containing suggestions for staying safe during the COVID-19 pandemic.
Better use of medications in aged care
The Commission has engaged Health Outcomes International (HOI) to conduct an evaluation of the work funded under the 2018-9 Better use of medications in aged care Budget measure. A part of this consultancy, HOI has produced a Discussion paper drawing on the key findings of a literature review of the evidence.
Improving medication management for older adults in residential aged care continues to be a national priority. There is promising evidence that the introduction of well-designed interventions can support change in prescribing practices in these settings.
You can access the discussion paper here.
Provider management of risks to consumers who live at home
Home based care is essential to supporting consumers to remain in their own home. The risks experienced by consumers accessing home-based care can differ depending on their individual needs and personal circumstances.
Consumers who are most at risk have some combination of the following characteristics:
- Live on their own
- Are socially isolated or lack close relationships
- Have few or no family or friends who ‘check in’ on them
- Have cognitive impairment and are unable to problem solve or ‘speak up’
- Have communication difficulties
- Have limited mobility
- Are highly dependent on their caregiver; and
- Have only one carer.
There are simple steps that you can take to protect your most vulnerable consumers and ensure they receive the best possible care:
- Undertake regular risks assessments for each consumer to identify those most at risk
- Review clinical governance arrangements in how management oversees the care of those at risk
- Consider ensuring consumers have more than one carer over the week. Having a single carer increases the risk of something going undetected, whereas more than one carer means that any issues should be identified quickly
- Undertake regular spot checks to ensure consumers are receiving the best possible care and the care you expect them to be receiving, and to identify areas of care to improve
- Be flexible to change the care and support as needed
- Undertake recruitment checks for new staff including police checks and verification of referee reports; and
- Ensure staff are trained to identify and report any concerns and create a culture of reporting concerns.
Providers who pro-actively manage these risks will ensure that they provide the best quality of care to their most dependent and vulnerable consumers.
Assessing the Standards – residential aged care services
We are pleased to advise that online Assessing the Standards workshops for residential aged care services will commence in mid-August.
This follows some intensive work by the Commission to translate our very popular in-person workshops for delivery through a virtual training environment.
The online workshops are designed to provide participants from residential aged care services with the knowledge, skills and practical experience to undertake a self-assessment and prepare for performance assessment against the Quality Standards. The workshop includes a number of activities which are consistent with the practical content included within the previous face to face workshops.
Through active participation in the 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 standards Quality Standards and/or identify opportunities for improvement
- Contribute effectively to their organisation’s continuous improvement systems.
The online workshops are aimed at staff from residential aged care services / organisations including:
- Care / unit / facility / regional managers
- Registered nurses
- Quality managers and coordinators
- Educators and trainers
- Service managers
- Quality managers
- Supervisors and team leaders
Participants are expected to have a sound knowledge and understanding of the Aged Care Quality Standards and their application.
A free sign language interpreting service
The Federal Government is funding a free national sign language interpreting service to help senior Australians who are deaf, deafblind or hard of hearing to navigate the aged care system and to support them to better engage and fully participate in their aged care services.
The service will be delivered by Auslan Connections, which will provide face-to-face sign language interpreting and video remote interpreting services to improve interactions with My Aged Care, aged care assessors, service providers and related organisations.
For more information, please contact Auslan Connections on 1300 010 877 or visit their website.
Dementia Australia National Symposium moves to free webinar series
Originally planned to be held in Sydney earlier this year, the ‘Dementia Australia National Symposium Series 2020 – Dementia care is quality care’ has now been transformed into an online series of virtual events.
The online series will feature presentations from people living with dementia, their families and carers as well as:
- Janet Anderson PSM, Aged Care Quality and Safety Commissioner
- Prof Dawn Brooker, Director of the University of Worcester Association for Dementia Studies UK
- Dr Lisa Trigg, Assistant Director, Research, Data and Intelligence, Social Care Wales, UK
- James Adonis, author and leadership educator
- Prof John Pollaers OAM, Chancellor, Swinburne University and Executive Chairman of Leef Independent Living Solutions
- Ita Buttrose AC OBE, Dementia Australia Ambassador and Chair ABC.
Journalist, broadcaster and comedian, Julie McCrossin AM will act as facilitator. The online series is being held weekly for six consecutive weeks beginning Tuesday 4 August. To join the webinars register through the Dementia Australia website.
- The Older Persons Advocacy Network (OPAN) has resources that can assist in identifying and responding to the abuse of older people. OPAN’S review of OPAN elder abuse advocacy and prevention programs final report can also be downloaded.
- A new electronic process allowing GPs to refer their patients to My Aged Care directly from their practice management systems is available. The form is currently being used by over 900 practices around Australia. You can also download a brochure which supports patients with information on the steps that can be taken once referred.
- Dementia Training Australia and the Wicking Dementia Research and Education Centre deliver a range of free online dementia training education and resources. Visit https://dta.com.au/ for training on understanding and preventing dementia and https://www.utas.edu.au/wicking for training offered by Wicking Dementia Research & Education.
- The Department of Health has provided an infographic which gives a quick view of the current coronavirus (COVID-19) situation in Australia. This is updated every afternoon based on the data received by 3pm from states and territories.
- Emergency Leave Factsheets for RACF - The Department of Health has published new factsheets for providers and residents on emergency leave from residential aged care facilities.
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 website 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 Wendy Russell, Uniting Care’s General Manager of Uniting Care’s COVID Ops Management Team for Aged Care & Community Services (ACCS) what the facilities are doing to keep residents and families connected.
Q: What has been the most challenging aspect for your service in implementing visitor restrictions?
A: The most challenging aspect of the restrictions has come since the general population has been able to move about and the aged care restrictions have stayed in place. Most families have been supportive and understand the need for the continued restrictions but the longer this goes on, the more difficult it has become. Where there are younger residents who have previously moved around independently, this has been more pronounced.
Q: 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?
A: Implementation of technology solutions – Skype, Zoom and FaceTime on iPads. We have also introduced CareApp a communication and engagement platform which we rolled out across 47 of our residential facilities. Sim enabled tablets are used to connect and share photos, videos and experiences with family. One of our facilities set up a message and photo frame for residents to share their photo and message with their family. Letter writing has become a regular activity at most sites.
Q: What activity do you believe has had the most positive/beneficial impact on consumers’ quality of life during the restrictions? In what ways?
A: A pen pal project that ran at one of our facilities has received very positive feedback from our residents who have enjoyed receiving letters from families and others in the community.
Q: What has been the most positive feedback from the consumers and their families?
A: CareApp has received excellent feedback from families who have signed up.
Q: With the possibility of the visitor restrictions lasting several more months, what other ideas have you got planned to implement?
A: We will need to increase our lifestyle offerings and continue to share ideas across our facilities.
Q: Can you tell us what you have learned/taken away from implementing these activities?
A: The learnings have been how to respond and implement strategies rapidly. Also, never underestimate the ability of your residents to use technology.
Q: Are there any activities your facility has introduced that you will continue post visitor restrictions?
A: All our activities will be continued post restrictions.