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   Click here for the latest advice from the Chief Health Officer

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.

Directives around masks and visitors

Exclude staff and visitors who:

• have a fever (37.5°C or higher) or symptoms of COVID-19
• have in the last 14 days been identified as a close contact of a COVID-19 case
• have in the last 14 days been in any of the locations on the self-isolate and get tested immediately list, at the times and dates listed
• have in the last 14 days been in any of the locations on the monitor for symptoms list, at the times and dates listed except where noted otherwise
• have in the last 14 days been in a location of interest in New Zealand
• on or after 7 November 2020 have been in a contact tracing location in South Australia.

Victorian residents can now visit residential aged care facilities in NSW.

Use extra precaution for visitors and staff in or from areas with increased testing (Liverpool LGA and Wingecarribee LGA )

Visit the NSW COVID-19 website at least daily for updates on areas of active community transmission.

In response to questions received from residential aged care facilities about implementing this guidance, a series of FAQs is available here.

Refer to the Infection Control Expert Group (ICEG) Guidelines on the use of face shields and other protective eyewear in health and residential care facilities.

Visitor guidelines

All residential aged care facilities in NSW should support visits for residents, unless they are experiencing a COVID-19 outbreak, or in a situation where restriction of access is required (see below). Allowing visits while maintaining appropriate screening and infection prevention measures improves the health and wellbeing of your residents. Please note that extra precautions may be required for some visitors – as detailed below.

Visitor access should be in line with the screening requirements set out in the Public Health (COVID-19 Aged Care Facilities) Order (No 3) 2020, and the guidance outlined in the Industry Code for Visiting Residential Aged Care Homes during COVID-19 and the CDNA National Guidelines for the prevention, control and public health management of COVID-19 outbreaks in residential care facilities in Australia.

Facilities are asked to:

• Record every visitor’s name and contact details, electronically where possible
• Ensure children are closely supervised
• Ask visitors to undertake hand hygiene on entering and leaving the facility, and on entering and leaving the resident’s room (or designated visiting area)
• Encourage visitors to remain within the resident’s room, or go to a designated outdoor area or alternative room where the resident and their visitors can keep apart from other residents
• Allow no more than two visitors per resident at a time – this does not mean only the same two people can ever visit a resident.

Situations where extra precautions are needed

Visitors who have been in the last 14 days:

• in an area with increased testing or
• to large shopping centre listed on the monitor for symptoms web page marked as “not excluded from visiting a residential aged care facility or residential disability care facility” must wear masks while in the facility and be escorted by facility staff when going to and from a resident’s room (or designated visiting area).

Facilities located in area with increased testing may accept visitors, however extra precautions are required. Facilities must ensure that visitors wear a mask while in the facility and are escorted by facility staff when going to and from the resident’s room (or designated visiting area).

Access to the Commonwealth Pandemic Leave Disaster Payment

The NSW Premier has partnered with the Commonwealth to give workers without leave entitlements access to the Pandemic Leave Disaster Payment arrangements. The media release can be accessed here.

To access the Pandemic Leave Disaster Payment – New South Wales, a worker will need to meet several criteria, set out here.  Below is an extract of the criteria:

You may be eligible if NSW Health has told you to self-isolate or quarantine. They need to give you these directions for any of the following reasons: you have coronavirus (COVID-19) you’ve been in close contact with a person who has COVID-19 you care for a child, 16 years or under, who has COVID-19 you care for a child, 16 years or under, who’s been in close contact with a person who has COVID-19. You may also be eligible if you’re caring for someone who has COVID-19. You must also meet all of the following: you’re at least 17 years old and live in New South Wales you’re an Australian resident or hold a visa that gives you the right to work in Australia you’re unable to go to work and earn an income you have no appropriate leave entitlements, including pandemic sick leave, personal leave or leave to care for another person your period of quarantine is after 17 September 2020. It is also noted that: You won’t be eligible if, during your 14 day isolation period, you get: any income, earnings or salary from paid work any income support payments, ABSTUDY Living Allowance, Paid Parental Leave or Dad and Partner Pay JobKeeper Payment.

If workers or their households are struggling, there are other financial supports that may be available in NSW, and if considered this may be of some assistance to them or their families. Click here for a full listing.

3rd Workforce Retention Bonus Payment

The government will provide a third Workforce Retention Payment, based on employment, at 30 November 2020.

This third payment will have the same eligibility criteria as the first two rounds (the first paid in July, the second scheduled for September) of the workforce retention bonus.

• Eligible residential care workers will receive up to $800 before tax, per quarter, for two quarters.
• Eligible home care workers will receive up to $600 before tax, per quarter, for two quarters.

Your employer must have made an application for the retention bonus in order for you to receive it.

The government has released frequently asked questions (FAQs) to provide further information:

• FAQs for care workers

The ANMF has also released an information sheet on the retention bonus for workers:

• ANMF information sheet for workers

Use this template letter to ask your employer if they have applied on your behalf.

National Aged Care Emergency Response Program

The government has announced a National Aged Care Emergency Response (NACER) Program, which aims to mobilise aged care staff from areas across Australia not experiencing community transmission, to assist in caring for people in aged care facilities impacted by COVID-19. While the initial focus is on supporting Victoria, it is a national program that can be expanded.

NACER is seeking experienced Registered Nurses, Enrolled Nurses, Personal Care Workers and Cleaners who are currently working in aged care to provide surge workforce support. A remuneration and support package is on offer, including a $5,000 bonus for successful completion of a rotation.

Ideally teams of six will be coordinated by the aged care provider and sent on placement for four weeks, followed by two weeks of quarantine.

Employers will need to endorse staff as having the right character, skills and experience, and the ability to work under pressure and in confronting environments.

Employers should carefully consider their own operational needs before agreeing to release staff – they will still be required to provide adequate staffing levels across all their sites to meet residents’ needs.

Further information on the NACER Program is available on the department’s website.

Precautions for caring for residents with suspected, probable, or confirmed COVID-19

When caring for residents with suspected, probable or confirmed COVID-19 in aged care homes, staff must use personal protective equipment (PPE) as recommended in the Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019) and by their state or territory.

For areas with significant community transmission of COVID-19, the Infection Control Expert Group has provided guidance regarding use of P2/N95 masks and protective eye wear/face shields in aged care homes. Specific national guidance has also been developed to support aged care homes’ response to COVID-19.

The Australian Commission on Safety and Quality in Health Care (the Commission) has developed this poster to support aged care workers with step-by-step instructions on how to put on and remove PPE, and how to fit check P2/N95 respirator masks, where they are required to be used.

Advice for home care service providers in NSW

Given the current risk of COVID-19 now in the community, NSW Health recommends the implementation of the following measures:

• Any staff with fever or respiratory symptoms, even mild, should be excluded from work. They should be advised to isolate at home and seek COVID-19 testing.
• Any staff who have been in any of the locations listed on the self-isolate and get tested immediately page, at the times and dates listed should not attend work
• When providing care to clients who live in, or have visited the above areas, staff must wear a surgical mask while providing services.
• Staff actively ask clients about symptoms on arrival. If staff become aware of a client with symptoms, that client should be isolated from others, and arrangements made for COVID-19 testing.

Process for requesting PPE

The Australian Government is prioritising Personal Protective Equipment (PPE) distribution from the National Medical Stockpile to aged care services that are most in need.

To ensure PPE from the National Medical Stockpile is effectively prioritised on a needs-basis, providers are being asked to complete a new Aged Care PPE Request Form. This form will be sent to you via email after an initial inquiry is made via the agedcarecovidppe@health.gov.au email address.

Providers will be asked a number of questions relating to their PPE needs, including staff numbers (or home client visits per day), number of care recipients, PPE supplies on hands, and PPE requirements. It is recommended someone with an appropriate level of operational knowledge complete the form.

If you have a confirmed or suspected case of COVID-19, a case manager will work with you on your PPE requirements.

At this stage, generally only masks are being distributed to residential and in home aged care services who are in a priority category.

A priority category is a residential or in home aged care service who:

• cannot access PPE through their usual means, and
• the Australian Government or State or Territory Government requires workers to wear masks in relation to a community transmission region, or
• they deliver personal care or other activities that require close physical contact, where:
  • there is an outbreak or suspected case of COVID-19 or another notifiable infectious respiratory disease, or
  • there is an immediate threat to the continuity of safe quality care due to a lack of access to PPE supplies.

Providers should also continue to try to source the PPE through suppliers while awaiting a response. Providers need to establish an ongoing general PPE supply.

In the absence of a vaccine for COVID-19, preventing exposure is the single most important step that any of us can take to protect ourselves and others from contracting this virus.

Providers should be undertaking routine screening of staff and visitors on entry irrespective of size or location. It is especially important for residential services located in communities (and/or drawing their staff from communities) where there is a local cluster of people with confirmed or suspected COVID-19, or which are considered to be at higher risk of an outbreak.

Entry screening advice for residential aged care facilities can be found here.

Use of face masks in the community to protect against COVID-19

The Australian Commission on Safety and Quality in Health Care has developed new resources to provide guidance to consumers on the use of face masks to protect against COVID-19. Wearing a face mask is now recommended by Australian health experts in areas where community transmission of COVID-19 is high, if physical distancing is not possible.

Fact sheet and FAQs from the Australian Commission on Safety and Quality in Health Care
The new fact sheet and answers to frequently asked questions will assist people to decide whether to wear a mask in the community, and provide advice on how to use face masks safely.

• Fact sheet on COVID-19 and face masks for consumers
• FAQs on community use of face masks

Current advice
The new resources support the recommendation of the Australian Government and Victorian Government to wear face masks in areas where there is community transmission of COVID-19. They explain how to safely put on and remove face masks, and reinforce the importance of existing prevention measures.

Wearing a face mask is currently recommended to help protect against droplets when a person with COVID-19 coughs, speaks or sneezes, if you are less than 1.5 metres away. Wearing a mask will also help protect others if you are infected with the virus.

Updated Industry Code on Visiting Residential Aged Care Homes During COVID-19

The updated Code reflects that:

• spouses, close relatives and social supports are not limited in the number of hours they spend with relatives
• children under 16 are can visit aged care homes
• staff are required to screen visitors, educate visitors about social distancing and hygiene during their visit, but not supervise visits
• residents are able to leave to attend small family gatherings (with providers undertaking a risk assessment prior to the outing and a screening process following the outing).

In accordance with this advice, it is appropriate for aged care facilities in the identified ‘hot spots’ in Victoria to adopt increased visitor restrictions.

Translation of COVID-19 Resources

For more translated resources, the Department of Home Affairs has a dedicated website – COVID-19 information in your language. This provides culturally and linguistically diverse communities with a single source of information in 63 languages other than English.

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.

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.

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.

Influenza vaccine requirement for workers

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

• from 1 May, you must have had 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.

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.

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 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.

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.

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 packages

On 31 August, the Federal Government announced an additional $563.3 million to extend support for the aged care sector’s response to COVID-19.

This takes government support to aged care to over $1.5 billion since the pandemic began.

On 1 May, the Prime Minister announced a 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. Contact us here.