The NSW Nurses and Midwives’ Association is providing support and advice to any members seeking information regarding the novel coronavirus (COVID-19).

Ensure you’re covered at work by joining the NSWNMA.

If you’re working for a private aged care provider, please check this page for information around self-isolation and your workplace entitlements

The evolving nature of the novel coronavirus (COVID-19) outbreak means our public health advice will continue to change. One thing remaining consistent however, is the contribution frontline nurses and health sector professionals are making to address it.

The Commonwealth Department of Health website contains detailed guidance for health sector workers and is updated regularly.

Updates to the CDNA Guidelines for Public Health Units

The Communicable Diseases Network Australia (CDNA) guidelines for public health units have been updated to include a new section on outbreak investigation and management in high-risk settings, including residential aged care.

The purpose of the guidelines is to provide nationally consistent advice and guidance to public health units in responding to a notifiable disease event. These guidelines capture the knowledge of experienced professionals, built on past research efforts, and provide advice on best practice based upon the best available evidence.

Outbreak management training

The outbreak management training module for aged care workers has been updated in accordance with the latest information from the CDNA.

Aged care workers are encourage to complete this updated training.

The training takes approximately 8 minutes to complete, and by the end of the module participants will be able to:

• Identify what a COVID-19 outbreak is
• Demonstrate the appropriate infection prevention control measures for a COVID-19 outbreak
• Explain how to isolate and cohort residents during a COVID-19 outbreak
• Identify appropriate cleaning and waste disposal procedures during a COVID-19 outbreak.

Access the Aged Care training modules here.

If you would like to access the aged care training, users will need to register their workplaces as ‘aged care’. If you have already registered for online training but not with ‘aged care’ as your workplace, email support@covid-19training.gov.au for a priority response.

Face to face assessments

From 25 May, Regional Assessment Services (RASs) and Aged Care Assessment Teams (ACATs) should offer face to face aged care assessments, where it is possible and safe to do so.

However, it is important to note that while COVID-19 circumstances continue, face to face assessments are not mandatory where this would be unsuitable or inappropriate for a client, service provider or assessment organisation. RAS and ACATs will continue to consider their local circumstances and client choice when determining whether aged care assessments are conducted face to face or by telephone or telehealth.

Outbreak management

When an Outbreak is Suspected: Providers must immediately notify their local Public Health Unit (PHU), and the Australian Government Department of Health.

• The PHU manages the outbreak, for example testing, contact tracing and infection control.
• The Department of Health will work with the provider to support them to identify whether an outbreak has occurred, and deliver additional support if required, such as in-reach pathology testing, access to PPE and workforce assistance.

Workforce Management: A critical aspect in the preparation phase is understanding the workforce impact and needs. It is essential providers put in place strategies to identify where and how they will get additional staff if there is an outbreak. Aged care providers must exhaust all possible avenues including contacting other providers for support; contacting recruitment agencies; reaching out to local and private district hospitals. The workforce surge measures that are in place are a last resort and work to complement the workforce that providers have sourced. They are not the full solution for a provider.

When an Outbreak is Confirmed: When an outbreak is confirmed, providers must establish an outbreak management team to direct, monitor and oversee the outbreak, confirm roles and responsibilities and liaise with their relevant Australian Government Department of Health state/territory officer. Providers will also need to put in place additional infection prevention and control measures, including:

• • Isolation or cohorting of affected residents
  • Maintaining hand hygiene
  • Wearing appropriate PPE
  • Practising cough and sneeze etiquette
  • Enhanced environmental cleaning
  • Placing signage at entrances and other locations in the facility
  • Screening of staff and visitors.

The Department of Health’s guide to outbreak management outlines how to identify if there is an outbreak at your facility and the steps to take to manage the outbreak. Access the guide here.

Inform the Federal Department of Health of any confirmed COVID-19 cases via agedcareCOVIDcases@health.gov.au – this will facilitate Australian Government support for PPE and staff supplementation.

The Department can help with information on resources to manage an emergency or service delivery issues. If you need urgent assistance outside of normal business hours please contact the department on 1800 852 649.
This information is also available on the department’s website.

The Communicable Diseases Network of Australia also have National Guidelines for the Prevention, Control and Public Health Management of COVID-19 Outbreaks in Residential Care Facilities in Australia. This visual flowchart summarises the key steps aged care providers need to take around COVID-19 in an easy to read and understand format.

Influenza vaccine requirement for workers

New legislation now requires all aged care workers to be vaccinated against Influenza

• from 1 May, you must have your influenza vaccination to work in or visit an aged care facility
• if you’re a residential aged care worker, you must not go to work if you have a fever or symptoms of a respiratory illness

Your employer should be making sure all staff receive a vaccination as soon as possible and meet the cost.

An aged care worker who is unable (or their facility is unable) to access an influenza vaccination is able to continue employment beyond 1 May 2020 on the basis that the vaccination has not been available to the person (5(d)).

NSW Ministry of Health have stated those who have actively sought a flu vaccine before 1 May 2020 but have not yet received one because of shortage in supply may still attend work. However, they must have a vaccine as soon as one becomes available to them.

Aged care providers having trouble with supply can report this to the Department of Health at COVID-19FluVaccine@health.gov.au 

The Commonwealth is currently seeking to improve access to the vaccine:

• The Australian Government has secured three million additional doses of seasonal influenza vaccine bringing the total number of flu vaccines to 16.5 million
• To assist access to the flu vaccine, Primary Health Networks (PHNs) have been contacting all residential aged care providers by region to undertake a needs assessment and coordinate influenza vaccination programs for those services with an identified need. The provisions may include sourcing vaccine supply and qualified vaccine administrators (see here for further details).

Personal Protective Equipment (PPE)

Where you require PPE to do your job safely, it is your employer’s obligation to provide it. If you are caring for a resident who is suspected or confirmed COVID positive you should be provided with a surgical mask, disposable gloves, a long sleeved gown and goggles or a face mask. This should be put on before entering the resident’s room and removed on exit.  You shouldn’t reuse any PPE unless it is marked as reusable, and then only where it has been properly cleaned in line with the manufacturer’s instructions before you reuse it.  If you don’t have the PPE that you need to do a task safely, then you should not do that task until the PPE is provided.

Read more about PPE here.

Request stock of PPE

Residential aged care providers can request PPE by sending an email to agedcareCOVIDPPE@health.gov.au

The Department will assess requests and may be in contact if additional information is required. Providers will be advised if their request has been successful. If so, state and territory governments will distribute the agreed PPE to the provider.

Priority will be given to aged care providers where there has been a confirmed case of COVID-19.

Guidance for Symptom Monitoring

This guidance was developed by the Communicable Disease Network of Australia (CDNA) and endorsed by the Australian Health Protection Principal Committee (AHPPC).

This guidance is intended for health and residential aged care settings considering monitoring for symptoms. Health screening for health and aged care workers for symptoms of COVID-19 in these settings may be used as one of a suite of measures to detect and prevent outbreaks.

You can find the guidance here.

Aged Care Visitor Access Code

A Visitor Access Code has been developed to ensure a nationally consistent visitation policy to residential aged care homes during the COVID-19 crisis.

Screening

Recommendations on screening of people entering residential facilities from the Aged Care Quality and Safety Commission (22 April 2020):

• Ideally, there should be a single point of entry to the facility, with someone tasked to continuously monitor that entry
• Every staff member or visitor arriving at the facility should be asked, at the point of entry, to respond to a standard set of risk screening questions. Services may want to consider giving these questions to each staff member or visitor on a pre-printed form on arrival to assist with understanding and recording

The screening questions could include:

• Have you been overseas or travelled on a cruise ship in the last 14 days?
• Have you been in contact with a confirmed or suspected case of COVID-19 in the last 14 days?
• Are you in close contact with or caring for someone who is currently unwell?
• Have you currently or within the last 7 days been unwell or been aware of any of the following symptoms:

– fever, night sweats or chills
– cough
– runny nose
– sore or scratchy throat
– shortness of breath

The staff member or visitor’s accurate response to the question about fever can be supported through temperature testing on entry. If temperature testing is used in addition to the standard screening questions, it is recommended that a no-touch method is adopted such as an infra-red temperature detection “gun” device.

Visitations

States and territories have established directions giving effect to the AHPPC’s recommendation that visitors and staff (including visiting workers) should not be permitted to enter a residential aged care facility, if they have not been vaccinated against influenza (after 1 May 2020).

Residential aged care facilities may wish to display this poster at entrances, to alert anyone entering the facility of these flu vaccination requirements.

Infection prevention and control measures in residential aged care must be balanced with the well being and best interests of the residents. It is acknowledged that this balance is sometimes challenging to achieve. Aged care providers should assess the needs of both residents and their families, and be proportionate in their response to and application of the restrictions.

At its meeting on Tuesday (21 April), the National Cabinet discussed residential aged care facility (RACF) visitation restrictions and reaffirmed the visitation principles set out by the AHPPC and agreed by National Cabinet on March 18. The AHPPC also reinforced restricting visits and visitors that should be implemented by RACFs.

The National Cabinet has reconfirmed that RACFs should not permit visitors and staff to enter facilities, if they have:

• returned from overseas in the last 14 days
• been in contact with a confirmed case of COVID-19 in the last 14 days
• a fever or any (even mild) symptoms of acute respiratory infection (e.g. cough, sore throat, runny nose, shortness of breath)
• not been vaccinated against influenza (after 1 May).

In relation to visits the following measures the AHPPC reinforced:

• Limiting visits to a short duration
• Limiting 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
• Visits should be conducted in a resident’s room, outdoors, or in a specific area designated by the RACF, rather than communal areas where the risk of transmission to residents is greater
• No large group visits or gatherings, including social activities or entertainment, should be permitted at this time
• No school groups of any size should be allowed to visit RACFs
• Children aged 16 years or less must be permitted to visit only by exception, as they are generally unable to comply with hygiene measures.

Visitors should also be encouraged to practise social distancing practices where possible, including maintaining a distance of 1.5 metres.

Measures such as phone or video calls must be accessible to all residents to enable more regular 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 AHPPC recommendations also state any staff with symptoms of acute respiratory infection (e.g. cough, sore throat, runny nose, shortness of breath) should be excluded from the workplace and tested for COVID-19. Staff must report their symptoms to the RACF. Sick leave policies must also enable employees to stay home, if they have symptoms of respiratory infection.

Read the legislation here.

Important processes

A reminder on some important processes that should be followed at all aged care facilities:

• If there is an outbreak in your facility, all staff and residents should be tested for COVID-19. An outbreak is when there is two or more confirmed cases in three days.
• Facilities should be recording if any of their staff work at multiple facilities or across services, whether for the same employer or another. This is important to contact trace if there is a suspected or confirmed case of COVID-19.

Discharging new and returning residents during COVID-19

The NSW Ministry of Health has developed advice for the safe and efficient discharge from hospital of new and returning residents of residential aged care facilities (RACFs). The advice includes a screening process and a discharge summary template.

A consistent approach will provide confidence that all new and returning residents at the time of discharge from hospital to RACFs have been screened by an appropriate medical officer and:

• were not experiencing acute respiratory symptoms or fevers compatible with COVID-19 and
• had not had any close contact with a confirmed COVID-19 patient in hospital.

NSW Health will now include a letter in the discharge paper work signed by the treating team confirming the person has been screened for COVID-19 symptoms. A template can be found here. 

Workers in RACF admitting residents returning from hospital should ensure they receive a copy of the discharge paperwork as part of their infection control management arrangements.

Royal Commission seeking submissions

The Royal Commission into Aged Care Quality and Safety is calling for submissions from the general public and organisations relating to the impact of the coronavirus (COVID-19) on the aged care sector.

The deadline for submissions is 30 June 2020, but that deadline is also subject to ongoing review, given the effects of COVID-19.

Read the full media release on the website and visit the submissions page for more information.

International Student Nurses

On 18 March, the Commonwealth Government announced it will relax international student nurse visa work conditions to provide workforce continuity for aged care facilities, home care providers and other health care workers.

This will allow international student nurses and other aged care workers to work more than the 40 hours a fortnight that they are currently. This measure will be examined on an ongoing basis. There are currently around 900 approved providers of residential aged care employers and around 1,000 approved providers of Home Care Packages. There are currently around 20,000 international student nurses studying in Australia.

COVID-19 support package

On 1 May, the Prime Minister announced an additional COVID-19 specific support package for residential aged care providers, totalling $205 million. This translates to around $900 per resident in major metropolitan areas and around $1350 per resident in all other areas.

The funds are “aimed at ensuring aged care providers can offer reinforced levels of safety and care for those who need it most”.

The Australian Nursing and Midwifery Federation (ANMF) says the Federal Government must guarantee the funding is fully and directly used to employ more nurses and suitably-qualified care staff and ensure the availability of appropriate personal protective equipment (PPE) to combat the COVID-19 pandemic.

Aged care providers must address chronic understaffing and the ongoing shortages of PPE as a matter of urgency if Australia is to ensure the safety and protection of all residents.

Additional Commonwealth Funding

On 20 March, an additional $444.6 million in funding, including a retention bonus for workers, was announced for the aged care sector:

• $234.9 million for a COVID-19 ‘retention bonus’ to ensure the continuity of the workforce for staff in both residential and home care. This means:

– Full-time direct care workers in residential care facilities will receive a payment of up to $800 after tax per quarter, paid for two quarters.
– Full-time home care workers will receive payments of up to $600 after tax per quarter, paid for two quarters.
– Part-time direct care workers receive a pro-rata payment for the amount of time you work. For example, if you work two days a week, you’ll receive 40 per cent of the payment.
– Payments will be made via your employer with the first payment expected in June (for the preceding quarter). The second payment will be paid in September.

The Australian Government Department of Health has been working on the mechanisms, processes and guidelines in order to release these funds for workers and providers.

In addition:

• $78.3 million in additional funding for residential care to support continuity of workforce supply.
• $26.9 million to increase the residential and home care Viability Supplements and the Homeless Supplement (including increased viability payments for National Aboriginal and Torres Strait Islander Flexible Aged Care Program providers and Multi-Purpose Services).
• $92.2 million in additional support to home care providers and organisations which deliver the Commonwealth Home Support Programme, including for services such as meals on wheels.
• An extra $12.3 million to support the My Aged Care call centre to respond to the needs of older Australia.

Prior to this, the Commonwealth Government announced a $2.4 billion health care package, with $101.2 million dedicated to the aged care sector to:

• educate and train more aged care workers in infection control;
• enable aged care providers to hire extra nurses and aged care workers for both residential and home care; and
• bolster the Aged Care Quality and Safety Commission’s capacity to ensure providers are stepping up infection control measures.

Other useful resources

• This document outlines special precautions when entering COVID-19 designated zones.
• COVID-19 factsheet for aged care workers.  This is a 4 page document with information on things like visit restrictions, changes to work visa hours arrangements, when people should or shouldn’t come to work etc.
• Cleaning – the Health Department has provided guidance on Environmental cleaning for residential aged care facilities.
• Information for in-home care clients – “Its OK to have home care” – is designed so carers can print off and distribute before entering their clients home to reassure them that it is OK to continue to receive care
• Flowchart/poster on when to use PPE in aged care settings
• This document provides more detail on what kind of PPE to wear when treating suspected or confirmed cases of COVID-19 and how to wear it
• PPE video from Australia’s Chief Nursing and Midwifery Officer, which provides a demonstration on how to appropriately use PPE

NSWNMA Support

If members are concerned their employer is not following the appropriate guidelines, the NSWNMA can provide assistance to ensure appropriate measures are in place. Contact us here.

Further information on PPE

Further information for private health nurses and midwives

The NSWNMA will continue to provide further updates for members as we receive them. Information contained on this page is current as of 18 March 2020. Contact us here.