In response to the coronavirus / COVID-19 epidemic, all aged care homes must put additional visitor control measures in place. This is a legal obligation imposed by the Australian Government and part of a risk-management strategy for protecting older people from a potentially fatal infection.
Do you have an effective visitor control plan in place? Where do you start? How do you know you’re doing all the right things?
Here are nine questions to help you get a handle on where you’re at and what you need to do.
This is a rapidly-changing issue so it’s always worth checking the very latest information on the Department of Health’s website.
Have you asked residents and their visitors how they would like to respond to the new visitor restrictions? Have you recorded this information, passed it on to management/the Board and incorporated it into your plans? In addition to these broad measures, it’s worthwhile planning ongoing simple ways to engage with consumers regarding visitor restrictions. In these chaotic times, such measures can reassure consumers and give them a voice when so many things are out of their control.
In its Fact Sheet on Restricted Visits, the Department of Health advises, “If you don’t absolutely have to go to support a resident in care, please don’t.” Do your residents and their potential visitors know this information? Have you shared the Fact Sheet (or other resources) with them? Have you shared your interim visitor control policies and procedures with them? (see question 5 below). There is a lot of misinformation out there, so it’s unwise to assume that everybody understands the situation.
Also bear in mind that a flat out “no you may not” can be antagonistic and lead to complications down the road. Much better than simply denying visitation is to offer alternatives. Is this feasible in your home? Do you have the technology and staff-competence to help residents communicate with loved ones via phone or the internet?
How many ways can visitors get in and out of your aged care home? Can all these ways be controlled by staff? How deep into the home is your entry control point? If visitors can easily pass through communal areas and chat to several staff and residents on their way to the entry control point, then you may have to shift it to a more external position.
Do staff – particularly staff who are controlling entry points – have access to clear, easy-to-read, up-to-date policies and procedures that tell them who they can and cannot allow into the home? Once they decide to admit a visitor, do staff have access to policies and procedures that tell them how these restricted visits should be conducted? Have you shared these policies with residents and their visitors?
Policies and procedures on who may enter the home should include information such as these points provided in the Australian Government Department of Health’s Fact Sheet on Restricted Visits:
The following people will not be permitted entry to residential aged care facilities:
The Fact Sheet also notes that visits are limited to a maximum of two immediate social supports (family members, close friends) or professional service or advocacy providers at one time.
Have you considered some of the practical difficulties that arise from these restrictions? How are you going to know whether someone has been overseas recently? How are you going to know if they’ve been vaccinated against influenza?
Be sure not to simply print this Fact Sheet once and hand it out. Things may change, so check for updates regularly.
At the moment, the key restrictions on visits as outlined in the Fact Sheet, are:
Some of these requirements are complex. Is there an induction process for visitors? Have staff been trained to deliver this induction?
Some of this advice is unhelpfully vague. What is a “short duration” for a visit? Ten minutes? Two hours? What exactly does a “health screening” require? Is taking a temperature sufficient to track if someone is unwell? You may have to decide these specifics for yourself, leaving some room to adapt things on a case-by-case basis. Any specific requirements that you decide to implement should be clearly noted in your interim visitor control policies and procedures.
And again, things may change quickly, so check for updates regularly.
It’s all well and good to issue clear guidelines, but they’re not much use if visitors ignore them. Do you have measures for ensuring that visitors don’t detour on their way to the meeting place or stay too long? Are staff trained to enforce these measures in a way that is openly communicative and compassionate, drawing on a shared understanding of health priorities?
Visitor control measures don’t just apply to consumers’ family members. Any person who arrives for a board meeting, medication advisory meeting, clinical governance meeting or any other gathering, will be subject to the new restrictions. Even meetings of regular staff within the home are subject to social distancing restrictions.
During these chaotic times, such meetings might be more important than ever and may even have to happen more frequently. You may have to come up with some creative solutions. Consider whether meetings can be held online, via phone linkups or even offsite.
Keep in mind that in the highly regulated aged care industry it’s not enough just to do the right thing – you also have to be able to prove you’ve done it. Some key things you want to make sure you record are:
The threat of COVID-19 is real and frightening, so it’s understandable that homes may want to respond to it with a strict, rigid set of rules, especially if they are understaffed. On the other hand, consumers are not prisoners and they must be provided with choice and treated with dignity and compassion.
There is no simple answer to how a home might find the right balance in this difficult situation, but the starting place will be clear communication. Is there a simple way for consumers to let you know their special circumstances? And is there a way for their concerns to be communicated up the chain to your key decision makers?