COVID-19 update: The Industry Access Code and reasonable restrictions on visits

In our last article, we summarised the changes to the State and Territory aged care Directives in New South Wales, South Australia, Queensland, Victoria, Tasmania and the Northern Territory.

Since our last update:

• there has been a significant outbreak of COVID-19 in Victoria and now, to a lesser extent, in New South Wales;
• the Industry Code on Visiting Residential Aged Care Homes (Code) has been reviewed by consumer and provider groups and a revised version of the Code has been released;
• Victoria and New South Wales have not yet updated their aged care directives in specific response to the outbreak however:
  • the Victorian Government has tightened restrictions on community movement in an attempt to reduce the spread of the virus;
  • other Australian States and Territories have responded by restricting travel from Victoria and most recently from some “hot spots” in NSW ;
  • some providers, including those in Victoria and New South Wales, have taken steps to restrict visitor access to residential aged care services in response to the outbreaks;
  • some providers in New South Wales have also taken steps to restrict access from their facilities to staff who have been known to have attended venues which have been the subject of NSW public health alerts as possible venues where persons with a diagnosis of COVID-19 have been known to attend.
• Western Australia, the Australian Capital Territory and Queensland have issued new aged care directives reflecting relatively minor changes.

We cover these updates in more detail below.

We have also included some commentary on a reasonable provider approach to restricting visits in response to the Victorian and New South Wales outbreaks.

Review of the Industry Code on Visiting Residential Aged Care Homes

The Code was reviewed on 26 June 2020 by consumer and provider groups and a new version was released on 3 July 2020. The updated Code can be accessed .

As summarised in the , the most recent review incorporated:

• feedback from consumers, families, advocates, providers and the public;
•  (dated 19 June 2020) from the AHPPC advice (building on the  from the Communicable Diseases Network Australia); and
• the most recent State and Territory Government Directives for visitors to residential aged care facilities.

The Code continues to emphasise the need for an industry wide response to ensuring residents have an opportunity to receive visitors during the COVID-19 pandemic while minimising the risk of spread of infection to and within the residential aged care home.

The Code continues to emphasise that providers must comply with state and territory emergency and health directives which are legally binding on providers. The Code also reminds providers they must comply with the Charter of Resident Rights and the Aged Care Quality Standards.

A summary of the important changes for providers in the updated version of the Code are detailed below.

Social distancing

Principle 3 has now been amended to include an overarching obligation on providers to ensure that they limit the overall number of people in their facilities to meet social distancing and hygiene requirements.

The Code now specifically provides that all visits are to be conducted in accordance with social distancing and hygiene requirements i.e. 1.5 m between people, good hand washing and a maximum number of people in a building in any one period of time which is determined on a state by state basis.

Providers must have a sign at the front door of the home that clearly designates the number of people that can be in the home at any one time.

Local clusters and Hot Spots

The Code introduces the concepts of ‘Local Clusters’ which is COVID-19 acquired in the local vicinity of the facility.

Principle 3 has been amended to provide that if there is a suspected or actual Local Cluster of COVID-19 in surrounding suburbs or a suspected or known case of COVID-19 within the home, the home may be required to temporarily increase restrictions on visitors. This might include restricting the overall number of visitors, reverting to shorter visits, offering additional ways to connect or where required, temporarily excluding visitors entirely.

The AHPPC recommendations also provide that in the case of a ‘Local Cluster’ it would also be appropriate for the facility to restrict visiting service providers to the home.

The amendments note that if there is a ‘Local Cluster’ and the home needs to increase restrictions, preference should be given for visits for residents who fall in the circumstances set out in Principle 7 (i.e. palliative residents, residents whose families have a long established routine of being involved in their care, residents whose families have travelled long distances for visits and residents with mental health issues).

The latest version of the Code has also been updated to include the concept of a ‘Hot Spot’ in the same way as many of the state and territory directions have.

The Code now provides that in addition to all of the continuing restrictions on visitors entering a home (they must not be unwell, must have a vaccination etc), visitors must not be permitted to enter the home if they have travelled from a designated ‘hot spot’ as determined by the states and territories.

Additional ways to connect

The Code confirms the principle that visits can occur in a number of ways.

The latest version of the Code now makes clear that in a normal period of operation, ‘additional ways to connect’ may be provided as additional or alternatives to visits (not the primary method) but that in periods of enhanced restrictions those additional ways to connect may be used in the place of visits and can include video conferencing, Zoom visits and window contacts. Under the Code ‘additional ways to connect’ means video conference, teleconference and window visits.

The Code now also provides that during an outbreak in the facility or a ‘Local Cluster’, window contacts might become the primary source of contact between residents and visitors for a period of time.

Visits and visiting hours

The latest version of the Code no longer includes any general time limit on visits.

It was a recommendation of the AHPPC that at any one time, each resident still be limited to a maximum of two visitors. While this does not appear in the Code each state and territory direction still limits the number of visits at any one time to a maximum of two visitors. This is a matter of law and providers must comply.

The latest version of the Code emphasises the importance of providers making designated areas (an area for residents and visitors to visit during the pandemic) available for residents who live in a shared room or who do not want to visit with a visitor in their room.

The Code acknowledges that in order to make sure that as many family and friends as possible get to see a resident that booking systems and time restrictions might be necessary.

The updated Code includes new arrangements relating to time limits:

• generally, where time limits need to be applied by a home in response to circumstances, they should be no less than 60 minutes.  If time limits are required they should only be as necessary for in person visits such as in designated visiting areas which are shared between other residents.
• an exception to this general rule is for short visits due to an outbreak, which may be 30 minutes (minimum).
• for consumers with dementia or who fall under Principle 7 the preference is for 60 minutes to be the time limit if the home has implemented increased restrictions (except of short visits implemented due to an outbreak). These visits may also have priority access to designated visiting areas.

The Code now:

• recognises that volunteers from the Community Visitors Scheme are a type of visitor under the Code. This is to ensure that residents can continue to access the community visitors scheme; and
• acknowledges that the home can specify limits to visiting hours. I.e. if there is an outbreak at the home and/or a ‘Local Cluster’ of COVID-19 in surrounding suburbs this may necessitate a return to shorter visiting hours.

Principle 7 – Circumstances requiring additional social supports

There a now 4 categories of residents which are considered to require additional support. They are as follows:

• palliative residents
• residents whose families have a long established routine of being involved in their care
• residents whose families have travelled long distances for visits
• residents with mental health issues

These residents are to be given priority in the following circumstances:

• in the event of a suspected or actual cluster or a suspected or known case which necessitates a reduction in the overall number and length of visits;
• where a time limit needs to be applied to a visit of no less than 60 minutes in the event that restrictions have to be increased at the home in the event of an outbreak or suspicion of an outbreak (as outlined above).
• in providing access to designated areas where visits can-not occur in the resident’s room.

Offsite access to medical and related services

The Code confirms that providers should make sure that residents get access to the right medical and related services whether that be via telehealth or off site.

The Code now emphasises that the screening processes should be proportionate to the risk and that quarantine and self-isolation on return to site should only occur if directed by the public health unit or upon the recommendation of the discharging medical practitioner.

External outings

There are new provisions in the Code which contemplate external outings and small family visits for residents ‘where these can be conducted in a safe manner’.

These changes are consistent with amendments that have been made to directions that had existed in some states which placed restricted residents rights to leave the home. These directions have been lifted in all states.

The Code now states that theses outings can safely occur where there is appropriate infection control mechanisms in place and agreement with the family to provide accurate information and engage in risk management procedures while on the outing and screening on return.

Providers are expected to provide information to families about their expectations in relation to outings and providers can reasonably expect residents and families to document their agreement to those procedures.

Update to border restrictions, identified ‘hotspots’ and the likely impact on visits   

The Code confirms that visitors who have recently travelled from a COVID-19 ‘Hot Spot’ (as determined by the State or Territory health authority) should not attend an aged care home.

Each State and Territory has its own approach to managing border restrictions and the risk associated with identified ‘Hot Spots’.

We have set out below (at the time of writing) the relevant border restrictions and identified ‘Hot Spots’ as well as a likely (and reasonable) potential approach that providers might be expected to take to restrict visits in response to current conditions.

Providers should frequently review the border restrictions, ‘Hot Spots’ and state directions and adapt visitor screening processes as needed.

Most jurisdictions provide an exception to the border restrictions for persons travelling from Victoria if the travel is necessary on compassionate grounds, for example to visit a terminally ill member of the person’s immediate family. If you have a visitor who has been in a ‘Hot Spot’ or in Victoria in the last 14 days, and they are seeking to visit a palliating resident, special care should be taken to review the relevant State/Territory directives and adopt an approach that is compassionate to the family member but considerate of resident and staff safety.

Restricting access in response to an actual or suspected outbreak 

The evolving situation in Victoria and now New South Wales is leading many providers to revisit their approach to visitor management. When determining an appropriate approach to visitor access, it is clear that a proportionate response should be adopted in response to the changing conditions within and around the aged care service.

We have set out some of the factors we suggest providers consider when seeking to impose increased restrictions on visitor access:

If there is a suspected or local cluster of COVID-19 in surrounding suburbs, providers should assess the risk and take proportionate action. Principle 3 of the Visitor Code suggests such action may include:

• restricting the overall number of visitors, reverting to shorter visits, only offering additional ways to contact; or
• where required, temporarily excluding visitors entirely, however the Department of Health’s position is that a total lockdown should be implemented only as a last resort.

If there is an actual outbreak in the home, totally excluding all visitors may be a reasonable and appropriate approach to minimise the risk to residents and the community. However the Code and the Department have made clear that any total exclusion of visitors should be temporary.

Providers should give consideration to the wishes and preferences of residents, unless visitors are strictly prohibited under state/territory directives.

Providers should provide regular and responsive communication to representatives and family members to ensure these groups are kept informed.

If your service requires advice in relation to managing the issues associated with an outbreak or a ‘Local Cluster’ we can assist.

Updates to aged care directives

The following table sets out the updated key dates and links to the applicable directions. These are changing rapidly therefore we suggest you check local requirements.

Victoria and New South Wales

As yet, there has been no change to the relevant aged care directives in either Victoria New South Wales responding to the latest outbreak. We anticipate that updates are imminent.

Western Australia

Western Australia’s latest directive came into force on 8 July 2020.

Consistent with the changes adopted across the other jurisdictions, Western Australia’s latest direction removes the restrictions on the number and length of care and support visits to a particular resident per day.

Although the directive broadly eases restrictions involving visits, it includes two new important provisions:

• A catch all that requires all visitors who enter to comply with the reasonable directions of the provider; and
• A requirement that a service provider should not come into the facility to provide a service to a resident if that service can be provided person via telehealth or some other adaptive model of care.

The direction has also been updated to provide a person who does not have an up to date influenza vaccination is able to enter the premises of a residential aged care facility if that person has a documented medical contraindication to an influenza vaccination.

Australian Capital Territory

The ACT’s latest directive came into force on 26 June 2020.

Consistent with the changes adopted in the other jurisdictions, the latest direction eases the restrictions on care and support visits. The direction now provides there is no time limit on care and support visits with the resident’s spouse close family or relative. There is still however a time limit of 2 hours on these visits by service providers. Care and support visits are still limited to a maximum or two people per resident at the same time.

Queensland

Queensland’s latest directive came into force on 10 July 2020.

The latest directive eases restrictions on visitor numbers for end of life visits. For end of life visits, more than two visitors may visit a resident at one time. Care and support visits other than an end of life visit are still restricted to a maximum of two visitors at a time per resident.

Further information

If you have any questions in relation to these changes or you need assistance in relation to managing an actual or suspected outbreak, please contact a member of our National Aged Care and Retirement Villages team.