Unlike the Royal Commission’s Interim Report ‘Neglect’, the surprisingly succinct 38-page ‘Aged care and COVID-19: a special report’ is more constructive than critical.
Noting that aged care residents make up 74% of COVID deaths in Australia – a “high figure” by international standards – but Australia’s overall mortality rate is relatively low at 0.25%, the Commissioners say they are releasing this report now – five months ahead of their Final Report – because they do not know how long the pandemic will last – and it is clear action is needed now.
“It is clear to us that people receiving aged care services, their loved ones, those providing care and the aged care sector itself need immediate support and action,” they write. “Governments need guidance based on the evidence we have heard and are able to summarise in this report.”
The Federal Government has responded by committing at least $40 million to increasing staffing levels in residential care, improved access to allied health and mental health services, a national aged care plan and mandatory infection control and prevention accreditation in aged care homes in response to the Royal Commission into Aged Care Quality and Safety’s special report into the COVID outbreaks in Australia’s aged care homes.
Governmnet singled out for lack of leadership
The Commissioners conclude that the Federal Government’s measures to prepare the aged care sector for the pandemic were “insufficient” in some ways – particularly in terms of leadership from the Commonwealth.
“Confused and inconsistent messaging from providers, the Australian Government, and State and Territory Governments emerged as themes in the submissions we have received on COVID-19,” the Commissioners state. “All too often, providers, care recipients and their families, and health workers did not have an answer to the critical question: who is in charge? At a time of crisis, such as this pandemic, clear leadership, direction and lines of communication are essential.”
However, overall, there is little criticism heaped on the Government or aged care providers.
“Now is not the time for blame,” the report states. “There is too much at stake. We are left in no doubt that people, governments and government departments have worked tirelessly to avert, contain and respond to this human tragedy. However, the nation needs to know what lessons have been and can still be learnt. The nation needs to know what is being done, and what will be done, to protect those people receiving aged care services—those who this virus has affected disproportionately and whose entitlement to high quality care in safe environments that protect their wellbeing and dignity falls within the scope of our commission.”
National aged care advisory body to guide the sector
The Commissioners make six recommendations – including the recommendation that the Government take up all of the recommendations by 1 December – just eight weeks away.
The recommendations include:
- Extra funding for staffing to allow aged care residents to receive more visitors: “The Australian Government should fund providers to ensure there are adequate staff available to deal with external visitors so that the Industry Code for Visiting Residential Aged Care Homes during COVID-19 (Visitation Code) can be modified to enable a greater number of more meaningful visits between people receiving care and their loved ones.”
- Improved access to allied health and mental health services for aged care residents: “The Australian Government should create Medicare Benefits Schedule items to increase the provision of allied health and mental health services to people living in residential aged care during the pandemic to prevent deterioration in their physical and mental health. Any barriers, whether real or perceived, to allied health and mental health professionals being able to enter residential aged care facilities should be removed unless justified on genuine public health grounds.
- A national aged care plan for COVID-19 and the establishment of a national aged care advisory body:
The Commissioners reject the model proposed in the Royal Commission’s COVID hearings for a national coordinating body specifically for aged care.
Instead, they propose a national aged care advisory body.
This would include:
- setting up protocols between the Commonwealth and the States and Territories based on the NSW Protocol but having regard to jurisdictional differences;
- establishing a mechanism for consultation with the aged care sector about use of Hospital in the Home programs in residential care;
- establishing protocols on who will decide about transfers to hospital of COVID-19 positive residents; and
- ensuring that significant outbreaks in facilities are investigated by an independent expert to identify lessons that can be learnt and the results of any such investigations disseminated to the sector.
The Commissioners acknowledge that the Government already set up a ‘time-limited AHPPC Aged Care Advisory Group’ on 21 August which they say is “positive” but add that it “does not go far enough”.
“It is critical that there is a body responsible for monitoring and planning for health emergencies as they apply to the aged care sector. There is a need for a body with a particular focus on the group of people most vulnerable to this and other infectious diseases to provide regular and timely practical information to the aged care sector,” they state.
The Commissioners add that they see this body as having a role beyond the current pandemic.
“For example, it will assist the sector to prepare for future influenza outbreaks which lead to many deaths in homes each winter.”
While the Commissioners don’t express clear support for hospital transfers for residents that test positive with COVID, it is evident that they believe residents should be entitled to equal access to the hospital system.
“Any policy on the use of Hospital in the Home in residential aged care facilities must be developed in consultation with the aged care sector and should ordinarily be confined to small outbreaks, as recommended by the independent Newmarch House review,” they say. “If Hospital in the Home is to be implemented in an aged care facility all relevant pre-conditions must be met before implementation.”
- Mandatory infection prevention and control for aged care homes: “All residential aged care homes should have one or more trained infection control officers as a condition of accreditation. The training requirements for these officers should be set by the aged care advisory body we propose.”
- The Government arrange with the States and Territories to deploy accredited infection prevention and control experts into aged care homes to provide training, assist with the preparation of outbreak management plans and assist with outbreaks.
Aged Care Minister says Government already “well progressed” on recommendations
In a doorstop interview in Devonport, Tasmania, Aged Care Minister, Senator Richard Colbeck, thanked the Commissioners for their “constructive” assistance and said the Commonwealth would accept all six recommendations – including the 1 December deadline to implement the recommendations.
Minister Colbeck added that the Government was already “well progressed” in delivering four of the six, but announced additional funding to help achieve all six.
This includes $40.6 million for two initiatives – another $29.8 million to bring forward the Government’s promised Serious Incident Response Scheme (SIRS) to early 2021 and an extra $10.8 million to enhance the skills and leadership of aged care nurses and personal care workers.
Will the Government be able to achieve all these measures by the Commissioners’ deadline?