Perhaps the most frightening feature of the pandemic year of 2020 for those with an interest in age care was the Covid-19 mortality rate amongst the residents and staff of care homes. Caught first by the rapid international spread of the virus in early 2020, then later by problems caused by the limits on access to medical treatment, governments of most the advanced economies struggled to bring community contagion under effective control. Residential care facilities proved to be particularly vulnerable.
Mortality figures collated and checked with great care have recently been published by the International Long-Term Care Policy Network, based in London. They show that in the 22 countries for which reliable figures are available for the first year of the pandemic (January 2020 to January 2021) on average, 41 per cent of all COVID-19 deaths in each country occurred among care home residents.
|Country||Total number of deaths due to COVID-19||Number of deaths of care home residents by COVID||Care home mortality rate: resident deaths as pct of Total COVID Deaths||Covid deaths as pct of all care home residents/beds|
Notes (Column 3). * Confirmed + probable deaths; all other figures are deaths confirmed as due to Covid-19
Deaths in care homes due to Covid-19 were a disproportionately high proportion of all pandemic deaths in almost all countries for which reliable data is available (see Table). The highest care home mortality to national total was in Australia, where 75 per cent of all Covid deaths occurred in such facilities.
Although the rate was somewhat lower in other comparable countries, the number of such deaths and the proportion of care home residents who died was typically much higher. In Canada, for example, 59 per cent of all Covid deaths were in care homes. In the Netherlands it was 51 per cent, Sweden 47 per cent, Austria 44 per cent, the UK 34 per cent. In the USA, there were 139,699 deaths in aged care homes, 39 per cent of the total deaths due to the pandemic in its first full year.
Care home deaths served as a test case of the effectiveness of public health policies to offer protection from contagion to some of their most vulnerable citizens. As the pandemic exposed their vulnerabilities at local, national and global level, the strength of existing social infrastructure was tested.
Care homes internationally, as in Australia, are funded and regulated by government to protect older people in need of ongoing care and to provide necessary support. They should have proven to be safe havens from contagion, offering quarantine like conditions of a sort, providing protection for their residents. Instead, they became centres for the spread of infection amongst the most vulnerable age group, evidence of the widespread failure of public policies.
The failure of the homes cannot be attributed to either the age or chronic illness of their residents. Nor can it be blamed on individual members of staff. Although a number of specific, local factors played a part in each episode of contagion, we also need to ask a fundamental question: Are there any common lessons to be learned and shared that should inform future policy decisions?
One clear lesson appears to be the importance of clear government policy and the exercise of public responsibility. As the Royal Commission found in the Australian case, competitive care markets did not prove conducive to providing safety.
Over the past 30 years or so, care markets have been deliberately introduced into aged care by governments in Australia and elsewhere, although to different extents. In Australia, competitive market pressures apply regardless of legal ownership status. This has fragmented the system, as authority has been increasingly delegated to the corporate business level where managerial prerogative takes priority over system integration and collaboration. Public hospitals, operating under state governments, were kept quite distinct, charged with other priorities and responsibilities.
In Australia it took a long time before the Commonwealth government realised it needed to exercise its responsibilities. Despite the earlier relatively successful experience in NSW, the Federal Government, responsible for aged care policy, funding, governance and regulation, has been accused of ignoring its responsibilities in Victoria for months while the pandemic exploded.
A second hard-learnt lesson from 2020 is that the conditions of employment for staff directly impact the safety of care provided. The reliance on low-paid staff with insecure jobs who often work in a number of different jobs proved dangerous. This was clear internationally, not just in Australia, with numerous epidemiological studies and reports by health authorities pointing to the link between the insecure employment of these essential workers and the spread of contagion within and between homes.
Many of the same failings seem to be on replay in 2021, only this time it has been problems with vaccination supply and coverage affecting both residents and, alarmingly, care staff. And in the government’s comprehensive response to the Royal Commission, there is nothing about ending a reliance on casualised care staff in residential care or elsewhere.
But there was some good news. While deaths in Australian care homes from Covid represented a mortality rate of 282.0 per 100,000 care recipients, in home care the mortality rate was much lower – just 0.82 deaths per 100,000 home care recipients.
Michael Fine is an honorary professor in the School of Social Sciences at Macquarie University.Do you have an idea for a story?
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