How COVID-19 exposed the flaws in aged care

| July 8, 2020

COVID 19 continues to highlight how fragile our economic, social and health systems are. Health systems are supposed to protect citizens, including the most vulnerable.

Recently I commented on workforce issues within the maternal/ child health nursing workforce in the context of the redeployment of clinicians away from essential provision of care to families with young children.

This was one of the many COVID 19 response strategies; and as a result we are now witnessing the negative impact of this service management decision on maternal mental health, family violence; and child neglect and abuse.

Currently under the spot light is the flawed aged care sector, now in the consciousness of Australians because of the devastating impact of COVID 19. In particular, Newmarch House in NSW with 19 residents dying as a result of the pandemic.

The ABC Four Corners program: Like the Plague, highlighted spectacular failings in a number of areas regarding the management of the COVID 19 response within the Newmarch facility.

To understand how this situation could go so wrong we need to start at the beginning and consider a cascade of serious issues that continues to persist across the aged care sector in Australia.

This is evidenced by four key findings identified by the 2018 Royal Commission into Aged Care. The failings found by the Royal Commission include:

• that care is designed around transactions, not relationships or care

• the system minimises the voices of people receiving care and their loved ones

• the system is hard to navigate and does not provide the information people need to make informed choices about their care

• the system relies on a regulatory model that does not provide transparency or an incentive to improve, and

• the workforce is under pressure and under-appreciated and lacks key skills.

The Aged Care Quality and Safety Commission responsible for ensuring the governance and accountability of service providers in the aged care sector, finds itself again under scrutiny despite the findings of the Royal Commission.

One would have to wonder if little has changed despite these findings highlighting ongoing appalling situations for elderly residents in care facilities, given the management of acutely unwell residents due to the COVID 19 infection.

Let’s be clear, aged care residential facilities do not have the required resources and equipment; nor staff expertise and appropriate carer to resident ratios to provide the level of care delivered by highly trained clinicians in an acute care setting. This was clearly highlighted in the Four Corners program.

Some of the critical failings identified by the Royal Commission have played out in the Newmarch House facility and clearly the situation has not improved, particularly in relation to the aged care workforce.

Annie Butler, the Federal Secretary of the Australian Nurses and Midwifery Federation, has highlighted underinvestment in care, the discrepancy between qualifications and training for aged care workers; and the failure to value the workforce.

The majority of the workforce are care workers, but care worker training varies dramatically across the sector, states and territories, creating a dangerous situation for the elderly in care.

Whilst registered nurses are employed within residential facilities, almost all of the care is provided by carers with minimum training who are in no way equipped to deal with the complexities of managing critically unwell residents. The lack of investment in the workforce has perpetuated and in many ways contributed to the devastating deaths of the elderly residents in care.

Marry this with a lack of sound policy reform, and poor implementation of appropriate evidenced models of care; and a decision such as managing very ill residents using a hospital in the home model, and we produce a prime example of how poorly considered strategies contribute to poor outcomes for the elderly in residential care.

The notion of implementing a hospital in the home model as a strategy for managing COVID 19 in elderly, frail residents demonstrated flawed decision making.

Hospital in the Home is a very useful service provision strategy which provides a level of standard health care to patients who would have otherwise been in hospital for clinical conditions such as cellulitis or urinary tract infections.

The care is provided by highly trained clinicians with expertise across the various specialities.  At the centre of this care are safeguarding policies and procedures to ensure patient safety. However, managing COVID 19 and the associated comorbidities are difficult in acute care settings, and one has to question why the Hospital in the Home approach was even considered and implemented at the Newmarch facility.

This strategy has not protected this vulnerable group because it is essentially an economic model dressed up as a model of care to suggest residents receive a standard of care equivalent to a hospital.

There are many critical lessons arising out of COVID 19 for all sectors. Governments, policy makers and bureaucrats need to reflect upon these failings as clearly identified by the Royal Commission.

Moving forward, improvement will require a shift in thinking to ensure priority is given to the recommendations made by the Royal Commission.  These should include consultation and partnership with experts and key stakeholders; such as families and the wider the community along with ongoing sound monitoring and evaluation of care for the elderly in residential facilities.

In no way has this article addressed all the issues in this situation, but it has stressed the opportunity for dialogue, just as the families of the residents of Newmarch House have made their voice heard.

The exclusion of families and the poor communication by Newmarch House fostered high levels of anxiety and fear and was probably the most poorly managed strategy of all, placing Newmarch residents and their families in great distress.

Right now my thoughts are with them and their elderly loved ones who have lost so much and suffered through a catastrophic situation.