As of 20 January 2023

This advice includes information on the management of:

1. Residents
2. Visitors
3. Staff
4. Ventilation

Providers of residential care are expected to balance their responsibilities to reduce the risk of COVID-19 entering RACFs while meeting the physical, social, and emotional needs of residents.

For the latest guidance on managing acute respiratory infections in RACFs see the Guidance for Aged Care Facilities on the Public Health Management of Acute Respiratory Infections (RACF ARI Guidance)

Residents

It is recommended that residents stay in their rooms if they develop any cold or flu symptoms (runny nose, sore throat, cough, fever) and be tested for COVID-19.

Residents who test positive to COVID-19

• If a resident tests positive to COVID-19, they should stay in their rooms for at least 7 days, and until their symptoms have resolved. A negative rapid antigen test is not required for residents to leave their room after this time.
• Where possible residents should wear a mask for up to 10 days after they test positive to COVID-19, particularly when there are other people around and in communal areas.
• If a resident still has symptoms after 7 days, consider whether they need to be reviewed by their doctor based on their clinical condition.
• To reduce the risk of respiratory virus outbreaks, residents should stay in their rooms while they have symptoms, even if they have a negative COVID-19 test.

Positive COVID-19 rapid antigen test (RAT) results

• If a resident tests positive on a COVID-19 RAT, they should register their result through the Service NSW portal.
• Where a resident is unable to independently complete the information on the Service NSW portal, a provider should register the result on behalf of the resident by selecting the "continue as guest" option. A separate form will need to be completed for each resident that tests positive to COVID-19.
• Other reporting requirements may be in place for the Commonwealth, local public health unit and/or Local Health District, which will trigger supports.
• Testing for COVID-19 is not recommended for residents for 4 weeks after they have recovered from COVID-19 unless a recovered resident experiences new respiratory symptoms within 4 weeks. They should be tested for COVID-19 and other respiratory pathogens, including influenza and respiratory syncytial virus (RSV).

Antiviral medicine usage

• COVID-19 antiviral medicines are available on the Pharmaceutical Benefits Scheme (PBS) for people over the age of 70 years, and other RACF residents with at least one other risk factor.
• The administration of antiviral treatment as soon as possible after symptom onset for people with COVID-19 reduces disease severity and can prevent hospitalisation or death.
• GPs and RACFs are encouraged to use the Antiviral Pre-assessment form to establish an advance preference for residents to receive COVID-19 and influenza antiviral medicines to support timely access and safe administration.
• Refer to Guidance on use of antivirals in residential aged care facilities (RACF).

Leaving the facility

• Residents should not leave the facility if they have tested positive for COVID-19 in the last 7 days, and/or have any COVID-19 symptoms. Residents should stay home while they have symptoms, even if they have a negative COVID-19 test.
• Facilities should ensure that residents are provided with a mask and appropriate mask wearing advice if they leave the facility, particularly if they are a case or contact and are required to leave for essential off site appointments. Masks should be worn in public areas particularly when there are high levels of COVID-19 circulating in the community.

Vaccination

For the best protection against severe illness it is important to be up to date for all vaccinations including COVID-19 and influenza. Residents should be strongly encouraged to receive both booster doses for COVID-19 if they are eligible. This helps provide added protection during times of increased COVID-19 in the community.

Visitors

Receiving visitors is essential for residents’ wellbeing and helps to reduce the impacts of social isolation on mental health. RACFs should ensure aged care residents are provided the opportunity to safely receive visitors. Facilities may determine their own advice to allow visitations to safely occur. Visits are permitted to occur even if there are cases in the facility.

Visits should be conducted in a manner that minimises the risk of introducing and spreading COVID-19 infection into the RACF, including:

• ensuring visitors do not have symptoms of COVID-19, have not been in close contact with a person who has COVID-19, or have tested positive to COVID-19 in the last 7 days (see Entry restrictions below)
• where possible, visits should be held outdoors or in well-ventilated areas away from other residents
• care should be taken to avoid crowding within the facility
• All visitors should wear masks to help protect those most vulnerable. However, masks can be removed for example, while communicating with another person who is deaf or hard of hearing
• all visitors should be encouraged to maintain physical distancing of 1.5m, particularly in communal areas.

Additional guidance on visiting a RACF is available in the Industry Code for Visiting Residential Aged Care Homes during COVID-19.

Entry restrictions

RACFs should ask visitors entering the facility if they have:

• undertaken and received a negative result from a COVID-19 RAT on the same day that they attend the care facility. Visitors providing essential care and entering on a regular basis can do less frequent testing, with the agreement of the RACF. In these circumstances, the minimum recommended interval is twice weekly.
• been in close contact with someone who has COVID-19
• any symptoms of COVID-19 (other than symptoms caused by a known health condition or medication).

It is strongly recommended that visitors not enter a RACF if they have:

• Tested positive for COVID-19. Visitors should not enter an RACF for at least 7 days after their positive test, unless authorised by the RACF for compassionate reasons.
• Been in close contact with someone who has COVID-19. They should follow the advice in the Advice for people exposed to COVID-19 fact sheet and should avoid visiting an RACF for at least 7 days.
• Any COVID-19 symptoms or are waiting for a COVID-19 test result.

If a visitor meets any of the above criteria and a visit must occur, it is strongly recommended that a negative rapid antigen test is undertaken before entry, and the visitor wears a mask whilst in the facility.

Emergency service providers are not considered visitors.

Vaccination

For the best protection against severe illness it is important to be up to date for all vaccinations including COVID-19 and influenza.

Staff

Entry restrictions

For facilities with a number of staff members, they are encouraged to enjoy their meal breaks in areas with good natural ventilation or outdoors.

Staff, including students, contractors, volunteers, pathology collectors and therapists should not enter an RACF if they have:

• Tested positive for COVID-19. Staff should not enter an RACF for at least 7 days after their positive test. Facilities should follow Table 1, page 8 of the RACF ARI Guidance to determine when it is safe for employees to return to work. The Australian Government’s High-Risk Settings Pandemic Payment is available for eligiblestaff who work in a high risk setting, such as aged care facilities, and cannot go to work because they have tested positive for COVID-19.
• Been in close contact with a person who has COVID-19. See section Staff exposed to COVID-19 below for further information.
• Any acute respiratory or influenza-like symptoms. For more detail about symptoms, refer to page 4 of the RACF ARI Guidance.

Staff exposed to COVID-19

If the exposure has been in the workplace, managers should refer to Appendix 2 of the RACF ARI Guidance to support decision making for when staff can safely return to work, particularly if they are critical to service delivery.

If the exposure has been outside of the workplace, staff should refer to the Advice for people exposed to COVID-19 fact sheet. Facilities are encouraged to determine their own advice for when it is safe for employees to return to work. This may include asking the staff member to take additional precautions to decrease the risk of transmission and test regularly after exposure to someone with COVID-19. Managers should refer to COVID-19 advice for staff in high-risk community and/or private settings to support their decision making.

Testing for COVID-19

It is recommended that RACF staff undergo a COVID-19 RAT at least every 3 days.

Mask wearing

All staff should wear a surgical mask covering their nose and mouth while indoors in the facility. A staff member may remove their mask:

• while communicating with another person who is deaf or hard of hearing
• if wearing a mask creates a risk to health and safety
• where clear enunciation or visibility of your mouth is essential
• if they are working in an indoor area and there is no other person is in the area.
• to eat or drink; staff are encouraged to enjoy their meal breaks in areas with good natural ventilation or outdoors.

Anyone removing a mask for one of the above reasons should remain 1.5 metres from others, particularly in indoor communal areas.

When the facility in an outbreak, refer to the RACF ARI Guidance for additional PPE advice.

Vaccination

Staff are strongly encouraged to stay up to date with all vaccinations including COVID-19 and influenza to aid protection against severe illness for themselves and the people they care for.

For further information, visit the Australian Government Department of Health and Aged Care advice for Residential aged care workers .

Ventilation

Ventilation is an important factor in minimising spread of COVID-19 and other respiratory viral infections. The key principle is to bring in fresh air to dilute the indoor air; simply re-circulating indoor air (for example, fans) is not effective. Natural ventilation should be used wherever possible. RACFs should consider seeking professional advice from an occupational hygienist or ventilation engineer. Carbon dioxide (CO2) monitors and HEPA filters can have a role but require users to have a good understanding of how to use them.