Regulatory compliance in a COVID-19 crisis: aged care

8 minute read  20.03.2020 Penelope Eden

The aged care sector continues to face significant and evolving challenges as it responds to the public health emergency posed by COVID-19.

A viral pandemic creates new and unprecedented risks for the aged care sector. Operators must act swiftly and take proactive steps to ensure that they are responding to the risks to consumers and staff, as well as managing broader operational issues, as Government policy and regulation continues to evolve.

The Aged Care Quality Standards

The need for high quality, clinically safe aged care has never been greater. The Aged Care Quality and Safety Commission (ACQSC) has shown an active interest in how operators are responding to the risks associated with COVID-19.

It is important for operators to assess the steps they propose to take and their performance against the Aged Care Quality Standards (Standards). This update examines some of the practical ways operators can align their response to COVID-19 with their compliance obligations in the Standards.

Standard 2: consumer planning

Operators will need to strike a balance between the public health and safety of the broader aged care community and individual autonomy. In managing the rapidly evolving situation, there will be circumstances where these two concepts will come into conflict. There may be times where consumer consultation will not be possible and affording consumers choice and dignity of risk may be difficult to justify in circumstances where it would jeopardise the public health and safety of other residents and staff.

New Government restrictions now limit visitors to residential aged care facilities, with children only permitted to visit in exceptional circumstances. Operators are encouraged to innovate and look to other means to ensure their clients can stay connected.

Aged care providers must consider how they will support the increased social and emotional needs of their consumers during a time where many people may feel isolated, anxious and uncertain. This could involve interventions such as:

  • Ensuring consumers have access to telephones, encouraging the use of mobile phones or other technology such as Skype or FaceTime;
  • Using technology to ensure residents are connected to each other and have adequate entertainment, for example watching the television, listening to music or podcasts;
  • Engaging with consumers about how they would like to spend their day, for example continuing to allow consumers to sit outside, take walks around the service and interact with each other where it is safe and appropriate to do so; and
  • Providing 'debrief' opportunities and encouraging consumers to engage with staff and discuss their concerns about COVID-19, the measures being implemented by the service and how these changes impact them.

Consumers and their families must be supported to understand your organisations COVID-19 response plan and its strategy to manage risk. Your communication regarding the needs for social distancing, increased hygiene measures and infection control must also provide an explanation for why these measures are necessary. As the situation continues to unfold, your response plan will also change and evolve. Ongoing, consistent and regular communication will be crucial during these uncertain times.

Standard 3: clinical and personal care

Aged care providers must demonstrate how their COVID-19 response plan aligns with the Communicable Diseases Network of Australia (CDNA) infection control guidelines.

Government restrictions on visitors to aged care services apply equally to visiting medical practitioners and allied health providers. Operators must be innovative and look to develop 'workarounds' such as the use of telehealth to enable continuity of care and reduce risk of contamination.

There will be a range of workforce challenges for operators, not least of which will be the likely spike in absenteeism of care staff required to self-isolate or those who are simply too anxious to come to work. Operators will also need to consider how they will manage the delivery of care services to consumers required to self-isolate and what their workforce model will look like. The Government recently lifted work restrictions on international student nurses to enable additional support to residential aged care and home care services. This means approximately 20,000 student nurses will no longer be subjected to a 40 hour fortnightly work limit. Work restrictions on other international and student groups will also likely be lifted as the situation evolves.

Providers who employ student nurses should consider how they will ensure these new employees are adequately trained in infection control measures and internal policies and procedures. The Department of Health has published an online training module for health care workers that covers the fundamentals of infection prevention and control for COVID-19. Operators should familiarise themselves with this resource and ensure it is readily available to the workforce.

High staff turnover and absenteeism may further exacerbate feelings of isolation and anxiety among your residents. Providers should consider how to ensure new employees are brought up to speed on the individual needs of consumers so as to avoid any unnecessary disruption and maintain a sense of continuity of care and community. This could look like:

  • Internal reviews and audits of compliance with policies and procedures which follow best practice;
  • Ongoing training sessions for all staff, at all levels, including new training sessions in relation to COVID-19 and refresher training sessions, for example in relation to infection control, hygiene and self-isolation measures;
  • Providing a COVID-19 resource hub, where up to date information can be accessed by staff, consumers and their families and representatives;
  • Providing personal protective equipment (PPE) and resources to staff, visitors, consumers and their families and representatives and ensuring adequate information is available about how it is used; and
  • Increased frequency of care plan reviews and integrating discussions around COVID-19 risk, infection control and increased hygiene measures to care plans – particularly as the situation evolves.

It is important to remember that although the restrictions on international student nurses have been lifted, providers will need to ensure this part of the workforce are able to provide safe, high quality care to residents. In order to ensure care remains at a high standard, training, as well as appropriate supervision and mentoring for these staff will be key.

Standard 7: human resources

There are two key risks faced by the aged care sector in responding to COVID-19: first, there will be an increased demand for aged care services and an increase in the clinical needs of residents. Second, there will be focus on clinical training in the areas of infection control and personal hygiene.

Operators will have already planned for the likelihood that their employees will be required to care for consumers with COVID-19. As well as educational support, operators must prepare for the increased emotional demands being placed on their employees. The workforce is likely to experience stress and anxiety not only due to an increased workload, but also in relation to the potential exposure of consumers and themselves. Employees required to self-isolate may have additional concerns about financial stability while they are unable to work. These additional stressors may compromise the level of care employees are capable of providing. Consider:

  • Establishing a system of communication to keep employees up to date in relation to COVID-19 developments;
  • Reminding employees of appropriate communication channels in relation to reporting personal exposure to COVID-19, exposure in the workplace, questions about isolation requirements or leave entitlements or any other relevant concerns and ensure that such communications are afforded the expected level of privacy;
  • Continuing to conduct internal quality reviews and maintain internal registers of critical incidents in order to monitor any changes in quality of care; and
  • Reminding employees of support that is available, including, where applicable, employee assistance programs.

Standard 8: organisational governance

The delivery of quality care and services is dependent on a number of systems working seamlessly to ensure continuous and responsive care. Aged care services should be prepared for significant disruption to their supply chains, including in relation to the workforce, clinical and non-clinical goods and services.

Aged care providers must be prepared for this disruption to last a number of months and be aware of the risk that this may intensify over the winter season.

Executives and senior management should act now to revisit policies and procedures to ensure there is an adequate business continuity plan and adequate resourcing to ensure continuous high quality care throughout the course of the pandemic.

We suggest:

  • Conducting internal reviews and audits of clinical and non-clinical needs to ensure adequate supply of goods and services over the winter period;
  • Conducting internal reviews and audits of workforce numbers, planned leave and rates of sick leave over the winter period to ensure the service is able to cope with disruption to staffing numbers;
  • Engaging in open conversations with your supply chain players (including the workforce) to ensure there will be adequate supply of goods and services and that they too have business continuity plans; and
  • Implementing systems that ensure your workforce, consumers, their families and representatives are safe at all times despite the increased regulation and pressures surrounding COVID-19.

Leadership is critical in planning for and responding to the unprecedented challenges of COVID-19 pandemic. Executives and senior management are reminded of the need to take a consistent approach and to be united, from the perspective of your staff, consumers, representatives and the public. Your community should be assured they are being led from the top.