‘This article was first written for AHHA’s monthly magazine, The Health Advocate.’
High density housing residents are at higher risk of viral transmission because of crowded living spaces and the need for people to share areas such as laundries, kitchens, stairwells and entries. During the peak of transmissions schools were closed, people were working from their homes and public spaces were closed, further contributing to physical crowding within the home environment.
It is well established that infection can spread quickly in high density and shared accommodation, so a COVID outbreak near, or in, one of these properties would be difficult to contain.
This higher risk, coupled with many people’s difficulties accessing information in language about rule changes and about COVID-19 screening and testing services, led to a situation where those at highest risk were least exposed to messages about what needed to be done to prevent transmission and manage outbreaks.
To address the need, the Victorian Government developed the High Risk Accommodation Response (HRAR) program in late 2020. The program funds a range of community health organisations to provide health support, rapid response COVID testing squads, COVID audits and deep cleaning to rooming houses, public and community housing, supported residential facilities and hostels.
cohealth, one of Victoria’s largest community health agencies, is one of the organisations tasked with delivering this program and has worked with the owners of 845 high density accommodation properties and their 16,000 residents to prevent COVID outbreaks.
Community health services are the ideal providers of the HRAR program because our model of care focuses on people facing disadvantage, and many of our existing clients already live in high-risk properties.
The early stages of the program involved building relationships with the owners, the proprietors and the residents of the accommodation sites, and undertaking COVID audits at each site to assess the on-site risks in the event of an outbreak.
cohealth spent months building relationships and earning the trust of the owners and managers of the 845 properties – it has been a mammoth task.
Building on existing relationships with vulnerable people
This program has allowed us to build on our existing relationships with clients living in high-risk accommodation and to identify and build trust with new clients. There is a real opportunity to continue to build on the trust generated to support residents to have the best health and wellbeing that they can beyond the pandemic.
As a local health provider, the community know cohealth, and trust us, so they feel more comfortable having us conduct a COVID audit, for example, or seeing our rapid response testing team in their building if there has been an exposure site nearby.
Peer workers ensure success of HRAR
A unique feature of the HRAR program is the involvement of peer workers. cohealth employed people who live in the high risk accommodation settings. This strategy ensures that the lived experience and knowledge of the peer workers was integrated into their mode of communication and interaction with the residents. For example, materials that are provided to HRAR residents are developed with input from people who live or have lived in that community.
HRAR teams respond to recent hotel outbreaks
During hotel quarantine outbreaks in Melbourne’s CBD in February 2021, the HRAR team worked swiftly to identify high-risk accommodation in the vicinity of exposure sites, and mobilise services to attend the properties.
Within hours of the news about the CBD hotel quarantine worker cohealth had identified 140 high-risk properties close to exposure sites, and plans were put in motion to support the residents.
Our workers were immediately on the phones to the owners and attending the properties to answer questions, connect people to testing, provide care packs and new masks and work out who may have been in contact with the exposure site.
The HRAR program continues to deliver much-needed services to the owners and residents of these properties in response to isolated outbreaks, and as the COVID vaccine program rolls out.
A scalable model
The HRAR program has application across a range of environments and situations and could be rolled out nationally using community-based organisations to not only prevent transmission of infectious diseases but to ensure hard to reach communities have access to health information and health promotion. Essentially, we can use this proactive outreach model to improve access and care navigation.
COVID-19 has given us a clear wakeup call about the impact of the social determinants of health on disease, reminding us of what we have forgotten – that pandemics have always impacted the poor and the marginalised most severely.
We can continue to support this community by continuing to work with them and looking further at how we can address the social determinants by improving our public housing stocks and reducing overcrowding as an infectious disease prevention strategy which will pay dividends during any further pandemic.