nsw and commonwealth joint aged care emergency response
TRANSCRIPT
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NSW and Commonwealth Joint
Aged Care Emergency Response
Plan for COVID-19 in Residential
Aged Care Facilities
Version 2.0
cover
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Acknowledgment
The Plan was prepared by representatives from the
NSW Ministry of Health (SHEOC Aged Care) and the
Commonwealth Department of Health (NSW/ACT
Health Grants Network, Aged Care Risk and Regulation
Team) with the collaboration of the NSW Ministry of
Health. Clinical Excellence Commission, HealthShare
NSW, Commonwealth Department of Health, Aged
Care Quality and Safety Commission, Home Affairs and
the Australian Defence Force.
Revision History
This Plan is a living document, which will be reviewed and revised as required.
Version Date Changes
1.0 19/03/2021 Initial Release
2.0 14/04/2021
23/06/2021
Reference to the COVID-19 National Plan AUS-CAIRS – updated wording Commonwealth Clinical First Nurse Responder – updated wording Updates to the Commonwealth workforce service offer Amendment to the Commonwealth’s service offer for Primary Care Plan endorsed by Dr. Brendan Murphy, CMO, Commonwealth Dept. of Health
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Contents Revision History ........................................................................................................................... 3
Section 1: Context ........................................................................................................................ 7
Purpose ............................................................................................................................................... 7
NSW and Commonwealth Joint Approach .......................................................................................... 7
Emergency Response Planning ........................................................................................................... 7
Figure 1: NSW Health and Commonwealth Joint Planning .................................................................. 8
Plans for the joint management of COVID-19 within RACFs in NSW .................................................. 8
Figure 2: Relationship of Plans for Managing COVID-19 in RACF ......................................................... 9
Section 2: Governance ................................................................................................................ 11
Key Stakeholders and Roles and Responsibilities ............................................................................. 11
Emergency Response Key Stakeholders............................................................................................ 12
Figure 3: Key stakeholders for managing COVID-19 outbreaks in RACFS .......................................... 12
Joint Governance .............................................................................................................................. 13
Figure 4: Joint protocol governance ................................................................................................... 13
Command, Control and Communication .......................................................................................... 14
Figure 5: Coordinated interagency response to COVID-19 within RACFs in NSW – Command and
Control Structure ................................................................................................................................ 14
Interagency Communication ............................................................................................................. 15
Section 3: Operational Intelligence ............................................................................................. 17
RACF Outbreak Categorisation ......................................................................................................... 17
Table 1: Categories of outbreaks ........................................................................................................ 17
Figure 6: Progression of outbreak categories..................................................................................... 17
AUS-CAIRS ......................................................................................................................................... 18
Section 4: Operational Response ................................................................................................ 20
Lines of Operation ............................................................................................................................. 20
Figure 7: Lines of operation – decision tree ....................................................................................... 20
Joint Response Escalation Pathways ................................................................................................. 21
Figure 8: Joint response escalation pathways .................................................................................... 21
Section 5: Service Offers ............................................................................................................. 23
Service Offers .................................................................................................................................... 23
Table 2: Service Offers ........................................................................................................................ 23
Commonwealth – Case Manager ...................................................................................................... 23
Commonwealth – Clinical First Nurse Responder ............................................................................. 23
Requesting other forms of Commonwealth assistance .................................................................... 24
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Service Offer 1: Access to timely and accurate testing ..................................................................... 25
Service Offer 2: Access to appropriate personal protective equipment (PPE) ................................. 26
Service Offer 3: Access to appropriate clinical waste management ................................................. 27
Service Offer 4: Access to food to maintain nutritional care needs of residents ............................. 28
Service Offer 5: Access to hospitality services - Linen ...................................................................... 28
Service Offer 6: Access to sufficient surge workforce ...................................................................... 29
Service Offer 7: Access to General Practice Service to maintain continuity of care ......................... 30
Service Offer 8: Provision of timely communication with residents and families ............................ 31
Service Offer 9: Provision of timely media support .......................................................................... 32
Section 6: Recovery .................................................................................................................... 34
Appendix 1: Joint Military Appreciation Process.......................................................................... 37
Figure 9: Joint Military Appreciation Process ..................................................................................... 37
Appendix 2: Templates ............................................................................................................... 38
Template 1: Outbreak Management Team Standing Agenda and Action List .................................. 38
Template 2: Aged Care Emergency Response Operational Update ................................................. 39
Template 3: Standards and Logistical Support Team ........................................................................ 40
Template 4: Senior Intergovernmental Oversight Group ................................................................. 42
Appendix 3: Terms of Reference ................................................................................................. 44
Standards and Logistical Support Team ............................................................................................ 44
Senior Intergovernmental Oversight Group ..................................................................................... 46
Appendix 4: Lines of Operation – decision point criteria .............................................................. 48
Section 1: Context
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Section 1: Context
Purpose
The NSW and Commonwealth Joint Aged Care Emergency Response (JACER) Plan for COVID-19 in
Residential Aged Care Facilities (RACFs) has been prepared by representatives of the NSW State
Health Emergency Operations Centre (SHEOC Aged Care) and the Commonwealth Department of
Health.
The JACER outlines the resources, triggers and pathways for the provision of a coordinated NSW and
Commonwealth emergency response to outbreaks of COVID-19 in RACFs.
NSW and Commonwealth Joint Approach
RACFs are high-risk for outbreaks of COVID-19 when community transmission occurs. This can lead
to significant morbidity and mortality of the vulnerable elderly population who reside in these
settings. In August 2020 National Cabinet agreed that each state and territory establish a joint and
coordinated Commonwealth and State/Territory Government approach to strengthen aged care
preparedness and capacity to respond to a rapid escalation of COVID-19 in the aged care sector.
The importance of a coordinated whole of government response, with clear roles, responsibilities
and escalation pathways has been highlighted in lessons learned from the Victorian Aged Care
Response Centre and COVID-19 outbreaks in aged care across Australia as well as the Royal
Commission into Aged Care Quality and Safety’s Aged care and COVID-19: a special report. The
Australian Government’s Guide to Establishment of an Aged Care Health Emergency Response
Operations Centre and the National COVID-19 Aged Care Plan (7th Edition) complement existing
emergency response planning for the aged care sector and provide a nationally consistent approach
to the establishment and operation of an Aged Care Emergency Response Operations Centre.
Emergency Response Planning
The SHEOC Aged Care (SHEOC AC) team was established within the State Health Emergency
Operations Centre in August 2020 to lead the operational planning and to coordinate and escalate
NSW Health’s emergency response capability to COVID-19 in RACFs with the aim of containing and
controlling the outbreak to bring it to an end as quickly and safely as possible.
To ensure the fast mobilisation of a coordinated government response, SHEOC AC undertook two
joint planning workshops with the Commonwealth Government in October and November 2020. The
JACER Plan workshop held in November 2020, utilised the Australian Defence Force, Joint Military
Appreciation Process (JMAP) planning tool (see Appendix 1). The JMAP is a planning tool traditionally
used by the ADF to plan complex operations involving two or more parties. With its focus on joint
operations, the five-step process was well suited to developing the NSW and Commonwealth
emergency response in residential aged care.
The joint planning timeline is at Figure 1.
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Figure 1: NSW Health and Commonwealth Joint Planning
June 2020
NSW MoH and the Commonwealth DoH formalise the coordination of government support to residential aged care providers managing a COVID-19 outbreak. Protocol to support joint management of a COVID-19 outbreak in a residential aged care facility (RACF) in NSW (NSW Joint Protocol)
Aug 2020
National Cabinet agreed for each state and territory establish a joint and coordinated Commonwealth and State/Territory Government approach to aged care preparedness and response to COVID-19 in the aged care sector. Release of: Guide to establishment of an aged care health emergency response operations centre.
Aug 2020 Establishment of the SHEOC Aged Care team to lead the operational planning and
support to coordinate and escalate NSW Health’s emergency response capability to COVID-19 within residential aged care facilities NSW Health – SHEOC Aged Care
Oct 2020
SHEOC AC host workshop with representatives from MOH and the Commonwealth Government to agree on governance & roles and responsibilities to progress joint planning and preparedness
Nov 2020
The National COVID-19 Aged Care Plan (7th edition) updated to guide the ongoing response to COVID-19 in aged care and provide the framework to support the aged care sector (residential and home-based care) to prevent, prepare, respond and recover from COVID-19
Nov – Dec 2020
NSW/Commonwealth Joint Planning exercise for a coordinated whole of government emergency response to COVID-19 within RACF (including representatives from SHEOC AC, Commonwealth DoH, Department of Home Affairs and ADF)
Plans for the joint management of COVID-19 within RACFs in NSW
Protocol to support joint management of a COVID-19 outbreak in a residential aged care facility in
NSW formalises the coordination of government support to an aged care approved provider in their
management of a COVID-19 outbreak in a Commonwealth funded RACF in NSW.
NSW Incident Action Plan for a Public Health Response to a Confirmed Case of COVID-19 in an
Aged Care Facility guides the public health response to prevent further transmission by rapidly
supporting RACFs with clear public health advice after a confirmed case of COVID-19 is identified
associated with a RACF.
State Health Emergency Operations Centre Aged Care Emergency Response Operational Plan
outlines the coordinated provision of support for residential aged care in the event of a COVID-19
outbreak through the through the State Health Emergency Operations Centre (SHEOC).
Local Health District RACF Outbreak Management Plans guide the local response in the event of a
COVID-19 outbreak in a RACF.
NSW and Commonwealth Joint Aged Care Emergency Response (JACER) Plan for COVID-19 in
Residential Aged Care Facilities outlines the resources, triggers and pathways for the provision of a
coordinated NSW and Commonwealth emergency response to outbreaks of COVID-19 in residential
aged care facilities (RACFs).
RACF Outbreak Management Plans guide a facility’s management of an outbreak. The primary
responsibility for managing COVID-19 outbreaks lies with the RACF. All RACFs should have an
outbreak management plan to support preparation, planning and testing for a COVID-19 outbreak.
See Figure 2 below for the relationship between the Commonwealth, State, LHD and RACF plans.
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Figure 2: Relationship of Plans for Managing COVID-19 in RACF
Section 2: Governance
Section 2: Governance
Key Stakeholders and Roles and Responsibilities
Stakeholders from NSW Health and the Commonwealth have key roles and responsibilities in
responding to a COVID-19 outbreak in RACFs, see Figure 3 below. In summary:
NSW Health has the role of providing public health and clinical operations advice in the
management and prevention of infectious diseases as well as specialist health care to residents of
aged care facilities when they need it. This is managed through Public Health Units (PHUs), Local
Health Districts (LHDs), the Public Health Response Branch (PHRB) the Clinical Excellence
Commission (CEC) and the State Health Emergency Operations Centre (SHEOC).
The SHEOC is responsible for co-ordinating and escalating the NSW Health emergency response
capability to COVID-19 within a RACF. This includes surge requirements for workforce, personal
protective equipment, waste management, testing, infection, prevention and control and cohorting
and liaising with key NSW and Commonwealth stakeholders.
The Australian Government (Department of Health and the Aged Care Quality and Safety
Commission) has responsibility for and regulates residential aged care under the Aged Care Act 1997
and the Aged Care Quality and Safety Commission Act 2018. The Commonwealth also has a role in
protecting aged care sector needs, ensuring they are considered in the event of a state of
emergency.
The Aged Care Quality and Safety Commission also leads the assessment of preparedness of
residential aged care providers to respond to outbreaks of COVID-19, in addition to fulfilling its usual
regulatory and compliance functions.
Aged care providers are expected to comply with their responsibilities under relevant legislation to
support the safety, care and wellbeing of aged care recipients. The Aged Care Act 1997 (the Act) and
associated Aged Care Principles, and the Aged Care Quality and Safety Commission Act 2018, set out
the legislative framework for the funding and regulation of aged care.
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Emergency Response Key Stakeholders
Stakeholders from NSW Health and the Commonwealth have key roles and responsibilities in responding to a COVID-19 outbreak in RACFs as outlined in
Figure 3.
Figure 3: Key stakeholders for managing COVID-19 outbreaks in RACFS
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Joint Governance
The Protocol to support joint management of a COVID-19 outbreak in a residential aged care facility in NSW outlines the governance structures
to be activated at the declaration of an outbreak in a RACF. The governance structure is outlined in Figure 4.
Figure 4: Joint protocol governance
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Command, Control and Communication
A coordinated inter-agency response to COVID-19 within NSW RACFs is required, therefore the chain of command below (Figure 5) has been established to
provide clear chains of command and lines of communication.
Figure 5: Coordinated interagency response to COVID-19 within RACFs in NSW – Command and Control Structure
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Interagency Communication
In order to ensure effective communication and information flows between the organisations
involved in the emergency response to COVID-19 within RACFs, primary points of contact have been
designated for NSW Health and for the Commonwealth.
The designation of the primary points of contact supports a coordinated emergency response
through streamlined communication. There may be some situation specific exceptions to the use of
these primary points of contact.
SHEOC Aged Care
SHEOC Aged Care is the primary point of contact for Commonwealth agencies wanting to
communicate with NSW Health.
Primary contact:
• Director, SHEOC Aged Care [email protected]
Secondary contact:
• SHEOC Duty Officer: [email protected]
• After hours: (02) 9461 7080
Commonwealth Department of Health – NSW/ACT
The Commonwealth Department of Health has offices in each state and territory, representing the
Department on a state and territory level.
In the context of COVID-19 outbreaks in RACFs, the Department of Health NSW/ACT Office works
collaboratively with the overall management of the response to support the viability and capacity of
RACFs to access a range of Commonwealth services.
The NSW / ACT State Manager, Department of Health, is the primary point of contact for NSW
Health agencies wanting to communicate with the Commonwealth.
Primary contact:
• Lisa Peterson, NSW/ACT State Manager [email protected].
Section 3: Operational Intelligence
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Section 3: Operational Intelligence
RACF Outbreak Categorisation
A common terminology has been agreed for reporting and communication purposes and is used to
designate a risk rating to RACFs based on the status of their outbreak. Each RACF will be assigned a
category (see Table 1), and the categorisation will be revised based on the progression of the
outbreak. Figure 6 shows the progression of outbreak categories.
Table 1: Categories of outbreaks
Category Criteria/trigger
CAT 3 Critical outbreak
• Active outbreak, and
• = or >72 hours since first case, and • One or more of the following triggers:
⮩ Rapid deterioration of the situation
⮩ The provider does not demonstrate capability to effectively lead and manage the outbreak response
⮩ The RACF premises are unsuitable to manage the outbreak effectively ⮩ The Local Health District does not have capacity to provide a clinical
outreach response ⮩ Any other issue impacting on the effective management of the
outbreak.
CAT 2 Ongoing outbreak
• Active outbreak, and • = or >72 hours since first case
CAT 1 New outbreak
• Active outbreak, and • <72 hours since first case
CAT 0 Nil outbreak
• No active outbreak, or • 14 days since commencement of enhanced surveillance
Enhanced surveillance • 14 days of nil transmission, and • PHU declared outbreak closed
Figure 6: Progression of outbreak categories
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AUS-CAIRS
AUS-CAIRS is an incident management system (IMS) implemented to respond to COVID-19
preparedness and outbreaks in RACFs. It is available as a national tool to assist an aged care
response centre model, providing an environment that supports timely and efficient coordination
and information sharing across multiple agencies. AUS-CAIRS captures key issues associated with
workforce, logistics, prevention, leadership, infection prevention and control, and communications.
This web-based platform assists COVID-responders from Commonwealth agencies, especially the
Department of Health, State and Territory Governments and other agencies or organisations to
share point-in-time information about RACF COVID-19 preparedness and outbreak management.
Information is restricted to jurisdictions, local areas and defined user roles to support appropriate
incident management processes. It is anticipated that the rollout of AUS-CAIRS in NSW will
commence from mid-April 2021.
Operational response
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Section 4: Operational Response
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Section 4: Operational Response
Lines of Operation The decision tree (Figure 7) guides the issues that are escalated to the SLST and SIOG based on criteria set for decision points 2 and 3, as per Appendix 4.
Figure 7: Lines of operation – decision tree
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Joint Response Escalation Pathways
The joint response escalation pathways (Figure 8) specify the pathways for accessing support services from the Commonwealth, LHDs and the SHEOC in an
emergency response. As per legislative arrangements, the RACF is responsible in the first instance for managing an outbreak.
Figure 8: Joint response escalation pathways
Section 5: Service Offers
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Section 5: Service Offers
Service Offers The service offers describe the resources the Commonwealth Government, LHDs and SHEOC can provide to
support the RACF in managing the outbreak (Table 2). Commonwealth support described in the service
offers are available to the Outbreak Management Teams and can be facilitated by the Commonwealth Case
Manager.
Table 2: Service Offers
Commonwealth – Case Manager The Commonwealth works collaboratively with the overall management of the COVID-19 response to
support the viability and capacity of the RACF to access services, including the allocation of a state based
24/7 Case Manager who will connect the RACF to available Commonwealth support. In the event of
multiple aged care outbreaks, there may be multiple case managers and the formation of case
management teams.
Commonwealth – Clinical First Nurse Responder The Commonwealth has contracts in place to enable the appointment of a Clinical First Responder (CFR) at
the start of an outbreak to assist the RACF:
• Assess preparedness to manage outbreak, workforce capacity and advise on workforce requirements for the RACF
• Review infection control processes, ensure they are compliant with the guidelines and the relevant
State health directions
• Check PPE stock and competencies, assist fit testing etc.
• Recommend enhanced cleaning protocols
• Identify significant capability gaps
• Provide direct management or nursing assistance if required until suitable surge workforce was
available.
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Requesting other forms of Commonwealth assistance State and territory governments have responsibility for coordinating and planning for the response to, and
recovery from, a disaster within their borders. When the total resources (government, community and
commercial) of an affected jurisdiction cannot reasonably cope with the needs of the situation, state and
territory governments are able to request Commonwealth Government assistance via the Australian
Government Disaster Response Plan (COMDISPLAN) through a request for Defence Assistance to the Civil
Community (DACC).
The decision on whether to request assistance through the COMDISPLAN or DACC should be guided by the
type of response required. In some circumstances, locally based Commonwealth Government resources
may be deployed in support of local authorities for limited periods without the need to activate
COMDISPLAN. This may include the provision of:
• DACC category 1, which is activated for a set period of time under local arrangements.
• DACC category 2 and 3 requests, which relate to more extensive or ongoing emergency situations, or
assistance associated with recovery from a civil emergency or disaster, must be approved and
coordinated through Emergency Management Australia, under the guidance of COMDISPLAN.
Requests for Commonwealth Government assistance should be made through existing processes by the
NSW State Emergency Operations Controller (SEOC).
For more information on the activation and operation of the COMDISPAN as well as the types of non-
financial assistance is available from the Home Affairs website.
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Service Offer 1: Access to timely and accurate testing The service offer describes the resources available from residential aged care facilities, local health districts,
the State Health Emergency Operations Centre and the Commonwealth when a resident or staff member
presents with acute respiratory illness or during an outbreak of COVID-19 within a RACF.
Escalation Organisation Service offer
Trigger: Resident or staff member with acute respiratory illness
Residential Aged Care Facility (RACF)
• Arrange testing for resident or staff member through the Commonwealth Government contract (see Commonwealth service offer) or Local Health District. 1
Trigger: A single case of COVID-19 is confirmed in a resident, staff member or frequent attendee of the RACF
Local Health District (LHD)
• PHU provides testing regime, including active surveillance, investigation and management of cases in staff, residents and frequent attendees, including management of swab results.
• Assist the RACF, through the support of mobile testing teams, clinical staff and laboratory resources as needed, to achieve swabbing of all residents and staff.
• Note: Local Health Districts may initiate asymptomatic testing as appropriate to the local situation.
3
Commonwealth • Funding of a dedicated pathology service (SONIC) for rapid specimen collection and testing of COVID-19 for residents and staff of RACFs. This includes voluntary asymptomatic surveillance testing of staff and residents in RACF (see Framework and Standard Operating Procedure for COVID-19 asymptomatic surveillance testing for NSW Residential Aged Care facilities).
• The pathology service is provided by Douglass Hanly Moir (DHM).
State Health Emergency Operations Centre (SHEOC)
• Additional resources to support Local Health District testing capacity including access to: mobile squad teams, adjunct staffing from St John Ambulance and equipment via: SHEOC Clinics
4
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Service Offer 2: Access to appropriate personal protective equipment (PPE) The service offer describes the PPE resources available from residential aged care facilities, the
Commonwealth and the State Health Emergency Operations Centre during an outbreak of COVID-19 within a
RACF.
Escalation Organisation Service offer
Trigger: A single case of COVID-19 is confirmed in a resident, staff member or frequent attendee of the RACF
1 Residential Aged Care Facility (RACF)
• Activate PPE strategies as outlined in its OutbreakManagement Plan.
Trigger: RACF is unable to manage locally
Commonwealth • Provision of PPE from the National Medical Stockpile.
Note: PPE is only provided for approved applications from
an eligible aged care provider. Note: National Medical
Stockpile quantities are not publicly available, however
there are no concerns regarding capacity to respond to
PPE requirements: Aged Care PPE Request2
State Health Emergency Operations Centre (SHEOC)
• Provision of Commonwealth PPE stock pre-positioned in NSW or NSW Health PPE stock via SHEOC Logistics who registers the request with and liaises with the Commonwealth.
• Note – Commonwealth reimburses NSW Health for PPE.
• Clinical Excellence Commission - Personal Protective Equipment
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Service Offer 3: Access to appropriate clinical waste management The service offer describes the clinical waste management resources available from residential aged care
facilities, the Commonwealth and the State Health Emergency Operations Centre during an outbreak of
COVID-19 within a RACF.
Escalation Organisation Service offer
Trigger: A single case of COVID-19 is confirmed in a resident, staff member or frequent attendee of the RACF
Residential Aged Care Facility (RACF)
• Activate clinical waste management strategies as outlined in its Outbreak Management Plan.
1
Trigger: RACF is unable to manage locally
State Health Emergency Operations Centre (SHEOC)
• Chief Financial Officer has approved RACF access to NSW Health clinical waste contract during a COVID-19 outbreak. Not-for-profit and for profit RACF can access services via the contract.
• The contract is with two providers: Cleanaway Daniels and Med-X Healthcare.
• The contract is accessed via HealthShare & allows for the two providers to subcontract other service providers to collect clinical waste from the RACF and transport it to the appropriate disposal site.
• Eligible providers can recoup additional costs through the COVID-19 Aged Care Support Program.
2
Commonwealth • In general waste removal logistical and financial support sits outside the usual remit of the Federal Government. The following conditions therefore need to occur to trigger consideration of Commonwealth access of additional resources: - High numbers of simultaneous COVID-19 outbreaks
in RACFs across NSW (e.g. more than eighty (80) RACFs at one time);
- Extraordinary pressure on the waste removal sector;
- An unmanageable clinical waste situation for multiple RACFs with outbreaks of COVID-19.
3
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Service Offer 4: Access to food to maintain nutritional care needs of residents The service offer describes the food resources available from residential aged care facilities and the State
Health Emergency Operations Centre during an outbreak of COVID-19 within a RACF. See the workforce
service offer for resources for food related workforce.
Escalation Organisation Service offer
Trigger: A single case of COVID-19 is confirmed in a resident, staff member or frequent attendee of the RACF
1
Residential Aged Care Facility (RACF)
• Activate food strategies, including to monitor and manage the weight and nutrition of all residents, as outlined in its Outbreak Management Plan.
Trigger: RACF is unable to manage locally
State Health Emergency Operations Centre (SHEOC)
• HealthShare offers a range of strategies:
- Deployment of Flying Squads - Meals will be prepared onsite if the RACF is within
three hours of the Wetherill Park Distribution Centre and kitchen access is available.
- Meals will be prepared offsite and delivered to the facility if the RACF is further than 3 hours from the Wetherill Park Distribution Centre
- Meals will be delivered to residents except for COVID- 19 positive residents
- If HealthShare NSW is unable to provide the food, food can be sourced from Gate Gourmet for residents on full diets. Textured food would be sourced from the Wetherill Park Distribution Centre.
- Note: Requires up to date information from the RACF about any specific dietary requirements for residents and numbers.
2
Service Offer 5: Access to hospitality services - Linen The service offer describes the hospitality (linen) resources available from residential aged care facilities and
the State Health Emergency Operations Centre during an outbreak of COVID-19 within a RACF. See the
workforce service offer for resources for linen related workforce.
Escalation Organisation Service offer
1
2
Trigger: A single case of COVID-19 is confirmed in a resident, staff member or frequent attendee of the RACF
Residential Aged Care Facility (RACF)
• Activate linen strategies as outlined in its Outbreak Management Plan.
Trigger: RACF is unable to manage locally
State Health Emergency Operations Centre (SHEOC)
• There are six HealthShare linen sites across NSW that would pick up linen, clean it offsite and return it to the RACF.
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Service Offer 6: Access to sufficient surge workforce The service offer describes the surge workforce resources available from residential aged care facilities, the
Commonwealth, local health districts and the State Health Emergency Operations Centre during an outbreak
of COVID-19 within a RACF.
Escalation Organisation Service offer
1
2
3
4
Trigger: A single case of COVID-19 is confirmed in a resident, staff member or frequent attendee of the RACF
Residential Aged Care Facility (RACF)
• Activate workforce surge strategies as outlined in its Outbreak Management Plan.
Trigger: RACF is unable to manage locally
Commonwealth • Aspen Medical* – Emergency response -– have pre- qualified and trained staff available for RACFs in remote locations directly impacted by COVID-19.
• Health X - contracted nurse workforce available for deployment to impacted services.
• Recruitment Consulting Staffing Association (RCSA)** –
24/7 concierge service for skilled aged care staff and ancillary staff
• Healthcare Australia (HCA)** – 24/7 concierge service to source skilled staff - nursing, allied health, personal care, domestic assistance.
• Torrens Health (ALPHA, YNA, Global) – Sub-contracted in NSW – mobile workforce consisting of nursing, allied health, personal care, domestic assistance
• The National Aged Care Emergency Response (NACER) mobilises experienced aged care workers from areas across Australia without community transmission of COVID-19. Includes RNs; ENs, personal care workers; and cleaners.
*The Commonwealth will pay the costs of staff deployed on behalf of eligible aged care providers engaged through Aspen
** Eligible providers are invoiced for staff costs and can seek reimbursement via COVID-19 Aged Care Support Program.
*** The NACER program is a supplementary program, which would only be called up if the contracted workforce arrangements could not meet demand.
Local Health District (LHD)
• Local workforce surge plans & arrangements
• Implementation of other care modalities or models of care to support continuity of care for residents, such as virtual care and community nursing
• Deployment of LHD staff to the RACF
• Clinically appropriate transfer of residents to hospital, if there is a need for a large surge workforce to be deployed. Decisions about transfer of residents would be made by the relevant healthcare team.
State Health Emergency Operations Centre (SHEOC)
• SHEOC Workforce Operations Team activates its workforce operational plan, which includes a range of workforce strategies: - Deploying NSW Health staff to the relevant LHD so
that staff from the impacted LHD can be deployed to the RACF.
- Accessing NSW Health Deployment Expression of Interest Register for potential NSW Health aged care experienced or other staff to be deployed.
- Deploying surge workforce to a designated location where residents have been transferred from the RACF for cohorting. Decisions about cohorting (including mass transfer) of residents by OMT/SHEOC.
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Service Offer 7: Access to General Practice Service to maintain continuity of care
The service offer describes the General Practice service resources available from residential aged care
facilities, the Commonwealth, local health districts and the State Health Emergency Operations Centre
during an outbreak of COVID-19 within a RACF1
Escalation Organisation Service offer
1
2
3
4
Trigger: A single case of COVID-19 is confirmed in a resident, staff member or frequent attendee of the RACF
Residential Aged Care Facility (RACF)
• Activate General Practice service strategies as outlined in its Outbreak Management Plan.
• Note: The model of care for delivery of General Practice services will vary across RACFs.
Trigger: RACF is unable to manage locally
Local Health District (LHD)
• Activate LHD GP & primary care pathways which may include: - Existing LHD joint initiatives with local GPs and
RACFs Health service / hospital (Generalist) VMOs
- PHN partnerships - Virtual GP models of care (examples below) - LHD medical practitioner / specialist / clinical team.
State Health Emergency Operations Centre (SHEOC)
• Coordinate and link to existing models of care (external to the LHD affected by the outbreak). For example: - NSW Rural Doctors Network (RDN) – supporting aged
care in rural areas - Telehealth - Western NSW Virtual Rural Generalist Service (24
hour virtual and face-to-face medical services (to support rather than replace local staff)
- Western NSW PHN – GP, Allied Health and Specialist telehealth consultations for RACFs (TRAC) Program
- South Western Sydney PHN – Integrated health team to support GPs providing care to residents of SWS
- North Coast PHN – COVID-19 RACF Outbreak GP
Framework
- Nepean Blue Mountains PHN – Resources available for GPs to support continuity of care in RACFs
Commonwealth • Facilitate access to GPs and primary care through bespoke arrangements as needed.
1 GPs models of care for RACFs are variable, e.g.: there may be multiple, a few or only one GP/s providing care in any one facility. Therefore, GP continuity of care may be disrupted for few or many RACF residents in a facility. In situations whereby a substitute ‘GP’ is unavailable – continuity of care for residents will be provided by another medical practitioner; (as outlined in this service offer)
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Service Offer 8: Provision of timely communication with residents and families The service offer describes the communication resources available from residential aged care facilities, local
health districts, the Commonwealth and the State Health Emergency Operations Centre during an outbreak
of COVID-19 within a RACF.
Escalation Organisation Service offer
1
2
3
4
Trigger: A single case of COVID-19 is confirmed in a resident, staff member or frequent attendee of the RACF
Residential Aged Care Facility (RACF)
• Activate strategies for communicating with residents and families as outlined in its Outbreak Management Plan.
Trigger: RACF is unable to manage locally
Local Health District (LHD)
• Communication tools and resources e.g. templates for letter to families, social media tiles.
• Guidance on local information release and media requests • Provide IT &/or equipment enablers.
Commonwealth • Assess & support management of RACF communications responsibilities.
• Link RACF to other organisations that can assist with communication such as the Older Persons Advocacy Network
• Provide communication tools and resources e.g. templates for letter to families, social media tiles
• Develop new communication tools and resources.
State Health Emergency Operations Centre (SHEOC)
• Communication tools and resources e.g. templates for letter to families, social media tiles, NSW Health RACF Toolkit
• Manage and support state-wide communications including social media tools and resources.
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Service Offer 9: Provision of timely media support The service offer describes the media support resources available from residential aged care facilities, the
Commonwealth and local health districts/the State Health Emergency Operations Centre during an outbreak
of COVID-19 within a RACF.
Escalation Organisation Service offer
Trigger: Media request
1
Residential Aged Care Facility (RACF)
• Activate strategies for communicating with media as outlined in its Outbreak Management Plan.
Trigger: RACF is unable to manage locally
2
Commonwealth • Assess and assist with management of RACF communications responsibilities.
• Responses to media requests directed to the DoH
Local Health District (LHD)
• Provide communication tools and resources e.g. templates for media statement.
• Respond to media requests directed to the LHD and MOH
• Review and develop draft communications for consistent messaging.
State Health Emergency Operations Centre (SHEOC)
3 3
REcovery
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Section 6: Recovery
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Section 6: Recovery Planning for the RACF’s transition back to business as usual needs to start from the beginning of the
outbreak. The response phase ends when the outbreak is declared over by the Public Health Unit. The PHU
should declare the outbreak over 14 days after the last confirmed case is effectively isolated (consistent
with CDNA national guidelines for the prevention, control and public health management of COVID-19
outbreaks in residential care facilities in Australia).
Depending on the scale of the outbreak, the PHU may consider allowing two incubation periods (28 days)
after the last confirmed case is effectively isolated before declaring the outbreak over. At this time RACF
will deescalate to the category of enhanced surveillance and the stand down response phase will be
activated. Planning for transition to business as usual and recovery activities and practical considerations
include:
Support and maintenance of quality care
• Surge workforce arrangements stay in place until the PHU has declared the outbreak over and the
service is able to operate utilising their own staffing cohort, with assistance ceasing on that day.
• Commonwealth case managers continue to support the RACFs and facilitate access to
Commonwealth supports as needed.
• Commonwealth/ACSQC, and NSW Health continue to ensure availability of IPC training resources.
• OMT ensure adequate stock of PPE and other supplies are available, as assistance will cease on the
day that the RACF returns to BAU.
Monitor for outbreaks
• Clearance of cases by PHU and release of contacts from isolation should proceed as per CDNA
Guidelines.
• RACF to continue to monitor residents and staff for symptoms and immediately undertake testing for
COVID-19 and notify PHU as required.
Communication activities
• Providing an indicative timeline at the start of the outbreak with targeted information to staff,
residents and carers/families that shows when and how key decisions are made and by whom such
as:
o Timing of testing and re-testing, including surveillance testing
o What is needed for the outbreak to be considered closed
o What is needed for visits to occur again, and whether there are likely to still be restrictions
o When furloughed staff can expect to return to work and under what circumstances.
• Ongoing public communications to reassure residents, families, staff and the public to support RACFs
return to BAU.
Evaluation of systems and revision of plans and procedures
• OMT should conduct a debrief with the PHU to identify strengths and weaknesses in outbreak
response and investigation processes, and to identify which policies, practices or procedure need to
be modified to improve response to future outbreaks.
• SHEOC and PHRB will review the outbreak and contribute to a debrief or investigation if deemed
necessary by the Deputy Controller.
• RACF should review and evaluate management protocols and incorporate lesson learnt into Business
Continuity Plans.
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• SHEOC Aged Care debrief and evaluation of the response; review and evaluate emergency response
operational plan and escalation pathways.
Appendices
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Appendices
Appendix 1: Joint Military Appreciation Process
Figure 9: Joint Military Appreciation Process
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Appendix 2: Templates
Template 1: Outbreak Management Team Standing Agenda and Action List
Date: DD/MM/2021
Time: XX: XX am/pm Venue: Virtual meeting
Attendees:
Participant Present
SHEOC
[Local Health District]
PHRB
Approved Provider/RACF
Discussion
1. Welcome, attendance and apologies
2. Status update
Public Health Update Testing (including # residents/staff swabbed):
Local Health District issues
Operations Update
Workforce
PPE
Communications – residents, families, media
Logistics – food, laundry, clinical waste
Continuity of care
3. Other issues
4. Actions (see action table)
5. Next meeting
6. Close
Actions (Completed actions in grey)
No* Action Responsible Due Comments
* The action number is in the format: Meeting number: Action number. For example, 1:1 is Meeting 1: Action 1.
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Template 2: Aged Care Emergency Response Operational Update
Subject DD/MM/YY 16:00 – Aged Care Emergency Response (ACER) Operations Update
From Director, ACER
RACF categories Critical outbreak > 72 hrs since first case with 1/+ escalation triggers X facilities
Ongoing outbreak > 72 hrs since first case X facilities
New outbreak <72 hrs since first case X facilities
Nil outbreak X facilities
Enhanced surveillance following closed outbreak X facilities
Operational issues [leave blank]
[Brief explanation in bold, underlined text of non-outbreak related operational issues or COVID-19 exposure. E.g. RACF with exposure to a confirmed COVID-19 case in a transport worker who transported residents from hospital to RACFs]
RACF [colour cell black, red, amber, green or blue consistent with RACF category]
[RACF or MPS name]
LHD [LHD name]
LHD PHU action [Key points only, with new issues or updates in red] [Final outcome in red bold text (e.g. isolation will be lifted on DD/MM/YY)]
Current Outbreaks
RACF [colour cell black, red, amber, green or blue consistent with RACF category]
[RACF name] [key information about the RACF such as number of residents and staff at RACF in total, dementia specific rooms etc]
LHD [LHD name]
Outbreak info Number of confirmed cases Nature of confirmed cases [e.g. ‘staff member – personal care assistant’]
Number of staff close contacts/furloughed [Key points only, with new issues or updates in red] [Final outcome in bold red (e.g. isolation will be lifted on DD/MM/YY)]
Testing [Key points only, with new issues or updates in red]
PPE/IPC [Key points only, with new issues or updates in red]
Care continuity [Key points only, with new issues or updates in red]
Workforce [Key points only, with new issues or updates in red]
Communication [Key points only, with new issues or updates in red]
Next OMT meeting [DD/MM/YY]
[leave blank]
Commonwealth actions
[Key points only, with new issues or updates in red]
Communications [title] [DD/MM/YY] [hyperlink] [New items or updates in red]
Other updates [Key points only, with new issues or updates in red]
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Template 3: Standards and Logistical Support Team
Standards and Logistical Support Team: Standing Agenda and Action List
Date: DD/MM/YYYY Time: XX: XX Venue: <insert location including virtual meeting details if appropriate>
Participant Present
SHEOC
Department of Health
Aged Care Quality and Safety Commission
Primary Health Network
Clinical Excellence Commission
Secretariat
1. Welcome, attendance and apologies
2. Actions update (Completed actions in grey)
No Action Responsible Due DD/MM/YYYY
Status
1.
2.
3.
4.
3. Status update
Category No of facilities
Critical outbreak > 72 hrs since first case with 1/+ escalation triggers
Ongoing outbreak > 72 hrs since first case
New outbreak <72 hrs since first case
Nil outbreak
Enhanced surveillance following closed outbreak
4. Status update – System level emergency response (capture any actions in the actions list)
Testing
Workforce
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General Practice workforce
PPE
Logistics – food, laundry, clinical waste
Communications – residents, families, media
Continuity of care
5. RACF specific issues escalated to SLST (capture any actions in the actions list)
RACF Issue/s SLST response
6. Other issues
7. Next meeting
8. Close
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Template 4: Senior Intergovernmental Oversight Group
Senior Intergovernmental Oversight Group: Standing Agenda and Action List
Date: DD/MM/YYYY
Time: XX: XX
Venue: <insert location including virtual meeting details if appropriate>
Participant Present
NSW Health
Department of Health
Aged Care Quality and Safety Commission
Secretariat
1. Welcome, attendance and apologies
2. Actions update (Completed actions in grey)
No Action Responsible Due DD/MM/YYYY
Status
1.
2.
3.
4.
3. Status update
Category No of facilities
Critical outbreak > 72 hrs since first case with 1/+ escalation triggers
Ongoing outbreak > 72 hrs since first case
New outbreak <72 hrs since first case
Nil outbreak
Enhanced surveillance following closed outbreak
4. Status update – System level emergency response (capture any actions in the actions list)
Testing
Workforce
General Practice workforce
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PPE
Logistics – food, laundry, clinical waste
Communications – residents, families, media
Continuity of care
5. Issues escalated by the Standards and Logistical Support Team (capture any actions in the actions list)
Issue/s SLST response
6. Other issues
7. Next meeting
8. Close
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Appendix 3: Terms of Reference
Standards and Logistical Support Team
Standards and Logistical Support Team (SLST)
Terms of Reference Endorsed: DD/MM/YYYY
Functions
The SLST’s functions are outlined the Protocol to support joint management of a COVID-19 outbreak in one or more residential aged care facilities (RACF) in NSW – Updated February 2021 (Joint Protocol) as:
• Coordination and escalation of the joint NSW & Commonwealth emergency response to COVID-19
outbreaks in RACF
• Monitor and action requirements for significant scaling of Commonwealth and State resources in
relation to multiple outbreaks
• Identification of and response to regulatory compliance concerns
• Document agreed actions
• Coordinate escalation of trigger events/issues as required to SIOG
• Communicate to peak bodies.
Membership
• Director, SHEOC Aged Care (Co-Chair)
• State Manager NSW and ACT, Department of Health (Co-Chair)
• Aged Care Quality and Safety Commission
• Primary Health Network
• Clinical Excellence Commission.
Secretariat Secretariat support is provided by the Department of Health.
Meetings
Members are expected to attend all meetings. Members may send a representative if they are not able to
attend a meeting. It is expected that the representative will brief the member on any relevant matters.
The Secretariat is responsible for arranging meetings as directed by the Chair. The initial meeting is to be
scheduled as required, with the subsequent meeting frequency to be as required.
A quorum requires a member or representative from each organisation to be present.
Meetings are to be held virtually.
Agenda and meeting records
The meeting agenda and record template is attached at Appendix 1. The agenda is prepared and circulated by the Secretariat with as much notice as possible before the meeting, noting that meetings may be called at short notice if required.
The Secretariat prepares the draft meeting record and circulates it to members immediately following the meeting. Confirmation of the meeting record is to occur at the next meeting or out of session if no further meetings are scheduled.
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Escalating matters to the SIOG
The approved provider of a residential aged care facility is expected to lead and manage implementation of its Outbreak Management Plan in response to the outbreak in the RACF to support the safety, care and wellbeing of residents and staff as required by legislation, including the Aged Care Act 1997. Support available to the approved provider from other parties, including the Commonwealth and NSW Health, is outlined in the Joint Protocol and the NSW and Commonwealth Joint Aged Care Emergency Response Plan for COVID-19 in RACF (Joint Plan).
Under the Lines of Operation in the Joint Plan, matters are to be escalated to the SLST where the provision of coordinated government support, as outlined in the Joint Plan service offers, is not addressing the issue.
Reporting
The SLST reports to the Department of Health via the State Manager NSW and ACT and the NSW Ministry of Health via the Director, SHEOC Aged Care.
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Senior Intergovernmental Oversight Group
Senior Intergovernmental Oversight Group (SIOG) Terms of Reference
Endorsed: DD/MM/YYYY
Functions
The SIOG’s functions are outlined the Protocol to support joint management of a COVID-19 outbreak in one or more residential aged care facilities (RACF) in NSW – Updated February 2021 (Joint Protocol) as:
• Monitor and action requirements for significant scaling of Commonwealth and State responses in relation to multiple outbreaks.
• Monitor progress of outbreak management and agree any actions required to address critical or emerging issues that require government support.
• Consider any relevant information.
• Consider issues identified under trigger events.
• Document agreed actions.
• Advise relevant Ministers on response to outbreaks.
• Communicate to peak bodies.
Membership
• Deputy Secretary, Ageing and Aged Care, Department of Health (Chair)
• Aged Care Quality and Safety Commissioner
• Deputy Secretary, Health System Strategy and Planning, NSW Health • State Health Emergency Operations Centre (SHEOC) Controller, NSW Ministry of Health
• Director, SHEOC Aged Care, NSW Ministry of Health
• Deputy Controller, Operations team, Public Health Response Branch, NSW Ministry of Health
Secretariat Secretariat support is provided by the Department of Health.
Meetings
Members are expected to attend all meetings. Members may send a representative if they are not able to attend a meeting. It is expected that the representative will brief the member on any relevant matters.
The Secretariat is responsible for arranging meetings as directed by the Chair. The initial meeting is to be scheduled as required, with the subsequent meeting frequency to be as required.
A quorum requires at least four members: • Department of Health (Chair) – 1 member • Aged Care Quality and Safety Commission – 1 member
• NSW Health – 2 members
Meetings are to be held virtually.
Agenda and meeting records
The meeting agenda and record template is attached at Appendix 1. The agenda is prepared and circulated by the Secretariat with as much notice as possible before the meeting, noting that meetings may be called at short notice if required.
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The Secretariat prepares the draft meeting record and circulates it to members immediately following the meeting. Confirmation of the meeting record is to occur at the next meeting or out of session if no further meetings are scheduled.
Escalating matters to the SIOG
The approved provider of a residential aged care facility is expected to lead and manage implementation of its Outbreak Management Plan in response to the outbreak in the RACF to support the safety, care and wellbeing of residents and staff as required by legislation, including the Aged Care Act 1997. Support available to the approved provider from other parties, including the Commonwealth and NSW Health, is outlined in the Joint Protocol and the NSW and Commonwealth Joint Aged Care Emergency Response Plan for COVID-19 in RACF.
Under the Lines of Operation in the NSW and Commonwealth Joint Aged Care Emergency Response Plan for COVID-19 in RACF, the Standards and Logistical Support Team (SLST) is to consider the following questions when deciding whether to escalate a matter to the SIOG:
• Has the matter been escalated to the SLST and is the SLST response addressing the issue? • Has SLST identified significant issues or risks to be addressed by the SIOG?
Relevant matters for escalation may include:
• Rapid deterioration of the situation
• The provider does not demonstrate capability to effectively lead and manage the outbreak response
• There are risks to the delivery of safe and continuous care • The need for additional coordinated Commonwealth and State responses because the current
support is reaching capacity or cannot adequately address the matter
• There are multiple, concurrent outbreaks requiring significant scaling of Commonwealth and State responses
• Any other issue impacting on the effective management of the outbreak.
Reporting The SIOG reports to the Secretary, Department of Health and the Secretary, NSW Health via the relevant members.
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Appendix 4: Lines of Operation – decision point criteria Decision point 2 – Is the provision of coordinated government support adequately addressing the
issue?
Decision Criteria:
o Does the issue require a coordinated State & Commonwealth response? • Rapid deterioration of the situation • There are multiple outbreaks requiring significant scaling of Commonwealth and
State responses.
o Is Commonwealth support nearing capacity or likely to be exceeded? o Is LHD support nearing capacity or likely to be exceeded? o Is the ability to provide safe and/or continuity of care at risk? o Is the solution needed not in the current service offerings?
Decision point 3: Has the SLST response adequately addressed the issue?
Decision Criteria:
o A service is at extreme risk of failure to provide safe continuity of care for residents. o The total resources (government, community and commercial) of NSW, including those
drawn from the Commonwealth through the coordinated interagency response, cannot reasonably cope with the needs of the situation.
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