Open Borders – What does this mean for your service?

Around Australia we are hearing the term open borders, as in ‘the borders will be open in time for Christmas’ – or perhaps not, depending on what State or Territory you live in.

While many people are rejoicing that they will be able to spend this holiday time with family and friends, many of whom they haven’t seen for months, others like aged care and disability providers may be viewing this with concern.

Yes, at some stage we have to start living with COVID, it’s not going away.

With so many unvaccinated people around the world, it’s also likely that we will continue to see variants that may cause flare-ups of the virus and impact even those who are currently vaccinated. While some of the more populated states have high vaccination rates of over 90%, some areas have much lower vaccination rates, which means that vulnerable people are at higher risk of catching the disease and having an adverse outcome. Those vulnerable populations include:

• Older people living in residential care or receiving home care; often their immune systems are not as responsive to vaccines and/or they are more vulnerable due to other underlying health conditions.
• Younger people living with a disability; their underlying health conditions or heavy reliance on close contact from support workers means they are at higher risk of someone passing on an infection. This is often compounded by the inability to get out and about in the fresh air. They may be restricted to enclosed spaces which also increases the risk of breathing in virus particles.
• People from Aboriginal and Torres Strait Islander backgrounds with a higher propensity for underlying health conditions such as diabetes and renal disease. This group of people are particularly at risk of an adverse outcome should they become infected with the virus. Overcrowded housing in some communities adds to the risk of transmission between household members.
• Seniors from culturally and linguistically diverse backgrounds, where English is not the primary language. These people can miss vital messaging or it can be misinterpreted. Additionally, if there is a distrust of authority due to past trauma experienced in other parts of the world, this can also impact on people from CALD populations accessing vaccinations.

So what does this mean for service providers who are supporting these population groups?

• In many states, the borders will be open before Christmas. Staff, clients and residents will be mingling with people from interstate, including people who are coming from a hot spot.
• A number of your staff will potentially be exposed to the virus and may have to be off work due to isolation requirements.
• There is a strong possibility that some of your residents or clients will be infected at some point too.
• For some organisations, you also know that some of your staff members and volunteers fall into the ‘at risk’ category themselves – you’re facing a double whammy!

And this is all likely to happen at a time when staff numbers are lower than normal, when suppliers close down, when senior management might be taking their break or head offices are closed.

What can you do to anticipate and address these issues effectively?

1. First and foremost, vaccinate and encourage vaccination.

The most effective rates of vaccination are seen where management has taken the lead throughout. They’ve stepped up and led by example, they’ve acknowledged staff concerns and addressed the issues raised by using peer-reviewed documentation and evidence, dispelling myths, and they’ve taken a firm stance where necessary, making sure that their vulnerable residents and clients are as safe as possible.

2. Have strong infection control practices in place and don’t allow staff to become complacent.

For many providers operating in states or territories where the virus has been well contained, staff may have become complacent. Service providers should be reviewing their infectious outbreak plans, running staff through drills in preparation for an outbreak and checking on essential supplies of sanitiser, masks, paper towels, etc – especially where your suppliers are likely to be short-staffed or closed over the holiday season.

3. Review your rosters.

Do you have sufficient staff rostered on during this time? Are these staff fully aware of appropriate responses in the event of an outbreak? Check who might be going on leave but be willing to come in to work in the event that an outbreak occurs.

4. Review your emergency workforce plan.

What are you going to do if you have half of your staff off with an infection or because they are waiting for the results of COVID tests? Clients and residents still need to be fed and cared for. Can you source relief staff easily?

If not, do you have other contingency plans in place such as using local businesses or frozen dinners to provide a replacement meal? And what about your staff? Are there accommodation options for those needing an alternative place to stay if they have family members who become infected or identified as close contacts?

5. Vaccination of agency staff or contractors.

Where you use agency staff or other contractors, have you ensured that they are vaccinated? Are you onboarding people properly, ensuring that they are fully aware of your infection control practices and what to do to minimise the chance of bringing the virus into your facility or exposing your home care clients to risk?

6. Enhanced cleaning standards in case of an outbreak.

Check that your cleaning team understands the requirements for enhanced cleaning practices in the event of an outbreak. Do you have sufficient stock of cleaning chemicals, disinfectants and other cleaning supplies on hand? What about your waste disposal facilities, are they able to withstand the increase in waste? With the increase in the use of cleaning items, paper towels, masks, etc, you may find your facility or centre is generating a lot more than would normally be expected.

7. Review your communication plan.

Is it up to date and relevant? Are you able to quickly respond to and sensitively answer questions from family members if you need to lock down your facility? What happens if their relative (a resident) contracts COVID and needs to be transferred to hospital? Do you have a standard letter or message that you can send out at short notice to home care clients if staff are unable to visit, or if you need to let them know they may potentially be a close contact in the event a staff member becomes ill? Do you have posters and information written in the relevant languages for clients/residents and their families where applicable?

8. Keep up to date with the latest public health orders.

This can seem easier said than done!

In some cases, there is a difference between the State public health orders and the Commonwealth Guidelines. Conditions can also change rapidly, so trying to keep up with the latest requirements can be a minefield. Management needs to be subscribed to Departmental and Government alerts and have a contingency for people whose role this is, to ensure updates are noted in a timely way and operational revisions made with changes clearly communicated to all stakeholders.

9. Maintaining social contact and support of clients.

Do you have processes and devices in place to minimise the risk of isolation for seniors and maintain social contact and support? For example, if a home care client becomes a close contact and needs to stay at home, possibly with only essential support visits from staff, can you provide alternative social support opportunities? 

For residents, how will you help them maintain contact with family and friends, e.g. additional assistance using Facetime or calls and how will staff be managed to do this safely? 

10. Review your client identification and individual emergency plans.

Residential care services should have in place processes that support correct identification of residents should care need to be provided by an emergency workforce.

Identification should be linked to emergency packs in the event that a resident needs to be moved. These emergency packs should include essential medications, continence aids, alerts, etc, and will support continuity of care.

For remote providers, all individual emergency plans should have been completed. Staff should review these if there has been any other recent adverse event such as a cyclone or flood requiring the person to be evacuated and where the person may have moved location.

11. Review Advance Care Plans.

Are they up to date and reflective of current situations? The sad truth is that if there is an outbreak at your facility or in the community some of your residents or clients may die. Catching COVID is bad enough, not having an Advance Care Plan followed or not match a person’s current needs exacerbates this and makes it harder for families.

12. Other emergency plans for natural disasters.

The other thing that rural and remote providers should be considering is emergency planning in the event of a cyclone or floods cutting off roads, or a community going into isolation due to an outbreak.

We have already seen several outbreaks in rural and remote communities, but what happens when there are multiple outbreaks across a region? This can impact significantly on access to sufficient resources (supplies and people).

Home care providers who deliver meals may need to work with other stakeholders and extend their service provision to ensure the wellbeing of vulnerable clients. Emergency packs should be in place already. On-site staff and family members should be notified of the need to continue service provision even in the face of a local outbreak. Vulnerable clients cannot be neglected.

I hope this summary of tips is helpful for you and your team.

I and the CDCS team are seeing first hand how challenging it is out there and we will be continuing to present and promote up-to-date information, so keep an eye on your inbox and for posts from our Facebook, Linked In and YouTube pages.

If you can think of someone else who might benefit from this article, send them a link. We’d appreciate it! And if you’re looking for more helpful resources, why not check out our Total Quality Package resource hub? We have culturally appropriate, tailored resources that are designed to make your job simpler and help you provide quality care to your clients. Click here to find out more.