The remarkable, deeply depressing special report by the aged care royal commission on the response to the pandemic illustrates the extent to which aged care and the needs of aged care facility residents are simply absent from policymakers’ minds.
Sacking aged care minister Richard Colbeck — a fate richly deserved by a minister who has presided over such colossal and fatal policy failure — won’t even begin to address the problem that key decision makers work without considering the needs of aged care, and the sector experts have no input into the systems of decision making.
Commissioners Tony Pagone and Lynelle Briggs explicitly avoid laying blame for the deaths of — so far — over 650 seniors in residential aged care and the outbreaks that tore first through NSW facilities and then, at a much larger scale, Victorian privately-run facilities.
But they identify huge structural problems in the way people making decisions failed to address the needs of the aged care sector, leaving providers, even with the best will in the world, struggling to stop their residents contracting the disease and dying from it.
The overarching conclusion from the report is that aged care was, in effect, shoehorned into the existing pandemic response, without consideration for the fact that it was the sector most exposed to the risk of infection and death.
COVID-19 is a public health crisis that has disproportionately affected aged care in Australia. Much was made during the hearing of whether there was an aged care-specific plan for COVID-19. There was not a COVID-19 plan devoted solely to aged care. But there was a national COVID-19 plan that the Australian Government sought to adapt and apply to the aged care sector.
But much of the governmental response to the pandemic was made without input from aged care experts or the sector itself.
The Communicable Diseases Network Australia, a sub-committee of the Australian Health Protection Principal Committee which has driven health policy advice to national cabinet through the pandemic, released national fuidelines for residential aged care facilities March. This was described by chief health bureaucrat Brendan Murphy as “the fundamental foundational plan” for the sector. But in the view of the commissioners, they were no substitute for a national aged care plan.
Worse, no one on the CDNA has aged care expertise, the commissioners found. And the “guidelines” issued in March proved disastrously inadequate. Anglicare used the guidelines as the basis for self-assessing its preparedness and realised, after the Newmarch House outbreak, that the guidelines weren’t enough. They “caused Newmarch to treat COVID-19 ‘as a flu-like illness’ when in reality it had ‘a lot more of an impact’”.
The AHPPC belatedly released an overhaul of aged care guidelines in late August. The commissioners recommend an advisory body specifically composed of aged care and geriatric medicine specialists to fill what is clearly a major advisory gap for policymakers. The government’s stop-gap, time-limited aged care advisory body set up in August isn’t good enough, the report says.
The guidelines also provided that infected residents should only be transferred to hospital “if their condition warrants”, phrasing now removed entirely from the guidelines. This contributed to the reluctance of NSW Health to accept the need to transfer Newmarch House residents to hospital after they’d become infected, an outcome that almost certainly led to more deaths at that facility. NSW Health preferred to employ “hospital in the home” processes. NSW Health, too, failed — even in the wake of Newmarch House debacle — to seek the input of aged care experts:
On 4 August 2020, NSW Health’s Agency for Clinical Innovation released a guideline entitled Caring for adults with COVID-19 in the home. This document was prepared without consultation with those who had recent experience of Hospital in the Home and without consultation with the aged care sector more generally.
The commission also suggests that whatever lessons were learnt from the NSW outbreaks were not “shared widely before community transmission put people living and working in aged care in Victoria at risk”.
That’s the statement for which Colbeck, and his advisers and senior bureaucrats, should resign forthwith. If the NSW aged care outbreaks were unforeseeable tests of the sector, they at least provided lessons that needed to be learned, and weren’t.
Nor is the failure confined to the minister. The AHPPC “provided no written guidance to the aged care sector in the period between 20 June 2020 and 3 August 2020”.
Nor does the purported regulator, the Aged Care Quality and Safety Commission, emerge with any credit, except that it knew the sector was particularly vulnerable. But its “regulation” was extraordinarily passive: in March, the commission wrote to aged care providers asking them to use an online survey to self-assess their preparedness against the discredited CDNA guidelines. Predictably, 99.5% assessed themselves as ready — indeed, 43% thought they were “best practice”.
The commission also used “assessment contacts by telephone”. Neither the commission nor the Department of Health mandated or recommended the use of face masks in aged care facilities, which would have contributed significantly to lowering infection rates.
From the regulator and the responsible minister, to the health officials driving pandemic policy, to state health departments, the needs of aged care recipients, and the expertise of people working in the sector, appear to have been back of mind at best as residential aged care faced its biggest ever challenge. Hundreds died as a result.
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