LASA’s 10-day Congress got underway on Monday, with the head of the peak body saying the sector must change.

Aged care must “fight” against “inertia”, said LASA chief executive officer, Sean Rooney. 

The perception of the sector will only change when we change, he said, noting that the Royal Commission into Aged Care Quality and Safety had held a mirror up to the sector, revealing uncomfortable truths.

Mr Rooney said aged care staff have experienced “grief” and “trauma” during this difficult year.

A panel on Monday saw aged care chief executives from around the globe comparing their COVID-19 experiences.

The UK: 50% of deaths from “lack of medical care”

Tom Lyons from Black Swan, which has 20 care homes in the UK, said occupancy was down to around 80 per cent across the country, compared with 90-95 per cent previously, and many providers are no longer profitable. Forty per cent of care homes have had COVID-19 outbreaks, he said. 

Between 2 March and 12 June there were 60,000 deaths in care homes, with 30 per cent or 20,000 involving COVID-19. Some weeks there were 3,000 deaths in care homes. 

Black Swan had three homes with outbreaks at the peak of the virus in March. The organisation lost a member of staff, and had a staff member who had a child in intensive care.

“It’s been a really tough time,” Mr Lyons said, explaining that they’d do “a lot of things” differently “knowing what we know now”.

My Lyons said there have been “excess deaths unrelated to COVID”. Fifty per cent of deaths were attributed to lack of medical care because residents in the UK weren’t able to go to hospital and GPs were refusing to come into care homes. The only oversight was via iPad.

Testing in the UK is still slow, with results sometimes taking weeks to come back.

The US: a “frightening experience”

Bruce Spurlock, from Cynosure Health aged care in the US, said the virus has spread unevenly across the country, and has been constantly evolving. “It’s hard to keep your arms around it,” he said.

Mr Spurlock said higher risk homes tended to be for-profit and that community spread and nursing hours were also determinants of COVID-19 risk in care homes across the US. The homes with the highest risk need the most attention, he said, rather than responding reactively to outbreaks.

Occupancy rates are also down in the US and many homes will not survive, he said.

In the US, there have been 238,000 infections in residential aged care, and 57,000 deaths. In California, where Mr Spurlock lives, there have been 26,000 cases in care homes and 4,500 deaths. On top of that, 19,000 workers have been infected and 152 workers have died. “Even folks you wouldn’t expect to die, have died,” he observed.

“Can you imagine coming to work and knowing that your body and your family is at risk, it’s a pretty frightening experience,” he said.

He said a lot of people in care homes have died from issues related to covid, but not from the virus, including deaths from loneliness, and the progression of illness more rapidly because of isolation from family and within a facility.

Australia: a “nightmare”

Vanda Iaconese, from Doutta Galla Aged Services, said her organisation has had 11 outbreaks and was managing five outbreaks at one time.

Their homes are mainly in the western suburbs of Melbourne. There have been outbreaks in 220 Victorian aged care homes since the end of June, and about 50 homes are still affected. “Community transmission” has had an impact on Doutta Galla. In Victoria there have been 20,000 cases and over 800 deaths. Of those deaths, around 660 have been in aged care homes.

Compared to overseas the numbers might seem low, “but for us they were quite large numbers,” she said.

Some staff are still symptomatic but are not contagious, she said.

Some advice has been conflicting, which has made the response difficult. She hopes their cases are coming to an end now that community transmission is lower.

Hospital staff who came to help were “very challenged” by the resident population, Ms Iaconese said.

“It’s been a nightmare and the most difficult challenge of my career,” she noted.

Getting ahead by preparing for the worst

The Congress also heard from Verity Leith, General Manager Residential Services, Benetas, who spoke about the ways the provider prepared for COVID-19, and the lessons it has learnt this year.

Ms Leith said the Benetas executive and crisis team met on the 5 March to discuss the pandemic and the implications if an outbreak occurred in one of their homes.

The general manager quality, outcomes and research chaired their meetings, which were held weekly from March until June, and continue fortnightly “to this day”.

They gathered information from a variety of sources, including the lessons learned in New South Wales after the Dorothy Henderson Lodge and Newmarch House outbreaks, media reports, they attended webinars, and CDNA and DHHS guidelines, as well as information from LASA and the Aged Care Quality and Safety Commission.

Different areas of the organisation were involved in the planning, including procurement, property, wellbeing and pastoral care, to ensure all angles were covered.

Initial thoughts that a covid outbreak would be similar to a flu outbreak were soon determined “far from the truth”, and specific tools and guidelines were developed. An infection control specialist was brought in to review their plans. This review was “invaluable”, Ms Leith said.

Infection control education and training programs were implemented, covering handwashing, outbreak management, infection prevention and control, and correct use of PPE. Donning and doffing practice stations were established and were required to be practiced daily to make sure staff were taking the necessary steps.

Benetas made sure it had adequate PPE supplies during the planning process.

This “discovery phase” identified major themes: governance, preparation, resident care, communication, infection prevention and control, workforce supply, and employee wellbeing.

It was challenging keeping up with all the information provided by various agencies, sometimes contradicting each other, Ms Leith said.

Employee welfare was also a major concern, and though the team tried to anticipate the challenges employees would face, it was only when they were in the midst of an outbreak that they could really understand how challenging the reality was. Regular meetings enabled staff to ask questions.

A ‘plan on a page’ was an A3 plan that could be used in the case of an outbreak. A more detailed ‘step-by-step’ ‘how to’ plan went in more detail about what was required. Both were to be actioned immediately by staff as soon as a case was identified.

The first outbreak: communication becomes key

A large Benetas home in Western Melbourne was the organisation’s first outbreak on 7 July, and it provided an opportunity to test the plans. The first 24 hours were “extremely intense” Ms Leith said. “Additional resources” were essential. A “large amount of activity” went on in the first 24-48 hours.

DHHS was overwhelmed at the same time, so could offer little assistance. Benetas had to trust its own knowledge and implement the procedures they had in place.

“Don’t wait to be advised by DHHS, or any other body, about what to do,” Ms Leith said.

Ms Leith said don’t underestimate the “huge” level of communication required. Every family member with a loved one in the home was called daily for 12 weeks. Overall, the high level of communication meant families were satisfied with the handling of the outbreak.

Be clear about who leads the outbreak management team, Ms Leith suggested.

Staff were not allowed to work between homes, even if that meant going short at times. “This was challenging but it’s absolutely critical” due to the rapid spread of infection, she said. “Expect high loss of regular staff” and establish a large casual bank not working elsewhere who can step in if needed, she said.

Pre-approval of new employee contracts can speed up the process of getting new staff, but make sure you quiz surge staff about where they have been working previously and be prepared to send staff home if they have been working elsewhere.

“Move hard and fast” to implement infection control and prevention. “Be very strict with screening all entrants to the home,” Ms Leith said.

A buddy system for “extremely tired” staff working in full PPE

Every shift, PPE and hand hygiene training was conducted. Staff get “extremely tired” working in full PPE every shift, and a PPE buddy/spotter helped workers to look out for each other to ensure they were using the PPE properly.

Contract catering and cleaning staff need to be included in training and establishing expectations.

A checklist for success

Looking back on their plan, Ms Leith said doctors should be consulted prior to an outbreak to determine how they can continue to provide services. Also know which hospitals will take residents if needed, and those that don’t.

End of life medications should be available for all confirmed cases, which might seem “presumptive”, but Ms Leith said residents’ condition can deteriorate rapidly and you don’t want them to be forced to wait for relief.

Paper-based care plans, food and fluid charts were pinned to doors. Continue to monitor weight loss, deconditioning and pressure injuries.

Continue to monitor weight loss, deconditioning and pressure injuries. Eating in rooms is not conducive to eating, and “weight loss became prevalent”. 

Get people onto pressure relieving mattresses as quickly as possible to prevent pressure injuries, Ms Leith suggested. 

Managers were visible on the floor and were not hidden away in the office, which made the staff feel “grateful of the manager’s support”. The fact they were “rolling up their sleeves” and doing what had to be done made staff feel they weren’t alone. Every day, the wellbeing team rang staff with a positive result, staff who had been a close contact, or staff awaiting results at home.

Wins, no matter how small, were always celebrated, Ms Leith said.

“We worked hard to celebrate the employees by recognising the efforts they made with chocolate, high energy drinks, pastries delivery by very appreciative families, flowers, anything we could do to let them know we were very grateful and aware of how hard they were working during this very difficult and long 12 weeks.”

Staying track was difficult because things moved so quickly. Daily huddle meetings were essential to discuss who was unwell, what staffing looked like, and anything that needed to be addressed. An afternoon meeting was also helpful to plan for the evening.

Documentation doesn’t have to be “pretty”, but keep everything together, she said.

A ‘battle board’ was a useful tool recommended by the Defence Force. It involved a whiteboard with a plan of the home with photos of residents so as you move residents around you can move the pictures of the faces so you know where everyone is. Different zones of the home can be colour-coded.

Image: Milan_Jovic, iStock.

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