Published in The Age, 29 July 2020
Residential aged care is in crisis in Victoria. In Melbourne, dozens of care homes have infected residents or staff. Forty-two residents have died and more are likely to die. This is a tragedy that should have been prevented.
We need an emergency response now, but that won’t be enough. Major aged care reform will be required in the near future to address the underlying problems.
The Newmarch House disaster in NSW highlighted all the immediate problems: not enough trained staff, lack of personal protective equipment, inadequate infection control, perverse incentives for risky work practices, failure to adequately compensate staff to stay home with symptoms, lack of information and support for families and friends of residents, and poor coordination and accountability between governments. Nineteen people died there.
It has been clear for months that residential aged care should have been the number one priority for reducing deaths from COVID-19. Internationally, a review of 26 countries, including Canada, the UK and the US, found nearly half of all COVID-19 deaths have been in residential aged care facilities. In Australia, 41 per cent of COVID-19 deaths have been in residential aged care.
Four months ago, in March, the Royal Commission into Aged Care Quality and Safety called on the Australian government and aged care providers to be vigilant about the impact of and response to COVID-19. The commission emphasised the importance of measures to prevent infection and the need to minimise the impact these measures had on the quality of life for people living in residential care – lack of contact and support from family and friends and isolation from the community.
The Commonwealth government provided substantial additional funds for aged care to address COVID-19: in May, $205 million to cover COVID-19 costs; in March, $340 million and then $100 million for training, extra staff, pathology services and improved infection control.
But money alone hasn’t been enough. Private aged care operators get the lion’s share of the more than $12 billion the Commonwealth spends on residential care. It’s not clear where the additional money has gone, and the difference in infection rates for public versus private facilities is stark.
Despite repeated calls for help, in Victoria, private providers are still struggling to get staff and personal protective equipment. Staff are often casual, poorly paid, unskilled and work in more than one facility. Until this week, staff couldn’t get pandemic leave if they had to self-isolate.
There has been little regional coordination of aged care with Victorian health and emergency services. Communication with families has been inadequate.
Although the Commonwealth has funding and regulatory responsibility for aged care, it has almost no capacity to monitor, coordinate and manage services on the ground, nor to communicate with and support the families of residents.
Everything is run centrally out of Canberra. On top of that, there is an obvious need to bring aged care together with GP, hospital and emergency services.
It has been obvious since the Newmarch fiasco that an immediate localised emergency response to coordinate and manage aged care was needed across the country to fix all the problems identified over the past four months.
Belatedly, this week the Commonwealth established a Victorian Aged Care Response Centre to coordinate and beef up the aged care response with Victorian health and emergency services.
Local coordination, management and accountability is an essential immediate step that should be put in place more widely in regional Victoria and across the country to prevent more widespread disasters in aged care.
But nobody should be under any illusion that emergency action to prevent the spread of infection is enough to the fix the underlying problems in aged care. The Royal Commission extensively documented the underfunding, poor quality and administrative faults well before COVID-19.
The Commonwealth’s current centralised, loosely governed, market model dominated by private companies providing large-scale “big box” institutional care for older people is no longer fit for purpose. The faults run deep and it will take commitment to fix them.
In the near future, major reform and additional funding will be required. As the baby boomers reach their 80s, many more people will need aged care. Most won’t want what’s currently on offer.
Older people should have the right to get the services they need to live a decent life. Key elements of reform should include much greater emphasis on home, rather than institutional care, better training and more staff to improve quality of care, and making sure there is much stronger local governance and accountability for aged care services to protect older people’s rights.