The views represented in this article are those of Professor Ibrahim. They do not necessarily reflect the views of HelloCare, yet we believe all opinions are important as they often represent the views of those with a softer yet important voice.

The ghastly scenarios we see, hear and discuss surrounding the COVID-19 pandemic are most urgent in our nursing homes.

We know, the high COVID-19 fatality rate of approximately 20% occurs in people over the age of 80 years with multiple comorbidities which is the exact population living in nursing homes.

Should COVID-19 take hold in our nursing homes where there are approximately 200,000 residents the premature deaths could be in the tens of thousands.

A system of care that is failing before the pandemic

We know from the Royal Commission into Aged Care the sector already has workforce shortages and a lack of clinical staff, that restrictive practices using physical and chemical restraint are prevalent and neglect and abuse.

The Royal Commission highlighted a lack of transparency and absence of data around performance and outcomes.

We know also from around the world that 20% of health professional will become unwell from COVID and that the workforce will decline as people stay home to care for their family.

Current concerns

These circumstances will lead to an increased number of premature deaths directly from COVID infection and indirectly from other causes due to workforce shortages, and limited access to health care.

There will be an increased use of physical and chemical restraint under the guise of ‘necessity’ because the residents become confused and aggressive due to the circumstances of the emergency, isolation, illness and inability of the nursing home to maintain usual care.

The most concerning longterm consequence is the loss of our social fabric—this will arise from disputes and value-laden judgments about what should be done at every step in managing the pandemic response.

Families we be traumatised by not being able to see a dying loved one, staff will feel isolated and unsupported as we leave them to fend for themselves and the residents while we focus our attention on the needs of the acute hospitals.

Answers need to these questions now

How will we know our loved one is getting the care they need?

How will we know staff are getting the support, resources and personal protective equipment they need to keep providing care as safely as possible? How will we know residents are being reassured and treated humanely?

Life and death decisions are being made about older people—who are the people we have entrusted with this process?

Compromising the care of older people is front and centre in arguments about the price to pay for the general ‘public good’.

This is the wrong mindset.

We do not compromise our social values in a crisis, we should hold onto what keeps us together as a society and remember the pandemic will pass. 

After the pandemic passes

When the pandemic is over, be it in six or twenty-four months what will you say to yourself and those around you? Will you still respect your ‘future-self’?

Our actions today remain with us for the rest of our lives.

Make it so we say I did something that was helpful to the community.

Let’s work to avoid any regrets that will inevitably come from not working together early enough with compassion and we opted for the easy option of sacrificing the lives of older people.

What we need now

A co-ordinated, standardised, compassionate, supportive response will alleviate the possibility of substantial and unnecessary psychological harm and mental illness affecting staff, residents and families.

The situations facing older people, their family the care staff require expert and community support as these are matters with complex moral, legal, ethical, clinical dimensions and personal impacts.

This requires a taskforce for each jurisdiction.

We also need a legal authority to advocate for the nursing homes and their staff around allocation of resources and to monitor the causes and circumstances of deaths in nursing homes.

Failure to address the situation now will normalise neglect and institutionalise our willingness of sacrificing older persons in the name of protecting the rest of the community.

We need to act.

A full lockdown of nursing homes is needed now to buy time to address issues. Our actions in protecting the health of older people during the pandemic protects our health and, the soul of our society.

Without action we will see the same scenes that occurred in Spain.

The views expressed in this article are my own.

By Professor Joseph E Ibrahim, Head, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash University

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