Nov 03, 2021

Aged care residents neglected, malnourished and left to die alone during outbreaks

Malnourished aged care residents

Residents became “dangerously deconditioned, malnourished or dehydrated because of isolation, loneliness and neglect” during outbreaks, a report on the review reveals. 

“Many were depressed and withdrawn, [and] cognitive impairment increased.” 

Dementia care posed particular challenges during outbreaks. 

“In some RACFs, during lockdown, residents with dementia died alone and neglected in their rooms.

“We heard repeatedly … that staff shortages and inexperience were aggravated by lack of experienced nursing leadership,” the report noted.

The “chaotic” responses were the result of staff shortages, poor leadership, inadequate pandemic planning, and poor infection control, the review found.

The review, commissioned by the federal government, gave rise to 38 recommendations, which the government has accepted in full.

The aim was to use past experiences to build better defences against COVID-19 and to be better able to manage outbreaks if and when they do occur.

Infectious diseases expert Professor Lyn Gilbert AO and aged care consultant Adjunct Professor Alan Lilly, who together have already conducted two examinations of Australia’s most serious outbreaks, conducted this latest review.

But the authors described nine lines of defence against COVID-19, likening each layer of defence to a slice of Swiss cheese. If the ‘holes’ in the cheese don’t overlap, the virus can not seep through, but when the holes line up, the virus can spread.

The nine lines of defence against COVID-19 in aged care are:

  • built environment and infrastructure,
  • clinical care,
  • effective interagency communication,
  • emergency response,
  • infection prevention and control,
  • leadership, management and governance,
  • planning and preparation,
  • preventing social isolation, and
  • workforce and staff mental health.

While all lines of defence are important, the authors said leadership is the “most critical” factor and “an essential component of all other lines of defence”.

The report makes 38 recommendations, with the government accepting them in their entirety. The recommendations include: 

  • reviewing the guidelines for ventilation in aged care, 
  • phasing out shared rooms and bathrooms, 
  • ensuring consistent GP support can be provided during an outbreak, 
  • local area health networks continue to build relationships with the aged care sector, 
  • the Commonwealth Department of Health maintains COVID-19 aged care information as a ‘single source of truth’, 
  • the Department continues to implement the recommendations from the royal commission’s investigation into aged care’s handling of COVID-19, 
  • increased funding for infection control in aged care, 
  • annual pandemic planning as part of compliance, 
  • providers must give effect to the ‘partnerships in care’ visiting requirements, and 
  • providers should plan for optimal staffing in the case of an outbreak.

The Minister for Health and Aged Care, Greg Hunt, said the review will help the sector, which is still navigating its way through a difficult period.  

Since the start of the pandemic, the government has spent more than $2.1 billion on COVID-19 support in aged care.

Australia’s pandemic performance was relatively positive compared to other similar countries. Of the 37 Organisation of Economic Co-operation and Development (OECD) countries, Australia ranks second lowest in terms of cases per 100,000 people and third lowest in case fatality rates.

“No time for complacency”

Yet, the report warns there is more to do; the subtitle of the report is ‘no time for complacency’.

The authors noted Australia’s early “widespread complacency” about the pandemic, with the sense the nation had initially “dodged a bullet”. Many providers were content with online infection control training and happy to continue employing contract staff from agencies. Many had little PPE in stock.

Their complacency was quickly shown to be misguided.

Even today, there are still problems within the aged care sector that have not been addressed, and for which “there is no time for complacency,” the authors wrote. 

And the pandemic is not over yet. Today the world passed another grim milestone: more than 5 million people have died from COVID-19.

The report says, “With many countries currently experiencing an increase in confirmed COVID-19 cases and increasing numbers of deaths, it is clear that there is no time for complacency.”

You can read the full report here: ‘Independent Review of COVID-19 Outbreaks in Australian Residential Aged Care Facilities’.


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  1. Well nothing has changed. On night shift we only have 7 staff forb120 resident and one staffer is the RN. Tonight we only have 3 AINs. Today they were 4 down. Happening every day! So much for trying to attract people into an industry that is supposed to need thousands of more staff in the future. Why aren’t they advertising for Australian citizens to work in this profession instead of hiring foureigners from overseas? That would be most of the problem solved. You see they don’t really care about our elderly let alone the staff. It is a money making business and greediness at play and the wrong people being hired that are feathering their own nest in an industry where it runs on a culture of save save save THE DOLLARS and wait for the planes to come in and the huge subsidies from the government past and present guys!


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