The deaths of 80 elderly people are imminent as a result of COVID-19 spreading through private aged care homes. Aged care behemoths were granted an extra $200m to cope with the pandemic but refuse to provide critical paid pandemic leave to an overwhelmingly casualised workforce, claiming it’s the government’s responsibility. The government says the buck stops with aged care operators. Meanwhile, Victoria’s publicly owned homes, with mandated staffing requirements, have few reported cases of COVID-19. Dr Sarah Russell investigates.
Victorian Premier Dan Andrews said “a bunch” of aged care workers were among those going to work when sick or while waiting for test results. “Let’s not judge them. Let’s try and work out what is driving it,” he said.
What’s driving it is simple: the marketisation (“corporatisation”) of aged care. Along with the entrance of private equity firms and superannuation and real estate investment trusts into the residential aged care sector as a result of the Aged Care Act (1997) came the casualisation of the workforce and a reliance on holders of 457 visas. Many staff in aged care are poorly paid and not entitled to paid leave.
Put simply, they cannot afford not to work. To make ends meet, casual staff work in several different aged care homes. Moving between homes has likely contributed to the spread of coronavirus in Victoria.
Aged care is now big business
Residential aged care in Australia is big business. The federal government spends a whopping $12.4 billion each year on aged care. Yet, in a recent letter to me, it was acknowledged that the government outsources responsibility for a coronavirus “outbreak management plan” to private providers. The government washes its hands of any responsibility.
Companies such as Estia Health, Japara, Regis and Bupa have large portfolios of aged care homes. Bupa Aged Care, for example, has 72 homes. It receives almost half a billion dollars in government funding each year.
The irony of the move towards a free market system is that private companies continue to put out their hands for more government money – without any transparency about how they spend our taxes.
Despite this lack of financial transparency, the Government recently gave the aged care industry an extra $205 million. When announcing the extra funding, Aged Care Minister Richard Colbeck, said: “This will contribute to the genuine extra costs that they’re incurring as they manage the COVID-19 outbreak.”
One extra cost is paid leave for staff who are required to self isolate. However, Leading Aged Services Australia, the peak body for private providers, claims the government should contribute to any paid pandemic leave. Didn’t the government just contribute with the $205 million?
The government continues to sit on its hands. The Fair Work Commission wants to hear more advice before making a final decision about paid pandemic leave for aged care staff. Seriously? How many residents must die before the commission makes a decision?
There are currently 66 aged care homes in Victoria with Covid-19 cases. These include Estia Health, Japara, Regis and Bupa aged care homes. With some 197 residents infected, it has been estimated that 40 per cent of them will die in coming days/weeks. So 80 deaths are imminent. This is four times as many who died in Newmarch House in New South Wales.
Without a public inquiry into the errors made during that outbreak, some aged care homes in Victoria seem destined to make some of the same mistakes.
Horror story unfolding
It is all so sad – and so avoidable. If governments had acted on the recommendations from numerous inquiries over the past decade – if they had listened to residents, relatives and staff – we would not have this horror story unfolding.
Peak bodies representing aged care providers have successfully lobbied the federal government for “flexibility in staffing”. Unlike childcare centres, hospitals and schools, there is no requirement for aged-care homes to have mandated staff-to-client ratios. This flexibility results in many aged-care homes being understaffed.
Aged care advocates and relatives of residents knew about the staffing crisis in aged care long before the pandemic. The government also knew. It gave $2 million to an Aged Care Workforce Strategy Taskforce. Once you waded through the report’s managerial speak – “the creation of a research translation ecosystem”; “touchpoints for consumers in their ageing journey”; and “a well-supported research translation pipeline”; you reached its conclusion: staff ratios were not needed. Staffing ratios will not “necessarily result in better quality of care outcomes.”
As a result, some aged care homes continue to operate without a registered nurse who is on site 24 hours a day.
Victorian-owned homes the stand out
The exception is Victorian-owned public aged care homes, which operate under the Safe Patient Care Act. This act prescribes ratios of registered nurses. On the morning shift, one registered nurse is required for every seven residents; in the afternoon, one registered nurse for every eight residents; and on the night shift, one registered nurse for every 15 residents.
Compare this with staffing in privately owned residential aged care homes, where a single registered nurse is often required to look after more than 100 residents.
Not surprisingly, data from the Aged Care Quality and Safety Commission indicates outbreaks in Victoria are almost exclusively a private sector aged-care issue. State-owned nursing homes comprise about 200 of the 750 in Victoria, but of the 66 aged care homes that have reported a COVID case since June, just six are state-government run.
10-hour online COVID course
Soon after the pandemic hit, Leading Aged Services Australia recognised the need to hire more staff in private aged care homes. It began promoting The national COVID-19 redeployment program, which aims to train a large numbers of unemployed people to work in aged care homes.
And the training required? A 10-hour online course. Considering the complexities of working in an aged-care home during a pandemic, it is inconceivable that someone with 10 hours of training is qualified to provide competent care. You simply can’t learn how to use PPE safely in an online video.
The pandemic has once and for all highlighted the systemic issues in aged care that were hiding in plain sight. What more will it take before the federal government finally admits that the care of vulnerable older people is too important to be left to the whims of the free market?
It is time the government ditched the Aged Care Sector Committee’s Aged Care Roadmap that has driven aged care down the neoliberal road and over the cliff.
Dr Sarah Russell is a public health researcher. She is the Principal Researcher at Research Matters and Chair of Progressives of the Peninsula. She was formerly the Director, Aged Care Matters.