Infection Control Spot Checks in Residential Aged Care: What Providers Need to Know

The Aged Care Quality and Safety Commission (ACQSC) is stepping up its program of infection control spot checks of residential aged care homes.

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Coronavirus Visitor Control in Aged Care: Check Your Readiness

In response to the coronavirus / COVID-19 epidemic, all aged care homes must put additional visitor control measures in place. This is a legal obligation imposed by the Australian Government and part of a risk-management strategy for protecting older people from a potentially fatal infection.

Do you have an effective visitor control plan in place? Where do you start? How do you know you’re doing all the right things?

Here are nine questions to help you get a handle on where you’re at and what you need to do.

 

1. Are you up to date on the latest advice?

This is a rapidly-changing issue so it’s always worth checking the very latest information on the Department of Health’s website.

 

2. Have you involved consumers in your visitor control plan?

Have you asked residents and their visitors how they would like to respond to the new visitor restrictions? Have you recorded this information, passed it on to management/the Board and incorporated it into your plans? In addition to these broad measures, it’s worthwhile planning ongoing simple ways to engage with consumers regarding visitor restrictions. In these chaotic times, such measures can reassure consumers and give them a voice when so many things are out of their control.

 

3. Have you informed residents and potential visitors about the risks, and facilitated alternatives to visiting in person (e.g. skype)?

In its Fact Sheet on Restricted Visits, the Department of Health advises, “If you don’t absolutely have to go to support a resident in care, please don’t.” Do your residents and their potential visitors know this information? Have you shared the Fact Sheet (or other resources) with them? Have you shared your interim visitor control policies and procedures with them? (see question 5 below). There is a lot of misinformation out there, so it’s unwise to assume that everybody understands the situation.

Also bear in mind that a flat out “no you may not” can be antagonistic and lead to complications down the road. Much better than simply denying visitation is to offer alternatives. Is this feasible in your home? Do you have the technology and staff-competence to help residents communicate with loved ones via phone or the internet?

 

4. Can you control entry points?

How many ways can visitors get in and out of your aged care home? Can all these ways be controlled by staff? How deep into the home is your entry control point? If visitors can easily pass through communal areas and chat to several staff and residents on their way to the entry control point, then you may have to shift it to a more external position.

 

5. Have you issued interim policies and procedures regarding visitor control measures?

Do staff – particularly staff who are controlling entry points – have access to clear, easy-to-read, up-to-date policies and procedures that tell them who they can and cannot allow into the home? Once they decide to admit a visitor, do staff have access to policies and procedures that tell them how these restricted visits should be conducted? Have you shared these policies with residents and their visitors?

 

Policies and procedures regarding who may enter the home

Policies and procedures on who may enter the home should include information such as these points provided in the Australian Government Department of Health’s Fact Sheet on Restricted Visits:

The following people will not be permitted entry to residential aged care facilities:

  • People who have returned from overseas in the last 14 days
  • People who have been in contact with a confirmed case of COVID-19 in the last 14 days
  • People who are unwell, in particular with fever or symptoms of acute respiratory infection (e.g. cough, sore throat, runny nose, shortness of breath)
  • People who have not been vaccinated against influenza (after 1 May 2020)
  • Children aged 16 years and under (exemptions can be assessed on a case-by-case basis, for example, where the resident is in palliative care).

The Fact Sheet also notes that visits are limited to a maximum of two immediate social supports (family members, close friends) or professional service or advocacy providers at one time.

Have you considered some of the practical difficulties that arise from these restrictions? How are you going to know whether someone has been overseas recently? How are you going to know if they’ve been vaccinated against influenza?

Be sure not to simply print this Fact Sheet once and hand it out. Things may change, so check for updates regularly.

 

Policies and procedures regarding how to conduct restricted visits

At the moment, the key restrictions on visits as outlined in the Fact Sheet, are:

  • limit visits to a short duration
  • limit visits to a maximum of two immediate social supports (family members, close friends) or professional service or advocacy providers at one time
  • conduct visits in a resident’s room, outdoors, or in a specific area designated by the aged care facility, rather than communal areas where the risk of transmission to residents is greater
  • visitors should undergo a health screening ahead of a visit
  • visitors should practise social distancing, including maintaining a distance of 1.5 metres from other people.

Some of these requirements are complex. Is there an induction process for visitors? Have staff been trained to deliver this induction?

Some of this advice is unhelpfully vague. What is a “short duration” for a visit? Ten minutes? Two hours? What exactly does a “health screening” require? Is taking a temperature sufficient to track if someone is unwell? You may have to decide these specifics for yourself, leaving some room to adapt things on a case-by-case basis. Any specific requirements that you decide to implement should be clearly noted in your interim visitor control policies and procedures.

And again, things may change quickly, so check for updates regularly.

 

6. Can you track visitors and control who they see and how long they stay?

It’s all well and good to issue clear guidelines, but they’re not much use if visitors ignore them. Do you have measures for ensuring that visitors don’t detour on their way to the meeting place or stay too long? Are staff trained to enforce these measures in a way that is openly communicative and compassionate, drawing on a shared understanding of health priorities?

 

7. Have you considered the impact of visitor control measures on the home’s committee and advisory meetings?

Visitor control measures don’t just apply to consumers’ family members. Any person who arrives for a board meeting, medication advisory meeting, clinical governance meeting or any other gathering, will be subject to the new restrictions. Even meetings of regular staff within the home are subject to social distancing restrictions.

During these chaotic times, such meetings might be more important than ever and may even have to happen more frequently. You may have to come up with some creative solutions. Consider whether meetings can be held online, via phone linkups or even offsite.

8. Can you record everything?

Keep in mind that in the highly regulated aged care industry it’s not enough just to do the right thing – you also have to be able to prove you’ve done it. Some key things you want to make sure you record are:

  • visitor control training and assessment for staff
  • your efforts to involve consumers in your visitor control plans, including evidence of how you responded to their input
  • policies and procedures
  • communications, guides and advice you have issued to staff, residents and visitors (emails, letters, posters, minutes of meetings)
  • visitor logs, including any visitor screening tests.

 

9. What about compassion?

The threat of COVID-19 is real and frightening, so it’s understandable that homes may want to respond to it with a strict, rigid set of rules, especially if they are understaffed. On the other hand, consumers are not prisoners and they must be provided with choice and treated with dignity and compassion.

There is no simple answer to how a home might find the right balance in this difficult situation, but the starting place will be clear communication. Is there a simple way for consumers to let you know their special circumstances? And is there a way for their concerns to be communicated up the chain to your key decision makers?

Mark Bryan
ABOUT THE AUTHOR | Mark Bryan
Mark is a Legal Research Consultant at CompliSpace and the editor for ACE. Mark has worked as a Legal Policy Officer for the Commonwealth Attorney-General’s Department and the NSW Department of Justice. He also spent three years as lead editor for the private sessions narratives team at the Royal Commission into Institutional Responses to Child Sexual Abuse. Mark holds a bachelor’s degree in Arts/Law from the Australian National University with First Class Honours in Law, a Graduate Diploma in Writing from UTS and a Graduate Certificate in Film Directing from the Australian Film Television and Radio School.

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