Residential care can be protected from COVID-19 spread

The Victorian Government’s road map out of COVID-19 was informed by the link between community transmission and our most vulnerable in aged care. As Victoria grapples with the deeply upsetting number of deaths in residential care facilities, Bass Coast Health and Kooweerup Regional Health Service (KRHS) offer leading examples of how to successfully avert the spread of COVID-19, protecting staff and vulnerable residents in care.

Both KRHS and Bass Coast Health have now experienced an outbreak, yet preparation along with swift coordinated action, prevented spread among staff and our much-loved residents.

It only takes one infected person to gain the status of outbreak. KRHS had two members of staff test positive; one was ‘contact traced’ to another outbreak. Bass Coast Health experienced an ‘outbreak’ when one agency staff member tested positive after it revealed they had worked at another facility with an outbreak. The positive tests were devastating news for the two health services that had worked so hard for the weeks and months beforehand to protect our most vulnerable, from the insidious transmission of COVID-19.

The next part of this story could have followed a familiar narrative of chaos and tragedy. Instead, KRHS and Bass Coast Health have emerged unscathed, albeit exhausted, and with a hugely positive story to tell.

The first part of the success story is the preparation prior to Outbreak. Both health services had comprehensive Outbreak Management Plans in place. At Bass Coast Health’s Kirrak House, visitors had already been restricted, staff had increased the use of Personal Protective Equipment (PPE) and were working longer shifts to reduce the number of staff coming into the facility. KRHS had done equally significant preparation work including setting up a COVID- 19 simulation room and all staff had undertaken training.

“Training was essential and put us on the front foot. The outbreak hit so quickly we would not have been able to cope without that preparation, it was a huge effort”, reflects Frank Megens, CEO KRHS.

As well as implementing the Outbreak Management Plans, contingency plans were set up drawing on the collaborative spirit of regional towns; Bass Coast Health worked with the local Shire to store materials; a number of changes were made including reduction of communal activities, provision of staff meals, and outsourcing laundry. KRHS implemented a three-step plan to ensure the continuity of its kitchen facilities; a 24-hour menu that can be delivered with minimal staff if necessary, an arrangement with the local hotel for the safe provision of senior’s meals and exclusive access to the Men’s Shed kitchen facilities that have undergone a deep clean for this purpose.

In both cases when positive tests were revealed, families and next of kin and residents were notified immediately and brought into the team to receive regular briefings and to be heard. “We were so grateful for the patience and support from families and next of kin, it gave our staff a boost to know that they were with us for every step of the way,” Jan Child, CEO Bass Coast Health.

In the outbreak context, the measures put in place assumed that any resident or staff member could carry the virus. “We had to implement enormous change in the facility that required support from across the whole health service, and we worked with staff, residents and relatives to solve problems quickly, capture opportunities and mitigate risk”, said Jan.

Both health services promptly adopted these new ways of working; additional and uncomfortable PPE was mandated and the management of the waste, while significant, was prioritised; multiple office moves occurred; distancing measures had an extraordinary impact on the usual way of doing things and teams began communicating with each other through new measures including daily musters to coordinate activities. The hallways of each residential care facility became lined with individual care stations for donning and doffing PPE for each resident interaction, and this was maintained throughout the day and night in each facility.

“The changes to some of our services to ensure continuity in the new COVID-19 world has involved significant investment, training and new learning and additional effort by everyone”, said Jan.

In both health services the mental health and wellbeing of residents has been top of mind. During the outbreak, residents had to stay in their rooms, while facilities received a ‘deep clean’ to remove any trace of the virus. Both services doubled their efforts to rebuild the social connection that residents normally enjoy through shared meals and recreation. Music, costumes, laughter, Father’s Day celebrations, exercise and counselling support have been essential elements of care in recent weeks.

KRHS has returned to window visits and a greater reliance on Skype. Bass Coast Health significantly boosted Wi-Fi capabilities and has drawn on additional staff to facilitate connection between residents and families. A new visiting hub will open in front of Kirrak

House in the coming weeks to ensure families and next of kin can see each other without entering the facility.

Both CEOs consider the significant effort was worth the relief on the faces of staff, residents and their families. “Some good has come from this extraordinary event. We have decluttered our facilities and they will maintain the minimalist look. We have upskilled our staff quicker than we ever could have imagined. We have built new partnerships in our community and strengthened relationships with our families. We are prepared for anything,” reflects Frank. Jan agrees. “The Kirrak staff and all Bass Coast Health staff are extremely proud of their vigilance in protecting our much-loved residents from this virus.”

Both health services have been declared by the Australian Government as free of the Outbreak status and are examples of exemplary models for managing a pandemic within an aged care facility with incredible support from the Victorian and Commonwealth Government and local communities.

Key to managing an outbreak in a residential care facility

• Staff trained in COVID-19 simulations to learn about and improve processes

• Prepared for potential furloughing of staff – workforce boosted to ensure continuity of care

• Collaboration with state and federal health departments

• Cross-organisational knowledge of Outbreak Management Plans

• Open and honest communication

• Regular engagement with residents and families from the beginning