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AN inspiring, but overlooked image of the recent firestorms in Australia still plays on my mind. Dedicated aged care workers, many of whom were concerned about losing their own homes, walked across paddocks because of road blockages to care for frail senior Australians in residential aged care facilities.
There are startling parallels in the way aged care clinicians and other workers have responded to the January firestorms and the subsequent coronavirus disease 2019 (COVID-19) pandemic.
Despite a welcome flattening of the curve, a pandemic firestorm remains a threat in Australian residential aged care homes, as has happened internationally, where up to half of all deaths from COVID-19 have occurred in nursing homes. In the US, UK and Europe, news headlines have included: “They’re death pits”: virus claims at least 7000 Lives in US nursing homes, Care home deaths “far higher” than UK official figures and Corpses of the elderly found by military abandoned in Spanish care homes.
If we are to learn anything from these disturbing international images, it is that older people require special assistance not only to prevent and respond to COVID-19 outbreaks, but for the optimal management of other acute and chronic conditions, including mental illness and dementia during the pandemic. This is clearly the responsiblity of medical practitioners.
Over the past few weeks, we have breathed a collective sigh of relief. Australia is likely to defy the predictions of mass deaths and mass palliation in our communities. However, we cannot yet be sure that we will avoid these worst-case scenarios for vulnerable groups, including over 200 000 residents living in aged care facilities. To mitigate this ongoing risk, medical practitioners have an advocacy role, including calling out negative attitudes which impact adversely on the aged care sector.
For example, there is a double standard in attitudes to residential aged care facilities compared with other hospitals and health services, despite the personal risks of contracting COVID-19 for all front-line staff in these environments. On one hand, there has been a punitive approach towards residential aged care providers who maintain the same strict rules of social isolation for their residents as imposed on the rest of the community. At the other extreme, after a COVID-19 outbreak ravaged Newmarch House in NSW, an aged care worker was scapegoated without a wider consideration of the systems issues contributing to the tragic deaths.
In stark contrast, the Tasmanian Premier Mr Peter Gutwein demonstrated leadership when he recently delivered the interim report on the COVID-19 North West Tasmanian regional hospital outbreak. He emphasised that blame should not be ascribed to any individuals after a cluster of deaths, the closure of hospitals and the quarantining of over 1300 health workers and their families. Instead, he accepted the critical lessons learnt to avoid future outbreaks through systems changes and sincerely thanked courageous frontline staff for their strong work ethic.
Many dedicated aged care clinicians and other workers have feared being held personally liable for the failures of our chronically underfunded aged care system for some time. Prior to the pandemic, the interim report of the Royal Commission into Aged Care Quality and Safety exposed a number of abhorrent cases of criminal conduct which clearly required punitive responses. In other cases, individual aged care clinicians and other workers were condemned for poor quality of care in residential aged care, when the root cause was a systems wide lack of access to GP, specialist and other health care. A negative blame game is damaging to the morale of the aged care workforce and is continuing to result in a high turnover of skilled aged care clinicians and other workers.
To compound the barriers deterring access to health care, many senior Australians are currently avoiding consulting GPs or other specialists despite the welcome roll-out of telehealth. This has prompted the federal Health Minister to encourage all Australians to continue to seek preventive and other health care because the pandemic has hidden victims, including those who are sick or dying but not from the virus.
Despite the recent damning statements by media about the whole sector, many residential aged care providers continue to provide a very high standard of care. With strict infection prevention and control procedures in addition to appropriate restriction of visitors, most residential aged care facilities are providing safe havens for senior Australians, as well as skilled respite care, post-operative care and rehabilitation to help reduce hospitalisation. On 1 May, the Prime Minister Mr Scott Morrison announced a welcome additional $205 million funding to help residential aged care maintain and enhance safe systems.
A negative community debate has also been raging about the restriction of visitors to residential aged care, despite many residents expressing their preference for strict lock downs with ongoing contact to loved ones by other means. Clearly, it is not acceptable for anyone to be denied visitors at the end of their lives or for other compassionate reasons. In response to this debate, the aged care sector is working in partnership with government to develop an Aged Care Visitor Access Code. The adoption of the COVIDSafe app by aged care staff, relatives and other visitors will also help protect senior Australians.
Nevertheless, despite these interventions, dying in isolation in a second wave of a pandemic firestorm remains a grim risk for vulnerable senior Australians, as we have recently seen in Singapore. It must be remembered that most of the 95 Australians who have died from COVID-19 have been over 70, and many families are traumatised after being restricted from attending their funerals following their lonely deaths in quarantine. Aged care providers and workers are acutely aware of this profoundly sad reality.
In recent weeks, the Australian medical profession has demonstrated what it can achieve with collective leadership and advocacy. Together, we can challenge and change negative attitudes to the aged care sector to protect our senior patients. We can also proactively provide the very best comprehensive health care, including optimal prevention and management of acute and chronic (non COVID-19) conditions via videoconferencing and face to face consultations to reduce their vulnerability to COVID-19.
Among the images that I will remember when the pandemic is over, it is a now famous wheelchair-bound 94-year-old woman being cheered by dedicated staff at Austin Health as she beat the odds and survived COVID-19.
When the pandemic is over, I hope we will also remember the major contribution of other doctors working in partnership with our aged care clinicians and other workers at the frontline keeping frail senior Australians safe and well – and out of hospital.
Or will we share the shameful legacy exposed internationally in nursing homes in the US, the UK and Europe?
We still have time to determine the course of this pandemic’s history. It is far from over.
Clinical Professor Leanne Rowe AM is a GP, past Chairman of the Royal Australian College of General Practitioners, non-executive director at Japara Healthcare, and co-author of Every Doctor: healthier doctors = healthier patients www.everydoctor.org
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.
I’m taking my mum out of her nursing home as she wasn’t allowed visits to come home with me and visits to her at the home were limited to 1 hour per day. Unlike the supposedly happy residents in this story, Mum was extremely depressed in her nursing home. I doubt very much that residents would willingly forego visits by their families, and that they would be just as happy with Skype sessions or trying to talk over a glass barrier. This doesn’t ring true at all for me. The government’s management of CoVid-19 has been deplorable. The laxatity of identity checks at borders was grossly irresponsible. I don’t believe the government was naive in expecting people to always tell the truth about their name, address and whether they had been to a hot spot. The government is well aware that people lie. For whatever their own reasons were, they simply chose not to have more stringent rules that would have protected us.
The government wittholds CoVid-19 infection rates in nursing homes from the public. The reason for this is to maintain the reputation of the nursing home. A resident would be admitted to a facility and none of the family would be aware of any existing CoVid cases. Nursing homes have their own policies which often are over and above directives set out by the health departments. Restrictions on top of restrictions for the poor residents.
If you’re at the end of life, family is everything. Restrictions which bar family visits and visits to the family home are cruel. The people that bear the brunt of government ineptitude are the nursing home residents who will face their final years living in misery, while the government will still pander to the tourism lobby, football clubs, pubs, restaurants etc. as though we can’t create a healthy economy via other means.
Well said. I agree wholeheartedly.
This is a timely and considered response and critical as we moved towards transition to a new normal which will likely result in more criticism of the aged care sector as the media quickly forgets and wants to move on.
It seems to me likely the sector will be required to effectively treat any unwell resident as possible Covid19 until proven not to have the disease due to the transmission risk and varied presentation of symptoms in the resident age group.
This will be a further pressure on the system which is one of the best in the OECD due to the mix of public and consumer funding. We must keep the balance to meet the needs of the very diverse Australian community.
The Medical professionals, nurses and staff of the aged care sector have responded to the needs of the people in their care and will continue to do so. They are all hero’s and I know if my mother was still in a memory support unit it would be an enormous relief to me as it must be to many right now.
On behalf of the Australian and New Zealand Society of Geriatric medicine we thank Professor Leanne Rowe for her insightful article. It could turn out that the management of COVID-19 in residential care becomes one of the most important clinical issues we face during the pandemic in Australia. The key will be the support provided to Aged Care by GPs, specialist outreach services to Aged Care run by geriatric medicine departments, public health units and state and federal governments. Health workers in hospital who are on the front line for COVID-19 are hailed as heroes. Aged Care staff who are at the front line to protect our most vulnerable do not receive the same accolades. Now is the time to think more about how we can support them and the older members of our society whom they care for.
Excellent article by Professor Leanne Rowe.
Aged Care staff in the residential care home that I attend have been doing an amazing job both before and continuing to do in the current Covid climate.
Most GPs who attend residential care patients are older and at risk themselves.
As the previous National Chair of the RACGP, our committee continually requested being able to provide Telehealth Consultations where appropriate for these residents. It is interesting that it took a Pandemic for the Government to provide these item numbers.
Hopefully, these Telehealth item numbers will still be able to be accessed after September 2020.
I would request also that the Federal Government cease treating GPs who visit Aged Care differently to GPs in private practice and other Specialists and finally allow the same medicare rebate for each patient that a GP sees in Residential Care and abolish the “Law of Diminishing return.”