What have we learned from coronavirus outbreaks in aged care?

With the globe in the grip of the coronavirus pandemic, aged care has been on the front line in the battle to contain the disease.

With older people particularly vulnerable to coronavirus and aged care residents living in close confines, aged care facilities world-wide have recorded clusters of cases.

In Australia, Dorothy Henderson Lodge had six residents and four employees contract the disease.

Federal Aged Care Minister Richard Colbeck told parliament on Monday that ten aged care residents and seven staff have tested positive to coronavirus across six different homes nation wide.

In the United States, Life Care Center in Kirkland, Washington, had 129 people test positive, including 81 residents.

Both Life Care Centre in the US and DHL here in Australia attracted intense attention from both the media and authorities. Staff and management grappled with the impossible challenge of caring for elderly residents succumbing to the disease. Both homes also lost the efforts of large numbers of staff who were either sick themselves or had to go into quarantine because they had been exposed to the virus.

With a little distance on both outbreaks now, although both are still feeling the effects of coronavirus, what are the lessons that can be learned?

Learnings from Dorothy Henderson Lodge

At a seminar held on Tuesday by Aged and Community Services Australia, the CEO of Baptist Care, Ross Low, spoke about the company’s learnings from the outbreak.

Mr Low said full personal protective equipment must be worn, including glasses. Baptist Care is currently going through 800 sets of PPE a day. 

Healthcare Australia did a wonderful job mobilising a workforce “almost immediately” after the first cases at DHL were identified, Mr Low said, but later positive case meant many of those staff quickly had to go into quarantine themselves because they had not been wearing full PPE. Mr Ross said if those staff had been wearing glasses as part of their PPE they wouldn’t have lost them.

Map out how you will communicate with staff, residents and families, Mr Low said. It was important for providers to work with staff to help them understand what coronavirus is, how it will affect them, and provide answers to questions they might receive from families. 

Also keep in touch with families. Baptist Care has been SMSing and notifying families of what’s been happening every day. Make sure you have all family contact details, and know who is the key person to contact, Mr Low suggested.

Have a “strong” approach to deal with the media, Mr Low said. “The media were very unhelpful,” he observed. Baptist Care employed a security firm to keep the media in the areas they were permitted.

Baptist Care is not permitting visitors into its homes. Their data showed they were receiving 700-800 visitors per day across the organisation, and that number poses too great a risk. Baptist Care didn’t want a second outbreak, especially in a regional facility where it would be impossible for extra staff to travel if they were needed.

Baptist Care has employed a communication coordinator who visits all residents with an ipad and phone, reads them messages from loved ones, sets up skype, and helps them keep in touch.

Staff are confined to their rooms. Mr Low said residents have lost some of their mobility since that decision was made. Staff try to take residents for walks, but have found they are sometimes reluctant to return to their rooms, which is understandable, but can create difficulties.

Know where you could find an alternate workforce, Mr Low suggested. Baptist Care is training hospitality staff who have lost their jobs to perform “lower level” activities within both residential and home care services. 

These staff receive training of one day of screening, one day of training, and then a buddying day within a facility (not DHL). A pilot is running now.

Mr Low suggested that providers test their crisis management plan, making sure that all the people needed are available and can be isolated. Take working from home into account, with the appropriate technology.

Make sure you have enough PPE. The government will supply it if you don’t have enough through their national stockpile.

Managing residents living with dementia has been difficult during the outbreak, Mr Low said. At DHL, staff did their best to contain residents living with dementia in the memory support unit, but one still contracted coronavirus.

Learnings from Life Care Center in the United States

In the United States, the Centers for Medicare and Medicaid Services and state regulators released a report on Life Care Center’s response to the coronavirus outbreak, providing valuable lessons that are applicable to homes around the world. 

• The report found Life Care, Kirkland, had inadequate infection control and did not use PPE effectively. 
• Staff worked in multiple facilities, spreading the disease to other homes.
• Staff worked while symptomatic, also causing the disease to spread.
• Contact precautions were inadequate.
• The facility didn’t identify and manage sick residents quickly enough, even as the number of respiratory infections increased.
• The centre failed to notify the state Department of Health about the increasing rate of infection.
• The facility failed to have a backup for their primary doctor, who fell ill.
• The facility did not have an adequate emergency action plan.

No one can avoid coronavirus. There is no immunity to it in the community, and it spreads easily. The elderly are particularly vulnerable. Strong infection controls and effective crisis management can help to minimise the damage in the case of an outbreak. When cases arise, it’s vital that we reflect, admit mistakes and identify learnings, so next time things are better.