Sep 30, 2020

Residents face altered reality as Victorian nursing homes emerge from crisis

 

COVID-19 infection numbers are starting to fall in Victorian aged care homes, and restrictions are slowly easing. But geriatrician Jesse Zanker is concerned about how residents will cope with the altered reality they will have to face during their first meal served back in the dining room.

“Residents have lost a lot of people they cared about, their friends. Some facilities have lost a quarter of their residents. Their first communal meals are going to be really distressing, because they’ve lost a lot of their mates.

“That’s going to be really tough for people,” he said.

Dr Jesse Zanker, supplied.
Dr Jesse Zanker, supplied.

Dr Zanker has been working as a geriatrician in Victoria’s COVID19-affected aged care homes, and has been sharing the human stories that have arisen from his experiences.

Though devastated by some of those experiences, he is also comforted by the fact he has been able to try to help people in some of the most dire circumstances of their lives. He hopes that by talking about what occurred, the way we deliver care for older people can be improved.

“I feel compelled to share these stories before we forget about these things and move on and repeat the mistakes of the past,” he told HelloCare.

Crows peck at overflowing garbage 

Working in aged care homes during the pandemic has been “unlike any clinical environment I’ve ever experienced,” Dr Zanker explained.

Simply entering one of the harder-hit facilities was extraordinary.

“You pull up on the side of the road. You get into your PPE on the street, you put on your N95 mask, and you walk in past large skip bins spilling over with clinical waste bags. 

“Sometimes the bins would be being pecked at by crows, [rubbish] spilling onto the ground. 

“You walk into the facility and there are multiple checkpoints. There’s a sense of chaos,” he said.

A military approach

Every aspect of how the homes operated was altered.

Bags of rubbish strewn around, supplied.
Bags of rubbish strewn around, supplied.

Facilities run by the Australian Defence Force were “very regimented”.

“You’d be hearing every hour, ‘All fluid charts on my desk at 11 hundred hours’, ‘all resident weights on my desk at 12 hundred hours’. 

“I’ve never experienced that in a residential aged care facility,” he said.

Bad news delivered amid chaos

It was impossible to hold family meetings in ways that doctors normally do. 

Generally, when delivering bad news, doctors would choose a quiet, safe environment where they can see the people properly, and provide information in a calm way.

“But my colleagues and I were constantly having to provide this information over the phone through PPE,” Dr Zanker said.

One day, deep in winter, it was raining outside and blowing a gale, Dr Zanker found himself taking a family into what was formerly the dining room to deliver unwelcome news. 

“It was about four by ten metres. The walls were lined with oxygen bottles on the ground. There was clinical waste in bags everywhere. 

“There were black bags with residents’ names on them all piled up in a corner. I didn’t know if they were the belongings of residents who had died or residents who were still living. There were piles of walking frames and disused commodes.”

Dr Zanker and the family were forced to navigate a path through the chaotic scene to find a space in which they could stand together. 

It was like nothing I’d ever seen, Dr Zanker said.

Married couples separated overnight

Husbands and wives were separated in the middle of the night when one was taken to hospital in a seemingly random decision, Dr Zanker said, explaining this scenario was “sadly common”.

In the former dining room, sit of a difficult family meeting, supplied.
In the former dining room, site of a difficult family meeting, supplied.

Though there are clear ethical frameworks for how these decisions should be made, the application of those guidelines was questionable, he said.

“It seemed inconsistent, the way decisions were made,” and they “seldom” reflected the guidelines.

At one aged care facility, staff and residents had come to the decision that residents would stay at the aged care home. However, a number of families took their concerns to the media, and overnight a decision was made to move the residents to hospital.

The decision seemed to be “reactive to the attention the facility had received” and was “in contrast” to other facilities that also had outbreaks but didn’t get hospital transfers. 

“I wonder about the consistency,” Dr Zanker said.

Though these stories took place in August, doctors he has spoken to said they are still not clear of procedures.

“Spiralling distress and heartache”

Dr Zanker is concerned about how the residents might be experiencing this “pretty awful” level of disorder and dysfunction.

Many residents have developed delirium and, for those living with dementia, sometimes their symptoms have worsened.

In some country areas, even where there is no COVID-19, residents have become more anxious and distressed because their loved ones have not been able to visit. 

“Many partners would visit every day to provide support with eating and drinking. If that’s the routine and it’s been the case for a year or two and suddenly it’s abruptly removed, you can imagine there’s spiralling distress and heartache. 

“It’s been hard for everybody, there’s no doubting that,” Dr Zanker said.

Fear and anxiety universal themes

Fear and anxiety have been universal themes among staff too. 

“Staff have been working hard for months and months and months,” Dr Zanker said.

Even those who haven’t had any exposure to COVID-19 are operating in an environment of heightened vigilance. A fellow staff member with a sniffle, a resident experiencing a spike in temperature, are all cause for serious alarm.

“There’s a lot of hypervigilance, but at the same time fatigue with that constant battle of being prepared for something. 

“Sometimes the anxiety and the stress is more contagious than the virus itself,” Dr Zanker said.

Staff must stay to build a better future for aged care

Staff with local understanding and knowledge of the residents are returning to work now, a simple fact that is nonetheless “really important”, Dr Zanker said.

He is hugely grateful for local staff who have worked so hard, and whose care for the residents is as thorough as it is genuine. 

He’s worried the negative media attention aged care has been facing will drive some away from the sector, just at the time when we need those people the most.

“It’s clear that a lot of the staff really care for the residents and want to do more but have been hamstrung by being overwhelmed by the burden of infection and the chaos and disorder,” he said. 

Dr Zanker wants to inspire in aged care workers a hope that there is still much more good work to be done.

Good can even come from COVID-19, he said. 

“We’re at a very low level now, but there’s a lot of good we can come to and better care for older people if we get it right this time. It can’t be done without staff who care and are involved. I’m grateful for those staff who worked really hard. We don’t want to lose them.”

 

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