As of 20 May 2022

Preparing for winter flu season

• RACFs should take precautionary steps in preparing for the 2022 winter flu season.
• All residents should be strongly encouraged to receive the 2022 seasonal flu vaccine, which can be given on the same day or at any time before or after their winter COVID-19 booster. The COVID-19 winter booster should be given 4 months after their first booster dose, or 3 months after a confirmed COVID-19 infection if they've had COVID-19 since their first booster dose,but should wait a maximum of 4 months after confirmed infection.
• It is strongly recommended that all visitors and staff be vaccinated for influenza before this winter and that aged care facilities communicate with their staff, families and other visitors to remind them about the importance of influenza vaccination.

Positive rapid antigen test results

• From 12 January 2022, a person must register their positive COVID-19 rapid antigen test 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. This can be done by selecting the "continue as guest" option on the Service NSW portal.
• A separate form will need to be completed for each resident that tests positive to COVID-19.
• The requirement to report a positive COVID-19 rapid antigen test result to Service NSW is in addition to other reporting requirements that might be in place for the Commonwealth, your local Public Health Unit and/or Local Health District, which will trigger supports

Visitors

It is recommended that each visitor shows evidence of a negative COVID-19 rapid antigen test result taken within 24 hours before entry. Visitors providing essential care and entering on a regular basis can, with the agreement of the RACF, do less frequent testing but the minimum interval recommended is twice weekly.

1. Residents are permitted to have two fully COVID vaccinated visitors aged 12 years and over, plus two children aged under 12 years per day:
• Visitors aged 12 years and over must have received a second dose of a COVID vaccination at least 14 days prior to their visit.
• Visitors are strongly encouraged to get a booster vaccine if they are eligible for one, and to have a negative Rapid Antigen Testing (RAT) prior to each visit
• Up to 2 children under 12 years are permitted to visit provided they are accompanied by a person fully vaccinated against COVID-19.
• Visitors are strongly encouraged to receive the 2022 seasonal flu vaccine as soon as it is possible.
• All visitors must wear a surgical mask over their nose and mouth while visiting indoors. For reasons when masks can be removed please see Additional Advice – Mandatory mask wearing.
• Wherever possible, the visit should be in an outdoor area. Visits should not be in any inside communal areas.
• People who are providing a service to the resident (including a health or other professional service) are not counted as a visitor.
• Existing requirements in the Public Health (COVID-19 Care Services) Order 2022 on visiting residents who are at end of life remain in place.
2. Under the Public Health (COVID-19 Care Services) Order 2022 the operator of the residential aged care facility can authorise a visitor unvaccinated against COVID-19 to enter and remain on the premises for the purpose of visiting a resident who is at the end of life. In such cases, appropriate care must be taken and it is strongly recommended:
• The visit is either facilitated outdoors, or solely inside the resident's room and
• The visitor takes a rapid antigen test before the visit.
3. An exemption to the Public Health (COVID-19 Care Services) Order 2022 has been signed to allow more than two visitors to visit a resident who is at the end of life:
• The exemption is subject to the condition that the operator of the facility takes reasonable steps to ensure:
• No more than 4 people (including children) visit at any one time
• All visitors wear a mask while in an indoor area, unless the visitor is interacting with the resident they are visiting
• There is minimal interaction between the visitors and the staff and other residents
4. Visitors must not enter a RACF at all if they:
• Have COVID-19 symptoms
• Are a household or close contact. These people must comply with the directions in the NSW Health Household and Close Contact Guideline and must not visit a RACF for at least 7 days after the last person in their house had a positive COVID-19 test. They should continue to avoid RACFs for an additional 7 days. If there are extenuating compassionate reasons for visiting a RACF and the visitor does not have symptoms of COVID-19, the facility may risk assess to determine whether a visit can safely occur 
• Are waiting for a COVID-19 test result.
• Have been overseas in the previous 14 days, unless they are:
• Fully vaccinated against COVID-19, it has been at least 7 days after arrival and they have received a negative rapid antigen test 6 days or later after arriving in NSW.
• People who are otherwise recently exposed to COVID-19 are recommended to not visit a RACF for at least 7 days after exposure.

Residents

Residents may leave the facility and attend family gatherings or other events but must abide by the current Public Health (COVID-19 General) Order 2022.

It is recommended that residents who leave the facility to attend a family gathering or event be tested using a RAT on Day 2 after their return and again on Day 6. If they develop any signs or symptoms of COVID-19 they should immediately be isolated and have a RAT and PCR test.

Testing for COVID-19 is not recommended for residents that have recovered from COVID-19 within the previous 12 weeks.

Residents should get a COVID-19 booster vaccine dose as soon as they are eligible for one.

Residents should not leave the facility if they have COVID-19 symptoms until they have had a RAT or PCR test and have received a negative result.

Facilities must ensure that residents are provided with appropriate personal protective equipment, infection control and mask wearing advice if they leave the facility. See the latest face mask rules.

Staff

Staff, including students and contractors should not enter a RACF if they have acute respiratory symptoms as detailed in Table 1 of the Acute Respiratory Infection Guidance 

It is recommended that RACF staff undergo a COVID-19 RAT prior to commencement of each shift. At a minimum, testing should occur three times per week. The more frequently  a COVID-19 rapid antigen test is undertaken the more effective is the process is to identify cases.

All staff, health practitioners and students entering a RACF must have 3 doses of a COVID-19 vaccine unless the person has received 2 doses of a COVID-19 vaccine and it is not after the later of the following

• 12 April 2022 or
• 6 weeks from the due date of the persons third dose (due date is 13 weeks after the persons second dose)

New workers can commence employment with 2 doses however, they must receive their third dose within 6 weeks of their due date to continue working.

There are 2 exemptions to the Public Health (COVID-19 Care Services) Order 2022 relating to the 3^rd dose of a COVID-19 vaccination:

1. The first exemption was made to allow a person who has had two doses of a COVID-19 vaccine to continue working without the third dose, only if they have been assessed as being essential to the operation of a residential aged care facility or the provision of disability or aged care services by the operator of the residential aged care facility or the responsible person for the disability or in-home and community aged care service. See further information on Public Health Orders and Exemptions.

This exemption is also subject to the condition that the worker take reasonable steps to get vaccinated as soon as practical. The exemption will be repealed on 1 June 2022.

2. The second exemption applies to persons entering a RACF to provide service, in-home and aged care service workers and disability workers and exempts the person from the requirement to have a third dose of a COVID-19 vaccine if:
• the person has had 2 doses of a COVID-19 vaccine, and
• was diagnosed with COVID-19 in the previous 4 months, and
• provides evidence of their diagnosis to the occupier of the RACF or their employer. Evidence of diagnosis can be either proof of registration with ServiceNSW of a positive rapid antigen test result or evidence of a positive COVID-19 PCR result.

The exemption also allows the employer to continue to allow the person to provide work.

This does not permanently exempt the person from the requirement to have a 3rd dose of a COVID vaccine. A person who does not meet the conditions in the exemption instrument must continue to comply with the direction in the Public Health (COVID-19 Care Services) Order 2022

On very rare occasions, there may be a medical contraindication to COVID-19 vaccination. A COVID-19 medical contraindication certificate is required in this circumstance.

All staff must wear a surgical mask while in the facility. For reasons when masks can be removed please see Additional Advice – mask wearing.

Managers should refer to Appendix 2 in the Acute Respiratory Infections Guidance to support assessment of exposure of workers, residents and visitors in Residential Aged Care Facilities for information on assessing level of risk and when staff can be permitted to work including to ensure service continuity. This guidance should be used by all private residential aged care facilities and community aged care providers to support decision making for work restrictions or permission where there has been staff exposure to COVID-19.

Staff who are a household or close contact must comply with the NSW Health Household and Close Contact Guideline and must not enter a RACF for at least 7 days after the last person in their household had a positive COVID-19 test. After 7 days, the employer must approve return to work, undertake a risk assessment and may ask the staff to take additional precautions to decrease the risk of transition. This applies to all workers entering a RACF to provide a service e.g. pathology collectors, therapists and other contractors. This does not apply to emergency services.

If a staff member is critical to service delivery and their absence would compromise delivery of care to residents, please discuss with the local Public Health Unit whether a return to within 7 days maybe allowed with additional risk mitigating measures.

All NSW Health operated aged care services should continue to use the NSW Health - Health Care Worker COVID-19 Exposure Risk Assessment Matrix. This includes Multi-Purpose Services (MPSs), state government residential aged care facilities (SGRACFs), Commonwealth Home Support Program (CHSP) services and Transitional Aged Care Services (TACP).

Please refer to the NSW Government website for further information about the current rules and restrictions in NSW.

RAT and PCR testing protocol

In recognition of the current Omicron outbreak and demand on pathology testing, the Protocol for RAT and PCR testing in residential aged care has been established to ensure appropriate access to pathology services and ensure that residential aged care facilities (RACFs) are able to access the support and resources required. This protocol should be used as the minimum testing requirements. Managers should refer to Appendix 2 in the Acute Respiratory Infection Guidance to support risk assessment and testing of workers, residents and visitors post exposure to COVID—19.