Aged Care Royal Commission COVID-19 Report
Written by Alan Whykes on October 3, 2020
Aged Care Royal Commissioners, the Honourable Tony Pagone QC and Lynelle Briggs AO, have handed a special report on the COVID-19 pandemic in aged care to the Governor-General, His Excellency, General the Honourable David Hurley AC DSC (Retd).
The report is the result of a hearing of the Royal Commission into Aged Care Quality and Safety into the impact of COVID-19 on aged care, which was held in Sydney from 10 to 13 August 2020. Read the report here.
The COVID-19 pandemic has been the greatest challenge Australia’s aged care sector has faced. Those who have suffered the most have been the residents, their families and aged care staff. This report makes six recommendations, among them, a requirement that the Australian Government report to the Australian Parliament no later than 1 December 2020 on the progress of their implementation. The report identifies four areas for immediate action to support the aged care sector:
- First, the Australian Government should fund providers to ensure there are adequate staff available to deal with external visitors to enable a greater number of more meaningful visits between people receiving care and their loved ones.
- Second, the Australian Government should create Medicare Benefits Schedule items to increase the provision of allied health and mental health services to people living in residential aged care during the pandemic to prevent deterioration in their physical and mental health.
- Third, the Australian Government should publish a national aged care plan for COVID-19 and establish a national aged care advisory body.
- Finally, the Australian Government should require providers to appoint infection control officers and should arrange for the deployment of accredited infection prevention and control experts into residential aged care homes.
When the Royal Commission was established in 2018, nobody could have foreseen that the aged care sector would be in the grip of this pandemic as the Royal Commissioners approached the end of their work. The Royal Commissioners have responded with the release of this report in advance of their Final Report, to be delivered to the Governor-General on 26 February 2021.
When the Royal Commissioners announced their COVID-19 inquiry in May, there were outbreaks in three aged care facilities in Sydney. By the time the hearing began in August, a major outbreak in aged care facilities in Melbourne was under way.
It is appropriate to release this special report now because, although no-one knows how long the pandemic will last, aged care residents continue to suffer and, tragically, more may die as a result of COVID-19. There is too much at stake to apportion blame at this time. However, the public needs to know what lessons have been, and can still be, learnt.
Recommendation 1 – Implementation
The Australian Government should report to Parliament by no later than 1 December 2020 on the implementation of these recommendations.
Recommendation 2 – Visitors and quality of life
The Australian Government should immediately fund providers that apply for funding to ensure there are adequate staff available to allow continued visits to people living in residential aged care by their families and friends.
Recommendation 3 – Allied health
The Australian Government should urgently create Medicare Benefits Schedule items to increase the provision of allied health services, including mental health services, to people in aged care during the pandemic. Any barriers, whether real or perceived, to allied health professionals being able to enter residential aged care facilities should be removed unless justified on genuine public health grounds.
Recommendation 4 – An aged care plan and advisory body
The Australian Government should establish a national aged care plan for COVID-19 through the National Cabinet in consultation with the aged care sector.
This plan should:
- establish a national aged care advisory body
- establish protocols between the Australian Government and the States and Territories based on the NSW Protocol but having regard to jurisdictional differences
- maximise the ability for people living in aged care homes to have visitors and to maintain their links with family, friends and the community
- establish a mechanism for consultation with the aged care sector about use of Hospital in the Home programs in residential aged care
- establish protocols on who will decide about transfers to hospital of COVID-19 positive residents, having regard to the protocol proposed by Aged and Community Services Australia
- ensure that significant outbreaks in facilities are investigated by an independent expert to identify lessons that can be learnt. The results of any such investigations should be promptly disseminated to the sector.
Recommendation 5 – Infection control expertise and personal protective equipment
All residential aged care homes should have one or more trained infection control officers as a condition of accreditation. The training requirements for these officers should be set by the aged care advisory body we propose.
The Australian Government should arrange with the States and Territories to deploy accredited infection prevention and control experts into residential aged care homes to provide training, assist with the preparation of outbreak management plans and assist with outbreaks.
Media release – Australian Medical Association, 1 October 2020
AMA CALLS FOR IMMEDIATE ACTION IN AGED CARE
AMA President, Dr Omar Khorshid, today said that standards of care for our elderly should not be compromised through chronic underfunding and under-resourcing of aged care.
On International Day of Older Persons, and the anniversary of the launch of the AMA and Australian Nursing and Midwifery Federation’s ‘Care Can’t Wait’ aged care campaign, we are repeating our call for immediate action.
Today the AMA is launching two new Position Statements focused on adequate care provision for our older people, to help guide and inform Government policy.
“Older Australians cannot wait for another budget,” Dr Khorshid said.
“Government must take immediate action and ensure that there are measures in the upcoming budget to drastically improve the situation in aged care.
“Our parents and grandparents, who have given so much to their families and their communities, deserve dignity and quality care.”
The AMA is calling for the Government to immediately address inadequacies in our aged care system by ensuring funding in the next week’s budget for:
- mandatory minimum staff-to-resident ratios in nursing homes;
- availability of registered nurses 24/7 in all nursing homes, with numbers based on the clinical needs of residents; and
- funding to ensure availability of home care packages for everyone who needs them.
“When COVID-19 reached Australia, we knew our aged care sector was woefully underprepared,” Dr Khorshid said.
“We also knew that older Australians were vulnerable to the virus, yet not enough was done by the Government, the aged care providers or the aged care regulator to ensure the sector was protected.
“Sadly, the Senate Select Committee on COVID-19 hearing on Tuesday confirmed what we long suspected. Deaths in aged care could have been prevented had the Government acted sooner,” Dr Khorshid said.
The AMA Medical Care for Older People Position Statement outlines what high quality medical care for all older Australians should involve, including access to GPs and other medical professionals, medical training required for medical professionals working with older people, hospital care and hospital transfers, medical care funding, clinical governance in aged care, communication protocols and telehealth.
AMA’s Palliative Care in the Aged Care Setting Position Statement outlines how to help our Older Australians live as fully and comfortably as possible with a life limiting illness. It outlines the AMA’s view on the palliative care service provision in both older person’s home and after they enter nursing homes. It summarises the role of medical practitioners in palliative care, the role of aged care providers, and palliative care planning and training required to implement palliative care in the aged care setting.
Medical Care for Older People Position Statement is available here – https://ama.com.au/position-statement/medical-care-older-people-position-statement-2020
Palliative Care in the Aged Care Setting Position Statement is available here – https://ama.com.au/position-statement/palliative-care-aged-care-setting-position-statement-2020
The AMA has made a number of submissions to the Aged Care Royal Commission with recommendations for improvement. They can be viewed here.
AMA Position Statements on aged care can be viewed here.
Media Release – Julie Collins MP, 2 October 2020
AGED CARE ROYAL COMMISSION SPECIAL REPORT ON COVID-19
The Royal Commission’s special report on COVID-19 confirms the Morrison Government had no plan for COVID-19 in aged care.
The result of the Morrison Government’s catastrophic failure is a national tragedy.
The foundations of our country’s aged care system have buckled under the pressure of a deadly disease and the Morrison Government did not do enough to stop it.
More than 660 older Australians have sadly died from COVID-19 in aged care homes.
Some families and loved ones were forced to say goodbye over Facetime.
Mothers and fathers, beloved grandparents and favourite aunts and uncles have been taken too soon.
Ants have been found crawling from wounds, with residents left to languish without care.
All because the Morrison Government failed to have a proper plan for COVID-19 in aged care.
Australians are owed action. The Morrison Government cannot announce its way out of this disaster.
The Morrison Government must implement the Royal Commission’s recommendations and it must be transparent about progressing them.
Scott Morrison and the failed Minister for Aged Care must do much more to ensure older Australians are safe and receiving high quality care in aged care homes.
Day after day the evidence mounts of serious neglect in aged care and every day all we see from the Morrison Government is running away, passing the buck and not accepting responsibility for its own failures.
Neglect. That’s the legacy of this Government when it comes to aged care.
Australians deserve better.
Media release – Senator the Hon Richard Colbeck, Minister for Aged Care and Senior Australians, 1 October 2020
Government welcomes Aged Care Royal Commission’s COVID-19 report recommendations
On this 30th anniversary of the International Day of Older Persons, the Australian Government welcomes the COVID-19 report from the Royal Commission into Aged Care Quality and Safety, which has been tabled in the Australian Parliament today.
The Royal Commission’s report tells us the COVID-19 pandemic has been the greatest challenge Australia’s aged care sector has faced and makes six recommendations to better prepare the aged care sector, its staff and residents for any future outbreaks.
The Government accepts all six recommendations in the report and has already made substantial progress on four of them.
The recommendations build on the Government’s existing COVID-19 measures.
The Government will invest $40.6 million in our initial response to the Royal Commission’s report and recommendations.
It has been continuously building and adapting the National Response Plan for COVID-19 in aged care since January 2020, with the aged care sector and with state and territory governments and health authorities, incorporating lessons learned from Australia and other countries.
We have invested more than $1.6 billion to support senior Australians in aged care since the start of the COVID-19 pandemic. The investment includes an additional $734.8 million announced in August to extend support for the sector’s response to the pandemic as part of the aged care response plan.
Wherever there are high rates of community transmission, the risk to older people and particularly those in residential aged care increases as demonstrated in Victoria.
The Government accepts the recommendation.
It will report to Parliament by no later than 1 December 2020 on the implementation of the Royal Commission’s recommendations.
The Government accepts the recommendation.
The Government has announced two packages to provide additional funding for staffing which supports visitations to aged care facilities by families and friends of residents.
In August, the Government committed an additional $245 million to support providers with COVID-19 related costs, including supporting communication with families and managing visitation arrangements, building on the first payment of the COVID supplement of $205 million announced in May.
The Government is also providing $12.5 million to support residents and their families with enhanced advocacy services and increased availability of grief and trauma services associated with a COVID-19 outbreak.
In addition, the Government will bring forward the introduction of the Serious Incident Response Scheme (SIRS) and invest an additional $29.8 million in the SIRS for residential aged care.
Legislation to support SIRS will be introduced to parliament in the spring sitting for the scheme to commence in early 2021.
This builds on earlier investments totalling $26.3 million to establish the system for reporting abuse or serious incidents in aged care facilities.
As part of the SIRS, residential aged care providers will be required to manage all incidents, with a focus on the safety and wellbeing of consumers and reducing preventable incidents from reoccurring.
Reporting under the SIRS will include a broader range of incidents, including neglect, psychological and emotional abuse and inappropriate use of physical or chemical restraint.
Significantly, the SIRS will also lift the current exemption on the reporting of resident-on‑resident incidents, where the perpetrator has an assessed cognitive impairment.
As the Royal Commission Interim Report states: “Informal carers, often family members who supplement the care provided in aged care homes, also play a critical role as the ‘eyes and ears’ – monitoring the quality of care their loved ones receive.”
The SIRS will provide an additional level of assurance when facilities, due to COVID-19, will still need to place a level of restrictions on visitations.
The Government accepts the recommendation.
While the Government has introduced a range of measures to support the mental health of residents of aged care facilities, it will continue to implement further measures.
The Government will provide additional funding to support increased access by residents to allied health services during the pandemic and will work with the sector to design and implement these measures.
The Government accepts the recommendation.
The Government has a specific national plan for aged care – the CDNA Guidelines for the Management of Outbreaks in Residential Care, which has been updated on two occasions, and which augments the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID‑19).
The national plan for aged care will continue to be updated incorporating the latest available information and released soon as Stage 7 of the National COVID-19 Aged Care Plan for the consideration by National Cabinet.
The Aged Care Advisory Group, established on 21 August 2020 under the Australian Health Protection Principal Committee (AHPPC), will be made permanent.
The other elements of this recommendation have already been undertaken or are in progress and will also be put to National Cabinet for consideration.
The Government accepts the recommendation.
Funding totalling $245 million will be paid to providers from October 2020 to support
It will mandate that aged care providers have trained infection control officers as detailed in this recommendation.
In addition, the Government today announces it will invest a further $10.8 million to enhance the skills and leadership qualities of aged care nurses to ensure older Australians receive the best care possible.
This investment will expand the Australian College of Nursing scholarship program, establish an Aged Care Transition to Practice Program, and create a skills development program for nurses and personal care workers in aged care.
The Government accepts the recommendation.
The Government has been working with state and territory governments to implement a decision of National Cabinet of 21 August to implement additional face-to-face infection control training and establish joint approaches to the management of outbreaks.
The Government thanks Australia’s frontline aged care workers and Commonwealth, state and territory public health officials. We are deeply aware of the tragic losses that followed the global pandemic and community transmission.
Every life lost to the pandemic is a tragedy.
But the collective efforts of our health workers and health officials and our COVID-19 Aged Care Plan have helped save thousands of lives and placed Australia at the forefront of the global response to COVID-19.
The Government’s actions to protect aged care have been and continue to be based on four key pillars:
Minimise Community Transmission
Controlling community transmission is the best defence we have in protecting vulnerable older Australians in aged care. Under the auspices of the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) action is being taken by the Commonwealth, states and territories to minimise community transmission including through:
- Minimising the spread of the disease into and across Australia including through quarantine arrangements and effective contact tracing and tracking
- Preparing the health system for increased numbers of patients
- Managing COVID‑19 cases
- Improving understanding of the virus and how it is transmitted
- Provision of information to help manage the risk of exposure and reduce spread
- Vaccination – consideration of the aged care sector in a potential COVID-19 vaccine program
The Government is providing critical surge workforce support to residential aged care facilities impacted by a COVID-19 outbreak. To date, more than 33,000 shifts have been filled by a Commonwealth-funded surge workforce including GPs, nurses, care workers, allied health workers, executive and ancillary staff.
The Victorian Aged Care Response Centre (VACRC), a joint initiative of the Commonwealth and Victorian Government, was established on 25 July 2020 to co-ordinate and expand resources to tackle the challenge of COVID-19 in residential aged care services.
Under the direction of the VACRC, clinical health staff provided through health services are also assisting to fill critical workforce shortages in residential aged care facilities, with 4,778 shifts filled to date. The VACRC has also assisted the aged care response to COVID-19 through the following activities:
- Australian Defence Force (ADF) personnel have visited 592 aged care facilities.
- 40 personnel from AUSMAT have completed 174 visits to 80 facilities.
- Western Health has provided assistance in prevention measures at 37 aged care facilities.
- 12 National Aged Care Emergency Response (NACER) teams, 76 personnel have been deployed to fill roles across the sector, including nursing, personal care, and cleaning.
- Deployment of TAS, WA, and SA government teams to support operations in residential aged care facilities.
- 101 Residential Aged Care Assistants and Safety Observers have been deployed by the Response Centre to 24 facilities.
- Regular Zoom meetings are being conducted with staff at aged care facilities to assist with return to work arrangements.
Public and private hospitals agreement
These historic agreements between the Commonwealth and each state and territory government alongside the private hospital sector, has ensured the full resources of Australia’s world class health system could be directed to the care of those who needed it. The $1.7 billion private hospital agreement has been instrumental in enabling more than 500 aged care residents to be transferred to private hospitals during the current Victorian second wave.
In addition, it has supported the in-reach of services from hospitals to aged care facilities to provide further clinical care.
Since February 2020, the Government has been working with the states and territories to ensure aged care facilities have sufficient supplies of personal protective equipment. To date, the National Medical Stockpile has provided aged care facilities with approximately:
- 17 million masks
- 4 million gowns
- 11 million gloves
- 4 million goggles and face shields
- 85,000 bottles of hand sanitiser
- 160,000 clinical waste bags.
Universal testing of staff and residents
Immediate testing is provided to staff and residents in a facility to seek to minimise a potential outbreak. Through this in-reach program, more than 152,000 tests at more than 11,000 site visits to 2,000 aged care facilities across Australia have been undertaken. The Government has also provided Medicare funded bulk-billed testing for aged care workers, including those who are asymptomatic. As Victoria starts to recover, this testing will be bolstered to safeguard against a risk of further outbreaks.
Additional investments to support the reform of the aged care sector will be announced as part of the Government’s 2020–21 Budget, to be delivered on 6 October.
Following a request from the Royal Commission, the Government agreed to extend its reporting period for a further three-and-a-half months due to the impact of COVID-19. This enabled the Royal Commission to examine the initial impact of COVID-19 on aged care and the response to date.
We thank the Commissioners for the COVID-19 report and for their work so far, and look forward to receiving their Final Report in February next year.
This article was originally published in the Tasmanian Times and was reposted with permission.