Home | COVID-19 | Simply ‘unprecedented’: Can we continue with the same old, same old?

Simply ‘unprecedented’: Can we continue with the same old, same old?

Before going further, I’d like to join with others to offer my gratitude and praise to those who have worked with older clients through the COVID-19 pandemic. Your vital contribution has been, and continues to be, way beyond important.

Nurses, care assistants, other care workers, paramedical support staff, along with domestic support staff, delivery staff and others, have been acknowledged over the past months as essential care workers and finally recognised for what they are – inspiring, hardworking, skilful and dedicated. Under ‘normal’ conditions, your work is too often just taken for granted.

In North America, Europe and China, the health and aged care workers have been called heroes. Here, we are less demonstrative – but there’s a quiet mood of gratitude and recognition. You’re just brilliant and we love you all. It’s time we acknowledged that without your contribution we could not continue.

The number of deaths across the globe from COVID-19 so far remains much lower than the 30–35 million of the HIV/AIDS infections or of other 20th century pandemics such as polio in the 1940s and ‘50s and the Spanish Flu in 1918–19. But as is clear from the experience of shutdown and social isolation we have all been through, the social, political and economic impact of the current pandemic is greater than almost anything else in living memory.

In this global event, we share a common experience of fear of contagion, lockdowns, the horror of the vast numbers of unnecessary deaths and the consequences of economic crisis. Indeed, there is just one word used to describe the massive impact of COVID-19. It is simply ‘unprecedented’.

One of the most horrific aspects has been the death rate in aged care homes across the world. In most of the other countries, many which have served as models for recent aged care policy here – the UK, Ireland, Canada and the USA – residential aged care facilities have become centres of cross-contagion and death for both residents and staff.

The experience in most western European countries has been no less frightening – in the Netherlands and Sweden, France, Spain and Italy, the deaths of both residents and staff have often been impossible for authorities to measure. It is only retrospectively that they have been able to include the numbers in the national death tolls. Estimates as high as 60–70 per cent of total national deaths have been circulated in Canada; elsewhere they are commonly 40–60 per cent.

In Australia, too, we have not been spared some of that tragedy. In the home most affected, Newmarch in Sydney’s west, it was reported in the Sydney Morning Herald that so many of the regular personnel were either infected or exposed to infection, that despite calling on agency staff, it was not possible to recruit anywhere near enough to replace those missing.

Whether or not there were deaths where you work, there have been massive disruptions across the aged care system in Australia. Perhaps most difficult have been the regimes of isolation imposed that have in many cases stopped family visits in residential aged care facilities. Where select visits have been allowed, many family members have complained about the restrictive conditions and the arbitrary conditions such as requiring evidence of current flu vaccinations.

Much less transparent have been the changes introduced to community support and home care services. It appears that some services involving home visits were cancelled, although many agencies continued to provide personal support to those clients who needed it.

While we have been lucky to escape the worst ravages overseas, we would be foolish not to learn some of the lessons. Clearly, decisive policy initiatives by state and Commonwealth authorities were crucial to Australia’s successful response. Yet when it came to aged care, the approach has been far from accepting the need for central responsibility. Each service management has the authority to determine its own response – a generous and flexible intention, no doubt, but inadequate as Australia’s and international experience with residential care has shown.

The Industry Code for Visiting Residential Aged Care Homes during COVID-19, negotiated in May by COTA and OPAN following a huge outcry from residents and family carers, was officially adopted by aged care providers. Amazingly, it was not mandatory, and its implementation has been left to the management of homes.

Like funding and quality assurance, the rights of visitors need to be enshrined in law or least enforced as a matter of national regulation.

Even before the virus hit, staffing levels for residential care in Australia had been found to be well below acceptable international standards. As an important article by Professor Kathy Eagar and colleagues published in the Medical Journal of Australia online has recently confirmed, the Australian average is well below even that in the US in staffing. Yet there is little alternative for most older Australians, as waiting lists of over a year for Home Care Packages continue.

If we are to be serious about aged care quality and ensure we can feel confident about our capacity to respond to COVID-19 and future biosecurity risks, we need not just more staff, but much better conditions of employment, more job security and, especially for the personal assistants responsible for direct client care, better pay and educational support.

If we truly want to recognise the inspiring contribution of those who currently work in aged care, we must take this opportunity to learn the lessons from the current pandemic. There will be many more learnings to come as research and data emerge over the coming months and years. But one lesson is already clear: the urgency of changing what we do now is simply unprecedented.

Michael Fine is an honorary professor at Macquarie University.

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