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This advice reflects the agreed position of the Palliative Care Community of Practice. It confirms the need to take a humanitarian approach to ensure that in the last days of life patients are supported to have contact with family and friends. Where a patient is receiving end of life care in hospital, Chief Executives and hospitals should ensure that visitors are only limited to the extent necessary to minimise risk.
A summary of relevant guidance for residential aged care facilities is also provided for reference.
This information will be reviewed regularly.
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During the pandemic, visitor management plans are agreed locally
- Under the NSW Health Management of COVID-19 in Healthcare Settings guidance, decision-making regarding visitors to NSW Health facilities is managed locally. This policy applies during the pandemic. Local public health units and infection control professionals, with engagement of other clinicians and stakeholders, should continue to determine local policy and practice for facilities and services.
- Additional restrictions or changes to visitor rules during the pandemic are agreed locally, including decisions to prevent face-to-face visits, to restrict visitor numbers/times, on the use of PPE, and/or to apply screening protocols. Visitor management plans should include appropriate risk assessment (inclusive of both clinical and infection control staff) that promotes the safety and wellbeing of patients and family members, whilst continuing to protect patients and staff from the risk of COVID-19.
- Services should be aware that overseas visitors to palliative patients may be subject to quarantine exemption. Contact the local public health unit for further guidance on this.
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Visitor management plans should consider the needs of people in the last days of life
Local visitor management plans should specifically consider how a humanitarian approach to contact of carers/family members with patients during the last days of their life will be supported and managed. While heightened visitor restrictions during the COVID-19 pandemic may apply compared to business as usual, NSW Health facilities should consider and implement optimal approaches to comfort care, including minimisation of risks of isolation and distress experienced by patients in the last days of life. This is also important to reduce carer’s distress which in turn may reduce the risk of complex grief in the future.
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Virtual communication should be used when face-to-face visits are too hazardous
- Where there is no suspicion of COVID-19 infection, face-to-face visiting should be maintained in some form during end of life care. For suspected or confirmed COVID-19 cases, or in facilities with higher risk, advice from infection control professionals should include use of virtual communication to connect patients with family members if in-person visits are deemed too hazardous. Infection prevention and control advice, and support for correct use of PPE, must be provided to family members and other visitors.
- If the “most” important person to a patient who is dying of COVID-19 also has COVID-19, consideration may be given to “admit’ the family member into the COVID-19 ward to allow them to be with their dying relative. Other infected family members should not be allowed to come to the hospital and will need to be provided with information and electronic means to assist with communicating with the dying patient.
- Agreed local approaches, should also consider local operational aspects including any additional burden placed on staff to ensure visitor compliance with the measures in place.
- Contact the local Chief Clinical Information Officer for advice on available devices to support virtual communication.
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Guidance for residential aged care facilities (RACF)
- The Commonwealth Department of Health has developed a COVID-19 Information guide for families and residents on restricted visits to RACFs.
- This includes guidance that RACF providers are ‘expected to show compassion and make sensible decisions on a case-by-case basis, including in relation to children and residents in palliative care.’
- Under the NSW Public Health (COVID-19 Residential Aged Care Facilities) Order 2020 residential aged care facilities (RACF) can allow a person to enter and remain on the premises for a number of reasons, including if the person is providing end-of-life support for a resident. A person under 16 years can only enter a RACF for the purposes of providing end-of-life support for a resident. Otherwise, all persons under 16 years are not permitted to enter. This is subject to the visitor meeting the requirements such as having an up to date flu vaccination if available to them and providing evidence, having a temperature below 37.5°C, not showing symptoms of acute respiratory infection, and have not been in close contact with a confirmed or suspected case of COVID-19. For more information, please see the NSW Health’s Frequently Asked Questions on the Public Health Order.
- The Industry code for visiting residential aged care homes during COVID-19 was developed by aged care peaks and consumer advocacy organisations to encourage a nationally consistent visitor policy to residential aged care homes during the COVID-19 pandemic that aligns with the Aged Care Quality Standards. The Code aims to apply a compassionate and consistent visitor policy that continues to minimise the risk of COVID-19 while providing innovative on-site visiting solutions to maintain the mental health and social wellbeing of residents. Under Principle 7 of the code, residents who are dying should be allowed in-room visits from loved ones on a regular basis. The number of visitors, length, frequency, and nature of the visits should reflect what is needed for the person to die with dignity and comfort, taking into account their physical, emotional, social and spiritual support needs. Erring on the side of compassion is important, given the difficulty in predicting when a person is going to die.
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Health and Social Policy Branch
- Palliative Care Community of Practice
- Legal and Regulatory Services
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning
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