Dec 11, 2020

“Catastrophic” when government failed to accept responsibility for aged care during COVID-19

 

The senate select committee has handed down a damning report on the government’s bungled handling of this year’s COVID-19 crisis in aged care homes, particularly in NSW and Victoria.

“The government is responsible for significant failings in the aged care sector prior to, and during the pandemic,” the report states.

COVID-19 “exposed and exacerbated long-running problems” in aged care.

The senate select committee was “disappointed” that “rather than accept its mistakes in leading the health response and keeping aged care residents safe”, the government has avoided “taking responsibility and shift[ed] blame onto the states.” 

Prime Minister Scott Morrison “created confusion” and splintered federal cooperation by “criticising state and territory decisions to close schools and impose domestic border restrictions,” the report also states.

Aged care suffered the most

Outbreaks of COVID-19 in residential aged care settings had the “poorest… outcomes” in Australia, the report notes. 

While cases in aged care homes represented only 7.5 per cent of all cases in Australia, they accounted for 74.6 per cent of COVID-19 deaths.

The outbreak in Victoria was particularly savage. Between 9 July and 11 September, COVID-19 outbreaks occurred in more than 200 Victorian aged care homes and 1,917 cases were recorded. Tragically, 557 people died.

“Horrific stories” about “inhumane conditions” emerged as the crisis developed. A recent article in the Lancet contained harrowing details: a 95-year-old woman in a Melbourne care home who had ants crawling on a leg wound, residents left without food or water for 18 hours, faeces on the floor of aged care homes, hundreds of residents locked in their rooms for weeks, and relatives banned from visiting loved ones. Some families were not even able to determine if their loved one was dead or alive.

The report outlines the committee’s findings following its inquiry into the government’s handling of COVID-19. Chapter 4 is dedicated to its findings in relation to aged care.

Passing the buck

Early in the pandemic, the federal government said it had responsibility for the aged care sector during the crisis.

The government’s initial COVID-19 response plan – the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) – implemented in February, noted that, “The Australian Government will also be responsible for residential aged care facilities; working with other healthcare providers to set standards to promote the safety and security of people in aged care and other institutional settings; and establishing and maintaining infection control guidelines, healthcare safety and quality standards’. 

But the government didn’t develop a COVID-19 plan specifically for the aged care sector, leaving aged care homes unable to properly respond to the crisis as it unfolded.

As the situation worsened, the Minister for Aged Care, Richard Colbeck, appeared to back away from and “obfuscate” the fact that the government was responsible for the sector.

In his appearance before the Senate Select Committee on COVID-19 on 21 August, Colbeck, when asked if it was the government’s responsibility to keep aged care residents safe during a pandemic, simply said the government was responsible for “the setting of the standards and, through the ACQSC, the application of the standards”.

When asked if it was the government’s responsibility to keep aged care residents, safe, he replied, “In combination with the states, it’s everybody’s responsibility to prevent the spread of the virus.”

This was a far cry from the government’s February promise.

A sector unprepared

The aged care sector was already in crisis before the pandemic, and without a proper plan from the government, it was “underprepared and ill-equipped to protect the safety of residents when the pandemic hit,” the report notes.

The senate committee said it “does not accept” the argument made by the minister and senior officials that when community transmission of COVID-19 occurs, outbreaks and deaths in aged care homes are “inevitable”.

Repeating the mistakes of history

The government not only failed to prepare aged care homes for COVID-19, it failed to learn from mistakes as the crisis developed.

Even when reports on the devastating outbreaks in Dorothy Henderson Lodge and Newmarch House said better use of personal protective equipment (PPE), among other measures, could have improved outcomes, sufficient PPE was still not available in aged care homes.

The Department of Health told the committee that of the 2,865 requests made by aged care service providers to access PPE from the national stockpile between March and mid-August, only 1,324 were approved.

The committee also heard that some aged care providers were only providing gloves for one hand and limiting masks to two per day, raising serious questions about infection control.

Too slow

A “more urgent” response to COVID-19 from the government could have prevented “significant loss of the lives of elderly Australians,” the report states.

When asked if any of the deaths in Victorian aged care homes were avoidable, Dr Brendan Murphy, Secretary of the Department of Health and former Chief Medical Officer, conceded that, “If we had stood up the Victorian Aged Care Response Centre earlier on… that’s something that might have prevented some of the spread amongst facilities by responding more quickly.”

Murphy also admitted that, “In hindsight, you could have implemented that [mandated use of masks for aged care workers in Victoria] earlier, absolutely.”

The senate committee said that if certain measures, such as the establishment of the Victorian Aged Care Response Centre, the introduction of paid pandemic leave for aged care workers, and the mandatory use of masks by aged care workers and COVID-19 residents, had been introduced sooner, the spread of COVID-19 within aged care homes and the deaths that resulted “could have been reduced”.

Light touch regulation

The committee was also damning of the regulator’s role throughout the pandemic.

The Aged Care Quality and Safety Commission failed to use its powers to ensure the safety of aged care residents, the report states.

It also placed “too much reliance” on self-assessment COVID-19 preparedness surveys for aged care homes to determine the sector’s readiness to keep older Australians safe.

The ACQSC should not have suspended unannounced visits during the pandemic, the senate committee also found.

The committee questioned why the ACQSC issued so few sanctions during the pandemic, particularly when there were so many complaints and non-compliance decisions at the time.

Between 1 January to 12 August 2020, the ACQSC received 5,934 complaints about aged care homes. Between 1 January to 4 August, the ACQSC made 229 decisions of noncompliance, yet it issued only five sanctions in the January to March quarter across Australia and no sanctions at all between April and June 2020. 

No sanctions were issued in Victoria between 1 June and 21 August 2020.

The report notes the committee is “concerned” that more than one-quarter of ACQSC employees are employed under temporary contracting arrangements. 

As 2020 draws to a close and the sector awaits the recommendations of the royal commission, let’s hope these findings, and others like them, will inspire the government to take genuine steps to steer the sector towards better times in 2021.

You can read the report in full here.

Image: Toa55, iStock.

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  1. I have been running a Street Stall with Trades Hall asking people to sign a petition for nursing ratios in Aged Care for the last four years after my mother died in a nursing home in horrible circumstances. I can honestly say that this issue has universal support and I would encourage any political party to take Aged Care reform on board simply because it is a winner. I think that we have had enough talking and more than enough reports to know that the current system is not working. We need Nurses back in Aged Care. Nurses cost a bit more than Nursing Attendants on temporary work visas but they deliver quality care which is many times better than what is being offered at the moment. Hundreds of people have died in Aged Care from COVID. Thousands have died from avoidable death. How many more people have to die before someone steps up and says enough is enough. No more.

    1. Well said Gian, the Aged Care sector just love staff that don,t ask question, challenge management directions.

  2. Sadly, increased “regulation” will be the inevitable outcome. If the “regulators” had provided the sector, especially small stand alone homes with support via a template to create an Outbreak Management Plan, showing EXACTLY what had to be in it, then at least maybe, a small portion of the sector may have been better prepared for a once in a lifetime pandemic.

    Regulation and compliance are certainly necessary, but SUPPORT from the regulator and government, not punishment would go some way to helping, but as always, when government and regulators are criticised for their handling of a situation, the response is almost always, more regulation, more punitive action.

    Staff and Managers who work in Aged Care and are passionate about their homes bear the brunt, and that is why many have had enough and are leaving.

  3. As long as aged care Nursing staff feel they should not shower and feed our residents it would not make any difference how many RNs or CMs are hired. The culture in Aged Care has always been “them and us”. Us meeting the AINs. RNs often don’t even believe it is their job to answer a call for assistance. My place has cut staff hours due to falling no’s of residents on one level which is high needs. There is still so much physical work to be done with 26 residents. Hoisting to toilets and showering then dressing , making beds and placing in fall out chairs then off to the next double assist. Then often and more than not, the AINs are expected to dish out meals due to a convenient lack of kitchen staff and then feed residents then off to answer calls and arrange other residents before breakfast. 4 staff for all this AND now that RNs have been able to pass their medications rounds onto poorly paid and overworked AINsin the last 5 years as it has become the norm since a couple of profit driven aged care facilities began doing it. Why don”t we do it?Don’t forget night shift with 4 x wards of 17 residents and the 4th floor on another levels dementia residents and high Needs double assistsx5 and wandering residents that have absconded as there is nobody supervise in the morning before 6.00am as we only have 2 staff on throughout the night for these 4 wards of 17 residents. And they have the hide throughout this Royal Commission to cut staff and hours! It is a slap in the face when we all know the ridiculous ratios and pay that staff have to contend with on a 24 hr basis and our residents are paying so much to be looked after, supposedly! RNs are so caught up in paper work / computer work (some more than others) they have no idea how to use a hoist some of them. God help us all!

  4. One more thing. We have 2 Dementia Specific wings of normal 13 each ward and two wards of high needs residents of 13 each ward then on another floor we have 3 wards of 17 residents and another floor we have17 high and low needs. We have Dementia residents all over the place and one ward is supposed to be Aging in place and independent, but half have early onset Dementia on this floor as on all the other floors but the resident’s families do not want their loved ones to go to a high needs wards or Dementia wards. Understandable. But the extra work load on the staff is ridiculous as residents are not where they should be and staff no’s are based on residents needs so if residents are on an “independent ward” they should be independent but half are not. What is going on? Even when there is room to transfer residents to appropriate wards for their needs often does not happen. Meaning less staff available for their needs and behaviours.

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