Australia’s deadliest virus mistake
Out of the sectors impacted by the coronavirus pandemic, none was brought to its knees harder than aged care - an area already in crisis before COVID-19 struck Australia.
A perfect storm of factors - including communal "homelike" environments, a high volume of foot traffic, chronic disease and lower immunity - made facilities "highly vulnerable to any external disaster", Monash University's Professor John Ibrahim wrote in a piece for The Conversation.
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"We had early warning of the catastrophic effects of COVID-19 in aged-care homes in March and April from countries like Spain and Italy, which saw widespread outbreaks and deaths in nursing homes," he said.
Yet a special report into the impact of the pandemic on aged care facilities, published in early October, found that the Federal Government's attempts to prepare the sector for the virus were "insufficient" - with three-quarters of the nation's coronavirus fatalities - a total of 685 people - linked to homes in NSW and Victoria.
The uptake of any Morrison Government plan for aged care (the royal commission found that there was not one specifically in place) was "patchy and the accreditation agency was weak in assisting the sector to prepare", Professor Colleen Doyle, a senior principal research fellow at the National Ageing Research Institute, told news.com.au.
Part of the problem, the report found, was that "bandaid fixes on the run" were implemented - meaning underlying issues weren't addressed.
A lack of clarity over who was in charge, and early lessons of the outbreaks at Newmarch House in NSW not being applied in Victoria as the virus quickly took hold, also contributed to the crisis.
"By the time daily infection rates began to rise in the community in Victoria in mid-June 2020, Australia had experienced two significant COVID-19 outbreaks in residential aged care homes," the report states.
"It is unclear whether the lessons learnt from those outbreaks were shared widely before community transmission put people living and working in aged care in Victoria at risk."
The real question, Professor Doyle said, is not what Victoria should have learnt from NSW, however, but: "Where was the Federal Government in responding to this pandemic?"
She said: "Aged care is solely a federal responsibility. Where was the Minister for Mental Health, when we saw relatives standing outside glass windows attempting to speak to residents? And where was the federal response to distressed staff unable to assist older residents?"
In a disturbing insight into the impact of COVID-19 restrictions on all residents, depression and anxiety among the elderly who have sometimes not received visitors for months is on the rise, the royal commission found.
The "blunt instrument" approach of individual nursing homes - locking down completely and leaving residents isolated from not just their families, friends and community, but each other - exacerbated an already troublesome aspect of the sector, Prof Doyle said.
"We know that social support is vital for people to maintain their mental health," Professor Doyle said.
"This led to an increase in mental health issues such as depression and anxiety in many residents, understandably … We know that loneliness is associated with depression and leads to poor outcomes including higher mortality and morbidity.
"If the Federal Government did not take mental health of older people seriously before the pandemic, at least one outcome of 2020 has been to raise the profile of the plight of older people in these settings."
Staff at aged care facilities have also been left "traumatised" by what they have experienced, the report states.
"The interim report noted that the aged care workforce is under-resourced and overworked," it said.
"It is now also traumatised. Care workers develop close relationships with residents. Many are grieving for residents who have died after contracting COVID-19. Others are anxious about bringing the virus into their workplace or home to their loved ones."
Senior Research Fellow at Australian Catholic University Dr Bridget Laging told news.com.au: "There are both international and local reports that many staff in aged care are working without adequate PPE and limited clinical oversight to support infection control processes."
On top of that, Dr Laging said, is the "highly casualised and part-time" nature of the aged care workforce itself.
"There are many staff working across multiple sites, contributing to the spread of outbreaks across the sector," she said, adding that with visitor restrictions in place, staff are the "most likely vector for the introduction of COVID-19 into aged care facilities".
"If we are to learn anything from this, it is the vital importance of a consistent workforce of staff with the right skills to ensure safe care delivery."
Originally published as Australia's deadliest virus mistake