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COVID-19 outbreaks exposed shortfalls in aged care, finds review

Recommendations from a review into COVID-19 outbreaks in aged care facilities aim to fix "shortcomings and systemic weaknesses" in the aged care system that were exposed by the COVID-19 pandemic in Australia.

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A recent independent review of COVID-19 outbreaks in aged care has resulted in a number of recommendations aiming to fix shortfalls in the aged care sector. [Source: Shutterstock]

The Federal Government has accepted all 38 recommendations from the Independent Review into COVID-19 Outbreaks in Australian Residential Aged Care Facilities (RACFs).

Titled, 'No time for complacency', the review was conducted by Professor Lyn Gilbert AO and Adjunct Professor Alan Lilly, and commissioned by the Commonwealth Department of Health and released on Monday.

Minister for Health and Aged Care, Greg Hunt, says the review will help inform the Government's navigation of the ongoing impact of the COVID-19 pandemic.

"It has been an extremely challenging time for all of us, but particularly senior and vulnerable Australians and those who care for them," says Minister Hunt.

"The Review’s 38 recommendations will help aged care facility administrators better prepare for and respond to future COVID-19 outbreaks and will assist the Government in monitoring and evaluating these measures.

"It will also be important that, as the community transitions to living with COVID, we continue with critical strategies such as vaccinations and testing, so that aged care residents and staff are protected."

The report outlines nine key areas of defence that can minimise the risk of COVID-19 outbreaks in aged care, which include:

  • Built environment and infrastructure

  • Clinical care

  • Effective interagency communication

  • Emergency response

  • Infection prevention and control

  • Leadership, management and governance

  • Planning and preparation

  • Preventing social isolation

  • Workforce and staff mental health

Minister for Senior Australians and Aged Care Services, Richard Colbeck, says the review recommendations are already being used to guide protection measures in aged care facilities with current outbreaks in New South Wales, Victoria, and the ACT.

"Importantly, the findings show that while community transmission is the biggest predictor of COVID‑19 outbreaks in aged care settings, effective leadership at all levels is the most critical factor in defending against the virus," says Minister Colbeck.

"We have listened to the experiences and stories of those living, working and caring in the aged care sector throughout the pandemic. We are committed to improving our preparation for and response to outbreaks, and better supporting our most vulnerable Australians."

Some of the recommendations from the Review include:

  • Recommendation 2: The Department advise the sector of changes required to mitigate risk of COVID-19 transmission

  • Recommendation 9: The Department maintains and publishes up to date COVID-19 information for the aged care sector as a 'single source of truth'

  • Recommendation 13: Approved providers ensure sufficient staff have completed online training and mentoring in emergency management and crisis leadership

  • Recommendation 15: A Commonwealth Case Manager is appointed to an outbreak as a single point of contact and oversight for that outbreak

  • Recommendation 21: The Department continues with implementing Infection Prevention and Control (IPC) recommendations made in the Royal Commission into Aged Care Quality and Safety's (Royal Commission) COVID-19 Special Report

  • Recommendation 27: Approved providers must submit annual Pandemic Planning evidence to confirm compliance with the required Standard

  • Recommendation 28: Approved providers must fully complement the Industry Cost for Visiting Residential Aged Care Homes during COVID-19

  • Recommendation 36: Approved providers develop pandemic workforce plans to allow for optimal staffing levels during a COVID-19 outbreak

  • Recommendation 38: Chief Health Officers consider implications of public health directions for residential aged care workers that could impact continuity of care

Head to the Health Department website for the full rundown of recommendations or to view the full report.

Poor leadership and governance resulted in quality care shortfalls

Residential aged care COVID-19 cases represent seven percent of all cases in Australia to date, but have been responsible for 75 percent of COVID-19 related deaths in the country.

In the review, the authors noted that poor leadership and governance seemed to lead to poorer outcomes in a residential aged care facility's response to an outbreak.

Some providers found it was often not clear who was in charge during an outbreak, leaving uncertainty around leadership and necessary changes to prevent COVID-19 transmission.

The report states, "The COVID-19 pandemic has exposed shortcomings and systemic weaknesses in the aged care system. Many of the issues were not new. Over the past twenty years and as many reviews and inquiries into the aged care sector, numerous recommendations have been made and not heeded.

"...It is clear that effective leadership is the key to success in managing COVID-19 outbreaks and that living the mantra, “go hard, go fast”, is positively correlated with better outcomes. 

"...Longstanding failures of leadership and governance identified by the [Royal Commission] meant that many RACFs were ill-equipped to manage a crisis such as COVID-19… There is widespread recognition within the aged care sector, in Australia and overseas, that competent crisis leadership and prioritisation of safety are vital to successful outbreak management; prompt leadership action can often prevent a major outbreak and save lives." 

Providers and the aged care workforce reported the COVID-19 outbreaks in aged care as "stretching the emotional limits" on those charged with delivering care to residents.

"Notwithstanding their best efforts, staff reported feeling pressure beyond the workplace. Many were reluctant or even afraid to go to work, fearing for their own or their families’ health," says the report.

While there were cases of confusion and shortfalls in aged care, the report noted examples of successful collaboration between aged care facilities and health services, and staff going beyond the call of duty to help residents and their families.

Peak body calls for Delta COVID-19 analysis

Industry peak body, Leading Age Services Australia (LASA), has welcomed the report and the Government's acceptance of all Review recommendations, however, it is calling on the Federal Government to conduct an independent analysis of the Delta COVID-19 strain.

LASA believes analysis of the Delta COVID-19 outbreak in aged care will further inform the sector on keeping residents and staff safe as Australia moves to a 'living with COVID-19' model.

Chief Executive Officer (CEO) of LASA, Sean Rooney, says, "We believe it’s a national priority to do all that we can to protect older Australians in aged care homes and the dedicated staff who care for them.

"The review by independent experts assists us in doing this as we continue to learn and adapt to COVID as it continues to impact aged care and the wider community.

"It provides meaningful insights that assist in our continuous review of practices in aged care to keep people safe. Having timely access to these insights enables the sector to respond appropriately.

"We need to ensure that best practices and procedures are based on the latest expert analysis, which is why the Government must conduct an independent analysis of Delta outbreaks so that we can be prepared."

LASA wants any information from an independent analysis of Delta outbreaks in aged care to be shared with service providers.

Additionally, the organisation wants the Government to ensure the additional operational costs of living with COVID in aged care are calculated and provided to aged care services to ensure aged care workers and facilities are resourced adequately.

LASA also wants to remind the community to work together with aged care providers to protect vulnerable older Australians from COVID-19.

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