Following on from the Government’s In-Home and Community Aged Care COVID-19 Preparedness webinar on Friday 13 March 2020, Government have provided a response to some frequently asked questions posed during the webinar.

DOWNLOAD FULL FAQS HERE – UPDATED 24 Mar 2020 

Key advice includes:

• CHSP service provider responsibilities regarding not meeting service outputs for grant agreements;
• Delivery of CHSP services for urgent and immediate care needs before contact with My Aged Care;
• Increasing CHSP service flexibility provisions from 20 to 100 per cent across services within existing grant agreements;
• Delivery of CHSP Social Support Group activities;
• CHSP data reporting in the data exchange (DEX);
• Access to emergency respite services;
• Urgent time-limited CHSP top-up services for packaged home care recipients; and
• Interactions between home care providers, care recipients and care staff.

Government has committed to continue to build on this resource (including adding responses to questions already sent through).

Members should also note LASA has prepared a checklist for home care providers as you manage your response to the impact of Coronavirus COVID-19.

Student Visa Extensions

Providers of Commonwealth funded aged care services will temporarily be able to offer more hours to international students to ensure the care of senior and vulnerable Australians, as part of the campaign to combat the impact of coronavirus (COVID‑19).

Please find attached a ‘Letter of Comfort’ from the Department of Home Affairs which outlines this arrangement.

The Government’s original plan to ask providers to apply for extensions is not being pursued.

Aged care providers that require PPE must now email agedcarecovidppe@health.gov.au for all requests. (Emails previously sent to the National Stockpile address don’t need to be resent, and have been captured in this new, dedicated aged care process).

All requests will be triaged by the Department of Health with priority given to facilities, programs and carers where there has been a confirmed case of COVID-19.

The following information must be provided in your email request:

• The facility, program or service requiring PPE (add your State/Territory in the subject heading also);
• If you have had a confirmed case of COVID-19 at your facility, program or service;
• Types and quantities of PPE required – please note, only masks are available at this stage and other PPE will be provided when available; and
• Details of other suppliers you have attempted to source PPE stock from.

If your facility, program or service is experiencing an outbreak of influenza the above process applies.

Requests can be made by residential care providers, CHSP providers and any workers providing support to people receiving aged care support living in the community. The Department of Health will triage your request to determine priority and may be in contact with you for further information.

Once approved the request for supplies will be shared with the National Incident Room who will work with your State or Territory Government to distribute the supplies. The Department advises that if you do not have a confirmed case of COVID-19 within your facility, program or service you should expect delays in receiving your PPE due to the increase in demand.

We know that access to PPE is an urgent and pressing issue for many Members and we are urgently advocating to the Department on issues that you are facing. Please let us know if you are facing critical difficulties and we will escalate with the Department.

CDNA Guidance (21 March) advised:

All cases who have specimens taken at clinical recovery can be released from isolation if they meet the criteria below.

Healthcare workers and workers in aged care facilities must meet the following criteria for release from isolation.

A confirmed case can be released from isolation if they meet all of the following criteria:

• the person has been afebrile (without fever) for the previous 48 hours;
• resolution of the acute illness for the previous 24 hours*;
• be at least 7 days after the onset of the acute illness;
• PCR negative on at least two consecutive respiratory specimens collected 24 hours apart after the acute illness has resolved** – this will be reviewed as the pandemic evolves in Australia.

* Some people may have pre-existing illnesses with chronic respiratory signs or symptoms, such as chronic cough. For these people, the treating medical practitioner should make an assessment as to whether the signs and symptoms of COVID-19 have resolved.

** If the patient has a productive cough due to a pre-existing respiratory illness or other ongoing lower respiratory tract disease, then the sputum or other lower respiratory tract specimens must be PCR negative for SARS-CoV-2. Otherwise upper respiratory tract specimens (nasopharyngeal or nose and throat swabs) must be PCR negative.

A small proportion of people may have an illness that has completely resolved but their respiratory specimens remain persistently PCR positive. A decision on release from isolation for these people should be made on a case-by-case basis after consultation between the person’s treating medical practitioner, the testing laboratory and public health, Results of viral culture, if available, may be included in this consideration.

The Department of Health appreciates that a service with limited allied health professional resourcing due to staff unavailability or COVID-19, would manage on-going care needs by diverting their resourcing to essential care. The Department is working with the Aged Care Quality and Safety Commission to get further advice on workforce issues.

The Department of Health have confirmed their approach, should there be a future ACFI review of your service which happens to relate to the time in which the COVID-19 outbreak was occurring. The key points are:

• to ensure an ACFI review officer can consider any exceptional circumstances that may have occurred during the COVID-19 outbreak, it is essential that your service documents the rationale for suspending certain care and what was implemented to ensure the needs of residents were met

• please note at an ACFI review your service may be requested to show evidence as to why an allied health professional was unavailable to deliver the treatment.

Your clinical team is best placed to advise what alternate care would be delivered by staff in circumstances where it is not possible for treatments to be delivered by an allied health professional.

When the ACFI allied health services are able to be safely recommenced, your service must maintain records as set out in the ACFI User Guide.

Public health authorities are skilled at undertaking exposed risk. It’s not the role of service providers to investigate exposed risk of any workforce or client diagnosed with COVID-19. Once someone is confirmed with COVID-19, your local public health authority will determine who, if anyone, has been in close contact with them while they were infectious, and these people will be directed to self-isolate.

Employees, volunteers and contractors must not visit a client’s home if they or another person in their home is under quarantine, investigation or is a suspected case.

If an employee, volunteer or contractor is asked to attend to a client who is in quarantine or under investigation, they are requested to:

• identify the urgency of the client’s support needs and discuss solutions and options with the client on how to deliver the service whilst safeguarding their quarantine period (e.g., leaving meals at the door, arranging home delivery services, utilising the assistance of others who are living with the person)
• If the client requires medical treatment, we expect them to:
  • telephone their doctor or local hospital Emergency Department to discuss how they can access medical treatment
  • if they are experiencing severe symptoms, they are to call 000 and advise the operator that they are in self-quarantine because of suspected COVID-19 risk.

Where significant works have already commenced and with the stringent risk management strategies, such as monitoring the health of the building workers on site daily, the ability to cordon off the building works until the final stage of connection, it would be of more risk to stop the works.

If the works continue past 1 May 2020, the building workers will all need to show evidence of having had their influenza vaccinations. – All persons coming into the aged care facility are required to have a flu vaccination from 1 May 2020

• greater than 15 minutes face-to-face contact in any setting with a confirmed case in the period extending from 24 hours before onset of symptoms in the confirmed case; or
• sharing of a closed space with a confirmed case for a prolonged period (e.g. more than 2 hours) in the period extending from 24 hours before onset of symptoms in the confirmed case.

For the purposes of surveillance, a close contact includes a person meeting any of the following criteria:

• Living in the same household or household-like setting (e.g. in a boarding school or hostel);
• Direct contact with the body fluids or laboratory specimens of a case without recommended PPE or failure of PPE.;
• A person who spent 2 hours or longer in the same room (eg. communal room in an aged care facility); or
• A person in the same hospital room when an aerosol generating procedure is undertaken on the case, without recommended PPE.

Casual contact is defined as any person having less than 15 minutes face-to-face contact with a symptomatic confirmed case in any setting, or sharing a closed space with a symptomatic confirmed case for less than 2 hours. This will include healthcare workers, other patients, or visitors who were in the same closed healthcare space as a case, but for shorter periods than those required for a close contact. Other closed settings might include schools or offices.

Note that healthcare workers and other contacts who have taken recommended infection control precautions, including the use of full PPE, while caring for a symptomatic confirmed COVID-19 case are not considered to be close contacts.

Healthcare workers who have used appropriate PPE effectively are not considered to be at risk of exposure. However, in case of unknown PPE breach, they should be advised to self-monitor and if they develop symptoms consistent with COVID-19 they should isolate themselves and notify their public health unit or staff health unit so they can be tested and managed as a suspected COVID-19 case (see recommendations below under Management of symptomatic contacts).

Other casual contacts may include extended family groups.

Asymptomatic close contacts should be advised to self-quarantine at home for 14 days following the last contact with the case, and to monitor their health for 14 days after the last possible contact with a confirmed COVID-19 case.

Self-quarantined close contacts should be advised on the processes for seeking medical care.

A medical clearance from a health care provider is not required for release from quarantine.

Casual contacts should monitor their health for 14 days and report any symptoms immediately to the local public health unit. There are no restrictions on movements; however, casual contacts should be advised to isolate themselves and contact the public health unit if they develop symptoms.

In addition to standard precautions, interim recommendations for the use of personal protective equipment (PPE) during clinical care of people with possible COVID-19 are:

• Contact and droplet precautions are recommended for routine care of patients in quarantine or with suspected or confirmed COVID-19.

Returned travellers are defined as those who have undertaken international travel to any country outside Australia in the last 14 days.
Different recommendations apply in management based on the risk assessment for different countries (see table)

Returned travellers who have travelled in or transited through mainland China, Italy, Iran or South Korea should self-quarantine at home for 14 days after leaving the higher risk country. Self-quarantined returned travellers should be advised on the processes for seeking medical care. See Medical care for quarantined individuals.

All returned travellers who have undertaken international travel in the last 14 days should self-monitor for symptoms, practise social distancing when outside the workplace and immediately isolate themselves if they become unwell.

Social distancing is an effective measure, but it is recognised that it cannot be practised in all situations and the aim is to generally reduce the potential for transmission. Whilst practising social distancing, people can travel to work (including by public transport) and carry out normal duties. Social distancing outside the workplace is aimed at nonessential activities and includes:

• Avoiding crowds and mass gatherings
• Avoiding small gatherings in enclosed spaces, for example family celebrations.
• Attempting to keep a distance of 1.5 metres between themselves and other people where possible, for example when out and about in public spaces.

All returned travellers who have undertaken international travel in the last 14 days who are unwell with fever, or with respiratory symptoms (with or without fever) or other symptoms consistent with COVID-19 should be isolated and managed as per the current recommendations for suspected cases.

Healthcare workers and other staff with close patient/resident/client contact who work in hospitals or aged care should take additional precautions given they come into contact with a high case load of potentially vulnerable patients. Staff should stay away from work for 14 days.

All healthcare workers should observe usual infection prevention and control practises in the workplace.

All healthcare workers and staff who have close patient/resident/client contact who have returned from any higher risk country should be advised not to undertake work in a health care aged care for 14 days since leaving the higher risk country.

Table correct as at 16 March 2020.

Healthcare workers, who are close contacts should be advised not to undertake work in a healthcare or aged care for 14 days following the last possible contact with the case. They should also be advised to self-quarantine at home for 14 days following the last contact with the case.

Public Health Units may assist infection control units of health facilities to identify and monitor healthcare worker close contacts.

Ensure that they are aware of the signs and symptoms of COVID-19, the requirements of quarantine and isolation, contact details of the PHU and the infection control practises that can prevent the transmission of COVID-19.

• Educate staff and consumers what to do if they feel unwell;
• Identify key staff and contingency plan for if they are unable to come to work;
• Ensure staff who have travelled overseas (see table below) take appropriate action. This should be extended to all care staff
• Request that consumers in the community who are in quarantine advise the provider; and
• Identify vulnerable consumers in the community and develop a plan for service continuity if staff shortages occur.

Information published by Fair Work Australia advises that employers should provide information and brief all employees, volunteers and contractors, including domestic and cleaning staff where applicable, on relevant information and procedures to prevent the spread of coronavirus. You should inform staff who meet the above criteria that they should remain isolated in their home.

If an employee is at risk of infection from coronavirus (for example, because the employee has recently travelled through mainland China, or has been in close contact with someone who has the virus or is suspected to have the virus), the employer should request the employee seek medical clearance from a doctor and to work from home (if possible), or not work during the risk period. Where an employer directs a full-time or part-time employee not to work, the employee would ordinarily be entitled to be paid while subject to the direction.  Employers should consider their obligations under any applicable enterprise agreement, award, employees’ contracts of employment, and workplace policies.

Where staff are working in the community providing home care information on the risk status of the clients they are visiting should be checked with each client.

Staff working in the community should not visit people at home who are suspected or confirmed cases, without appropriate supervision of the Public Health Unit.

Employees should advise their employer if they develop symptoms during the isolation period, particularly if they have been in the workplace.

Employees should comply with the requirements for returned travellers FAQ 16.

Details of Public Health Units are available here.

When collecting respiratory specimens, transmission-based precautions should be observed whether or not respiratory symptoms are present.

For most patients with mild illness in the community, collection of upper respiratory specimens (i.e. nasopharyngeal or oropharyngeal swabs) is a low risk procedure and can be performed using contact and droplet precautions:

• Perform hand hygiene before donning gown, gloves, eye protection (goggles or face shield), and surgical mask.
• To collect throat or nasopharyngeal swab stand slightly to the side of the patient to avoid exposure to respiratory secretions, should the patient cough or sneeze.
• At completion of consultation, remove personal protective equipment (PPE) and perform hand hygiene, wipe any contacted/contaminated surfaces with detergent /disinfectant.
• Note that, for droplet precautions, the room does not need to be left empty after sample collection.

If the person has severe symptoms suggestive of pneumonia, e.g. fever and breathing difficulty, or frequent, severe or productive coughing episodes then contact and airborne precautions should be observed. People with these symptoms should be managed in hospital, call 000 for assistance.

Public Health Unit staff should be available to contribute to the expert assessment of patients under investigation. The response to a notification will normally be carried out in collaboration with the clinicians managing the case, and be guided by the COVID-19 public health unit checklist and the COVID-19 investigation form (currently pending).

Confirmed case
A person who tests positive to a validated specific SARS-CoV-2 nucleic acid test or has the virus identified by electron microscopy or viral culture.

Probable case
A person with fever (≥38°C)1 or history of fever (e.g. night sweats, chills) OR acute respiratory infection (e.g. cough, shortness of breath, sore throat) AND who is a household contact of a confirmed case of COVID-19, where testing has not been conducted.

Suspect case
A person who meets the following epidemiological and clinical criteria:

Self-isolating people should use a surgical mask if they need to leave home and be in a public area, are visiting a medical facility or if having symptoms and other people are in the room.

Those who are suspected of having the virus should use surgical masks if they have to go out in public places until told by public health authorities not to.

Those with confirmed virus should wear a surgical mask if leaving the house, when in contact with health care workers or when having symptoms and other people are in the room. Currently, those confirmed with the virus are being treated in hospital but this may change over time.

Aged care facilities are high-risk settings for infectious disease outbreaks. This is due to the fact that there is often high density living with extensive close physical contact between staff and residents during the provision of care. Residents are at increased risk of severe illness and death due to their age and presence of co-morbid conditions. There are often many visitors, volunteers and staff moving between the community and facilities, which can promote the spread of infectious diseases.

In addition to usual preventative protocols, aged care facilities should ensure that high rates of influenza vaccination are maintained amongst all occupants and staff. Messaging to discourage unwell visitors from visiting facilities and occupants should be reinforced, and care should be taken to ensure unwell staff and volunteers know not to present to work while symptomatic with any infectious condition. Visitors, residents and staff should be encouraged to increase their frequency of hand hygiene (with soap and water or using alcohol hand rub), surface cleaning, and to use correct cough/sneeze etiquette.

Practising good hand and sneeze/cough hygiene is the best defence:

• wash hands frequently with soap and water, before and after eating, and after going to the toilet;
• cover cough and sneezes (into the bend of the elbow), dispose of tissues, and use alcohol-based hand sanitizer; and
• if unwell, avoid contact with others (touching, kissing, hugging, and other intimate contact.

People who feel unwell should stay at home and should not attend work.

Residents of aged care facilities should be advised that if any family members or visitors meet the restrictions, residents will not be able to have these visitors. These visitors will need to be isolated in their own homes.

In most circumstances the amount of infectious virus on any contaminated surface is likely have decreased significantly by 72 hours.  Regular cleaning of frequently-touched hard surfaces and hands will reduce the risk of infection.

When cleaning, staff should minimise the risk of being infected with coronavirus by wearing gloves and using alcohol-based hand sanitiser before and after wearing gloves. If cleaning rooms or areas of the workplace where a person with a confirmed case of coronavirus or a person in isolation has frequented staff may wish to wear a surgical mask as an added precaution. If a confirmed case of coronavirus or a person in isolation is in a room that cleaning staff need to enter, they may ask the resident to put on a surgical mask if they have one available.

• the person has not been feverish for the previous 48 hours;
• resolution of the acute illness for the previous 24 hours;
• be at least 7 days after the onset of the acute illness; and
• PCR negative on at least two consecutive respiratory specimens collected 24 hours apart after the acute illness has resolved.
  [Note: PCR stands for Polymerase Chain Reaction – a simple biological test used to amplify information in DNA – so PCR negative reflects a lack of virus]

It is also possible that someone may become infected by touching a surface, object or the hand of an infected person that has been contaminated with respiratory secretions and then touching their own mouth, nose, or eyes (such as touching door knob or shaking hands then touching own face).

These include:

• cough;
• sore throat;
• difficulty breathing; and
• fever.

Generally, these infections can cause more severe symptoms in people with weakened immune systems, older people, and those with long-term conditions like diabetes, cancer and chronic lung disease.

Call this line if you are seeking information on novel coronavirus COVID-19. The line operates 24 hours a day, seven days a week.