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As more of our elderly die of COVID-19 in aged-care homes each day, many residences have gone into strict lockdown to try to stop the virus’s spread among Australia’s most vulnerable.

At Newmarch House in Kingswood, in Sydney’s west, for example, another person died on Tuesday morning, taking the total deaths there to 16.

So lockdowns are a vital weapon in the fight against coronavirus. But in some homes they have also meant crucial services have been slashed. 

Inq has heard cases of meal services cancelled, limited grooming and a health specialist denied visits to her elderly clients.

Services slashed

James’* parents live in a retirement village in southern New South Wales. His mother lives with dementia and his dad, in his 90s, is frail. The centre usually serves meals in its common areas and delivers dinner to James’ parents in their home.  

In March, family members and residents were sent an email saying the meal services would be suspended due to COVID-19.

“My gut feeling is that they weren’t getting the volumes of meals to prepare in the social areas so due to costs they stopped all meal services … It wasn’t worth bringing in the cook and staff to deliver meals,” James told Inq.  

The centre didn’t offer alternatives and Meals on Wheels in the area had a two- to three-week wait. James’ father doesn’t know how to cook and his mum, unstable on her feet and forgetful, shouldn’t.

“It’s dangerous for her to try, and it’s a concern,” James said. His parents rely on their other son to bring them prepared meals. 

Visits by the podiatrist, who trims his mother’s nails and remove her corns, have also been cancelled. “It affects her stability … Without her feet getting maintained, it does increase the risk she’ll fall,” James said. 

Another woman said that after hairdressing services were cancelled, she was worried about her dad’s eyebrows growing long and falling into his eyes, causing infections. 

Simone*, an occupational therapist who also works in NSW, said some nursing homes had refused her entry.

“Sometimes I can’t get in regardless of how much care a client needs,” she said. Families have called her wanting an appointment simply to get an honest opinion on how their family members are doing.

When she was able to go in she found standards had dropped: “Clients are at risk of pressure sores. The staff haven’t been keeping up the care at all.”  

Simone blames the lower standards on limited staffing: “Nursing homes don’t have the funding to offer one-on-one staff-patient ratios, and some staff are afraid of taking on extra tasks for fear of getting it wrong.” 

Limited visits place pressure on staff

Aged-care staff often rely on family members for help with meals, exercise and grooming, said Brett Holmes, a spokesman for the Australian Nursing and Midwifery Federation.

“[Without family and therapists’ help there’s] a lot of extra pressure on staff,” he said. “This is where the under-staffing that the industry has been rife with really shows up.” 

On average, people in care get two hours and 50 minutes of staff time, but need four hours and 18 minutes, he said. The federation has been campaigning for more staff and a better mix of staff skills, and more registered and enrolled nurses. 

“We have no idea what the impact COVID-19 will have on the budget capacity to address these issues,” he said. 

Luke Westenberg, the chief executive of the Aged Care Industry Organisation, said providers had been under financial pressure for a long time. 

Although he hadn’t heard of staffing ratios being affected by the virus: “COVID-19 has increased the need for resources and the cost for providers.”

 A difficult balance

Minister for Aged Care Richard Colbeck said guidelines had been put in place by the Australian Health Protection Principal Committee to protect the vulnerable elderly.

“These guidelines specifically allow clinical care professionals to enter residential aged-care facilities including general practitioners, pharmacists, clinical care teams (such as physiotherapists and occupational therapists) and dementia care specialists,” he said.

“Like all visitors to a service, clinical care professionals need to meet the entry restriction criteria set out in the directions of their state or territory, and screening requirements established by residential aged-care providers.”

Limiting transmission while also ensuring quality of life is a tough balance to strike, Marcus Riley, director of the advocacy group Global Ageing Network, said.

“A key part of a person’s quality of life is maintaining relationships and connectivity and being up to date with the wider community and on a personal basis,” he said. 

“[But] we all need to be adhering strictly to relevant health, hygiene, social distancing measures.” 

On May 1 the government released a draft voluntary code of practice which would allow visitors to see dying relatives and those who they have a “clearly established pattern of involvement in providing a resident’s care and support”. The final report is due on Monday, May 11. 

The code also provides a complaints process to raise concerns with providers.  

“Ideally this code wouldn’t be necessary, but it’s a good and reasonable framework,” Riley said. A one-off payment of $205 million has been pledged to the aged-care sector to help it respond and comply with the new code. 

Neither Riley nor Westenberg believes this will fix the ongoing problems. 

“The justified focus is on the here and now, but we also need stakeholders to work towards permanent solutions,” Riley said. “This includes better funding arrangements and more flexible access for the elderly.” 

*Names changed for privacy