Federal departments had no specific COVID plan for aged care: royal commission counsel

Michelle Grattan, University of Canberra

Australia’s aged care sector was “underprepared” to deal with the COVID-19 outbreak and federal authorities had no specific plan for it, according to a stinging indictment from Peter Rozen QC, senior counsel assisting the royal commission into aged care.

In a statement critical of authorities and providers, Rozen said while much was done to prepare the health sector more generally for the pandemic, “neither the Commonwealth Department of Health nor the aged care regulator developed a COVID-19 plan specifically for the aged care sector”.

Rozen was speaking at the start of several days of hearings to look at the sector’s preparations and response to the crisis. The commission will probe the NSW outbreaks in homes but not delve in detail into particular homes in Victoria because the crisis is ongoing there.

Aged care is a Commonwealth responsibility, while the states are responsible for health.

Rozen said on Commonwealth data, more than 1,000 residents had been diagnosed with COVID-19, of whom 168 had died.

The pandemic had “starkly exposed” the flaws in the sector that had been highlighted during the royal commission.

In view of the deficiencies it was “hardly surprising that the aged care sector has struggled to respond to COVID-19”.

He stressed the consequences of the deskilling of the aged care workforce and a shortage of clinical skills in homes.

Rozen quoted health minister Greg Hunt saying on July 29 that “aged care around the country has been immensely prepared”. But, Rozen said, “in a number of important respects, the evidence will demonstrate that the sector has been underprepared”.

“We will be asking if greater attention to preparation may have saved lives and could save lives in the future.”

Rozen said that between June 19 and August 3, a crucial period when new infections in Victoria escalated, there was no updated advice for the aged care sector from the Australian Health Protection Principal Committee – the main source of COVID advice.

“There was no advice about how the sector should respond to the risk posed by aged care workers who may be COVID-19 positive yet asymptomatic, particularly those who work in multiple facilities.”

Rozen was critical of the Commonwealth regulator, the Aged Care Quality and Safety Commission, which oversees the sector.

“The regulator did not have an appropriate aged care sector COVID-19 response plan. Given that it was widely understood that recipients of aged care services were a high risk group, this seems surprising.”

On March 17, the regulator wrote to providers with a survey asking about their preparedness. Overwhelmingly they claimed to be prepared, but evidence would be critical of this survey, Rozen said.

He questioned the late timing of the regulator’s action in relation to the Newmarch House in Sydney and the fact the regulator had not investigated the circumstances of the Dorothy Henderson Lodge and Newmarch House outbreaks.

Read more:
View from The Hill: Aged care crisis reflects poor preparation and a broken system

“We also have concerns about whether the regulator’s powers of investigation are adequate,” Rozen said, adding that comparable regulators in areas such as workplace or airline safety were not as fettered.

There were “notorious problems” in the relationship between the health system run by the states and the Commonwealth aged care sector, Rozen said.

He detailed an argument between federal and NSW authorities about whether residents with COVID should be transferred to hospitals, with the federal authorities wanting transfers and the state official opposing.

“Equal access to the hospital system is the fundamental right of all Australians young or old and regardless of where they live,” Rozen said.

“Many of the residents in aged care homes worked their entire lives to build the world class health system of which Australians are justifiable proud.

“They have the same right to access it in their hour of need as the rest of the community. To put it very directly, older people are no less deserving of care because they are old. Such an approach is ageist”.

Rozen noted the time it took, after experience in Sydney, for the Commonwealth health department to advise providers that 80-100% of their workforce might need to isolate in a major outbreak, and even then it was not highlighted.

“Regulators in other fields such as workplace safety publish page one ‘alerts’ to disseminate promptly via safety information they learn from incident investigations.”

Rozen said masks were not made compulsory for aged care workers until July 13 – two days after the first recorded deaths of an aged care resident in Victoria. On July 13, the number of new Victorian infections was 250.

“Why did authorities wait until after the fir
st death to take what seems the simple and obvious step of making masks compulsory for aged care workers?”

Commonwealth aged care regulator admits it was told of St Basil’s outbreak

The head of the Commonwealth’s Aged Care Quality and Safety Commission, Janet Anderson, has told a Senate inquiry St Basil’s Home for the Aged informed the commission of its COVID outbreak on July 10 – contrary to claims made previously that the Commonwealth was not told until July 14.

In a letter to the Senate committee on COVID-19, Anderson wrote she had become aware that on July 10, during a telephone call responding to the commission’s assessment contact program the St Basil’s representative “provided information that one staff member … was diagnosed with COVID-19 on 8 July 2020 and the Public Health Unit (PHU) had been advised”.

Anderson, the aged care minister, Richard Colbeck, and the secretary of the federal health department Brendan Murphy all told the committee on August 4 the Commonwealth had not been informed about the outbreak until July 14.

That was when the Victorian health and human services department notified it. The time lag has been seen by the Andrews government’s critics as further evidence of its poor administration.

In her letter Anderson said the commission was not the first responder to an outbreak and the phone contact had been part of a commission program to seek assurances from facilities that COVID plans had been developed and were ready to be acted on.

“The regulatory official from the Commission who made the assessment contact referred the service’s responses to the Commission’s COVID-19 Response Team and this information was escalated internally and recorded in the Commission’s daily COVID-19 confirmed case tracker, Anderson wrote.

“The Commission did not escalate the matter externally at the time because the St Basil’s representative had confirmed in the interview that they had advised the PHU [the Victorian Public Health Unit] of the outbreak. The representative also confirmed that they had read the ‘First 24 hours’ document.”

Anderson noted this federal health department document lists four actions to be taken in the first 30 minutes. These steps are: isolate and inform the COVID-19 positive case(s); contact the local Public Health Unit; contact the Commonwealth Health Department; lock down the facility.

Anderson said the commission was later advised about the outbreak by the health department on July 14.

“To manage any risks of provider failure to notify the relevant authorities of a COVID-19 outbreak, the Commission now has arrangements in place to confirm immediately with the Commonwealth Department of Health that they have been directly notified by the affected aged care service of any outbreak at that service that comes to the Commision’s attention by whatever means.”

Asked about the bungle, Scott Morrison was sharp. He said the commission was an independent body that operated formally separate from the government but he was concerned about the breakdown in communication.

He said where there were breakdowns and issues, he wanted to know about them and fix them.

“We will be following [the matter] through with the commissioner. And at the end of the day, they’re an independent statutory office and they know their responsibilities and they need to live up to them.”The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Should all aged-care residents with COVID-19 be moved to hospital? Probably, but there are drawbacks too

Jed Montayre, Western Sydney University and Richard Iain Lindley, University of Sydney

COVID-19 is continuing to devastate Victorian aged-care homes, with 1,435 active cases now linked to the sector, and at least 130 residents having died.

The question of whether to automatically move residents with COVID-19 out of aged-care homes and into hospital has divided public and expert opinion.

There are both advantages and disadvantages to consider.

Read more:
4 steps to avert a full-blown coronavirus disaster in Victoria’s aged care homes

Different states have different policies

South Australia pledges to send any resident who tests positive for COVID-19 to hospital.

In New South Wales, a resident who tests positive is to be immediately assessed by the facility management, public health and local hospital services to plan the initial response — whether that’s a transfer to hospital or remaining at the home.

Victorian policy is similar. The public health officer responding to an outbreak notification will assess the patient and assist with this decision.

As of the beginning of this week, more than 300 Victorian aged-care residents with COVID-19 had been transferred to hospital. But that leaves a similar number remaining at home.

Certainly no other state is facing the pressure Victoria is to get this response right.

Elderly woman lying in hospital bed.
Different states have different policies on whether to move aged-care residents with COVID-19 to hospital.

What can hospitals offer that aged-care homes can’t?

Specialist treatment

COVID-19 is a serious infection with very high death rates among frail older people.

While aged-care homes can provide a degree of nursing and medical care, hospitals are best positioned to provide specialist treatment and the sophisticated interventions many patients will need.

Better infection control measures

Arguably the key reason to move an infected resident to hospital is to stop COVID-19 spreading to other residents and staff. Aged-care settings are not conducive to infection control in the same way hospitals are.

First, they’re not designed like hospitals. As well as not having the same clinical features, many aged-care facilities follow a “boutique” design with common areas for gatherings and events. Residents and staff can easily congregate in these spaces.

The best efforts to isolate a resident with COVID-19 in aged care could easily be compromised. For example, it’s common for residents with dementia to wander in the corridors. Being contained may exacerbate these sort of behaviours among confused and anxious residents.

More highly trained nurses

Staff shortages in aged care were well documented even before the pandemic. A further depleted workforce during COVID-19 — due to staff off work and restrictions on working across multiple facilities — likely means they’re stretched even thinner. Staff may not always have the capacity to supervise isolated residents or follow infection control procedures.

The much higher ratio of highly trained nursing staff in hospitals should ensure better adherence to the guidelines around proper use of personal protective equipment.

For example, registered nurses in aged-care facilities don’t usually provide direct care to residents. Instead they supervise care provided by unregulated staff often with limited infection control training.

Read more:
View from The Hill: Aged care crisis reflects poor preparation and a broken system

What are the disadvantages of hospital transfers?

Older people benefit from carers who know them

The care people receive in aged-care homes relies significantly on staff knowing the residents’ personal and clinical profiles. Aged-care facilities promote person centred care models, which value residents’ rights while striving to create a home-like environment.

Familiar faces who understand residents’ personal preferences may be particularly valuable during a time when residents aren’t able to see their loved ones.

A nurse and a man with a walking stick are seated on a couch. The nurse is reading.
Residents in aged care develop relationships with staff over time.

Introducing a completely new environment during an illness, particularly for residents with dementia, may do more harm than good.

Limited knowledge about the resident could lead to unmet needs while in hospital, which could trigger behaviours that are difficult to manage.

For older adults with dementia, the likelihood of incidents like falls and infections increases when they’re admitted to hospital.

Read more:
Social housing, aged care and Black Americans: how coronavirus affects already disadvantaged groups

The hospital perspective

Importantly, hospitals may not be able to cope with such a large influx of aged-care residents at one time. The rising numbers of COVID-19 cases from the general population, including older adults living in the community, have already put the health system under a lot of stress.

So there’s an argument that if COVID-19 cases can be managed within the aged-care home, they should be, to avert pressure from the hospital system.

Worryingly though, we’ve seen reports of the health department denying requests for aged-care residents with COVID-19 to be transferred to hospital.

Respecting autonomy and the right for care

On balance, as much as possible, it’s probably be better to transfer residents to hospital as soon as they test positive to COVID-19. This offers the best chance of preventing widespread infection among other residents and staff, and disease spread from the home into the community.

But we must also respect residents’ autonomy. They might have requested not to be transferred to hospital, even if their illness is life-threatening, by way of an advanced care directive. This might still be their wish, or the preference of their relatives and decision-makers.

Conversely, residents or their surrogate decision-makers might request hospital care, even when care is possible within the home. Again, we argue this is their right.

We should also allow people to change their minds, as these decisions may have been agreed upon before the pandemic.

Read more:
Banning visitors to aged care during coronavirus raises several ethical questions – with no simple answers

The Conversation

Jed Montayre, Senior Lecturer (Nursing), Western Sydney University and Richard Iain Lindley, Professor of Geriatric Medicine, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

View from The Hill: There’s no case for keeping secret any aged care facility’s COVID details

Michelle Grattan, University of Canberra

Should the public know the details of all the Victorian aged care facilities that have had COVID-19 cases?

“Yes” seems the obvious answer. But not according to the Health department or Aged Care Minister Richard Colbeck.

At Tuesday’s hearing of the Senate committee monitoring the government’s responses to the pandemic, Greens senator Rachel Siewert sought this information, asking about providers, residents, cases and deaths.

Health department secretary Brendan Murphy – formerly chief medical officer who in that role was often at Scott Morrison’s side at news conferences – asked to provide the information to the committee “in camera”.

“Some of the facilities don’t want it publicly known that they have outbreaks,” Murphy said.

“Many, many of them have been open about it and it’s in the media. But some of them have just had one staff member and the facility has been locked down and it’s been controlled. And they’re obviously worried about reputational issues.”

When Siewert put it that the public had a right to know, Colbeck said the families with a member in a facility were “aware of what’s happening.

“But I am concerned about the stress that’s placed on facilities by some of the public elements of this process.

“I understand where you’re coming from in one sense, but talking to, particularly some of the smaller facilities, their capacity to deal with a huge influx of, say media inquiry can severely impact on the facility.

“And in the circumstance where they’re doing well, the families are being appropriately advised … I’m reluctant to have a public hit list of facilities that have been unfortunate enough to have an outbreak of COVID within them.”

He and Murphy said facilities with outbreaks are locked down and don’t take new residents.

Victorian premier Daniel Andrews reported on Tuesday that all of the latest 11 deaths were linked to outbreaks in aged care facilities. They are part of a chain of multiple deaths, now announced day after day, from aged care in this Victorian second wave. On Tuesday’s figures, there were 1186 active COVID cases relating to aged care facilities (this includes residents and staff).

The Victorian government provides a list of the facilities that have had the largest outbreaks. State government sources, asked on Tuesday night, said it is not seeking to keep secret the others. It doesn’t provide details of deaths in circumstances where that would identify individuals.

The arguments advanced by Murphy and Colbeck for secrecy are flawed and can give the public little confidence.

These are institutions funded and regulated by the federal government, and provided with a great deal of taxpayers’ money. There should be total transparency about what happens in them.

We know from official and media reports over years, and the experience of many families, that it’s vital to get as much information as possible in real time about what’s going on in aged care.

While facilities that have had minimal COVID cases are not in the same class as those with massive outbreaks, it doesn’t mean the details of those homes and cases should be hidden.

It is understandable facilities do not want “reputational” damage. But the magnitude of what is occurring in the sector in Victoria means we are past that concern. It is now a question of accountability.

Colbeck is worried about “media inquiries” and a “hit list”.

“Media inquiries” refers to journalists asking for facts, questions the public would reasonably want answered. As for a “hit list”: families making decisions in the future about institutions have the right to know how an institution performed in the COVID crisis.

How cases arose in facilities – even a single case – is also relevant to assessing the pandemic across the sector.

Committee chair Katy Gallagher said later on Twitter the committee would consider Murphy’s request for the information to be provided in camera.

But she added it would need to be persuaded “of the public interest test of keeping it secret”. That, one would think, would be very difficult.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

AUSMAT teams start work in aged care homes today. But what does this ‘SAS of the medical world’ actually do?

from www.shutterstock.com

Jamie Ranse, Griffith University

The emergency response to Victoria’s COVID-19 crisis has been ramped up today with AUSMAT teams now working alongside defence force and hospital nurses in aged care homes.

This comes as the total number of active COVID-19 cases linked to aged care in Victoria is now at 913.

Federal health minister Greg Hunt recently said AUSMAT, or Australian medical assistance teams, are:

[…] the best of the best. They are the SAS of the medical world.

But what is an AUSMAT? What can they do? And what do we need to think about when deploying them?

Read more:
View from The Hill: Aged care crisis reflects poor preparation and a broken system

What is a medical assistance team?

A medical assistance team is a group of doctors, nurses and/or paramedics who provide clinical care and health support during a health crisis, as part of a recognised organisation.

Logistics, environmental health and other personnel often support these clinical teams.

Medical assistance teams contribute to a coordinated health response in an attempt to restore and/or maintain the health capacity of a community affected by disaster or public health emergency.

In Australia, a medical assistance team may be a civilian government team (such as AUSMAT), non-government organisations (such as Disaster Relief Australia or St John Ambulance Australia), the Australian Defence Force, or a combination of these.

While an AUSMAT is usually deployed internationally, teams were deployed in Australia during last summer’s bushfires, to help with evacuations from China to Christmas Island at the start of the pandemic, and in April to support COVID-19 efforts in northwest Tasmania.

Who’s in an AUSMAT?

Health-care professionals in an AUSMAT usually work at hospitals, health services or ambulance services in states and territories across Australia.

When required, they are released from their local duties to be deployed as part of an AUSMAT response.

They are often highly experienced and leaders in their disciplines. Members undertake additional education and training to work in disaster environments and to manage the health response.

They are also highly regarded. AUSMAT was one of the first medical assistance teams worldwide to be endorsed by the World Health Organisation.

How have they been deployed internationally?

AUSMATs were set up after the 2002 Bali bombings, then used after the 2004 Indian Ocean tsunami.

Since then, AUSMATs have been used during crises, mainly in South Asia, Southeast Asia and Oceania, including the 2010 Pakistan floods, 2011 Christchurch earthquake and Typhoon Haiyan which hit the Philippines in 2014.

AUSMAT also assisted during last year’s Samoan measles outbreak.

Read more:
Measles in Samoa: how a small island nation found itself in the grips of an outbreak disaster

What are the issues when deploying them during COVID-19?

The role of an AUSMAT team will change over the duration of their deployment. Based on previous experience, AUSMAT members may provide direct patient care, coordination of care, or leadership roles.

There is the risk that temporarily sending health workers to work in Victoria as part of an AUSMAT will leave their existing hospitals and health services short-staffed.

At this stage, this is not thought to be a great concern as areas outside Victoria are not yet so significantly impacted by COVID-19, making it easier that their home states will manage without them.

However, if the situation worsens in other states, it may become harder to convince these states to release staff to support interstate efforts.

We also need to look after the physical and psychological well-being of AUSMAT health-care professionals.

We prepare them to assist with emergency health efforts but we don’t always prepare them to return to their normal roles afterwards. Some find it difficult to adjust.

Read more:
4 steps to avert a full-blown coronavirus disaster in Victoria’s aged care homes

What are the benefits to other states?

As well as directly helping the health response where they are sent, there are other benefits to an AUSMAT deployment.

When health workers from other states, such as South Australia and Queensland, work alongside AUSMAT and defence force teams, they can take that experience back to their home states to better prepare for a local COVID-19 outbreak.

Read more:
Coronavirus pandemic shows it’s time for an Australian Centre for Disease Control – in Darwin

The Conversation

Jamie Ranse, Senior Research Fellow; Emergency Care, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Social housing, aged care and Black Americans: how coronavirus affects already disadvantaged groups

Hassan Vally, La Trobe University

While it’s true anyone is at risk of catching and becoming ill with COVID-19, it’s becoming increasingly clear this virus discriminates.

From early in the pandemic, we’ve seen how COVID-19 disproportionately affects older people and those with other health conditions, who are more likely to develop severe symptoms and die.

But as well as discriminating on the basis of biology, this virus discriminates on the basis of socioeconomic disadvantage. It ruthlessly picks on the most vulnerable in society.

Read more:
Our lives matter – Melbourne public housing residents talk about why COVID-19 hits them hard

The Melbourne tower blocks

The recent COVID-19 cases in social housing, which saw nine public housing towers in Melbourne’s north put into hard lockdown, brought this into sharp focus. These tower blocks accommodate some of the most vulnerable people in our community.

People living in these buildings experience high levels of unemployment and job insecurity, generally exist on low wages, have limited access to education, are often from migrant backgrounds, and in some instances are victims of trauma.

The fact we saw the virus spread through these towers should be no surprise given what we know about how it spreads in crowded conditions and shared spaces. Physical distancing is almost impossible when you have big families living in two-bedroom units.

An elderly person is assisted by a carer.
Aged care residents are at higher risk from COVID-19.

Importantly, for cultural and language reasons, generic health messaging may miss the mark for these groups.

These factors combine to put social housing residents at increased risk of contracting the virus.

Aged-care facilities

Another group this pandemic disproportionately affects is aged-care residents. In aged-care facilities we have a perfect storm: an environment conducive to virus transmission and residents who are among the most susceptible to serious outcomes from infection.

Add into the equation the well-documented system deficiencies and workforce issues that have plagued Australia’s aged-care sector, and we have another situation in which some of the most vulnerable in our society are disproportionately affected by COVID-19.

We’ve seen this in Australia and around the world. Once you have community transmission of COVID-19 it’s hard to keep it out of aged-care facilities, and once in, outbreaks in this setting can be difficult to stop.

Read more:
4 steps to avert a full-blown coronavirus disaster in Victoria’s aged care homes

African Americans in the United States

The disproportionate effect of the pandemic on the most disadvantaged, vulnerable and marginalised in society is not just evident in Australia, but throughout the world.

There is perhaps no better example than the plight of African Americans in the United States. Figures released in May reported Black Americans were dying at almost three times the rate of white Americans from COVID-19.

One of the main reasons Black Americans face a higher health burden from COVID-19 is their increased rate of accompanying health problems such as heart disease, high blood pressure and diabetes.

This burden is amplified by the fact many are excluded from the basic access to health care we take for granted here in Australia.

Read more:
We could have more coronavirus outbreaks in tower blocks. Here’s how lockdown should work

And it’s not only the health effects of the virus which hit the disadvantaged harder. These people are also much more vulnerable to the indirect economic impacts of the pandemic, by virtue of their lower financial resources to begin with.

Looking across the globe

COVID-19’s discrimination against the vulnerable also extends to entire countries. Poorer and less developed nations, such as in Africa and Latin America, will potentially suffer the most in the immediate and longer term.

With weaker health systems, scarcity of medical resources (less equipment such as ventilators, for example) and large, vulnerable populations, these countries are less able to cope with a crisis of this magnitude.

And beyond the demands placed on their health systems, these countries have less capacity to withstand the economic shocks of the pandemic. Its effects could well catapult them into further crises, such as food insecurity.

Read more:
Coronavirus discriminates against Black lives through surveillance, policing and the absence of health data

We know infectious diseases, like other health conditions, are highly influenced by the social determinants of health. That is, the conditions in which people live, learn and work play a significant role in influencing their health outcomes.

Broadly speaking, the greater a person’s socioeconomic disadvantage, the poorer their health.

In shining a light on these inequities the pandemic also provides an opportunity for us to begin to address them, which will have both short and longer term health benefits.The Conversation

Hassan Vally, Associate Professor, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Vital Signs: the COVID-19 crisis in aged care shows elimination is the only effective strategy


Richard Holden, UNSW

As Victoria struggles to get its hotel-quarantine-debacle-driven COVID-19 outbreak under control, there has been renewed focus on the plight of those in aged-care facilities.

The facts are these. Between March 26 and July 5, Victoria recorded 20 deaths. None of those were in aged-care facilities. Between July 6 and July 29 there were 47 deaths in such facilities, nearly double the number from all other areas. COVID-19 cases have now been recorded in 87 aged-care facilities, with 10 aged-care facilities currently linked to about 50 or more cases.

These facts are undisputed.

What is – just barely – still in dispute is whether Australia should be following some kind of augmented herd-immunity strategy where we “protect” older Australians and let COVID-19 rip throughout the rest of the community.

Based on the data, that idea makes no sense.

Sweden tried it, and it was a disaster. Sweden’s chief epidemiologist admitted more than eight weeks ago he was wrong. Sweden’s central bank has acknowledged it will experience worse economic outcomes than its neighbours, along with the dramatically worse health outcomes.

Read more:
No, Australia should not follow Sweden’s approach to coronavirus

Can we ‘protect’ older Australians?

But the tragedy taking place in Victoria right now also demonstrates the impossibility of isolating and protecting older Australians in aged-care facilities.

The cases in Victorian facilities involve both residents and staff. Indeed, the number of staff infected is significant.

These grim facts represent public health and labour market truths.

First, a higher “viral load” tends to make someone more contagious. Any relatively large number of people in a confined space is a recipe for disaster.

Second, staff in aged-care facilities in Australia often work at multiple facilities and are employed as casual workers. They are lowly paid and their work is quite insecure.

Read more:
‘Far too many’ Victorians are going to work while sick. Far too many have no choice

Australia’s Fair Work Commission highlighted the problem of insecure work in its decision this week to provide “pandemic leave” to aged-care workers:

There is a real risk that employees who do not have access to leave entitlements might not report Covid-19 symptoms

Even if we sought to strictly quarantine the residents of those facilities, the staff can’t be locked down.

Imagine what that would look like. Have the workers spend, say, six weeks living in a facility and go into quarantine on the way in and out. Victoria hasn’t even been able to manage its existing hotel quarantine. And these workers typically have other care responsibilities in their own homes.

Thinking we can somehow cleanly segregate older and particularly vulnerable Australians from the rest of the community is a fantasy.

Elimination is the only option

The dreadful events playing out in these facilities also remind us why we need to functionally eliminate all local transmission in Australian states and territories.

If even a relatively small number of cases are in the community, this terribly infectious disease will spread unless the reproduction rate is kept below 1.

The inevitable result is that some of the most vulnerable Australians – people who have contributed to this country all their lives – will die in large numbers and in terrible conditions.

They will often die alone, with their loved ones and family members unable to touch them or even be with them as they pass.

This human tragedy ought to concern us all.

Read more:
View from The Hill: Aged care crisis reflects poor preparation and a broken system

But even without considering that, any reasonable cost-benefit analysis using the “value of a statistical life” favours elimination over other strategies.

To protect older Australians we need to protect all Australians. That means a commitment to stamp out all community transmission, and understanding the evidence that close to 90% of the economic cost of this pandemic comes from the pandemic itself, not the wise lockdown measures that are an investment in our future economic health.

Read more:
Vital Signs: the cost of lockdowns is nowhere near as big as we have been told

And as a polite reminder to the Australian press: what makes for a good “story” is not the same as what makes for a good public policy debate.

The evidence is in and the answer is clear. We must try and eliminate local transmission of COVID-19 in Australia for the health and economic benefit of Australians of all ages.The Conversation

Richard Holden, Professor of Economics, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

View from The Hill: Aged care crisis reflects poor preparation and a broken system

Michelle Grattan, University of Canberra

Scott Morrison wasn’t going to be caught out twice. In Hawaii during the bushfires, the prime minister had hesitated before returning (slightly) early.

On Tuesday he wasn’t on holiday but starting a tour of several days in Queensland, where there’s a state election in a few months.

He aborted the trip on its first morning, announcing during a visit to a seafood business that he’d return to Canberra because of the COVID crisis in aged care in Victoria.

The funding and regulating of aged care is a federal responsibility, while responsibility for health rests with the states. What’s happening in Victoria involves both governments and tension has erupted.

During the pandemic federal, state and territory governments, joined in the national cabinet, have largely sought to avoid public blame games. They’ve bitten their tongues over their differences and frustrations, although there’s been private briefing to the media and some obvious signs of irritation.

But on Tuesday, blame was being assigned, in what might be described as passive aggressive displays.

Victorian Premier Daniel Andrews stressed the aged-care system was the Commonwealth government’s responsibility. “The Commonwealth government have asked for help and that is exactly what my government and our agencies will provide to them,” he said.

Federal Health Minister Greg Hunt, on the other hand, highlighted the “massive breach of hotel quarantine” – that is, the Andrews government’s big lapse – that had led to widespread community transmission. “The greatest threat to any institution is a major community outbreak,” Hunt said.

He’s right. But the question is, could the federal government have done more to erect a firewall to protect the vulnerable people in these institutions which come under its regulation?

Last Friday acting federal chief medical officer Paul Kelly, appearing with Morrison at a news conference, rejected the suggestion aged care was an area of substantial failure in the pandemic.

“I wouldn’t say that it has been a failure up to now,” Kelly said.

“Certainly a large number of aged-care facilities have had either cases in staff or in residents in recent times in Victoria. … We certainly have had very rapid action wherever a case has been found.”

But Kelly did admit the situation was “a real concern”.

With growing community alarm, shocking reports in the media about conditions at facilities, and a clamour from frantic families, the federal government at the weekend announced a Victorian aged-care response centre to co-ordinate efforts, which was set up by Monday.

A large number of army personnel had already been dispatched to the state to deal with the general COVID outbreak, and they were pulled into the aged-care effort.

On Tuesday Hunt said the federal government would bring in an Australian Medical Assistance Team (AUSMAT). Such teams are sent to deal with crisis situations, such as a natural disaster – Hunt called them “the SAS of the medical world”. Hunt also promised more protective equipment for Victorian facilities.

A call was put out for health staff from interstate, particularly South Australia and NSW, and Morrison had talks on Tuesday evening about this mobilisation.

Meanwhile the Victorian government has paused non-urgent elective surgery, freeing up not just beds but staff to fill vacancies in nursing homes created by carers having COVID or isolating because they’ve been in contact with cases. Morrison reportedly was annoyed Andrews didn’t do this faster.

According to federal government figures, as of early Tuesday, there were about 70 residential aged-care facilities in Victoria associated with active cases, involving 433 residents and 339 staff. There have been 42 deaths of residents in the Victorian second wave.

Andrews noted only five of the cases were in public aged-care facilities.

With both governments scrambling to contain the situation, it is hard not to conclude the federal government failed to follow the maxim it embraced so strongly in giving assistance to the economy: go early, go hard.

A low-paid workforce with people often taking shifts in multiple institutions always meant a high chance many staff would be infected, and workers without leave provisions would often be reluctant to stay at home if unwell, because they did not want to lose money or could not afford to.

Belatedly, there has been federal, state and Fair Work Commission action to address this lethal problem.

The federal messaging on masks was inexplicably slow, and there have been complaints about inadequate supplies of protective clothing for these institutions.

After the disaster of Sydney’s Newmarch House, with 19 deaths, everyone should have been on the highest alert.

The real issue, however, is that the aged-care system is simply not fit for purpose in normal times and so was inevitably destined to fail when under this sort of extreme pressure.

Hunt on Tuesday praised the care his late father received in a home. “I cannot imagine better care that my family and my father could have got.”

But Andrews said “I wouldn’t want my mum in some of these places”, an observation many distraught families will relate to.

The interim report of the Royal Commission into Aged Care, released late last year, was scathing, declaring older people and their families were left “isolated and powerless in this hidden-from-view system”.

COVID has provided a tragic real-time vindication of the commission’s observation.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australians want more funding for higher-quality aged care — and most are willing to pay extra tax to achieve it


Julie Ratcliffe, Flinders University

It’s often said the true measure of any society is how well it treats its most vulnerable members. By this measure, Australia is falling woefully short. The Royal Commission into Aged Care Quality and Safety recently highlighted shocking instances of abuse and neglect involving our most vulnerable older citizens.

The aged care sector represents a multibillion-dollar industry, predominantly publicly funded. But during the proceedings of the royal commission, it’s been characterised as a sector receiving significant underinvestment and delivering substandard care.

It has failed to keep up with community expectations and the changing needs of our older population.

Our new research, published today, suggests most Australians believe more public money should be devoted to providing higher-quality aged care – and many would even be willing to pay higher taxes to this end.

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Exploring Australians’ attitudes to aged care funding

The Caring Futures Institute at Flinders University recently conducted a first-of-its-kind survey — both in Australia and internationally — to assess the views of the general public on the quality of aged care and the future funding of the sector.

We surveyed more than 10,000 Australian adults not currently receiving aged care services, aged between 18 and 91, with representation from every state and territory.

Elderly man sits on the couch happily talking with young female carer.
Many people prefer to receive aged care at home rather than to move into a residential facility.

There was strong recognition among the general public of the central role government funding plays in the financing of a quality aged care system. Almost 90% of our survey respondents indicated the government should provide more funding to support the delivery of quality aged care.

According to the Royal Commission’s findings, the Australian government currently allocates 4% of tax collected to Australia’s aged care system. Our respondents said on average 8% of tax collected should be spent on Australia’s aged care system (as opposed to other public services).

Some 61% of current taxpaying respondents were willing to pay an additional 1.4% per year in income tax so all Australians had access to a satisfactory level of quality aged care. Further, 55% of current taxpayers would be willing to pay an extra 1.7% in tax — equating to 3.1% additional income tax in total — to ensure equal access to a high level of quality aged care.

Most respondents indicated they would be willing to pay co-contributions (fees out of their own pocket) if they needed to access aged care services in the future. Those who have experienced the aged care system through a close family member or friend receiving care would be willing to make higher co-contributions on average than those without current experience.

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An overwhelming majority of respondents indicated they would prefer to remain living at home rather than enter a residential care facility if their health had deteriorated to the extent that they required an intensive level of care and support.

In general, we found younger people would be willing to pay more than older people to stay at home. In total, 72% of our survey respondents indicated they would be willing to pay A$184 per week on average, equating to almost A$10,000 per year, to remain living at home and avoid moving into a residential care facility.

Young people tended to be willing to pay more.
Ratcliffe et al. Caring Futures Institute, Flinders University, South Australia. Royal Commission into Aged Care Quality and Safety Research Report no 6 July 2020, Author provided

What is quality in aged care?

There was a high level of agreement among our survey respondents about what constitutes quality in aged care. Characteristics consistently rated as highly important included:

  • treating the older person with respect and dignity at all times

  • a trained and skilled workforce providing care that supports the older person’s health and well-being, and

  • the ability to lodge complaints with the knowledge that appropriate action will be taken.

In 2017-18 almost a million Australians accessed home care services and more than 200,000 people were permanently living in residential aged care. These estimates are expected to increase rapidly in the coming decades due to growth in Australia’s ageing population.

There is an urgent need for different care models to accommodate the overwhelming preference of the vast majority of Australians to remain living and cared for at home as they age.

There is an urgent need for new investment in aged care infrastructure to deliver a uniformly skilled and trained workforce to accommodate the needs, expectations and preferences of increasing numbers of older people in our society.

And finally, there’s an urgent need for stronger integration between the aged care sector and the health system to ensure all older Australians can access the care and services they need to maximise their quality of life.

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Our survey responses highlight that the general public recognise the fundamental importance of additional investment in the sector, including to ensure all aged care staff have the skills and training needed to provide the highest standards of care.

The findings provide an important and timely societal perspective with which to inform aged care policy and practice in Australia and in other countries which share similar values, aspirations and circumstances.The Conversation

Julie Ratcliffe, Professor of Health Economics and Mathew Flinders Fellow, Caring Futures Institute, Flinders University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

4 steps to avert a full-blown coronavirus disaster in Victoria’s aged care homes


Joseph Ibrahim, Monash University

As of July 22, the total number of COVID-19 infections nationally was 12,896, with 128 deaths. This figure includes 43 aged-care residents.

In Victoria, at least 45 aged-care facilities have now reported outbreaks, with about 383 positive cases in the sector overall (including among staff).

St Basil’s Home for the Aged in Fawkner and Estia Health in Ardeer have the largest number of cases: 73 and 67 respectively.

Although these outbreaks don’t compare to what we’ve seen internationally, the rising case numbers within Victorian aged-care homes are of grave national concern.

We’ll need a concerted community effort to arrest this looming disaster.

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Aged care was in crisis even before COVID-19

The interim report of the Royal Commission into Aged Care Quality and Safety laid bare the system failures in the provision of aged care in Australia.

These deficits include workforce and skill shortages. A report on the sector’s performance between October and December 2019 found around 20% of facilities audited did not meet standards in “safe and effective personal and clinical care”, while 13% fell short on the measure of a “safe, clean and well-maintained service environment”.

This makes aged-care homes highly vulnerable to any external disaster.

Several other factors set the scene for infection transmission in aged care, including its design. Residential aged care is intended to provide a home-like physical environment. While this serves an important purpose, it means aged-care homes may be missing some clinical features needed for optimal infection control, such as prominent placement of multiple hand basins.

Aged-care homes are designed differently to clinical settings like hospitals.

Communal spaces and a high volume of foot traffic (residents, staff, external contractors and visitors) also increase the risk of infection, while some residents have shared rooms and bathrooms.

And residents have a range of cognitive and physical disabilities that can make it difficult to adhere to the fundamental infection control measures of social distancing and handwashing.

COVID-19 and the elderly

We had early warning of the catastrophic effects of COVID-19 in aged-care homes in March and April from countries like Spain and Italy, which saw widespread outbreaks and deaths in nursing homes.

While roughly one-third of COVID-19 deaths in Australia so far have been aged-care residents, a review taking in 26 countries found this group has accounted for almost half of coronavirus deaths.

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Severe illness and death from COVID-19 is more likely in older people because they tend to have lower immunity, less biological reserve and higher rates of chronic conditions such as type-2 diabetes, high blood pressure, heart failure and renal disease.

One study found the case-fatality rate — the proportion of people who get COVID-19 who will die — is 33.7% for aged-care residents.

Avoiding disaster

We need a coordinated, standardised, compassionate, supportive response to prevent premature deaths, and to minimise psychological harm to residents, families and staff.

Different aged-care homes will need different strategies to suit their varying circumstances. For example, facilities located in areas without community transmission, such as South Australia, will be different to those where there’s community spread, like in NSW and Victoria. And the needs of those homes with an active outbreak, such as St Basil’s or Estia Health, will be different again.

But broadly speaking, I believe these four key pillars are applicable to all aged-care homes.

1. Stop COVID-19 entering

In areas where there’s community transmission, all aged-care homes should be put into lockdown, with tight controls at entry and exit points. This should be done as humanely as possible, for example by creating teams to keep residents connected to family and community, and with exceptions for essential visitors.

Staff should be tested routinely and counselled about limiting contact with other people outside the workplace. Staff should also only work in one facility, and be allocated the same group of residents (to minimise the number of contacts in the event of a confirmed or suspected infection).

Finally, the development and provision of specific guidance, training and support around the use of personal protective equipment (PPE) is essential. Individual homes should be supported to engage experienced infection control nurses to train staff if possible on site.

We’ve known since early in the pandemic that older people are more susceptible to COVID-19.

2. Be prepared in case it does

Every aged-care home in Australia should have a “risk and readiness” rating to determine the likelihood of a COVID-19 outbreak and the facility’s ability to prevent and manage an initial infection.

This would include factors such as the experience and size of the aged-care provider, location of the facility, the size and structure of the building, ventilation, access to open spaces, the residents’ profile, staff numbers and skills, and past performance in accreditation audits.

And each home should have designated vacant rooms to be ready for isolation of any suspected cases.

Finally, the government should establish a national rapid response and advisory team dedicated to the management of aged-care homes during COVID-19. This would strengthen existing public health response units and should include clinicians with expertise in aged care.

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3. Respond quickly and decisively when an outbreak occurs

Aged-care homes along with public health units should have protocols for coordination of their on-site response, with clear lines of accountability for action and escalation.

They should rapidly separate residents when an outbreak occurs, rather than relying on a continued usual model of care with the addition of PPE.

Aged-care homes require productive partnerships with hospitals to ensure residents can get the specialised care they need. Wherever possible, all confirmed cases should be sent to a clinical setting such as an acute or sub-acute hospital.

And importantly, all homes should have dedicated communication channels to keep family members informed.

4. Learn from past experience

The two major aged-care outbreaks in NSW, particularly the one in Newmarch House, attracted national attention. But we’re still awaiting a public statement from government about the lessons learned.

There are also ongoing inquiries into COVID-19 in aged care by a senate committee and the Royal Commission. But neither are due to report for some time.

The government should release interim reports into the investigations of recent outbreaks which might give us valuable information about reducing transmission.

Eliminating COVID-19 outbreaks from aged-care homes reduces community transmission, the need for hospital care and reduces premature death. This benefits the whole nation.

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The Conversation

Joseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.