Prof Joe Covid 19 Aged Care Podcast

Episode 29 Prof Joe brings three guests, Marie Crossland, Lisa Clinnick and Gabriel Villaflor. Together we examine the challenges of maintaining usual operations in an aged care home during the ongoing COVID-19 pandemic. Aged care homes do not simply stop operating or caring for residents because of the pandemic. Aged care is an essential service.Marie, Lisa and Gabriel, provide their insights into the day-to-day operations, adjusting existing models of care around to maintain lifestyle and managing dying. The three bring a wealth of lived experiences of managing and delivering aged care services. The podcast concludes with their top three issues to address for the future.

Episode 28 introduces our guest Professor Lyn Gilbert who is an infectious disease physician and a clinical microbiologist and has Master’s degree in Bioethics. Lyn is a senior researcher at the Marie Bashir Institute for Emerging Infections and Biosecurity and at Sydney Health Ethics at the University of Sydney. Listen to Lyn reflect and describe her account of outbreak management in care homes drawing on the experiences of Covid-19 outbreaks in two aged care facilities In Sydney NSW.

Episode 27 introduces Prof Joe's ninth action point - Continuing to operate during a COVID-19 Pandemic

Episode 26 introduces our guest Dr Rosie Forlano, an experienced psychiatrist who works at one of our largest public hospitals in Victoria.Prof Joe and Dr Rosie Forlano explore the mental health challenges faced by aged care and health workers in managing the ethical and moral dilemmas arising from Covid-19 pandemic. The explore ‘moral injury’ defined as the psychological distress that results from actions, or the lack of them, which violate someone’s moral or ethical code.Examples how this may arise include Following decisions made by others that you believe are unethical or against guidance you’re your profession; putting residents or workmates in danger because we are working outside our normal competency and; feeling let down because we are working with insufficient resources that could have been avoided.

Episode 25 introduces our guest Dr Simon Brown-Greaves, a psychologist, dispute negotiator and wellbeing and organisational consultant in leadership as well as the Director and CEO of FBG Group.Prof Joe and Simon explore the stress and psychological well being. Simon has personal experience with Covid-19. Simon was on a cruise ship in South America, then evacuated and quarantined in Sydney where he had an infection with Covid-19.Listen to Simon explore and explain the threats to our mental wellbeing during Covid-19, how people respond differently to the stress, how to adapt and how to help each other. Prof Joe and Simon also examine the issue of disenfranchised grief which is more likely to occur in an aged care setting. Ken Doka, coined the term ‘disenfranchised grief’ to describe “grief that results when a person experiences a significant loss and the resultant grief is not openly acknowledged, socially validated, or publicly mourned.” For example, this often occurs after a death of an older person with dementia who was living in aged care.

Episode 24 introduces Prof Joe's eighth point - Mental Health and Well Being at Times of Crisis.

Episode 23 introduces our guest Dr Professor John Banja who is a Professor in the Department of Rehabilitation Medicine and a medical ethicist at the Center for Ethics at Emory University in Atlanta.Prof Joe and Prof John Banja have a wide-ranging discussion about why care staff and professionals need to be and feel protected as they can save others, we draw on the experience of the USA to explore the things that we expected to happen but didn’t and explore the extraordinary ways that a pandemic exposes the weak spots and imperfections of a culture, e.g., those most at risk are the least protected.

Episode 22 introduces our guest Dr Shelly Jeffcott, an experienced psychologist who studies, teaches and applies the science of human behavior to improve patient care. Shelly brings a different view to the usual and is currently the Strategy Implementation and Quality Improvement Manager at Scottish Ambulance Service Glasgow, United Kingdom.Prof Joe and Shelly we examine how to protect staff and maintain trust in times of crises. We explore how to improve our teamwork, and how people who are empowered are better at solving the unexpected problems. Shelly explains the five dangerous elements that can destroy teamwork (lack of trust; pretending to agree to avoid conflict; lack of commitment; not holding team members to account and; focussing on personal rather than team goals) and how to avoid this from happening.

Episode 21 introduces Prof Joe's seventh point - Accessing treatment in desperate times

Episode 20 introduces our guest Dr Nicola de Savary, a consultant geriatrician at Oxford University Hospitals and geriatric medicine lead for the Clinical Ethics Advisory Group. Nicola has been instrumental in creating and implementing the local pandemic ethics framework and treatment escalation plan for patients at admission. Nicola is also supporting care homes with decision making around admission of elderly patients.Dr Nicola de Savary describes her experiences as a medical specialist providing care for older people and as a member of a clinical ethics committee that had to consider optimal use of resources. We explore her experiences as the doctor in charge of patients with Covid-19 and the need to increase medical support into care homes. These insights are invaluable as the UK has over 40,000 deaths from Covid-19 of which at least 10,000 have occurred in care home residents.

Episode 19 we discuss with Jane Newbound, a senior nurse with over 40-years of experience and who is currently co-ordinating aged care projects in the Southern Metropolitan Region Palliative Care Consortium. Jane has experience in the public and private sector as well as with the accreditation in aged care. Jane draws on her lived experiences everyday working in a catchment with over 160 facilities providing care to about more than 13,000 residents.We discuss the options confronting the management of residents infected with Covid-19 and consider the optimal arrangements. We explore with Jane the challenges of setting up a facility and health service specifically for residents who are confirmed Covid-19 positive cases. The workforce, resources and access to health services requirements are explored in an honest, fearless and direct manner. The episode concludes with reflections on the past two months around what has worked and what needs to improve.

Episode 18 introduces Prof Joe’s sixth action point – Accessing Treatment in Desperate Times.

Episode 17 we interview Marie Crossland the CEO of Napier Street aged care facility and Dr Lisa Clinnick the Director of Aged Care Services at Ballarat Health Services which operates a nine public sector aged care service. Marie and Lisa review the approach to screening residents and what to do when a resident has symptoms or signs that raise the possibility of an infection with Covid-19. Their experience as leaders and nurses working in aged care services means their advice is practical and realistic.

Episode 16 provides a discussion of Prof Joe’s fourth action point – – Detection, Surveillance, Isolation and Suspected Cases.What do we do about the resident who is showing symptoms of infection but hasn’t yet been confirmed? How do we confirm positive, or better, negative status? This episode focusses on how facilities should best manage this situation including discussion about physical separation, PPE and screening.In today’s episode:~ How do we manage the resident who falls in the yellow group, and is showing signs of infection?~ What is meant by the term ‘cohorting’ of residents? How should we be doing this?~ How should we approach suspected patients? What tests should be done and why?~ How does the screening process work?~ When can we remove precautions from suspected or positive patient?Dr Sarah Whiting, an Infectious Diseases and General Medicine Specialist at The Alfred Hospital, joins us again to discuss the clinical guidelines and practicalities around screening residents living in aged care facilities.References:Krumholz HM. If you have coronavirus symptoms, assume you have the illness, even if you test negative. The New York Times [Internet]. 2020 Mar [cited 2020 Apr 28]. Available from: https://www.nytimes.com/2020/04/01/well/live/coronavirus-symptoms-tests-false-negative.htmlBritish Geriatrics Society. Managing the COVID-19 pandemic in care homes: Good Practice Guide. British Geriatrics Society. 2020 Mar. Available from: https://www.bgs.org.uk/resources/covid-19-managing-the-covid-19-pandemic-in-care-homesAustralian Government Department of Health. Infection control expert groupL COVID-19 infection prevention and control for residential care facilities [internet]. Canberra: Department of Health. 2020 Apr [cited 2020 Apr 28]. Available from: https://www.health.gov.au/sites/default/files/documents/2020/04/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilities.pdf

Episode 15 provides a discussion of Prof Joe’s fourth action point – Detection, Surveillance, Isolation and Suspected Cases.PPE is a term that we’ve all become very familiar with. But today we address the questions we may have in order to actually understand what it is and how to use it. We discuss exactly what constitutes PPE, how to wear it and what to do if we breach our PPE.In today’s episode:~ What are some of the rights and wrongs when it comes to PPE use?~ What do we do in case of a PPE shortage?~ What constitutes a breach in PPE?~ What are the differences in PPE required for healthy patients vs. suspected patients vs. confirmed patients?Today Sue Atkins, who is a Regional Infection Control Advisor with the Department of Health and Human Services joins us to discuss the current guidelines for the use of Personal Protective Equipment in aged care facilities. Sue talks us through the fine details of the common situations that staff and residents experience.References:Department of Health and Human Services. How to put on (don) and take off (doff) your personal protective equipment (PPE) [internet]. Melbourne: Victoria State Government. 2020 Apr [cited 2020 Apr 28]. Available from: https://www.dhhs.vic.gov.au/sites/default/files/documents/202004/COVID-19_How%20to%20put%20on%20and%20take%20off%20your%20PPE.pdfAustralian Government Department of Health. Infection control expert groupL COVID-19 infection prevention and control for residential care facilities [internet]. Canberra: Department of Health. 2020 Apr [cited 2020 Apr 28]. Available from: https://www.health.gov.au/sites/default/files/documents/2020/04/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilities.pdfNSW Government. Recommended Guidance on Mask Use in New South Wales [internet]. Sydney: NSW Government. 2020 Mar [cited 2020 Apr 28]. Available from: http://cec.health.nsw.gov.au/__data/assets/pdf_file/0007/572875/Recommended-Guidance-on-Mask-Use-in-NSW.pdfThe British Medical Journal. COVID-19: PPE Guidance. BMJ. 2020 Apr. Available from: https://www.bmj.com/sites/default/files/attachments/resources/2020/04/cv19-ppe-v1.0-web.pdf

Episode 14 provides a discussion of Prof Joe’s fourth action point – – Detection, Surveillance, Isolation and Suspected Cases.Today we delve further into the course of infection of COVID-19 and how it might present. But older people are not your typical population, and aged care facilities are not your typical living environment. Join us as we discuss the need for screening and early detection in aged care facilities and how we can go about this.In today’s episode:~ How might older people present differently to the general population?~ How often should we be screening aged care residents for signs of disease?~ How should we monitor a COVID-19 positive patient within the aged care facility?~ Why do we recommend a colour code system to simplify the system of what needs to be done for patients according to their COVID-19 status?Prof Joe introduces Dr Sarah Whiting, an Infectious Diseases and General Medicine Specialist at The Alfred Hospital, to discuss the clinical guidelines and practicalities around screening residents living in aged care facilities.References:High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C et al. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. CID. 2009 Jan. DOI: 10.1086/595683British Geriatrics Society. Managing the COVID-19 pandemic in care homes: Good Practice Guide. British Geriatrics Society. 2020 Mar. Available from: https://www.bgs.org.uk/resources/covid-19-managing-the-covid-19-pandemic-in-care-homesAustralian Government Department of Health. Infection control expert groupL COVID-19 infection prevention and control for residential care facilities [internet]. Canberra: Department of Health. 2020 Apr [cited 2020 Apr 28]. Available from: https://www.health.gov.au/sites/default/files/documents/2020/04/coronavirus-covid-19-guidelines-for-infection-prevention-and-control-in-residential-care-facilities.pdf

Episode 13 introduces Prof Joe’s fourth action point – Detection, Surveillance, Isolation and Suspected Cases.This introductory episode explains the importance of screening residents and early detection of disease in our aged care facilities. But how can we practically manage this? We have proposed a colour code system to split patients up according to whether they’re completely asymptomatic (green), showing symptoms of possible infection (yellow) and positive patients (red).On today’s episode:~ What is the colour code system?~ Why are we splitting residents into groups according to COVID-19 status?

An Open Letter to the Prime Minister, Health Minister and Aged Care MinisterWe want the same thing. But what we need to safely ease restrictions on our Aged Care Residents, is the re-establishment of trust in, and transparency from, the Federal Government. To save our loved ones from the harm of isolation, we need to be able to trust that the measures being adopted have been properly thought out, committed to, and will be vigilantly monitored, so that we can trust our family and friends in Aged Care will be safe.The difficulty here for you is this. The foundations of the Australian Aged Care system, as the current Royal Commission has pointed out, has suffered serious neglect and is failing our residents already.So, to reduce the lockout harm, the Government needs to rapidly fix these foundation issues to provide a foundation for Covid prevention and management measures. A system based on a house of cards will simply collapse.

Episode 11:1) Everyone has the same shared understanding of the problem~ Knowing what to do – protocols around handwashing~ Adopting this – so it becomes a strong part of the culture~ Something we can do as a team is something we can be proud of.~ The biggest enemy is invisible. The best thing we can do doesn’t seem obvious~ Need a shared understanding - Open discussion to know what people understand and what they’re worried about~ Use handover times and expand to second meeting at end of a shift to collect info and feedback2) Lead by example from the top~ Ask the CEO, board members, doctors to make a display of how important it is to wash hands~ Watch people lead by example3) Choose a leader from within the ranks~ A manager sends an email, provides online learning and ticks a box saying infection control is complete~ A leader is a person, no matter what their qualifications, remains the most motivated, loves their job and the staff the most. Need a role model~ Give the leader the right vision – don’t make it reactionary (don’t be scared), want to become known for never compromising infection control~ Do it for people~ Make it competitive – chance to prove you’re the best aged care facility in the area, state, country, world~ Empower the leader to shift the culture – show that the CEO considers this work is very important and that their work should be listened to~ Look past paper qualifications and look at personal attributes4) Make everything available~ Hand sanitizer everywhere. PPE where needed. Cleaning chemicals. Everything required to do the job without compromise.5) Teach, Re-teach, repeat, and be proud of it~ Best way to learn anything is to do it multiple times a day, at every opportunity and to do it together with other people~ Don’t learn from a book~ At beginning and end of every shift, huddle process where group gets together~ Wash hands together, sing song together – remind each we’re washing hands together right now to save lives~ Only become good a skill by repetition. Think of the skill of hand washing in the same way you think of a skill of learning a musical instrument~ We all know how to do it, and now is the time to do it properly every time we wash our hands~ The Japanese have a great ritual whenever a new customer enters a restaurant, all the staff shout IRASSHAMASE which means 'Welcome to the Store'6) Have a system to evaluate infection control~ Feedback – beginning, during and end of the shifti. Important at end of shift – are there enough supplies, are there enough handwashing sinks, what are some of the barriersii. Did anyone have any issues, did anyone see anyone else having issues?iii. How can we help to do things better? Look after each other?~ Everyone hates being policed. But it's also important to help each other improve.~ Ask after the health and wellbeing of the person~ Be mindful of body language and how you present yourself7) Build a check point~ Coordinate entry and exits as a check point with fixed process~ Someone at each check point (entrance) checking temperature and asking the COVID-19 questions – most places already do this~ Add on supervising handwashing8) Work as a team to support your staff and be proud of your work~ Walk the talk~ Ask after each other, help each other out~ Support staff staying at home if they’re unwell, support them getting tested and follow up with them~ We are very proud of staff and people working in aged careInfection control is going to be the thing that saves lives

Episode 10 provides a discussion of Prof Joe’s third action point – An Uncompromising Approach to Infection Control.Today we take a different stance on combatting the pandemic. Let’s look at COVID-19 from military perspective, with COVID the threat and nursing homes the combat field. We see how like any successful operation, behind any victory is successful leadership.On today’s episode:~ How every single person in the aged care community, from healthcare workers to residents and their families, can contribute and help keep people safe.~ Why is leadership so important during this crisis?~ How will successful leaders create a positive, collaborative culture within RACS?~ Why we need to completely flip conventional hierarchical forms of management and change the style of leadership.Join Prof Joe and Greg Van Borssum (an Award winning Film Director and choreographer, World Champion Pistol Shooter, Martial Arts Expert and Life Line Ambassador) for an inspiring discussion about leadership, culture and team work. Greg, cuts through the technical aspects to remind us that doing the basics well and look after each other is the key to success.