Government and sector come together to settle lockdown dispute

The beef between the aged care sector and the government over restrictive measures in the sector looks to have been settled, with the announcement of a draft code of conduct on visitation rights as well as a $205 million bump in emergency funding.

Last week the government called out aged care providers who had enforced stricter lockdown protocols than federally mandated. However, the sector’s peak bodies said that harsh restrictions are saving lives, and they placed an ad in the major newspapers calling for an extra $1.3 billion in funding to combat the virus.

Now the government plans to finalise an industry code of conduct for the sector that will include mandatory visitation allowances for family members.

The coronavirus pandemic has played havoc on an already embattled industry, and the debate about facility lockdowns has rumbled on since the government announced restrictions in mid-March.

The Morrison government mandated that visitors who are sick or anyone returning from overseas must be barred from going to an aged care facilitie. Only short visits to residents at facilities are allowed, with a maximum of two people once a day.

Any visits must take place in a resident’s room or a designated space, barring any communal areas, and the government urged everyone to practise social distancing of 1.5 metres.

Prime Minister Scott Morrison said that entry to a facility is barred to staff who have been overseas, people who have been in contact with a confirmed COVID-19 case, and anyone whose flu vaccine wasn't up to date.

All visiting school groups have also been barred from aged care, as has any outside entertainment. Children under the age of 16 can only visit with special exemptions.

Morrison has said that palliative care restrictions will be left to the discretion of the facilities, as long as they adhere to the general social distancing principles already expected of the general population.

But since March, there have been several large outbreaks at facilities across Australia, notably at Anglicare’s Newmarch House, BaptistCare’s Dorothy Henderson Lodge and most recently at a Melbourne facility.

The national cabinet met on Friday to discuss the code as well as plans for a mental health recovery plan and a return for professional sports.

Human rights concern

Advocates, such as COTA, want the code pushed through and to be made mandatory. It will empower the government to force aged care providers to lift self-imposed lockdowns.

There are worries that levels of care are suffering due to the lockdowns, and with the many stories arising from the royal commission, trust in providers is at an all-time low.

One resident from an aged care home in Queensland reached out to Aged Care Insite and said he has been locked in his room for two weeks and had visitors turned away.

An aged care chief executive, located in the ACT, told Aged Care Insite that they are not currently self-enforcing a lockdown, especially as there are now no cases of COVID-19 in the territory. However, they said that they agree with other providers and, were community transmission to ramp up in the area, they would lock down their facility.

Speaking to Aged Care Insite prior to the cabinet meeting, COTA chief executive Ian Yates said that forced lockdowns have had a serious effect on the physical and mental health of residents. He also wondered what plan providers have if the crisis lasts for the foreseeable future.

“We have cases where a family member – it's either usually a spouse or a daughter or sometimes a niece – has been going into the home either daily or several times a week, spending time with a relative with dementia, assisting with behaviour control, and with feeding,” Yates said.

“And our view is there is no more risk in letting that person in – with all the hygiene and security processes – than there is in having their staff come in and out every day. In fact, they're effectively a volunteer staff member, because they're doing things the staff don't have time to do.

“And then there were situations where family had not been able to have access to the resident, and we're getting now up to six weeks. And as a very senior figure in government asked me, 'What have the providers got as a plan? Do they think that if we're locked down for another six months they can stop people seeing their family for six months?'" Yates said.

Mismanagement

Transparency has been at the centre of problems in aged care, and the families of residents at Sydney’s Newmarch House have been vocal about what they see as poor standards of care during the outbreak, while NSW Premier Gladys Berejiklian took a swipe at the management of the provider.

"What's happening there isn't acceptable, and unfortunately you do notice a difference in the way people who run these aged care homes across the nation are dealing with the issue," Berejiklian told ABC News Breakfast after the 13th death at the facility from COVID-19 was announced.

"Some are doing it better than others. And unfortunately, this particular operator has been left wanting on a number of levels."

There have now been 59 cases of coronavirus linked to Newmarch House. However, questions could also be asked of the government’s involvement in managing the outbreak.

A surge workforce was provided when 50 or so staff were forced into self-isolation, but questions could be asked as to what other support has been provided.

The minister for aged care, Richard Colbeck, had previously told Aged Care Insite that his department also has strategies in place for home care providers should any home care recipients contract COVID-19 or need to be in isolation, and these providers and their staff will have access to the PPE stockpile should the need arise.

“State and territory Public Health Units manage COVID-19 outbreaks in Australia,” Colbeck told Aged Care Insite.

“The NSW Public Health Unit has been on site supporting Newmarch House, including providing clinical and infection control advice.

“The PHU may issue directives to the service or individual members of the community to reduce the spread of COVID-19 and provide clinical excellence advice to services.

“Aged care approved providers are required to follow the advice of the PHU, the guidance developed by the Australian Health Protection Principal Committee (AHPPC), and directions from their state government.”

Professor Joe Ibrahim from Monash University believes that governments, both sate and federal, are culpable for any mishandling or shortcomings exposed by the pandemic.

“Each state and territory's Public Health Unit is responsible for the outbreak responses. If you want to talk about culpability, then both federal and state – according to the national emergency management response plan – are the two groups front and centre that are leading this.

“And so, if you want to be asking questions about the response and whether it's appropriate or not, then they're the two groups to start with. Then you can come talk to the provider, but the provider is reliant on the expert, the technical expertise and the resources from the government and the health department.”

Ibrahim argues that a national aged care taskforce needs to be set up to help battle this crisis, made up of experts who know the needs of the aged care sector.

Sector lauded for great results

In a press conference with the PM on Friday, Colbeck said the sector should be applauded for the good job it has done in dealing with the virus, and he lauded the spirit which saw the groups put the industry code together so quickly.

Colbeck said the code will cover visitation across all aspects of residential aged care while the funding boost is a recognition of the “genuine extra costs” providers have faced during the crisis.

The $205 million boost amounts to around $900 per resident in major metropolitan areas and around $1350 per resident in all other areas.

“The health, wellbeing and safety of elderly residents is our highest priority – and this measure helps reassure family and friends that everything is being done to look after their loved ones during this most difficult time,” Colbeck said.

The latest round of funding follows the $235 million retention bonus paid to residential and home care workers to strengthen the workforce during the pandemic, and $101 million to support providers directly impacted by an outbreak.

Additionally, the Business Improvement Fund has been extended for another year with $48 million in support as required by providers.

As for the code of conduct, the peak bodies will now undertake consultation with consumers and residential aged care providers from 1–7 May before finalising and implementing.  

Colbeck also announced that of the 23 homes which found cases of the virus, 15 are now COVID-19 free, including the hard-hit Dorothy Henderson Lodge in Sydney – the first aged care home to see an outbreak.

Currently, 29 of the Australians who have died because of COVID-19 have been aged care recipients – 25 residential aged care and four home care recipients.

The draft Aged Care Visitor Access Code can be found here.

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