The report by the Royal Commission into Aged Care Quality and Safety on the impact of Covid-19 is superficial and adds little to what is already being done to prevent and manage Covid in aged care. The Commission’s conclusion regarding Australia’s performance on COVID-19 in residential aged care is misleading and obscures the truth.
The Commission argues that Australia has done well. But it plays with statistics by comparing Australia to Canada and the United Kingdom. Comparing aged care mortality rates in Victoria to Canada and the UK paints a much bleaker picture.
At the start of October there were 1986 Covid cases among aged care residents in Victoria; 637, or about 1 in 100, aged care residents in Victoria had died, which is about 85 per cent of all Covid deaths in Victoria.
The Commission takes the view that ‘Now is not the time for blame’. But it should not use the emotive language of ‘blame’ to dodge the important question of accountability.
Without an analysis of what went wrong and who was responsible, it is hard to draw lessons about what to do in the future. The Commission has squibbed it on accountability and analysis.
The partners, family and friends of those 637 people who have died have a right to expect that those responsible are held accountable for their failures and that there is a proper analysis of what went wrong. The truth is that many of the infections and deaths in aged care could and should have been prevented.
The Commissioners argue that it was not their job to conduct a full inquiry into the impact of Covid-19. Instead they conducted a superficial one that makes some obvious recommendations and misses others.
The Royal Commission has taken a political decision to not confront the question of failure and accountability. Instead, it has handpassed that responsibility back to the Federal Government, which, of course, is responsible for the aged care system.
With little analysis or justification, the Commission makes four recommendations for the Federal Government: (1) Staff aged care facilities properly to enable more visits by residents’ families and friends. (2) Change Medicare funding so more allied health and mental health services are provided in aged care facilities. (3) Publish a national aged care plan for Covid-19. (4) Deploy infection prevention and control experts in residential aged care homes.
Staffing is obviously important to enable more visits. But more visits during the pandemic is not the main reason there should be more staff. About 60 per cent of aged care facilities in Australia are chronically understaffed, including for allied health and mental health staff, and that is affecting all elements of residents’ care.
The Federal Government should create a rescue fund to bring staffing in low-performing aged care facilities up to standard, and it should require low-performing facilities to produce a recovery plan by 31 December 2020 outlining how they propose to have adequate staff levels by the middle of next year at the latest.
A new Medicare item for allied health is best described as a Band-Aid measure.
To say that the Federal Government should establish a national aged care plan is to state the bleeding obvious. The Commission spends time describing the planning, guidelines and advice that went on between March and September without actually analysing why things went so badly wrong.
The Victorian experience shows that Commonwealth planning for the aged care system was wholly inadequate. Measures to ensure infection control, surge staffing to overcome staff shortages, coordination between aged care and health services, the availability of personal protective equipment, communication with residents and families, and measures to ensure contact between family and residents all failed. The Commission does little analysis of these failures and makes no recommendations to fix them.
Much of what happened in the second wave should have been anticipated after the Newmarch House experience in NSW during the first wave.
The Commonwealth should have been much more prepared. The Federal Government massively underestimated the scale of the effort that would be needed. The government placed far too much responsibility on providers and did not take on enough responsibility itself.
Because the Commission fails to analyse the problem properly, it gets the planning solution wrong. What is needed now is not more national advice and protocols between the Commonwealth and the States, as the Commission recommends, but much better regional and local coordination and management of aged care to solve problems on the ground.
The Commission makes a passing reference to residents’ rights in relation to access to health care, but fails to grasp the utter failure to protect residents’ rights that the Covid experience has revealed.
Residents and their families had little say about how they were treated. Often they weren’t even told what was happening. Yet the Royal Commission fails to make recommendations to address the lack of information and transparency, and to emphasise the importance of residents and families being involved in decisions.
The Royal Commission’s recommendations are at best superficial and outdated. No one can rule out further major outbreaks of Covid that could affect aged care services. It is a terrible shame that the Commission has not done a better job in preparing Australia for that possibility.
Dr Hal Swerissen is Health Fellow at the Grattan Institute and co-author of Rethinking aged care (Grattan, 2020).