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ROYAL COMMISSION: Aged care wasn't prepared for COVID

The Royal Commission into Aged Care Quality and Safety held hearings, running from 10-13 August, covering the impact of COVID-19 on the aged care sector and how the Australian Government and the industry responded to the pandemic.

Senior Counsel Assisting Peter Rozen QC expressed that Australia has the highest rates in the world of aged care deaths as a proportion of deaths from COVID-19. [Source: Aged Care Royal Commission
Senior Counsel Assisting Peter Rozen QC expressed that Australia has the highest rates in the world of aged care deaths as a proportion of deaths from COVID-19. [Source: Aged Care Royal Commission

Opening for the hearings, Senior Counsel Assisting, Peter Rozen QC, expressed that recent events had led to Australia having the highest rates in the world of residential aged care deaths as a proportion of deaths from COVID-19.

He added that COVID-19 has highlighted all the flaws in the aged care sector that have been found in previous hearings by the Royal Commission.

"It can be seen, Commissioners, that the aged care system we have in 2020 is not a system that is failing. It’s the system operating as it was designed to operate. We should not be surprised at the results," says Mr Rozen.

Mr Rozen said further that the Commission would be scrutinising how prepared the aged care sector was for a disaster like COVID-19.

"While there was a great deal done to prepare the Australian health sector more generally for the pandemic, the evidence will reveal that neither the Commonwealth Department of Health nor the aged care regulator developed COVID-19 plan specifically for the aged care sector," explained Mr Rozen.

Mask response was slow

First witnesses for day one of the hearings, 10 August, was Professor Mary-Louise McLaws, Professor of Epidemiology, Healthcare Infection and Infectious Diseases Control, Faculty of Medicine, University of NSW (UNSW), and Professor Nicola Spurrier, Chief Public Health Officer, Department of Health and Wellbeing, SA Health.

Both experts covered the complexities and seriousness of COVID-19 and how easily the virus can spread.

Mr Rozen inquired about the mandatory mask response, identifying that the community transmission in Victoria increased in the middle of June but masks were only compulsory for aged care workers in the middle of July.

Professor McLaws told the Commission that she was surprised as to why masks weren't enforced in residential aged care facilities earlier on.

"Masks were universally required in Victoria in the beginning of July. So I am not sure why the residential aged care facilities were considered any different to hospitals, given what we know around the world," says Professor McLaws.

Professor Spurrier added that while South Australia is in a different situation from Victoria, the State is looking at making masks mandatory in aged care facilities when staff are doing close care with residents.

She admits that this move would be precautionary since SA currently doesn't have any major problems with COVID-19, however, SA Health believes it will be beneficial to get people used to wearing masks and Personal Protective Equipment (PPE), and get residents used to seeing people in masks when receiving care.

South Australia has since implemented these precautionary measures for aged care on Thursday, 13 August.

Mixed messages and rushed strategies

On the second day of the Commission, 11 August, the Commission heard from multiple COVID-19 affected facilities, Government departments and experts around how the different organisations worked together.

It was shown that aged care providers with COVID-19 within their facilities were provided a lot of mixed information around PPE, and pre-condition procedures weren't followed when it came to "hospital in the home" directions.

Dr James Branley, Head of Infectious Diseases at Nepean Hospital in New South Wales (NSW), who worked within multiple nursing homes with COVID-19 outbreaks, was put under pressure around the poor implementation of "hospital in the home" strategies.

Senior Counsel Assisting Rozen inquired as to why the "hospital in the home" system was implemented in an aged care facility when the normal conditions for this system were not met. There was no written agreement in place with the facility and training was provided to staff during the system implementation, rather than before it was implemented.

Dr Branley says that he believes the conditions of "hospital in the home" were implemented as best they could given the circumstances.

He also believed that the hospitalisation of residents wasn't the safest move to undertake for residents or for preventing the spread of disease.

"I think the movement of patients represents a risk, and the mass movement of elderly patients in the literature is not beneficial to those residents in the studies that I’ve looked at," says Dr Branley.

"Movement of patients does pose a risk of transmission, and I will be very interested to look at Victoria when the Victorian situation has been fully analysed. 

"But I think the number of healthcare workers that are potentially exposed and the number of other patients in health care facilities that are exposed by mass movement of positive patients or of negative patients that are falsely negative and not yet positive poses a really significant health issue and it’s a public health issue."

Dr Branley added that he believed they underestimated how many aged care staff were positive for COVID-19, and in future they need to "focus on eliminating positive staff from that workplace".

Aged care needs to be a COVID-19 national priority

On the third day of the Commission, 12 August, Professor Joseph Ibrahim, Head of Health Law and Ageing Research Unit, Department of Forensic Medicine at Monash University, appeared to provide his opinion on what he believes to be a heavily bungled attempt by a wide variety of organisations to contain COVID-19 in aged care.

"This is the worst disaster that is still unfolding before my eyes and it’s the worst in my entire career. I didn’t think we would sink any lower following the Royal Commission findings from last year and yet we have," says Professor Ibrahim. 

"In my opinion, hundreds of residents are, and will, die prematurely because people have failed to act. There’s a level of apathy, a lack of urgency. There’s an attitude of futility which leads to an absence of action.

"The reliance or promotion of advanced care plans as a way to manage the pandemic and the focus on leaving residents in their setting I think is wrong and inappropriate. When I voiced my concerns, I have had comments saying that everything is under control, that I’m simply overreacting and causing panic. 

"We have the knowledge to do better. We fail because we have treated residents as second class citizens. There’s an absence of accountability. There still is and there are no consequences for failing to deliver good care in aged care."

Professor Ibrahim explained to the Commission that Australia is ranking with the second or third highest rate of death in residential aged care.

He recommended to the Commission in his statement that the high risk of catastrophic consequences in aged care needs to be a national priority, as aged care residents account for one percent of the population but are 68 percent of all COVID-19 deaths. 

Professor Ibrahim was very critical of the Federal and State Government and aged care reactions to COVID-19, stating that all the responses to the pandemic in the sector are still leaving a lot of questions to be addressed.

"I wanted to stress [that] all of this was foreseeable," says Professor Ibrahim.

The Royal Commission continued it's hearings on 13-14 August in Sydney, covering aged care accommodation.

For more information about the coronavirus, visit the Aged Care Guide COVID-19 update page.

Do you have any questions about the coronavirus that you want answered? Tell us in the comments below or email journalist@dps.com.au.

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