COVID-19 has created both challenges and opportunities for aged care providers, staff and clients. This article examines how the Brotherhood of St Laurence (BSL) Aged Care division changed its approach to home- and centre-based service delivery during the first national lockdown.
Making these changes, the division continued service provision to vulnerable clients during a challenging period while also rapidly upskilling its personal care workforce to ensure all client needs were met.
“Not just fair-weather services”
The division made an early decision that both Home and Community Care were essential services. Support continuity was particularly important for the BSL as many clients have complex behavioural, social and/or clinical needs. Across the organisation, the BSL maintains a strong commitment to the most disadvantaged community members. This commitment is strongly reflected in aged care. Centre-based programs therefore do more than just provide leisure activities: centres provide meals, welfare support, social connection and a sense of community. Many members visit every day. In this context, support continuity was paramount.
While closing centres, in line with government directives, staff and case managers ensured that clients were supported, heard and connected. This included adapting centre-based programs to home settings.
To quote a senior manager: “We offered support that we thought our own families would need, during this initial COVID period, to keep [clients] going and supported.” This decision often involved going above and beyond ‘typical’ home care. Clients were not only provided greater access to ICT and support to use it, but tailored case management was provided on a far more significant scale.
Beyond guaranteeing essential needs, like food, medicine or clinical care, staff conducted welfare checks, linked clients with other available services (particularly if their previous supports were no longer available), checked in with families and carers, and managed people’s anxieties and fears around COVID-19.
Operating across metropolitan Melbourne, BSL case managers reported the following:
- Clients welcomed service continuity, but some families were concerned about receiving care workers in home. Case managers conducted more engagement work to reassure families and clients. Increased contact helped assess client welfare and changing support requirements.
- A lot of case management work already involved phone-based check-ins. During lockdown, activities were scaled up. Daily phone calls allowed case managers to communicate to clients and their families that it was safe (and indeed safest) to receive care at home. In some cases, staff were able to encourage and support clients to seek medical attention for urgent care needs.
- Addressing social isolation through technology has benefited some clients, but others require ongoing support to use it. For others, cognitive and sensory impairments make the use of enabling technologies very difficult if not impossible. Likewise, telehealth consultations have had a mixed response – useful in some instances and unsuitable in many others
- Staff saw a marked change in caseload; clients who were previously quite independent suddenly became less so, largely because they were restricted to remaining at home and found themselves isolated and in need of support. In some cases, families stepped back due to restrictions. Formal supports became increasingly important to meet personal and clinical needs.
A critical decision involved rapidly upskilling home and community care staff in providing clinical support and to use outreach case management approaches. With these changes, services continued operating under the challenging circumstances imposed by social distancing requirements, even while other providers were altering, closing or withdrawing services.
Keys to success
Practice shifts in home and community care were rapid. Changes were underpinned by the following four factors:
- Operational success was partially determined by having a “single source of decision-making” on COVID-19 matters that helped cut through the “noise of information” in the early days of lockdown. Daily meetings (which included senior managers and other staff from across the division and organisation) enabled updates on current information and policy announcements. A secondary benefit was a structured management approach for escalating issues and making quick decisions. Clear and consistent communication with our workforce also provided reassurance and supported a calm working environment, where staff could focus on the task at hand.
- The division is a strong supporter of case management, particularly for older people experiencing disadvantage. During this period, case management provided a basis for more proactive outreach and monitoring to check in on client welfare and wellbeing, and helped comfort clients and manage a phased return to receiving services (where they had stopped).
- By responding to changing need in the community, the division had to broaden the scope of support provided; this required greater workforce assistance. Senior managers supported home care staff by developing and rolling out new learning modules that used a combination of digital and face-to-face training. Training in infection control, use of personal protective equipment (PPE) and hand hygiene was provided to all staff online. Small-scale, in-person training was used to reinforce hygiene techniques and teach correct donning and doffing procedures for PPE. These modules were developed in conjunction with available government information
- Upskilling home and community care staff had an additional positive impact, reassuring staff that they knew what they were asked to do and that their jobs were secure; subsequently, very few withdrew from work for personal or health reasons. In turn, staff could better communicate to clients and their families that it was safe to continue receiving services. Ongoing communication from senior management down to clients has helped alleviate concerns.
Lessons for the future
This pandemic has had the unforeseen effect of enabling the BSL’s Aged Care division to improve staff skill development and strengthen its approaches to client care. In extraordinary times, staff and clients have benefited from adaptability and the introduction of different measures and approaches into daily practice. By adopting a clinical approach to upskilling our personal care workers and community support workers, services continued to operate and meet the growth in demand. These are positive, proactive changes that should remain in place – not only for the next pandemic, but to continue to support quality, person-centred care for the most vulnerable in our community.
Dr Amber Mills is senior research fellow (inclusive ageing) and James Finnis is policy advisor (inclusive communities) in the Research and Policy Centre at the Brotherhood of St Laurence.
 The exception is Cottage Respite, which chose to stay open unless ordered to close. At four-weeks in this service was at capacity, due to increased demand. In many ways, respite compensated for other programs which had closed or become less available (e.g. meal programs, lawn bowls, community connection, social groups, etc.). Respite also provided much needed support to families during this period.Do you have an idea for a story?
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