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General advice for the care of patients in residential aged care facilities

COVID-19 is acknowledged as a significant health risk for older adults. RACFs are high-risk settings for infection outbreak due to a number of factors such as the number of residents, shared living environments and workforce mobility. Residents, by nature of their age and likelihood of having comorbidities, are at high-risk of more severe illness if they contract COVID-19. With the current pressures on the healthcare system, many RACF residents who test positive to COVID-19 will continue to be cared for at the RACF.

Patients’ suitability for care at a RACF should be guided by the National COVID-19 Clinical Evidence Taskforce’s pathways to care for adults with COVID-19 to asses risk factors for severe disease and the need for transfer to hospital.

All RACFs should have a response plan in place to manage COVID-19 outbreaks. If you or your practice provide services to residents of a facility, you should ensure your practice contact details and a list of your specific patients are included as part of this plan.

If you are providing care for patients in RACFs, you can do this via telehealth in collaboration with a facility nurse or carer where it is safe and clinically appropriate. If you need to assess a patient face-to-face, ensure you have access to the appropriate personal protective equipment (PPE). You may need to provide care for other illnesses as well as for COVID-19.

The current recommendations from the National COVID-19 Clinical Evidence Taskforce for managing people with COVID-19 who are older and living with frailty and cognitive impairment include:

  • identifying and confirming advance care directives and plans
  • discussing and agreeing goals of care with the patient or medical decision maker
  • providing respiratory support and other disease modifying treatments if goals of care include active disease management
  • undertaking a clinical assessment to determine the expected prognosis
  • establishing ongoing communications with a carer or family member
  • managing breathlessness or cough and avoiding fans and nebulised medications due to potential for aerosol generation
  • organising support for patient mental wellbeing
  • when considering treatment options, taking individual decision-making around goals of care into account
  • discussing decisions around proceeding to more invasive forms of ventilation with the patient or their substitute/medical treatment decision-maker
  • seeking specialist palliative care support and advice if a person has symptoms such as breathlessness or delirium which are difficult to manage, and/or is imminently dying.22

Many residents in RACFs will meet the eligibility criteria for antiviral treatments in the event they test positive to COVID-19. As with all medicines, patients or carers will need to provide informed consent for these medicines to be prescribed. GPs working with patients in RACFs may find it helpful to pre-emptively discuss these medicines with their patients, even if they do not have COVID-19, to determine eligibility criteria and obtain pre-consent for these medicines to be prescribed in the event they test positive for COVID-19. A subsequent discussion is advised at the point at which the patient requires the medicine to confirm the pre-consent is still applicable.