LESSONS FROM A PANDEMIC

One of our largest aged care members, VMCH experienced 15 lockdowns during Victoria’s deadly second wave. Twenty four of its staff and nine residents tested positive for COVID-19 across five of its facilities, including one being a home for people with an Acquired Brain Injury (ABI).

Sadly, there were three deaths within one residence where four residents and 12 staff tested positive in the hot spot of Sunshine North, Victoria. Compared to other aged care residences in Victoria, VMCH, fared well, mainly because it used the experience of a single lockdown during the first wave as a chance to learn and put in place a strategy that prepared it well for the second wave. VMCH CEO Sonya Smart shared her learnings with CHA’s Health Matters.

“We set up a Critical Incident Team and followed a disaster recovery and business continuity plan that had been developed 18 months previously. We had training across the organisation so that key staff in leadership roles across the organisation knew exactly what they had to do.
“Early on we put in place some clear rules: no staff could return to work for 14 days if they had been overseas; staff had to fill out forms to declare their exposure to COVID, whether they had travelled recently as well as tell us other places where they might be working. They were also to undergo temperature checks.
“We also said initially no visitors or contractors could visit our sites if they had been overseas, in fact we closed our sites to all visitors completely except for palliative and distress visits. This was one of the hardest aspects of managing the outbreaks across aged care residences, and while it was an emotional and distressing time for our residents, staff and families, it was a necessary step to maintaining infection control.
“What we were aiming to do was to reduce the movement of staff across our organisation, to try to keep them at one site only and then to reduce movement within that site as well.

COMMUNICATIONS

“They say that you can never communicate too much and this was never truer than during this time. We started communicating with everyone – even if we didn’t know the answers. We also regularly surveyed staff, clients and residents to get their feedback, criticisms and support, and every week I held a live cast via MS Teams for all staff, with guests from across the organisation.
“I wrote every day to families and residents in lockdown – even if there was nothing to report.
“We made a decision early on to centralise communication to ensure that the messaging was consistent and correct and maintained a philosophy of being open and honest throughout. We even told families about the build-up of clinical waste outside residences before it hit the news just to keep them informed.
“For those residents who had tested positive we gave them a mobile phone to keep in their room, and staff made sure families were able to speak with their loved ones as often as possible, to try and maintain that connection, and so families could know that they were okay.
“Every day a select team made outbound calls to family members to keep them updated about what was happening and messages from loved ones. We also diverted calls from residences to the call centre, this enabled the site to focus on management of staff and care and ensure that families’ calls were always answered and they were never left without someone to speak to, and were kept informed about their loved one’s condition at all times.

STAFFING AND RESOURCES

“One of the hardest aspects of this pandemic was our service closures. Our day programs for our at home aged care and disability services programs were ceased, which meant that we had to stand down about 150 staff.
“At the same time, we set up 500 staff to work from home including those working from three metro sites and numerous smaller regional sites.
“We also moved our specialist education school for children with a wide range of intellectual, physical, profound multiple and sensory disabilities online within three days, which must be something of a record.
“We provided practical shopping support by getting essential items that were in short supply such as tea, coffee and toilet paper to staff.
“We had to identify staff who were working for other organisations – whether that’s healthcare, disability, community and aged care facilities – and asked them to be vigilant, to choose a single provider and then we started paying them to isolate , if they were required to. We wanted our staff to know that they are valued, and to reduce the risk of working across multiple organisations, due to financial constraints.
“We have been working hard to reduce the number of casuals in our aged care residences for some time. Approximately 30 percent of our workforce across our 12 residences are casual workers. Interestingly though, there were no issues of transmission in community at-home aged care which has a higher percentage of casual workers , and potentially a larger risk of contracting COVID-19, and then passing it on to others.
“We really must know the rosters for each of your services to ensure coverage is understood, and to know exactly what staff numbers were in place. Within the first 24 hours of a lockdown, primary staff often don’t come in even if they say they will. This was a challenge for us, and understandable, as there was a lot of fear and apprehension about working within a residence with an active outbreak. We found that once more information was known about numbers of infection staff returned – usually the next day or two after the initial lockdown was commenced.

WORKFORCE

“At the peak we recruited 130 staff in one month, as well as utilising a third of the 150 staff we had to stand down due to the closure of a number of community disability and in-home aged care services. Some of these redeployed staff went into different roles, in order to fill the changed needs of the organisation, which they all handled wonderfully.
“We learned early that the surge workforce were often poorly trained, and hadn’t been told they were required to work across services with positive cases. Many were working across multiple services, which contravened our own internal policies of confining staff to working on one site only. To get workers we had to set up or own contract as providers of the government surge workforce were telling us they were not getting paid and were not willing to supply workers.
“On top of this, the accommodation support meant to be available from the government for workers was not practical, for one of our services the nearest available accommodation was 40 kilometres away. To expedite matters we negotiated accommodation closer to our services, paying for it ourselves. Negotiating those things in the midst of a crisis was not our priority, whereas the safety of residents and staff was.

TRAINING

“We started with the basics, simple things like handwashing and the application of hand sanitiser . We also learned that we needed to provide more locations for hand sanitisers, and also ensure we had enough stock on hand, as needed.
“We did Personal Protective Equipment (PPE) training, where we taught staff how to don and doff the required outbreak gear, as it is more difficult than appears. We did this in various ways and formats, including in person, online, via text message, Facebook, signage on sites, and even Instagram.
“We deployed trained RNs and our internal Learning and Organisational Development team to provide on-site training which was highly effective in sites with positive cases so as to ensure no breaches and to provide practical support to staff. That training module was adapted for volunteers outside the VMCH system and it was made available online for any new employees’ requirements, which turned out to be essential to their success.
“It was important to reward staff and recognise their efforts so we launched a new very visible ‘Praise’ program which is all about recognising and rewarding the terrific work of our staff and volunteers, who exemplify one of VMCH’s six values We sent treats to sites, like donuts, cakes and pizzas to provide support and to show that we valued their efforts. Banners were made and put out the front of each residence thanking our staff and promoting their good work.

PHYSICAL SITES

“I have read a number of suggested environmental design ideas but my initial thoughts on these is that they do not take into account that the greatest risk to our residents is actually the staff and visitors.
“Any design must take into account the residents’ greatest need is social connection with family and loved ones.
“Our residents, and their families repeatedly mentioned that they missed that physical contact, even something as simple as a hug. We all need that, as humans. We can’t remove that aspect of care; physical touch is so important.
“In the future, I would suggest for new builds that there are multiple entry points that can be managed easily, to stop or control the flow of visitors and staff. There should also be more hand wash sinks. The days of the shared bathrooms and bedrooms are over, except for couples. We need to have the ability to break up large wings and create smaller cohorts and groups of residents, if necessary, to avoid the spread of any future outbreaks.
“We also need to be able to store large amounts of PPE on site and it has to be accessible. There needs to be sanitiser points inside bedroom doors, outside bedroom doors and in bathrooms. There should be good size internal and external waste disposal points, to make it easier to store the waste created from the large amounts of PPE used. One of the biggest issue was lack of regular clinical waste removal from the site, due to the prioritisation of the acute hospitals.
“And there should be visiting spaces at the front of building so that visitor traffic is reduced throughout the building.

THE TOP 10 LEARNINGS

1. Communication: Do more of it, both internal and external. Find ways to use different mediums, don’t underestimate the use of outbound calls to maintain relationship and loyalty;
2. Critical incident planning: This needs to be ongoing as part of regular management;
3. Make sure you have Healthcare infections on your risk matrix along with mitigating strategies. One that we will be utilising is mask wearing during winter months to manage influenza. There stringent controls not only make sense in protecting lives but also financially. Every outbreak affects occupancy, sick leave, agency and casual coverage, increased cleaning.
4. Expectations of health professionals: Expedited and active treatment from GPs and Locums is needed, to ensure quick and proactive management of health issue.
5. Next normal work environment: There’s a need to maintain the strength of relationships and connection – by creating casual spaces to meet and be relaxed, we need a balance, it’s good for staff, and good for business;
6. Infection control consultant: There is a need for ongoing maintenance and to adhere to their own discernment of issues, and trust their learning and training – rather than undertake verbatim government regulations, which may not be suitable.
7. Speed available for change: We can move quickly if we need to. There’s always a reason that we don’t do things quickly, but we can do it, especially if we involve our community to help us shape change. It can be hard to go against the ways we have done things previously, and there are always blockers, different expectations of timeframes and also resourcing, but it can be done. For example, working from home – this was expedited, we moved very quickly, but we got it done, and our at home workforce is thriving.
8. Embrace technology: Technology is great for community, it extends service offerings, allows for efficient management, and maintains relationships. It has been more appropriate for those who do not want the stress of travel, whether it is for work, or whether it is for health or social services. Going forward, the use of technology will be a customer expectation.
9. Be brave: make the decisions people may not like or need you to make, take control and centralise, and push back against bureaucracy. You know your organisation, your people, your service. Make the choices that you think are needed – and back them.
10. Remember your values: What would you want a leader to do for your mum, dad or sister?