On this page
- Introduction
- Purpose
- Relevant legislation, policy and guidance
- Complying with the NSW Public Health Order
- Screening visitors and staff
- Flu vaccination requirement
- Clinical placements
- Strategies to enable visitor access during COVID-19 pandemic
- Exceptional circumstances
- Appendix A: Industry code for visiting residential aged care homes during COVID-19
- Document information
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.
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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.
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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.
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Complying with NSW Public Health Order and directions from the Chief Health Officer and/or delegate
The NSW Public Health (COVID-19 Residential Aged Care Facilities) Order (No 3) 2020 updates the NSW Public Health (COVID-19 Residential Aged Care Facilities) Order (no 2) 2020. The order is in effect until 17 December 2020.
SGRACFs and MPSs must comply with this Order. 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.
Under the Order, SGRACFs and residential aged care sections of MPSs can allow a person to enter and remain on the premises, if the person is:
- an employee or contractor of the SGRACF or residential aged care section of the MPS
- a representative of a union to which an employee or contractor of the SGRACF or MPS belongs
- providing goods or services that are necessary for the effective operation of the facility
- providing health, medical or pharmaceutical services to a resident
- providing personal care services to a resident
- making a care and support visit to a resident (a care and support visit is by no more than two persons together, for the purposes of providing care and support to the resident, and not including visits from medical professionals)
- providing end-of-life support for a resident
- emergency management or law enforcement
- a prospective resident of the SGRACF or MPS.
From 24 July 2020 the Secretary has advised that NSW Health’s risk level has been escalated to moderate (Amber). This requires all health workers to wear a surgical mask if they are within 1.5m of patients. Residents SGRACFs and MPSs are not required to wear a mask. Further advice on the Amber risk requirements is available at the COVID-19 Infection Prevention and Control: Response and Escalation Framework - FAQs.
The NSW Chief Health Officer or delegate is providing regular updates to RACFs in line with current public health advice around restrictions for staff, visitors, specific Local Government Areas and updates on PPE requirements. The most recent advice from the Chief Health Officer can be found here.
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Screening visitors and staff
To comply with the requirements under the Order, SGRACFs and MPSs must ask staff and visitors to answer screening questions and check their temperature (with a non-contact infrared thermometer, if available). Screening questions should include:
- Have you returned from overseas travel, a cruise ship or been to Victoria in the last 14 days?
- Have you had any close contact with a confirmed or suspected case of COVID-19?
- Are you in close contact or caring for someone who is currently unwell?
- Have you been in a location and time associated with NSW community transmission in the last 14 days?
- Do you currently, or in the last 7 days, have any symptoms of acute respiratory infection (e.g. cough, sore/scratchy throat, runny nose, shortness of breath, fever)?
- Have you received an up-to-date vaccination against influenza, or can you provide a medical certificate stating that you have a medical contraindication to the influenza vaccine?
If the staff or visitor answers yes to questions 1-5, or no to question 6, or their temperature is 37.5°C or higher, they cannot enter the SGRACF or an MPS residential aged care section.
If the staff or visitor answers yes to questions 1-4, advise them to:
- call the National COVID-19 Helpline (1800 020 080)
- stay home and self-isolate
- get tested, even if you have no symptoms
- watch for COVID-19 symptoms and get retested should any symptoms recur
If the staff or visitor answer yes to question 1-3, advise them to:
- Stay in isolation for 14 days, even if you get a negative test, because it can take 14 days before you may show symptoms or test positive
- (for staff) follow the usual sick leave protocol. Special leave may apply – staff should consult local Workforce/Workplace Relations.
If the staff or visitors answer yes to questions 4 and 5, advise them to:
- Stay home and self-isolate
- Get tested immediately
If the test result is negative and they answered no to questions 1-4, then they no longer need to stay in self-isolation.
It is important to note that 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.
From 17 April 2020 until further notice, NSW public hospital and health services are screening staff and visitors before they enter a NSW Health facility. This includes temperature checks to measure for the presence of a fever. Current NSW Health COVID-19 clinical testing criteria for temperature is a fever of 38°C or greater. However, under the Public Health Order, entry to all NSW Health RACFs (SGRACF and MPS) requires a temperature of less than 37.5°C.
Temperature to enter RACF: Less than 37.5°C
Flu vaccination requirement
The Australian Health Protection Principal Committee (AHPPC), the key medical advice committee for health emergencies, advised National Cabinet that all residential aged care staff, visiting workers, and visitors should be vaccinated with this season’s flu vaccine by 1 May 2020. NSW Government, like all states and territories, issued a Public Health Order following this recommendation.
Under the Order, staff and visitors are not to enter or remain on premises of a RACF if they do not have an up-to-date flu vaccination. However, staff and visitors are exempt from this requirement if they provide a completed Influenza Vaccine Medical Contraindication Form issued by a medical practitioner, certifying that they have a medical contraindication to the influenza vaccine.
SGRACFs and MPSs must take all reasonable steps to comply with the Order. If a visitor refuses to comply, staff must advise that they cannot enter the facility.
NSW Health is taking a reasonable approach to this requirement. If a person is attempting to access the vaccine but is having supply issues, or a person is allergic to the vaccine or has a medical reason for not being able to have it, then the vaccine is not ‘available’ to them. There are only limited medical contraindications for not having the vaccine (anaphylaxis after a previous dose of any influenza vaccine or anaphylaxis after any component of an influenza vaccine). For more information about flu vaccine contraindications and precautions, see the Australian Immunisation Handbook – Influenza.
SGRACFs and MPSs must request that visitors provide a medical certificate from a medical practitioner confirming that a person cannot have the vaccine for medical reasons. The Ministry of Health has developed an approved Influenza Vaccine Medical Contraindication Form for General Practitioners to use when someone would like to confirm a medical contraindication to the influenza vaccination requirements set out in the Order.
In an emergency, where NSW Ambulance, Fire and Rescue NSW or NSW Police Force are attending a RACF or where tradespeople are required for urgent repairs, it is considered reasonable for them to enter even if they have not been screened or cannot show they have a flu vaccination. If possible, they should limit contact with residents and staff. However, if such personnel are attending the RACF in a non-emergency or non-urgent situation (such as planned attendances), they must have had an up-to-date flu vaccination, or provide a medical certificate stating that the person cannot have the vaccine for medical reasons.
In all other circumstances, staff and visitors must be vaccinated with this season’s flu vaccine and providers must seek evidence from the staff member or visitor that this is the case. Facilities should consider maintaining immunisation records to demonstrate compliance if required.
Staff must comply with the Public Health Order, which aligns with updated NSW Health PD2020_017 Occupational Assessment, Screening and Vaccination Against Specified Infectious Diseases, published 27 May 2020. Section 4.1 outlines the flu vaccination requirements for staff working in NSW Health RACFs and NSW Health staff working in government and non-government RACFs.
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Clinical placements
NSW Health will continue to offer safe, risk-assessed clinical placements where possible, ensuring compliance with the Order. The Order supports facilities continuing student clinical/work placements. 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.
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Strategies to enable visitor access during COVID-19 pandemic
SGRACFs and MPSs could use the strategies in the table below, to enable visitor access. These strategies aim to support SGRACFs and MPSs in complying with the requirements under the Order, while best meeting the care and welfare needs of residents, carers and families during the COVID-19 pandemic.
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
Resident and/or carer/family nominates visitor/s.
Limit visitors to 2 at a time. Communicate to the resident’s carers/families weekly with photos of residents and staff (with consent), share any updates and changes, and options available to stay connected and interact with their loved ones.
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 under the Public Health Order, i.e:
- answer NO to screening questions 1-5
- show evidence of their up-to-date flu vaccination (or medical certificate as evidence of medical contraindication)
- 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 refuse vaccination, arrange an alternative contact method such as a phone or video call. Note: persons who cannot have the vaccine due to a medical contraindication, can still visit under the Order, if they provide a medical certificate stating that they cannot have the vaccine for medical reasons.
- 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).
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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.
Restrict visits to a resident’s room, outdoors, or in a designated area. Do not allow visits in communal areas where risk of transmission to residents is greater.
Strategies for consideration in SGRACFs and MPSs
- Ask visitors to contact the facility before their visit to find a mutually convenient time.
- Take a flexible and compassionate approach to visiting times that considers the external commitments of visitors, such as work.
- 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.
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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 a small number of 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.
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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).