Residents of residential aged care facilities are at increased risk of COVID-19 infection and are more vulnerable to serious complications if they do become infected. As there is currently no vaccination to prevent COVID-19, avoidance of exposure is the single most important measure for preventing COVID-19 in this setting.

Residential aged care facilities must implement measures to prevent introduction of COVID-19 into their facility and ensure they are prepared to manage outbreaks of COVID-19 if they occur. Detailed guidelines on managing outbreaks are provided in the Australian Department of Health’s COVID-19 guidelines for outbreaks in residential care facilities.

The guidelines outline specific additional measures recommended by the Australian Health Protection Principal Committee (AHPPC) to prevent the introduction of COVID-19 into residential aged care facilities. The principles are also applicable to many settings including residential facilities for people with physical and mental disabilities, detention and correctional centres.

Restrictions on entry into the facility

The following staff and visitors should not be permitted to enter the facility:

• Those who have returned or arrived from overseas in the last 14 days.
• Those who have had contact with a confirmed case of COVID-19 in the last 14 days. A contact is defined as anyone who has been in contact with a known case while they were infectious, which includes the 24 hours before they became symptomatic.
• Those who have not been vaccinated against influenza (after 1 May 2020).
• Those with fever or symptoms of acute respiratory infection (e.g. cough, sore throat, runny nose, shortness of breath). Residential aged care facilities should:
• request that staff and visitors provide details on their current health status (screening for fever could also be considered upon entry)
• ensure that staff are aware of the early symptoms of COVID-19 and know to report their symptoms to management. Any staff member who has a fever or symptoms of COVID-19 should be excluded from the workplace and undergo testing. Sick leave policies must allow employees to stay at home if they have symptoms of COVID-19.

Measures to limit visitors and visits

To reduce the risk of transmission of COVID-19 to residents, facilities should implement the following measures for restricting visits and visitors:

• Limit visits to a short duration.
• No large group visits or gatherings, including social activities or entertainment (including school groups of any size).
• Limit visits to a maximum of two visitors at one time per day. These may be immediate social supports (family members, close friends) or professional service or advocacy.
• Children aged 16 years or less should not be permitted to visit, as they are generally unable to comply with hygiene measures. Exemptions to this can be assessed on a case-by-case basis, for example, where the resident is in palliative care.
• Conduct visits in the resident’s room, outdoors, or in a specific area designated by the residential care facility, rather than communal areas where the risk of transmission to other residents is greater.

In addition:

• All visitors should be encouraged to practice social distancing where possible, including maintaining a distance of 1.5 metres.
• Measures such as phone or video calls should be made available to all residents to enable continuation of communication with family members. Family and friends should be encouraged to maintain contact with residents by phone and other social communication apps, as appropriate.

The recommendations outlined may be altered according to the particular circumstance of the resident, including those who are in palliative care or residents in dementia units, which should be considered on a case-by-case basis. These situations may necessitate increased social contact with visitors.

Movement of residents into and out of the facility

In relation to the movement of residents in and out of the facility:

• No new residents with COVID-19 compatible symptoms should be permitted to enter the facility.
• Residents being admitted or re-admitted from other health facilities and communities should be actively screened for the symptoms of COVID-19.
• Residents being admitted from other health facilities should be assessed by appropriate medical staff prior to admission to the facility.
• Appropriate infection prevention practices should be implemented for residents returning from treatment or care at other facilities. Consult the Clinical Excellence Commission infection prevention and control information sheet for technical assistance.
• External excursions for residents should be prohibited.

Contact your public health unit immediately on 1300 066 055 if three or more cases of influenza like illness (ILI) occur within 3 days, or if there is suspicion of COVID-19 transmission.

General advice for hygiene measures for COVID-19 and other respiratory outbreaks (e.g. influenza)

Signage and other forms of communication (i.e. information and factsheets) must be used to convey key messages, including what actions the facility is taking to protect visitors, residents and staff, and explaining what they can do to protect themselves and their family members. This includes signs on appropriate hand washing techniques upon entry and throughout the facility. Staff should:

• ensure visitors perform hand hygiene before entering and after leaving the resident’s room and the facility
• promote the annual flu vaccine to visitors.

Facilities must ensure that the following are available at the entrance of the facility and in each resident’s room:

• adequate hand washing facilities and alcohol based hand rub
• tissues
• lined disposal receptacles.

Consult the CEC infection prevention and control information page for technical assistance and signage: Clinical Excellence Commission: Coronavirus COVID-19.

Adapting emergency plans for COVID-19

Residential aged care facilities are responsible for establishing emergency plans in the event of disease outbreaks or broader community epidemics. Many facilities will have existing plans focused on influenza and gastroenteritis, and these can be built upon to prepare for COVID-19. Emergency plans should include:

• procedures to follow if an outbreak is suspected, including a method for seeking medical assessment and diagnosis
• protocols to rapidly implement enhanced infection control measures
• ensuring adequate and appropriate care is provided to the infected individual including isolation of the patient
• maintaining adequate supplies of surgical gloves, masks, gowns and hand sanitiser
• rapid notification for staff, families, carers, and your local public health unit.