This article was written by Kim O'Connell, Luke Hawthorne and Sarah-Jane Frydman.
According to the Aged Care Royal Commission, the first eight months of the COVID-19 pandemic have been "the greatest challenge Australia's aged care sector has faced."
The Commission has now taken the extraordinary step of releasing a Special Report on Aged Care and COVID-19 (Special Report), which provides recommendations for immediate action by the Government to address issues in the Aged Care Sector.
From 10 to 13 August 2020, the Aged Care Royal Commission held hearings as part of an investigation into the response to COVID-19 in aged care homes across Australia. Five broad recommendations have emerged in its Special Report, together with a recommendation that the Federal Government report to Parliament on implementation of the recommendations by 1 December 2020. The recommendations and the initial response from the Federal Government, are discussed below.
The Special Report does not seek to apportion blame for mistakes which may have been made in aged care homes to date, but does seek to identify "what lessons have been and can still be learnt" in relation to protecting aged care residents and staff from COVID-19, improving outbreak management and ensuring that residents have equal access to medical treatment and ongoing contact with family and friends during the pandemic.
Recommendation 1 – An urgent report on implementation
The Aged Care Royal Commission has declared that the recommendations made are "important and the public has a right to know how the Government has responded to them." As such, the Commission has recommended that the Australian Government should report to Parliament by no later than 1 December 2020 on the implementation of these recommendations.
Recommendation 2 – Visitors and quality of life
The Aged Care Royal Commission has acknowledged that visits from family and friends are critical to the physical, mental and emotional health and wellbeing of people living in residential aged care and also their friends and families. These visits have been affected by the various public health orders issued by States and Territories – but also by the disproportionate risk faced by aged care residents when exposed to COVID-19. As a consequence, some providers have also opted to impose stricter obligations than those mandated by regulatory guidelines in order to further reduce that risk. The Commission makes it clear that visits should be humane and proportionate to risk and in all but extreme cases, blanket bans on visits are unacceptable.
Evidence before the Commission has made plain that the mental health of aged care residents is dependent on being able to spend "meaningful and fulfilling" time with loved ones.
The Commission acknowledges attempts by the sector and the Commonwealth Department of Health to address this issue – however, such efforts have had limited impact owing to a lack of funding for additional staff to facilitate visits by conducting screening, assisting with personal protective equipment and where necessary, accompanying visitors.
Therefore, the Commission recommends that the Australian Government should immediately fund providers that apply for funding to ensure there are adequate staff available to allow continued visits to people living in residential aged care by their families and friends.
Recommendation 3 – Allied Health
Evidence given to the Commission by allied health professionals (such as physiotherapists) has confirmed that COVID-19 restrictions have caused a decline in allied service delivery to aged care residents at a time when residents' physical and mental health is at greater risk due to restrictions on visits by family and friends.
The Commission recommends the creation of additional Medicare Benefits Schedule items to increase the provision of allied health services, including mental health services, to residents of aged care during the pandemic.
Recommendation 4 – National Body and Advisory Plan
The Federal Government's response to the COVID-19 pandemic has been informed by the Australian Health Protection Principal Committee (AHPPC), an advisory body chaired by the Chief Medical Officer. The AHPPC does not have an aged care specialist among its members and although the AHPPC recognised the particular vulnerability of aged care residents to the virus, the measures taken by the Government to ensure the preparedness of aged care homes were according to the Commission, "in some respects insufficient to ensure preparedness". While the Government appointed a time limited AHPPC Aged Care Advisory Group on 21 August 2020, the Commission believes that does not go far enough and should not be time limited.
Following the significant number of infections and deaths of aged care residents due to COVID-19, the Commission notes there is a clear need for a "defined consolidated national aged care COVID-19 plan", which can inform the practices of aged care homes around the country. Better protocols for coordination between State, Territory and Commonwealth Governments are required, along the lines of the protocol established between New South Wales and the Commonwealth after the outbreak of COVID-19 at Newmarch House in April 2020. These are yet to be implemented in other States and Territories and the Commission's recommendation is that the national aged care advisory body should establish a national advisory plan.
One matter that the Commission noted should be addressed in clear terms, is whether and in what circumstances, a resident of an aged care home will be transferred to hospital. The evidence before the Commission demonstrated a lack of clear guidance and practice around this and differences of opinion had arisen between those responsible at State, Commonwealth and clinical levels in individual cases. Some witnesses commented on the lack of suitability of aged care homes. The Commission accepts that there is not a "one size fits all" answer to the question of when a resident should be transferred to hospital, as different aged care homes have varying capacity to provide a suitable environment for residents who have contracted COVID-19.
The Commission noted that there is a need for "much closer collaboration as an entire health system" at State and Australian Government level.
Recommendations 5 and 6 – All Residential Aged Care homes should have one or more trained infection control officers as a condition of accreditation and the Government should deploy infection prevention and control officers into facilities to provide training and assist with outbreaks.
The Commission heard evidence that aged care homes have insufficient capacity to implement infection control measures, particularly at a level suitable to restrict the spread of COVID-19. In addition, they heard evidence about a lack of training for staff in the use of personal protective equipment, and in some cases, shortages of PPE made available to staff. The Commission noted that a lack of suitable PPE is "deplorable".
The Report notes that infection control measures are important not only for the health, wellbeing and safety of residents, but also of workers in aged care, who are at risk of catching COVID-19.
Federal Government Response
The Aged Care Royal Commission has made significant recommendations which will address some of the issues that have adversely affected residents of aged care homes. In a press release issued yesterday, the Minister for Aged Care, Senator Richard Colbeck, announced that the Commonwealth Government has accepted all six recommendations, saying that it has already made "substantial progress" on four of them and committing $40.6 million to the initial response to the Royal Commission's report and recommendations. Significant commitments included in that announcement are:
- The Government will bring forward the introduction of the Serious Incident Response Scheme (SIRS) and invest an additional $29.8 million in the SIRS for residential aged care. The Scheme will extend beyond COVID-19.
- The Aged Care Advisory Group, established on 21 August 2020 under the AHPPC, will be made permanent.
- The Government will mandate that aged care homes have infection control officers and will invest $10.8 million to expand the Australian College of Nursing scholarship program and create a skills development program for nurses and personal care workers in aged care.
While these and other Government measures address the recommendations made by the Commission in the Special Report, it is clear that they represent further significant changes for providers of residential aged care. The challenge for providers to meet frequently changing guidance, restrictions and regulatory requirements will continue. It is to be hoped that these further measures provide clearer guidance, lines of responsibility and additional funding to support the care of aged care residents, and enable providers to avoid some of the harsher restrictions that have been placed on residents, their friends and families, which have impacted the quality of life of residents during the pandemic.