Australia’s aged care homes are being devastated by the current wave of COVID infections, with more than 1,100 outbreaks affecting over 7,000 residents and staff.
Fear of outbreaks has prompted other homes to lock down and their residents are suffering the serious physical and psychological effects of isolation and, sometimes, inadequate care, due to major staff shortages.
Government responses to last May’s Aged Care Royal Commission’s recommendations have only begun to scratch the surface of longstanding problems in the aged care sector.
Major workforce issues remain and responses of aged care providers to the threat of COVID in their facilities are highly variable.
Government decisions about broader community public health can have significant and damaging impacts on the health and wellbeing of aged care residents and staff.
Early in the COVID pandemic it became clear that residents of aged care homes were at high risk of serious illness and death. During 2020, Australia had a relatively low rate of COVID deaths at 3.6 per 100,000 population. However, three quarters of all deaths (685 of 910) were aged care residents, at a rate of around 309 per 100,000 residents.
Infections and deaths are not the whole story. Independent reviews of COVID outbreaks in aged care identified other serious adverse effects of lockdowns.
Residents were confined to their rooms and visitors excluded. Family members were often unable to communicate with loved ones for weeks. Staff who were infected or close contacts were replaced by “surge” workers, many of whom had no experience in aged care or infection control. Many residents became depressed, confused or de-conditioned from lack of exercise.
In some homes, remaining staff were overwhelmed by excessive workloads and could not provide adequate care. Some were abused by angry relatives or vilified by the media.
A special report into COVID by the Aged Care Royal Commission, in September 2020, concluded:
The COVID-19 pandemic has been the greatest challenge Australia’s aged care sector has faced […] Thousands of residents […] have endured months of isolation, which has had a terrible effect on their physical, mental and emotional wellbeing.
The reviews identified leadership and communication failures, shortages of properly trained staff and poor infection control as major problems – but there was wide variation between homes.
Support from Commonwealth and state government agencies was essential during outbreaks – for public health and infection control advice, laboratory testing and staff replacements. But many homes were let down by poor communication and coordination, inadequate planning and preparation and contradictory advice.
In response to the Royal Commission’s recommendations, the federal government promised nearly $18 billion in additional funding over five years – a fraction of what was recommended, and most of it yet to be allocated.
Aged care homes must now employ a nurse with approved infection control training, but their responsibilities and ongoing support and training remain undefined. There have been no moves to improve pay, working conditions or training of aged care workers, whose numbers have fallen since 2020.
There is a plethora of advice from expert committees and government agencies but little information about how effectively or consistently it is being implemented. To date, about 90% of aged care residents and almost all aged care staff have received two vaccine doses but earlier delays in the vaccine rollout mean many are yet to receive boosters.
Despite improvements, the aged care sector is currently under extreme pressure. The number of homes with COVID outbreaks more than doubled between January 7 and 14.
There have been relatively few deaths, so far, but government assurances that Omicron is not significantly impacting residents’ health, contradicts reports from the frontline. Many facilities are in lockdown, whether or not there is an outbreak and staff shortages are critical.
The serious adverse effects of isolation and neglect are potentially as severe and more widespread than in 2020 and likely to contribute to premature deaths. Unlike cases and deaths from Omicron, they will not be documented as COVID-related but likely attributed to old age or other underlying conditions.
It is not clear whether political leaders who advocated lifting restrictions and “pushing through” the Omicron wave considered the human rights of aged care residents.
Measures introduced to protect the community from Omicron have been widely criticised as too little, too late, and easing of restrictions too premature. Aged care residents and other vulnerable groups have been disproportionately affected by the massive surge in community transmission. They will be again, in future waves, unless their needs are considered through more nuanced, proactive strategies than either “let it rip” or lockout/lockdown.
There is an urgent need for the Royal Commission’s recommendations to be fully implemented as soon as possible and for aged care reform to be coordinated with reform of the whole care system: hospitals, aged, disability and primary care, and public health.
The Royal Commission highlighted longstanding deficiencies in the aged care sector, but they can’t be fixed during a crisis. Aged care providers need support to build resilience and ensure service continuity. This will require significant financial commitment from government.
Addressing the aged care staff crisis will require an effective campaign – planned in consultation with frontline workers, managers and clients – to attract workers by offering better pay, conditions, training and career structures.
Lyn Gilbert, Honorary Professor Faculty of Health and Medical Science, Univeristy of Sydney; Senior Researcher Sydney Institue for Infectious Disease, University of Sydney., University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
All these decisions seem to disregard the vulnerable lives of elderly nursing home residents. There is no “push through” option for most residents.
The government has failed, it set nursing homes up to fail by leaving them significantly underfunded for too many years.
The government,state and federal delivered lip service but very little else. Number one on my list is the banning of sick covid infected nursing home residents from hospital, forcing them to remain in Homes where isolation is virtually impossible.
Look at the tens of millions of taxpayers dollars that was paid to a couple of companies to supply “surge” staffing …turns out only 1% of the need was able to be filled. While that is disgraceful what of all the money paid out to these organisations that must have known all along that they couldn’t supply the personell?
Who is making these stupid bloody decisions, certainly not people like us at the coal face, doing the job, underfunded and knowing that neither the government nor most of the community understand what’s going on!
Why don’t they ask us? I reckon it must be easier to not know while preparing for another round of self congratulations!
A very sad situation for our elderly, also the workers. You can’t just throw money at the problem, proper care and attention is lacking by our politicians. Aged care has become just another “industry” and it needs to change NOW.
I am so tired of both sides of politics, I see no one who stands out as “caring”. God help us all when we get old and especially old people now.