Home-care guidelines for patients with COVID-19

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.

  1. Communicable Diseases Network Australia. Coronavirus Disease 2019 (COVID-19): CDNA National guidelines for public health units. Version 6.7. Canberra: Department of Health, 2022 Content/cdna-song-novel-coronavirus.htm [Accessed 13 May 2022].
  2. Australian Technical Advisory Group on Immunisation. Clinical guidance for COVID-19 vaccine providers. Canberra; ATAGI, 2022 [Accessed 13 May 2022].
  3. Department of Health. How COVID-19 vaccines work. Canberra, 2022 vaccines/how-they-work [Accessed 19 may 2022].
  4. Rees S, Fisher J. COVID-19 and the mental health of people from refugee backgrounds. Int J Health Serv 2021;50(4):415–17. doi: 10.1177/0020731420942475.
  5. National COVID-19 Clinical Evidence Taskforce. Management of adults with mild COVID-19 (version 42.1). Melbourne, 2022 [Accessed 19May 2022].
  6. Community Health Pathways – NSW Collaboration. COVID-19 Active Case Management, 2022.
  7. National COVID-19 Clinical Evidence Taskforce. Pathways to care for adults with COVID-19 (version 4.2). Melbourne: National COVID-19 Clinical Evidence Taskforce, 2022 [Accessed 19 May 2022].
  8. Agency for Clinical Innovation. Caring for adults and children in the community with COVID-19. Sydney: NSW Health, 2022 [Accessed 19 May 2022].
  9. National COVID-19 Clinical Evidence Taskforce. Pathways to care for children and adolescents with COVID-19 (version 2.1). Melbourne: National COVID-19 Clinical Evidence Taskforce, 2022 [Accessed 19 May 2022].
  10. National COVID-19 Clinical Evidence Taskforce. Steroids for people with asthma or COPD and COVID-19. Melbourne: National COVID-19 Clinical Evidence Taskforce, 2022 [Accessed 19 May 2022].
  11. National COVID-19 Clinical Evidence Taskforce. ACEIs/ARBs in patients with COVID-19. Melbourne: National COVID-19 Clinical Evidence Taskforce, 2022 [Accessed 19 May 2022].
  12. National COVID-19 Clinical Evidence Taskforce. Oestrogen-containing therapies. Melbourne: National COVID-19 Clinical Evidence Taskforce, 2022 [Accessed 10 June 2022].
  13. Cagnacci A, Bonaccorsi G, Gambacciani M, Board of the Italian Menopause Society Collaborators. Reflections and recommendations on the COVID-19 pandemic: Should hormone therapy be discontinued? Maturitas, 2020;138:76–77. doi: 10.1016/j.maturitas.2020.05.022.
  14. Australian Government Department of Health. Lagevrio (molnupiravir) PBS Factsheet. Canberra: DoH, 2022 [Accessed 15 June 2022]
  15. Australian Government Department of Health. Paxlovid® (nirmatrelvir and ritonavir) Pharmaceutical Benefits Scheme Factsheet. Canberra: DoH, 2022 [Accessed 15 June 2022]
  16. National COVID-19 Clinical Evidence Taskforce. Corticosteriods (systemic) for adults. Melbourne: National COVID-19 Clinical Evidence Taskforce, 2022 [Accessed 19 May 2022].
  17. Australian Government Department of Health. Guidance on the use of personal protective equipment (PPE) for health care workers in the context of COVID-19. Canberra: DoH, 2021 [Accessed 19 May 2022].
  18. Infection Control Expert Group. Information about cleaning and disinfection for health and residential care facilities. Canberra: Australian Government, 2020 coronavirus-covid-19-environmental-cleaning-and-disinfection-principles-for- health-and-residential-care-facilities-coronavirus-covid-19-environmental- cleaning-and-disinfection-principles-for-health-and-residential-care-fac.pdf [Accessed 19 May 2022].
  19. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Melbourne: RACGP, 2021. A message for pregnant women and their families information-for-pregnant-women [Accessed 19 May 2022]
  20. National COVID-19 Clinical Evidence Taskforce. Pregnancy and Perinatal care. Melbourne: National COVID-19 Clinical Evidence Taskforce, 2022 [Accessed 19 May 2022].
  21. The Royal Children’s Hospital Melbourne. Clinical Practice Guidelines – COVID-19. Melbourne: The Royal Children’s Hospital Melbourne, 2021 [Accessed 19 May 2022].
  22. National COVID-19 Clinical Evidence Taskforce. Management of people with COVD-19 who are older and living with frailty and/or cognitive impairment (version 5.0). Melbourne: National COVID-19 Clinical Evidence Taskforce, 2021 [Accessed 18 May 2022].

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