Aged care – we can do better

There’s no doubt that aged care homes were, and probably still are, ill-prepared for Covid-19. It’s also tragic that by 29 August, 407 aged care residents had died of the virus, presumably without family members close by. 

Ten aged care residences in Victoria are responsible for over 1,500 cases of Covid. More than 1,000 aged and disability care staff nation-wide are likely to have acquired the virus at work, according to the Health Workers Union, and 120 facilities (1.3%) have reported infections.

Seven months after the first case in Australia, Minister for Aged Care, Richard Colbeck, appeared like a rabbit caught in the headlights, surprised that he was expected to be leading the fight to protect the elderly in care from this pandemic or those looking after them.  

It should have been obvious to him that aged care is congregate and that this and the vulnerability of the elderly with pre-existing complex health needs should have been big red flags.  (Just as inadequate preparation in Victoria for residents in high rise public housing and quarantine in hotels should have rung alarm bells.)

Communications around Covid-19 have generally been below par, uncoordinated and, in some cases contradictory such as PPE and isolation guidelines.  Federal advice does not require aged carers to wear masks as part of ‘good hygiene’ practices. 

Appropriate PPE use in a COVID-positive environment demands close attention, vigilance, and supervision at all times to don and doff gowns, masks, gloves, and face shields safely.  Despite the need being recognised in March, appropriate face-to-face PPE training was only recently coordinated in aged care services following a surge in health care workers acquiring COVID. 

What passes for a national plan, cites national guidelines but does not oblige providers to have a management plan, establish screening protocols, monitor the health of staff and residents, etc. Providers are only required to inform the department, manage outbreaks and follow advice on infection control and appropriate use of PPE once an outbreak occurs.  And they will be reimbursed for the extra costs only after the outbreak it is over.  

It was hardly surprising that carers and nurses would catch the virus yet it was months before back-up staffing was provided.  

We should be eternally grateful to aged carers whose work is often difficult, demanding, not always pleasant, and now somewhat risky.

Stringent PPE practices will be unfamiliar to carers and in many respects at odds with their intimate role as home-maker-carer.  We know PPE is necessary but it must be alarming for many residents to be confronted by masks and plastic gowns. Elderly people isolated in hospital will be finding it very difficult, especially those living with dementia. 

Demands are again being made to set nurse-to-resident ratios and for aged care to be equipped more like hospitals. The AMA is calling for an audit of every facility. 

Yes, aged care should provide staff to meet resident needs but it would be truly tragic if Covid drives a return to the ‘medical model’ in aged care. Who would want to live out their last months or years in a hospital-like environment? People are residents, not patients in aged care. 

The best aged care residences are those that are most home-like, familiar, welcoming to friends and family, located in amongst ordinary streetscapes, still connected to the outside world.

The best homes encourage residents to live normal lives for as long as possible – gardening, walking, exercising, making art, cooking, being entertained, talking and laughing with volunteers and visitors. 

If there is a silver lining in all of this it is that there have been only 36 deaths overall due to flu this year and none since April.  This compares with 902 deaths in 2019 (0.29%) when 313,000 people were diagnosed with flu (a very bad year for flu) and almost 4,000 were admitted to hospital, despite widespread vaccination. The median age of those who died was 82 and many of them would have been in aged care.

Like so much that is Covid-related, perhaps it is a time for real reform. 

  • Aged care could be a state government responsibility (funded by the Commonwealth) so there is a better continuum of care planning with hospitals and perhaps there should be more specialised geriatric hospitals and clinics, more palliative care in homes, and better choices available to people at end of life.  
  • Let’s open private aged care provider books and make sure public funds are not siphoned off to support religious activity or inordinate profits to owners and shareholders.  
  • We should encourage community-based, not-for-profit operators, perhaps backed by local government, to provide aged care so people can stay in their communities. 
  • Let’s enable informed decision-making for those entering aged care by providing the means to compare the performance of aged care facilities. 
  • Let’s provide more Home Care Packages to ensure those who have been assessed as needing community support are not waiting 12 months or more to receive it. It’s a false economy to ration this service. Australia has one of the highest percentages of elderly people in institutional care of any developed country.  
  • Nutrition, specialised staff training, dental care, and in-home support should all be significantly improved.  Wages should be increased, and greater incentivisation provided for general practitioners to work more closely with aged care providers. 

Funding is immensely complicated with subsidies, bonds and fees. Bed licenses are rationed and eligibility for aged care has tightened in recent years to the most frail residents meaning levels of carer support are much higher. The goalposts keep moving on funding for levels of frailty and cuts in 2012, 2015 and 2016 sent many providers close to the wall before an injection into the sector of $320 million last year. 

The Royal Commission into Aged Care Quality and Safety will hand down its final report in November and it’s likely to call for a major overhaul. Its interim report is titled Aged Care in Australia: A Shocking Tale of Neglect.

We can do better than this.

Photo by Georg Arthur Pflueger on Unsplash

Photo by Marcel Strauß on Unsplash, above

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