On 20 March, Moran Engadine Aged Care in Sydney, New South Wales, received the news that a resident at the facility was confirmed with COVID-19, launching the nursing home into a strict two-week lockdown.
The 78-year-old resident had been put in isolation three days prior to the official diagnosis because of a mild sore throat, but after a swab test came back positive for the coronavirus.
Around 19 staff who had come into contact with the resident went into self-isolation for 13 days, as did six residents who were exhibiting mild cold and flu symptoms.
While the facility didn't have any other confirmed cases of the coronavirus, the staff, residents and their families were stressed and shocked by the presence of COVID-19 in Moran Engadine.
Mary Gibbs, General Manager at Moran Engadine, says the day after the COVID-19 positive result came back for a resident, they had 21 staff members call in sick.
"It was quite a big shock to [staff], there were a lot of tears, there was a lot of confusion and a lot of distress. We had to work on it, all my managers and myself, stayed over the fortnight. We decided that, because it was unpredictable, we didn't know what we were facing from day to day, shift to shift," explained Ms Gibbs.
"There was a lot of emotional drainage coming from that area. I had to do a lot of counselling and reassurance. Reassure [staff] that the practices we were doing were the right practices... It was only the second day when the impact of it - what we found was we had 21 staff off sick the next day. That was separate to those 19 in isolation. So the panic and fear had gone through the staff.
"We didn't know what to expect from one minute to the next. It was quite emotional and I don't think I was prepared for that component. I mean, I have been nursing for 37 years and not [seen] that intensity.
"We have experienced flu pandemics and things like that, but the fear of the unknown with COVID-19 made a traumatic impact into the workforce, their understanding, and the fear for their own families or their young children they were looking after."
She says that all the staff had undertaken pandemic and outbreak training two days before the Department of Health confirmed a positive case of coronavirus at the facility.
Some staff members ended up staying at the facility over the fortnight because of the potential exposure they had to coronavirus and didn't want to spread it to their own families.
Residents stepped up to the challenge
While staffing levels were low at the facility during this time, residents from the lower care levels of the facility were proactive helping other residents and supporting aged care staff. This includes assisting with serving meals and even making 350 masks for staff and residents.
Ms Gibbs believes it was a stressful time for residents, who kept positive through the lockdown and were keen to help and volunteer where they could.
"[The residents] were a really nice, supportive team. They would be waiting for me to come back to my room so they could give me a cup of tea before midnight. It was just a different feel; it was surreal. It was something that I have never gone through and I hope to never go through again. But what it did show me was when things were down, all hands were in," says Ms Gibbs.
Moran Engadine had been planning before the COVID-19 positive case, with technology being set up for residents to communicate with their families.
Residents were communicating with their families over Skype, face time and phone calls during the lockdown.
The facility also hired an additional 18 staff to provide individual support to residents.
Ms Gibbs says the staff and residents were proud of themselves and the resilience they showed during the COVID-19 lockdown, which was backed up by a positive statement from NSW Health Minister Brad Hazzard.
Minister Hazzard's statement was distributed around the facility to remind residents and staff of all the hard work they were putting in.
How staff coped with a live COVID-19 case
As the providers dealt with the outbreak inside the facility, other problems started to develop for staff from within their local community.
Moran Engadine is located in the middle of a shopping centre which is considered something of a lifeline for staff, who would usually go there for coffee during their downtime.
However, the Moran staff were being refused service by shop owners after they found out there was a confirmed case of COVID-19 at the facility.
"That became such a hit to all of us. It was something minor but you didn't expect that from the community. That bit of negativity that there was something wrong with you and that was how people were perceiving [us]," says Ms Gibbs.
Additionally, staff were feeling that negativity on their way into work while wearing their uniforms. Ms Gibbs said they had to implement a laundry service for the staff to use, so they could travel in plain clothes and change into their staff uniform once they arrived at work.
Protocols and procedures
Before the lockdown, the facility was already temperature checking visitors and kept a logbook of all staff and visitors that entered the facility.
The resident with COVID-19 was isolated in his own wing by himself and was wearing a mask, which was a little difficult because he has dementia.
There were strict hand hygiene protocols and Personal Protective Equipment (PPE) was enforced when handling the resident.
Every level and common areas were thoroughly cleaned, including handrails and solid surfaces, which was undertaken three to five times a shift.
Ms Gibbs says communications with the Public Health Unit started from 9am every morning and she felt like she was in a daily battle for more PPE for the facility.
The facility was following the instructions from the Public Health Unit, including regular reporting on the resident with COVID-19.
Additionally, the aged care facility was placing residents in isolation who were showcasing cold and flu symptoms. They were eventually swabbed for coronavirus and no further cases were found with COVID-19.
Head office of Moran Aged Care also picked up a lot of administration and communication tasks for the facility so staff at Moran Engadine could focus on taking care of their residents.
Moran Engadine Aged Care to date
Whilst the resident recovered from the virus, life at Moran Engadine will likely never be the same again.
Ms Gibbs says, "I don't know if we will ever be back to normal. I really don't. We still haven't had a sufficient break from that COVID-19. While we have maintained the same standard through the program, we are a lot stricter with our staffing, making sure they are co-located in one area [in the facility]. Making sure we don't run activities across the floor.
"We have to maintain how we deliver care. We have looked at that model and strengthened that at a team level. We don't know what today brings, because there is a new guideline from the Minister and a new one from the PM. We are always changing and it is a fluid environment."
Prime Minister Scott Morrison urged providers not to go above and beyond the visitor restrictions recommended by the National Cabinet on Tuesday.
However, Ms Gibbs says that the facility has reached the second tier of fear, which is allowing visitors to enter the nursing home again.
"As a home, we are very proactive and had control of who was coming in and out of our home prior to COVID-19 and during the COVID-19, we had total control now. But now the Government wants us to open our doors and allow visitors," explains Ms Gibbs.
"I have been able to protect my staff, I have been able to protect my residents up until now. But the fear of having to allow 280 people through your building every day all day is quite a fearful thing.
"We are currently looking at ways to open their doors and being reassured we can protect staff and residents. We don't have sufficient PPE for people to come into the building every day. That is the fear we are at now."
Moran Engadine is attempting to come up with a plan that makes them feel comfortable with allowing people into the facility but also allows for the safety of residents and staff.
Ms Gibbs says while staff are exhausted and mentally drained, they are happy with the outcome and glad no one deteriorated during this period and no clinical care was missed.
Although, relying on the honesty of visitors will be stressful for the staff, and checking temperatures and other controls take up a lot of resources.
Ms Gibbs adds that no one at the facility wants to experience the stress and mental fortitude that was required over the two-week lockdown.
"The pressure, the responsibility, the fear of the unknown, the fear of do we have enough stock each day. That I didn't expect and my staff didn't expect. They didn't expect the emotional trauma it had," says Ms Gibbs.
"This will scar us for a while."
For more information about the coronavirus, visit the Aged Care Guide's COVID-19 update page.
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