• Get set up with telehealth and online scripts so you can keep delivering care to residential patients. Click here for more information on telehealth, including access to the healthdirect Video Call service. Don’t forget that:
  • You can team up with an onsite registered nurse or physiotherapist to support physical examinations.
  • Home care providers can support clients to teleconference.

• Update advance care directives with patients and their families. Consider how COVID-19 changes the end of life directives for the resident and risks for the family visiting. More information is available from HealthPathways [Username: manchealth  Password: conn3ct3d]

• Engage with residential care facility management and become familiar with their infection prevention and control practices and outbreak management.

• Consider regular ear wax checks now that audiology services are limited or do not have access to facilities.

• Refresh your knowledge of end-stage palliative respiratory symptom management. More information is available from HealthPathways [Username: manchealth  Password: conn3ct3d]

• Older people at home can be very lonely. It is important for older people to maintain contact with their community aged care providers and not refuse services. The aged care sector is working differently to meet the safety requirements of COVID-19, e.g. a house cleaning visit may become a gardening visit and chat while maintaining physical distancing. Welfare checks are occurring regularly through a range of approaches, including waving at the front gate.

• TESTING – know which pathology services are providing mobile testing into RACFs and into private homes. The mobile services are targeting vulnerable people, not the general population. You will have one in your area!

• Update advance care directives with patients and their families. Consider how COVID-19 changes the end of life directives for the resident, the risks for the family visiting and the risks of abnormal bereavement, particularly in light of recent changes to funerals (viewing the body, public gatherings, etc). Learn more via the Australian Government Department of Health. Additional information on advance care directives is available here.
  • Advance Care Planning Australia webinars are available here.

• Oxygen – encourage older people at home to order earlier than normal, supplies are tight.

• Know when staff go to work in the aged care sector. Visit the Department of Health for more information.
  • They need to receive their flu vaccinations by 1 May with a certificate or evidence that they have had it.

If you work predominately in RACFs:

• Keep up to date through the cross sector aged care Basecamps. Check the ‘Looking for more information’ section below to be added to the network email list.

• Support the staff to understand that testing without symptoms gives a false reading. This is often requested when the hospitals transfer residents back.

• Support the staff to understand the significance of staff flu vaccinations. If we had a vaccine for COVID-19, would you have it?

• If you need support with infection protection and control practices with older people, check the ‘Looking for more information’ section below.

Detailed information on COVID-19 for the health and aged care sector is available from the Department of Health website.

Sector support and updates:

• Extensive funding packages are available to subsidise RACFs with outbreaks, provide staff incentives during the pandemic, etc.
• The changes to the assessment process to enter aged care services have been placed on hold.
• For daily newsletter updates to the industry, subscribe here.
• The  Royal Commission into Aged Care Quality and Safety activities have been placed on hold, submissions are still be accepted with constant changing deadline.
• PPE supplies for all aged care providers are now through the one email address ensuring equal access. Limited supplies are starting to be delivered.
• NSW Ministry of Health will be including a respiratory status section in all discharge letters from hospitals.

Residential aged care facilities:

• Facilities with confirmed COVID-19 cases will be able to access personal protective equipment from the national stockpile.
• The Communicable Diseases Network Australia Coronavirus (COVID-19) Guidelines for Outbreaks in Residential Care Facilities is available here.
• Some pathology services are establishing mobile services to cover nursing homes. LHDs are considering how to support this if pathology is not available.
• Implementing visiting guidelines to no more than two visitors per day.
• All staff and visitors must carry evidence of flu vaccines by 1 May to enter homes.
• Fly-in fly-out teams are being coordinated by NSW Ministry of Health, should any RACF experience staffing issues during a COVID-19 outbreak.

Community aged care services:

• People aged 65 years and older with confirmed COVID-19 can access urgent or immediate Commonwealth Home Support Programme services for six weeks without assessment through My Aged Care.
• Commonwealth Home Support Programme services that are group social / transport activities have been encouraged to look at alternate models and funding has been made more flexible to support this.
• Community providers are routinely screening clients before a visit. For all people living in community with COVID-19 a home isolation kit is sent through the LHD Public Health Unit and includes masks, hand hygiene products and directions on how to look after themselves and their families.
• Extensive planning and preparations are underway in community aged care services. Group respite programs are cancelled and are starting to do 1:1 visits to people’s homes. Personal protective equipment is limited, particularly Commonwealth Home Support Programme services such as transport, new approaches to service are being considered.
• The COVID-19 guide for home care providers in home care is now available.
• Additional funding is available to providers to extend home care packages during COVID-19.
• Older people with no services who require support with shopping, hygiene and meals can access Commonwealth Home Support Programs during COVID-19 without an assessment. Access through My Aged Care or direct to local services.

Key resources:

• Extensive resources for aged care health professionals
• COVID 19 information for older people and their families
• Free infection prevention and control education for the aged care sector
• Free Clinical Excellence Commission IP&C education (including five-minute YouTube clips)
• NDIS COVID-19 updates

The NSW Ministry of Health has enacted a statewide secondary triage system of residents in nursing homes.

All non-urgent flu and COVID-19 related calls from residential aged care facilities to NSW Ambulance will now be secondarily triaged by a remote accredited emergency physician consultation service.

All clinically appropriate patients will be diverted to community-based models of care, keeping in line with public health recommendations.

Local health districts are responding to support the triage system.

• NNSWLHD has developed a nurse practitioner led in-reach program of support for RACFs. It is now accepting referrals and providing advice and support to RACFs. Click here to download a fact sheet. Learn more via HealthPathways [Username: manchealth  Password: conn3ct3d].
• MNCLHD is currently communicating the outreach pathways through COVID-19 cross sector channels to: nurse practitioners, palliative care services, community nursing services and psychogeriatric services.
• NCPHN has provided extensive support to building these systems by updating existing RACF listings and building a profile of homes and after hours key contacts, linking the LHDs together through extensive COVID-19 communication strategies and sector knowledge. Strong, collaborative, integrated ways of working are being built.

North Coast PHN is working collaboratively with the Mid North Coast and Northern NSW LHDs, residential aged care facilities and community aged care providers to ensure a coordinated response to COVID-19. Regular virtual region-wide meetings are being held and an online resource library has been created on Basecamp to support collaboration and networking across services.

NCPHN has supported both LHDs RACF planning activities through undertaking extensive planning surveys. Of note are the small number of RACFs with only RN on call coverage over night and limited GP coverage in some facilities. Other activities include supporting services that are requiring support with infection prevention and control practices. Modelling of pathways for older people during COVID-19 is in its early stages and will result in broad collaboration with LHDs and the aged care sector to provide clarity of local supports for older people during COVID-19.

Extensive planning and preparations are underway in facilities. Visitor changes with no more than two visitors at once are being enacted with many facilities stepping this up to a semi lockdown approach with only health professionals able to enter facilities. Consideration is being provided for families of residents who are terminal and/or palliative.

Families are being encouraged to communicate through telehealth and ‘window visits’ are being set up. Welfare roles have been established in some facilities to focus on maintaining family connections.

Extensive planning and preparations are underway in community aged care services. Group respite programs are cancelled and are starting to do one on one visits to people’s homes. Personal protective equipment is limited, particularly Commonwealth Home Support Programme services such as transport, new approaches to service are being considered.

Some community services are struggling to provide their standard services. Reasons are diverse, including supplies of PPE. Of note are transport services and smaller programs whose infection prevention and control understanding may need support. A toolbox of resources is currently being sourced by NCPHN to assist these programs. Transport meetings are being negotiated in NNSW with social sector support services.

Extensive planning and preparations are underway in the local health districts including a range of activities to support residential aged care facilities to keep residents at home. See ‘Secondary triage system for residential aged care‘ below.

MNCLHD has developed a listing of services and providers offering support and shopping for older people. A similar list is being built in NNSW by Social Futures. Links will be published as they become available.

Palliative Care – both LHD’s services are keen to support GPs with any complex cases during this time, in particular end stage respiratory distress with COVID-19. MNCLHD is setting up a palliative care hotline – more as this becomes available.

Dementia Australia has added a range of COVID-19 fact sheets with tips for people living with dementia.

The fact sheets are available now and include:

• Tips for people living with dementia – outlines the coronavirus/COVID-19 symptoms, hygiene tips, the importance of having a good support network, ideas to remain active and engaged while in self-isolation, and where to go for help.
• Tips for carers, families and friends of people living with dementia – outlines the coronavirus/COVID-19 symptoms, hygiene tips, helpful tips for primary carers, as well as for family, friends or neighbours, ideas for remaining active and engaged while in self-isolation, and where to go for help.
• Tips for residential care providers – outlines the impacts coronavirus/COVID-19 may have on residents, tips on alternative activities and how to support continued engagement with families and carers.
• Tips for home care providers – outlines the impacts coronavirus/COVID-19 may have on a person living with dementia, tips to reduce heightened anxiety and where to go for help.

Click here to learn more.

Contact Bron McCrae, Deputy Director Healthy Living and Ageing, North Coast Primary Health Network at [email protected] or phone 0447 113 823.