Articles

Covid death and the nursing home – the report is tabled.

The “Aged Care and Covid-19 – a special report”, prepared by the Royal Commission into Aged Care Quality and Safety makes fascinating reading. 

Released on September 30, it highlights the human cost imposed when elderly people are separated from their loved ones in the name of disease control and the plight of those who died alone and isolated because of lockdown during our Covid-19 crisis.

Yes, it explores the terrible dilemma, the need to find the balance between risking the Covid-19 infection of elderly people who live in close proximity to each other and the importance of meeting their other needs. These appear to be in conflict. But in fact they needn’t be and we need to work this out.

It would be easy to be confused. All around the world, there has been savage criticism of those governments that allowed the disease to rampage through care homes  to kill the elderly.

But although it sounds counter-intuitive to say it –  any protective initiative against disease – the current pandemic and any in the future – has to also make sure residents aren’t just protected, but that they don’t suffer a living death instead.

In August this year, the Royal Commission was prompted to deviate from its main task of reporting early next year on wider issues in aged care, by the Covid-19 outbreak at Sydney’s Newmarch House. There 19 residents died with 37 residents and 34 staff infected.

At that time the pandemic was having its worst impact in NSW. But then the second wave hit the state of Victoria, forcing large swathes of the state into lockdown. During that wave, only tapering off now, 103 aged care facilities across the state had active cases, with 900 residents infected and 46 dying from the virus.

“Never before has the aged care sector in Australia faced a challenge like COVID-19. As at 19 September 2020, 844 people have died in Australia as a result of the virus. Of these, 629 were living in aged care homes at the time of their deaths, although many died in hospital.”

(These figures are updated every day on the Federal Department of Health’s own website. It shows that on Tuesday, October 6, in Australia, there have been 894 Covid-19 deaths. Of these, 673 have occurred in aged care residences, where 2050 elderly people have been infected. To follow this regular update, go to:

https://www.health.gov.au/resources/covid-19-cases-in-aged-care-services-residential-care)

The commissioners noted that the aged care workforce is “under-resourced and overworked.” They concede that the aged care sector is one where people have worked tirelessly, but asks what lessons have been learnt.

So isolation of the elderly and lockdowns prevent the spread of Covid-19? Not really. 

Mr Michael Lye, Deputy Secretary for Ageing and Aged Care in the Australian Department of Health, specifically said, when giving evidence to the Commission, that he was not aware of any cases where visitation resulted in a case of COVID-19 within a facility.

That is, not one.

So there’s quite a few things to be sorted in relation to managing infection in aged care facilities. 

The report pointed out that workers feared not just the infection and death of patients but the infection and death of themselves and their own families. And if I were the person responsible for running such an institution, I’d be very afraid of the consequences for my workers too.

More exploration and education is needed on this. But in the meantime, the special report says “there are four areas where immediate action can and should be taken to support the aged care sector:”

  • First, the Australian Government should fund providers to ensure there are adequate staff available to deal with external visitors to enable a greater number of more meaningful visits between people receiving care and their loved ones.
  • Second, the Australian Government should create Medicare Benefits Schedule items to increase the provision of allied health and mental health services to people living in residential aged care during the pandemic to prevent deterioration in their physical and mental health.
  • Third, the Australian Government should publish a national aged care plan for COVID-19 and establish a national aged care advisory body.
  • Finally, the Australian Government should require providers to appoint infection control officers and should arrange for the deployment of accredited infection prevention and control experts into residential aged care homes.

It’s interesting that the Commission’s priorities are about human connection and relationships. And so they should be.

However, to recommendation one, we’ve seen nursing homes where the amount of staff employed to work with visitors would make absolutely no difference – they are in emotional lockdown. The “home” is safe and the only way to keep it that way is by locking out the outside world. We suggest this is a psychological state, fuelled by insecurity because of lack of information and education. Any financial resources thrown at this problem need to be simple, practical, educational ones, delivered by people with good teaching skills, who are not the superiors of the workers they are educating.

In NSW there is an illusion that, after pressure from various levels of government, aged care residents were allowed visitors. But this was still at the discretion of the aged care facility. There was little consistency between one place and another. In one case, staff said their approach was imposed on them by the state’s “Public Health Unit”. When this unit could be tracked down, it had no mechanism for engaging with the public and referred them back to the nursing home.

It will be interesting to see how the second recommendation is implemented. The report found that depression, anxiety, confusion and suicide risk among aged care residents has increased during Covid-19. But we live in a culture that sees depression, anxiety, confusion and suicide risk among aged care residents as entirely normal. We’ll have to change the culture for this to succeed. That is, the attitudes of those outside the locked gates of aged care.

Looking at three and four, it looks as though the Commission is actually suggesting by-passing the existing Aged Care Quality and Safety Commission, headed by Janet Anderson. In a different world, wouldn’t the tasks required of that recommendation fall under its remit or review?

Certainly, that commission has received much criticism in the media. The national broadcaster the ABC, and others, have criticised it for visiting only 13 percent of nursing homes with Covid-19 outbreaks and sanctioning fewer than 10 per cent of homes with outbreaks.

It has honed in on the case of Victorian providers Doutta Galla, who had four homes that experienced outbreaks. In particular, it shone the spotlight on one that was accredited on July 20 this year, without an assessor being on site, something that Dr Rodney Jilek, a compliance officer has said is unacceptable.

“It’s a poor excuse to say they couldn’t risk infection control by being in there. Would we say that if it was a childcare centre and there were children who had died?” Dr Jilek asked the ABC.

For more on that report, go to: https://www.abc.net.au/news/2020-09-29/aged-care-deaths-prompt-family-anger-at-regulator/12693160

More than 100 homes recorded only a single case, a surprising number – only one infection, according to the ABC. It’s helpful to know this – it implies their infection control strategies were swift and effective. 

Did they extinguish the threat with powerful, rapidly actioned policies? If so, these are the success stories that we need to look at more closely. Did their responses involve moving the Covid-19 infected out of the aged care residence into hospitals swiftly, where the disease could be managed and a very high standard of infection control was already in place?

By going to the Federal government’s own website, https://www.health.gov.au/sites/default/files/documents/2020/09/covid-19-outbreaks-in-australian-residential-aged-care-facilities-11-september-2020.pdf

we can see variations in the numbers and ask the questions of the nursing homes ourselves – something particularly important to those with family members there.  There are aged care facilities on that list that had several cases and others where cases escalated rapidly. What were the factors responsible for that wide variation? 

That page also shows that at a number of places, it was only staff who became infected and no residents. 

Does this suggest that staff were infected as they moved from working in one place to another?  Do these figures suggest work practices, rather than visits from family, were the source of infection? 

Senator Richard Colbeck, Minister for Aged Care and Senior Australians has responded to the Commission’s report, saying most of the recommendations are already being implemented. But he has been accused of being missing in action, when it comes to managing the Covid-19 crisis in our nursing homes.

While he may be satisfied with his performance, members of the general public would have been reassured if he’d had a stronger presence. And the last two of the Commission’s recommendations listed above wouldn’t have been needed if the Senator had weighed into negotiations with the government over the care of the elderly more effectively. He could have argued for a bigger role on the basis that his charges were the most likely to be affected, that he had the most skin in the game.

To see the Minister’s responses, go to:

https://www.health.gov.au/ministers/senator-the-hon-richard-colbeck/media/government-welcomes-aged-care-royal-commissions-covid-19-report-recommendations

To read the commission’s special report into aged care and covid-19, go to:

https://agedcare.royalcommission.gov.au/sites/default/files/2020-10/aged-care-and-covid-19-a-special-report.pdf

The ABC asks: Are you worried about aged care in Australia?

“The aged care royal commission continues and so does our investigation. Let us know if you have a story or issue you’d like the ABC to look into. Email aged.care@abc.net.au to tell us your story,” it says.

Leave a Reply

%d bloggers like this: