As of 14 December 2022

• NSW Health has a risk management approach to discharging people to RACFs which involves medical and epidemiological screening for COVID-19, and PCR or Rapid Antigen testing if appropriate. This process aims to provide confidence that new and returning residents have been risk assessed for COVID-19 at the time of discharge.
• When a resident has been admitted to hospital and is ready for discharge, the treating team will medically screen and risk assess the resident for COVID-19, and complete a RAT or rapid PCR test within 24 hours prior to discharge. The treating team will communicate a resident's COVID-19 screening/test result to the RACF with an information sheet and discharge letter that explains the risk assessment. This is in addition to the usual discharge records.
• RACFs should screen and risk assess all new and returning residents who are asymptomatic and not suspected of COVID-19. This includes medical screening and assessment of epidemiological risk factors. Depending on the risk assessment, the RACF may implement additional infection prevention and control measures on admission.
• Processes for admissions/re-admissions to facilities where there is a current outbreak will be in line with relevant and up-to-date national guidelines on infection prevention and control. These include the CDNA National Guidelines for the Prevention, Control and Public Health Management of Outbreaks of Acute Respiratory Infection (including COVID-19 and Influenza) in Residential Care Facilities in Australia and the Infection Control Expert Group COVID-19 Infection Prevention and Control Manual. Decisions should also be based on the advice of the local Outbreak Management Team. Consultation with the resident and their representatives should occur and the wishes of the resident to return should be considered. Carers/families may wish to seek alternative arrangements until the outbreak is over. NSW Health aged care outreach teams / specialised staff should be engaged as soon as possible to assist with discharge planning (where available) in the person's geographic area, and the social work team should be engaged to provide support as needed.
• Transfer back to the aged care facility for residents who have been hospitalised with COVID-19 should be managed in line with the CDNA guidelines.

Note: Hospital acquired functional decline (HAFD) in older patients can be significant: efforts should be made to prevent decline and to preserve function throughout the resident's hospital admission through multidisciplinary input including allied health consultations (physiotherapists, occupational therapists, nutrition and dietetics, speech pathologists), as required. On discharge to the RACF, residents may require multidisciplinary rehabilitation to prevent further deconditioning and decline in independence and function.