External staff, IT systems, communication – all present unexpected challenges.
All came to the fore at Dorothy Henderson Lodge, which now will be remembered as the site of Australia’s first major coronavirus outbreak in an aged care home.
On 3 March, a long-time staff member at the home in Sydney’s Macquarie Park tested positive for COVID-19 – the first case of community transmission in NSW, at a time when the number of cases across the country was only 41.
21 people would become infected – 16 residents and five staff. Sadly, six of those residents would pass away.
Last Thursday, NSW Health declared that the COVID-19 outbreak at Dorothy Henderson Lodge was over – nine weeks after the first case.
BaptistCare CEO Ross Low has earned praise throughout that time for his response.
The head of the NSW and ACT-based Not For Profit for almost a decade, Ross leads 18 aged care homes, nine retirement villages, plus home care and community housing and services and had announced plans to retire in January (he has agreed to remain in the role until the search for a replacement is completed).
He also has 1,711 residents and their families under his wing, as well as over 3,500 staff and 1,000 volunteers.
We talked to Ross about how the situation unfolded – and the lessons BaptistCare has taken away from their experience.
COVID-19 is different – health authorities a vital partner
The CEO says that as an aged care provider, BaptistCare was prepared for outbreaks of infectious diseases – with senior management reviewing the existing crisis management plan and pandemic plan prior to the outbreak at Dorothy Henderson Lodge.
But Ross agrees this experience was one of the most challenging in their 75-year history.
“We have learnt a lot about some of the operational challenges that are unique to COVID-19 that you would not necessarily expect in a typical infection control scenario,” he said.
Ross says immediate attempts were made with NSW Health to contain the further spread of the virus by trying to contain the virus within the initial affected wing (the home has six wings with separate staff working in each one).
Two residents – a 95-year-old woman and an 82-year-old man – had already been hospitalised with respiratory issues and later returned positive results (both passed away from the virus).
Staff sent home immediately to self-quarantine
All staff who had come into contact with the confirmed staff member were sent home immediately to self-isolate.
Here, Ross credits the help of the NSW Health infection control team who isolated affected residents and staff, and introduced measures to prevent further spread, such as Personal Protective Equipment (PPE).
The home was immediately closed to visitors, but staffing quickly became an urgent issue.
The media widely reported that many staff did not come to work the day after the confirmation of the first case – and Ross says staff did react with great concern.
Staffing “crucial for business continuity”
“Staffing is a major challenge when your entire complement of care and clinical staff are required to self-isolate as a precautionary measure, and we have seen this at affected sites across the country,” he stated.
Ross says the central location of the home – and cooperation of the health authorities – was key in helping them address this challenge quickly and fill the gaps in staffing with Healthcare Australia stepping in to provide emergency personnel.
“Since the initial outbreak at Dorothy Henderson Lodge, BaptistCare have worked closely with NSW Health, the Department of Health, the Aged Care and Quality and Safety Commission, Healthcare Australia and other government authorities over the course of the outbreak. We are very grateful for their expert assistance and the guidance from all involved,” he said.
“An outbreak of COVID-19 is unlike any other typical outbreak. We learned firsthand that staffing was crucial for business continuity and this is definitely something any organisation should forward plan as COVID outbreaks can require the isolation of many staff members at one time. Sourcing replacement staffing is difficult, and continuity of care suffers almost immediately.”
New ‘Carer Reserves’ for outbreak situations
Ross says BaptistCare has since introduced new programs across their organisation – including their Carer Reserves Program, a team of 110 staff members who can be deployed to any home in the event of another outbreak – to strengthen their emergency response.
“We believe better cross-sector collaboration, facilitated by government, will help to overcome resourcing challenges more effectively and efficiently, should COVID-19 affect additional aged care sites in future,” he stated.
Centralised hotline for families to call – plus individual coordinators for residents
Ross also stressed the importance of quick communication with families and staff.
A centralised hotline was set up for families to call at any time with questions.
“Communication. I can’t stress this enough. Communication with families is absolutely paramount and even then, some people might say what we didn’t do enough. We knew and understood that this was an anxious time for our residents and their families, so we made sure that we were frequent and consistent with our updates, even when we had no new information to offer,” Ross says.
A team of nurses made the initial call to all Dorothy Henderson residents’ families to explain what was happening at the home and to answer any questions or concerns.
Staff members were designated to arrange phone or video calls to read out email messages between residents and family members – a role that BaptistCare has now rolled across all 18 homes.
Constant communication with staff required
The CEO also pointed to staff wellbeing as vital.
“For those who have tested positive, or are self-isolating waiting to see if they develop the illness, frequent contact with the organisation is important. Employee Assistance Programs can help with this. We would recommend Providers have access to EAP services for their staff, both during and following the outbreak.”
BaptistCare supported Dorothy Henderson Lodge staff through regular phone calls, emails and SMSs, and kept up to date with what was happening at the home.
“Safety and training sessions were arranged with health authorities and infection control specialists so that staff members could ask any questions,” Ross adds.
You can watch a video of one of the staff briefings here.
Home forced to revert to paper-based system
IT systems – specifically the lack of a universal software system that all staff know how to use – also proved to be a challenge.
BaptistCare uses an electronic system to develop their care plans, monitor clinical events, and capture progress notes and other medical information, but Ross says this quickly became ineffective when the replacement staff had no idea of how to use it.
“We switched to our backup paper-based system so that the staff could document the care being delivered. This included paper-based charting of all clinical observations,” Ross said.
“We would recommend that Providers who are using electronic systems have a plan to switch to paper-based modes in the event that a large proportion of their staff are required to self-isolate.”
No sharing of RNs across wings
The outbreak also resulted in a significant increase in Registered Nurses being required, Ross added –and again the lack of a single system for dispensing medication became an issue.
“Isolating each wing of the home meant that we needed a minimum of six RNs 24 hours/day,” he explained.
“The RNs we were able to source were largely hospital-based. Without our own staff on site, the agency RNs were required to administer medications. Our blister-pack model of medication delivery caused problems for the RNs, because it made identification of individual medications difficult and time-consuming.”
“We would recommend that Providers identify external staffing agencies that have the capacity to provide large numbers of staff. We acknowledge this isn’t always possible, and that the Federal Government has put contingency plans in place to provide a surge workforce.”
Coordinator needed to work with health authorities
Working closely with multiple health and aged care authorities is also crucial in an outbreak situation, Ross adds.
“We would recommend that Providers identify a senior person to take on this full-time coordination role if a COVID-19 outbreak occurs.”
The benefits of being a larger provider
“BaptistCare has the capacity to send SMS text messages to groups of people, including family and friends. Some days saw us sending multiple messages to keep people updated. This capacity was exceptionally useful during the outbreak.”
Being a larger provider, BaptistCare also had the benefit of its own Customer Engagement Centre to take and make calls.
“This was useful to handle large volumes of calls in the early part of the outbreak. We would recommend that Providers consider how they might develop a rapid communications protocol and have it ready to use in the event of an outbreak.”
Safety zones established for families to visit
Visits by families have also continued, albeit subject to the changing conditions including the new Industry Code launched this week.
Initially, families were able to visit residents under extenuating circumstances, including palliative care.
“As a starting point we introduced safe visiting zones around the perimeter of all 18 of our aged care homes so that residents could visit and see their loved ones.”
“We also appointed a Connections Coordinator at each location, whose sole focus is to connect families with their loved ones via safe visiting, video or phone calls. Families are also encouraged to drop off care packages for their loved ones. Visiting restrictions have since been eased at our locations to allow for safe visitations inside the homes, particularly as winter approaches.”
Some staff still not returned to work
In positive news, the four staff members who tested positive have now recovered and those who were in isolation as a precaution have been able to return to work0555
In total, over 80% of the original team at Dorothy Henderson Lodge is now back at work.
“Some have elected to take personal leave including maternity and long service leave,” Ross says.
However, the CEO says the majority of staff and residents are enjoying being back together again and settling back into their routines.
“We are most proud of our staff, who showed they would do anything for our residents.”