As news of a second death at Anglicare’s Newmarch House aged care facility in NSW hit the airwaves late Sunday afternoon, feelings of sympathy – from those who have followed this story closely – were not solely reserved for the friends and families of the deceased.
This high-care facility located in the suburb of Caddens now has over 41 confirmed COVID-19 cases, one of which happens to be an unnamed female carer who made national headlines when it was alleged that she worked five shifts at the home while visibly sick.
The actions of the carer were lambasted by both media and government officials last week, but it has since been revealed that fatigue was the woman’s only symptom, which she believed to be the result of working two jobs and her responsibilities at home.
A source who is close to the case recently told the Daily Telegraph that the carer at the center of this tragedy had “absolutely no idea” that she had the virus, and that she is currently inconsolable and having counseling to try to come to terms with what has happened.
The woman was cleared of any wrongdoing by police last week, with NSW Premier Gladys Berejiklian stating that she ‘felt’ for the carer and wanted to tell her directly that she had done nothing wrong.
And when you consider the amount of mixed opinion and confusion being shared by aged care workers online, it’s not hard to imagine how a tragedy like this can occur.
The symptoms of COVID-19 vary enormously between individuals, often mimicking every-day ailments that an employee would not usually consider taking personal leave for.
At present, aged care homes are asking workers to stay home if they display any symptoms like fever, chills, sore throat, coughing or shortness of breath, but those with other issues are often forced to make a calculated decision.
Like many aged care workers, the carer involved in this tragedy was a low-paid individual who is struggling to make ends meet at home.
Although we believe that no aged care worker would intentionally go to work if they suspected that they may be infected, asking people who can’t afford to stay home to self diagnose their symptoms is a risky proposition.
Paul Gilbert, Assistant Secretary of the Victorian branch of the ANMF (VB), shared his thoughts with HelloCare on some of the issues that may influence an aged care worker’s decision on whether or not to go to work.
“The ball lies very much in the employer’s court here. We have seen some state and national employers act very quickly to inform staff of their rights and responsibilities, others less so,” said Mr. Gilbert.
“As an employee, if you know you will be supported, both financially and otherwise, by your employer if you self-isolate then you are more likely to do so on the basis of symptoms rather than a diagnosis.”
“If your employer’s culture is not supportive, as an employee you are less likely to ‘rock the boat’ when the symptoms could be COVID related, or may have no relationship at all with COVID.”
“A casual with no sick leave entitlement is not in a situation where they can simply not come to work without employer support. These are unprecedented times, and employers need to put in place very clear support for potentially affected employees.”
“This generally means offering special paid leave for staff who need to self-isolate. Many employers have been doing this voluntarily.”
“The implications for staff exposed to or contracting COVID have been less clear, and in fact have changed over time.”
“The implications for agency staff missing out on work, and whether they will be eligible for the Job Keeper payment, has been and remains extraordinarily difficult to navigate.”
According to Leading Age Services Australia (LASA), CEO, Sean Rooney,many providers are offering paid pandemic leave for precisely this reason, but it isn’t something that is sustainable without government support.
“It’s important to remember that most of the funding that the government had so far announced for aged care is going straight to workers for the retention bonus,” said Mr. Rooney.
“At the same time providers are incurring significant additional costs on top of – for residential care – the average $6.40 per resident per day that they were losing before the crisis began.”
“That is why the peaks called for a comprehensive rescue package for the industry last week, including funding for pandemic leave.”
The criteria for COVID-19 testing has also been a topic of conjecture amongst those in the aged care industry, as multiple guidelines have created an environment of mixed messaging that has left many scratching their heads.
Although many would think that aged care and healthcare professionals would be regulated in a similar fashion, public and private hospitals are regulated by each state, while residential aged care is actually regulated by the Commonwealth.
According to Professor Joseph Ibrahim, a specialist in geriatric medicine and aged care safety at Monash University, testing protocols have been inadequate and a lack of transparency in aged care, in general, has hindered the national response to the pandemic.
“Protocols do not take into consideration that older people have atypical presentations, for example, they may develop functional decline or not mount a temperature,” said Professor Ibrahim.
“Multiple guidelines cause confusion–however the reason is that public health are responsible for pandemic management which are jurisdictional responsibilities.”
“What we see when we review the national response plan is an absence of information about RACS and the sector as a whole, and how it operates, and the gaps identified by the Royal Commission.”
Currently, aged care workers are only eligible for testing if they have COVID-19 symptoms or if they suspect that they may be infected after coming into contact with others who have tested positive for the virus.
And according to LASA, CEO, Sean Rooney, there is still plenty of room for improvement.
“We believe communication on when to get tested and when to self-isolate can be improved and must be constantly reiterated,” said Mr. Rooney.
“It is critical if staff and residents have any suspicion of having a cold or even a ‘scratchy throat’ that they self-isolate and are tested.”
“Other areas where expanded testing should be considered include the immediate family of care workers and any new admissions to aged care services. There are strong calls for residents returning to facilities from hospital to be tested.”
“In considering expanding testing we need to be thinking about the vulnerability of the potentially exposed population groups rather than just the base probability of detecting an infection.”
This is one of the lessons learnt from some of the catastrophic outcomes we have seen in aged care homes overseas.”
“We don’t think workers would consciously expose those they care for to the risk of infection for financial reasons but asking them to self-isolate unpaid is not fair either.”
Photo Credit – iStock – KatarzynaBialasiewicz
As a registered nurse and infection control consultant I’d like to suggest that all staff, i.e. nurses, chefs, maintenance men, clerks as well as residents, in residential aged care facilities are tested say twice a week whether or not they have symptoms of Corona virus. This way asymptomatic people will be diagnosed early thus reducing the risk of spread. Infected staff should be sent off duty on full pay.