Numerous inquiries, reviews and consultations over the years have provided mounds of evidence of negligence, neglect and abuse in residential aged care homes. Yet the recommendations have mostly been ignored. Now we watch in horror as the number of elderly residents who die from Covid-19 continues to climb. The government is eventually going to have to explain to the nation how this entirely predictable tragedy occurred on its watch, writes Dr Sarah Russell.
Australia has one of the highest rates in the world of deaths in residential aged care as a proportion of total Covid-19 deaths. So far,198 residents in aged care homes have died; they are partners, siblings, parents, grandparents and friends.
We have Covid-19 outbreaks raging in numerous aged care homes yet the government is refusing to tell us which ones.
Whose side is the government on?
At a Senate inquiry hearing on August 4, 2020, Dr Brendan Murphy, secretary of the Department of Health, and Senator Richard Colbeck, the Minister for Aged Care, refused to name the aged care homes. They explained that providers didn’t want to be publicly named because they were worried about “reputational damage”.
It is not the role of the Department of Health or the government to protect aged care homes from reputational damage. Imagine the government refusing to tell the public which schools, workplaces, restaurants or child-care centres had Covid outbreaks because of concerns about “reputational damage”.
Tragedy could have been prevented
The horror story now unfolding in Victoria could have been prevented if the federal Health Minister, Greg Hunt and Minister Colbeck, had listened to complaints from residents, relatives and staff, read the research evidence or acted on some of the recommendations made by coroners.
Eight years ago, for example, a coroner recommended aged-care homes appoint a designated infection control manager, and all aged-care homes develop a document outlining what must be done in the event of an outbreak.
For years, the federal government has kicked the can down the road. There have been so many inquiries, reviews, consultations, thinktanks and task forces that have provided mounds of evidence of inadequate personal care, negligence, neglect, abuse and assault. These inquiries have resulted in a large number of recommendations, most of which have been ignored by successive governments.
In 2018, soon after the federal government had announced yet another inquiry into aged care, I bumped into Minister Hunt jogging on the local boardwalk. I stopped him to ask why we needed another inquiry. Surely the government was aware of the systemic problems in the aged care sector.
I claimed our aged care system was a national disgrace. Minister Hunt disagreed, claiming Australia had a world-class aged care system. So it came as no surprise when he recently defended private aged care providers. He claimed his father had received excellent care in a private aged care home. However, unlike the 8,600 submissions to the Royal Commission into Aged Care Quality and Safety, Minister Hunt’s anecdote is not data.
On July 29, as Covid-19 was raging through a large number of aged care homes in Melbourne, Minister Hunt was quoted as saying: “Aged care around the country has been immensely prepared.”
He was possibly referring to the Aged Care Quality and Safety Commission online survey in which 99.5% of providers said they were prepared for an outbreak.
Self-reporting can’t be trusted
Since the introduction of the Aged Care Act 1997, the aged care sector has relied on self-regulation. However, providers have an appalling track record of self-reporting. In 2015, for example, it was reported that one in eight claims for government subsidies were exaggerated. The regulator should have known not to trust the results of a self-reported survey.
On April 13, Minister Colbeck said: “As unlikely as it might be, we have plans in place for worst case scenarios where an outbreak in aged care facilities mean local staff are unable to continue to provide care due to an infection in the service.” However, according to Mr Rozen, QC, at the Royal Commission into Aged Care Quality and Safety, the sector has been under-prepared: “Neither the Commonwealth Department of Health nor the aged care regulator developed a Covid-19 plan specifically for the aged care sector.”
This claim has been disputed, although, to date, no documents of a pandemic plan specifically for the aged care sector have been made public. I did, however, receive a letter from the assistant secretary, Aged Care COVID-19 Measures Implementation Branch, that claims that individual providers are responsible for an “outbreak management plan”, not the Federal Government.
“In the event of an outbreak, the relevant Public Health Unit is responsible for supporting aged care services to manage an outbreak and provides advice on testing, clinical care and infection control. It is the responsibility of aged care providers to ensure they have an outbreak management plan in place that includes how to manage COVID-19 positive residents on-site if required.”
Yesterday, Dr Murphy, the secretary of the Department of Health, told the Royal Commission that a “surge workforce” had been planned prior to any Covid-19 outbreaks in aged care. However, documents show the government entered into a contract with Mable and Aspen Medical a month after the first outbreak of Covid in NSW.
Sector had ample warning
Clearly the sector should have taken steps to better prepare, given that it had ample warning, following the Newmarch House calamity in March, five months ago.
According to Professor Joseph Ibrahim, the steps should have included a national audit of all residential aged care facilities to judge their level of preparedness; proper dissemination of the lessons learnt from Newmarch House, and a systemic approach to providing clear, clinical and infectious diseases advice to residential aged care homes through a national coordinating body established for this purpose.
But none of this was done. So we now have a Covid-19 outbreak in numerous private aged care homes.
My interest is transparency, not reputations. So I have prepared a list of Victorian homes that currently have an outbreak. This list is updated daily via word of mouth from members of the Aged Care Advocacy Facebook Group.
Sooner or later the Health Minister, the Minister for Aged Care and the regulator need to come clean. They need to explain to all of us exactly how this heart-breaking tragedy – which many of us predicted – occurred on their watch.
Dr Sarah Russell is a public health researcher who specialises in qualitative research. She has been the Principal Researcher at Research Matters since 1999. She is also the Director, Aged Care Matters. She believes the aged care system requires greater scrutiny, accountability and transparency.