Australia’s prime minister and some in the aged care industry appear to be at odds over one of the most contentious issues of the COVID-19 pandemic – how to protect the elderly, the most vulnerable members of the community during this crisis.
Though united in their mission to keep older Australians safe, the government and some providers differ in their views about the best way to achieve this outcome.
Having seen the horrific circumstances in aged care facilities in Europe and the United States, some Australian providers have made the difficult decision to place complete visitor bans on aged care facilities to protect residents from infection, but the government yesterday called for greater flexibility.
The uncertainty is causing deep upset within the aged care industry, with a number of aged care providers reporting abuse from residents and anguish from residents and relatives who are concerned the current restrictions will be lifted.
Yesterday, the Prime Minister said the government is “very concerned” about restrictions aged care providers are imposing on residents that go “over and above” those recommended by the government.
He issued a “strong reminder” not to “shut people away” or “lock” them in their room.
“There is great concern that the isolation of elderly people in residential care facilities, where they have been prevented from having any visits from loved ones and support people, is not good for their well-being, is not good for their health,” the prime minister said.
Close relatives should be able to visit and those who support their loved ones in care should also be able to continue providing that support, Mr Morrison said.
He said residents should also be able to move freely around facilities, including going to common rooms and outdoor areas.
The prime minister’s concerns were echoed by the chief medical officer, Brendan Murphy.
“It is not reasonable in a situation as we are now, across pretty much the whole country, where community outbreaks are not in existence, to lock poor residents away from their family,” he said.
The only exception in which lockdowns are appropriate is in the tragic event of an outbreak in a facility, or where there is an outbreak in the region the facility is operating in.
Lockdowns should not be put in place for “convenience” and decisions in this area should always be made “in the interests of residents”, Mr Morrison said.
Mr Morrison said lockdowns were never the government’s recommendation.
“The advice… was very clear about ensuring that there could be visits of two a day, from close relatives and support people. This would be undertaken in the resident’s rooms but otherwise residents would be able to be in other parts of the facility. They could sit in common rooms, they could sit in outdoor areas of these facilities.
“We would like as many freedoms to be extended to residents in aged care facilities as is possible,” he said.
“There is no recommendation from the medical expert panel that they should be confined,” Mr Morrison said.
Yet many aged care facilities have made the difficult decision that the best way to ensure the safety of residents during COVID-19 is to impose lockdowns.
Leading Age Services Australia CEO, Sean Rooney, said the “horrific” outbreaks of COVID-19 in nursing homes overseas have made visitor restrictions in Australia a necessity.
“For many aged care operators, their visitor restrictions have reflected the horrific record we have seen in some overseas locations, where 40 per cent or more of deaths have been in residential homes,” Mr Rooney said.
Aged Care Guild acting CEO, Nicholas Brown, said, “The COVID‐19 pandemic is an unprecedented health emergency and, as such, has required an unprecedented response.”
Aged and Community Services Australia CEO, Pat Sparrow, said providers have had to make the “difficult decision” to place tighter restrictions than the government’s recommendations due to their location and the needs of residents.
“We have taken a very strong position in aged care because we are looking after vulnerable people,” she said.
“Given the terrible circumstances we face, results to date indicate the situation has been managed as well as can be expected,” Ms Sparrow said.
When the decision is made to ban visitors, it’s not made lightly, she said.
“We are acutely aware of the hardship being faced by many families and residents in aged care. Our first priority will always be the health and safety of the vulnerable older Australians in our care,” she said.
Mr Rooney said providers’ decisions to “escalate” visiting restrictions have been “overwhelmingly supported” by families and have “saved lives”.
But he said residential aged care providers are open to relaxing restrictions on a case-by-case basis.
Mr Brown said residents and families have expressed deep concern to providers about easing visitor restrictions following the prime minister’s comments.
“Following these comments, in addition to abuse from some family members, providers are starting to report anguish from senior Australians in their care who are greatly concerned their lives will be put at risk by re-opening their home to all visitors,” Mr Brown said.
Older Persons Advocacy Network CEO, Craig Gear, told HelloCare he was glad to see the prime minister reinforcing the message that a balanced approach to visitors is needed during COVID-19.
“There’s absolutely the need for constraints and restrictions so that people’s visitations can be managed in a controlled and safe manner,” he said.
But OPAN is hearing from “quite a lot” of families that loved ones and carers are being completely shut out of facilities with no flexibility and no consideration of compassionate exceptions.
“Sometimes that’s because the providers don’t have the staff there to manage a controlled visitation process, others it was just a decision centrally from the head office as a risk management approach,” Mr Gear said.
“While I appreciate that risk management is factored in there, when there’s not COVID-19 around, a blanket rule does not seem to be the most appropriate approach,” he said.
Mr Gear said some providers appear unwilling to listen to visitation requests on compassionate ground and also to facilitate greater support for residents.
Families in the routine of giving residents their meals or providing emotional support for a loved one living with severe dementia, were suddenly locked out, causing grave concerns.
He has also heard of palliative care patients who aren’t considered to be in the final 48 hours of life and therefore prevented from having visitors.
“Our concern is where there has been a complete lockdown and there hasn’t been the transparency around how families could question or ask for consideration of exceptional circumstances,” Mr Gear explained to HelloCare.
“Obviously it’s a very different situation when COVID’s in a facility or any infectious diseases in a facility. That’s a different situation,” he said.
Ms Sparrow said providers are working hard to ensure residents stay socially connected and physically active.
“This is an unprecedented situation,” she said. “Not all decisions will be perfect because we are balancing a serious pandemic with keeping people socially connected.
“There are increased mental and health supports available across Australia to try and limit the social isolation many are experiencing. Providers are very focussed on supporting the mental and spiritual health and wellbeing of residents.”
But Mr Gear said social and emotional support can sometimes be as little as one ipad virtual visit with family a week.
Health Minister Greg Hunt said the best way to protect the health of aged care staff and residents is to ensure that nobody enters an aged care facility if they are in any way unwell.
Mr Murphy said, “You do not go to an aged care facility if you have the slightest respiratory symptom. (If you have) a sore throat or a tickle, you stay away.”
The government has secured an additional 100 million facemarks, which will be becoming available over the next six weeks.
The government will also increase the testing capacity for aged care workers.
“Anyone who works at an aged care facility is eligible for a COVID-19 test and can get them… every resident and every staff member can be tested,” Mr Hunt said.
