Visitor restrictions in aged care facilities have proven to be a flashpoint in Australia’s handling of the COVID-19 pandemic, with providers and the government clashing over the best way to protect the elderly, the people who are most vulnerable to the disease.
Here at HelloCare, we have spoken to a range of people about how the visitor restrictions are affecting them, from a daughter devastated she can no longer visit her father daily to feed and change him, to managers grappling with the most difficult decisions of their career.
Their stories are as diverse as the industry. What lockdown means for one provider is quite different to what it means for another, and demonstrates what is true for the industry – aged care is hugely varied, and some do it better than others.
Maria Iannotti, father in residential aged care emerging from lockdown
“My father’s nursing home has been in lockdown for five weeks.
“A resident alerted me on Monday that they are going to open it up. When I rang them, they said the times they are offering is half hour visits between 1.30 to 3.30 Monday to Friday, and I think they are allowing visits on Saturday and Sunday. You have to have your flu shot. It has to be in the resident’s room.
“When I spoke to the woman at the facility I said, ‘that’s the time I work’. I can’t come at that time. I don’t want to wait until the weekend.
“Yesterday, I rang head office. I said it’s really unfair, if they don’t allow us, I’m going to take this higher.
“All I’m asking is for my father’s facility to offer another time but, no, it’s not possible.
“My father is Italian, he has dementia.
“He is 89 years old. I saw him a week ago through a window.
“He wouldn’t even look at me. He didn’t even acknowledge me. He’s got cataracts and he can’t see properly.
“I’ve seen my father every day for the six years he’s been in that facility, apart from a short period when I had cancer surgery.
“I go in and feed my father every night. On the weekend sometimes I go in twice. I go in to feed him breakfast, and I go in in the afternoon. I change him. I speak to him, because no one else at the facility can speak to him in Italian. I sit with him.
“The carers send an email every week to let you know he’s eating and everything.
“But they’ve been able to do whatever they want. They have been given carte blanche. At the end of the day, you don’t want to make waves, because you’re afraid of reprisal.
“I’m my father’s primary carer. I work, and I have to be psychologically strong because I’m a teacher. I had my routine. At 20 past four, I would leave work and go and see him, and feed him, and sit with him.
“But you have to keep going.
“Even though he has dementia and he’s 89, you’d like to think that they don’t forget the person that they love.
“They offered me Facetime, but he wouldn’t understand. He can speak English, but with the dementia, there’s been cognitive decline.
“I’ve emailed my member of parliament and I will even go to the prime minister if I have to.
“People have to know what this is like. My father is my only family. When I see him next Tuesday it will be six weeks.
“I don’t know what effect this will be having on him. He will have forgotten me by the time he sees me.
“I understand the reason for the lockdown. I would not want to put my father or any of the residents in danger. You can imagine after nearly six-and-a-half years you get to know them all. I would never want to do that.
“But to deny me, when I’ve seen dad every day… It has to be brought out in the open. People have to talk about it. Often people say, ‘they’re old’, but they’re still people.”
Alasdair Croydon, chief operating officer, Mark Moran Group, lockdown easing
“In the week prior to 16 March we came to the conclusion it was time to impose some restrictions, so we sent out a communication to our residents. On that date we, in effect, allowed no relatives or friends unless the resident was being actively palliated.
“We have people in our independent living units and their husband or wife is in the residential aged care facility. They can come across and spend all day in the RAC with their wives or husbands, feeding them and so on. They share the same building.
“Anybody who was here every day, all day, we continue to allow that.
“Anybody being palliated, we certainly allowed those families to come.
“We cancelled all access cards to the building, forced everybody to come through the main point of entry, sanitised hands, asked them the usual questions about travel and so on, checked for symptoms, and then let them into the building.
“We also have a number of residents who have private carers, and we continue to allow some of the health professionals in, and put them through the same process.
“We set up Skype accounts for each of our levels. We have multiple iPad devices. We’ve been doing dedicated Skype meetings between families and residents for five weeks. They are in touch two to three times a week.
“Some families were a little disquieted.
“I think the comments by the prime minister on Friday became a turning point. We have about four families who are absolutely adamant – ‘the prime minister has said I can visit, you will let me in regardless’.
“I get it. Those people have been supportive and helpful along the way, but five weeks is a long time.
“We’re in a no man’s land. I understand where the prime minister and Professor Murphy are coming from. If you look statistically and numerically at the incidences of COVID-1 in the community, it’s dropping. And I get it, five weeks has been a long time. But the flip side of this is, overseas, numerically, for those facilities where COVID-19 has turned up, the mortality rate has been 40 per cent or more.
“If you look at Baptist Care and Dorothy Henderson, the numbers aren’t good.
“What is interesting is that we’ve got 30 lots of correspondence from families begging us not to pull back our current restrictions. They say ‘you’ve done a great job so far, you’ve kept everybody safe, please don’t relax just for a few people who don’t get the level of risk’.
“How do we balance trying to care for our residents, when overwhelmingly, the majority of our families don’t want us to move to the government’s restrictions?
“When you read the (prime minister’s) speech, it’s obvious there’s an implied threat here from the government. In effect, if you don’t pull back from your current restrictions and somebody makes a complaint to the commission, we think the commission will investigate and you will get issued with a notice of non-compliance. Which is a pretty big threat, because you end up on the commission’s website, named and shamed, for actually trying to manage and protect residents and staff, which strikes me as unfair.
“I’ve got families who’ve sent emails to my managers saying if you open the doors, and my relative gets COVID-19, I’m going to sue you.
“Somewhere in there is a balance.
“Our clinical quality risk committee has arrived at the point, we’re not going to go to the level that the government is requiring, but we are certainly going to pull back from where we are.
“We will allow access for two families per resident per week, for fifteen minutes in their room. They will go through the questioning, the temperature testing, the hand sanitising. We will give them masks to wear. We will have staff escort them to the resident’s room. We will make sure you are socially distant, and then at the 15 minute clock, we will escort you back out of the building.
“I think that’s probably reasonable. Vaucluse is not that far from Woollahra, which is a hotspot. So geographically, we are close.
“But it’s also become obvious to me that if I write to the commission, the working of the speech makes it fairly clear that the likelihood of getting an exemption is virtually nil.
“The residents have been wonderfully supportive. At Vaucluse our residents have less clinical accuity, so we have a large population who still have their facilities, can articular their views and opinions on their own behalf and the bulk of them have been very supportive. They understand the risk.
“They understand, if I’m 80 and I have a cardiac disorder, if I get this there’s a reasonable chance I will die. And they don’t want to die.
“Our staff have been very, very good. We surveyed our staff and asked them a whole lot of questions about their other employment, so anybody who works somewhere else, or anybody who’s visited another residential aged care facility, and we followed up with anybody who had.
“Their emotional and psychological wellbeing is as important as everybody else’s.
“I think the industry’s done an amazing job, and the community should be proud of them.”
Gemma*, aged care worker, facility is in lockdown
“There was no hesitation when they went into lockdown. The facility had more mental health challenges and a lot of high care, so some families already weren’t visiting as much.
“The ones who were visiting, they really felt it.
“The residents have structured their lives so they don’t have anxiety, and that’s been thrown out of kilter. You’re just upsetting their whole routine.
“Some of them are really anxious and are more likely to act out. Most of them were already having times when they lashed out, but it gave more possibility for that.
“Lockdown made the already difficult environment even more challenging because we couldn’t explain to residents why their routine had been upset and why people couldn’t come and visit them.
“We were seeing angry outbursts and manhandling between residents. It was not a nice thing to see.
“There were situations when I was in harm’s way. And I saw other staff in harm’s way too.
“They’re feeling cabin fever.
“We should have explored the technology side of things more and allow these residents to know their families are okay on the outside and are thinking of them.
“They were not facilitating communications as well as they could have.
“One nurse spoke to a family member who didn’t ask for their loved one, so the next time they rang the nurse took the phone and gave it to the resident, and said speak to your husband.
“Staff are stressed. There is quite a good staff-to-resident ratio, but the needs of the residents are challenging.
“The fact that leave got cancelled, which is understandable, it didn’t help with the stress levels.
“Staff morale was not fantastic, it’s not great.
“I think staff want leadership to say they are doing a good job.
“I think lockdown was the right decision. You’ve got to be so careful. You don’t know who you’ve come in contact with. You don’t want to be that person who brings it into the home. I feel so sorry for that person in New South Wales (at Newmarch).
“The lockdown has affected my health, and the health of the residents. They are mulling in their own thoughts and it’s toxic.”
Sally*, personal care assistant, five weeks of lockdown
“Though staff have maintained high spirits, it has been heartbreaking for residents at times.
“Under lockdown, some days have been better than others.
“The residents miss their families, which is absolutely heartbreaking. But they know it won’t be forever.
“The majority understand why the restrictions have been put in place but a handful don’t, which is very sad.
“Some residents have had to go into self isolation for two weeks… they have had to have meals in their rooms and not take part in activities. They have become very anxious.
“Staff put on a brave face, and keep their spirits high to reassure residents. They’re doing a fantastic job.
“Considering all the circumstances, the lockdown is the right decision for her facility.
“Staff have their temperature taken every day and are sent home if they have any sign of a heightened temperature. The facility has strict hand washing and hygiene and are wearing gloves but not aprons or face masks.
“The leisure and activities team has been kept busy doing a fantastic job organising Facetime and calls with relatives and extra activities.”
Alex McKenna, CEO Cooinda Care, window visits allowed
“We have engaged with residents and family members to gauge what they want to happen. It was important we weren’t authoritarian in this matter.
“I personally rang over 50 per cent of families to gauge what they would like us to do. We wanted them to be a part of the decision. Unfortunately what’s happening with Anglicare at the moment, it adds weight to our position at the moment.
“It was about looking at the evidence, looking at the request of families, looking at the requests of residents, and then looking at a plan as to how we can navigate this together.
“It was a difficult decision to make, but at the same time it was so easy. The residents want to be safe. This is their home.
“About 98 per cent of our residents overwhelmingly support our approach and wish it to continue.
“We are allowing people in on compassionate grounds.
“We will not block anyone from coming to see their loved one. We’re asking them if they’ve made the right decision.
“We have had some people come in, for some people not being able to visit felt like an amputation.
“We have what we call ‘windows of wonder’ that is whereby on one side of the window we have a loved one on the outside and on the inside we have the resident. In the inclement we are moving two of our windows of wonder to be more internal for the welfare of the both the visitors and the residents as well. We’ve put some patio heaters as well
“It’s been very well accepted and received.
“For about 95 per cent of residents it’s been smooth sailing. We’ve got very low care, high functioning residents. They’re used to going down the street, buying the paper every morning. It’s probably affected them more than it has our other residents who are less mobile, requiring more assistance.
“But it’s about looking at opportunities, not threats. We’ve had some that like to go for a walk so we’ve started a walking group.
“We’ve taken a very proactive approach, and what we want everybody, barring natural cause deaths over a period of time which are part and parcel of the aged care industry, we want everybody to be here at the end.
“Our health and wellbeing team have done a fantastic job. We invest heavily in the wellbeing of residents, and even more so at times like this.
“We take a sensible proactive approach, whether it’s flu season or gastro, and the resident is always at the centre of it.”
* Names have been changed.
Comments has been lightly edited for readability.
Image supplied: Resident Sheila Burnell with visitors Alanna Burnell with daughers Imogen and Pia.