If the Andrews government is culpable for the unfolding catastrophe in Victoria, the Morrison government is equally responsible for a full-blown crisis in aged care facilities — despite its efforts at misdirection. And it has even less excuse.
After years of complaints and media exposés of rotten aged care, the government not merely established a royal commission into the sector but in 2018 set up a new approach to regulation, shifting responsibility for aged care accreditation, monitoring and complaints-handling into a new bespoke commission.
That body, the Aged Care Quality and Safety Commission, commenced effective operations in January this year. And it seems to have failed in its first major challenge — ensuring the sector did its utmost to prevent infection getting into aged care facilities.
It’s now clear that the risk posed by aged care workers, in both the home care and residential care sub-sector, working in multiple sites with elderly clients was completely missed by both the government and the commission due to a focus on trying to ensure affected facilities were properly staffed.
During the initial outbreaks at aged care facilities in NSW that saw large numbers of workers having to self-isolate, the government rushed staff from other facilities, or “surge staff” from Aspen Medical, into affected centres.
The federal government also encouraged facilities to use an online workforce supplier to bring in additional staff. Even as the outbreak spread rapidly in Victoria, the commission, as part of its guidelines for Victorian aged care providers, had no concerns about workers working across multiple sites. On June 30 it told Victorian facilities:
“Your staff list and their contact details should be kept up to date. As far as possible you should be aware of which staff also work in other aged care or health services. Make sure your records about this are up to date.”
That was despite Health Department guidelines that during facility outbreaks, “facility staff, including casual and agency staff, should not work at another facility, until the outbreak is declared as over”.
Nineteen days later, the government effectively banned staff working at more than one site in Victoria. What had been the policy solution to one problem had become the critical vector for spreading infections.
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All parties are in furious agreement aged care continues to struggle with workforce issues, but no government seems to be able to find a way to address it despite pumping ever greater sums into aged care and expanding opportunities for private companies in the sector.
The commission itself has repeated several times that it was “closely monitoring” Victorian facilities before taking action against the Menarock Essendon facility on July 16 and St Basil’s 10 days later. The latter only came after the relevant union fielded complaints about major breaches of infection control guidelines in the sector.
This appears to be consistent with the commission’s preferred regulatory approach. In its regulatory strategy, the commission argues “neither persistent punishment nor persistent persuasion is effective on its own in achieving” best practice regulation.
“Our regulatory strategy is based on a responsive risk-based approach” the commission says. It emphasises an escalating set of response to breaches by providers that begin with education, “complaints resolution where the outcome results in an informed, empowered consumer”, publication of performance data and monitoring and only culminating in penalties “for persistent and/or serious non-compliance with approved provider aged care responsibilities”.
Health Minister Greg Hunt insisted yesterday that “aged care around the country has been immensely prepared” and that “very similar proportions of public and also private and not-for-profit aged cares have had infections in the area”. On Wednesday he tried to suggest criticism of aged care providers was unfair on aged care workers, saying “the idea that our carers, that our nurses are not providing that care, I think, is a dangerous statement to make. They are wonderful human beings and I won’t hear a word against them.”
That’s a complete straw man. No one has criticised aged care workers. The targets are aged care providers — particularly privately run facilities — and the federal government, which has direct regulatory and funding responsibility for all aged care, both residential and in-home.
“A responsive risk-based approach” hasn’t cut it, and aged care residents are paying with their lives.
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