Marie, Lisa and Gabriel, provide their insights into the day-to-day operations, adjusting existing models of care around to maintain lifestyle and managing dying. The three bring a wealth of lived experiences of managing and delivering aged care services. The podcast concludes with their top three issues to address for the future.

Prof Joe and Dr Rosie Forlano explore the mental health challenges faced by aged care and health workers in managing the ethical and moral dilemmas arising from Covid-19 pandemic. The explore ‘moral injury’ defined as the psychological distress that results from actions, or the lack of them, which violate someone’s moral or ethical code.

Examples how this may arise include Following decisions made by others that you believe are unethical or against guidance you’re your profession; putting residents or workmates in danger because we are working outside our normal competency and; feeling let down because we are working with insufficient resources that could have been avoided.

Prof Joe and Simon explore the stress and psychological well being. Simon has personal experience with Covid-19. Simon was on a cruise ship in South America, then evacuated and quarantined in Sydney where he had an infection with Covid-19.

Listen to Simon explore and explain the threats to our mental wellbeing during Covid-19, how people respond differently to the stress, how to adapt and how to help each other. Prof Joe and Simon also examine the issue of disenfranchised grief which is more likely to occur in an aged care setting. Ken Doka, coined the term ‘disenfranchised grief’ to describe “grief that results when a person experiences a significant loss and the resultant grief is not openly acknowledged, socially validated, or publicly mourned.” For example, this often occurs after a death of an older person with dementia who was living in aged care.

Prof Joe and Prof John Banja have a wide-ranging discussion about why care staff and professionals need to be and feel protected as they can save others, we draw on the experience of the USA to explore the things that we expected to happen but didn’t and explore the extraordinary ways that a pandemic exposes the weak spots and imperfections of a culture, e.g., those most at risk are the least protected.

Prof Joe and Shelly we examine how to protect staff and maintain trust in times of crises. We explore how to improve our teamwork, and how people who are empowered are better at solving the unexpected problems. Shelly explains the five dangerous elements that can destroy teamwork (lack of trust; pretending to agree to avoid conflict; lack of commitment; not holding team members to account and; focussing on personal rather than team goals) and how to avoid this from happening.

Dr Nicola de Savary describes her experiences as a medical specialist providing care for older people and as a member of a clinical ethics committee that had to consider optimal use of resources. We explore her experiences as the doctor in charge of patients with Covid-19 and the need to increase medical support into care homes. These insights are invaluable as the UK has over 40,000 deaths from Covid-19 of which at least 10,000 have occurred in care home residents.

We discuss the options confronting the management of residents infected with Covid-19 and consider the optimal arrangements. We explore with Jane the challenges of setting up a facility and health service specifically for residents who are confirmed Covid-19 positive cases. The workforce, resources and access to health services requirements are explored in an honest, fearless and direct manner. The episode concludes with reflections on the past two months around what has worked and what needs to improve.

What do we do about the resident who is showing symptoms of infection but hasn’t yet been confirmed? How do we confirm positive, or better, negative status? This episode focusses on how facilities should best manage this situation including discussion about physical separation, PPE and screening.

In today’s episode:

~ How do we manage the resident who falls in the yellow group, and is showing signs of infection?

~ What is meant by the term ‘cohorting’ of residents? How should we be doing this?

~ How should we approach suspected patients? What tests should be done and why?

~ How does the screening process work?

~ When can we remove precautions from suspected or positive patient?

Dr Sarah Whiting, an Infectious Diseases and General Medicine Specialist at The Alfred Hospital, joins us again to discuss the clinical guidelines and practicalities around screening residents living in aged care facilities.

References:

Krumholz HM. If you have coronavirus symptoms, assume you have the illness, even if you test negative. The New York Times [Internet]. 2020 Mar [cited 2020 Apr 28]. Available from: https://www.nytimes.com/2020/04/01/well/live/coronavirus-symptoms-tests-false-negative.html

British Geriatrics Society. Managing the COVID-19 pandemic in care homes: Good Practice Guide. British Geriatrics Society. 2020 Mar. Available from: https://www.bgs.org.uk/resources/covid-19-managing-the-covid-19-pandemic-in-care-homes

Australian Government Department of Health. Infection control expert groupL COVID-19 infection prevention and control for residential care facilities [internet]. Canberra: Department of Health. 2020 Apr [cited 2020 Apr 28]. Available from: https://www.health.gov.au/sites/default/files/documents/2020/04/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilities.pdf

PPE is a term that we’ve all become very familiar with. But today we address the questions we may have in order to actually understand what it is and how to use it. We discuss exactly what constitutes PPE, how to wear it and what to do if we breach our PPE.

In today’s episode:

~ What are some of the rights and wrongs when it comes to PPE use?

~ What do we do in case of a PPE shortage?

~ What constitutes a breach in PPE?

~ What are the differences in PPE required for healthy patients vs. suspected patients vs. confirmed patients?

Today Sue Atkins, who is a Regional Infection Control Advisor with the Department of Health and Human Services joins us to discuss the current guidelines for the use of Personal Protective Equipment in aged care facilities. Sue talks us through the fine details of the common situations that staff and residents experience.

References:

Department of Health and Human Services. How to put on (don) and take off (doff) your personal protective equipment (PPE) [internet]. Melbourne: Victoria State Government. 2020 Apr [cited 2020 Apr 28]. Available from: https://www.dhhs.vic.gov.au/sites/default/files/documents/202004/COVID-19_How%20to%20put%20on%20and%20take%20off%20your%20PPE.pdf

Australian Government Department of Health. Infection control expert groupL COVID-19 infection prevention and control for residential care facilities [internet]. Canberra: Department of Health. 2020 Apr [cited 2020 Apr 28]. Available from: https://www.health.gov.au/sites/default/files/documents/2020/04/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilities.pdf

NSW Government. Recommended Guidance on Mask Use in New South Wales [internet]. Sydney: NSW Government. 2020 Mar [cited 2020 Apr 28]. Available from: http://cec.health.nsw.gov.au/__data/assets/pdf_file/0007/572875/Recommended-Guidance-on-Mask-Use-in-NSW.pdf

The British Medical Journal. COVID-19: PPE Guidance. BMJ. 2020 Apr. Available from: https://www.bmj.com/sites/default/files/attachments/resources/2020/04/cv19-ppe-v1.0-web.pdf

Today we delve further into the course of infection of COVID-19 and how it might present. But older people are not your typical population, and aged care facilities are not your typical living environment. Join us as we discuss the need for screening and early detection in aged care facilities and how we can go about this.

In today’s episode:

~ How might older people present differently to the general population?

~ How often should we be screening aged care residents for signs of disease?

~ How should we monitor a COVID-19 positive patient within the aged care facility?

~ Why do we recommend a colour code system to simplify the system of what needs to be done for patients according to their COVID-19 status?

Prof Joe introduces Dr Sarah Whiting, an Infectious Diseases and General Medicine Specialist at The Alfred Hospital, to discuss the clinical guidelines and practicalities around screening residents living in aged care facilities.

References:

High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C et al. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. CID. 2009 Jan. DOI: 10.1086/595683

British Geriatrics Society. Managing the COVID-19 pandemic in care homes: Good Practice Guide. British Geriatrics Society. 2020 Mar. Available from: https://www.bgs.org.uk/resources/covid-19-managing-the-covid-19-pandemic-in-care-homes

Australian Government Department of Health. Infection control expert groupL COVID-19 infection prevention and control for residential care facilities [internet]. Canberra: Department of Health. 2020 Apr [cited 2020 Apr 28]. Available from: https://www.health.gov.au/sites/default/files/documents/2020/04/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilities.pdf

This introductory episode explains the importance of screening residents and early detection of disease in our aged care facilities. But how can we practically manage this? We have proposed a colour code system to split patients up according to whether they’re completely asymptomatic (green), showing symptoms of possible infection (yellow) and positive patients (red).

On today’s episode:

~ What is the colour code system?

~ Why are we splitting residents into groups according to COVID-19 status?

We want the same thing. But what we need to safely ease restrictions on our Aged Care Residents, is the re-establishment of trust in, and transparency from, the Federal Government. To save our loved ones from the harm of isolation, we need to be able to trust that the measures being adopted have been properly thought out, committed to, and will be vigilantly monitored, so that we can trust our family and friends in Aged Care will be safe.

The difficulty here for you is this. The foundations of the Australian Aged Care system, as the current Royal Commission has pointed out, has suffered serious neglect and is failing our residents already.

So, to reduce the lockout harm, the Government needs to rapidly fix these foundation issues to provide a foundation for Covid prevention and management measures. A system based on a house of cards will simply collapse.

1) Everyone has the same shared understanding of the problem

~ Knowing what to do – protocols around handwashing

~ Adopting this – so it becomes a strong part of the culture

~ Something we can do as a team is something we can be proud of.

~ The biggest enemy is invisible. The best thing we can do doesn’t seem obvious

~ Need a shared understanding - Open discussion to know what people understand and what they’re worried about

~ Use handover times and expand to second meeting at end of a shift to collect info and feedback

2) Lead by example from the top

~ Ask the CEO, board members, doctors to make a display of how important it is to wash hands

~ Watch people lead by example

3) Choose a leader from within the ranks

~ A manager sends an email, provides online learning and ticks a box saying infection control is complete

~ A leader is a person, no matter what their qualifications, remains the most motivated, loves their job and the staff the most. Need a role model

~ Give the leader the right vision – don’t make it reactionary (don’t be scared), want to become known for never compromising infection control

~ Do it for people

~ Make it competitive – chance to prove you’re the best aged care facility in the area, state, country, world

~ Empower the leader to shift the culture – show that the CEO considers this work is very important and that their work should be listened to

~ Look past paper qualifications and look at personal attributes

4) Make everything available

~ Hand sanitizer everywhere. PPE where needed. Cleaning chemicals. Everything required to do the job without compromise.

5) Teach, Re-teach, repeat, and be proud of it

~ Best way to learn anything is to do it multiple times a day, at every opportunity and to do it together with other people

~ Don’t learn from a book

~ At beginning and end of every shift, huddle process where group gets together

~ Wash hands together, sing song together – remind each we’re washing hands together right now to save lives

~ Only become good a skill by repetition. Think of the skill of hand washing in the same way you think of a skill of learning a musical instrument

~ We all know how to do it, and now is the time to do it properly every time we wash our hands

~ The Japanese have a great ritual whenever a new customer enters a restaurant, all the staff shout IRASSHAMASE which means 'Welcome to the Store'

6) Have a system to evaluate infection control

~ Feedback – beginning, during and end of the shift

i. Important at end of shift – are there enough supplies, are there enough handwashing sinks, what are some of the barriers

ii. Did anyone have any issues, did anyone see anyone else having issues?

iii. How can we help to do things better? Look after each other?

~ Everyone hates being policed. But it's also important to help each other improve.

~ Ask after the health and wellbeing of the person

~ Be mindful of body language and how you present yourself

7) Build a check point

~ Coordinate entry and exits as a check point with fixed process

~ Someone at each check point (entrance) checking temperature and asking the COVID-19 questions – most places already do this

~ Add on supervising handwashing

8) Work as a team to support your staff and be proud of your work

~ Walk the talk

~ Ask after each other, help each other out

~ Support staff staying at home if they’re unwell, support them getting tested and follow up with them

~ We are very proud of staff and people working in aged care

Infection control is going to be the thing that saves lives

Today we take a different stance on combatting the pandemic. Let’s look at COVID-19 from military perspective, with COVID the threat and nursing homes the combat field. We see how like any successful operation, behind any victory is successful leadership.

On today’s episode:

~ How every single person in the aged care community, from healthcare workers to residents and their families, can contribute and help keep people safe.

~ Why is leadership so important during this crisis?

~ How will successful leaders create a positive, collaborative culture within RACS?

~ Why we need to completely flip conventional hierarchical forms of management and change the style of leadership.

Join Prof Joe and Greg Van Borssum (an Award winning Film Director and choreographer, World Champion Pistol Shooter, Martial Arts Expert and Life Line Ambassador) for an inspiring discussion about leadership, culture and team work. Greg, cuts through the technical aspects to remind us that doing the basics well and look after each other is the key to success.

Associate Professor Noleen Bennet (Infection Control Consultant) joins Prof Joe in this episode and brings us back to basics with the principles of infection control. How is COVID-19 transmitted? What are the principles of infection control and how can we practice them? Should I be wearing a mask or gloves when visiting a relative? These are a few of the questions that Noleen addresses during this episode.

On today’s episode:

~ How is COVID-19 transmitted? How does this guide what infection control procedures should be in place?

~ How can we practice infection control in aged care facilities?

~ How should we be preparing in advance for infection control during an outbreak?

~ What should be included in an outbreak plan?

~ Where can we find resources for infection control and prevention?

References:

Department of Health and Human Services. Coronarvirus (COVID-19): Plan for the Victorian Aged Care Sector. Melbourne: Victoria State Government; March 2020. 53 p.

Department of Health and Human Services. Physical distancing and other transmission reduction measures – coronavirus (COVID-19) [Internet]. Melbourne: Victoria State Government; 2020 [cited 2020 Apr 11]. Available from: https://www.dhhs.vic.gov.au/coronavirus-covid-19-transmission-reduction-measures

National Health and Medical Research Council. Australian Guidelines for the Prevention and Control of Infection in Healthcare [Internet]. Canberra: National Health and Medical Research Council; 2019 May [cited 2020 Apr 11]. 363 p. Available from: https://www.safetyandquality.gov.au/sites/default/files/2020-03/australian_guidelines_for_the_prevention_and_control_of_infection-in_healthcare_februrary_2020.pdf

Ministry of Civil Affairs. Urgent call for prevention and control of the novel coronavirus pneumonia in nursing homes [internet]. Beijing: Ministry of Civil Affairs, 2020 [cited 2020 Apr 8]. Available from: http://www.mca.gov.cn/article/xw/mzyw/202001/20200100023683.shtml

The Weekly Source. Real lessons from the UK frontline [Internet]. Sydney: DCM Media, 2020 [cited 2020 Apr 11]. Available from: https://www.theweeklysource.com.au/real-lessons-from-the-uk-frontline/

This episode explains the importance of paying close and meticulous attention to the fundamentals of infection control. The most important practice is one we have known and often overlooked, that is hand washing. We explore how the seemingly simple strategies done well is our best protection to keep the virus out and save lives.

Prof Joe welcomes Ian Yates (CEO of Councils of the Ageing – COTA) to the podcast today, who offers valuable insight into the current situation in aged care. Both share their initial concern surrounding the harsh lockdown in aged care facilities, but why are they both now advocating for a total lockdown? Join us as Ian Yates shares the accounts and experiences of residents and their families on the issue of lockdown.

On today’s episode:

~ How facilities are adapting to the situation?

~ Why chemical restraint is not and should not be the answer.

~ Is work currently being done behind the scenes in the aged care sector?

~ Why is a consistent message between state governments important for success in the aged care sector?

Following the recent Royal Commission, trust in the aged care sector is lower than ever. So introduction of a complete lockdown in aged care facilities may understandably cause a lot of distress for families of residents unable to see their loved ones. However, innovation within aged care facilities is helping create trust with families and create connectedness during the pandemic.

On today’s episode:

~ What are some of the compromises that may come with a complete lockdown?

~ Why is there currently an innate mistrust in the aged care sector? What are facilities doing to repair this?

~ What innovative things are aged care facilities doing to maintain connection during the lockdown?

~ What is a communications officer? And, why are we advocating for this role during the lockdown?

Join Prof Joe, Marie Crossland (CEO Napier Street Aged Care Services), Sally Eastwood (occupational therapist) and Jeremy Ley (community advocate) as they discuss these issues and advocate for a new role within aged care facilities - the communications officer.

References:

Royal Commission into Aged Care Quality and Safety. Interim Report: Neglect [Internet]. Canberra: Australian Government; 2019 [cited 2020 Apr 11]. Available from: https://agedcare.royalcommission.gov.au/publications/Documents/interim-report/interim-report-volume-1.pdf

Laging B, Doyle C. Virtual karaoke and museum tours: how older people can cope with loneliness during the coronavirus crisis. The Conversation [Internet]. 2020 Mar [cited 2020 Apr 8]. Available from: https://theconversation.com/virtual-karaoke-and-museum-tours-how-older-people-can-cope-with-loneliness-during-the-coronavirus-crisis-133771

Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. The Lancet. 2020 Mar. Available from: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30061-X/fulltext

Wang H, Li T, Barbarino P, Gauthier S, Brodaty H, Molinuevo JL et al. Dementia care during COVID-19. The Lancet. 2020 Mar. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30755-8/fulltext#back-bib9

This introductory episode goes further into exploring what led to the shocking scenes coming out of Spain’s aged care facilities, and how in Australia our aged care system may be at risk of similar events. With the recent Royal Commission highlighting serious deficiencies in our aged care sector, listen as we introduce some measures that we can put in place to ensure a humane lockdown and keep our residents safe.

On today’s episode:

~ What failures are there in our current aged care system have that make us more like Spain than what we may think?

~ Why might the families of our residents be concerned about a complete lockdown?

~ What measures can we put in place to ensure a humane lockdown?

Reference:

Royal Commission into Aged Care Quality and Safety. Interim Report: Neglect [Internet]. Canberra: Australian Government; 2019 [cited 2020 Apr 11]. Available from: https://agedcare.royalcommission.gov.au/publications/Documents/interim-report/interim-report-volume-1.pdf

Ibrahim JE. Royal Commission in Aged Care Quality and Safety: the key clinical issues. Medical Journal of Australia. 2019 Jun;210(10):439-41

As a society we’re being told stay home and not have visitors. Yet nursing homes are still allowed visitors despite residents being in their home.

Join Prof Joe and Marie Crossland (CEO Napier Street Aged Care Services) for a discussion on why they advocate for harder lockdown restrictions in aged care facilities. They describe what this may look like in nursing homes and address the difficult scenarios, such as family members who provide vital daily care for their elderly relatives.

On today’s episode:

~ How are nursing homes maintaining contact during the current lockdown?

~ What will a complete lockdown look like?

~ How do residents and families feel about the lockdown restrictions?

~ Should there be any exceptions to these restrictions?

References:

Laging B, Doyle C. Virtual karaoke and museum tours: how older people can cope with loneliness during the coronavirus crisis. The Conversation [Internet]. 2020 Mar [cited 2020 Apr 8]. Available from: https://theconversation.com/virtual-karaoke-and-museum-tours-how-older-people-can-cope-with-loneliness-during-the-coronavirus-crisis-133771

Atabakhsh V. Social distancing: 6 ways to help older adults change their routines. The Conversation [Internet]. 2020 Mar [cited 2020 Apr 8]. Available from: https://theconversation.com/social-distancing-6-ways-to-help-older-adults-change-their-routines-134186

D’Adamo H, Yoshikawa T, Ouslander JG. Coronavirus Disease 2019 in Geriatrics and Long-term Care: The ABCDs of COVID-19. J Am Geriatr Soc. 2020 Mar [ahead of print]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32212386

McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG et al. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. NEJM. 2020 Mar. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa2005412?query=featured_home

This introductory episode explains the current lockdown restrictions for nursing homes, residents and their families. But is this enough? Many nursing homes are going above and beyond the current restrictions believing that prevention is our best protection to keep the virus out and save lives.

On today’s episode:

~ What are the current lockdown restrictions to aged care facilities?

~ Why are some aged care facilities going beyond the current lockdown restrictions?

~ What is the situation in Europe? How should the current state of nursing homes in Spain guide action here in Australia?

References:

Belligoni S. 5 reasons the coronavirus hit Italy so hard. The Conversation [Internet]. 2020 Mar [cited 2020 Apr 8]. Available from: https://theconversation.com/5-reasons-the-coronavirus-hit-italy-so-hard-134636

Gonzalez M, Troya MS. Spanish prosecutors launch investigation after bodies found inside senior nursing homes. EL PAIS [Internet]. 2020 Mar 24 [cited 2020 Apr 9]; Society:[about 2 p]. Available from: https://english.elpais.com/society/2020-03-24/spanish-prosecutors-launch-investigation-after-bodies-found-inside-senior-homes.html

On today’s episode:

~ Why are aged care residents particularly at risk?

~ Nursing homes are designed to be a home rather than hospital - how can they provide hospital level care during this pandemic?

~ What is needed to protect our residents from spread of the virus in nursing homes?

~ We should re-frame our thinking from isolation to protection.

~ What effect will under-resourcing of our aged care system have during the pandemic?

~ What happens when support services for nursing homes become overwhelmed?

Join Prof Joe as he outlines 9 action points to help save lives in nursing homes during this pandemic. These points will each be explored in their own episode each week.

References:

• Vally H. Why are older people more at risk of coronavirus? The Conversation [Internet]. 2020 Mar [cited 2020 Apr 8]. Available from:

  https://theconversation.com/why-are-older-people-more-at-risk-of-coronavirus-133770

• D’Adamo H, Yoshikawa T, Ouslander JG. Coronavirus Disease 2019 in Geriatrics and Long-term Care: The ABCDs of COVID-19. J Am Geriatr Soc. 2020 Mar [ahead of print]. Available from:

  https://www.ncbi.nlm.nih.gov/pubmed/32212386

• McMichael TM, Currie DW, Clark S, Pogosjans S, Kay M, Schwartz NG et al. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. NEJM. 2020 Mar. Available from:

  https://www.nejm.org/doi/full/10.1056/NEJMoa2005412?query=featured_home

Connect with us @Profjoeonline. If you’re an aged care professional connect with us at the Prof Joe Covid-19 Aged Care Facebook Group.