The Royal Commission into Aged Care Quality and Safety hearings resumed on Monday, with counsel assisting the royal commission, Peter Rozen QC, opening proceedings. He began with damning observations of the sector’s handling of the COVID-19 outbreaks in aged care facilities in both New South Wales and Victoria.
Mr Rozen acknowledged the “extraordinarily difficult times” the sector is experiencing at present.
He said that 168 residents of aged care facilities have died in what he described as a “human tragedy”. He said 68 per cent of all COVID-19 deaths in Australia relate to people in residential aged care; one of the highest rates of deaths in residential aged care as a percentage of total deaths in the world.
Mr Rozen outlined the issues the royal commission will be addressing in hearings over the coming three days. The hearings are being held remotely.
Mr Rozen said low staffing numbers were a constant problem in aged care facilities. Since 1998, there has been no requirement for nursing homes to have a nurse on site, meaning providers have the final say in “the numbers and skill mix” of their workforce.
Proposals to introduce staff ratios during the royal commission have been deflected by both the sector and the government, Mr Rozen said.
“The aged care system we have in 2020 is not a system that is failing. It is the system operating as it was designed to operate. We should not be surprised at the results.”
Mr Rozen questioned the observation by the Minister for Health, Greg Hunt, that the sector was “immensely prepared” for COVID-19.
Mr Rozen said The Australian Health Protection Principal Committee is the main source of information about COVID-19 in Australia, but it did not provide any update to its guidance between 19 June 2020 and 3 August 2020, “a crucial period of six weeks during which the number of new daily infections in Victoria grew from 25 to 413”.
Mr Rozen suggested that the lessons learnt from the two aged care outbreaks in Sydney at Newmarch House and Dorothy Henderson Lodge were not “appropriately distilled and conveyed” to the sector.
He said the royal commission will be looking closely into this matter.
Mr Rozen questioned the “very optimistic” results from the Aged Care Quality and Safety Commission’s survey of aged care providers about their preparedness for COVID-19.
The survey found more than 99 per cent of respondents said they had an infection control/respiratory outbreak plan, they had a plan for communicating with staff, residents, volunteers, family members in the case of an outbreak, and they have assessed their readiness for a COVID-19 outbreak as either ‘satisfactory’ (56.8%) or ‘best practice’ (42.7%).
Mr Rozen said the commission will hear from Professor Joseph Ibrahim, who he expects will be “highly critical” of this survey.
Mr Rozen said the royal commission will ask if the Quality Commission’s powers should be extended to have greater powers of investigation, for example to allow it to enter the premises of a provider with the provider’s consent.
As the current regulations stand, the commission can’t enter an aged care facility without the provider’s consent.
Mr Rozen also described the difficulties seen in delegating responsibilities between the provider, the state government and the federal government.
“Who would call the shots?” Mr Rozen asked. “For example, who would decide when it is appropriate for a COVID-19 positive resident to be transferred from an aged care home, which falls under the jurisdiction of the Commonwealth, to a hospital which falls under the state system?”
He said it appears these questions were not adequately addressed in planning for COVID-19. “They should have been,” Mr Rozen said.
Grant Milland, CEO of Anglicare, operator or Newmarch House, said the roles and responsibilities of the various state and Commonwealth authorities assisting Anglicare to respond to the Newmarch outbreak were unclear, according to Mr Rozen.
Mr Millard says that there was ‘often confusion about designation and decision-making authority’, Mr Rozen said.
Mr Millard said the advice they received was often “conflicting” and “lacked clarity”, and there was a “frustrating level of dysfunction” in the discussions between Anglicare management and the “numerous government departments, agencies and hospital employees at both Federal and State level”.
However, Richard Lye, from the Commonwealth Department of Health, has said he did not consider there was any lack of clarity about roles and responsibilities.
“That perceptions about this central question of two of the major players involved in the Newmarch House outbreak could be so different is itself a cause for concern,” Mr Rozen told the hearing.
Mr Rozen spoke of the need for infection control specialists in aged care facilities.
He said Kathy Dempsey, from the NSW Clinical Excellence Commission, and another expert in infection control were deployed from day one of the outbreak at Dorothy Henderson Lodge, help that was described as “invaluable”.
However, infection control expertise was not brought into Newmarch House until two weeks into the outbreak.
In 2012, an inquiry into the deaths of four aged care residents after an outbreak of gastroenteritis recommended that every facility employ a designated infection control manager.
However, this recommendation was never implemented, Mr Rozen said.
Hong Kong, which has been one of the most successful nations in beating COVID-19 in residential aged care, has required government-trained infection control officers to be employed in care homes since the 2003 SARS outbreak.
The royal commission heard from Merle Mitchell AM, who is a resident in an aged care facility in the Melbourne suburb of Glen Waverley.
Ms Mitchell has been in lock down for weeks, in her room that looks onto a brick wall. The only contact she has had is with her physio. She said over time the lockdown conditions have become worse, despite the fact there have been no COVID-19 cases at the facility.
She has only seen her daughter once in the last two weeks, when she was allowed a window visit for her daughter’s birthday.
She said after a doctor’s appointment she had to be in “isolation” in a small room with only a very small window for two weeks. She saw no one other than the staff who brought her food. “It’s a real lockdown,” she said. Doctor’s appointments are discouraged, she said.
Ms Mitchell said she understood why the restrictions were in place, but she told the royal commission that given her current circumstances, she would prefer to be dead than living in an aged care facility.
Image: Royal Commission.