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The Covid crisis in aged care

Aug 4, 2020 • 16m 33s

Aged care has been one of the hardest hit sectors during this phase of the Covid pandemic, with residents and their carers making up a large proportion of those catching the virus. Today, Rick Morton on the crisis in our aged care facilities, and why we should have seen it coming.

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The Covid crisis in aged care

279 • Aug 4, 2020

The Covid crisis in aged care

RUBY:

From Schwartz Media, I’m Ruby Jones, this is 7am.

Aged care has been one of the hardest hit sectors during this phase of the Covid pandemic. Residents and their carers make up a large proportion of those catching the virus.

The sector is also being examined by a Royal Commission, following widespread allegations of mismanagement and poor care.

Today, Rick Morton on the crisis in our aged care facilities.. and why we should have seen it coming.

Archival Tape -- Reporter:

“Military medics and interstate nurses are being rushed into aged care homes in Victoria amid a growing health crisis that is disproportionately affecting the vulnerable elderly.”

Archival Tape -- Reporter:

“The Epping Gardens aged care facility in Melbourne has recorded 83 cases, 61 residents and 22 staff members…”

Archival Tape -- Reporter:

“Yesterday there were just 24 cases at this aged care home in Melbourne’s north, today there are 77…”

Archival Tape -- Reporter:

“Outbreaks are continuing to grow with a jump of 19 cases at a nursing home in Kilsyth in the city’s outer east. “

Archival Tape -- Reporter:

“Grief-stricken families are desperate for answers over the aged care disaster that’s now responsible for more than 900 cases.”

RUBY:

Rick, a few weeks ago, there were barely any cases of Covid-19 in Victorian aged care centers. So can you tell me how this happened? How is it that so many centers are now grappling with outbreaks?

RICK:

You don't have to go back very far to find the first infiltration of aged care in Victoria. It's only a couple of weeks ago really now in hindsight. But once the virus gets a foot in those institutions, it's very hard to contain.

RUBY:

Rick Morton is a senior reporter at The Saturday Paper.

RICK:

And to really answer the question about how it spreads, though, I think you need to go back to basics in which this sector is extremely underfunded. It has an extremely low paid and unskilled workforce. The lack of skills is not their fault, it's just not a sector that's been given a lot of love by successive governments over the past decades. And so what you've got is a lot of itinerant workers, a lot of migrant workers in low paid jobs who are working more than one job.

And they don't have the same access to personal protective equipment, particularly the start of this pandemic. I heard lots of stories from people in aged care who were trying to get masks and gowns and gloves from the national stockpile, but they were all going to hospitals and ICU units because that's where the main focus was at the time.

A lot of that's caught up since. But you've still got workers going from one facility to the next to the next. And if one of those gets coronavirus and it takes a few days before they're tested or we find out, then it's quite possible and in many cases it did happen it means they've worked across multiple different centers. And so you've got this kind of seeding from the community into these closed-door institutions and away you go.

RUBY:

Rick, is this something that we should have seen coming? Weren't aged care centers huge vectors for the virus overseas?

RICK:

Yes. And you know, in Europe, particularly like England, Spain and France.

Archival Tape -- Reporter:

Scandal now surrounds Italy’s largest nursing in nearby Milan where at least 143 people have died since the beginning of March…

RICK:

But not just overseas. I mean, we had a case in Newmarch house run by Anglicare in Sydney a couple of months ago during the first stage of this pandemic.

Archival Tape -- Reporter:

“Coronavirus-affected nursing home in Sydney’s west has held a conference with family members who are demanding better care. The call came after a 79-year-old woman became the fourth resident to die in less than a week at Newmarch house. “

RICK:

19 residents died. And I think there are more than 60 infections all up.

Archival Tape -- Reporter:

“The death toll from the coronavirus that plagued Newmarch house in western Sydney has left families of residents heartbroken and searching for answers.”

RICK:

There were reports out of various European countries that found between 42 and 57 percent of deaths from the virus were happening in care homes. In Canada, it's 85 percent.

Archival Tape -- Reporter:

“Right now, we’re seeing terrible tragedies in long-term care facilities across the country. This is unacceptable…”

RICK:

So we really can't say we didn't know. It's just not feasible in any way, shape or form to say that we were not warned. We were warned and we had ample evidence.

RUBY:

And, Rick, where does the responsibility lie here? Because there have been tensions between the Victorian government and the federal government over who is actually responsible for the care in these centers. So where does the buck stop?

RICK:

It's an incredibly thorny question. Aged care is the federal government sector. In 2011, the Gillard government signed with all of the states and territories a new COAG agreement

Archival Tape -- Gillard:

“I’m here today with Minister Butler to announce the government’s new policy on the future of aged care…”

RICK:

which made the Commonwealth assume full responsibility for the care needs of anyone over the age of 65

Archival Tape -- Gillard:

“More people will get to keep their home and more people will get to stay in their home and it will put our aged care system on a sustainable footing…”

RICK:

or if you were indigenous, anyone over the age of 50 because they have shorter life spans on account of inequality. And so the commonwealth took full responsibility.

Archival Tape -- Gillard:

“So it can provide the kind of care that Australians expect and deserve as our population changes…”

RICK:

They fund it. They write the rules. They regulate it. They are meant to check. Obviously, we've got a public health emergency in Victoria and the states run the hospital system.

But ultimately. The longer term questions about what happens afterwards, they are federal government responsibility and it is the federal government that must take stock here and prevent this from happening in the future, because this was a long time coming.

RUBY:

We’ll be back in a moment.

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RUBY:

Rick, the federal government took responsibility for the funding of aged care, almost a decade ago now. What is the situation currently, in terms of the resources that the sector has?

RICK:

Almost 80 percent of all the money in aged care is the 27 billion dollar a year sector, 80% of that comes from the taxpayer. So from the commonwealth. So nursing homes get a proportion of that based on the frailty and the needs of the residents in each home.

The coalition decided that a bunch of providers were rorting the ACFI the direct care subsidy. So they slashed it. They paused the indexation. Despite the fact that people were older and more frail than ever.

So in 2015 and 2016, $1.2 billion was taken out of the ACFI out of the direct care subsidy. It was about $2 billion all up if you include them. The measures that happened before and after. And that brought the sector to its knees.

Now, I'm not here to defend aged care providers. I'm not saying they need buckets of money, certainly not the private providers. But what happened was that at one point for about a year and a half, aged care funding, overall in terms of care didn't grow at all.

And in the complex health care domain, it fell. And the government has known about this, they were warned about this. There were you know, IFOI stuff two years ago from the Department of Health, and actually they knew the changes were bad because they created a table called winners and losers. And they found that the proportion of aged care providers who were functioning essentially at an operating loss went up to more than half as a result of those changes. That figure is now across the board, is closer to 75 percent of providers operating at a loss.

And the royal commission now has come out and said that what it needs, by their estimate at the moment, is an extra 50 to 100 percent funding from both taxpayers and consumers most likely, and the community.

Archival Tape -- Reporter:

“While we are a very rich nation, one the richest nations on the planet, at the richest time in history, that’s not delivering the quality aged care services that we need and are going to need more of in the future…”

RICK:

So that's an extra, you know, 13, 15 billion dollars a year at a conservative estimate and almost twenty-seven billion dollars on top of 27 billion dollars now.

That alone should tell you how bad things are.

RUBY:

Right - so you’re saying there have been effective funding cuts for years now - which have had an impact on the ability of these homes to provide care. Given that, were you at all surprised when Covid took hold in the sector in the way that it has?

RICK:

No, not at all. And, you know, I'm not a clairvoyant. I'm just someone who's followed the policy.

Like, you know, for years leading up to this outbreak. You were hearing stories, including at the royal commission.

Archival Tape -- Royal Commission:

“Miss Henderson you were the director of nursing at Greenway Gardens from around April of last year…”

RICK:

Including one of these facilities. Well, one of the providers of one of these facilities is currently experiencing an outbreak.

Archival Tape -- Royal Commission:

“And that was reporting to you?”

Archival Tape -- Ms Henderson:

“Yes.”

Archival Tape -- Royal Commission:

“Were you delivering clinical care on the floor at Greenway Gardens?”

Archival Tape -- Ms Henderson:

“That wasn’t my direct role.”

RICK:

And at this facility in Greenway Gardens, in the Royal Commission, they had a clinical care coordinator, which is the second-highest clinical position at an aged care, they’re meant to oversee all of the care, make sure the medications are right, make sure the staff are following up on, you know, wound checks, documenting everything, making sure that residents don't suffer. They had a clinical care coordinator only employed three days a week.

Archival Tape -- Royal Commission:

“And was three days a week sufficient for her to complete her duties as a clinical care manager at that time?”

Archival Tape -- Ms Henderson:

“No.”

RICK:

And most of their job, at least half of it, according to some testimony, was trying to maximize government funding through the ACFI, the direct care subsidy.

Archival Tape -- Ms Henderson:

“In my opinion I believe it meant that the care coordinator was not able to spend enough time on the floor, supervising what was happening and observing what was happening. And it meant she wasn’t able to follow up effectively on wound care, and generally see what was happening day to day…”

RICK:

Now, that's not a perfect system. You shouldn't have to employ consultants to get adequate funding in a government funded healthcare system. You shouldn't have to do that. But the fact that they do is poor performance from them, but it also goes back to the government.

Archival Tape -- Ms Henderson:

“Staff are trying to provide care under very difficult circumstances. And yet we are expected to do the paperwork. Where is our priority? Our priority should always be with residents and the documentation comes after...”

RICK:

The government knows. They knew all of this stuff. So I wasn't surprised at all.

And I was talking to someone the other day where they used to work as an aged care nurse and they used to have to shower eight people before breakfast. Eight elderly, frail residents with dementia. Can you imagine how long that would take to do it properly? He said it was much more like a machine line. Get em in. Get em out. Get em in. Get em out. And that's everywhere. That's not an isolated story, so.

You know, all of this stuff comes together and then you get one of the most infectious diseases, humankind has ever seen. And what chance did they have? What chance did they ever have? You know, they can barely manage influenza outbreaks.

RUBY:

And what is happening now to these people who are in these aged care homes in Victoria who either have coronavirus or are at risk of contracting it?

RICK:

Well, I mean, a lot of them are dying. We've been seeing reports for the last couple days of residents who are left in their beds dead overnight because they didn't have refrigeration on site. And they're telling families to come and get them because they're deteriorating or rotting away.

Like this is. This is kind of what we saw in Italy, right. Where people were deciding who got care based on how old you are and how likely you were to survive.

And, you know, I've been having arguments with people on social media who are saying, yeah, but they were gonna die anyway. So who cares? And I'm like, well, that's kind of the problem, isn't it? Through funding and government policy, it's almost like we've ingrained this cultural notion in our heads that they are susceptible. But you kind of ignore the fact that people who are in hospital, even the ones who haven't died, but they've got the infection, their loved ones can't hold their hands.

And so you've got all of this emotional toll kind of being exacted through these, in some cases, necessary restrictions.

But if you really believe the argument that they would have died anyway, if that is really what you feel. My point has always been that, okay, fine. But at least in those other circumstances, you could have held their hand as they went. That's what we did with my grandma. And I think everyone should have that right.

RUBY:

Rick, thank you so much for your time today.

RICK:

Thank you so much, really appreciate it.

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RUBY:

Also in the news —

The Victorian Premier has announced a series of new restrictions relating to workplaces in the state.

The new ‘stage 4’ restrictions mean many shops in Melbourne will be closed, though drive-through pick-ups and home delivery will still be available.

There are exemptions for essential businesses, which will be able continue to operate unchanged, including supermarkets, bottle shops, banks, pharmacies and post offices.

Abattoirs will move to a two-thirds production model, and workers will be required to wear full PPE and will be temperature checked at work.

The construction industry will also be scaled back with commercial builders no longer able to have more than 25 per of staff on site.

The Premier Daniel Andrews said the aim of the new restrictions is to significantly reduce the movement of people

While most of these ‘stage four’ restrictions apply to Melbourne, the changes to abattoirs also apply to regional Victoria.

Businesses that are affected by the restrictions can apply for a $5-thousand dollar grant from the state government.

The Premier flagged that there will be further announcements about penalties today.

And the Prime Minister has announced a $1500 'pandemic disaster payment' for Victorians.

The payment will be available to workers who have exhausted, or do not have, sick leave and have been directed to stay at home by a public health official.

I’m Ruby Jones, this is 7am, see you tomorrow.

Aged care has been one of the hardest hit sectors during this phase of the Covid pandemic, with residents and their carers making up a large proportion of those catching the virus. The sector is also being examined by a Royal Commission, following widespread allegations of mismanagement and poor care. Today, Rick Morton on the crisis in our aged care facilities, and why we should have seen it coming.

Guest: Senior reporter for The Saturday Paper Rick Morton.

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7am is a daily show from The Monthly and The Saturday Paper. It’s produced by Ruby Schwartz, Atticus Bastow, and Michelle Macklem.

Elle Marsh is our features and field producer, in a position supported by the Judith Neilson Institute for Journalism and Ideas.

Brian Campeau mixes the show. Our editor is Osman Faruqi. Erik Jensen is our editor-in-chief.
Our theme music is by Ned Beckley and Josh Hogan of Envelope Audio.

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279: The Covid crisis in aged care