Death, stress and low wages: Covid Inquiry on aged care

The Department of the Prime Minister and Cabinet (PMC) and the Prime Minister have released the final report of an independent inquiry into Australia's response to Covid-19.

The 871-page Covid-19 Response Inquiry report covered pandemic impacts across governance and leadership, border closures, vulnerable demographics, and the economy, concluding that the country is in a worse position to respond to a pandemic now than it was in 2020.

Prime Minister Anthony Albanese said the independent inquiry was in the national interest, to review both successes and failures and better prepare for the future.

“I thank the panel members for their dedicated work. I also thank the many individuals and organisations who shared their experiences of the pandemic," Mr Albanese said.

“The Australian Government is committed to doing all that we can to ensure Australia is fully equipped and prepared to face future pandemics. We will release a response after careful consideration of the Inquiry report."

The Inquiry panel provided the government with nine guiding recommendations and 26 actions for change to ensure national preparedness for the next public health emergency, which Health Minister Mark Butler said will come sooner or later.

"There's a real concern that people wouldn't respond to those directions in the same way they did - the very cooperative, community spirited way they did - in those first couple of years of the pandemic," Mr Butler told ABC News Breakfast.

"And that's a serious concern, because there is going to be another one of these. I hope it's not for a very long time, but there will be another pandemic. They are going to be more frequent. They might be even more deadly than the Covid-19 virus was.

"So, we have to rebuild that trust, and central to that is a confidence the community has that decisions that governments are making are evidence based; are grounded in good evidence that balances risks and benefits of a particular decision, and also takes account of some of the broader impacts we saw right through the report."

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During 2020, 75 per cent of all reported Covid-19 deaths occurred in residential aged care

From the outset it was apparent that the risks of disease severity and death increased with age, however, the report calls the effect on residential aged care facilities "disproportionate."

"In 2020 the majority of the 900 or so people who died from Covid-19-associated illness in Australia were older people – 24 per cent of those who died were in the 85 to 89 year age group and 34 per cent were aged 90 and older."

The Inquiry has heard that the factors that determined how well aged care facilities managed an outbreak were the strength of their governance structures and their leadership

While residential aged care providers regularly deal with outbreaks of disease, the report concluded that the sector, in general, was severely underprepared and ill-equipped for an event of this magnitude. This was due to a number of factors combining, including: "pre-existing structural weakness across the sector, a lack of planning, and underdeveloped sector representation to government."

The panel said that the governmental guidance offered to facilities during the height of the pandemic was often too generic, concluding that future disease planning needed to be highly detailed and consider everything from building layout to individual case needs.

Restrictions may have prevented transmission of the virus, but they came at the cost of quality of life, dignity and choice for older Australians

On 18 March 2020 the National Cabinet put restrictions on visitor entry into residential aged care facilities in a bid to minimise disease transmission. We know know that this decision, and its subsequent iterations, deeply impacted the health and wellbeing of residents and staff.

The Inquiry heard that "confusion, frustration, distress, loneliness, poor mental health, cognitive decline, malnutrition and loss of weight and declining physical function," can all be attributed to the enforced separation of residents and their informal care networks.

Furthermore, the removal of friends and family from facilities was yet another increase to the workload of staff, who went to great lengths to maintain residents' connections to loved ones.

During the COVID-19 pandemic, most aged care workers earned as little as $2 above the minimum wage

The government introduced measures such as paid pandemic leave for aged care workers, a High‑Risk Settings Pandemic Payment, and the Aged Care Workforce Retention Bonus, as well as grants to providers. There was a massive surge in government workforce initiatives from as early as March 2020, as Healthcare Australia nurses were deployed to outbreak-affected facilities.

However, there is no denying the profound mental and physical impact the pandemic had on the aged care workforce.

The Inquiry heard that risks to physical health – including increased exposure to Covid-19, unsuitable PPE, increased workloads, exhaustion and injury – were secondary to the severe mental health impacts and emotional distress faced by many, with providers reporting they are still employing counselling services for their staff to process the trauma they experienced.

"There was a perception they were not well compensated or recognised for the additional burdens brought by the pandemic and felt stigmatised by the media for perceived lack of effort to adequately protect older Australians," the report said.

The panel Inquiry listed a number of actionable recommendations for the Albanese government to consider, with some particularly relevant to older people, health, and aged care (below).

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Aged-care related report recommendations:

• Action 3: Conduct post-action reviews of outstanding key Covid-19 response measures to ensure lessons are captured.
• Action 5: Develop updated health emergency planning and response arrangements in conjunction with states and territories, and key partners, including consideration of escalation and de-escalation points, real-time review and a focus on post-emergency recovery.
• Action 6: Develop legislative and policy frameworks to support responses in a public health emergency, including for essential services and essential workers.
• Action 8: Establish mechanisms for National Cabinet to receive additional integrated expert advice for a whole-of-society emergency, including advice on social, human rights, economic and broader health impacts (including mental health considerations), as well as specific impacts on priority populations.
• Action 9: Agree and document the responsibilities of the Commonwealth Government, state and territory government and key partners in a national health emergency. This should include escalation (and de-escalation) triggers for National Cabinet’s activation and operating principles to enhance national coordination and maintain public confidence and trust.
• Action 18: Proactively address populations most at risk and consider existing inequities in access to services (health and non-health) and other social determinants of health in pandemic management plans and responses, identifying where additional support or alternative approaches are required to support an emergency response with consideration for health, social and economic factors.
• Action 19: Develop a communication strategy for use in national health emergencies that ensures Australians, including those in priority populations, families and industries, have the information they need to manage their social, work and family lives.
• Action 23: Progress development of the Australian Centre for Disease Control in line with its initial progress review and to include additional functions to map and enhance national pandemic detection and response capability.

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