Australia’s aged care homes are devastated by the current wave of COVID infections, with more than 1,100 households affecting more than 7,000 residents and staff. Fear of epidemics has caused other homes to close, and their residents are suffering the severe physical and psychological effects of isolation and, at times, inadequate care, due to a severe shortage of staff.
Government responses to the Royal Commission on the care of the aged last May recommendations have only begun to scratch the surface of longstanding problems in the elderly care sector. Major workforce issues remain, and elder care providers’ responses to the threat of COVID in their facilities vary widely.
Government decisions regarding the public health of the wider community can have significant and adverse effects on the health and well-being of residents and staff of aged care facilities.
A high risk group
Early in the COVID pandemic, it became clear that residents of nursing homes for the elderly were at high risk of serious illness and death. In 2020, Australia had a relatively low COVID death rate at 3.6 per 100,000 population. However, three quarters of all deaths (685 out of 910) were boarders for the elderly, at a rate of about 309 per 100,000 population.
The residents were confined in their rooms and visitors excluded. Family members were often unable to communicate with loved ones for weeks. Infected staff or close contacts were replaced with “peak” workers, many of whom had no experience in elderly care or infection control. Many residents have become depressed, confused or deconditioned from lack of exercise.
In some homes, the remaining staff were overwhelmed by an excessive workload and could not providing adequate care. Some have been abused by angry relatives or vilified by the media.
A special report in COVID by the Royal Commission on the Care of the Aged, in September 2020, concluded
The COVID-19 pandemic has been the biggest challenge facing Australia’s aged care sector […] Thousands of inhabitants […] endured months of isolation which had a terrible effect on their physical, mental and emotional well-being.
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What went wrong?
The reviews identified leadership and communication failures, shortages of properly trained staff and poor infection control as major issues – but there were wide variations between homes.
Support from Commonwealth and state government agencies has been essential during outbreaks – for public health and infection control advice, laboratory testing and staff replacements. But many homes have been let down by poor communication and coordination, inadequate planning and preparation, and conflicting advice.
Little has changed
In response to the recommendations of the Royal Commission, the federal government promised nearly $18 billion in additional funding over five years – a fraction of what was recommended, and most of it has yet to be allocated.
Aged care homes must now employ a nurse with approved infection control training, but their responsibilities and ongoing support and training remain undefined. No measures have been taken to improve wages, working conditions or training for older workers, the numbers fell since 2020.
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There is a plethora of advice from expert committees and government agencies, but little information on the effectiveness or consistency of their implementation. To date, around 90% of residents in aged care facilities and almost all staff in aged care facilities have received two doses of the vaccine, but earlier delays in rolling out the vaccine mean that many are haven’t received any boosters yet.
Despite improvements, the elderly care sector is currently under extreme pressure. The number of households with COVID outbreaks over double between January 7 and 14.
There have been relatively few deaths so far, but government assurances that Omicron has no significant impact on residents’ health contradict reports from the First line. Many facilities are closed whether or not there is an outbreak and staffing shortages are critical.
The serious adverse effects of isolation and neglect are potentially as severe and more widespread than in 2020 and likely to contribute to premature deaths. Unlike the Omicron cases and deaths, they will not be documented as COVID-related but likely attributed to old age or other underlying conditions.
It’s unclear whether the political leaders who advocated lifting restrictions and “passing” the Omicron wave took into account the human rights of elderly residents.
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An urgent need for reform and future planning
The measures introduced to protect the Omicron community have been widely criticized as too few, too late and the easing of restrictions too premature. Residents of aged care facilities and other vulnerable groups have been disproportionately affected by the massive increase in community transmission. They will be again, in future waves, unless their needs are catered for by more nuanced and proactive strategies than “let it go” or lock/lock.
There is an urgent need for the recommendations of the Royal Commission to be fully implemented as soon as possible and for the reform of care for the elderly to be coordinated with the reform of the whole care system: hospitals, elderly people, disabled people and care primary, and public health.
The Royal Commission has highlighted longstanding shortcomings in the aged care sector, but they cannot be fixed during a crisis. Elderly care providers need support to build resilience and ensure continuity of services. This will require a significant financial commitment from the government.
Solving the elder care workforce crisis will require an effective campaign – planned in consultation with frontline workers, managers and customers – to attract workers by offering better pay, conditions, training and career structures.