NZACA Industry Advice

Neil Miller
Senior Policy Advisor

Contact

Updated 18 June 2020

NZACA Guidance to Aged Residential Care at Covid-19 Level 1                 

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Covid-19 Level 1 consists of a removal of domestic Covid-19 restrictions due to elimination of Covid-19 in New Zealand.  Physical distancing is no longer specifically required.

Attention to infection prevention and control practices need to be maintained. This is a good time to review IPC policies and procedures to ensure they reflect Covid-19 additions and learnings.

Screening

A COVID-19 screening form has been developed for Alert Level 1 by the Ministry of Health. This form must be completed a maximum of 48 hours before proposed transfer or admission to an Aged Residential Care facility.

Testing

Covid-19 testing is only required in accordance with the Covid-19 case definition.

14-day Isolation

14-day isolation for new admissions is no longer required.

Visiting

Ensure all visitors are aware of the need for ongoing infection prevention measures due to the vulnerable population in aged residential care.

There must be a register of visitors for the purposes of contact tracing. This should include a declaration that the visitor has no potentially infectious illness. Visits may continue to be by appointment or pre-arrangement but should not be restricted.

No visitor who arrives in New Zealand at level 1 should visit a facility without providing evidence of a negative Covid-19 test and a surgical mask is recommended. See additional guidance.

Short term respite

All respite and day care can recommence.

PPE

PPE is not required except for Covid-19 suspect, probable or confirmed cases where full contact and droplet precautions are recommended. This includes PPE to be worn, including N95 masks.  A confirmed case is likely to lead to a change in the national Covid-19 risk level.

Leaving the facility

Leaving the facility is a right and cannot be restricted at level 1. Residents can be encouraged to be responsible for good hygiene practice and to keep a record of their movements for the purposes of contract tracing.

Regular activities

Regular activities can all recommence.  Ensure all providers of services are aware of the need for ongoing infection prevention measures and that they must not attend or continue with sessions if at all unwell.

Rhonda Sherriff, NZACA Clinical Advisor, is available for members to seek clinical advice between 9.00am and 5.00pm Monday to Friday (excluding public holidays) on 0800 445 200 or helpline@nzaca.org.nz

Neil Miller
Senior Policy Advisor

Contact

21 May 2020

NZACA Guidance to Rest Homes at Covid-19 Level 2

Click here to download this as a PDF

Covid-19 Level 2 consists of a gradual easing of lock down restrictions.  For aged residential care, most restrictions are at the discretion of the provider.

Best practice infection prevention and control practices are to be maintained.  Take a risk management approach using clinical judgement.

Below is the specific advice of the NZACA for level 2:

Screening

The Screening Form should be completed 2-days before admissions and provided to the rest home.

Testing

NZACA recommends a Covid-19 test with a negative result prior to admission of all new residents.

PPE

Wear a surgical mask for residents in 14-day isolation. Full PPE is not required for asymptomatic residents.

It is best practice to wear a surgical mask when in contact with residents.

Wearing of masks should be supported by hand hygiene.

For Covid-19 confirmed or probable cases full PPE to be worn, including N95 masks,

14-day Isolation

Maintain 14-day isolation for new admissions and re-admissions (after an over-night hospital stay).

Outpatient Appointments

There is not any requirement to put a resident into isolation following an outpatient appointment. It is advised that residents and staff wear surgical masks at appointments.

14-days isolation is advised if there are risks identified that must be mitigated. For example, if a resident enters a ‘red zone’ and/or is exposed to risks in an Emergency Department in a hospital.

Outings

Residents can leave the home, but it is advised that they maintain their ‘bubble’ and physical distancing. If they don’t, they may then be isolated for 14-days.

Staffing

Staff should maintain the practices they adopted under levels 3 and 4.

Continue to zone your facilities as far as practicable and restrict staff movement between zones.

Visiting

Visits are to be by appointment only. There must be a register of visitors.

The frequency and length of visits may be restricted so that there is adequate oversight.

Visitors must be asked screening questions prior to entry. Staff must explain procedures to them.

Visitors are only to go to the place allocated for the visit, usually the resident’s room.

Please see the full NZACA Level-2 Visitor Guidelines here.

Allied Workers

Every allied worker or contractor will need to follow the similar guidelines set out for all incoming visitors. That includes a register and screening questions on being met on arrival by staff.

Maintain social distancing where possible. Follow IPC practices and wear appropriate PPE. For example, hairdressers to remain in their salon and have full PPE.

Exit the facility doffing and disposing of all PPE appropriately and signing out as required.

Rhonda Sherriff, NZACA Clinical Advisor, is available for members to seek clinical advice between 9.00am and 5.00pm Monday to Friday (excluding public holidays) on 0800 445 200 or helpline@nzaca.org.nz

Neil Miller
Senior Policy Advisor

Contact

20 May 2020

A conversation with the Nursing Leadership Group

The Aged Care Association’s Nursing Leadership Group welcomed members for an informal Zoom conversation to discuss the transition to Covid-19 Level 2 and the challenges faced by the aged care sector.

7 May 2020

NZACA Visitor Guidance for Rest Homes at Covid-19 Level 2

For facilities with no known cases of COVID-19

Click here to download this as a PDF

At level 2 it is anticipated that there will be high initial demand for visits. Not everyone is going to be able to
visit immediately.

The following recommendations are to manage visiting to minimise the risk of COVID-19 transmission to
residents and staff.

1. Specified facility visiting hours
• All visits to be by agreement with the clinical or facility manager.
• Consider regular visiting hours for each individual site / unit when staff are available to ensure adherence to additional health and safety / infection control requirements.
• Visits to be one person to each resident unless otherwise agreed by the clinical or facility manager.
• A roster of visiting times where visitors pick a regular time to visit each week may be helpful.

2. Maximum number of designated whanau or friends who are the resident’s sole visitors

• To facilitate a smooth transition and meet resident / visitor expectations identification of visitors and communication of the process should occur before level 2 commences if possible.
• Clinical or facility managers may limit to no more than two designated visitors per resident to manage the volumes of visits unless the facility has the additional resources to manage a higher number of visitors.
• Maintain a log of all visitors including their contact details and who they have contact with during their visit (i.e. staff and resident visited).
• Children under 12 years only with the prior approval of the clinical or facility manager.
• Staff supporting visitors are familiar with the correct process and the register is readily available.

3. Length of visits
• Length of visits to be at the discretion of the clinical manager taking into consideration:
– resident preferences
– how many visitors can safely be supported at any time by staff
– the needs of all residents
– extenuating situations (e.g. visitors travelling long distances and end of life visits).
• Visitors should be aware of the anticipated length of the visit prior to visiting.
• Clinical or facility managers may limit most visits to half an hour to manage the risks and the demand for visits.

4. Infection prevention and control (IPC)
• All visitors sign a declaration form which includes screening questions, including verifying visitors have no signs and symptoms of potentially infectious illness.
• Staff need to explain the IPC visitors are expected to follow.
• Hand hygiene is required for all visitors on entry and when requested by staff for IPC.
• Physical distancing of 2 metres is required during all visits, but limited physical contact can be allowed on compassionate grounds with the prior approval of the clinical or facility manager.
• Masks can be recommended to prevent the spread of droplets from carriers of COVID-19.
• Visitors to residents at the end of life may have the use of masks waived whilst in the resident’s room at the discretion of the facility manager.
• The use (putting on and taking off) of any additional PPE must be overseen by staff following instruction.
• Goods brought into the facility by the visitor must meet IPC guidelines (e.g. be wiped down) and is at the
discretion of the clinical or facility manager.

5. Designated areas
• Visitors should be advised where they can go during the visit.
• In most cases visits would be limited to the resident’s room.
• The visitor may be escorted by a designated staff member to and from the resident.

Rhonda Sherriff, NZACA Clinical Advisor, is available for members to seek clinical advice between 9.00am and 5.00pm Monday to Friday (excluding public holidays) on 0800 445 200 or helpline@nzaca.org.nz

Rhonda Sherriff
NZACA Clinical Advisor

Contact

Neil Miller
Senior Policy Advisor

Contact

24 April 2020

NZACA Guidance for Rest Homes at Covid-19 Level 3

Click here to download this as a PDF

For aged residential care, Covid-19 Level 3 restrictions are recommended to be the same as Level 4 in most areas. Level 3 increases some of the risks and so there are three additional recommendations to all aged care providers:

1. It is best practice for masks to be worn by all care staff where available and we are working with DHBs on supply. Wearing of masks should be supported by thorough washing of hands.
2. Full PPE to be worn, including N95 masks, for Covid-19 confirmed or probable/suspected cases.
3. Restrict the length of time staff members spend completing tasks with an isolated symptomatic or Covid-19 confirmed/probable/suspected resident.

It is recognised there is increased risk of contamination with visits over 15 minutes.

The following advice remains from Level 4:

• End of life compassionate visits by a designated family member (approved by the facility/clinical manager) as a prior arrangement.

• Continue 14-day isolation for all new admissions.

• Recommend Covid-19 testing for new admissions and re-admissions.

• Zone your facilities as far as practicable and restrict staff movement between zones. Staff should be rostered to one area to work and remain in that area rather than be rostered throughout the complex. Tasks will need to be reviewed as part of this overall strategy. This lessens the risk of transmission throughthe complex.

• PPE to be changed when moving between residents/zones.

• Continue to monitor staff competency with PPE management and processes.

• Staff are not to work if they experience any Covid-19 or respiratory symptoms. They need to be tested for Covid-19, and are not to return to work until they have a negative result and no symptoms for 48-hours.

• Staff should not work in more than one facility.

• Management to keep a register of staff living arrangements i.e. whom and how many people they live or flat with in their bubble and what work they undertake. This will need to be revised again with the changes to Level 3 as some staff may increase their contacts to include siblings, children outside of their home, etc. This will ensure Public Health are able to track and trace staff movements and who may be at risk if further facilities announce Covid-19 cases.

• Staff should be advised of infection control protocols/practices to adhere to when finishing their duty/shift and going home. It’s advisable that staff remove their footwear before entering their place of residence, removing work clothing/uniform and launder them every day, shower immediately on arrival home to mitigate any risk of transmission alongside the usual infection control precautions of good hand washing practices and maintaining social
distancing.

Rhonda Sherriff, NZACA Clinical Advisor, is available for members to seek clinical advice between 9.00am and 5.00pm Monday to Friday (excluding public holidays) on 0800 445 200 or helpline@nzaca.org.nz

Rhonda Sherriff
NZACA Clinical Advisor

Contact

Neil Miller
Senior Policy Advisor

Contact

13 April 2020

Covid-19 Infection Control Practices

Further to infection control advice given last week to members about keeping staff working in specific areas (units) rather than across whole facilities, it is recommended that management also develop a register of staff’s living accommodation (whom and how many people they live or flat with) and what work they undertake. This will assist management to ensure they are able to track and trace staff movements and identify who may be at risk on their staff in the event of any further Covid-19 cases.

Tracking and tracing of staff’s living arrangements has been highlighted by Public Health as a potential risk of transmission if aged care staff are living and working alongside family and friends (flatmates) who work in other aged care facilities or health care sites. This increases the risk of potential transmission and therefore staff should be advised of infection control protocols to adhere to when finishing their shift and going home.

It is advised that staff remove their footwear before entering their place of residence, remove clothing/uniform and shower immediately to mitigate any risk of transmission alongside the usual infection control precautions of hand washing and maintaining social distancing.

Rhonda Sherriff, NZACA Clinical Advisor, is available for members to seek clinical advice between 9.00am and 5.00pm Monday to Friday (excluding public holidays) on 0800 445 200 or helpline@nzaca.org.nz

Rhonda Sherriff
NZACA Clinical Advisor

Contact

9 April 2020

COVID–19 staffing guidelines to consider for multi care level ARC sites

Following outbreaks of COVID-19 in several NZ aged care facilities over recent weeks it’s timely to review and consider staff accessibility to different areas throughout the complex.

There has been criticism from Public Health infection control specialists about ARC staff not working solely within their designated area (laundry, kitchen, cleaning, etc), instead being observed working across the whole facility. The same principles apply to care staff working across the facility rather than in a designated work area (rest home, hospital and dementia wings).

While the threat of COVID -19 transference exists, staff should be assigned to work in specific areas of the facility rather than having the general “run” of the complex. This will necessitate staffing and tasks being reviewed and made more specific to area location and rotation but would reduce the number of staff having to be stood down should an outbreak occur.

Areas to consider and review are:

• Laundry service. Who can access the laundry and which staff distribute clean garments and laundry throughout the facility? Laundry staff dealing with soiled linen then delivering clean linen and residents clothing back into all areas of the facility provides potential for the spread of the virus. As does care staff accessing the laundry to pick up articles of linen and clothing. You may need to rethink how this system can be reviewed to minimise the exposure of staff in all
areas and allocate wing staff to distribute the clean linen from a designated drop off point. Think how staff communicate with the laundry to access additional linen, rather than visiting it.

• Kitchen/meal service. Who has access to the kitchen and which staff are permitted to access this area for meal preparation, collection and distribution, accessing food supplies, crockery and cutlery management/washing, etc.
You may need to review how morning/afternoon tea and suppers are prepared and who is responsible for meal distribution if kitchen staff are currently doing this role. Ensure that when supplies are dropped off, they are left outside of the kitchen area and allocated staff then treat these according to the guidelines before storing them appropriately in the kitchen.

• Cleaning. Cleaning staff should be rostered to specific areas within the facility only and remain there for the duration of the pandemic, ensuring they follow all good infection control processes.

• Care staff. All care staff should be allocated/rostered to specific wings of the facility and remain there, rather than being rostered elsewhere within the complex to fill roster gaps (if this is possible). Should an outbreak occur you then minimise the risk of having a lot of staff stood down, if they have not worked in areas of risk.

• Other staff. Consider staff who work across the facility (rather than specific areas) such as maintenance people, and how infection control practices are managed to keep these staff and all onsite residents safe.

• Management. Management overview of the facility and how senior staff interact with the residents and staff throughout the complex also needs to be considered and minimised if possible. Alternative ways of communication will need to be considered/explored to ensure interaction with others is minimised.

Maintaining “hubs of staff” is essential to minimise interaction between units and lessen the risk of spread throughout the complex.

Rhonda Sherriff, NZACA Clinical Advisor, is available for members to seek clinical advice between 9.00am and 5.00pm Monday to Friday (excluding public holidays) on 0800 445 200 or helpline@nzaca.org.nz

Rhonda Sherriff
NZACA Clinical Advisor

Contact

3 April 2020

COVID–19 Questions and Answers

Rhonda Sherriff, NZACA Clinical Advisor

Click here to download this as a PDF

1) Can we up-skill our Registered Nurses in Venepuncture techniques (taking blood samples) if laboratories can no longer visit our facilities to take blood samples?

Answer: Registered Nurses can take blood providing they have received full education, training and proven competency.

Some DHBs and training facilities have online venepuncture education available for staff to study. Providing there are competent trainers to teach, provide practical demonstrations, observe the RN’s practice and sign them off as competent, then they can perform this procedure. This may be advantageous if laboratories cut services to aged care facilities during the COVID-19 outbreak.

2) I have two employees (Caregivers) who are over 70 and as fit as a fiddle. They have told me  they will remain at home because the Government has said that everyone over 70 has to stay at home. I query this as the Government have also said that they would be asking retired nurses and doctors to work again. It puts me in a very difficult situation as far as having enough staff on the floor. I would really appreciate your thoughts on this matter.

Answer: Many managers are facing the exact same problem as yourself with staff over 70 choosing not to  work, resigning, or getting doctors medical certificates to put themselves off work during Alert Level 4.

The Government’s announcement that people over 70 were more at risk of contracting COVID-19 due to weaker immunity is adding further difficulties for management to staff their facilities.

Firstly, I recommend that you review your employment contract to ensure you are completely familiar with the employment clauses that would pertain to this particular situation.

I suggest that you speak individually with each of your two staff members to ascertain their thoughts, fears and concerns, and be able to provide a level of support/understanding. Assure them that you will do all you can to protect them whilst working in the facility, should they then choose to carry on working.

If they have a health condition, then they will be required to present a medical certificate for the time frame they will be off on sick leave. Ultimately it is their decision to determine whether they wish to continue working in a health
setting, but they need to ensure they follow employment practice and don’t just abandon their employment. Communication will be paramount in this atypical situation.

Further Answer to Question 2 – information supplied to the NZACA by Barrister Wendy Aldred, Stout Street Chambers:
The Government has announced a new COVID-19 payment that will be available to essential businesses for essential workers from Monday 6 April 2020 when the details will be made available. This new payment is intended to support essential workers who have to stay at home to comply with public health guidance, and whose employers are unable to keep paying them. ARC employers will be able to access this payment.

The Health and Safety at Work Act 2015 applies to all workplaces, and all persons conducting a business or undertaking (PCBUs) (which will include the operators of rest homes) are required by the Act to take all reasonably practicable steps to keep workers safe. Workers also have a right to refuse to work if they reasonably believe their work to be unsafe. Any person over 70 and any person with an underlying health condition who has a doctor’s opinion saying they should not be at work during the COVID-19 situation has a reasonable claim to not be safe at work in the present circumstances. That is confirmed by the Government’s general advice to all vulnerable persons to stay at home to avoid the risk of contracting the virus. An employer requiring any vulnerable person to come to work would be likely held to be in breach of their obligations under the law and could be the subject of significant penalties under the health and safety legislation.

Rhonda Sherriff, NZACA Clinical Advisor, is available for members to seek clinical advice between 9.00am and 5.00pm Monday to Friday (excluding public holidays) on 0800 445 200 or helpline@nzaca.org.nz.

Rhonda Sherriff
NZACA Clinical Advisor

3 April 2020

COVID-19 Testing

The NZACA Board and Management has met this afternoon and wishes to make clear to the membership the following position with regard to COVID-19 testing.

• Every new resident prior to admission into aged residential care, whether from hospital or the community, must be tested for COVID19.
• If the test is positive, then the ARC facility will not accept the resident.
• If the test is negative, then the ARC facility will admit the resident, but they will be isolated for 14 days.

The position of the Association is consistent with the call from the Prime Minister Jacinda Ardern and the Director-General of Health, Ashley Bloomfield, for more testing of vulnerable populations, which includes older New Zealanders.

The Association’s position has been communicated to the Ministry of Health this afternoon.

Simon Wallace
Chief Executive

Related correspondance – COVID-19 testing and admissions policy:

Letter sent to Director-General Dr Ashley Bloomfield | 8 April 2020
Reply from Director-General Dr Ashley Bloomfield | 8 April 2020

Simon Wallace
Chief Executive