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Introduction

Residential aged care (RAC) is an essential service for older people and some younger people with complex health conditions and disability who can no longer live at home and need help with everyday tasks or health care. NSW Health operates RAC in nine State Government Residential Aged Care Facilities (SGRACFs) and 63 Multipurpose Services (MPSs).

In response to the COVID-19 pandemic, the aged care sector has adopted a precautionary approach to visits in residential aged care facilities (RACFs) based on available medical advice and relevant Public Health Orders. This includes regulating visitors’ access to RACFs and screening staff and visitors on entry. COVID-19 is a significant health risk particularly for older people and individuals with co-morbidities or low immunity. International, national and state reports show that RACFs are particularly susceptible to COVID-19 outbreaks.

As restrictions ease, it is important to keep people living in residential aged care facilities safe now and into the future. Implementing visitation practices informed by up to date medical advice will help maintain COVID-safe environments and encourage physical distancing.

Purpose

The purpose of this Guideline is to support SGRACFs and MPSs implement visitation practices that comply with relevant legislation, while ensuring safety and meeting the needs of residents, staff, carers and families, and the general community. NSW Health acknowledges the challenges of balancing the wellbeing and best interests of residents, carers and family with infection prevention and control measures.

This Guideline provides strategies for visitor access during COVID-19 that SGRACFs and MPSs could consider. The strategies are informed by relevant legislation, policies, up to date medical advice and industry guidance. The decision to implement the proposed strategies or similar strategies remains with the local health district (District), ensuring that they comply with the relevant State and Commonwealth legislation. As legal provisions can change, SGRACFs and MPSs are expected to keep up to date to ensure they remain compliant with the legal requirements.

Relevant legislation, policy and guidance

Key legislation, policy and guidance about visitor restrictions, include:

The Aged Care Quality Standards and Charter of Aged Care Rights still apply during any pandemic, and National Safety and Quality Health Service Standards: Guide for Multi-Purpose Services and Small Hospitals still apply during any pandemic.

Complying with NSW Public Health Order and directions from the Chief Health Officer and/or delegate

Aged Care services are now incorporated in the Public Health (COVID-19 Gathering Restrictions) Order 2021 and under the Order, residential aged care facilities “must consider the advice of the Chief Health Officer in relation to the following matters: 

  1. the management of visitors to the premises of the facility,
  2. the screening of staff and visitors before entering the premises of the facility,
  3. the conduct of group recreational or other activities for residents of the facility,
  4. the wearing of face masks by staff and visitors,
  5. vaccinations against influenza or COVID-19 for staff, visitors and residents.

It applies to all RACFs that provide care or accommodation under residential care subsidies or flexible care subsidies as per the Commonwealth’s Aged Care Act 1997. This includes facilities that provide respite care to residents and transition care for Transitional Aged Care Programme clients in a SGRACF or MPS.

Current risk levels are monitored on the COVID-19 Risk Monitoring Dashboard. A full matrix of the infection prevention and control practices under each alert level is available with the Framework, together with the printable posters to support communication with staff and patients.

The NSW Health Chief Health Officer continues to provide regular updates to residential aged care facilities. This advice includes recommendations regarding mask wearing by staff and visitors and visitation limitations in certain local government areas. See the most recent Advice to residential aged care facilities.

Screening visitors and staff

The NSW Health Chief Health Officer advice outlines any screening criteria facilities are expected to implement for staff and visitors, including temperature checks. Refer to the COVID-19 screening at NSW healthcare facilities webpage and any additional requirements detailed in the frequently updated advice to RACFs.

It is important to note that a person with very mild symptoms or no symptoms can be infected or transmit the virus.

Screening of staff and visitors on entry does not replace other essential arrangements and practices that must be in place for all residential aged care services, including hand hygiene using the correct technique, physical distancing wherever possible, and environmental cleaning with the required cleaning products.

Temperature to enter RACF: Less than 37.5°C

Flu vaccination requirement

NSW Health Staff must comply with the updated NSW Health  PD2020_017 Occupational Assessment, Screening and Vaccination Against Specified Infectious Diseases, published 27 May 2020. Section 4 outlines the flu vaccination requirements for staff working in NSW Health RACFs and NSW Health staff working in government and non-government RACFs.

Clinical placements

NSW Health will continue to offer safe, risk-assessed clinical placements where possible. Placements can continue in aged care facilities with students required to pass screening to enter the facility.

Districts and/or facilities should continue to make decisions around clinical placements based on risk assessments and considering local circumstances. Districts are encouraged to implement local reporting processes to capture any symptoms in the student cohort and make it clear to students that if they are sick, they are not to attend the NSW Health facility.

Facilities must consider specific COVID-19 measures including, but not limited to, assessing physical distancing and/or using PPE, adequate PPE supplies, supervision capacity, and hosting students in alternative settings. Where needed, Districts are encouraged to identify other placement options with University and Registered Training Organisation (RTO) partners.

In all situations, facilities must prioritise safety and quality of care of residents, staff and students.

Strategies to enable visitor access during COVID-19 pandemic

SGRACFs and MPSs could use the strategies in the table below, to enable visitor access.

Facilities must actively facilitate connections between residents and their cares, families, and friends, in line with the Charter of Aged Care Rights.

New residents: For a new SGRACF or MPS resident and their carers and families, an in-person tour of the facility and view of the resident’s new room is allowed. However, wherever possible, the SGRACF or MPS should offer virtual tours of the new room and facility.

Outbreak: If there is an outbreak in the facility or in the local community, further restrictions may be placed on visitor access, while continuing to attend to all residents’ overall needs.

Facilities should implement restrictions in a transparent and well communicated way, indicating a likely timeframe including when the stricter restrictions will be reviewed. Where there is an outbreak, residents may need to be isolated to their rooms, but must still be offered activities and exercise contributing to quality of life.

During an outbreak in the facility, families and friends can deliver letters, parcels, gifts, food, and communication devices to facilities.

Industry code for visiting residential aged care homes during COVID-19: SGRACFs and MPSs should consider the principles, rights, and responsibilities of the Code at Appendix A.

Aged care peaks and consumer advocacy organisations developed the Code 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.

Visits and visitor numbers

Requirements

Visits and visitor numbers

Strategies for Consideration in SGRACFs and MPSs

  • Visits should be conducted in a resident's room, outdoors, or a specified area in the RACF, rather than communal areas with other residents.
  • Residential aged care facilities may be required to impose restrictions on the total number of visitors in a facility at any one time to ensure that hygiene, infection prevention and control, and physical distancing requirements are safely met.
  • Interact with external groups such as school groups, virtual exercise classes and entertainment like live-streamed concerts via Skype or Zoom on tablets.
  • Residents Wall of Love: put up messages and craft on an external wall or fence to communicate with the community.

Visitor screening on entry

Requirements

A visitor can enter the facility if they meet the requirements in the frequently updated advice to residential aged care facilities. i.e:

  • answer screening questions indicating no symptoms or exposure.
  • have a temperature below 37.5°C.

Strategies for consideration in SGRACFs and MPSs

  • Create a single entry and exit point and use temporary screens or relocate furniture to restrict access to other parts of the facility.
  • Delegate monitoring and screening all people entering the facility to a staff member or volunteer.
  • Use a no-touch method for temperature checks with an infra-red temperature detection device (if available).
  • Maintain a register of visitors entering and exiting the facility including name, purpose, contact details, answers to screening questions and temperature check, and evidence of current flu vaccination or medical certificate providing evidence that visitor has a valid exemption from the vaccination requirement.
  • For persons wanting to visit, but arrange an alternative contact method such as a phone or video call.
  • Use name badges that can be cleaned after each use for regular visitors that have provided evidence of current flu vaccination. Add a new coloured dot to the badge as evidence of passing screening on that day (like the NSW Health staff screening procedure).
  • If a resident requires health care outside the facility, minimise the risk of transmission by arranging direct transport to the appointment, call ahead to minimise waiting time, ask the resident to wait for the appointment in the car rather than in the waiting room, and screen the resident and support person on return to the facility (temperature check and screening questions).

Changes to how people visit

Requirements

Practice infection prevention and control as well as screening visitors.

Encourage visitors to practice physical distancing where possible, by maintaining 1.5 metres between themselves and other people.

Strategies for consideration in SGRACFs and MPSs

  • Ask visitors to contact the facility before their visit to find a mutually convenient time.
  • It is important to reduce the potential for crowding and the risk of environmental contamination.
  • A flexible and compassionate approach to visiting times should be taken. Time limits for use of a designated visiting area may be required by some residential aged care facilities, in order to make the area available to a range of visitors, but a minimum visiting time of 60 minutes is recommended in these instances. If visits occur in a resident's room, time limits should be more flexible and relaxed.
  • Allocate visiting time for visitors to minimise the number of people in the facility at one time. Provide PPE if required.
  • Arrange visiting with appropriate physical distancing such as outdoors, across a gate/fence, through a window or glass panel.
  • Provide a dedicated space inside or in the garden for visits or create a “window of love” where families can see their loved ones and communicate through phones.
  • Encourage good hygiene practices for all visitors when they are inside and outside the service.
  • Provide antibacterial sanitiser and plastic zip lock bags at the entry point for visitors to clean their devices (such as phones and tablets) and place them in a zip lock bag. Encourage disposal of the zip lock before they exit.
  • Request visitors to only use public bathrooms and to not enter communal areas.
  • Use telehealth where possible to allow residents to access external medical and related services (e.g. allied health appointments) on a safe but prompt basis. This may also require wearing of PPE in certain circumstances.
  • To maintain regular social connection between residents and carers/family/friends, use a range of communication methods such as letters, audio/video calls and messaging through phones or tablets.
  • Create a secure online page (such as Facebook, ensuring it is in line with District guidelines and support) to update carers and families on the latest news, activities in the facility, and stay connected through photos and videos.
  • Where possible, increase leisure and lifestyle activities, including exercise, and individual activities to meet the needs of residents in place of group activities.

Exceptional circumstances

There are exceptional circumstances when longer visits are required. These may require additional infection control training, PPE use and other measures to comply with the facility’s infection prevention and control procedures.

Residents who are dying and in their final weeks should be allowed in-person 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, considering their individual circumstances, including risk of COVID-19 transmission. A compassionate approach is important, given the difficulty in predicting when a person is going to die.

Visitors who have a clearly established pattern of providing a resident’s care and support (daily or many times a week) should be allowed to visit as usual, depending on local requirements at the facility. This may include helping a resident with their meals or with essential behaviour management. The length, frequency, and nature of the visits should reflect what is needed for the person to be cared for appropriately and consistent with established practices and routines.

It is vital that all SGRACFs and MPSs exercise care and compassion in implementing the required measures to control visitor access and keep residents and carers/family at the centre of decision making. Each situation should be reviewed by the facility on a case by case basis.

The NSW Health Palliative Care Community of Practice (COPS) has also developed a resource: Supporting visits and contact with family for inpatients in the last days of life.

Appendix A: Industry code for visiting residential aged care homes during COVID-19

Industry code for visiting residential aged care homes during COVID-19.

Document information

Developed by

Aged Care/Aged Health Community of Practice Stream 2: Residential Aged Care Facilities – Working Group.

Consultation

Endorsed by

Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning, NSW Ministry of Health.

For use by

  • Staff working in NSW State Government Residential Aged Care Facilities (SGRACFs)
  • NSW Multipurpose Services (MPSs).
Current as at: Monday 10 May 2021
Contact page owner: Health Protection NSW