Today a new Industry Code for Visiting Residential Aged Care Homes was released.
The objective of the Code is to provide an agreed industry approach to ensure aged care residents are provided the opportunity to receive visitors during the COVID-19 pandemic, while minimising the risk of its introduction to, or spread within, a residential care home.
We need to ensure that older Australians remain safe and are protected during the Coronavirus (COVID-19) pandemic. Low community transmissions as a result of Government policies, and the effective efforts of the aged care sector, have prevented widespread outbreaks in residential care homes.
This industry code will be adopted during the period of COVID-19, after which usual practices will return. During other infectious outbreaks only a small number of compassionate visits would be permitted, however it is recognised that COVID-19 will require a sustained period of action compared to the usual period for other infectious outbreaks. As the wider community begins to progressively return to pre-COVID-19 activities, it is important that older Australians generally and residential aged care in particular, maintain caution over a sustained period of months. This means that we need to ensure visiting procedures supporting the rights of older people and can be sustained in a way that also maintains the protection of all residents of an aged care home over the longer term.
Human rights recognise that all people living in an aged care home have the right to freedom of movement and association, including the right for residents to see their families. A human rights approach is fundamental to this Code but does not mean the rights of an individual prevail above all else. An individual’s rights must be exercised giving consideration to the welfare and wellbeing of others, or to put it yet another way, one individual’s rights should never override the rights of another person, they must be balanced with them. Services will continue a person-centred approach in their relationship with residents. The approach and application of the Code will recognise cultural, language and spiritual diversity, cultural or environmental contexts and Aboriginal and Torres Strait Islander peoples and communities.
The Aged Care Quality Standards and the Charter of Aged Care Rights still apply throughout any pandemic (including being informed about care and services in a way they understand such as in their preferred language) and the Aged Care Quality and Safety Commission (ACQSC) has provided guidance resources for the aged care sector including specific guidance about visitations. Additional guidance regarding COVID-19 has been provided by the Australian Health Protection Principal Committee (AHPPC) building on the initial advice by the Communicable Diseases Network Australia (CDNA) which outlines the management of risk of infection including the restriction to the overall number of people in an aged care home.
Residential care homes, residents and visitors need to work together to find the right balance between protecting residents from COVID-19 and providing them with vital social connections and support. Many aged care providers are already compliant with the essence of this Code. They have been effective in communicating with residents and visitors; facilitating new and innovative practices that permit visitations; and increasing staff time to supplement care and support activities that previously were conducted by volunteers, families or friends of residents. However, a number of real cases and complaints have been made regarding some providers implementing rigid and inflexible procedures, above the advice provided by Government or the regulators, which do not facilitate compassionate exemptions. Similarly, there is evidence some visitors have not complied with requested Entry Procedures. Given the vulnerability and frailty of residents and in some cases the potential for residents to naturally pass away during the prolonged pandemic period, it is understandable that families and friends are seeking the maximum safe period of visitation and homes are seeking to minimise the risk of COVID-19 being introduced.
The appropriate place to address concerns under the Code starts with consultation between providers and residents and family members to address their concerns locally. This process may include support for the resident or family, or advocacy on their behalf by the Older Persons Advocacy Network (OPAN); and the provider may seek support from its peak body’s member advice line where needed. For clarity, any person can make a complaint to the Aged Care Quality and Safety Commission at any time and this Code does not change those arrangements.
Additional Ways to Connect –
• Videoconference service such as Skype, Zoom etc
• Telephone calls
Designated Areas – A designated area is an area set aside by the home where visits between residents and visitor/s are to occur during the COVID pandemic. Designated areas are put in place to allow for safe interactions between residents and visitors that minimise the risk of infection and that allow for social distancing requirements.
Longer Visit – Various State Emergency and Health Directives restrict visits to aged care to no longer than 2 hours during the COVID-19 period.
Resident – Is the care recipient under the Aged Care Act. The views and wishes of the older person (resident) about who visits, and how visits are conducted should be sought in the first instance. Where this is not possible, then the views of their substitute/supported decision maker (attorney) should be sought, noting that it is the substitute/supported decision maker’s obligation to make the decision in line with the wishes and preferences of and in accordance with how the older person would have made them.
Short Visit – Various State Emergency and Health Directives restrict visits to aged care to no longer than 2 hours during the COVID-19 period. In order to facilitate visits in a manner consistent with infection prevention and control measures many providers have set up dedicated visiting areas and increased cleaning activities following a visit. In order to facilitate as many families and friends as possible to see a resident, booking systems and associated time restrictions have been put in place. In many cases this means in practice that visit bookings are for 30 minutes, which should be the minimum time for visits.
State or Territory Emergency and Health Directives – The following State or Territory Emergency and Health Directives, relevant to aged care which are in force as at 11 May 2020 include:
• Western Australia
• Northern Territory
• South Australia
• New South Wales
• Australian Capital Territory
Visitor/s – Visitors include any person a resident chooses to see including their family, family of choice, friends, religious or spiritual advisors. It is not up to the aged care home or its staff to determine who is or is not eligible to be a visitor. The presence of a Guardianship order, Power of Attorney or involvement of the Next of Kin does not automatically preclude other people from visiting, though may be informative when prioritising who to let visit when multiple people are requesting visits for the same resident.However, medical and allied health staff, Community Visitors Scheme volunteers, aged care advocates, legal representatives, or carers privately contracted by the resident or their family carers are not visitors for the purpose of this Code. They are considered workers (including volunteers) under the various State Emergency and Health Directives. Such workers will be required to comply with an aged care homes’ practices including their infection prevention and control measures.Visit/s – Visits may occur in a range of ways including in a resident’s room, designated internal areas, gardens or other designated areas. Visits may be up to 2 hours in duration and should be at least 30 minutes. Offering the maximum visiting time, or agreeing to longer periods, may be given priority for someone with dementia, or for the situations covered by Principle 7 of this Code. Visits will be conducted in accordance with Infection Prevention and Control measures, including Social Distancing (see CDNA, p10).
• In-Room Visit – Occur in the resident’s room and may require additional PPE to be worn. In-room visits may not be appropriate when living in shared rooms and in situations covered under Principle 7A of the Code alternative locations should be provided.• In-Person Visit – Occurs in a dedicated area or outside, not behind a protection screen.
Where in-room or in-person visits cannot occur, and the visit is meaningful for residents (e.g. people living with dementia or sensory loss), a window visit may need to be offered. Such visits may occur in a dedicated space behind a protective screen, via a balcony, through a gate or behind a window. Additional ways to connect may be offered as an alternative to minimise the risk of COVID-19 spread.