Prior to the COVID-19 pandemic, and this current outbreak, family members were regularly involved in the care of their loved ones in Residential Aged Care Facilities. It is well known that visitors provide crucial care and support to residents, including but not limited to social and emotional connection, support with day-to-day tasks such as eating, support to communicate their preferences to staff, and monitoring quality and safety. During the COVID-19 pandemic, outbreaks in Residential Aged Care Facilities have required restrictions on visitors to manage the risk of infection to residents. However as the pandemic has gone on, concerns have been raised that these restrictions are putting residents at risk of other adverse health outcomes and substantially decreased their quality of life.
What we have heard
HCCA has heard from our members that visitor restrictions currently imposed by ACT Health in several Residential Aged Care Facilities in the ACT are impacting their ability to provide care and support to their loved ones. There are concerns that continued restrictions at this level are likely to have impacts on health through malnutrition, unnecessary falls, and harm to mental health. Concerns raised with HCCA reflect the national and international evidence that there are significant issues for people with dementia and their families, in particular mental health and carers’ ability to provide essential care and support.
Multiple community members have expressed concerns that restrictions in aged care facilities have been in place for some time and seem likely to continue indefinitely. They are concerned not only about their inability to visit their family members, but the restrictions on movement by residents, which could lead to further poor health outcomes.
Balancing Risk and Quality of Life
One survey respondent from a survey HCCA undertook regarding recent experiences of COVID-19 said, “Residents are basically locked in rooms all day with physical and mental health deteriorating […] There are more health issues to balance than just Covid.” This has been backed up by conversations and reports from other HCCA members, who have described the experiences of their family members as “essentially solitary confinement”. One member said that their mother had been in her room for nine days, unable to take the short walks necessary to help manage congestive heart failure. Another said that their father was on his sixth week of bed rest and had concerns for the impact of this on his physical capacity.
The mental health consequences of prolonged isolation for both residents and their families has been documented in previous outbreaks and is being felt in the current outbreak. Members described residents with dementia crying on video calls as they do not understand why no-one is able to visit them or what they have done wrong. One survey respondent said, “For some the risk to their mental health is worse than the possible risk itself.”
It is worth noting that many aged care residents are fully vaccinated, as are the family members who wish to visit them. Additionally, most people who spoke to HCCA said they were happy to wear PPE, visit in controlled settings, and some wished to help with care for their family member during staff shortages. Several expressed frustration that residents and their families had no choice or say in how the risk of COVID was being balanced with other health risks.
HCCA members have said that communication from both the ACT Government and Residential Aged Care Facilities has been inadequate, inconsistent and confusing. Families of residents are not being provided with rationale for facilities locking out visitors for one or two cases among staff, and family members are not supported to visit where it is essential. Even when a visit is for essential care, such as supporting a resident to eat, staff in some facilities still refuse to allow visits, or place unreasonable restrictions on them, such as restricting visits to weekdays.
Guidelines on visitation are inconsistent between facilities, with some facilities imposing their own additional restrictions on top of health directions. There is confusion in the community about which restriction are being imposed by ACT Health, the Commonwealth Government or facilities themselves, so family members do not know who they should contact if they have an issue with visiting a loved one.
While the current COVID-19 outbreak poses a risk to older people, this needs to be balanced with the risk of poor physical and mental health outcomes due to long periods of isolation or inadequate care due to visitor restrictions.
- ACT Health provides clear public guidelines that balance the rights of residents to visitors in future public health advice for residential aged care facilities.
- ACT Health promotes the COTA Industry Code to all Residential Aged Care Facilities in the ACT, emphasising the importance of visitors, even during outbreaks.
- ACT Health publishes a clear definition of essential and compassionate visitors for Residential Aged Care Facilities to ensure consistency across the sector.
- Residential Aged Care Facilities be supported with funding and/or resourcing to facilitate safe visitation during COVID-19 outbreaks.
The Royal Commission into Aged Care Quality and Safety’s special report on COVID-19, highlighted the importance of visitors, stating that, “Visits from family and friends are critical to the physical, mental and emotional health and wellbeing of people living in residential aged care and also their friends and families.” It reported that, under visitor restrictions during the Victorian outbreak, staff time had been stretched trying to meet the day-to-day care needs of residents, compounded by staffing issues. It draws attention to two main reasons visitors are important in aged care, “Visitors often provide part of the care and support which is needed by older people in aged care homes. […] conversation, exercise, and assisting them to eat and drink, as well as maintaining continuing connection with life and the community” and “a critical role as the ‘eyes and ears’—monitoring the quality of care their loved ones receive”.
Impacts of visitor restrictions appear to be particularly significant for people with dementia. In their November 2020 discussion paper, ‘One Day the Support was Gone’, Dementia Australia reported that, “limiting essential visits has resulted in poor physical and psychological outcomes for residents with dementia, including weight loss, agitation and accelerated cognitive decline.” Their report recommended that “infection control measures and training are extended to carers so that essential visits may be maintained should crisis or emergency measures need to be reinstated.”
These issues are reinforced by the International Long Term Care Policy Network’s review of international restrictions on visits to aged care facilities throughout 2020. They found that blanket restrictions on visits had detrimental effects on residents, families and staff. They recommended that:
- Blanket visitor and family caregiver bans should not be used to prevent COVID-19 infections in care homes
- Safe on-site visiting practices should be used, with options chosen based on local levels of community transmission and in discussion with residents, families and staff and health authorities
- ‘Family caregivers’ should be designated as essential partners in a resident’s care during the pandemic and be able to have more frequent, longer hands-on visits if they can be supported to do so safely
- Care homes should receive additional government funding and support to implement safe visiting practices
- Regulators should be ensuring that care homes meet residents’ rights to have visitors and that safe visiting practices are being used.
Industry Code for Visiting Residential Aged Care Homes during COVID-19
In response to visitor restrictions, COTA Australia developed the Industry Code which includes an ‘essential visitor’ policy which requires that all residents are always allowed one visitor, regardless of outbreak status. This code includes risk management suggestions for facilities during outbreaks, and was developed in consultation with residents, providers and carers. However, the code notes that public health authorities, such as ACT Health, hold the ultimate decision-making capacity on restrictions in Residential Aged Care Facilities.
The ACT Government COVID-19 website tells aged care facilities to develop an outbreak management plan in line with the Australian Department of Health’s COVID-19 guidelines for outbreaks in residential care facilities. These guidelines state that during an outbreak, providers should “restrict visits from regular visitors and families of residents to essential and compassionate reasons,” not restrict visitors entirely. The National COVID-19 Aged Care Plan, also from the Commonwealth Department of Health, refers specifically to the COTA Industry Code, stating, “Quality of care for older Australians is dependent upon ensuring the right balance of protections and infection prevention responses.”
HCCA will continue to work with our colleagues at COTA ACT on these issues. If you would like to discuss this please contact C Moore via [email protected].
 Commonwealth, 2020, Royal Commission into Aged Care Quality and Safety, ‘Aged care and COVID-19: a special report’, https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf (Accessed 13 January 2022).
 Dementia Australia, 2020, One Day the Support was Gone… The mental health impact of COVID-19 on people living with dementia, their families and carers, https://www.dementia.org.au/sites/default/files/2020-11/PFOD-Discussion-Paper-Nov-2020-ver1.pdf (Accessed 13 January 2022).
Low L-F et al., 2021, ‘Safe visiting at care homes during COVID-19: A review of international guidelines and emerging practices during the COVID-19 pandemic’, International Long-Term Care Policy Network, https://ltccovid.org/wp-content/uploads/2021/01/Care-home-visiting-policies-international-report-19-January-2021-1.pdf (Accessed 13 January 2022).
 COTA Australia, 2021, Industry Code for Visiting in Aged Care, https://www.cota.org.au/wp-content/uploads/2021/12/Industry-Code-for-Visitiing-Aged-Care-Homes-22122021.pdf (Accessed 13 January 2022).
 ACT Government, 2022, Advice for Staff and Operators of Aged Care Facilities, https://www.covid19.act.gov.au/services-and-support/aged-care/advice-for-staff-and-operators-of-aged-care-facilities (Accessed 13 January 2022).
 Commonwealth Department of Health, 2021, COVID-19 guidelines for outbreaks in residential care facilities, https://www.health.gov.au/resources/publications/coronavirus-covid-19-guidelines-for-outbreaks-in-residential-care-facilities (Accessed 13 January 2022).
 Commonwealth Department of Health, 2020, National COVID-19 Aged Care Plan 7th Edition, https://www.health.gov.au/sites/default/files/documents/2020/12/updated-national-covid-19-aged-care-plan-7th-edition_2.pdf (Accessed 13 January 2022).
Date published: 13/1/2022