On 24 December 2020, the Aged Care Quality and Safety Commission (ACQSC) released a report detailing the 'lessons learned' by 34 approved providers – who between them, operate 104 residential aged care services in Victoria (providers) – that experienced COVID-19 outbreaks (outbreaks) during late June 2020 through to September 2020 (Report).

While not providing specific recommendations or findings, the Report details practices adopted by providers that were effective in managing the outbreak. The Report identifies the common themes, challenges and learnings the providers shared in interviews with the ACQSC and a summary of changes introduced during the outbreak period of late June 2020 to September 2020 (outbreak period).

A range of factors were critical for providers in managing outbreaks at their facilities. These included strong and decisive leadership and governance, regular and consistent communication with stakeholders, effective infection prevention and control strategies, proactive workforce planning and effective clinical care and service delivery.

Despite these significant challenges, the Report concludes that many providers responded well and 'rose to the challenge' finding innovative ways to 'ensure the health, safety and wellbeing of residents' was maintained. The Report observes that in some cases, the COVID-19 outbreaks have strengthened the operational resilience of some providers, providing an opportunity for systems, governance and process review to ensure providers are well prepared for any future crisis.

Outbreak management planning

While the Report noted that the sophistication of outbreak management plans varied between providers, effective outbreak management plans were customised to reflect the specific attributes of each provider (and each facility). This included building design and layout, individual residents' care needs, the capacity of the facility to deliver certain services given COVID-19 restrictions, and the ability and capacity of local service providers and contractors to provide assistance. Providers also noted the importance of collaborating with a variety of stakeholders, including residents, government agencies, service providers, external contactors and staff in developing an outbreak management plan.

Some providers also described lessons learned from previous infectious outbreaks at their facilities, evacuations during bushfire seasons and other disaster recovery events, in helping them prepare for and initiate a rapid response when an outbreak occurred.

Governance

In responding to the outbreak, a range of different management structures were adopted. The Report observed that those providers who implemented a 'command and control' approach to the outbreak were more effective in enabling a decisive and rapid response. Establishing a single lead or 'commander' who provided clarity and enabled staff to focus on their specific role.

The Report also highlighted the importance of board members having diverse skills and expertise, particularly clinical expertise. Some providers noted that recent changes made in response to the introduction of the Aged Care Quality Standards regarding their organisations clinical governance and infection control 'paid off' during the outbreak period, with those governance processes enhancing the resilience of some providers.

Human resources

Providers were not prepared for the large number of staff furloughed in the early part of the outbreak. Infection control protocols (particularly, donning and doffing personal protective equipment (PPE)) meant routine tasks took longer to perform. This, along with the need to effectively source separate workforces to enable cohorting of residents, created an immediate need for additional staff. The Report identified that where additional staff were sourced, in some instances those additional staff were unable or unwilling to complete certain tasks. In a number of instances, agency staff did not understand infection control procedures and lacked experience working in a residential aged care setting.

In the early days of the outbreak, providers did not adequately identify the infection risk presented by staff working at multiple residential aged care facilities. Providers have reviewed their HR policies over the course of the pandemic to adequately scope and identify these risks.

Care and service delivery

The Report details the significant difficulties encountered in delivering care during the outbreak period. This was compounded where regular staff familiar with residents, were furloughed and additional staff were sourced from acute care settings. One provider observed that 'the clinical surge workforce didn't go beyond providing acute clinical care, while the aged care workforce found the hospital-like care difficult'.

The Report considered that the efforts made by some providers to simplify documents, checklists and charts available at the point of care enhanced staff and resident confidence in the delivery of care.

Infection prevention and control

Providers were often not prepared for the time and expertise required to properly use and monitor PPE or the number of staff required to care for a COVID positive resident. Many providers relied on 'on the floor' training and used the 'trainer model' to ensure compliance with infection control procedures. Cohorting also presented a significant challenge, particularly where shared living facilities were present. Consistent and repeated cleaning was required in common areas which created additional resourcing challenges for providers.

The Report found that procuring sufficient PPE, and storing and disposing of PPE was an issue experienced by all providers. Additionally, training staff in the correct use of PPE and ensuring routine adherence to donning and doffing practices was an ongoing priority for providers.

Communication

Providers emphasised the importance of 'effective, regular and consistent communication throughout an outbreak'. This extended to communication with residents, their families, staff, external service providers and government agencies. The Report concluded that providers who established a centralised communications team with responsibility for communicating with stakeholders were better placed to achieve consistent and quality communications.

Specific takeaways from the outbreak period

While largely reflecting much of the earlier commentary contained in the Royal Commission into Aged Care Quality and Safety's 'Aged Care and COVID-19: A Special Report', the Report provides specific takeaways from the outbreak period. Although the Report noted that between the period of July 2020 through to September 2020, the ACQSC imposed regulatory action in the form of a Notice to Agree Certain Matters on over 20 aged care providers in Victoria that 'struggled to respond effectively to a COVID-19 outbreak at one or more of their facilities', the Report strikes a largely positive tone regarding the performance of providers. The Report concludes by noting that many providers reported undertaking ongoing improvements, particularly in the areas of governance and work health and safety as a consequence of the learnings arising from the outbreak period.

Contact us to find out more about how these findings apply to your organisation.