Outbreaks – Coming to a Place Near You?

Citizens in Melbourne are now experiencing a scary ‘spike’ in COVID-19 cases, with community-based transmission in play and Government agencies treating this as a major outbreak. Premier Daniel Andrews stated it is ‘a civic duty’ to be tested as Health Workers started to go door to door in hot spot suburbs to test people.  This is in addition to the testing clinics that have been overrun with worried people over the last few days. The Army has even been called in to assist with logistics and transport.

So what does this mean for Aged Care Providers?

For those in Melbourne, the stakes are really high right now and Providers may need to re-evaluate their infection control, access, monitoring and education processes (again). But this is a situation that could arise anywhere, so for those in other parts of the country who may be thinking it’s “not my problem”… this could easily be a future scenario you face as well.

A recent COVID-19 scare in regional Victoria highlights just how quickly one ‘infected’ person can set off a chain reaction that locks down not just one Care Home, but also impacts on other related services who share common staff, management personnel and suppliers. This case resulted in a significant impact to the service, staff, residents and the local community.

So what should staff and families be aware of, and alert to in our Residential Care facilities?

Appropriate and ongoing infection control practices, education and promotion for all levels within the organisation, as well as residents and their families and friends is as critical as ever.

Vulnerabilities

People living in Aged Care Homes are highly vulnerable to contagious outbreaks, like COVID-19, Influenza and Gastro. This is in part due to the ageing process; their immune systems are just not as strong as that of younger people and they don’t respond as quickly or as effectively to viral infections. Having other health issues such as hypertension, renal disease and diabetes just adds to the risk and to the potential for an adverse outcome should the person become infected.

It also doesn’t help that the COVID-19 virus is highly contagious, which means it can be easily transmitted between a carrier and other non-infected people. We know from news reports and from researchers of the virus that people can be active spreaders of the virus prior to showing any symptoms (asymptomatic) and can inadvertently pass on the infection to others.

It’s for this reason that whenever there is an outbreak of an infectious disease (not just COVID-19) in a residential setting, that movement in and out of the centre and contact between residents needs to be closely managed as providers seek to minimise the risk of infection to other vulnerable residents.

Understandably, management also want to ensure that they have sufficient staff to continue caring for the residents and to maintain quality care and support outcomes. This is jeopardised if staff come in contact with infected residents and/or their family members and become infected themselves.

While there have been high profile outbreaks noted in a number of facilities, the majority of residential aged care homes are managing the risks well, with staff currently reported as feeling more confident in the safety of working directly with the residents than going out to do their shopping at their local supermarket. Most care staff are very aware of their responsibilities to vulnerable residents and are also trying to minimise the risk of picking up the infection outside of work.

Of course, this virus and our response to containing and overcoming it will continue for many months. As restrictions of community movement is lifted over the next month or two, it is likely that community transmission will increase again, with staff and family members being more at risk of picking up the virus; but families and residents don’t want to be separated for long periods of time and want to have the opportunity to connect once more.

What are the key things that need to be in place to minimise the risk of an outbreak, or the impact on vulnerable elderly people?

Mandatory Flu Vaccination Program

All Residential Care Homes must have a Flu Vaccination Program in place.  This has been a requirement since the 2019 Flu Season. Your service must take precautions to prevent and control the flu and minimise infection-related risks.

As of the 1st of May it also became mandatory to have an up-to-date flu vaccination for the 2020 Flu season for anyone working in or visiting a residential care home. (The timeframe around how long this requirement remains in place varies from state to state, so check on the Department of Health website for more information.)

Guidelines for Outbreaks in Residential Care

Keeping up-to-date with the Communicable Disease Network Australia (CDNA) National Guidelines is a must for Providers. This also includes advice on topics for staff education and training. For the latest version go to the Department’s site.

Key messages to promote to Residents and their Families and Friends

The more people that come in contact with vulnerable people, the more at risk they become. People shouldn’t visit relatives or friends who live in a residential care home if:

• they have returned from overseas within the last 14 days or been in a COVID-19 hotspot;
• been in contact with a confirmed COVID-19 case in the last 14 days;
• are showing any signs or symptoms like a cough, sore throat, shortness of breath or fatigue.

Consider whether taking children under the age of 16 years into a Residential Care Home is safe for the older person during this outbreak. These visits may need to be limited except in special circumstances.

Key resources to refer to include Fact Sheets and information on the Department of Health site.

Where the infection rate is low in the community, and where there are no outbreaks of COVID-19 or other infectious diseases in a residential care home, most homes accept having up to two people visit the resident each day. This is especially important where a family carer has been visiting the person to provide additional care and support, such as assisted feeding or where the person has dementia.

However, management has to follow current Commonwealth Government guidelines and State Health Directives that relate to protecting people living in residential care. These include:

• making sure visits are kept short;
• screening visitors to the facility for symptoms of fever where possible;
• promoting and supporting hand hygiene practices for people entering and leaving the facility;
• allowing no more than two visitors, at any one time or per day;
• encouraging visitors to maintain social distancing practices e.g. keeping 1.5m from the Resident;
• making sure visits occur in a resident’s room, safe outdoor areas, or in a specific designated area;
• ensuring there are no large group visits or gatherings, including social activities or entertainment.

But there may well be times when it’s just not safe to have visitors. When this happens we need to adapt the way we support Residents to stay in touch with their families and friends to make sure that everyone can stay connected and feel supported.

If it’s not possible to visit with the person face to face there are other ways family can still connect. Families and carers have been demonstrating a number of effective ways to keep in touch over the past month, such as:

• phone calls – using landlines or mobile phones. Often smartphones are able to easily link in a number of callers using an inbuilt ‘merge call’ function;
• video conferencing – using communication apps such as FaceTime, Zoom and WhatsApp;
• writing letters and sending pictures to their family member;
• visiting and speaking to the person through the window.

If you want to see this described in a clear and visual way, check out the StoryBoard we developed with the Aged Care Quality and Safety Commission – “Keeping your loved one safe in residential care”.

Supporting safe, quality care for aged care consumers during visitor restrictions

Unless there is an outbreak of an infectious disease in the Care Home, there is no reason for residents to be isolated from other residents. They can socialise with other people living in the care home, but this is likely to be with smaller groups and ensuring social distancing is maintained.

Residents should be able to continue to participate in activities such as bingo or quiz sessions, craft activities, therapy and exercise sessions and morning or afternoon teas. Pet therapy is still occurring in some centres, using existing pets who are living in the residential home, or bringing in staff pets.

Therapy programs can continue. These are important for people who are rehabilitating and should be continued where possible.

Where safe, residents might like to visit the facility gardens with a support worker or family carer, or they can sit outside on a verandah and chat to others and enjoy the fresh air.

Some activities will change a little bit like sing-alongs from visiting performers. Residents might now sing along with their favourite performer via YouTube videos pre-recorded by the performer. There are a large number of special shows that are currently being shown via streaming platforms and even some virtual tours of famous museums of the world! Knowing the person and their personal interests will help inform suggestions on shows or tours.

The new ‘Industry Code’ for visiting Aged Care Homes is a helpful resource.  For a copy of the code and the fact sheet click below:

• Industry Code
• Fact Sheet

Expectations – what Providers and staff need to know

The Aged Care Quality and Safety Commission released a Guide on Visitor Restrictions in late April which lays out key issues, action that can be taken by providers and examples of strategies. If you or your team have not seen this yet, click here.

CDCS has been working with the Aged Care Quality and Safety Commission to develop a range of visual StoryBoards to assist the wider community to understand how to protect Aged Care Residents, seniors living in the community, and staff. You can find these resources by clicking here.

Let’s all work together to ensure the safety and comfort of our elders at this time.

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.