May 14, 2020

COVID-19 reveals deep flaws in aged care system

Covid-19 is likely to bring a lot of businesses to their knees, but aged care facilities shouldn’t be among them.

Residential aged care may not be everyone’s first choice – we all say we never want to end up in one – but the reality is it is serving a purpose and more than 1000 people a week are moving into or out of a facility in Australia.

The rapid closure and sale of what are ostensibly people’s homes would be a very severe way to see an end to what many individuals and families would consider an essential service.

For many people, caring for themselves or a loved one in their own home is not an option; and most aged care facilities offer a more than satisfactory environment where people are well looked after and cared for by people committed to their vocation.

It’s a difficult business financially at the best of times; but even in better times – pre COVID-19 – many aged care providers were in financial strife.

The most recent available report into the financial performance of aged care by StewartBrown found that in the six months to December 2019, 56 per cent of aged care homes were operating at a loss. It is expected to be 60 per cent by June.

According to the accounting firm, to remain viable the aged care sector – in particular residential aged care, is in need of significant funding reform in addition to the COVID-19 emergency funding. 

The StewartBrown report was completed before the government directed an additional $205 million funding boost to aged care providers to help them deal with unplanned costs incurred during the COVID-19 pandemic – including visitor screening, personal protective equipment and administrative workload. 

The payment equates to $900 per occupied residential care bed for operators in metropolitan areas and $1350 for those in regional areas. It takes the total funding provided to the sector to deal with the pandemic to over $850 million – about half of what the sector says it needs just to see it through.

The latest funding comes with a code of conduct for visitations to residential aged care following concerns that residents were being locked away from family and friends as facilities grappled with keeping COVID-19 out.

For the majority of facilities, tough restrictions have worked – although not always to the satisfaction of family members who would have preferred to make regular personal contact with loved ones in care in recent weeks, especially those in palliative care.

It is heart breaking to see a married couple of 56 years – one in care and the other self-isolating in their own home in – not able to give each other a hug when they meet due to social distancing measures.

Where visits haven’t been allowed, many facilities have been as quick as other businesses to offer alternative communications.

One Canberra care facility has appointed a connections co-ordinator and eight additional staff, engaged to work alongside existing carers, which allows them to spend more time with each resident and help make connections with loved ones – whether it is by phone or internet apps such as Skype or zoom. They have also established a special visitations room to allow timed family visits (albeit across tables two metres apart).

Another has employed additional activities staff for the weekends to ensure similar increased connection at a time generally left for family to fill – which is especially good for residents who didn’t get any visitors pre Covd-19.

Mistakenly, others stopped all activities and went into lockdown overdrive in a possible state of panic.

After a stressful period of uncertainty and confusion about what providers were doing to protect residents, the new code of conduct should clarify what’s required to establish the right mix of measures to ensure resident and staff safety and resident wellbeing, says Marcus Riley, chief executive officer of Queensland’s BallyCara.

But as restrictions are lifted the code needs to be adaptable, says Riley, who is also a director of the Global Ageing Network. He points to the World Health Organisation figures for Europe showing half of all deaths from coronavirus had occurred in aged care facilities.

The consequences of not maintaining strict visitation or protection procedures are obviously devastating. Sydney’s Newmarch House, with multiple deaths and a spreading virus, is a horror movie in the making. 

Riley says that despite the industry continuing in a new normal, the COVID-19 funding hasn’t addressed a number of underlying issues that could bring financially stretched facilities to their knees, such as the impact of more people leaving aged care facilities than arriving.

Aged care providers rely partly on the payment of refundable accommodation deposits or the equivalent in rent type payments by incoming residents for a large portion of their operating costs. The departure of large numbers of residents, with no new ones would spell (further) financial ruin. 

“The broken nature of the aged care system has not been rectified,” says Riley.

If there is one thing the pandemic has done it is to place a much greater focus on the medical needs as well as the wellbeing of older people.

The new normal for aged care should not be one of reliance on skeleton staff; of poor and limited options for communication with friends or loved ones; of minimal spending on food and lifestyle options, rationed PPE, of the limited options of recreational activities – bingo or nothing. 

Expectations that the Royal Commission into Aged Care Quality and Safety will take a holistic approach to the sector are even are greater now than before hearings were suspended in March.

Combined with what the Royal Commission has already heard about how aged care can operate, it is essential that the industry gets the financial and operational reforms needed to support viable, sustainable businesses, accessible to those who rely on it, and with the needs and interests of residents and users at the heart of their operations.

The alternative is to have fewer facilities and for families themselves to take responsibility for looking after their older friends and relatives. In addition to the soul searching about our relationship with our elderly and their care, this would require a lot more funding for in home-care than is occurring in already tough conditions.

Bina Brown is a director of aged care solutions company Third Age Matters. This article originally appeared in The Australian Financial Review.

Image: LPETTET, iStock. Model does not represent actual people or events.

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  1. Like this article, well executed. Would love to connect with you Bina. I’m an Occupational Therapist working in a Residential Aged Care facility.

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