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Upcoming Changes to Outbreak Management in Residential Aged Care

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The Independent Review of COVID-19 Outbreaks in Australian Residential Aged Care Facilities issued its final report on 1 November 2021. The review was conducted by Professor Lyn Gilbert AO and Adjunct Professor Alan Lilly.

In it's response to the report, the Government agreed to implement all 38 recommendations made in the report, heralding another raft of changes to the way residential aged care homes are regulated.

Here are the recommendations of the report that directly affect residential aged care homes, along with a summary of the Government’s plans for implementation.

 

Built environment and infrastructure – the physical environment in which residents live

Key recommendations: after a review of the current ventilation requirements, the Department of Health (the department) should consult with the aged care sector on phasing-out shared rooms and bathrooms to reduce the risk of COVID-19 transmission.

Government action: The Government will work with the aged care sector and relevant stakeholders to develop a reformed Residential Aged Care Accommodation framework, to commence from July 2024, and will further consider these recommendations in this context.

 

Emergency response – the multidisciplinary response to managing an outbreak

Key recommendations: Approved Providers should ensure that sufficient staff have completed online training and monitoring in emergency management and crisis leadership, to prepare them to manage an outbreak.

Government action: It’s not clear from the Government’s response whether they intend to do anything new about this requirement or whether they are satisfied that the recommendation is addressed by existing arrangements. The response says that “Government will work with relevant stakeholders to implement” the recommendation. But it also says that this requirement is already addressed by Standard 7 of the Aged Care Quality Standards and the work of the Aged Care Quality and Safety Commission in publishing guidance and monitoring and assessing compliance.

 

Infection prevention and control – skills, attributes and knowledge required to prevent infection

Key recommendations:

  • The department should consider long-term funding requirements for improving IPC in RACFs and embedding it as business-as-usual.
  • The department should ensure that RACF ‘IPC Leads’ have ongoing support from Approved Providers and access to IPC specialists.
  • The department should review the adequacy of current COVID-19 clinical waste guidelines to promote a nationally consistent approach to collection, segregation, storage and disposal of clinical waste.

 

Government action: the Government is working with states and territories to arrange more funding and support. This includes $135.9 million to implement the new Australian National Aged Care Classification model for residential aged care, to be implemented from 1 October 2022.

In regard to clinical waste, “the department is working with the Commission and the Australian Commission on Safety and Quality in Health Care to revise the Aged Care Quality Standards and associated guidance material, and will consider strengthening requirements relating to clinical waste management as part of this process.”

 

Leadership, management and governance – the day-to-day oversight of the delivery of care

Key recommendations: Approved Providers should consider individual leadership coaching to support managers in acquiring additional skills to enhance leadership capacity, in both business-as-usual and emergency management

Government action: the Government is investing $30.1 million from December 2021 to support aged care providers to improve their governance arrangements and meet strengthened legislative obligations through the 2021–22 Budget. Changes include:

  • new governance obligations from 2022 to lift leadership capability in the sector by requiring improvements to the composition and accountability of aged care boards
  • a review of the Aged Care Quality Standards, focussing on key areas of concern identified by the Royal Commission such as governance, dementia, and food and nutrition
  • the appointment of an Assistant Commissioner for Sector Capability and Education to the Commission to lead a transformational change program. This will include leading the development of a program for 3,700 aged care leaders to improve their corporate and clinical governance capability.

The department has also funded the development of an emergency management training and mentoring program.

 

Planning and preparation – putting in place measures to prevent or manage an outbreak

Key recommendations:

  • The Aged Care Quality and Safety Commission should determine a minimum standard to give effect to best practice pandemic planning and preparation in a RACF.
  • Approved Providers must submit an annual Pandemic Planning attestation to confirm compliance with the required Standard. The governing body must approve the attestation and submission.

 

Government action: the Government supports these recommendations but has yet to specify what it will do about them. According to the Government’s response, they will “further consider implementation options” and “the Commission and the department will work together to develop any additional or more specific measures that might be considered in the review of the Standards.”

 

Preventing social isolation – reducing impacts of visitor restrictions on residents

Many of the recommendations in this section relate to the steps providers should take to facilitate visitation. The Government’s view appears to be that these recommendations are covered by the existing powers and regulatory strategies of the Aged Care Quality and Safety Commission and by the Australian Health Protection Principal Committee’s (AHPPC) statement of 1 October 2021.

In regard to several of the other recommendations, the Government has indicated that it will take some action, though it has provided scant detail:

Key recommendations: Chief Health Officer (or equivalent) public health directions for residential aged care (however titled) should give effect to the Industry Code for Visiting Residential Aged Care Homes during COVID-19 and provide site access for the Older Persons Advocacy Network.

Government action: “The Industry Code continues to be reviewed and will be further adjusted as the sector transitions to living with COVID.”

 

Key recommendations:

  • Approved Providers should provide continued access to allied health services and in-room therapies designed to reduce cognitive, nutritional, mobility and physical decline.
  • Approved providers should give appropriate additional consideration to residents with special needs, including people living with dementia.

 

Government action: the Government is “working to see an uplift in the ability of Approved Providers to support people with special needs, including people living with dementia, consistent with the findings of the Royal Commission that both diversity and dementia should be core business in the aged care sector.”

 

Workforce and staff mental health – the provision of a healthy workforce

Key recommendations:

  • Approved Providers develop pandemic workforce plans to facilitate optimal staffing levels during a COVID-19 outbreak.
  • Chief Health Officers consider the implication of public health directions for residential aged care workers, which may impact continuity of care for residents.

 

Government action: the Government will not be making changes in regard to these requirements, noting that these recommendations are “matters for Approved Providers and state and territory Governments”.

Key recommendations: the department reviews its “restricting workforce mobility” arrangements and consults with Approved Providers, residential aged care staff and their representatives.

Government action: the Government’s response suggests that the Government believes this issue is adequately covered by existing arrangements and no changes need to be made.

 

What now for Aged Care Providers?

Providers should anticipate that major changes to outbreak management requirements will be introduced sometime in the next few months as the industry transitions into a state of “living with COVID”. Now is a good time to ensure that you have simple, efficient training and communication systems in place so that you can inform your board, update your procedures and train your staff quickly each time new requirements are introduced.

 

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