Report an indictment of government's unpreparedness

COVID-19 in aged care recommendations welcome but don't go far enough, say nurses

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Visits from family and friends are critical to the physical, mental and emotional health and wellbeing of people living in residential aged care: Aged care royal commissioners. Image: Shuttlerstock

Visits from family and friends are critical to the physical, mental and emotional health and wellbeing of people living in residential aged care: Aged care royal commissioners. Image: Shuttlerstock

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Royal Commission special report on COVID-19 makes six recommendations. Government accepts all.

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An indictment of federal and state governments' unpreparedness and prevarication is how one seniors' advocacy organisation has described the aged care royal commission's special report into the handling of the pandemic in aged care.

"The mandatory deployment of qualified infection control staff in nursing homes is long overdue. The vast majority of COVID deaths have been in residential aged care and every year hundreds and sometimes thousands of nursing home residents fall victim to the flu or die of complications following gastro outbreaks," said Paul Versteege from Combined Pensioners and Superannuants Association.

The vast majority of COVID deaths have been in residential aged care and every year hundreds and sometimes thousands of nursing home residents fall victim to the flu or die of complications following gastro outbreaks. - Paul Versteege CPSA

Australian nurses have also criticised the report as not going far enough to protect vulnerable residents in aged care.

The Australian Nursing and Midwifery Federation has said the highly anticipated report fails to address core staffing problems of "dangerously inadequate levels of qualified nurses and care staff with the right skills mix and the tragic consequences of understaffing on elderly residents".

The ANMF called for more transparency by providers on funding.

The report has been generally welcomed by health and aged care bodies throughout Australia as has the Federal Government's acceptance of the royal commission's six recommendation.

The government has said it has already made "substantial progress" on four of the recommendations and says it will invest $40.6 million in its initial response.

It also announced a further $10.8 million to enhance the skills and leadership qualities of aged care nurses by expanding the Australian College of Nursing scholarship program, establishing an Aged Care Transition to Practice Program, and creating a skills development program for nurses and personal care workers in aged care.

ANMF federal secretary Annie Butler said nursing homes desperately need additional nurses and care staff to provide safe, effective care outcomes for residents, not just to enable more visitors.

"While that is critical for the wellbeing of residents, more staff are urgently needed just to meet basic needs for residents in far too many nursing homes," Ms Butler said.

More staff are urgently needed just to meet basic needs for residents in far too many nursing homes. - Annie Butler ANMF

"Our members have been on the frontline during the pandemic and have witnessed how it has stretched staff and resources even further, again demonstrating the importance of having sufficient staffing levels and skills mix, to cope with intensified demands and workloads.

"In Victoria, where privately-run nursing homes set their own staff ratios, there's been more deaths and higher rates of COVID-19, than in government facilities, which have mandated minimum staffing levels, including registered nurses on every shift.

"We welcome the recommendation for immediate additional funding but reiterate the need for greater transparency for any additional government funding, because aged care providers must be held accountable - and actually use the money for its intended purpose of employing additional nurses and carers for the depleted sector."

Our members have been on the frontline during the pandemic and have witnessed how it has stretched staff and resources even further, again demonstrating the importance of having sufficient staffing levels and skills mix, to cope with intensified demands and workloads - Annie Butler ANMF federal secretary

As at September 19, 2020, 844 people had died in Australia as a result of COVID-19. Of these, 629 were living in aged care homes at the time of their deaths, although many died in hospital.

Royal commissioners Tony Pagone and Lynelle Briggs said in their report: "The COVID-19 pandemic has been the greatest challenge Australia's aged care sector has faced. Those who have suffered the most have been the residents, their families and aged care staff.

"The suffering has not been confined to those homes which have experienced outbreaks. Thousands of residents in homes that have not suffered outbreaks have endured months of isolation which has had and continues to have a terrible effect on their physical, mental and emotional wellbeing."

Royal commissioners Lynelle Briggs and Tony Pagone.

Royal commissioners Lynelle Briggs and Tony Pagone.

The report is critical of the lack of clear leadership which left families, providers and health workers unable to answer the critical question of who was in charge. It has called for the establishment of an aged care advisory body and said there was "a clear need for a defined, consolidated, national aged care COVID-19 plan".

The royal commission has recommended the federal government immediate fund extra staff in aged care homes to allow continued visits by families and friends.

"While many residents of aged care homes have not experienced a COVID-19 outbreak at their facility, they have endured restrictions for most of this year that go beyond those endured by the general community," said the report

"The understandable restriction of visits between older people and their friends and families has had tragic, irreparable and lasting effects which must immediately be addressed as much as possible.

"Visits from family and friends are critical to the physical, mental and emotional health and wellbeing of people living in residential aged care and also their friends and families. The benefit of such visits cannot be wholly replaced by technology."

The report also recommends the urgent creation of Medicare Benefits Schedule items to increase the provision of allied health services, including mental health services, to people in aged care during the pandemic.

"Any barriers, whether real or perceived, to allied health professionals being able to enter residential aged care facilities should be removed unless justified on genuine public health grounds," it says.

All residential aged care homes should also have one or more trained infection control officers as a condition of accreditation, and the Australian Government should arrange with the States and Territories to deploy accredited infection prevention and control experts into residential aged care homes to provide training, assist with the preparation of outbreak management plans and assist with outbreaks.

The royal commissioners also stress that now is not the time for blame.

" There is too much at stake," they say. "We are left in no doubt that people, governments and government departments have worked tirelessly to avert, contain and respond to this human tragedy.

"However, the nation needs to know what lessons have been and can still be learnt. The nation needs to know what is being done, and what will be done, to protect those people receiving aged care services - those who this virus has affected disproportionately and whose entitlement to high quality care in safe environments that protect their wellbeing and dignity falls within the scope of our commission."

The report requests the government to report to Parliament on the implementation of the recommendations by December 1.

In his response to the report Sean Rooney, chief executive of Leading Aged Services Australia (LASA) which represents providers of age services across residential care, home care and retirement living/seniors housing, called for immediate "big and bold steps". A strict timeline for implementation of the six recommendations was essential, he said.

"Protecting older Australians receiving care and support in our aged care system from COVID-19 is a national priority and this report and its recommendations will make a big difference."

"We acknowledge that everyone involved in aged care is working incredibly hard but we also know that our treasured older Australians are still at risk.

"Our valued workforce are doing all they can to protect those in their care and we need the rest of community to play their part by doing all they can to stop the spread in the wider community."

Sensible achieveable recommendations.

Sensible achieveable recommendations.

Council on the Ageing chief Executive, Ian Yates, said he was pleased the government had immediately accepted all six recommendations of the Royal Commission; but he said the devil will be in the detail and government must move quickly to ensure they are fully implemented in ways that equally strengthen infection control and support the emotional mental and physical health and wellbeing of all residents.

"The report makes very sensible, achievable recommendations that recognise the need for a co-ordinated response to outbreaks and increased infection control by nursing home providers," Mr Yates said.

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