Oct 02, 2020

Blame should not be confused with accountability, expert responds to royal commission report


The royal commission’s report on the aged care sector’s failed response to the pandemic does not go far enough and a full inquiry should be held, says a leading aged care expert.

The report by the Royal Commission into Aged Care Quality and Safety on the aged care sector’s response to COVID-19 was written as the “human tragedy” of COVID-19 unfolded. 

“When the Prime Minister announced this Royal Commission in 2018, nobody could have foreseen that the aged care sector would find itself in the grips of a pandemic,” the report notes.

But as the royal commission turned its focus to the pandemic, the full horror of the crisis was just becoming clear.

From 0 to 1,000 cases in a month

When the royal commission announced it would look into the sector’s response to COVID-19 on 17 May 2020, outbreaks had only occurred in three homes. But by the time hearings commenced on 10 August 2020, there were infections in dozens of aged care homes, and, tragically, 189 residents had died.

As the hearings were underway, further deaths and infections associated with aged care homes were announced daily.

The statistics tell a chilling story. On 7 July 2020, there were no active cases of COVID-19 in residential aged care. Only a month later, on 9 August 2020, the day before hearings commenced, the figure exceeded 1,000. 

“The first recorded death of an aged care resident from COVID-19 in Victoria was on 11 July 2020. As at 13 September 2020, there have been 563 deaths,” the report states. That number sits at 637 today.

Who is accountable?

Given the harrowing circumstances, the royal commission was right in noting that “now is not the time for blame”.

But Professor Joseph Ibrahim, head of Health Law and Ageing research at Monash University, told HelloCare blame should not be confused with accountability, and that people should be held accountable for what has gone wrong.

“Now is not the time for blame, but it’s always the time for accountability,” he said. 

A more prescriptive approach needed

He supports the “philosophy” of the report, but he said he would have liked to see a “far more prescriptive” approach. “They should have been far more prescriptive about the need to get things done in a timely way and I think they should also have been far more prescriptive in how success is to be evaluated,” he said.

“I think the royal commission should have been much stronger and unambiguous about what actually had to happen.” 

“We have a good idea about what we should be doing,” said Professor Ibrahim. “We’re just not doing it.”

Professor Ibrahim would like to see a full inquiry into how the pandemic is being managed in aged care.

“Not on an even keel”

He’s concerned the people who led the aged care system into the crisis are the same ones who are supposed to be leading us out of it. “How are you supposed to make things better when you’re not even on an even keel,” he said.

Make visitor code mandatory

The report makes a recommendation, which the government has accepted, to provide additional funding for more staff to deal with visitors in aged care homes. But Professor Ibrahim would like to have seen the industry code for aged care visits made mandatory.

Council on the Ageing chief executive, Ian Yates, said he would like to “discuss with the government” the code being made mandatory. “Many providers are ignoring it,” he said in a statement.

Mr Ibrahim said the code would also benefit from amendments that would allow a nuanced approach so it can be adapted, and a mechanism for appeals, with the possibility for prompt responses to those appeals.

Senior nurses and personal care workers should be consulted in planning for COVID-19 in aged care, Professor Ibrahim said, because they are aware of the realities on the ground in aged care during an outbreak. 

Mr Ibrahim doubts all 2,700 aged care homes in Australia would be prepared for an outbreak.

“I’m not convinced that 2,700 providers are all switched on and ready to go,” he said. There is “wide variation” in the sector, he said, noting that he doesn’t believe the government has sufficiently identified those that are at greatest risk from an outbreak and provided them with the support they need.

Aged care infections not result of community transmission

Mr Ibrahim said outbreaks in aged care are not the result of community transmission.

“Even at low very rates of community transmission, aged care is highly vulnerable,” he said.

With around 26,000 COVID-19 cases in a population of 24 million, “Australia has never had a high rate of community transmission,” he said.

In Victoria’s 800 aged care homes, there have been around 200 outbreaks. If that rate of infection was applied to the state’s 2 million households, there would have been around 200,000 households with outbreaks. But with 26,000 individual cases in Victoria, though tragic, the number is nowhere near that.

HelloCare published this article ‘Saving Aged Care Will Save Our Souls And Society’ by Professor Ibrahim back in March 2020.

Image: Dean Mitchell, iStock.

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  1. Firstly, the government should have a template of actions to be taken in case of a pandemic.

    They should have a comprehensive national plan to deal with emergencies that occur whether that be Covid 19 or a fire.

    An example of the incompetent, I operate an aged care facility in Canberra. Our Covid plan has been checked by federal officials, ACT state health and the Health resource from the Canberra hospital.
    On the sixth of October the ACT health department expects to issue its covid 19 action plan. Eight months after covid arrived and the only thing we need from them is access to the hospital in case of a positive covid resident… and the answer is a substantial NO. Disgraceful.

    Who should we blame or hold accountable, clearly the sector has been struggling financially for several years due to the federal government cutting billions of dollars from funding.

    How exactly would the good professor apply mandatory visitation? Would a facility at Longreach, Cameron’s Corner or Lakes Entrance have the same stringent and necessary visitor restrictions as the centre of Melbourne, surely not. It’s so easy to print nonsense.

    As to the government being “prescriptive”, the government refuses to be prescriptive, I have lobbied for a decade to have government sourced identical documentation for every facility. At present every facility has to struggle to source appropriate documents to meet today’s requirements, then we find that they are now unpopular or dated.
    The sector and its regulators are plagued by interpretation which sees a variation in standards that could easily be avoided with a little direction rather than criticism.

  2. Unfortunately the Departmental Officials in all the variously named aged care regulators, over many years, have been out manoeuvred by the consultants and lobbyists.

    Officials have learnt that bending to the will of the lobbyists is safe and “…the consultant told me to do it….” is a good excuse.

    It is a long time since we have had a competent, energetic and influential Minister for Aged Care.

    Even the Royal Commission is struggling to find the courage to identify the poorly lead, overly complex regulators and disinterested Ministers as the main problem.

  3. Professor Ibrahim is correct.

    Responsibility and not blame. But still, you would not give the captain of the Titanic another gig would you? I mean, like:

    What’s your profession?
    Ships Captain.
    What was your previous ship?
    The Titanic.
    OK mate, we’ll call you – don’t call us.

    Not really inspiring is it.

    But still, successive governments have all failed aged care. So lets not pin all the blame on the current administration. Liberal and Labor over the years have simply ignored it. Its just that the current bunch of numpties are left standing holding the grenade and the pin is on the ground and they are nervously looking around not knowing what to do.

  4. Sadly, every comment in this thread is spot on. and when blame… sorry….. responsibility falls at the feet of the government or the regulator, it is the sector’s many good providers and their staff who feel the pain. I don’t think this industry could possible have more regulation, but what we need is less, but more effective and CLEAR regulation so that providers, most who are busting their backsides everyday to keep up with this nightmare and provide high quality care do not have to jump through over 600 points of regulatory contact. Get rid of providers who are dodgy of course, but give the rest of us some much needed leadership and guidance, not just a big stick…


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