Action plan for the recommendations of the Independent Review of COVID 19 Clusters in Aged Residential Care Facilities

Information on how the recommendations from the Independent Review of COVID 19 Clusters in Aged Residential Care Facilities will be actioned by the Ministry of Health through seven workstreams.

A letter to the aged care sector from the Director-General of Health

Dr Ashley Bloomfield has thanked the ARC sector for their hard work and dedication as they worked to ensure the safety of New Zealand’s elderly during the COVID-19 pandemic. You can read the letter in this related news article: Aged Residential Care (ARC) Action Plan.

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Sector feedback on the recommendations

The Independent Review of COVID-19 Clusters in Aged Residential Care (ARC) Facilities Report (the report) contained 19 recommendations. On 12 June 2020 the Ministry of Health invited a range of key stakeholder groups to provide feedback on the recommendations via Citizenspace. Stakeholders included participants interviewed by the panel members during the review (including Māori providers), the New Zealand Aged Care Association, the Care Association New Zealand, district health boards (including Te Tumu Whakarae), regional public health units (including Hāpai Te Hauora I Māori Public Health), Māori and non-Māori professional associations, unions, other government agencies, and consumer organisations.

Thirty responses were received over the three-week survey period ending 3 July 2020. Respondents rated each recommendations’ importance, indicated a completion date, and were asked to highlight local, existing work programmes relevant to the report’s recommendations that could be nationally leveraged. 

Across all stakeholder groups, respondents indicated strong support for the report’s recommendations. Respondents also highlighted several local initiatives that could inform the development of national policies or guidelines that could then underpin local application more broadly across New Zealand. The Ministry would like to thank those people and organisations who made the time to provide feedback. 


Action plan for the recommendations 

The following Action Plan is divided into seven workstreams. Each workstream addresses one or more of the recommendations made in the review and is categorised to demonstrate alignment with the Ministry’s obligations under Te Tiriti o Waitangi. 

The Ministry has considered synergies with the recommendations made in other reports and reviews related to COVID-19. Opportunities for collaboration are outlined in the Action plan. Respondents provided advice on the lead agency for certain recommendations. There was strong support that the first two workstreams would be most effectively implemented by a cross-sector, multidisciplinary team. Dr Phil Wood, Chief Advisor, Healthy Aging team, will be the Ministry clinical leader for Workstreams one and two.

Number Workstream details Te Tiriti responsibilities Recommendations Lead agency Completion date Status
1 A National Outbreak Management Policy is developed for the purpose of local implementation in Aged Residential Care (ARC) Sector. This policy must be responsive to Māori, with active measures to protect Māori staff, residents, whānau, and communities. The policy will cover:  
  • Staff, resident and whānau psychosocial support
  • Communication and reporting requirements and channels
  • Relationship building
  • Decision-making and escalation pathways
  • Rapid formation of response team
  • Early case recognition protocols in high-risk environments
  • Practice scenarios
  • Supported clinical rotations or placements in ARC to broaden workforce capability
Tino rangatiratanga
Equity 
Active protection 
Options
Partnership
Recommendation 2 Recommendation 3 
Recommendation 7 
Recommendation 9 
Recommendation 10 
Recommendation 11 
Recommendation 12
Healthy System Improvement and Innovation and Office of the Chief Nurse, Ministry of Health  November 2020 Underway
2 A Pandemic Management Workbook is developed for ARC. National pandemic management plans are adapted to local contexts, understood by ARC providers and able to be readily implemented. Tino rangatiratanga
Equity
Active protection
Options
Partnership
Recommendation 4 
Recommendation 5
Recommendation 6
Recommendation 8
Recommendation 13
Recommendation 15 
Recommendation 16
Recommendation 18
Healthy System Improvement and Innovation, Ministry of Health December 2020 Underway
3 Processes for PPE supply, stock management, and guidance on use is effectively communicated to ARC, nationally consistent, and transparent.

IPC strategy is developed specific to the ARC sector and scalable for local contexts.
Partnership
Options
Equity
Recommendation 6 
Recommendation 14
Office of the Chief Nurse and COVID-19 Health System Response, Ministry of Health January 2021 Underway
4 Acknowledgement by the Ministry of the substantive work done by the ARC sector to prevent and manage the COVID‑19 cluster outbreaks.  Partnership Recommendation 1 Ministry of Health August 2020 Complete
5 ARC providers can access information on relevant quality improvement initiatives and network locally to support continuous learning across the sector.  Equity
Options
Recommendation 19 Health Quality & Safety Commission January 2021 Underway
6 Alignment of expectations for ARC across regulatory and contractual obligations as relates to IPC and pandemic planning. Active protection Recommendation 13 Healthy System Improvement and Innovation, Ministry of Health June 2021 Underway
7 Strengthened IPC Standard within the new Health & Disability Services Standard (NZS 8134) with up-to-date information from sector experts Partnership Recommendation 17 Standards New Zealand, Ministry of Business, Innovation, and Employment April 2021 Underway

Linking with the sector

In enacting this Action Plan, there are many key stakeholders the Ministry will link with. This includes, but is not limited to, the following agencies: 

  • Iwi, Hapū, whānau, and Māori communities
  • Health Quality & Safety Commission 
  • NZ Aged Care Association and Care Association NZ 
  • Māori ARC Providers
  • Public Health Units, Te Rōpū Whakakaupapa Urutā and Hāpai Te Hauora
  • DHBs and Central TAS
  • Consumer organisations
  • Unions
  • Standards New Zealand, Ministry Business, Innovation, and Employment
  • Professional colleges and associations

If you or your organisation have any questions, see opportunities for collaboration, or would like to receive regular updates on the progress of the Action Plan please email the Project Manager, [email protected].


Recommendations 

For quick reference, the report recommendations are below. You can also read the complete report — Independent Review of COVID 19 Clusters in Aged Residential Care Facilities.

Recommendation 1: Acknowledgement by the Ministry of the substantive work done by the ARC sector to prevent and manage the COVID 19 cluster outbreaks.

Recommendation 2: ARC, DHB, and PHU to develop a national outbreak management policy with leadership roles, reporting processes and communication channels, and including policy on, IPC strategies, case recognition, staff and resident management and support, supply and use of PPE, testing, screening, isolation, lockdown, and resident transfers and admissions.

Recommendation 3: The development of protocols for the rapid formation of a regional ARC IMT, which includes representation and decision-making capability from both the ARC sector, PHU, DHB and relevant specialist units, and the training and practise scenarios that are undertaken to sustain this capacity on agreed occasions.

Recommendation 4: Identify and provide psychosocial support for staff wellbeing during a stand down and in the period after, taking into account the unique circumstances of the individual including accommodation, whānau/family, and community.

Recommendation 5: Identify and provide psychosocial support for residents’ wellbeing during and after outbreaks including alternatives to visitation during lockdown, taking into account the unique circumstances and identity of the resident.

Recommendation 6: Review IPC standards and develop a national IPC strategy as it relates to the ARC sector. This should then be applied regionally and locally. This should be done with a working group consisting of representatives from the ARC sector, DHBs, and the Ministry.

An effective IPC strategy needs to address environmental, organisational, and individual barriers to adherence. Intervention programmes need strong leadership and the involvement of staff at all levels. Infection prevention does not rely solely on a functional infection control team, but also depends on facility organisation, bed occupancy, staffing, and workload.

Recommendation 7: That protocols clarify case recognition to identify infections early and the place of surveillance during a pandemic in high risk environments.

Recommendation 8: A pandemic management workbook relevant to the ARC sector is developed through collaboration between the ARC sector, PHUs, DHBs, IPC, and the Ministry. The workbook should include:

  1. early establishment of an ARC facility IMT, which includes representation and decision-making capability from the ARC sector, DHB, PHU, IPC and any relevant specialist units (these may be tailored depending on the nature of the outbreak)
  2. essential responsibilities of the executive management team
  3. the communication strategy, including internal communication, newsletters to whānau/family, local community, PHU, DHB, etc
  4. staffing opportunities and resources including accommodation, travel, and wellbeing support
  5. developing cohorts/bubbles within facilities (to be localised to the facility)
  6. pre-shift screening and testing thresholds for staff
  7. staff contacts, rosters, living situation, and membership of a “bubble”
  8. staff support chain, agreement about test result dissemination
  9. clear processes and procedures for when a staff member develops symptoms at home, or during a shift
  10. PPE supply, storage, and access, which reflects the perceived threat/risk
  11. better resident identification and technology to enable backfill staff to provide safe and efficient care
  12. wellbeing support for residents including technology, visiting opportunities, and end-of-life support
  13. decision point for transfer from residential facility to DHB, required briefing material, and up-to-date resident identification information
  14. decision point for DHB staffing assistance to residential facility, required briefing material, and up-to-date resident identification information
  15. routine simulation exercises for isolating units of an ARC facility and/or isolation of staff members as part of IPC plan.

Recommendation 9: Further consideration be given to the reputational consequences for ARC facilities and stigmatisation of ARC staff, for example reconsider method for naming outbreaks.

Recommendation 10: Reporting requirement to PHUs, DHBs, and others need simplification and streamlining including appropriate software, spreadsheet, etc documentation to improve this.

Recommendation 11: Clarify and reinforce strong communication channels between DHB, PHUs and DHB IPC teams. Work together to establish protocols for cooperative and mutually respectful alliances to manage similar situations in the future. Incident and emergency management could provide a useful framework and scenario exercises could be helpful.

Recommendation 12: Explore options for familiarising the broader workforce with the aged care environment (such as through clinical rotations or supported placements) to enable a well-prepared surge workforce. Incident and emergency management could provide a useful framework and scenario exercises could be helpful.

Recommendation 13: A review is undertaken as part of the national annual review of the ARRC services agreement between DHBs and ARC providers to ensure alignment and consistency with Health and Disability Services Standards (NZS 8134) and Ministry pandemic plans.

Recommendation 14: Reinforce PPE supply, storage, stock management, utilisation advice and “outbreak” kits in collaboration with relevant sector representatives.

Recommendation 15: Provision of support for localising pandemic planning, policies, and procedures especially standalone units.

Recommendation 16: Develop pathways for de-escalation, means to avoid complacency, and acknowledgement of successes and champions.

Recommendation 17: As part of the ongoing review of the Health and Disability Services Standards (NZS 8134:2008), strengthen the IPC standard or guideline, as deemed appropriate, concerning pandemic planning. This may include evidence of relationship between PHU, DHB, and IPC experts.

Recommendation 18: Give consideration to timing of infection surveillance of health of residents and staff, reporting to PHU it is a notifiable disease or discussion with DHB infection control.

Recommendation 19: Establish a continuous learning/quality cycle with regional networks. For smaller/standalone ARC providers, without a central office, establish local networks with assistance of DHB, to identify potential networks to link with.

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