Yes – the NSW Chief Health Officer (or delegate) regularly provides updated advice to RACFs on the COVID-19 situation in NSW and any implications for the aged care sector. If further restrictions are in place and outlined in these updates, RACFs must comply with this advice.
Under the Public Health (COVID-19 Aged Care Facilities) Order (No 4) 2020, the “Minister directs that the operator a residential aged care facility must consider advice of the Chief Health Officer when deciding the number of person’s who may be permitted to enter or remain on the premises of the facility to visit a resident of the facility”.
NSW Health encourages RACFs to regularly check the NSW Health and NSW Government websites for the latest information on COVID-19.
Under the Public Health (COVID-19 Aged Care Facilities) Order (No 4) 2020, a staff member permitted to enter is not to enter or remain on the premises of residential aged care facility if the staff member does not have an up-to-date vaccination against influenza, unless:
For certainty, an up-to-date vaccination against influenza refers to the 2020 vaccine. While NSW Health considers there to be some supply of the 2020 vaccine remaining, where the vaccine is not accessible, the vaccine may not be considered available to the staff member.
See the approved Medical contraindication to the influenza vaccination requirements form.
Under clause 7 of the Public Health Order, the operator of a residential aged care facility (RACF) must take all reasonable steps to ensure a staff member does not enter the premises in contravention of the requirements.
There are only limited medical contraindications for the influenza vaccination. Where a staff member has a medical contraindication to the influenza vaccine, they must present the operator with the approved form signed by a registered medical practitioner in which the medical practitioner certifies that the staff member has a medical contraindication to the vaccination against influenza.
The contraindications included on the form are based on the contraindications and precautions for influenza vaccination detailed in the Australian Immunisation Handbook.
Providers will need to seek their own legal advice regarding what to do if a staff member does not get vaccinated and does not come within the exemptions under the Order – they may need to re-deploy them until they are vaccinated, or the pandemic is over.
Vaccination restrictions have been eased for visitors entering RACFs providing a care and support visit as influenza circulating in the community and the amount of vaccine currently available is very low. However, it still remains a condition of entry into a RACF for people to be free of any respiratory symptoms.
There are no restrictions in NSW under the current public health orders on people leaving their place of residence. Individual residents should be permitted to leave the RACF to attend small family gatherings and group excursions. Residents should exercise caution when leaving the facility and follow the current advice from NSW Health around residents leaving the facility.
However, when there is a risk of COVID-19 circulating within the community, some restrictions may be placed on residents leaving RACFs in certain areas. The NSW Chief Health Officer provides updates for RACFs on the current restrictions across NSW (Advice to RACFs).
The size of the family gathering should be in line with current jurisdictional advice and physical distancing and hygiene measures should be adhered to during the visit. The RACF should conduct a risk assessment for each visit, taking into account the local epidemiology, number of people attending and the feasibility of physical distancing. The RACF should maintain a record of the visit location, number of people in the gathering and the date of visit.
Outings should be planned to take place outdoors as much as possible. However, with the hot weather over the summer period, a safe excursion to a well-ventilated, open-plan indoor environment is also acceptable. If planning a visit to an indoor environment, choose venues that are well-ventilated and not crowded. Visits to venues such as clubs should be planned with the venue to ensure residents’ safety and comfort. Residents should also wear face masks when physical distancing cannot be maintained, including on shared transport, where possible.
There is no requirement for routine testing on return to the RACF, unless the person develops signs or symptoms of COVID-19. Clinical judgement should be applied — for example, where a patient is coming to the RACF from an area with known community transmission. Further information is available in the CDNA National Guidelines for the Prevention, Control and Public Health Management of COVID-19 Outbreaks in Residential Care Facilities in Australia.
RACF providers should wherever possible also facilitate visits to the RACF that are informed by the Industry Code for Visiting Residential Aged Care Homes During COVID-19, as well as facilitating alternative ways for residents to maintain contact with friends and family, such as through remote options like phone, video calls or social communication apps.
Under clause 6 of the Public Health (COVID-19 Aged Care Facilities) Order (No 4) 2020 persons permitted to enter a RACF cannot enter on a particular day if the person has a temperature of 37.5 degrees or higher or symptoms of acute respiratory infection.
Under Clause 7 of the Public Health Order, the operator of a RACF must take all reasonable steps to ensure a person does not enter the premises in contravention of the listed requirements.
While a RACF could argue that to comply within this order they cannot let anyone into the facility unless they first check their temperature, they also have a responsibility to not impede residents receiving the care they require in an emergency.
RACF providers should note that since 24 March, NSW Ambulance staff have been required to undertake wellness checks, including checking of temperatures, prior to the commencement of their shift.
In addition, NSW Ambulance has procedures in place to determine the suspected or confirmed COVID-19 status of all patients and the appropriate use of PPE at all times.
After a suspected or confirmed COVID-19 patient is transported, a thorough clean of the vehicle and equipment surfaces is completed using detergent/disinfectant wipes.
For this reason, it is NSW Health’s position that if there is an emergency requiring an ambulance call out, it is reasonable to allow paramedics into a RACF to provide care and treatment without requiring a temperature check first.
As part of their role in assisting NSW Health to manage the flow of patients in and out of hospitals, the NSW Health Patient Transport Services (PTS) may transport people with suspected or confirmed COVID-19.
Under Clause 6 of the Public Health (COVID-19 Aged Care Facilities) Order (No 4) 2020 persons are not to enter or remain on premises of a RACF if the person has a temperature of 37.5 degrees or higher or symptoms of acute respiratory infection.
Public health facilities notify PTS if a patient has suspected or confirmed COVID-19 when making an online booking, and community patients are also screened over the phone using NSW Health recommendations for risk of infection. When transporting a patient with suspected or confirmed COVID-19, all crews must adhere to NSW Health Clinical Excellence Commission guidelines for standard, droplet and contact precautions and a surgical mask is also placed on the patient.
In addition, once a patient is transported to their required location, crews are required to complete an ‘infectious clean’ of the vehicle in accordance with best practice advice obtained from the NSW Health Clinical Excellence Commission.
As well as these infection control measures for transporting patients, PTS have implemented procedures at the beginning of each shift to ask every staff member whether they have recent onset of respiratory symptoms or fever. Staff with symptoms are either excluded from work or assessed for COVID-19 and, if COVID-19 testing is recommended, staff are self-isolating until COVID-19 is excluded.
NSW Health Patient Transport Services (PTS) will continue to align their IPC procedures with the current status of NSW Health (green, amber or red) as described in the CEC: COVID 19 Infection Prevention and Control Response and Escalation Framework.
It is therefore NSW Health’s view that RACFs should continue to use PTS services, in the knowledge that staff are already screened before each shift and take all necessary precautions when they are transporting patients.
Under Clause 6 of the Public Health (COVID-19 Residential Aged Care Facilities) Order (No 4) 2020 persons who are permitted to enter a RACF under the Order are not are not to enter or remain on premises of a RACF if the person has a temperature of 37.5 degrees or higher or symptoms of acute respiratory infection.
NSW Health considers that it is reasonable for a RACF to conduct temperature checks and symptom screening for visitors and staff of RACFs each day before they are allowed to enter care areas. The CDNA Guidelines state that visitors must stay away from the facility until symptoms such as fever have resolved.
RACF can continue to host students on placement.
The Public Health Order outlines circumstances in which people can and cannot enter and remain on the premises of a RACF. Allowable reasons for a person, including a student, to be on the premises include being present for:
Student placements can continue under the Order provided that the students meet the criteria in the Public Health Order that all staff need to meet including having 2020 influenza vaccination, if available to them (unless they have presented the approved form signed by a registered medical practitioner indicating they a medical contraindication), having a temperature below 37.5 degrees and not having been overseas in the previous 14 days or in contact with a confirmed COVID-19 case.
If these criteria are satisfied, hosting or not hosting student placements is at the discretion of the RACF as per usual arrangements.
Under the Public Health (COVID-19 Aged Care Facilities) Order (No.4) 2020 only certain persons are permitted to enter and remain on the premises of a RACF. However, such persons cannot enter or remain on the premises of a RACF if (a) during the 14 days immediately before the proposed entry, the person arrived in Australia from a place outside Australia, or (b) during the 14 days immediately before the proposed entry, the person had known contact with a person who has a confirmed case of COVID-19, or (c) the person has a temperature of 37.5 degrees or higher or symptoms of acute respiratory infection, or (d) the person does not have an up-to-date vaccination against influenza, (unless the person provides a medical certificate in the approved form, issued by a medical practitioner, certifying that the person has a medical contraindication to the vaccination against influenza). Please note that the influenza vaccination requirement only applies to staff members of residential aged care facilities. It is an offence to fail to comply with the order without reasonable excuse.
Under the Order, if a person is providing emergency management or law-enforcement functions in an emergency or providing goods or services to the RACF in an emergency (attending to urgent repairs) then the person is not required to be have an up-to-date vaccine against influenza. If possible, the officers/tradespeople should limit contact with residents and staff.
However, if such personnel are attending the RACF in a non-emergency or non-urgent situations (such as planned attendances), they do need to have been vaccinated against influenza, unless the person provides a certificate in the approved form, issued by a medical practitioner, certifying that the person has a medical contraindication to the vaccination against influenza.
Under Clause 7 of the Public Health Order, the operator of a RACF must take all reasonable steps to ensure a person does not enter the premises in contravention of the listed requirements. It is an offence to fail to comply with the order without reasonable excuse.
The Ministry of Health has developed an approved form for use by medical practitioners for people seeking confirmation of a medical contraindication to the influenza vaccination requirements set out in the Public Health (COVID-19 Aged Care Facilities) Order (No 4) 2020.
The approved form has been distributed to key stakeholders, including the Royal Australian College of General Practitioners and Primary Health Care Networks. See a copy of the approved influenza vaccine medical contraindication form for use by General Practitioners.
Under the Public Health Order, persons providing personal care service to residents, such as hairdressers are permitted to enter a RACF.
However, such persons cannot enter or remain on the premises of a RACF if:
It is an offence to fail to comply with the order without reasonable excuse.
Persons entering RACFs should adhere to equivalent social distancing and hygiene practices as they have implemented in community settings.
No - Spouses, close relatives and social supports are not limited in the number of hours that they spend with their spouse/relative. Visitors should practise social distancing where possible, including maintaining a distance of 1.5 metres. Visitors have a responsibility to supervise any children with them, practise hand hygiene and respiratory etiquette.
A flexible and compassionate approach to visiting times should be taken. Time limits for use of a designated visiting area may be required by some residential aged care facilities, in order to make the area available to a range of visitors, but a minimum visiting time of 60 minutes is recommended in these instances. If visits occur in a resident’s room, time limits should be more flexible and relaxed.
Under the Public Health (COVID-19 Aged Care Facilities) Order (No 4) 2020, there are no limits to the number of visitors a resident can have at any one time. Visits should be conducted in a resident’s room, outdoors, or a specified area in the RACF, rather than communal areas with other residents.
Additional restrictions on the number of visitors at any one time may be in place if there is COVID-19 community transmission. Please see Advice to RACFs for further updates and any current visitor restrictions that are in place.
In some circumstances, residential aged care facilities may be required to impose restrictions on the total number of visitors in a facility at any one time to ensure that hygiene, infection prevention and control, and physical distancing requirements are safely met. It is important to reduce the potential for crowding and the risk of environmental contamination, and good adherence to these measures will reduce the risk of transmission of COVID-19.
Yes - Children of all ages are permitted to enter RACFs — all visitors, including children, must adhere to social distancing and personal hygiene requirements.
A care and support visit is defined in the Public Health (COVID-19 Aged Care Facilities) Order (No 4) 2020 as “a visit made to the resident for the purposes of providing care and support to the resident.“
A care and support visit should be consistent with the principles outlined in the Industry Code for Visiting Residential Aged Care Homes during COVID-19; that is, residents who have a clearly established and regular pattern of involvement from visitors contributing to their care and support (daily or a number of times per week) must continue to have these visits facilitated. In addition, a care and support visit includes provision of support to maintain the mental wellbeing of the resident, where a serious mental illness is known or emerging and where the maintenance of social and family connection may contribute to relieving social and emotional distress for the resident. This includes volunteer visits such as the Community Visitors Scheme, amongst others.
People visiting for the purposes of a care and support visit are required to undertake entry and screening requirements. A person cannot enter or remain on the premises of a RACF if they have a temperature of 37.5 degrees or higher or symptoms of acute respiratory infection. However, persons visiting for a care and support visit do not require an influenza vaccination.
Please check the Advice to RACFs for any further visitor restrictions that may be in place.
A welfare and wellbeing visit is defined in the Public Health (COVID-19 Aged Care Facilities) Order (No 4) 2020 as “a visit made to one or more residents to the facility for the purposes of providing a welfare or wellbeing service”.
Examples of the types of welfare and wellbeing visits include but are not limited to:
People making a welfare and wellbeing visit are subject to the same entry and screening requirements, and physical distancing requirements, as other visitors. People visiting for the purposes of a welfare and wellbeing visit cannot enter or remain on the premises of a RACF if they have a temperature of 37.5 degrees or higher or symptoms of acute respiratory infection. However, persons visiting for a welfare and wellbeing visit do not require an influenza vaccination.
The inclusion of a welfare and wellbeing visit in the Public Health Order means that residential aged care facilities may hold events for their residents. NSW Health encourages outdoor events and activities in line with physical distancing requirements as much as possible. Well-ventilated indoor activities are appropriate following a risk assessment by the residential aged care facility.