Information for Residential Aged Care Facilities
Older adults often have weaker immune systems and can be affected by underlying chronic disease which make them more susceptible to infections. The COVID-19 pandemic has disproportionately affected elderly people – especially those residing in aged care facilities - leading to high rates of severe illness and mortality in this age group. Rapid response to cases of respiratory disease, or to disease outbreaks, is vital to protect the health of vulnerable residents. The Public Health Unit provides support and advice to residential aged care facilities (RACFs) on various aspects of disease and outbreak management.
The Public Health Unit is notified of diseases which are listed under the Public Health Act 2010, and if associated with a residential aged care facility, will assist in following up individual cases, clusters, and suspected outbreaks. The Public Health Unit can also assist RACF's to manage outbreaks of non-notifiable conditions such as scabies abd rhinovirus. Below you will find information on reporting and managing respiratory cases and disease outbreaks in residential aged care facilities, vaccination requirements, and recommendations for residents, staff and volunteers.
The latest advice for aged care services can be found on the NSW Health website.
Residential aged care facilities should contact the South Eastern Sydney Public Health Unit by phone (02 9382 8333) or email as soon as possible if they suspect a disease outbreak or unexplained fever in staff or residents.
An acute respiratory illness (ARI) outbreak is defined as two or more cases of COVID-19 or influenza during a 72 hour period.
A gastrointestinal illness outbreak is defined as two or more people of any age with sudden onset of diarrhoea or vomiting at any one time in any institution.
ARI definition - recent onset of new or worsening cough, runny nose, breathing difficulty, and/or sore throat with or without other symptoms.
Other symptoms include:
- Headache, muscle aches (myalgia), fatigue, nausea or vomiting and diarrhoea. Loss of smell and taste and loss of appetite can also occur with COVID-19, but may be less common with new variants of the disease.
- Fever (≥37.5°C) can occur, however is less common in elderly individuals.
- In the elderly, other symptoms to consider are new onset or increase in confusion, change in baseline behaviour, falling, or exacerbation of underlying chronic illness (eg. increasing shortness of breath in someone with congestive heart failure)
Residents with non-respiratory symptoms should be tested for respiratory pathogens, especially if there are already ARI cases in the facility.
To contact the South Eastern Sydney Public Health Unit, phone 02 9382 8333
If your facility has one or more cases of ARI follow the guidelines, starting with isolating symptomatic residents and testing for COVID-19 and influenza.
The Public Health Unit is available to you anytime for support with potential outbreak management, so there is no requirement to wait for the release of laboratory results before making contact. You may contact the South Eastern Sydney Public Health Unit by phone (02) 9382 8333 or email.
Once you have notified the Public Health Unit, you will be contacted by a staff member who will work through a risk assessment with you. If the outbreak definition is met, you will be sent a link for a line list, a document shared between the facility and the PHU which is used to monitor the outbreak by recording test results, vaccination status and other details for residents and affected staff.
You will also be advised on increasing infection control measures such as:
- Personal protective measures
- Isolation of ill residents
- Reducing the risk of disease spread by excluding infected staff and restricting the number of visitors
- Thorough cleaning of potentially infected surfaces
If any residents, with or without symptoms, are sent to a hospital during the outbreak, the hospital should be notified that the facility is experiencing a possible or confirmed ARI outbreak.
Managing visitors during an outbreak: Generally, essential visitors will be able to visit under strict infection control precautions. However, due to the significant risk to elderly people posed by ARI’s, a precautionary approach will be taken which may be restrictive until the situation is fully assessed. We advise against the use of terms like “lockdown” which can be unhelpful when managing the situation and distressing to family members. Ask visitors to perform hand hygiene and wear PPE, and ensure instructive signage is clearly visible throughout the centre. For further information about managing visitor during an outbreak, refer to the guidelines.
Guidance on use of antivirals in residential aged care facilities: The administration of antiviral treatment soon after symptom onset for people with COVID-19 or influenza can reduce disease severity. Additionally, the administration of influenza antivirals to residents of RACFs after exposure reduces the risk of them developing influenza and assists in controlling the outbreak. For information about the use of antivirals in residential aged care facilities, refer to the Guidance on use of antivirals in residential aged care facilities resources.
Under the NSW Public Health Act 2010, residential aged care facilities are legally required to notify suspected outbreaks of gastroenteritis to their local Public Health Unit. If your facility has one or more cases of gastroenteritis simultaneously, or you suspect there is an outbreak, you should contact the South Eastern Sydney Public Health Unit by phone (02) 9382 8333 or email. The Public Health Unit is available to you anytime for support with potential outbreak management, so there is no requirement to wait for the release of laboratory results before making contact.
Once you have notified the Public Health Unit, you will be contacted by a staff member who will work through a risk assessment with you. If the outbreak definition is met, you will be sent a line list which you can use to monitor the outbreak and testing results.
Actions to follow a suspected gastroenteritis outbreak are:
- Commence infection control measures and cleaning
- Inform the facility Infection Control Practitioner & facility management
- Inform medical team, collect faecal specimens for laboratory testing
- Post signs and alcohol-based hand sanitiser at the entrance to affected areas
- Notify the Public Health Unit on 02 9382 8333
- Distribute information to staff, residents and visitors
For more information see the NSW Gastro Pack for Hospitals and Aged Care Facilities
Staff, health practitioners, volunteers and visitors entering a RACF are required to be vaccinated against COVID-19. More details are available here.
Influenza vaccination is strongly recommended for staff as it protects them and provides an additional layer of protection for high risk residents. Best practice targets are 95% vaccination coverage, in both staff and residents, prior to the beginning of the flu season. Australian Government-subsidised providers of residential aged care are required to:
- Provide staff and volunteers with access to free flu vaccination each year. Providers are required to cover the cost of the program.
- Actively promote the benefits of an annual vaccination for their staff and volunteers, and for the health outcomes of care recipients.
- Keep records of the number of staff that receive a flu vaccination each year (whether or not under the approved provider’s flu vaccination scheme).
Unvaccinated staff are at higher risk of acquiring and transmitting influenza. Therefore, during a confirmed influenza outbreak, it is recommended that any unvaccinated staff only be allowed to work if asymptomatic, wearing a mask, and taking appropriate antiviral prophylaxis. Staff members with an ARI should be excluded from work while they are infectious, that is, at least 5 days after onset of acute illness, or until they are symptom free, whichever is longer.
For more information, visit the Residential care facilities and influenza page on the NSW website.
Residential aged care facilities are able to order their own influenza vaccines if they have a Vaccine Account Number (VAN) through the Toll Healthcare link. To apply for a VAN, call the NSW Vaccine Centre on 1300 656 132.
Below are links to agencies and other organisations that contain useful information:
- Guidance for Residential Aged Care Facilities on the public health management of Acute Respiratory Infections (including COVID-19 and Influenza)
- COVID-19 advice for Residential Aged Care Facilities
- Residential care facilities and influenza
- Guidance on use of antivirals in residential aged care facilities
- COVID-19 posters
- Residential care facilities and influenza posters
- Visitors poster
- Influenza vaccination for residential care staff brochure (available in Arabic, Chinese, English, Filipino, Hindi, Nepali, Polish and Vietnamese)
- Gastroenteritis in aged care facilities resources
- A-Z infectious disease factsheets
- Public Health Act 2010