As of 18 July 2022

Winter flu season

• RACFs should take precautionary steps in managing 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 second COVID-19 booster (winter booster). The second COVID-19 booster should be given 3 months after their first booster dose, or 3 months after a confirmed COVID-19 infection.
• It is strongly recommended that all visitors and staff be vaccinated for influenza this winter, and that RACFs communicate with their staff, families, and other visitors to remind them about the importance of influenza vaccination.

Visitors

Testing for COVID-19

Visitors should provide evidence of a negative COVID-19 rapid antigen test (RAT) result taken just before entry. Visitors providing essential care and entering on a regular basis can, with the agreement of the RACF, do less frequent testing. In these circumstances, the minimum recommended interval is twice weekly.

Emergency service providers are not considered visitors and are not required to do a COVID-19 test prior to entry.

Limitation on numbers

Visitor restrictions are no longer included in the Public Health Order. However, the recommended limit for visitors is 2 adults and 2 children per resident within a 24-hour period. Operators of RACF may increase the number of visitors for a resident depending on their circumstances. For example:

• A special occasion such a birthday
• Visitors have travelled a long distance
• Visitors have not seen the resident for an extended period of time
• It is for the purposes of end of life.

Additional measures

• Where possible, visits should be held outdoors or in well-ventilated areas away from other residents.
• All visitors over 12 years of age 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.
• Visitors and staff should maintain social distance and limit interactions.
• Visitors should not move between different areas of the facility and should only visit the resident in their room or in an outdoor location.

Vaccination

• Visitors are strongly encouraged to be vaccinated for COVID-19 and to receive their booster when it is due.
• Visitors are strongly encouraged to be vaccinated for seasonal influenza.

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 Guidelines 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 where possible. 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 tested positive for COVID-19 in the past 10 days.

Residents

Positive COVID-19 rapid antigen test results

• A resident 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 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.
• Other reporting requirements may be in place for the Commonwealth, your local Public Health Unit and/or Local Health District, which will trigger supports.
• Testing for COVID-19 is not recommended for residents that have recovered from COVID-19 within the previous 4 weeks.
• Recovered residents with new symptoms should be tested for COVID-19 and other respiratory pathogens, including influenza.

Leaving the facility

• Residents may leave the facility and attend family gatherings or other events but must follow the current Public Health (COVID-19 General) Order (No 2) 2022 and rules for people in NSW.
• Residents should 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 have a COVID-19 test and self-isolate until their symptoms are gone.
• 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 a mask and appropriate mask wearing advice if they leave the facility. See the latest face mask rules.

Vaccination

Residents should get a flu vaccine, COVID-19 booster dose or a second booster (winter booster) as soon as they are eligible.

Staff

• Staff, including students and contractors, should not enter a RACF if they have acute respiratory or influenza-like 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, as regular COVID-19 rapid antigen testing is more effective than singular tests to identify cases.
• All staff must wear a surgical mask while in the facility. For reasons when masks can be removed please see Additional Advice – mask wearing.

Vaccination

All staff should be vaccinated according to the recommended schedule in the ATAGI guidance for residential aged care workers.

Under the Public Health (COVID-19 Care Services) Order (No 2) 2022 all staff, health practitioners and students entering a RACF must have had 3 doses of a COVID-19 vaccine. The third dose is due 3 months after a person's second dose. For staff (including new staff) who have had 2 doses of a COVID-19 vaccine, they must have their third dose within 6 weeks of their third dose being due.

Exemptions under the Public Health (COVID-19 Care Services) Order (No 2) 2022 relating to the third dose of a COVID-19 vaccination may apply to some staff, including:

• An exemption which allows a person who has had two doses of a COVID-19 vaccine to continue working without the third dose if they have been assessed by the facility as being essential to the operation of a RACF or ongoing provision of aged care services.
  
  The exempt worker must take reasonable steps to get vaccinated as soon as practical. If they have not taken reasonable attempts, they are not exempt from their third COVID-19 vaccination.
• An exemption which allows a person who has had two doses of a COVID-19 vaccine to continue working without the third dose if they:
• were diagnosed with COVID-19 in the previous 4 months, and
• can provide evidence of their diagnosis to the RACF and/or their employer. Evidence of diagnosis can be either proof of registration with Service NSW of a positive rapid antigen test result, or evidence of a positive COVID-19 PCR result.

See further information on Public Health Orders and Exemptions.

These exemptions do not permanently exempt the person from the requirement to have a third dose of a COVID-19 vaccine. Staff who do not meet the conditions in the exemption instrument must comply with the vaccination direction in the Public Health (COVID-19 Care Services) Order (No 2) 2022 . Facilities should work with staff to make sure that they are able to access their third dose of a COVID-19 vaccine when it is due. 

Staff who have a medical contraindication to all reasonably available COVID-19 vaccinations will require a COVID-19 medical contraindication certificate.

Staff exposed to COVID-19

If there is a staff exposure to COVID-19 in a RACF, managers should use Appendix 2 in the Acute Respiratory Infections Guidance to support decision making.

Staff who are a household or close contact must comply with the NSW Health Household and Close Contact Guidelines 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 undertake a risk assessment before approving their return to work.  This may include asking the staff member to take additional precautions to decrease the risk of transmission. This applies to all workers entering a RACF to provide a service, including pathology collectors, therapists and other contractors, however does not apply to emergency service providers.

If a staff member is critical to service delivery and their absence would compromise ongoing care for residents, a return within 7 days may be allowed with additional risk mitigation measures. For further information, see Managing RACF staff returning to work after exposure to COVID-19.

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).