The national Aged Care Quality and Safety Commissioner, Janet Anderson, has described managing a COVID-19 outbreak as “an extremely challenging task”.
“We have learned that every instance of an outbreak at an aged care facility pushes aside business as usual,” she said.
Two of Sydney’s pandemic hot spots – Newmarch House and Dorothy Henderson Lodge – have provided early pointers on how a nursing home should manage a COVID-19 outbreak.
Quickly isolate residents and staff
Infectious diseases physician Lyn Gilbert, chief investigator at the Australian Partnership for Preparedness Research on Infectious Disease Emergencies, said the most effective things Dorothy Henderson Lodge did were closing the facility to visitors, engaging a senior infection control specialist at the start and requiring regular staff to self-quarantine.
BaptistCare shut down the facility to visitors and notified families the day after the outbreak was detected.
The layout of the complex helped to contain the outbreak.
The Lodge is divided into six wings, one of which was isolated for Covid-positive residents and their nurses and carers and treated as a hazard site.
That reduced the need to keep residents confined to their rooms and to medicate and sedate anyone with dementia. It also reduced the amount of PPE needed.
In a facility with a different layout, best practice may involve isolating COVID-positive residents in clearly identified rooms.
The NSWNMA recommends that members prepare for any COVID-19 infection by finding out where their facility plans to put residents who need to be isolated and what arrangements will be made for dementia sufferers.
At Newmarch House, the virus is believed to have spread from an infected staff member who attended work for six shifts.
After learning that a staff member and a resident had tested positive, Anglicare announced that all Newmarch residents were in self-isolation in their own rooms and all staff had been “directed to wear full PPE when caring for residents”.
Paid leave for isolation
Identifying possible sources of infection is vital to containing outbreaks and best practice may include sending all possibly exposed staff home on paid COVID leave to protect workers and residents.
The NSWNMA expects providers to provide paid leave for all members sent home due to an outbreak and accommodation for members who do not wish to isolate at home.
At Dorothy Henderson Lodge, all staff who may have had contact with the virus were sent home on full pay.
Anglicare accommodated some COVID-positive Newmarch House staff at a retirement village with all food provided.
It accommodated some non-infected staff at hotels so they did not have to worry about bringing the virus home.
PPE and Fit testing for staff
Throughout the aged care sector, many members are worried whether their facility has enough of the correct PPE and whether they have the right training to use PPE properly.
The NSWNMA expects facilities to have adequate supplies of PPE as required under guidelines laid down by NSW Health’s Clinical Excellence Commission.
PPE must include sufficient P2/N95 masks for palliating residents.
Facilities should have a clear plan for donning and doffing of PPE.
Providers should arrange fit testing for staff who will be expected to care for COVID-positive residents and who require P2/N95 masks.
Anglicare CEO, Grant Millard, told the Sydney Morning Herald that promises made by suppliers of PPE fell through and state and federal authorities did not supply Newmarch House with adequate PPE, especially gowns.
He said there was enough protective gear to care for those who were COVID-19 positive but not enough to cover staff attending other seemingly non-positive residents.
“And that’s a key learning for everybody about an outbreak. You must assume that every resident in that home is positive,” he added.
Second jobs
Aged care providers are scrambling to find enough staff to carry the additional workload imposed by COVID-19.
They want to reduce the high cost of overtime, double shifts and agency nurses.
They also want to prevent cross-contamination from one facility to another.
As a result, many members have been pressured to give up their second jobs and work only for one employer.
However, there is no guarantee of ongoing employment when coronavirus is no longer an issue.
NSWNMA Assistant General Secretary, Judith Kiejda, says it is unfair to expect a worker to give up their relationship with another workplace, and the accumulated sick leave, long service leave and other entitlements that come with that second job.
She says the union has confirmed with the federal government that there is no government policy or medical advice requiring aged care workers to limit their employment to one site.
Judith says employers should ensure transmission is minimised by proper screening of workers and visitors, appropriate infection control and adequate PPE.
Where to go for aged care safety information:
NSWNMA advice for aged care workers on COVID-19: https://thelamp.com.au/specialities/aged-care/aged-care-information-on-covid-19/
Federal government advice for aged care workers and providers on COVID-19: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-advice-for-the-health-and-aged-care-sector/providing-aged-care-services-during-covid-19