Case study: RAC-off COVID - COVID-19 preparedness in local aged care facilities in Western NSW

In 2020, Western NSW Local Health District (WNSWLHD) had 49 non-LHD residential aged care facilities (RACF), with 3111 Commonwealth-funded beds, independently owned and operated under 28 different organisations. Facilities (spanning almost 500km) ranged in size from eight to 148 beds, with wide variation in staffing levels and expertise.

The risk of COVID-19 to vulnerable residents in RACF became clear, based on the experiences of other countries and within Australia. In April 2020, the RACF liaison role commenced working closely with providers to minimise the impact of COVID-19 and reduce potential hospitalisations. Sites needed significant support with their COVID-19 preparedness and additional expertise was sourced from a public health clinical nurse consultant and infection prevention and control clinical nurse consultant.

Steps taken included:

• conducting readiness assessments for each site
• establishing a virtual community of practice to ensure all sites were up-to-date with current and constantly changing State and Commonwealth guidelines. Additional participants included the primary health network, NSW Ambulance, geriatrician, palliative care, and aged care services
• linking sites to infection prevention and control education via LHD clinical nurse educators/clinical nurse consultants and online education
• distributing a flyer and providing a succinct list of LHD contacts reinforcing the commitment to support RACF
• developing a District outbreak management plan and linking with RACF outbreak management plans, including local plans (and floorplans) and providing feedback where feasible
• conducting desktop exercises to test outbreak management plans and RACF preparedness for an outbreak
• conducting infection prevention and control audits for all sites, with the provision of written recommendations
• delivering the NSW Clinical Excellence Commission’s Infection Prevention and Control Train the Trainer program.

Preparedness was put to the test with the first two outbreaks in September 2021. Since that time in ongoing activity, the team:

• streamlines and supports Outbreak Management Team meetings
• provides guidance to RACF on any COVID-19 (and now influenza) related issues
• works through an extensive list of priority actions with the Outbreak Management Team, including personal protective equipment (PPE)/RATs, surge staffing, infection prevention and control processes, updating Advance Care Directives (with a COVID lens, to ensure resident/family wishes are known), swabbing/RAT protocols, checking GP availability and oral anti-viral access
• troubleshoots for multiple issues, including sourcing PPE/RATs, arranging WNSWLHD staff to collect swabs, linking with Virtual COVID Care in the Community medical experts, and in one case providing staff.

The Director of Public Health has provided oversight and expert advice to the WNSWLHD team and community of practice, building on her existing relationships with RACF managers. Given that many participants are competitors, achieving open communication has been challenging, however using tools such as Slido for anonymous questions/ comments has assisted. Building trust with RACF became the foundation of swift and decisive action when a facility was in outbreak, along with access to the team’s collective expertise.

Early preparation work saw most facilities ready for outbreaks, with much improved infection prevention and control practices, risk minimisation and Advance Care Directives. Facility managers were able to call several WNSWLHD staff directly, who worked to keep residents safe within their ‘homes’. Benefits of strong, collegial relationships have been realised beyond the scope of COVID-19, with facilities working on other projects with WNSWLHD and the public health network and continuation of the community of practice, including a broadened scope to include other aged care priorities.

A survey of facilities was conducted in November 2020 to test the perceived effectiveness of the support provided: 100% of respondents (n=19) agreed/strongly agreed that they were well prepared for a COVID-positive resident or staff member, and 100% reported that the infection prevention and control audit was very/extremely helpful.

Between September 2021 and July 2022, WNSWLHD supported 104 non-WNSWLHD outbreaks, with a total of 1037 COVID-positive residents. Forty one residents were transferred to hospital (including several for Sotrovimab infusions).