The royal commission has wrapped up its examination of the aged care sector’s response to COVID-19 with a scathing assessment of the government’s failure to prepare the sector for what it should have known lay ahead.

“We will be submitting that it was not well prepared,” said counsel assisting Peter Rozen QC in his opening remarks.

“Tragically, not all that could be done was done,” he said.

The sector was not prepared in the early days, in March, and it did not pass on the lessons learnt at Dorothy Henderson Lodge or Newmarch House.

“As a result, the sector was not properly prepared in June 2020 when we witnessed high levels of community transmission of the virus in Melbourne. 

“And based on the evidence that you have heard the sector is not properly prepared now,” Mr Rozen said.

The problems in aged care were well known

Mr Rozen said the key problems facing the aged care sector are well known and it should have been easily foreseeable that these weaknesses would have caused problems during a global pandemic.

‘Any aged care sector plan had, at the very least, to identify each of these matters and provide a detailed and practical set of solutions to them,” Mr Rozen said.

Given that high numbers of older people had died in nursing homes overseas during COVID-19 outbreaks, Mr Rozen said it should have been clear to the government that detailed planning was needed.

A plan for the aged care sector needed to address the well-known problems of: gaps in workforce numbers and training, access to PPE and training in its proper use, the lack of clinical skills among aged care staff, lack of even “foundational” knowledge about infection control among personal care workers, the challenges of achieving high-level infection control in a home-like setting, gaps in governance and managerial ability in parts of the sector, the operational differences between aged care facilities and hospitals, and the challenges associated with the interface with the state health sector.

Plans based on flu outbreaks 

Most guidance for the aged care sector in the lead up to and during COVID-19 came from the Communicable Disease Network of Australia.

But Mr Rozen pointed out the CDNA’s guidance was based on “previous work on influenza outbreaks in residential care facilities”. 

This reference may have left some providers with the misconception that “their existing influenza plans would hold them in good stead for COVID-19”, leaving them “woefully unprepared”, Mr Rozen said.

The interface between aged care providers and government

“Any aged care response plan worth its salt needs to explain how the aged care health interface will be addressed,” Mr Rozen said.

Professor Joseph Ibrahim, a senior medical specialist in geriatric medicine and Head of the Health Law and Ageing Research Unit at Monash University, told the royal commission it doesn’t take “great insight” to see that “having three to four different groups in authority wanting to run something is going to create confusion”.

Yet the CDNA guidelines didn’t address the issue at all. 

Infection control expertise lacking

The aged care sector’s heavy reliance on personal care workers meant knowledge of infection control procedures by many aged care workers was lacking.

Even senior managers were often not aware of the level of infection control that would be needed to tackle COVID-19.

A suitable plan for the aged care sector could have provided a “template for a range of the best practice tasks and preparation that providers ought to be carrying out”, Mr Rozen said. 

He asked why the Australian College of Infection Prevention and Control could not have helped, with its 66 infection control practitioner experts offering guidance toused to help aged care facilities prepare?

“What could be more important to the nation right now than to deploy these experts to help our floundering aged care sector respond to this pandemic?” Mr Rozen said.

It was the “pointy end of preparedness” that was lacking in the government’s plan for aged care to tackle COVID-19, Mr Rozen noted.

Masks made compulsory too late

Mr Rozen also said masks were made compulsory in nursing homes too late.

Daily new infection rates in Melbourne rose from 20 on 16 June, to 76 on 30 June, but masks were not made compulsory for aged care workers until 13 July 2020, two days after the first recorded death of an aged care resident in Victoria from COVID- 19. 

When masks were made compulsory for aged care workers, the number of new infections in Victoria had reached 250. 

Law by press release

How the decree to wear masks was made was also unclear, Mr Rozen observed.

“The legal instrument by which this important measure concerning masks was effected is unclear. 

“Our researchers have not revealed any instrument imposing the requirement. Professor Murphy was not sure and thought it might have been a Victorian public health order. He said he would have to check. We await the outcome of that checking. 

“Mr Lye was not necessarily sure it was such an order. This level of confusion by senior officers in the Department of Health is far from reassuring, it appears to have been law by press release. 

“This is not the hallmark of a considered approach, but, rather, decision-making on the run reacting to circumstances,” Mr Rozen said.

“We asked who was watching the figures and thinking about what they meant for the aged care sector,” he asked.

COVID-19 deaths in aged care among the worst in world

Mr Rozen concluded his remarks by saying the sector has been hindered in its response to COVID-19 by a “lack of coordinated planning by all levels of government”.

“There have been 220 deaths of residents in residential aged care due to COVID-19. This represents 70 per cent of all the country’s COVID-19 deaths. On this measure, we’re one of the worst-performing countries in the world,” he said. 

Image: Adene Sanchez, iStock.

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