Sunday, 28 June 2020

Nursing Home Tragedy – Institutional and Policy Failure, a Commentary


The Australian Fed and State Governments have done amazing work to contain Covid-19 spread. But the significant loss of life at Sydney Anglicare Newmarch Nursing Home deserve closer look. Why? Without a review mistakes made maybe repeated in the future.

According to the ABC Four Corners Program, lack of appropriate prompt intervention at Newmarch after initial Covid-19 detection, by “18th day [led to] 56 infections, 22 staff and 34 residents, 12 people dead’’, and final total life loss of 19.

So what fell short? Remember families on Tele protesting outside the Nursing Home for days asking info about their elderly folk inside the aged care facility? The Four Corners episode now reveals a more worrying account from interviews with families as per link: https://youtu.be/1b3YJagAkLs

In a nutshell, I am paraphrasing some key points applying policy lenses:
  • There appear to be clear inadequacies in care, clinical management and policy framework to safeguard the wellbeing of residents
  • Elderly people were denied the option of being treated in a hospital setting equipped with higher level clinical care
  • Families not allowed input into clinical management such as having the choice to have their elderly treated in hospital
  • Government orders/regulations were in place to prevent families from removing elderly relatives from the Nursing Home even if the elderly person did not have Covid-19. Families told breach of orders could result in substantial $ fines  
  • The longer elderly people were left in the Newmarch facility, the more of them contracted Covid-19.
  • Reports by some elderly people that they were not given adequate nutrition - expected to make do with peanut butter sandwiches or frozen sandwich lunches
  • Families denied basic communication with elderly residents
  • Poor infection controls
  • One reported lack of readily available supplies to support dehydrated residents
Surprisingly the Government Regulator that is the Aged Care Quality and Safety Commissioner told the ABC thatsays there is nothing that fell short on Newmarch”.


Although Nursing Homes are operated by private and NGO agencies, these facilities are partly funded the Federal Government and individual residents. They are also regulated by Government. Residents in Nursing Homes on paper have similar rights to everyone in the community, even more so in their case as vulnerable groups they have a right to be protected.

At the peak of the Covid-19 crisis, it was clear the Government daily briefs had hospitals and GP medical sites well covered in it its planning at a granular level. There seems to be gaps when it comes to Nursing Homes (even though after the tragedy the Government provided extra funding to these facilities).

To date, it is not clear why the Fed Government in its fore planning did not prioritise giving daily or regular updates on how Nursing Homes were faring – in terms of detection, containment, clinical management reviews, and general care. This is was essential for rapid monitoring.

Why was it that rapid improvements were not being implemented to contain daily spread and offer better clinical care as soon as it was obvious Newmarch had no capacity to offer very basic care? Why is this different to overseas evacuees? Why is the treatment different to many other mainstream clusters?

Why it is that available public info indicates that basic personal care, clinical care and even nutrition were awfully neglected? Quite honestly, is peanut sandwich the sort of meals that would adequately support someone to fight Covid-19 infection? 

We could go on with lack of personal care – how could Government not concern itself where an elderly person has no access to a bath for more than two weeks?


The issues raised by this tragedy go well beyond Newmarch – the Government need to look at its own policy, care and clinical frameworks guiding Nursing Home operations and the interface with hospitals. One could go on staffing issues, perhaps a subject for another day.

Links
ABC Four Corners. Like the Plague: How Coronavirus spread among our most vulnerable elderly residents. Jun 22, 2020. https://youtu.be/1b3YJagAkLs


'No one knows where it came from': Inside Australia's first COVID-19 cluster.

The Sydney Morning Herald, Harriet Alexander, 10 May 2020

Sixth resident of Sydney nursing home dies of coronavirus as national tally rises to 41. April 2020

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