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The phone call that caused the aged-care crisis

Aug 27, 2020 • 16m 30s

The ongoing crisis in aged care has become one of the defining elements of Australia’s second wave. There are currently over 1500 active cases linked to aged care in Victoria, and hundreds have died. Today, Rick Morton on the new details that explain what went so wrong, and what the government could have done to save lives.

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The phone call that caused the aged-care crisis

296 • Aug 27, 2020

The phone call that caused the aged-care crisis

RUBY:

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

The ongoing crisis in aged care has become one of the defining elements of Australia’s second wave.

Archival tape -- Unidentified Reporter:

“Australia’s COVID death rate amongst aged care residents is one of the highest in the world.”

RUBY:

There are currently over fifteen hundred active cases linked to aged care in Victoria, nearly half of the state’s total number of active cases.

Archival tape -- Unidentified Reporter:

“Three hundred and forty-two have now died from the virus in the country’s aged care system.”

RUBY:

Today, senior reporter for The Saturday Paper, Rick Morton, on the new details that explain what went so wrong, and what the government could have done to save lives.

RUBY:

Rick, aged care has really been at the centre of the second wave of coronavirus. How did that happen?

RICK:

I can give you a really specific example, actually. So in mid-July, an aged care worker hired under the federal government's Covid-19 surge workforce was tested for the virus. And instead of quarantining, they then continued to work at a nursing home in Melbourne's south west for three days. On the third day, the employee was called while they were at the nursing home and told that they were positive for the coronavirus.

The outbreak that followed that at Benetas St Georges in Altona Meadows has killed four residents now. It's also thought that this worker had worked in another aged care home days before they got their test. But the service didn't know that. Benetas didn't know that. So that's just one example. But this has happened on a number of occasions. In fact, it was one of the biggest drivers of transmission in the early weeks of the second wave in Victoria.

One senior aged care sector worker told me that if you have an outbreak in your home, you have to, as the provider within half an hour, report it to the State Department of Health and the Federal Department of Health. So what that means is that the Federal Health Department - the Commonwealth government - unequivocally has a list of every single facility that has an outbreak and knows where and how the virus is spreading throughout the sector.

RUBY:

That information isn’t shared with nursing homes? What happens to it?

RICK:

Nobody can tell you because they haven't released it. It's sitting somewhere in the Department of Health, the Federal Department of Health. As one of the many aged care sources I spoke to for that piece told me, and I'll quote them here: “We cannot get this list. We have been asking for local heat maps of community transmission so providers can understand geographically if it's in their area.” So they're saying that if they had the list, it might have actually helped control an outbreak across Victoria because it would have helped them track staff.

You know, this person I was talking to said that they were particularly asking for the list of infectious facilities - so any facility that had at least one case, either resident or staff - they wanted that list. So it was not just the caring nursing staff that they're worried about, but there's catering professionals and there's laundry services, all people who work in and around aged care homes that, you know, they don't just work in one facility. And providers have been begging. They've been repeatedly asking for it. And they, you know, they said we cannot get it. They won't give it to us.

RUBY:

So why? Why isn't the federal government giving or sharing this data?

RICK:

Well, that's a very good question. So despite the green to release the heat map data in the first wave of the pandemic, the aged care minister, Richard Colbeck, changed his tune at a Senate committee hearing earlier this month during which he said providers did not want the data released.

Archival tape -- Richard Colbeck:

“Talking to, particularly some of the smaller facilities - their capacity to deal with a huge influx of, say, media enquiry, can impact severely on the facility…”

RICK:

He says that the reason for that is because providers have told him that they don’t want it released because it would be bad for the reputational damage and they'd have to deal with a whole bunch of media enquiries and they don't have the staff to do that.

Archival tape -- Richard Colbeck:

“I’m reluctant to have a public hitlist of facilities that have been unfortunate enough to have an outbreak of Covid within them…”

RICK:

The senior aged care sector source that I spoke to said this is 100% not true. And, you know, I spoke to a couple of others to triangulate a position from the three major aged care peak bodies, and they were all saying, none of us have said that. Not one. None of their members had come to them and said that they asked the government not to release it, because they're desperate for it to be released.

RUBY:

So, Rick, what is the impact of this decision, that was made for whatever reason, not to share this data? Can we definitely say that it has led to outbreaks?

RICK:

Well, I mean, we don't know at the moment and we don't know for sure. But I suspect any enquiry that comes out of this will find that. And one of the reasons we don't know now is because they haven't released the list. So, you know, there are providers out there who don't actually know what they could have avoided if they'd known about these outbreaks. And, you know, this is a really important example of a failure. But it's not the only one. It's just the latest one, really. And I think we have to go back to June to find the genesis of this story in Victoria. And it started with a single phone call.

RUBY:

We’ll be back in a moment.

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RUBY:

What happened in June, and how does it relate to the current crisis in aged care?

RICK:

Back in June, there was a phone call between senior state and federal government officials set up to discuss a draught protocol about what should be done in the event of the virus getting into a nursing home. So on that call, it was really heated. In fact, you know, someone described it to me as the worst phone call they’ve ever been involved with.

And the aged care sector was seriously, seriously urging - in fact, you know, I would go so far as to say begging - senior health officials within the Commonwealth, telling them that residents who tested positive should be taken out of the nursing home and into hospitals to limit the spread within those aged care homes. But the federal government at this point was resistant to the idea, or at least they didn't come and back up the providers. And it's interesting to me because, you know, one person on that call, you know, they had the distinct impression that this was about keeping the hospitals for the young. And so whatever the reason, ultimately the decision was taken to to keep residents in place. And that decision has cost lives. There's no question about that.

RUBY:

And there’s evidence that this could have been done differently?

RICK:

There’s oodles, oodles of evidence. So the international examples are actually really, really stark. And the one that was actually brought up on that June 10 phone call was a presentation that was made to the British House of Lords by Hong Kong's head of infection control, in which they were told that the island city recorded no aged care deaths because they had a priority to move any infected resident out of the facility to stop the spread. And interestingly, you know, places like Hong Kong and South Korea and Taiwan, their pandemic plans, unlike the one at the federal government in Australia, they weren't adapted from influenza.

RUBY:

And, Rick, there is a royal commission underway right now, and it is examining the government's response to the Covid-19 crisis in aged care - what has it heard on this issue?

RICK:

It's one of the most important opening addresses on a particular theme at this royal commission that I've seen. I mean, Counsel Assisting Peter Rozen QC opened the Covid-19 hearings for the Aged Care Quality and Safety Royal Commission. And he was very plainly worded. He said that the Commonwealth were incredibly disorganised. In fact, he specifically said they did not have a plan.

Archival tape -- Peter Rozen QC:

“While there was a great deal done to prepare the Australian health sector more generally for the pandemic, the evidence will reveal that neither the Commonwealth Department of Health nor the aged care regulator developed a Covid-19 plan specifically for the aged care sector.”

RICK:

There was a lot of backwards and forwards about that. And, you know, Brendan Murphy, the former chief medical officer for Australia and now secretary of the Department of Health, was incredibly incensed by that characterisation.

Archival tape -- Brendan Murphy:

“Commissioners, could I crave your indulgence, commissioners, and ask if it’s possible that I could make a very very brief opening statement, to respond to some of the statements made by the council assisting in his opening address on Monday, where it was alleged that the Australian government has not planned or prepared for the impact of Covid-19, and as a result we’ve had a high death rate - neither of those statements is accurate, and none of the witnesses today have been asked to respond to those issues…”

RICK:

But when they hit the stand on Wednesday, they couldn't actually prove that there was a plan. In fact, all they could point to was a document that was called guidelines for three successive updates. And we heard last week at the parliamentary enquiry hearing that those guidelines were suddenly changed to be called a national aged care plan. Only a week and a half ago, as if that alone would solve the crisis.

RUBY:

So essentially, this comes down to the fact that the federal government and the aged care regulator just didn't have a plan. Is this a story of inaction, Rick?

RICK:

It is. And it's a particular species of inaction, which is even more terrifying. It's one where you don't act in the face of all of the evidence. So, you know, we have a sector that didn't have a plan, a department that didn't have a plan, a regulator that thought its only plan was to call nursing homes and get them to tell them in their own words whether they thought they were ready.

And, of course, you know, a lot of them said that they thought they were best practise, including Newmarch house, where 19 people died. So we start at that point. And then when you do have experience both in Sydney at this point with Dorothy Henderson Lodge in Newmarch House, but also in New York and in London, where nursing homes were identified very early as one of the biggest drivers, in fact, the biggest driver of transmission of that outbreak.

And you've got a sector that we know, not just me, but them - they all know that it has been vastly underfunded, that complex healthcare has not been funded properly for at least the last six years, that severe behaviours, which is dementia, which is one of the things that make it harder to control an outbreak in an aged care home because there's wandering behaviours and people who don't fully understand why they're being isolated, they know that this sector is not funded to anywhere near the standard of a hospital. And then you've got a standoff between the federal government and the state governments when the federal government knows early on, at least according to documents, tended to the royal commission, what the correct answer is, which is: move people out to a facility where we can control the spread.

This is not about...yes, it's never good to move an elderly person to a hospital. It's not ideal, but nothing about this pandemic is ideal. Right. But the people left behind who are currently negative for coronavirus have a right to remain negative. And early on, the federal government at least knew that they had options. You know, they had Greg Hunt, the health minister, announced this to great fanfare in late March, that they'd come up with this amazing agreement, private hospital national partnership agreement with the states and territories where they could commandeer private hospital beds.

I think it was 33,000 beds,102,000 private hospital staff could be commandeered, not just for people who were clinically in need of care, but for vulnerable - and this is in the agreement - for vulnerable clients, including aged care residents who need not just clinical treatment, but isolation. And the aged care regulator quoted from that specifically very early on in April and May to remind them. And for some reason that was never invoked in New South Wales. And when it was invoked in Victoria, it wasn't until it was too late.

RUBY:

And what has been the impact of that failure to act until it was too late?

RICK:

So at the moment, there are about 400 or so aged care residents in private hospital beds in Victoria. But if that had been done at the start when you had those index cases, you might have stopped a lot of this spread.
So it's one of those stories where you... you’re an audience member, right, watching a movie where you know what's gonna happen, and you're screaming at the screen saying, don't go into the cellar! Don't go into the basement! I know what's down there! And the person up there should know because, you know, they've missed all these clues.

And we're not talking about the benefit of hindsight here. I want to be really clear about that. This was predicted with foresight. So this is not a simple case of saying, ah, well, now we know of course, we should have done better. They knew. And that's I think what hurts most about this story is that they knew. They ignored. They did nothing. They pretended that they were doing something which in some cases is actually more damaging than doing nothing at all, because it made some people kind of sit back and go, well, maybe they'll come to the party, maybe they'll put the extra resources where they need it. I mean, we still don't have clinical infection expertise on the ground within the first 24 hours of an outbreak in every single facility.

We still don't have that. Why don't we have that? Why aren't they sharing this information about outbreaks that could have stopped - in at least one case that I'm aware of, but I'm sure many more - could have stopped a nursing home operator hiring a Commonwealth-funded agency worker who had been at another site that had an outbreak that this new home didn't know about.

It's just... frustrating. And I've been dealing with this sector for six or seven years, and ordinarily they're very quick to, well not quick but they're cautiously guarded in their criticism of the government because the taxpayer funds about 80 percent of their total revenue stream. So they never want to criticise the government lest the government retaliate. And I've never come across people in this sector so furious and more alarmingly, so desperate, like they know that people are dying and they don't know what to do about it.

RUBY:

Rick, thank you so much for your time today.

RICK:

Thanks for having me. Ruby.

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RUBY:

Also in the news today…

Nearly 400 people quarantined at the Travelodge Hotel in Sydney have been relocated after police and health officials found the hotel had failed to meet public health standards. Issues raised by returning travellers included floors covered in grime, mold and food left in rooms by previous guests.

NSW Police Commissioner Mick Fuller said action was taken after photos from guests were circulated. The hotel has been removed from NSW’s quarantine program.

And a new report from Greenpeace has found air pollution from Australia’s ageing coal-fired power stations kills around 800 people each year.

This estimated national death toll is twice that of the number of smoke inhalation deaths in the recent catastrophic bushfire season.

I’m Ruby Jones, this is 7am. See ya tomorrow.

The ongoing crisis in aged care has become one of the defining elements of Australia’s second wave. There are currently over 1500 active cases linked to aged care in Victoria, nearly half of the state’s total number of active cases, and hundreds have died. Today, Rick Morton on the new details that explain what went so wrong, and what the government could have done to save lives.

Guest: Senior reporter for The Saturday Paper Rick Morton.

Background reading:

Federal government holds back vital Covid-19 spread data in The Saturday Paper
Exclusive: The phone call that denied elderly patients access to hospital in The Saturday Paper

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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.

New episodes of 7am are released every weekday morning. Subscribe in your favourite podcast app, to make sure you don’t miss out.

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296: The phone call that caused the aged-care crisis