RACFs should continue to align requirements for staff and visitors to wear PPE based on the regularly updated Advice to residential aged care facilities
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 seven State Government Residential Aged Care Facilities (SGRACFs) and 63 Multipurpose Services (MPSs).
In response to the COVID-19 pandemic, SGRACFs and MPSs must enhance infection prevention and control measures and review staff moving between RAC sections and Acute/Emergency Departments (EDs), to reduce the risk of transmission. 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 residential aged care facilities (RACFs) are particularly susceptible to COVID-19 outbreaks.
Staff, including health workers, may be required to move between many sections of a health facility. In MPSs, staff may need to provide emergency care in ED, acute inpatient care, community health services, and care for residents in the RAC section.
Staff in rural communities often work between many facilities, such as MPSs, private RACFs or other hospitals. In metropolitan communities, staff may work across many aged care facilities or from acute wards to aged care facilities. Under the
NSW Health Code of Conduct (4.3.7), full-time staff must seek Chief Executive approval for secondary employment, and part-time staff must seek approval if there is a potential conflict of interest or their total work raises issues about excessive working hours. Such approval for other employment must not be unreasonably withheld.
The purpose of this Guideline is to provide general infection prevention and control principles and practical workflow strategies that SGRACFs and MPSs can adapt to the local level to minimise the potential risk of COVID-19 transmission. The decision to implement the proposed 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.
Aged Care Quality Standards,
Charter of Aged Care Rights and National Safety and Quality Health Service Standards
Guide for Multi-Purpose Services and Small Hospitals still apply during any pandemic.
The Agency for Clinical Innovation’s
Pandemic Kindness Movement includes resources to support healthcare workers with the potential challenges of the COVID-19 pandemic. This is based on six key areas: basic needs, safety, love and belonging, esteem, contribution and leadership actions.
Maintain evidence-based practice of ensuring culturally safe work environments (see
Aboriginal Health Plan 2013-2023 and the
NSW Plan for Healthy and Culturally and Linguistically Diverse Communities 2019-2023).
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:
This 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.
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.
All staff working across many facilities should follow strict
infection prevention and control practices when entering and leaving each facility. As recommended in the Chief Medical Officer’s advice, staff should pass screening questions and temperature checks before entering the residential aged care section and facilities should consider documenting screening details.
Infection prevention and control practices can include:
See the Clinical Excellence Commission’s (CEC)
COVID-19 Information Sheet for healthcare workers: Scrubs, uniforms, aprons and gowns for more information. This information sheet states that there have been no documented cases of novel coronavirus transmission via clothing at this point of the pandemic. Health workers can wear a uniform outside the hospital/health facility and for community visits if they used PPE due to close contact with a person who has suspected, probable or confirmed COVID-19 and they are within 1.5 metres. The choice to change out of a uniform before leaving work is a personal choice.
To minimise possible COVID-19 transmission, when residents are required to attend appointments outside the Residential Aged Care Facility, facilities should regularly review the
advice from the NSW Chief Health Officer. Additionally, facilities should also encourage staff to take meal breaks in the staff dining room or open areas such as outdoor gardens and maintain physical distancing and hand hygiene.
Consider using the guides for staff arriving and leaving the SGRACF or MPS at
Appendix A and
NSW Health will continue to provide updated advice on additional COVID-19 measures for staff and facilities to prevent the introduction of COVID-19. Advice around the requirement for staff to wear surgical masks in the facility will continue to be reviewed and updated based on the current public health situation. Staff should always refer to the latest advice provided by the NSW Chief Health Officer found at
Advice to residential aged care facilities on the NSW Health website..
All staff must practice physical distancing to limit COVID-19 transmission. Where practical, health workers and residents must keep 1.5 metres apart, except when providing direct care, assessment or diagnostics.
Standard infection prevention and control precautions are covered in
CEC guidelines, the
Infection Control Expert GroupCOVID-19 Infection Prevention and Control for Residential Care Facilities and the Department of Health’s
COVID-19 Environmental cleaning and disinfection principles for health and residential care facilities.
Basic principles include:
Use transmission-based precautions and standard precautions, when standard precautions alone are insufficient to prevent transmission. The three types of transmission-based precautions are:
Staff should assess and monitor risk by:
Where an MPS is a designated district COVID-19 MPS, follow local district Protocol with advice on symptomatic management and self-isolation (CDNA Guidelines), and Public Health Unit advice.
Where an MPS is a designated district non-COVID-19 MPS, refer patients to testing and further management at a larger facility if required, as per local district Protocol.
Where staff provide services across multiple sections of an MPS (Acute, ED and residential aged care), minimise movement to other areas where possible, by:
SGRACFs and MPSs may consider implementing some of the strategies below. Local district requirements apply.
Please note: It is recognised that implementing some strategies may not be practical for many NSW Health facilities and these strategies are provided as a guide to consider.
To prepare for possible staff illness and self-isolation, apply the district’s workforce surge plan or develop staff contingency plans, by:
Consider engaging staff with various backgrounds to provide the diverse skills required, including:
The Registered Nurse should notify the Nurse Manager/Health Service Manager of all suspected, probable or confirmed COVID-19 cases and if they require after-hours admission to the ED’s red/hot zone. This is a designated area for patients presenting to ED with respiratory symptoms, fever or a positive response to screening questions. All other patients may be placed in the green/cold zone.
The Nurse Manager/Health Service Manager should arrange a residential aged care staffing replacement as necessary.
Staff: Any staff member with flu-like symptoms or fever must stay at home, see
Complying with the NSW Public Health Orders and directions from the Chief Health Officer and/or Secretary. Staff who treated a resident who is then a confirmed case, must stay at home for two weeks.
Resident: Consider any resident with flu-like symptoms or fever as a suspected COVID-19 case until test results are available. To minimise risk of transmission:
If an MPS tests or admits COVID-19 positive patients, consider reinstating unused clinical spaces for patient care.
Where possible, a designated self-contained area or zone of the facility/hospital should be used to manage people with COVID-19. Where possible, this should include:
If a resident is identified as COVID-19 positive, notify the district Public Health Unit and the Department of Health via
agedcareCOVIDcases@health.gov.au. Liaise with PHU to implement local Incident Action Plan.
SGRACFs and MPSs may wish to consider using this checklist and adapting it to suit the IPC arrangements in place.
SGRACFs and MPSs may wish to consider using this checklist.
CEC's COVID-19 Information Sheet for scrubs, uniforms, aprons and gowns.
Aged Care/Aged Health community of practice Stream 2: Residential Aged Care Facilities – Working Group.
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning, NSW Ministry of Health.
Aged Care Unit, Public Health Response Branch.
Staff working in NSW State Government Residential Aged Care Facilities (SGRACFs) and NSW Multipurpose Services (MPSs).