Aged Care Facilities Research Articles

The quality of residential aged care in the context of the Australian aged care reforms: A scoping review.

Australia has been undergoing a major aged care reform process since 2012 focused on consumer-oriented home and community-supported care, but little is known about the impact of these reforms on residential aged care delivery. This study aimed to review research about the quality of residential aged care service delivery during the implementation period of these reforms. The review followed a five-stage scoping review framework and searched five databases for articles published between 2012 and February 2022 (the 10-year implementation period of the reforms). Initial searches identified 495 articles. Articles were imported to Covidence™ for title, abstract and full-text screening. Twenty-two articles were included in the review. Articles were framed using the micro (residents and families)/meso (staff)/macro (governance, government) continuum in the operation of residential aged care facilities. Most articles focused on workforce perspectives. Attention was paid to workforce issues and a limited focus was on consumer experience and expectations. There is a need for an evaluation of the reforms as a vehicle for promoting consumer empowerment. Many contributing factors to quality of care were identified, and there were some quality issues that were contrary to the intended objectives of the reforms. These warrant closer attention.

A Novel Web-Based Application for Influenza and COVID-19 Outbreak Detection and Response in Residential Aged Care Facilities.

The use of innovative digital health technologies in public health is expanding quickly, including the use of these tools in outbreak response. The translation of a digital health innovation into effective public health practice is a complex process requiring diverse enablers across the people, process, and technology domains. This paper describes a novel web-based application that was designed and implemented by a district-level public health authority to assist residential aged care facilities in influenza and COVID-19 outbreak detection and response. It discusses some of the challenges, enablers, and key lessons learned in designing and implementing such a novel application from the perspectives of the public health practitioners (the authors) that undertook this project.

The evaluation and enhancement strategies of core competencies for older adult caregivers in integrated medical and older adult care institutions.

The study aimed to understand the main skills of older adult caregivers and find ways to improve these skills. We selected participants using a method called random cluster sampling, where caregivers from 17 different medical and nursing care facilities across seven districts in Hangzhou were chosen. We collected 492 valid questionnaires and conducted interviews with 150 people. To analyze the data, we used T-tests and Analysis of Variance (ANOVA) to identify what factors affect caregivers' skills. We also performed multiple regression analysis to explore these factors in more depth. The analysis showed that age (p = 0.041), annual income (p < 0.001), and having a training certificate (p < 0.001) significantly influence the skills of older adult caregivers. Specifically, caregivers' age and whether they had a training certificate were linked to how competent they were, with income being a very strong factor. The study highlighted a gap between the caregivers' current skills and the skills needed for high-quality care. This gap shows the need for training programs that are specifically tailored to the caregivers' diverse needs and cultural backgrounds. Medical and eldercare facilities should adjust their work and educational programs accordingly. It's also important to look at how caregivers are paid to make sure their salary reflects their skills and the quality of care they provide. Finally, it's crucial to integrate a comprehensive training program that leads to certification within eldercare organizations.

Seeking residents' views regarding Australian residential aged care: A scoping review.

This scoping review aimed to explore topics on which the views of residents of Australian residential aged care facilities (RACFs) have been sought. Scoping review methodology as outlined by Arksey and O'Malley was used to identify, explore and report on the range of literature regarding views of RACF residents. Seven electronic databases were searched using broad search terms relevant to the RACF context. Descriptive numerical analysis was completed for publication year, journal name and target profession, research methods and participant types. Thematic analysis then focussed on the aims of the included studies. Four thousand two hundred and ninety studies were screened, and 104 publications met the inclusion criteria. A broad range of topics were explored by researchers, with the largest number of papers focused on residents' views of systems within RACFs (n = 24) and new programs and interventions (n = 21). Smaller topic areas included health conditions and health-care services (n = 13), socialisation (n = 13), physical activity (n = 3), self-care (n = 4), leisure (n = 4), general everyday life (n = 20) and aspects of the residential aged care environment (n = 15). There was limited exploration of meaningful activity (n = 13). The inclusion of residents with cognitive impairment was inconsistent, and the voices of other stakeholders were often privileged. Voices of residents must be heard in order to prioritise the health and well-being of this population. More research which focuses on what is important to residents is needed and must include residents with cognitive impairment more effectively. Identification of optimal research methods with this population would make an important contribution in this area.

Factors Influencing the Usage Frequency of Community Elderly Care Facilities and Their Functional Spaces: A Multilevel Based Study

The construction of community elderly care facilities (CECF) is pivotal for promoting healthy aging and “aging in place” for older people. This study focuses on the low utilization rates of community elderly care facilities in the Dongcheng and Xicheng Districts, core areas of Beijing. The explainable machine learning method is used to analyze data across three dimensions: the elderly’s individual attributes, characteristics of the community elderly care station (CECS), and features of the built environment around CECS and subdistrict, to identify the important factors that influence the usage frequency of overall CECS and its different functional spaces, and also the correlation between factors and usage frequency of CECS. It shows that the most important factors are the features of CSCF, including the degree of space acceptance and satisfaction with services provided, which influence the usage frequency of nine functional spaces (R2 ≥ 0.68) and overall (R2 = 0.56). In addition, older people’s individual factors, such as age and physical condition, significantly influence the usage of specific spaces such as rehabilitation therapy rooms and assistive bathing rooms. The influence of built environment characteristics is relatively low, with factors such as the density of bus stations and housing prices within the subdistrict and the mean distance from CECF to the nearest subway stations being more important. These findings provide a reference for the construction of indoor environments, management of service quality, and optimal site selection for future community elderly care facilities.

Residents’ future residential preference and its affecting factors in the rapid urbanization zone of rural China from a family life cycle perspective

Understanding farmers’ future residential preferences and the factors affecting these choices is crucial for tackling the issues related to hollow village management and rural planning. Despite limited research on the role of the family life cycle, this study explores how the family life cycle, characteristics of the household head, livelihood strategies, and resource availability shape farmers’ future residential preferences. Data were collected from 777 households in China’s main grain-producing area. The findings reveal that 52.90% of households prefer to stay in their current rural residences. Other favored options are elderly care facilities (13.90%), living with children in the village (12.36%), and ancestral homes (11.68%). The family life cycle significantly affects these preferences (p < 0.01), with changes in family structure and age leading to different living choices. Specifically, households in the initial (71.29%), burden (70.32%), and stable stages (40.14%) prefer their current rural residences, while those in the maintenance and empty-nest stages opt for living with their children’s residences (22.22% and 16.96%, respectively) or in elderly care facilities (30.00% and 33.93%). Meanwhile, age, health, income, livelihood strategies, and land ownership also markedly influence the choice of residence. Recommendations include educational programs for elderly rural residents, improving older individuals’ adaptability to rural changes, creating more rural employment opportunities, and enhancing medical and infrastructural services for the sustainable rural development.

Applying generative AI with retrieval augmented generation to summarize and extract key clinical information from electronic health records

BackgroundMalnutrition is a prevalent issue in aged care facilities (RACFs), leading to adverse health outcomes. The ability to efficiently extract key clinical information from a large volume of data in electronic health records (EHR) can improve understanding about the extent of the problem and developing effective interventions. This research aimed to test the efficacy of zero-shot prompt engineering applied to generative artificial intelligence (AI) models on their own and in combination with retrieval augmented generation (RAG), for the automating tasks of summarizing both structured and unstructured data in EHR and extracting important malnutrition information. MethodologyWe utilized Llama 2 13B model with zero-shot prompting. The dataset comprises unstructured and structured EHRs related to malnutrition management in 40 Australian RACFs. We employed zero-shot learning to the model alone first, then combined it with RAG to accomplish two tasks: generate structured summaries about the nutritional status of a client and extract key information about malnutrition risk factors. We utilized 25 notes in the first task and 1,399 in the second task. We evaluated the model’s output of each task manually against a gold standard dataset. ResultThe evaluation outcomes indicated that zero-shot learning applied to generative AI model is highly effective in summarizing and extracting information about nutritional status of RACFs’ clients. The generated summaries provided concise and accurate representation of the original data with an overall accuracy of 93.25%. The addition of RAG improved the summarization process, leading to a 6% increase and achieving an accuracy of 99.25%. The model also proved its capability in extracting risk factors with an accuracy of 90%. However, adding RAG did not further improve accuracy in this task. Overall, the model has shown a robust performance when information was explicitly stated in the notes; however, it could encounter hallucination limitations, particularly when details were not explicitly provided. ConclusionThis study demonstrates the high performance and limitations of applying zero-shot learning to generative AI models to automatic generation of structured summarization of EHRs data and extracting key clinical information. The inclusion of the RAG approach improved the model performance and mitigated the hallucination problem.

A Guide to Measuring Heart and Respiratory Rates Based on Off-the-Shelf Photoplethysmographic Hardware and Open-Source Software.

The remote monitoring of vital signs via wearable devices holds significant potential for alleviating the strain on hospital resources and elder-care facilities. Among the various techniques available, photoplethysmography stands out as particularly promising for assessing vital signs such as heart rate, respiratory rate, oxygen saturation, and blood pressure. Despite the efficacy of this method, many commercially available wearables, bearing Conformité Européenne marks and the approval of the Food and Drug Administration, are often integrated within proprietary, closed data ecosystems and are very expensive. In an effort to democratize access to affordable wearable devices, our research endeavored to develop an open-source photoplethysmographic sensor utilizing off-the-shelf hardware and open-source software components. The primary aim of this investigation was to ascertain whether the combination of off-the-shelf hardware components and open-source software yielded vital-sign measurements (specifically heart rate and respiratory rate) comparable to those obtained from more expensive, commercially endorsed medical devices. Conducted as a prospective, single-center study, the research involved the assessment of fifteen participants for three minutes in four distinct positions, supine, seated, standing, and walking in place. The sensor consisted of four PulseSensors measuring photoplethysmographic signals with green light in reflection mode. Subsequent signal processing utilized various open-source Python packages. The heart rate assessment involved the comparison of three distinct methodologies, while the respiratory rate analysis entailed the evaluation of fifteen different algorithmic combinations. For one-minute average heart rates' determination, the Neurokit process pipeline achieved the best results in a seated position with a Spearman's coefficient of 0.9 and a mean difference of 0.59 BPM. For the respiratory rate, the combined utilization of Neurokit and Charlton algorithms yielded the most favorable outcomes with a Spearman's coefficient of 0.82 and a mean difference of 1.90 BrPM. This research found that off-the-shelf components are able to produce comparable results for heart and respiratory rates to those of commercial and approved medical wearables.

Eyes on the pandemic: using photovoice in group and remotely with social professionals of aged care facilities

ABSTRACT The COVID-19 pandemic had a major impact on aged care services. In Portugal, social workers are key frontline professionals in aged care services. A photovoice program called “Eyes on the Pandemic” was carried out to capture the internal experiences of frontline social workers working in aged care services during the first year of the COVID-19 pandemic. Photovoice is a qualitative, participatory action-research method in which participants share key experiences of their lives through photographs and narratives (voices) presented and discussed with others. Thirteen social workers between 24 and 41 years old participated. This article describes the planning, implementation, and evaluation of this project. The findings suggest that the social workers’ experiences were defined by a reinvention of intervention, the maintenance of a balance between personal and professional life, the crucial importance of teamwork, management of the pandemic repercussions on older people’s well-being, and encounters with the uncertain future. The results illuminate the lived experience of the COVID-19 pandemic inside aged care facilities and could inform practices and policies by consolidating lessons learned during this difficult period. The benefits of attending the program referred by the participants, lead to conclude that photovoice proved to be a good group intervention tool.

Research on Optimization Design Strategies for Natural Ventilation in Living Units of Institutional Elderly Care Facilities Based on Computational Fluid Dynamics Simulation

As China transitions into a deeply aging society, the elderly population’s growth has driven a rapid increase in elderly care institutions and facilities during the “13th Five-Year Plan” period, rising by over 235% compared to the “12th Five-Year Plan”. The ongoing normalization of COVID-19 prevention measures has underscored the urgent need to improve natural ventilation in elderly care residential facilities. This study conducted empirical surveys to assess the current state of natural ventilation in typical elderly care facilities and analyzed the architectural elements influencing it. By examining the needs and preferences of the elderly for natural ventilation, two basic living space layout types were identified through typological analysis. Suitable CFD simulation software was then employed to model key elements, and effective methods to enhance ventilation were summarized. This study found that modifying the floor plan to reduce the depth of south-facing rooms to 8.4 m, relocating external openings to the center of the rooms, adjusting the ratio of ventilation openings to room area to greater than 1/12, and adding 0.5 m high windows facing internal traffic roads can significantly improve indoor ventilation while maintaining privacy. Furthermore, placing the main activity and resting areas of the elderly in well-ventilated zones with minimal drafts can enhance both comfort and ventilation effectiveness. The research provides a scientific basis and methodological guidance for the construction and renovation of elderly care residential facilities.

Introducing virtual reality to older adults: A qualitative analysis of a co-design innovation with care staff

Previous studies of Virtual Reality (VR) in aged care settings have demonstrated that the benefits can be multiple, including improved social connection and engagement and reduced social isolation in later life. However, there remains a lack of widespread uptake of VR in aged care facilities. This prompts an important question: Given the potential benefits, why is there such poor engagement in VR by aged care facilities? The aim of this qualitative study is to investigate the experience of introducing VR into an aged care facility. Our innovative approach supported care staff to introduce VR into aged care facilities. Fieldwork diaries and focus group discussions were used to document experiences of introducing VR, including the obstacles, challenges and benefits and the adaptations to aged care environments that were required to accommodate new VR activities. Thematic analysis of the data revealed that VR can be an important medium to support the wellbeing of older residents. However, our findings also indicate that there are significant challenges associated with introducing VR, including substantial costs in time, money and institutional resources and attention. This study concludes that, to be successful, VR requires substantive care and relational resources from both staff and residents that are only visible when paying attention to the contextual adjustments required to introduce the technology to a new setting. This suggests that other research on gerontechnologies would likely also benefit from further attention to the role of the broader social context – including care and relational resources – in ensuring their successful design and implementation.

The Social Entrepreneurship and Empowerment Culture among Youth in Elderly Care

This study investigates the factors and strategies that empower youth involvement in social entrepreneurship within the elderly care setting. It employs a qualitative design with a phenomenological approach. The purposive sampling method was adopted to interview youths aged between 18 and 30 and elderly service providers aged 30 to 50 years and above. The results indicated that the main factors driving youth involvement in social entrepreneurship in the elderly care setting include experience, awareness, skills, and financial capital as sub-themes. The strategies for empowering and generating income among youths in social entrepreneurship in elderly care settings refer to the education system, promotion through government programs, free training courses, and financial support. This study can also provide insights into the country’s preparation in terms of human capital development, aiming to enhance the well-being of the elderly and the career involvement of youth in providing sustainable elderly care services and facilities.

Reducing Leak and Increasing Comfort of an N95 Filtering Facepiece Respirator for Aged-Care Workers Using a Customized, Soft, and Compliant Mask Frame

Abstract This prospective cohort study examines the quantitative fit-factor and tolerability impact of a novel custom frame designed to fit beneath N95 filtering facepiece respirators (FFRs) in a healthcare setting. Conducted at a medium-sized metropolitan residential aged care facility (RACF) in South Australia, sixty participants underwent quantitative fit testing while wearing institutional-provided N95 FFRs. Utilizing three-dimensional (3D) face scanning with a proprietary iPhone app, personalized frames were created using flexible silicone foam with a rigid plastic interior “backbone” to ensure compliance and comfort. Following the fitting of custom frames, participants underwent repeat quantitative fit testing using the same style and size of N95 FFRs. Results indicate a remarkable improvement, with 81.5% of participants achieving a pass on quantitative fit testing when using their custom frame in conjunction with the N95 FFRs, compared to a baseline pass rate of only 21.7% (odds ratio (OR) 20.9, 95% confidence interval (CI): 8.26, 58.50, p &amp;lt; 0.001 via logistic regression). Additionally, participants reported a 2.4 times higher level of tolerability when wearing the custom frame with their N95 FFRs compared to using FFRs alone (p &amp;lt; 0.001). In conclusion, the study demonstrates that wearing a customized frame device under an N95 FFR significantly enhances the likelihood of achieving a pass on quantitative fitting and offers a substantially more tolerable experience for wearers. These findings highlight the potential of personalized frame devices to improve respiratory protection efficacy and wearer comfort in healthcare settings.

The Impact Caregiver’ Job Stress on the Safety Management Activities in Elderly Care Facilities: Mediating Effect of TMX(Team-Member Exchange)

The Impact Caregiver’ Job Stress on the Safety Management Activities in Elderly Care Facilities: Mediating Effect of TMX(Team-Member Exchange)

Dietitians' perceptions of employment models used in Australian residential aged care facilities.

The qualitative study aimed to explore dietitians' perceptions of employment status and engagement models with residential aged care facilities (RACF) and the impact on work activities and resident care. Dietitians currently working in RACF were recruited through convenience and snowball sampling, including contacting a list of dietitians who had previously consented to be contacted for research. A semi-structured interview guide was developed by the research team, pilot-tested and then used in each individual interview. Data were analysed using constant comparison and reflexive thematic analysis. Thirty-one dietitians (n = 29 female; median age, 39 years) with a range of experience working in different employment status and engagement models in RACF participated in an interview. Five themes were identified: (1) Being an employee allows for better integration and utilisation in the RACF, (2) Contract work creates a scarcity of time, (3) Ad hoc work does not meaningfully address nutrition challenges and may not be good for resident care, (4) Regularly scheduled visits support positive outcomes for residents and (5) Acknowledging many different employment models. Characteristics of engagement models likely affect dietitian work job satisfaction, individual resident care and food service in RACF. Regular dietetic engagement in RACFs is required to support resident-centred evidence-based dietetic practice and to improve residents' nutrition care. There is an opportunity for policy mandates to assist RACFs in regularly engaging a dietitian to ensure all residents have access to timely, high-quality nutrition care.

‘The Sanctuary’ – developing a human-animal model to promote health in a supported residential aged care setting

Abstract Human-animal relationships are vital for many older persons. Finding ways to include animals in aged care settings can be part of reorienting aged care settings from a solely humancentric focus to a human-animal inclusive one for the 21st century. This case study project report describes the development of an animal inclusive model of care for a Residential Aged Care Facility (RACF) in a regional town in Australia. The model’s primary objective was to facilitate residents’ empowerment through safe engagements with animals as a source of health and wellbeing while incorporating best practise animal-care and husbandry. Exemplars used to inform the model included The Eden AlternativeTM and Care Farms. The Sanctuary model sought to cover several gaps identified in these approaches. These included clear policies and protocols regarding animal welfare, infrastructure needs (animal housing and designated human-animal interaction areas), staffing models, stakeholder engagement approaches (both within the RACF and the local community) and developing sustainable resourcing and financial frameworks. A vision to establish a refuge for both humans and animals was inherent in the design of the Sanctuary model, and to operationalize this vision, policies, resourcing plans and practical processes were formulated informed by multi-species ethical understandings. Regrettably, it was not possible to fully implement the model. However, this case study is presented with the aim of seeking to redress the noted 85% wastage of global health research; a wastage that includes human-animal research knowledge. Insights into opportunities and barriers and experiential knowledge are shared with the aim of facilitating future endeavours to implement parallel visions that embed human and animal inclusive models in residential aged care in the future.

A quasi-experimental study to assess the impact of green gardens on elderly anxiety: A socio-ecological perspective

ABSTRACT By 2050, it’s projected that the elderly population will make up approximately 14% of the global populace. United Nations forecasts indicate a notable increase in the average age of Iran’s population, expected to rise from 29.5%–49.4% by 2100, presenting significant societal and environmental challenges for the future. Given this demographic shift, addressing the implications of an aging population in Iran is paramount, underscoring the necessity for a socio-ecological approach. This experimental study seeks to explore the effects of green gardens on the mental well-being of the elderly, employing practical experience and a socio-ecological perspective. The study cohort consisted of elderly individuals residing in eldercare facilities in Kermanshah city, located in western Iran. Utilizing a purposive sampling method, 80 individuals were carefully selected and included in the study. Participants were then randomly divided into two groups: an experimental group (n = 40) and a control group (n = 40), ensuring demographic homogeneity. Adopting a quasi-experimental research design with pre-test/posttest measures and a control group, data were gathered through the Geriatric Anxiety Inventory (GAI) questionnaire. The results revealed statistically significant differences in anxiety variables—cognitive (p < .01, d = 0.78), arousal (p < .01, d = 1.64), and somatic (p < .01, d = 0.85) aspects—both before and after the implementation of green garden initiatives in eldercare facilities among the experimental group. Conversely, no significant changes were observed in these variables within the control group before and after the intervention. The practical application of the socio-ecological approach has the potential to strengthen the connection between the elderly and their environment, leading to substantial changes in human resources concerning psychological characteristics and contributing to the development of green spaces in urban areas. This research provides valuable insights into addressing the health and well-being of the aging population through socio-ecological interventions. Furthermore, this study has practical and theoretical implications by addressing urban agriculture practices. Overall, this study contributes to urban agriculture practice on one hand and has a significant impact on the health of the elderly on the other hand.

Adverse Drug Event–Related Hospital Admissions among Australian Aged Care Residents: A Cross-Sectional Study

ObjectivesTo investigate the proportion, characteristics, causality, severity, preventability, and independently associated factors for adverse drug event (ADE)–related admissions in aged care residents admitted to the major public hospitals in Tasmania, Australia. DesignRetrospective cross-sectional study. Setting and ParticipantsResidential aged care facility (RACF) patients aged ≥65 years who had an unplanned admission to one of the 4 Tasmanian public hospitals between July 1, 2018, and June 30, 2021. MethodsWe accessed the medical records of RACF patients. The ADEs were initially identified via chart review and a trigger tool. Hospitalizations attributable to ADEs were then determined by expert consensus. The causality, preventability, and severity of each ADE admission were assessed using standard criteria. ResultsNinety-one residents (18.2%) of 500 randomly selected experienced potential ADE-related hospitalizations. ADEs were considered possible (n = 58, 64%) or definite/probable (n = 33, 36%). The most common ADEs were falls (n = 19, 21%), hypotension (n = 16, 18%), and confusion or delirium (n = 10, 11%). ADEs were frequently associated with renin-angiotensin system inhibitors (n = 43, 47.3%), opioids (n = 43, 47.3%), and diuretics (n = 40, 44%). Most ADEs were of moderate severity (n = 90, 99%) and considered not preventable (n = 60, 66%). Rheumatologic disease [odds ratio (OR) 1.89, 95% CI 1.09-3.30; P = .024] and previous adverse drug reaction (ADR) (OR 12.91, 95% CI 6.84-24.37; P < .001) were associated with ADE hospitalizations. Conclusions and ImplicationsThis study highlights that hospitalization for moderately severe ADEs is common among RACF residents. Opioids and antihypertensives were the common drug classes associated with harm. Rheumatologic disease (due to opioids) and previous ADR were identified as independently associated factors, which may warrant tailored interventions.

Australian Residential Aged Care Facilities Managers’ and Nurses’ Experiences In Implementing Telehealth and Social Connection During COVID-19

Introduction: Residential aged care facility (RACF) residents are highly vulnerable to severe infection and death from COVID-19. During the pandemic, telehealth (telephone and video) provided a mechanism to deliver for health care and social support. We examined logistical factors associated with telehealth, reasons for its use and barriers associated with the choice of telehealth. Methods: A mixed method exploratory study. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using a hybrid framework approach; deductive analysis followed by inductive analysis for sub-themes. Results: Participants (n=19) reported an increase in telehealth use during COVID-19. Organisations bought new equipment, predominately tablets; half had internet connectivity difficulties; nurses used personal devices to overcome connectivity issues or inadequate devices and 74% used three or more platforms/software. Few residents had personal digital devices or could connect with family and friends alone. Five key sub-themes emerged from qualitative data. 1. Needing and persisting with telehealth. RACFs had limited video telehealth use before COVID-19. 2. Being dependent on health providers offering telehealth services. Telehealth was used for a broad range of services. However, many health providers did not offer telehealth consultations. 3 Residents living with dementia. Telehealth was suitable for residents with dementia, depending on the disease stage and clinical need. 4. Challenges with implementing telehealth consultations. Most challenges pertained to workflows. 5. Suitability of videoconferencing for social connection. Staff supported residents with video calls which were highly valued. Conclusion: To capitalise on and sustain telehealth activity in RACFs, further guidance and support to overcome operational barriers are required.

COVID-19 outbreaks in residential aged care facilities: an agent-based modeling study.

A disproportionate number of COVID-19 deaths occur in Residential Aged Care Facilities (RACFs), where better evidence is needed to target COVID-19 interventions to prevent mortality. This study used an agent-based model to assess the role of community prevalence, vaccination strategies, and non-pharmaceutical interventions (NPIs) on COVID-19 outcomes in RACFs in Victoria, Australia. The model simulated outbreaks in RACFs over time, and was calibrated to distributions for outbreak size, outbreak duration, and case fatality rate in Victorian RACFs over 2022. The number of incursions to RACFs per day were estimated to fit total deaths and diagnoses over time and community prevalence.Total infections, diagnoses, and deaths in RACFs were estimated over July 2023-June 2024 under scenarios of different: community epidemic wave assumptions (magnitude and frequency); RACF vaccination strategies (6-monthly, 12-monthly, no further vaccines); additional non-pharmaceutical interventions (10, 25, 50% efficacy); and reduction in incursions (30% or 60%). Total RACF outcomes were proportional to cumulative community infections and incursion rates, suggesting potential for strategic visitation/staff policies or community-based interventions to reduce deaths. Recency of vaccination when epidemic waves occurred was critical; compared with 6-monthly boosters, 12-monthly boosters had approximately 1.2 times more deaths and no further boosters had approximately 1.6 times more deaths over July 2023-June 2024. Additional NPIs, even with only 10-25% efficacy, could lead to a 13-31% reduction in deaths in RACFs. Future community epidemic wave patterns are unknown but will be major drivers of outcomes in RACFs. Maintaining high coverage of recent vaccination, minimizing incursions, and increasing NPIs can have a major impact on cumulative infections and deaths.