Advice to residential aged care facilities (RACFs)

This advice includes information for RACFs on the management of:

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

Many residents are at higher risk of severe illness if they develop COVID-19, influenza or RSV. Providers of residential aged care need to balance their responsibilities to reduce the risk of COVID-19, influenza, RSV and other infections entering RACFs while meeting the physical, social, and emotional needs of residents.

Facilities should have appropriate preparedness plans in place to ensure a timely response to acute respiratory infections (ARIs). Facilities should refer to Guidance for Aged Care Facilities on the Public Health Management of Acute Respiratory Infections (RACF ARI Guidance) for outbreak management advice.

Residents

Vaccination

• For the best protection against severe COVID-19 and influenza, it is strongly encouraged that residents are up to date with all recommended vaccines. The Australian Technical Advisory Group on Immunisation (ATAGI) has issued its latest advice on 1 September 2023, recommending all adults aged 75 years and older receive an additional 2023 COVID-19 vaccine dose if 6 months have passed since their last dose.
• Facilities can contact the Australian Department of Health and Aged Care at racfvaccineclinics@health.gov.au if they have issues accessing the vaccine.

Pre-assessment for testing and antiviral medicines

• GPs and RACFs are encouraged to use the Pre-assessment action plan for respiratory infections in aged care facility residents to establish an action plan in the event of developing COVID-19 or influenza. This supports timely testing and access to antiviral medicines.
• The administration of antiviral treatment as soon as possible after symptom onset or diagnosis, especially for people with COVID-19, reduces the risk of severe disease and can prevent hospitalisation and death.

COVID-19 antiviral medicines

• COVID-19 antiviral medicines are available on the Pharmaceutical Benefits Scheme (PBS) for eligible aged care residents.
• RACFs are encouraged to replenish supply of COVID-19 antivirals for rapid availability. They can be ordered as per the usual practice for RACFs.

Influenza antiviral medicines

• RACFs are encouraged to replenish supply of oseltamivir (Tamiflu) in preparation for influenza outbreaks. 
• Facilities can order Oseltamivir (Tamiflu®) directly from the State Vaccine Centre by completing the online RACF influenza antiviral treatment access form.​
  
• For advice on preparing and administering oseltamivir capsule contents, refer to the Clinical Excellence Commission’s Information for clinicians – preparing individual doses and suspensions of oseltamivir using capsule contents.

For further information on antivirals, refer to Guidance on use of antivirals in residential aged care facilities (RACF).

Residents who test positive to COVID-19

• If a resident tests positive to COVID-19, refer to the RACF ARI Guidance.
• The registration of positive COVID-19 RATs through the Service NSW portal is no longer required. This decision was made to reduce the burden on aged care staff and based on alternative pathways to monitor and manage respiratory illness outbreaks in RACFs.

Leaving the facility

If residents who have tested positive or have symptoms of acute respiratory symptoms need to leave the facility, they should wear a mask and be provided with appropriate mask wearing advice.

Visitors

Receiving visitors is essential for resident wellbeing and helps to reduce the impact of social isolation. The risk of spreading COVID-19 and other respiratory viruses can be reduced by supporting visits to occur in the safest possible way. Risk mitigation strategies include:

• Highlighting that visitors should not enter RACFs when respiratory symptoms are present.
• Where possible, visits should be held outdoors or in well-ventilated areas away from other residents.

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

Entry restrictions

• Visitors should not enter the facility if they have:
• Tested positive for COVID-19. Visitors should not enter an RACF for at least 7 days after their positive test, unless agreement has been reached with the RACF (e.g. for compassionate reasons).
• Any acute respiratory symptoms or are waiting for a COVID-19 or other respiratory pathogen test result. For further information please refer to the advice in the Advice for people exposed to COVID-19 factsheet.

• If a visit must occur when a visitor meets the above circumstances, the visitor must wear a mask when moving through the facility and minimise movement within the facility.

Mask wearing

For all visitors, wearing a mask indoors is encouraged when respiratory viruses are circulating at moderate or high levels in the community, as per the NSW Respiratory Surveillance Report.

Staff

Entry restrictions

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 and when symptoms have resolved. Facilities should follow the RACF ARI Guidance to determine when it is safe for employees to return to work. Eligible providers can claim aged care worker COVID-19 leave payment grants quarterly. These grants replace the previous High Risk Settings Pandemic Payment.
• Any acute respiratory or influenza-like symptoms.
• Been in close contact with a person who has COVID-19. See below for further information.

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.

Testing staff for COVID-19

It's encouraged that facilities provide free RATs to staff to promote testing as required but regular surveillance testing is not required when there are low levels of COVID-19 in the community. Please note that staff with respiratory symptoms should not attend work even with a negative RAT result.

Mask wearing

• Masks should be worn by staff when there are moderate or high levels of respiratory viruses circulating in the community as indicated by the NSW Respiratory Surveillance Report.
• Please remember that masks can be removed for staff:
• While communicating with people who are hearing impaired
• 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 alone in an indoor area
• To eat or drink; staff are encouraged to enjoy their meal breaks in areas with good natural ventilation or outdoors.
• Staff removing a mask for one of the above reasons can decrease the risk of transmission by physically distancing from others, if appropriate.

Vaccination

• Staff are strongly encouraged to stay up to date with all recommended vaccines including COVID-19 and influenza.
• Providers should review COVID-19 staff vaccination rates and facilitate access to vaccination for those who are due. For information on recommended COVID-19 vaccine doses see the latest ATAGI advice.
• Providers must comply with the Australian Government Department of Health and Aged Care's mandatory flu vaccination program, which includes:
• Offering free flu vaccinations to all staff and recording vaccination information.
• Demonstrating how flu vaccinations have been promoted and how staff and volunteers have been informed about the benefits of vaccination.
• Demonstrating the steps taken to encourage staff and volunteers to get vaccinated.
• For further information, visit Australian Government Department of Health and Aged Care advice for residential aged care workers and Australian Government Department of Health and Aged Care responsibilities of residential aged care providers.

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, a fan) is not effective. Natural ventilation should be used wherever possible. RACFs can consider seeking professional advice from an occupational hygienist or ventilation engineer. Carbon dioxide (CO2) monitors and HEPA filters may play a role but require users to have a good understanding of how to use them.