Aged Care Essentials Article | COVID-19 Testing and Isolation Rules

Written by Mark Bryan | 18/01/2022

The rules on COVID-19 testing and isolation are changing rapidly as the Commonwealth, state/territory governments, as well as local public health units (PHUs) struggle to respond to the spread of the Omicron variant. Today we summarise the rules as they are on 18 January 2022, and, more importantly, point you to some key sources to help you stay up to date.

Key Points

A person with symptoms of COVID-19 must test and isolate until they receive the results of their test. If the test is positive, they must isolate for at least seven days.
See state/territory information below for advice on when to use a Polymerase Chain Reaction (PCR) test versus a Rapid Antigen Test (RAT).
A person who is a “close contact” of a confirmed COVID-19 case must test and isolate for at least seven days. In most cases, this person must isolate for seven days even if they have no symptoms and even if they receive a negative test result. There are some exceptions for aged care workers.
There is a general definition of “close contact” and a separate definition that applies to aged care workers.
There are Commonwealth rules on testing and isolation, and there are state/territory rules. These two sets of rules are not always consistent.
In all states/territories except Western Australia, a person who tested positive or is a close contact must avoid “high risk settings” (including aged care homes) for several days* after leaving isolation. This rule does not apply to aged care workers, but in most states/territories it does apparently apply to residents, which is probably an oversight. (*Seven days under Commonwealth rules. Three days in some states/territories. See state/territory information below).
The terms “isolate”, “quarantine” and “stay at home” are sometimes used interchangeably and the differences among them (if any) are not clearly defined.
The information in this article is correct as at 18 January 2022. After that date, the rules may have changed. See the “More information” links below.

Testing and Isolation/Quarantine Rules

Commonwealth

These are the national rules. Current information suggests that these rules apply in every state/territory except Western Australia. All aged care providers except those in Western Australia should try to follow these rules as well as the rules in their state/territory. If this is impractical, seek advice from your state/territory department of health via the links below or discuss with your local PHU.

Aged Care Worker Who Has Symptoms or is a Close Contact

Definition of “Close Contact (Aged Care Worker)”

For aged care workers, a special definition of “close contact” applies under the Commonwealth Permissions and Restrictions Framework for Workers in Residential Aged Care Facilities – Interim Guidance.

If a worker has been exposed to COVID-19 in a household or household like setting (other than the workplace):

The worker is a close contact if they spent four hours or longer in a household or “household-like” setting with someone confirmed to be COVID-19 positive.

If a worker has been exposed to COVID-19 in the workplace:

The worker is a “close contact” only if they:

were not wearing airborne precautions PPE (N95/P2 masks, eye protection, gowns, and gloves) where aerosol generating behaviours or procedures have been involved
have had at least 15 minutes face to face contact where both mask and eyewear were not worn by exposed person and the case was without a mask
have spent greater than 2 hours within the same room with a case during their infectious period, where masks have been removed for this period.

Testing and Isolation/Quarantine

The following applies to staff who are close contacts and staff who have COVID-19 symptoms:

The managers of the aged care service, in collaboration with their local PHU must conduct a risk assessment in regard to the impact of staff absences on the service.

If the impact of absent staff on the service is low:

Immediately quarantine close contacts and symptomatic staff for 7 days.
Day 1-2 and 6 RAT test
Return to work (RTW) when day 6 test result returns negative and asymptomatic.
Continue to monitor for symptoms for a further14 days
Apply additional requirements on RTW as below.

If the impact of absent staff on the service is high:

If symptomatic and unwell immediately quarantine and take RAT test. If positive, isolate for 7 days. If negative:

Day 1-2 and Day 6 RAT test.
RTW when day 6 test result returns negative.
Apply additional requirements below.
Continue to monitor for symptoms for further 14 days.

If asymptomatic:

Continue to work with negative Day 1 RAT.
RAT test every working day, until Day 6-7 result clear (prior to commencement of workday).
Monitor for symptoms, test, and isolate immediately if symptoms develop.

Additional requirements

Work in P2/N95 respirator for the first 7 days following exposure.
No shared break areas.
Limit work to a single site/area.
Continue to quarantine in community until cleared or negative test day 6-7, travel to work via own transport or individual ride share following a negative RAT.

Person with COVID-19 Symptoms (Who is Not a Close Contact) Note: this section does not apply to aged care workers.
Initial Testing and Isolation/Quarantine	Get tested and isolate until you receive the results of the test. The Commonwealth rules are inconsistent and unclear about whether you need to attend a clinic to be tested or can self-test via RAT. Follow the rules in your state/territory.
Negative Result	You do not need to isolate or quarantine. However, if you feel unwell you should follow your workplace policies and consider whether it is appropriate for you to attend work.
Positive Result	Isolate at home for at least 7 days from the day you had your test. If you have symptoms at Day 6, you must stay at home until symptoms are gone. If you have no symptoms at Day 7, you can return to normal living and leave your home. You do not need a further test.
Additional Considerations for Aged Care Homes	After leaving isolation anyone who is not an aged care worker should wear a mask when leaving the home and avoid visiting high-risk settings (including aged care homes) for at least 7 days following negative test or end of symptoms. Technically, this rule applies to aged care residents, but this is probably an oversight.

“Close Contact” With COVID-19 Symptoms Note: this section does not apply to aged care workers.
Definition of “Close Contact”	A close contact is a person who has spent four hours or longer in a household or “household-like” setting (such as an aged care home) with someone confirmed to be COVID-19 positive.
Initial Testing and Isolation/Quarantine	Take a RAT self-test or PCR test. Stay home for 7 days since you last had contact with the person who has COVID-19.
Negative Result	Continue isolation. On Day 6 of isolation, take a RAT self-test. If your Day 6 test is negative, you can leave home and return to normal living after completing the 7 days of home isolation. If you test positive for COVID-19 follow the instructions under “Positive Result” below.
Positive Result	Isolate at home for at least 7 days from the day you had the test. If you have symptoms at Day 6, you must stay at home until symptoms are gone. If you have no symptoms at Day 7, you can return to normal living and leave your home. You do not need a further test.
Additional Considerations for Aged Care Homes	After leaving isolation anyone who is not an aged care worker should wear a mask when leaving the home and avoid visiting high-risk settings (including aged care homes) for at least 7 days following negative test or end of symptoms. Technically, this rule applies to aged care residents, but this is probably an oversight.

“Close Contact” Without COVID-19 Symptoms Note: this section does not apply to aged care workers.
Definition of “Close Contact”	A close contact is a person who has spent four hours or longer in a household or “household-like” setting (such as a workplace) with someone confirmed to be COVID-19 positive.
Initial Testing and Isolation/Quarantine	Monitor for symptoms. If symptoms develop, take a RAT self-test or PCR test. Stay home for 7 days since you last had contact with the person who has COVID-19.
Negative Result	Continue isolation. On Day 6 of isolation, take a RAT self-test. If your Day 6 test is negative and you have no symptoms, you can leave home and return to normal living after completing the 7 days of home isolation. If you test positive for COVID-19 follow the instructions under “Positive Result” below.
Positive Result	Isolate at home for at least 7 days from the day you had the test. You do not need to confirm the results of the RAT with a PCR. If you have symptoms at Day 6, you must stay at home until symptoms are gone. If you have no symptoms at Day 7, you can return to normal living and leave your home. You do not need a further test.
Additional Considerations for Aged Care Homes	After leaving isolation anyone who is not an aged care worker should wear a mask when leaving the home and avoid visiting high-risk settings (including aged care homes) for at least 7 days following negative test or end of symptoms. Technically, this rule applies to aged care residents, but this is probably an oversight.

More Commonwealth information: https://www.health.gov.au/health-alerts/covid-19/testing; https://www.health.gov.au/health-alerts/covid-19/testing-positive; https://www.health.gov.au/resources/publications/covid-19-test-isolate-national-protocols; Commonwealth Permissions and Restrictions Framework for Workers in Residential Aged Care Facilities – Interim Guidance.

Australian Capital Territory (ACT)

Follow the Commonwealth rules and keep in mind these additional considerations:

In the ACT a “close contact” is also referred to as a “household contact”.
When testing, you may use either a PCR or RAT.
If you are a close contact, you must report this to the ACT Government via the Online Declaration Form.
For close contacts, Day 0 of isolation is the day when the confirmed COVID-19 case received their positive test result.
If you test positive to a RAT, you must report this to the ACT Government via the Online Declaration Form.
Anyone who tests positive should avoid high risk settings such as aged care homes for three days after leaving isolation. This does not apply to residents of aged care homes but appears to apply to workers. It is not clear if this is a rule or a recommendation.
It is recommended that close contacts avoid high risk settings such as aged care homes for seven days after leaving isolation. But it is not required.

More ACT information: https://www.covid19.act.gov.au/stay-safe-and-healthy/symptoms-and-getting-tested/when-to-get-tested; https://www.covid19.act.gov.au/stay-safe-and-healthy/exposed-to-covid19; https://www.covid19.act.gov.au/travel/online-travel-forms#Declaration-form; https://www.covid19.act.gov.au/stay-safe-and-healthy/recovering-from-covid-19.

Northern Territory (NT)

Follow the Commonwealth rules and keep in mind these additional considerations:

When testing, you may use either a PCR or RAT.
If you test positive to a RAT, you must report this to the NT Government via the Online Declaration Form.
For people who test positive, the length of the isolation period depends on whether you are fully vaccinated or unvaccinated. Fully vaccinated people must isolate for seven days. Unvaccinated people must isolate for 10 days. (It’s not clear how the rules deal with partially vaccinated people).
For close contacts, the length of the isolation period depends on whether you are fully vaccinated or unvaccinated. Fully vaccinated close contacts must isolate for seven days. Unvaccinated close contacts must isolate for 14 days. (It’s not clear how the rules deal with partially vaccinated people).
Anyone who tests positive in the NT must not enter a risk facility such as an aged care home for seven days after leaving isolation. This rule only applies to people who test positive. If you are a close contact who did not test positive, you may enter an aged care home immediately after your isolation.

More NT information: https://coronavirus.nt.gov.au/stay-safe/living-with-covid-19/covid-19-positive; https://coronavirus.nt.gov.au/stay-safe/living-with-covid-19/close-contacts; https://forms.nt.gov.au/Produce/wizard/446c9d91-ac59-41de-bf55-5f15b5c4da12/?prepared=true&logGuid=3bc58ebd-40d2-4ef7-ba8d-290a76a08e10.

New South Wales (NSW)

Follow the Commonwealth rules and keep in mind these additional considerations:

In NSW a “close contact” is also referred to as a “household contact”.
The NSW Government appears to prefer people use RAT and not PCR unless they are particularly vulnerable (e.g., pregnant, immunocompromised, Aboriginal or Torres Strait Islander).
If you test positive to a RAT, you must report the result via Service NSW.
NSW advises: “For three days after leaving isolation, wear a mask when near to or talking to other people and avoid visiting high risk settings (health care, aged care, disability care or correctional facilities). If you work in one of these settings speak to your employer before returning.” It’s not clear if this is a recommendation or a requirement.

In addition to these considerations, bear in mind the advice in the NSW protocol on the use of PCR and RAT testing in residential aged care homes, including:

A resident who receives a positive RAT, and who is the first case at the facility, will require a confirmatory PCR test if they have no symptoms OR have no other exposures. Whilst awaiting the PCR result, or if the resident is symptomatic, RAT testing should be undertaken for all residents and staff in the impacted area of the facility based on a risk assessment. For example this may be a specific wing within the facility or the whole facility where the facility is a small facility or impacted residents have access to other areas.
On a receipt of a positive RAT, in a resident, and while waiting on the PCR test results, the aged care home should activate their outbreak management plan.
If a negative PCR test result is returned for the tested resident, an outbreak response is not required.

More NSW information: https://www.health.nsw.gov.au/Infectious/factsheets/Pages/people-exposed-to-covid.aspx; https://www.health.nsw.gov.au/Infectious/factsheets/Pages/racf-testing.aspx; https://www.health.nsw.gov.au/Infectious/factsheets/Pages/advice-for-confirmed.aspx.

Queensland (QLD)

Follow the Commonwealth rules and keep in mind these additional considerations:

If you have symptoms or are a close contact, use a RAT. Use a PCR only if you cannot get a RAT.
In QLD a “close contact” is also referred to as a “household contact” or “household-like” contact.
Close contacts should get tested only if they have COVID-19 symptoms.
For close contacts, it is not clear whether Day 0 of isolation begins when you learn that you are close contact or on the day the diagnosed person received their positive test result.
If you test positive to a RAT, you must report the results here.

More QLD information: https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/stay-informed/testing-and-fever-clinics; https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/current-status/public-health-directions/confirmed-cases-and-close-contacts/close-contacts; https://www.qld.gov.au/health/conditions/health-alerts/coronavirus-covid-19/current-status/public-health-directions/aged-care.

South Australia (SA)

Follow the Commonwealth rules and keep in mind these additional considerations:

In SA, the definition of “close contact” is different. See below.
A person who has symptoms but is not a close contact should PCR test.
Close contacts should use a RAT. If a RAT is not available, use PCR.
Anyone who tests positive must isolate for 10 days.
Anyone who tests positive to a RAT must report to SA Health.
If you are a close contact, you can access a kit of two free rapid antigen tests to complete your required test. You must register before collecting your kits from the RAT Collection Point.

SA Definition of “Close Contact”

In SA a “close contact” is defined as:

a household member or intimate partner of a person with COVID-19 during their infectious period
someone who has had close personal interaction with a person with COVID-19 during their infectious period:
- for 15 minutes or more and
- where masks are not worn by the person and the COVID-19 case and
- in close physical proximity and
- in an indoor setting
someone who has been notified by SA Health that they are a close contact
someone who has been to an exposure site listed on the SA Health website.

People with COVID-19 are considered infectious two days before their symptoms started or if they didn’t have any noticeable symptoms, they are considered infectious two days before they had their positive COVID-19 test taken. The infectious period ends 10 days after they had their positive test taken.

As cases increase, some close contacts may not receive an SMS from SA Health. If you know you are a close contact, please do not wait to be contacted – get tested and quarantine immediately.

More SA information: https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/covid-19/testing+and+tracing/close+contacts; https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/covid-19/testing+and+tracing/testing+for+covid-19; https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/covid-19/testing+and+tracing/close+contacts; https://forms.sa.gov.au/#/form/61d8bc18ad9c585180ab5454/app/61e4b0404d4331c0b4844069.

Tasmania (TAS)

Follow the Commonwealth rules and keep in mind these additional considerations:

Use a RAT unless you fall into a category of people advised to get PCR (e.g., people with immunodeficiency).
Rapid antigen tests (RAT) are available for free for anyone who is symptomatic, a close contact of a confirmed case or has been directed by Public Health to take one. Eligible people who require a RAT kit need to register their details via the online registration form.
Anyone who tests positive to a RAT must register the result via the online declaration form.

More TAS information: https://www.coronavirus.tas.gov.au/keeping-yourself-safe/testing-for-covid-19; https://www.coronavirus.tas.gov.au/keeping-yourself-safe/testing-for-covid-19/types-of-covid-19-tests;

Victoria (VIC)

Follow the Commonwealth rules and keep in mind these additional considerations:

The Victorian Government advises that everyone’s first option should be a RAT.
In VIC a “close contact” is also referred to as a “household contact” or “household-like” contact.
Anyone who receives a positive RAT result must report it via the online form or Coronavirus Hotline. For more information see here.

More VIC information: https://www.coronavirus.vic.gov.au/getting-tested; https://www.coronavirus.vic.gov.au/checklist-contacts; https://www.health.vic.gov.au/covid-19/current-covid-19-residential-aged-care-restrictions.

Western Australia (WA)

WA has its own definition of “close contact” (see below) and its own approach to testing and isolation, separate from the Commonwealth rules. Under this approach:

anyone who has symptoms or has visited an exposure site must get tested at a COVID clinic. Current information suggests that WA clinics use only PCR tests
the Western Australian Department of Health will then advise that person about their quarantine requirements
the Department will also conduct contact tracing and advise any close contacts about their quarantine requirements.

For advice, contact your PHU or the Residential Care Line on 6457 3146.

More WA information: https://www.healthywa.wa.gov.au/Articles/A_E/Coronavirus/COVID19-testing; https://www.healthywa.wa.gov.au/Articles/A_E/Coronavirus/Contact-tracing-for-COVID19; https://www.wa.gov.au/government/covid-19-coronavirus/covid-19-coronavirus-what-you-can-and-cant-do#GetTested.

WA Definition of “Close Contact”

In WA a close contact is:

a person who has had face-to-face contact OR shared a close space, for any amount of duration, with someone who has been diagnosed with COVID-19 (while they were considered infectious)
a person who has been in an area where there is a high prevalence of COVID-19 infection or has been in a venue when COVID-19 transmission was occurring.

If you're confirmed as a close contact, the contact tracer will talk to you about needing to quarantine.

Summary – Practical Tips

While this article has provided support in outlining the current rules on COVID-19 testing and isolation, we are all aware that it continues to be a rapid and everchanging environment. To help you apply this information in the everyday practices of your aged care facility, here are some practical tips to consider:

Have you updated policies and procedures where practices are changed and need to be followed by staff?
Consider the best way to communicate to staff and other stakeholders (including consumers and their representatives) the changing information, particularly where interim guidelines are provided and need to be followed.
Consider your wider information system and the best way to provide ongoing information about changes, and record your communications. Consider the value in providing key information in different ways to support everybody’s understanding. Consider how current policies and procedures support these changes and what key organisation committees and personnel need to be involved (e.g. IPC Leads need to be involved).
Staff learning and linked competencies need to reflect and support the current rules on COVID-19 testing, required procedures and outbreak management. This should be part of your overall infection prevention and control planning, especially across the pillars related to preparedness, prevention and outbreak management.

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