Vaccinations and outbreak preparedness

Aged Care Vaccinations and Preparing for Outbreaks – Winter 2024

Thursday, 20 June 2024

Presented by:

Rhiannon Box

Assistant Secretary, Emergency Preparedness and Response, Department of Health and Aged Care

Speakers:

Alison McMillan
Chief Nursing and Midwifery Officer, Department of Health and Aged Care

Janet Anderson
Aged Care Quality and Safety Commissioner

Genevieve Donnelly
Assistant Secretary, National Immunisation Division, Department of Health and Aged Care

[Opening visual of slide with text saying ‘Australian Government with Crest (logo)’, ‘Department of Health and Aged Care’, ‘Aged care vaccinations and preparing for outbreaks – Winter 2024’, ‘agedcareengagement.health.gov.au’]

 [The visuals during this webinar are of each speaker presenting in turn via video, with reference to the content of a PowerPoint presentation being played on screen]

Rhiannon Box:

Good afternoon all and welcome to today’s webinar on vaccinations and outbreak preparedness in aged care. Thank you for joining us. I am Rhiannon Box, the Assistant Secretary of the Emergency Preparedness and Response Branch at the Department of Health and Aged Care.

I begin today by acknowledging the traditional custodians of the many lands on which we meet. For me it’s the Ngunnawal people and I pay my respects to their Elders past, present and emerging. I extend that respect to all Aboriginal and Torres Strait Islander peoples here today and to the traditional custodians of all the lands that you are joining us from.

Today I am joined by Janet Anderson, the Aged Care Quality and Safety Commissioner, Professor Alison McMillan, the Chief Nursing and Midwifery Officer for the Department of Health and Aged Care, and Genevieve Donnelly, Assistant Secretary, National Immunisation Division for the Department of Health and Aged Care.

Thank you to those of you who have sent through questions in advance. We will be answering your questions at the end of the presentations. And if you think of a question during today’s update you can also use the Q&A function on the right hand side of your screen to submit a question for the panel to answer. If we don’t get to all of your questions today we will publish answers to them on the webinar page of the Department’s website.

To start today’s webinar I would like to give you a quick update on the current status of COVID‑19 and other respiratory illnesses in aged care. Last Friday the 14th of June the COVID outbreaks in residential aged care snapshot reported 487 active outbreaks with 4,147 COVID cases amongst both staff and residents. Since around mid-April there has been a marked increase in COVID-19 outbreaks and cases in residential aged care. Small decreases in new outbreaks were observed in last week’s reporting with 12 new outbreaks in the previous seven days to Friday 14 June which was down from the week before which was 32 new outbreaks and the week before that which was 76 new outbreaks. The Department will continue to closely monitor new outbreaks to determine if this is the start of a downward trend.

Rates of respiratory illnesses including influenza and RSV in the community are also continuing to rise. Respiratory illness particularly at this time of year remains a concern for older people who are at higher risk of serious illness, hospitalisation and death from these diseases. Vaccinations are the best way to protect people from serious illness and having to go into hospital but at the moment vaccination rates in aged care are too low particularly for COVID-19. A COVID-19 vaccination is recommended every 12 months for people aged over 65 and every six months for people over 75 who have a weaker immune system because of a health condition or medication. People also no longer have to wait for six months after having a COVID-19 infection to get their COVID-19 vaccine. COVID-19 vaccines are free for everyone and flu vaccines are free for people aged over 65.

My panel colleagues will talk more about the importance of COVID -19 vaccinations and making sure that people in aged care can get the recommended vaccines as soon as they need them. 

I also wanted to touch quickly on the reminders for infection prevention and control practices. We realise that you may have heard this information already but it is imperative that we are responding to the increased risks of COVID-19, flu and other respiratory viruses increasing across the country. Some simple measures that can be put in place quickly in your home are regular rapid antigen testing for staff and visitors upon entry to the home to screen for infection, respiratory hygiene measures for both staff and visitors such as appropriate wearing of masks, hand hygiene which may include washing your hands more frequently, making sure staff and residents are up to date with their vaccinations, and staying home if staff are unwell or have respiratory symptoms.

Our first speaker today is Janet Anderson, the Aged Care Commissioner, and she will talk about the responsibilities of aged care providers under the Aged Care Act and the Aged Care Quality and Safety Standards to ensure timely access to vaccinations for both staff and residents and that adequate levels of IPC and outbreak preparedness are maintained. Thanks Janet.

Janet Anderson:

Thank you Rhiannon and good afternoon everyone. Here we are again. We just heard from Rhiannon that there’s been an increase in COVID outbreaks and cases in residential aged care and also in rates of respiratory illness including flu and RSV in the community and in aged care.

Those increases are very much front of mind for the Commission and that’s one of the reasons we’re participating in this webinar today. To help you as providers and the sector more generally what we’ve done is published today a media statement highlighting the importance of COVID preparedness by providers and we’ve also published a regulatory bulletin on COVID vaccination in residential aged care homes. And that information is all available on our Commission website but also can be linked from the Department’s website.

Another source of useful up to date information is the letter that the Chief Medical Officer of the Department of Health and Aged Care and I jointly sent to all board chairs of residential aged care providers in late May. So please if you’ve not seen it go and find it because it is several pages of fairly carefully curated information all of which is relevant to you as residential care providers. And I know that Alison will be subsequently talking about some of that important information as well.

Let me start my specific comments by recapping the argument and the evidence in favour of being proactive in relation to managing and minimising COVID risks. And forgive me if this is all too familiar but the pandemic is still with us. COVID is still circulating in the community which means it is also continuing to walk into residential aged care homes. Now we know that old age is the biggest risk to becoming seriously ill with COVID-19 and influenza and people living in residential aged care are particularly vulnerable to infections. Those of you who work in an aged care home absolutely know that. And we also know from all the statistics which have been gathered over the last four years that a significant proportion of all deaths associated with COVID-19 occur in people aged over 80 years. And that is the population for whom we are responsible.

Providers have certain responsibilities which you would be very familiar with, legal obligations under the Aged Care Act and the Quality of Care Principles, to ensure the safe, effective and quality delivery of personal and clinical care. And that is very familiar territory to you. If that’s news then there’s a longer conversation we have to have. The Commission as the national regulator oversees your adherence or compliance with those responsibilities and we respond to providers where we find you’ve veered off track, you’re non-compliant with one of your obligations. But we certainly expect that your management of COVID-19 is now fully integrated in how you plan and deliver individual care for older people and manage your services and also govern your organisation.

So that includes managing and responding to COVID risks as part of individual care planning and the delivery of care to each older person including ensuring or enabling their access to vaccinations and also antiviral medications. Now there’s been some confusion that I’ve encountered between vaccinations and antiviral medications and both of these separately and together have been game changers in enabling providers to more effectively manage the risks of COVID-19 and reducing the impact of the virus on individuals. Vaccination as you know is a vital element of your preventative measures and antivirals are the treatment of choice for older people who have a COVID infection. So importantly it’s not either/or. Both are essential and aged care providers are responsible for ensuring that residents have timely access to both.

Now we’re also looking for you to continue your vigilance and ensure that you are implementing robust infection prevention and control practices and procedures to minimise the risk of transmission and to ensure an effective response to outbreak, and we’re looking for governing bodies of providers to be accountable for how their organisation is managing COVID related risks consistent with the Quality Standards, and that includes timely access to vaccinations for residents and staff.

Now if you need reminding fully, four of the eight existing Quality Standards are relevant here. Standard 2 requires all providers to undertake ongoing assessment and planning for the care and services with older people. Standard 3 is personal care and clinical care. So we’re looking for providers to deliver safe and effective care in accordance with the older person’s needs. And there are a number of elements within Standard 3 which go specifically or more generally to preventative measures and responding to an outbreak. And Standard 3 also requires providers specifically to minimise infection related risks. And those of you who are most familiar with the Standards will know it’s positioned down the bottom of that list of requirements. Then we come to Standard 7 which is about human resources. So that requires providers to ensure that you have a workforce that is planned, trained, equipped, supported to deliver all the requirements of the Quality Standards including managing COVID risks. And then there’s Standard 8, organisational governance, which has a raft of expectations on providers in terms of the systems and processes you have in place to manage different sorts of risks and to ensure appropriate levels of corporate and clinical governance.

So when we’re monitoring providers we’re looking for evidence that these responsibilities are being delivered for each older person receiving care as part of their individual care planning and delivery. Not as an add on, not as something special, but now four years in integrated into their care planning and management.

Now let me talk briefly about IPC. To protect the older people in your care you know only too well by now that you have obligations to ensure that you have really robust infection prevention and control practices and procedures in place. And we recommend that you self-audit your readiness. There are tools available for you including self-assessment checklists on our website. I commend them to you. If you haven’t checked them out already then I would really like you to because there is much to be learned and gained if you road test them in your own service. What we’re wanting to ensure is that you have processes in place to monitor vaccination due dates as part of your care planning, that you’re managing consent and arrangements for vaccinations as soon as individuals are eligible, that you’re referring individuals to and engaging with general practitioners or ensuring access to pharmacists, whatever is required, that your services offer flu and COVID vaccinations to staff, that you are promoting the value of vaccinations, that you have arrangements in place for rapid prescription and access to COVID antivirals, that all your staff, all your workers are trained in IPC and adhering to IPC practices, that you have outbreak and workforce management plans which are up to date and that you have simulated so that it’s not something you put on a shelf or keep in an e-file somewhere that you haven’t looked at for some time. Get it out. Run yourself through it again. Do a drill. Make sure that you know what you need to do and everyone knows their role and the part that they play.

And when we’re monitoring you as providers against those expectations what we’re looking for is evidence that your services are well managed and that you’re focused on embedding practices that support the prevention and management of COVID-19. Now the question you probably have in your mind about now is well how is the Commission keeping an eye on us in this regard? Glad you asked. We actively monitor services’ COVID vaccination rates and outbreak data to identify providers who may be struggling to meet their responsibilities. And I’ll come back to that in a moment. But we also use our other intelligence channels to come to understand how risk is being managed. So we look at for example the findings we have from our site audits, we look at the complaints that we’re receiving about services, and we also keep an eye on our serious incident notifications to see whether they are also mentioning poor responses to an outbreak. And where we identify unmanaged risks to older people or non-compliance we’ll take action to require the provider to address the concerns.

Now the specific action we take will depend on the level of risk to older people and also the provider’s demonstrated capacity and willingness to manage that risk. And this is key. Where a provider is unwilling or unable to do what’s required we’ll actively case manage them through frequent engagement to ensure that the required actions are being taken in a timely manner. And where the provider continues to be unable to meet those community expectations which are now legislated obligations we will take regulatory action. But the provider gets to choose what they do and the decisions they make and the means by which they address the identified non‑compliance.

Now we have taken over 6,000 targeted infection control monitoring spot checks at services over the last four years. Over 6,000. We continue to do it. And what we really are ramping up at the moment in the context of the rise in outbreaks is an increase in our monitoring of provider self‑assessment and readiness.

All right. Let me turn briefly to vaccination. In response to the worryingly low vaccination rates for older people in residential care that Rhiannon referred to we have developed and are commencing a targeted regulatory campaign to monitor those providers with services who are reporting very low resident COVID vaccination rates. Now if you aren’t aware of this, in fact that data of COVID-19 vaccination rates of residents by facility across Australia is available on the Department’s website. And in fact it’s been picked up in some media commentary just today. So it's worth having a look and seeing if you’re on the list and what it says about you if you are on the list.

The first stage in our current regulatory campaign, this ramping up of effort that we’re undertaking, involves targeted, onsite visits to services with the lowest resident vaccination rates. And what we’re doing when we go on site is to try to understand how those providers are supporting and enabling older people to be informed about and to access vaccinations both for COVID-19 and for the flu. And we’re also looking at the providers’ arrangements to ensure that COVID-19 antivirals are readily accessible for individuals during outbreaks. So again what arrangements are in place in advance to ensure that GPs are willing and able to write the necessary prescriptions, that we have lined up the informed consent of the individuals to that sort of therapy, that pharmacies are available to dispense the necessary medication and so on. It’s not rocket science. And all of you have had some sort of exposure and experience to this already so it’s not new.

Now we will assess all the information we collect through our regulatory channels and where necessary we will engage with providers to ensure that you are meeting your obligations. And as I said earlier that may involve further regulatory action if necessary. So if you’re a provider you’re on notice that we’re being proactive in monitoring your preventative measures and also your response to COVID outbreaks. And we expect you to be proactive just as we are being proactive. Don’t wait for us to approach you with some focused questions about this. Audit yourself. Find and fix any gaps in your provisions, and especially in relation to the vaccination status of your residents.

The old adage about prevention being better than cure has never been more relevant or important. And we’re looking all the while as the Commission for evidence that you as a provider understand that and that you’re acting on it. Thanks Rhiannon.

Rhiannon Box:

Thanks Janet. Now before I hand over to Professor Alison McMillan I would just like to reiterate the current recommendations for vaccinations. For 75 years and older it is recommended to receive a dose of COVID-19 vaccine every six months. For people aged between 65 and 74 it is recommended that you receive a dose every 12 months however you are eligible to receive a dose every six months. And for people aged between 18 and 74 years with severe immunocompromise it is recommended to receive a dose every 12 months however they are also eligible to receive a dose every six months.

The most simple way to be able to make sure that residents in your homes are up to date with their vaccinations would be to hold a vaccination clinic every six months so that everybody is getting a regular dose of COVID-19 every six months. It is possible also to hold the flu clinic and the COVID clinic on the same day. It is safe and effective to receive the COVID-19 and the flu vaccine at the same time.

Janet Anderson:

Sorry. I know I’m interrupting the flow but there’s another clarification which I think providers would really value. There’s no longer a requirement for someone to wait the minimum time between their last COVID infection and having the COVID vaccination. We’re encountering a little bit of confusion and I thought I would just add that on the end of your own clarification. Thank you. 

Rhiannon Box:

Thanks Janet. That’s absolutely right. There is no need to wait. There was previously a recommendation to wait six months. There is no longer a need to wait any amount of time between having a COVID outbreak or a COVID infection and receiving a COVID vaccine. Thank you Janet. I will now hand over to Professor Alison McMillan who will talk to us about the updated CDNA guidelines for residential aged care homes. Thanks Alison.

Alison McMillan:

[Visual of slide with text saying ‘Professor Alison McMillan’, ‘Chief Nursing and Midwifery Officer’, ‘Department of Health and Aged Care’]

Thank you Rhiannon and Janet. Good afternoon everyone. It’s good to see so many people joining us. Here we are again as we say. But the information we’re trying to share with you is really very important to protect the most vulnerable in our society.

So as Rhiannon has mentioned already we are seeing an increase in COVID cases in residential aged care homes and unfortunately we are continuing to see low vaccination rates. You’ve heard from Janet. That information has been published. The Commission is following up particularly in facilities where those numbers are quite low. It is critically important that you play your part as providers to make sure that we get as many people vaccinated as we possibly can.

So to reiterate again what Janet has said, the Chief Medical Officer Professor Paul Kelly and Janet, the Aged Care Quality and Safety Commissioner, recently wrote to all providers about the responsibilities that you all have in this space. It is important that if residents and care recipients or their families have any concerns about the vaccine they are encouraged to talk to their doctor or primary care giver about those concerns. 

[Visual of slide with text saying ‘Communicable Diseases Network Australia’, ‘National Outbreak Management Guideline for Acute Respiratory Infection (including COVID-19, influenza and RSV) in Residential Aged Care Homes’, ‘Version 2.0’, ‘June 2024’, ‘Scan to access:’, with image of QR code’, ‘agedcareengagement.health.gov.au’]

But I’m here today to talk predominantly about the importance of the new National Outbreak Management Guidance. Now the guidance has changed. You can see just by the slide here next to me that we’ve gone at this point in time for a very strong focus on residential aged care homes. Now these have gone through extensive consultation. We’ve had many people to be a part of this and some of what I’m going to talk about, the changes, are based on feedback you’ve given us about some things that weren’t clear enough or were confusing or because of changes that have been made that can make this guidance a little simpler to understand.

So on the 14th of June the Communicable Diseases Network of Australia published these updated National Outbreak Management Guidelines for Acute Respiratory Infection – of course it includes COVID, influenza and RSV – in Residential Aged Care Homes. But as I say many people have had considerable input into this. You can access this guidance now by doing the old QR code thing with your phone and that QR code will take you. Isn’t technology amazing these days about what we can do with a QR code. And that will take you to the Department’s website.

The guidance is provided to assist you provide the best care possible and it’s intended to be practical information for the prevention and of course if necessary the management of outbreaks of acute respiratory infection. And that might be COVID, it might be flu or it might be RSV, or unfortunately could be a combination. So the approach is pretty similar in many cases.

However we do operate in a federation and so the guidelines have occasionally some differentiation between what the public health guidance should be in the state and territory you work in. We continue to strive to get consistent guidance across all jurisdictions and I believe this is closer but you need to look at this in the context of what does the public health unit in the state and territory you’re in also require you to do. But as I say we’re working hard to try and get greater consistency.

The changes we’ve made reflect changes in epidemiology, the context of best practice and all of the evidence available to us. And you’ll see in some of those things how we talk in a public health context about taking a proportionate approach so that over time we began to better understand elements of this. And so some of these changes I think you will find positive because it can make things clearer for you and your ability to deliver the best possible care.

Of course they take a risk-based approach and as always early identification is the best option. Early identification and action is the greatest chance where you will manage and reduce outbreaks. So the resources provide you with tools in order that these can help you prevent outbreaks and manage them. And importantly I think I’ll just reiterate these aren’t solely for COVID anymore. We’ve gone to look to try to look at all respiratory infections and in many cases your infections definitely could be a combination.

So what are some of the changes? The most significant change to these guidelines that I want to highlight is about the changes to the isolation periods for both cases and contacts following a positive COVID-19 diagnosis. And this is all in the guidance but you can see it here on the slide. So residents and staff diagnosed with COVID-19 can now end their isolation period after five days which is a reduction from seven, provided the acute symptoms have resolved and a COVID test is negative, or after seven days if those symptoms have resolved and there’s been no fever for more than 24 hours. No testing in that case is required.

The changes that you can see on this slide are outlined on page 11 of the updated guidance and please familiarise yourself because obviously if we’re reducing the time that your staff need to be isolated we’re getting your staff back quicker. Better for residents. Better for staff. Better for everyone.

Another change is about the resident’s choice regarding isolation. And as we’ve found and we’ve all realised over time we did take a very stringent approach perhaps early in the pandemic about the isolation of residents but we’ve taken a more proportionate response. So we’re of course thinking about the elements of responsibility for dignity for consumers and the choices which of course as Janet has talked about in the Standards, like Standard 1. And so this is a critical change in maintaining a resident’s human rights and wellbeing as well as the provider meeting their requirements under Standard 1. So I know these are tricky and they’re nuanced but they’re important. 

So the changes require you to engage with the resident and provide information and get them involved in the conversation about isolation. Ask them what they’d like to do. Would they like to quarantine or be with other residents that have been exposed? Importantly those conversations need to be held. And record their preferences in their care plans and act with them and for them what they want to do.

The guidance now includes guidance about new rapid antigen tests, as we know RATs, because there are new RATs available. The combination RATs work like the COVID RAT used to but can test for multiple viruses at the same time. So it can test for COVID, flu A, flu B and RSV. And if no pathogen is picked up by the use of a combination RAT the resident should be then assessed by their GP and it may be necessary the GP, nurse practitioner, health professional may see that it’s necessary to do a more formalised PCR test but that’s a clinical decision. And there’s certainly more information available to you in the chat about these rapid antigen tests or RATs.

The guidance includes also references to the new aged care infection prevention and control guide. Now these are expected to be released next month. And we have worked with the Australian Commissoin for Safety and Quality in Healthcare to give you as providers more guidance on IPC that’s specific to the aged care setting. This is a really great step forward and I’m sure many of you through different pathways may well have contributed to these. So these are coming and these I think will be very helpful. It gives advice on minimising infection risk for both older people and the workforce which I think is important. And I’m very appreciative of all of those people who’ve worked so hard on these guidelines, those that have been part of the consultation. In our next webinar we’ll be providing further information on this guidance. It’s still based on the traditional principles that we all know around infection prevention and control but it’s given some as I say more nuance to the care setting. Frankly less acute hospital focused, more about where you work and what you do which is so important.

And lastly now we’ll focus on outbreak management just not for COVID-19. The CDNA guidelines now do include RSV which has been added into the definition of an outbreak and it is where two or more residents who test positive to RSV within a 72 hour period for COVID, influenza, RSV. So you can see we’ve tried to make things a little simpler and clearer by this advice. 

What hasn’t changed? Because that’s important too. It’s important that you all regularly review your outbreak management plans and workforce capacity plans to ensure that you and your staff know what to do. So here’s a little action plan, nine steps about what to do and how to do it. This is a really good, quick aide-memoire about what you need to do in an outbreak. The guidance is about initial actions, what you should do when new respiratory symptoms are identified in a resident. And you all know the sooner you act, the quicker you act, the greater chance you’ve got of minimising cross infection and protecting all of the residents in your facility.

Make sure also when you’re thinking about this and looking at this new guidance are you clear on the pathways to the GPs, have you got access to a nurse practitioner who can support you in an outbreak. And remember pharmacists are now very much a part of our plan in this multidisciplinary approach. So do you and your staff – remember also out of hours, at weekends – know the pathways that are established for your facility where you see an outbreak emerging.

Home care and CHSP providers should also follow similar steps that are outlined in this guidance today when thinking about what you do.

Now many of you who have been on this webinar have seen and heard my droning on about IPC for a very long time but we know IPC is key to preventing outbreaks and as I say minimising transmission. And it is everyone’s responsibility and as we all know these viruses will exploit any chink in your armour. So it is about the continuous reiteration, the continuous reminding, reinforcement to every member of your workforce or residents, families and other loved ones about how we all play our part in this. So these are the things that we know you all do every day and I know that I’m talking to the converted, but it is really important that not only I remind you but then you remind your staff, your residents and all of those volunteers and visitors who come to your facility. This is how we’ll protect our most vulnerable and how we’ll keep this mortality rate much lower than it was in the early part of the pandemic. 

Thanks again for everything that you do. I know that it’s a challenging time but we have seen amazing improvement and changes in how we respond and we’ve all learnt a great deal during the last four and a half years. So I’m going to hand back to Rhiannon and then we probably can move to Genevieve. Thank you everyone.

Rhiannon Box:

Thanks very much Alison. I would now like to invite Genevieve Donnelly to speak to the COVID‑19 and influenza vaccination programs and provide information on what supports are available to residential aged care homes and providers to access vaccinations if required. Thanks Genevieve.

Genevieve Donnelly:

[Visual of slide with text saying ‘Genevieve Donnelly’, ‘Assistant Secretary’, ‘National Immunisation Division’, ‘Department of Health and Aged Care’]

Thanks Rhiannon and thank you to everyone who’s made the time to attend this webinar today.

As everyone has said it’s still very important to be vaccinated against COVID-19 and influenza and that being part of the way we manage the risk of both of these diseases in aged care. It does provide protection against the most severe of the disease. We understand that aged care providers have competing demands but timely vaccination is an important part of delivering high quality care. We know people may feel like they’ve had enough shots already but we also know that it’s not enough because immunity wanes over time, the virus strains change over time and COVID-19 cases continue in aged care homes.

COVID-19 has caused severe illness, hospitalisation and deaths in older adults particularly those with major medical conditions and those aged 75 years and older. Current evidence and recommendations are for six monthly vaccinations in people over 75 years as protection starts to wane after this time. One analysis of COVID-19 infections has shown that around 7.2% of people aged 75 years and older were hospitalised with COVID-19 compared with around 2% in those aged 65 to 74 and 1% of people aged 18 to 49. Aged care providers and families of older people have a really important role to play in offering and strongly encouraging COVID-19 and influenza vaccinations for our residents. Having early conversations with people and their families about the importance of vaccinations is critical to help protect residents.

To summarise following Rhiannon’s introduction and the presentations from Janet and Alison the recommendation is that for those aged 75 years and over we continue to recommend a dose of COVID-19 every six months. For those 65 to 74 it’s vaccination every 12 months but eligible every six. For all other adults it’s a single dose a year. Annual influenza vaccination is recommended for all people aged 65 and over.

Vaccination is very important as there is a higher rate of illness in people aged 65 and over for both of these conditions. Eligible adults aged 65 and over can receive free influenza vaccinations through the National Immunisation Program. It’s also important to know as Rhiannon said earlier that you do not have to wait a minimum time between your last COVID infection and having your recommended COVID vaccinations, and it is safe to have both your COVID-19 and annual flu vaccines at the same time. People can speak to their healthcare professional such as their GP, pharmacist or healthcare workers to discuss COVID-19 and influenza vaccinations for themselves.

Further information on COVID and influenza vaccines including eligibility is available through the Australian Immunisation Handbook. People can also check the booster eligibility checker available on the Department’s website. The tool is based on the latest recommendations regarding vaccinations and is designed for people who’ve completed a primary course of COVID‑19 vaccinations. This tool though does not replace medical advice. So certainly we’ll provide a link to this eligibility tracker or you’ll find it under COVID-19 booster eligibility tracker on the Department of Health and Aged Care website.

The Australian Government continues to ensure that COVID and influenza vaccines are available to all residents free of charge. And the Department is supporting access to COVID and influenza vaccines for residential aged care residents through payments to GPs and pharmacists for visiting to deliver these vaccines to residents, through vulnerable people vaccination programs which enables primary care networks to tailor vaccination activities to meet the needs of residents in their regions, and through the vaccine administration partners program which is available when primary care cannot meet the demand in areas.

In terms of our primary health networks in aged care PHNs continue to be an important part of supporting aged care homes to arrange COVID vaccinations for residents. We’re working very closely with PHNs and primary care providers to assist homes that need help to find a COVID vaccine provider and this is particularly important because 99% of COVID vaccinations in aged care are administered by primary care providers like GPs and pharmacists. If you’re having trouble getting your usual primary care provider to assist please contact another GP or pharmacist or your PHN rather than waiting. We have a list of eligible primary care providers in your area if you’re not sure. So please if in doubt reach out to your PHN or call us through the Vaccine Operations Centre and we’re here to help.

During 2023 PHNs contacted all aged care homes throughout Australia to offer support and have been contacting many homes again over recent months. We’re also working with PHNs to support aged care homes with the lowest rates of vaccination uptake and homes with large numbers of residents due for their next round of vaccinations shortly. We’re prioritising delivery of COVID vaccinations to primary care providers doing COVID-19 vaccinations in residential aged care as well. If you continue to have difficulty in accessing vaccination services or require further assistance in terms of the vaccines there will be a link to an email address provided through the slides. Thanks Rhiannon.

Rhiannon Box:

Thanks Genevieve.

We will now move to the Q&A component of our webinar today and we’ll attempt to get through as many questions as possible. I might start with the pre-submitted questions that we’ve received ahead of today’s webinar. Now we received a number of questions around the compulsory requirement for aged care providers to keep and record vaccination records for staff and volunteers. And the questions related to what if staff and volunteers refuse to disclose this? Are staff vaccination reporting requirements still mandatory for home care services? 

So providers of residential, in-home and community aged care must continue to report weekly on the status of COVID-19 vaccinations via the My Aged Care Portal. It is a legislative requirement under the Records Principles 2014 that all aged care residential providers and home care must also record COVID-19 and influenza vaccinations for residents and staff.

The Australian Government is not currently mandating vaccinations for aged care workers in residential aged care or home care settings but aged care providers must report the number of staff who have voluntarily informed them if they have received a COVID-19 vaccination. If a staff member has voluntarily informed you that they have not been vaccinated services are still required to include them in the total number of workers reported through the provider portal.

And I might just jump – because it is related I might just jump over to a question that we’ve received in Slido which relates to the reporting of vaccination rates through the My Aged Care Portal. And the question is:

Q:        The Aged Care Portal for reporting vaccination rates kept the same questions for so many years, example winter dose. Which winter are you referring to? Please ask questions relevant to the current climate to make it clearer. How many refusal? How many residents have three doses, four, five, six dose, etcetera?

Apologies. The Department is aware that aged care providers are not currently able to report COVID-19 vaccination booster doses via the My Aged Care Portal and that the questions do not currently allow for contemporary reporting of vaccinations for residents and workers. We are working behind the scenes to get this updated and we anticipate a solution will be provided in the coming weeks. The Department has included new instructions in the portal to make reporting simpler for updating resident and worker vaccinations. These instruct providers to record residents who have had a booster dose in the last six months under question 7 and staff in the third dose data field. I understand this is a workaround and it is a temporary workaround and we are absolutely working to update the My Aged Care Portal. And thank you for your patience and continued support.

There is another question that relates to the reporting in the My Aged Care Portal which is:

Q:        Is it only COVID outbreaks that need to be reported in the My Aged Care Portal? Why not flu, gastro and RSV?

So the Department of Health and Aged Care collects data directly from aged care homes on COVID-19 outbreaks, COVID-19 cases for both staff and residents, and resident deaths from COVID-19. We do not currently request that aged care homes report cases or outbreaks of flu, RSV or gastro. These diseases are captured through the jurisdictional reporting system, the National Notifiable Diseases Surveillance System, and the Department monitors that surveillance system very closely to get a good understanding of how these diseases are being transmitted in the community and what the levels of these diseases are in people aged over 65 and people aged over 75.

Whilst we don’t currently require that providers do report data on outbreaks of flu and other respiratory and infectious diseases this may change in the future but at the current time the Department is only requiring providers to report cases, outbreaks and deaths from COVID-19.

Okay. I will go back to another one of our pre-submitted questions which relates to vaccinations. And the questions relate to:

Q:        How long is the funding for vaccination clinics through PHN going to continue and can the Commonwealth mandate - - -

Sorry. I’ll stop there. I’ll hand over to Genevieve for a response. Thank you.

Genevieve Donnelly:

Thank you Rhiannon. So early in the pandemic Government funded Commonwealth vaccination clinics nationally to provide GP led COVID-19 vaccination services and these clinics are no longer operational as we’ve moved to a primary healthcare model. So that PHN funding was announced in the MYEFO budget of December 2023 and certainly continues this year to support people as we roll into the standard advice and stabilising advice.

Rhiannon Box:

Thank you Genevieve. I will now go to another one of our pre-submitted questions which relates to stopping the spread of infections. And the question is:

Q:        How can we possibly stop the spread of respiratory infections in a locked dementia wing?

And I might ask the Aged Care Commissioner to take this question. Thank you Janet.

Janet Anderson:

Thanks Rhiannon. Let me start by reiterating that a provider’s obligations are clear and you know them. I don’t need to recite them. They are spread across eight standards and many other obligations in the Act. My first question I suppose in response to the question which is being posed is what research have you done? Have you gone looking for guidance on this matter? Because there are many, many services, not just in Australia but in fact internationally, who have exactly the same challenge as you. So there are resources online. There are a number of which are Australian specific and I really would commend them to you. So activate your research instincts and go and look. Have a look for example at the resource that we’ve published which is titled Infection Prevention and Control in Aged Care: Cognitive Decline and Dementia. Sounds pretty relevant to me.

There is also the CDNA updated national guidance that Alison spoke about. That also contains some really useful advice and tips for managing risk in relation to people with dementia who may not be subject to reason and may have behaviours of concern. The other resource towards which I would point you is Dementia Australia. Now if you haven’t checked out their website they have a number of resources which are really apposite and very helpful and they also have a helpline. So if you have a particular circumstance and you are challenged by how to best manage that risk give them a ring and set out for them the concerns that you have or the challenges you’re experiencing and see what they have to suggest to you.

But really there’s no one size fits all here and you would know that. If you are a person with responsibility for caring for those with cognitive impairment then fundamentally it’s about understanding the individual and doing your very best to manage the risks at an individual level and for the cohort who resides in that secure unit. Thanks Rhiannon.

Rhiannon Box:

Thanks Janet. The next question relates to mandating influenza vaccinations for staff. And the question is:

Q:        Can the Commonwealth mandate influenza vaccinations for staff working in residential aged care homes?

So vaccination remains the most important measure we have to protect against severe disease from influenza particularly in high risk settings such as residential aged care. The Department strongly encourages all aged care workers to get vaccinated against both influenza and COVID‑19 to aid in the protection against infection and severe disease for themselves, for their families and for the older people that they care for. To help prevent the spread of flu in residential aged care, providers are required to have a mandatory flu vaccination program in place to comply with the Aged Care Quality Standards and that’s a mandatory flu vaccination program for staff. Providers must also take appropriate precautions to prevent and control the spread of flu which includes offering free influenza vaccinations to staff and volunteers annually.

Providers should be notifying staff and volunteers the key dates for the upcoming flu vaccination and whether they will be offered on site to help encourage uptake. Services should also have an effective infection prevention and control program that is consistent with the guidelines including the updated CDNA guidelines that Alison has spoken to today. Individual services can also mandate vaccinations should they wish to and that includes for flu if required.

Okay. The next question that we have relates to flu vaccinations again and I might hand this one to Genevieve. And the question is:

Q:        Flu vaccination supplies for regional New South Wales?

Thanks Genevieve.

Genevieve Donnelly:

Yes. So vaccinations across COVID and influenza are through two slightly different pathways as you’ll be well aware. While we can prioritise through the Department the distribution of COVID directly to aged care clinics that may be happening for vaccinations we certainly encourage you to reach out to your jurisdictional immunisation coordinators and departments if you aren’t able to access the influenza vaccines because those are delivered at a jurisdictional level. So we can certainly provide email addresses for that should you be struggling in that space.

Rhiannon Box:

Thanks Genevieve. The next one relates to storage of PPE. And I might see if Professor McMillan would like to take this question. And the question is:

Q:        What is the best practice for storage of PPE in a resident’s room during an outbreak?

Thanks Alison.

Alison McMillan:

Thanks Rhiannon.

My first response to this is that as you all know there is a requirement for every facility to have an infection prevention and control nurse in your facility which is the most important person to help you deal with managing the donning and doffing, the storage of the PPE and all of those things. And that needs to be taken – the style of your facility, the room design, the corridors are complex issues and so that IPC nurse who’s been trained in this work is the best resource to work with you to answer these questions.

If you do for whatever reason store PPE in a room and that individual has got an infection then that does become considered contaminated and can’t be re-used. So it’s always better to have the capacity to have it stored outside the room but you’ve got to think of other elements such as trip safety, safe storage, resident access, all of those sort of things. So look I’m not saying it’s an easy answer because it simply isn’t, and it is the person trained in your facility who’s best to help to make those decision makings about how best to store the PPE so that it can be accessed and donning and doffing can be done safely but also it doesn’t create a trip hazard and doesn’t waste valuable PPE unnecessarily.

There is lots of guidance on this as well but it is that risk approach that’s the most important. And so I do really strongly recommend that that’s the person that provides facilities advice in relation to how to maintain safety from an infection prevention and control perspective but also from an occupational health and safety perspective. So again reiterate the importance of that in making decisions about how to store and where to store PPE. Thanks Rhiannon.

Rhiannon Box:

Thanks Alison. The next question I have relates to vaccinations again so I will hand to Genevieve. And the question is:

Q:        There is a lot of movement to have residents vaccinated but less for staff. Is there scope to make the provision of COVID vaccines available to staff by providers as we have for influenza vaccines?

Thanks Genevieve.

Genevieve Donnelly:

Thanks Rhiannon. There is certainly plenty of COVID vaccines available to everyone who is eligible and everyone over 18 is eligible to get COVID vaccinated. That vaccination can be provided by GPs, through pharmacies and through your healthcare providers who are registered providers. You can find information on where to get vaccinated on the HealthDirect website. There are locators available there. Also with the providers where you hold clinics some of those are available to provide to residents and staff as well. So if you’re not able to find providers who are able to assist then you can certainly call and the VOC will be able to assist you in accessing those.

Rhiannon Box:

Thanks Genevieve. The next question I might hand to the Aged Care Commissioner and the question is:

Q:        If every resident in a memory support unit is infected with COVID-19 have we failed?

Thanks Janet.

Janet Anderson:

Thanks Rhiannon. My answer is going to frustrate everyone because my answer is that depends. Let me elaborate that very briefly because I realise that’s fairly unhelpful. To create the extreme picture if you’ve chocked open the secure perimeter door and you have ushered in numbers of people who’ve tested positive for COVID and invited them to wander around the secure facility interacting with all the residents then yes, you have failed. And the Commission is going to be very exercised and reaching for our most significant powers because you’ve effectively turned away from every single obligation in the Act.

In contrast if you have the systems and processes in place to govern the organisation and the clinical care, if you have trained staff who know what they’re doing and are supervised in good IPC practice, if you have embedded risk controls in your care planning for each resident, you know the resident, you understand the risks in relation to their cognitive status, their behaviours and you have a behaviour support plan in place which is very effective in assisting in the management of their behaviours, and you’re ready to activate your COVID response plan swiftly and effectively in the event of an outbreak to minimise the impact, then you tell us all of that and we’ll say keep on that track. Keep doing those really good things because you are demonstrating best practice. More power to you. Thank you. 

Rhiannon Box:

Thanks Janet. Now noting we only have one minute left I might just go to this question regarding the timeframe between having COVID and a vaccination because I think it’s a really important point that we want everyone leaving this webinar today to understand. And I’ll hand over to Genevieve. The question is:

Q:        What was the timeframe between having COVID and getting a vaccination?

Thanks Genevieve. 

Genevieve Donnelly:

So there is no longer a requirement to wait between having had an infection of COVID-19 and receiving your next vaccination. I know that that has been a recommendation in the past and it did make things a little bit tricky but that is no longer part of the recommendations and so please continue. Do not hold back and wait. Book in your clinics and vaccinate your residents please.

Rhiannon Box:

Thanks Genevieve. Now we do have a few questions that we haven’t had time to get to today but we will provide answers to those questions along with some of the links of the resources that we’ve discussed in today’s webinar on the Department’s website where this webinar will be published. 

So that concludes today’s webinar. Thank you so much to everybody who took the time out of their day to join us. If you have any other questions that you think of today or in the coming weeks please email us at agedcareCOVIDliaison@health.gov.au. When the webinar finishes a short survey will pop up in your browser. It takes around one minute to answer three questions and we would really appreciate if you could take a moment to help us improve our webinars. Thank you to everybody who was able to join us today. We hope you found this session useful.

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