Clashes between Newmarch House management and various government departments about who had the authority to make decisions and resolve disputes inhibited the aged care facility’s ability to cope with the outbreak, the Royal Commission has heard.
“Over the course of the outbreak, there has been a frustrating level of dysfunction in the collaboration between Newmarch House/Anglicare management and the numerous government departments, agencies and hospital employees at both Federal and state level,” said Grant Millard, the CEO of Anglicare, which operates Newmarch House.
Advice from government departments was sometimes conflicting, and there was also uncertainty about who had authority to resolve disputes or to give advice.
In the question of keeping residents within the home or sending them to hospital, Mr Millard said the matter was escalated to the Aged Care Minister, who resolved the impasse within a matter of hours.
There were “robust” discussions about “cohorting” and “decanting” of residents, he said, referring to the movement of residents to hospital or putting ‘hospital in the home’ systems in place within Newmarch House.
Discussions became so heated, one of the home’s infection control advisors, Dr James Branley threatened to leave.
Mr Millard said having a clear “line of command” would have greatly helped the circumstances Newmarch found itself in.
The Newmarch experience is in contrast with the experience of Opal Aged Care and HammondCare, representatives of which also appeared at the royal commission on Tuesday. Opal and HammondCare had in-house clinical expertise that meant they were able to retain the decision making capacity within their organisation, even when it was in conflict with advice being provided by government departments.
Aged care receives lower funding than hospitals
Mr Millard said if he had his time again he would be more “assertive” on the subject of hospital transfers and would “strongly push” for residents who tested positive for COVID-19 to be immediately transferred to hospital.
He said having the positive cases remain in the home put a huge burden on staff, and made caring for the well residents difficult.
He also said Newmarch was faced with a “critical shortage” in RNs and care workers, and felt they were left to their own devices to source those people.
Commissioner Briggs questioned the assumptions made about the nursing home’s ability to provide resources equal to those in a hospital.
Mr Millard estimated that residents of an aged care facility are funded to the tune of around $250-$300 per resident, whereas hospital patients receive around $1,200-$1,300.
“You get what you pay for. To expect hospital-like care in a residential aged care facility, anyone who expects that, needs to understand the different resourcing,” said council assisting Peter Rozen QC.
Planning based on inaccurate assumptions about COVID-19
The royal commission also heard the home’s self assessment of its infection control procedures was based on the erroneous assumption that an outbreak of COVID-19 would be similar to an outbreak of influenza.
Erica Roy, General Manager of Service Development and Practice Governance, Anglicare, said all of Anglicare’s homes answered ‘yes’ to all 23 questions asked in the self-assessment tool.
Questions included ‘does the service have an infection control/respiratory outbreak plan?’ and ‘has the service updated its infection control/outbreak plan this year?’. All homes said they operate ‘best practice’ infection control procedures.
Ms Roy said initial advice from the Communicable Diseases Network of Australia was that an outbreak of COVID-19 was like an outbreak of influenza.
Ms Roy said the lessons she learned fromNewmarch House were that they needed to allow for more staff being unable to work and they required infection control specialists on the ground.
Newmarch received advice that 20-30 per cent of staff would not be available in the event of an outbreak. They planned for the loss of 30-40 per cent of staff, but in actuality, Newmarch lost 87 per cent of its workforce.
It quickly became apparent that ‘surge staffing’ obtained through online aged care employment platform, Mable, didn’t have the skills and qualifications needed, given the highly complex circumstances.
Many had no residential aged care experience, and no practical experience with PPE, Mr MIllard said. “They weren’t up to the task. It was dangerous to them,” he said.
Aged care staff were “terrified” of COVID-19, Mr Millard said, which made it all the more difficult to fill gaps in the roster.
Confusion around PPE
Mr Milland told the royal commission that obtaining personal protective equipment was “incredibly challenging” and the home received inconsistent advice about how to use the gear.
There was a “lack of clarity about PPE access pathways at state and federal levels”, he noted. There was “no centralised point of contact” and also “challenges in continuity of access and timely delivery”.
Infection control specialist Dr Branley told staff to wear full PPE for all residents, but “contrary views” were expressed when the home sought access to the national stockpile.
A letter from the NSW Department of Health read, “Please make sure the facility knows not to use full PPE for anyone but positive and suspected cases. NSW Health is not in a position to approve what we already have.”
The confusion about PPE was “deeply distressing”, Mr Millard said.
He said the home was trying to apply hospital-like standards, but didn’t have the equipment to do so.
“They did not die alone”
Mr Millard became emotional as he spoke of the “extremely difficult time” experienced at Newmarch House during the outbreak and he paid his respects to everyone who worked so hard on the response.
He reassured the families of the residents who died, that they did not die alone. “They knew they were loved and cared for,” he said.
“It’s been traumatic for everyone involved,” he said, conceding the organisation was “overwhelmed” by the challenges COVID-19 presented.
“My heart goes out to Victorian homes at the moment,” he said.