Update – Industry Code for Visiting Residential Aged Care Homes during COVID-19 commences

In our last article on this topic (available here), we explained the background to the new Code, as well as the issues the aged care industry is facing in managing visitors during this unprecedented time.

The Industry Code for Visiting Residential Aged Care Homes during COVID-19 (the Code) was finalised and commenced on Monday, 11 May 2020.

The Code represents a voluntary industry code, developed through collaboration between several industry peak bodies and consumer advocacy organisations, in response to Government warnings of intervention and further regulation.

Key differences between draft and finalised Code

While the finalised Code is largely consistent with the previous consultation draft, new provisions include:

• ‘Short visits’ are now defined in the Code as being, at a minimum, 30 minutes. ‘Longer visits’ may be required in certain circumstances, but the maximum allowed time for visits to aged care facilities under current State/Territory health directives is two hours.
• ‘Visitors’ are now defined in the Code to include any person the resident chooses to see, including family, families of choice, friends, religious or spiritual advisors. Providers are not permitted to determine who is or is not eligible to be a visitor. However, staff, volunteers, aged care advocates, legal representatives or privately contracted carers are not visitors for the purpose of the Code.
• The Code now expressly recognises residents’ rights to transfer to other accommodation or an alternate residential aged care home, following clarification of any public health directives, resident wishes and consideration of support needs.

What can aged care service providers do to comply with the Code?

The objective of the Code is to provide an agreed industry approach to ensure aged care residents are provided the opportunity to receive visitors during the COVID-19 pandemic, while minimising the risk of its introduction to, or spread within, a residential care home.

Providers who decide to adhere to the Code must:

• continue to facilitate visits between residents and visitors consistent with the Charter of Aged Care Rights and State/Territory COVID-19 related directives;
• ensure that each facility has its own solution for on-site visiting (e.g. a dedicated visiting room or requiring visitors to attend each resident’s room). A window visit may be offered instead (e.g. a visit in a dedicated space behind a protective screen, via a balcony, through a gate or behind a window), unless this would be ineffective for the resident, in which case the provider must explore alternate approaches. Additional ways to connect, such as phone calls and videoconferencing software, may also be offered as an alternative;
• ensure that the wishes and preferences of residents are at the centre of all decision making in relation to who visits them, with their choices being sought and respected (unless the visitor is prohibited under State/Territory directives);
• have documented procedures for handling requests for visits;
• if a facility is not affected by an outbreak, allow residents to continue to use public spaces within the facility, subject to social distancing requirements and within the constraints imposed by the layout of each home (e.g. limits on numbers);
• maintain residents’ right to access medical and related services, with appropriate use of telehealth options. Where a resident attends a medical or health service offsite, providers should follow a reasonable, proportionate and risk-based approach to infection prevention and control;
• accept delivery of any letters, parcels and other items from friends and family on behalf of the resident, subject to the provider’s appropriate infection prevention and control measures;
• as needed, ensure that ‘longer visits’ are provided in the following circumstances:
  
  • Residents who are dying should be allowed in-room visits from loved ones on a regular basis. The number of visitors, length, frequency and nature of the visits should reflect what is needed for the person to die with dignity and comfort, taking into account their physical, emotional, social and spiritual support needs. It is important that providers err on the side of compassion.
  • Residents who have a clearly established and regular pattern of involvement from visitors contributing to their care and support (e.g. behaviour support for dementia) must continue to have these visits facilitated. The length, frequency and nature of the visits should reflect the resident’s care needs, may be an in-room visit or in-person visit and should be consistent with established practices and routines.
  • Visits from family, families of choice and friends who travel extensive distances to visit the resident. A prior agreement between the visitor and the provider will be required to determine if an extended-duration visit can be accommodated.
• ensure that residents are informed of, and provided access to, Older Persons Advocacy Network (OPAN) or other formal advocates, and that residents’ legal representatives are heard and their substituted decisions upheld where able and lawful;
• provide timely and regular updates to residents and their nominated representatives. Proactive communication must occur with residents and families where an outbreak occurs, delivered consistently across the resident population;
• ensure that all staff are vaccinated under State/Territory health directives and Australian Government Guidelines;
• appropriately support staff to facilitate in-person and in-room visits, including written processes and procedures; and
• if a suspected or actual outbreak of COVID-19 occurs at a facility, or there is a suspected/known case within a facility, implement increased visitor restrictions in a transparent manner, with open and clear communication to residents and relevant family members. During such periods, the facility must provide alternate communication approaches, including assistance to use these, to assist residents to keep in touch with their loved ones.

In addition to the above, providers who implement to the Code may:

• regulate the overall number of visitors in order to minimise the risk of introduction of COVID-19 into a residential care home;
• require visitors to attend the facility only for ‘short visits’, and introduce additional procedures such as booking systems to manage total number of visits, and visits occurring only in designated areas and at agreed times. The Code defines ‘short visit’ as a minimum of 30 minutes. Providers will need to adopt a flexible and compassionate approach to visiting times to allow visitations to occur at different times (e.g. to accommodate visitors who work during business hours);
• refuse entry to their facility to any person, or request any person to leave the premises, for any justifiable reason consistent with the Code; and
• move into increased visitor restrictions when an outbreak has occurred within the facility (including non-COVID-19), or a declared outbreak/clusters have occurred in the local area, or if there are other extraordinary circumstances that require it.

Existing aged care legislation and regulations, including the Aged Care Act 1997 (Cth), its related Principles, the Aged Care Quality Standards, the Carers Recognition Act 2010 (Cth) and Charter of Aged Care Rights, will continue to apply throughout the pandemic. Providers and visitors also remain bound by State/Territory health directives, which take precedence over the Code.

What can providers require from visitors?

Visitors must comply with infection control processes put in place by the provider, and must not attend a facility if they are unwell or displaying any cold, flu, respiratory or other COVID-19 related symptoms. Providers will need to make their own decisions on appropriate infection control procedures for their facility, however the Code expressly notes the following as minimum entry requirements for visitors:

• responding honestly to screening questions about COVID-19 risk factors;
• demonstrating an up to date flu vaccination; and
• complying with the provider’s other requirements, including hand hygiene, having their temperature checked upon arrival, wearing personal protective equipment (if required), adhering to social distancing requirements and remaining in a resident’s room or designated visiting area.

Review of the Code

The Code will be reviewed three weeks after its implementation, on Friday 29 May 2020.