Residential aged care was already struggling before Covid, the arrival of which threatens to collapse the industry. It is surely time to redesign aged care to meet the needs of future generations.
Inadequate Commonwealth funding for residential aged care has left half of metropolitan facilities and almost three-quarters of regional facilities in financial stress. The expense of preparing for Covid has added to this stress and many facilities may not survive the cost of an outbreak.
The fundamental problem is that residential aged care is being expected to provide quality care for older people with problems that it was never designed to handle. Thirty years ago, there were government institutions that cared for older people with chronic mental health problems, with intellectual disability and with severe behavioural problems associated with dementia. The States were provided with Commonwealth money to build homes for younger people with acquired brain and spinal cord injuries but these homes were often not built.
The result is that aged care facilities are now expected to care for older people with complex medical and nursing problems; with dementia, including a full range of associated behavioural issues; with chronic mental health problems; with intellectual disability; while also housing young people with severe disabilities. This is all expected in one environment with one poorly funded staffing mix.
The system was already broken, partly for the reasons given above, partly by inadequate funding and partly by the entry of new operators, some of whose loyalties to resident care were stretched by competing interests. The Royal Commission graphically documented the current situation in part of the industry.
Covid-19 presents a challenge for which no one could have adequately prepared. Aged care facilities are not hospitals but government guidelines to the industry would suggest that they are expected to provide equivalent care with little significant additional funding or staffing. Supplies of PPE (personal protective equipment) promised by the Commonwealth have not materialised forcing some facilities to source from overseas or local supermarkets.
The experience of Newmarch has demonstrated that aged care facilities are the most vulnerable of all our institutions in the face of Covid-19. Many people in this age group with multiple chronic medical problems will not survive and will not wish to go to hospital and intensive care.
There are many facilities of high quality which have prepared thoroughly and may cope with an outbreak with appropriate support. Others, however, are not in that position and could experience the same catastrophe as occurred at Newmarch.
Local Health Districts and Primary Care Networks are working with local aged care facilities to provide as much support as possible but there is still a shortage of PPE and little guarantee that there would be adequate staffing to cover staff who have to isolate or quarantine.
The experience of Newmarch, as described in the SMH of 16 May, suggests that special units should be being prepared to take cases if facilities need a safety net. This would help to prevent spread and assist facilities to cope. These units would ideally be staffed by nurses trained in respiratory and palliative care and equipped with sufficient PPE to allow families to be present at the bedside.
We are, by no means, out of the woods with regard to Covid-19, although we are in a better position than most countries. Countries that had early results equivalent to Australia have experienced second waves as lockdown restrictions were lifted. We may have another 12 months before a vaccine or cure is available and we must not let our aged care system be a casualty of Covid.
After Covid, and perhaps even before, we need to start to redesign the aged care system so that older people can confidently expect a dignified and safe last few years. This will mean adequately funding and staffing existing facilities but also developing new models, some smaller in size and some targeted to specific groups of older people. Community controlled and cooperative housing models should be considered.
Perhaps younger people feel we don’t deserve anything better given how we have mismanaged the planet. Boomers, however, will expect something better than we provided to previous generations.
John Ward, Geriatrician with an interest in health equity.
11 Parkview St, Georgetown, 2298