As Victoria’s
Covid-19 crisis continues, it is in Australia’s interest that we reflect how we
might deal better in preventing a spread and enhancing preparedness in dealing
with any potential outbreak in the rest of the nation.
Previously lack of coordinated aged care response to Covid-19 had been cited by many commentators. The Government has now set up an Aged Care Response Centre drawing together Federal and State Government agencies, some professional associations and Peak bodies see here
This is intended to
foster better and rapid response, including linkage with the hospital system
and multidisciplinary teams. According to Federal and Victoria Governments
announcements, the new coordinated system will better support communication
with families including situations where a family work toward removing their
elderly from aged care facility.
Over the last week I
picked up on some interesting comments by Professor Joseph Ibrahim, Monash
University and Professor Mary-Louise McLaws, Epidemilogist. The United Workers
Union Survey expressing views of 1000 aged care workers is also great value,
including comments made Carolyn Smith, President of United Workers Union.
Clearly more scrutiny
seems necessary for optimal Covid-19 response within aged care homes.
Staff shortage is a
recurring theme. Similarly, everyone seems to agree that the nursing homes have
long and strongly relied on untrained casual workforce. Perversely, these
nursing homes run without adequate registered nurses whose skills are essential
to foster quality clinical and personal care.
So for those of us in
Australian States that so far have contained Covid-19 spread, questions still
remain – what are the aged care contingency workforce plans for the country
that leaders have put in place over the last months of planning preparation? What
do those plans look like and will be good for the public families with members
in care to know. Let’s face it, the Victorian Premier Andrew recently said he
did not have confidence in the majority of those private aged care homes in his
state – and he would not put his mum in there!
The everyday picture
from the ground highlights basic stuff that unless it is addressed in a systemic
way, the potential for certain things to go wrong is there. Let’s look at some
views of the United Workers Union surveyed 1000 nation-wide:
- Close to a third of aged care workers did not get Covid-19 safety training including appropriate PPE use.
- Concern of clear planned training schedule as stated “We did not get personal training about Covid-19, it was online. Half of the people didn’t even know there was training.”
- Lacks good planning for workforce training that take account of the casual structure of the workforce
- Over two-thirds felt not equipped to handle coronavirus outbreak
- They see ‘Danger of cross infection’ I care settings
- The majority of workers felt swamped by extra workloads
- A massive 90 per cent of workers revealed not enough time is allocated to fully take care of their basic duties in providing personal care to the elderly
- “We wake them up, put them in a chair, all day with no visitors, no extra staff and put them back to bed 8 hours later, with staff hardly getting a chance to talk to them….it’s not really care, I feel like a robot.”
- “Some residents are going all day without staff even entering their rooms as there isn’t enough of us.”
This survey concludes
that there is absence of national preparedness seen in lack of strategy and
plans to ensure the workforce was prepared, trained and equipped with safety
protection measures.
My mind puzzled as to
who is now overseeing aged care workforce development policy and strategy? I
noted from my search that since the Feds abolished the Health Workforce
Australia in 2014, apparently ‘the essential functions were transferred to the
Department of Health’ (link).
But is the Department
involved? Or did aged care workforce development become a casualty of
neoliberal cut backs and doing away with Government planning?
Given recent events
exposing staff shortage and neglect from having adequate registered nurses in
nursing homes, it will be good to know who is responsible for workforce
development policy and strategy for aged care.
Some of the
highlights from ABC interviews with Professors Joseph Ibrahim and Professor
Mary-Louise McLaws are really worthwhile following up, they give you another
layer of complexity that needs to be fleshed out. It will be great to know how
Governments are responding to the sorts of difficulties that these experts
raise. Here are some key points they shared on ABC:
- We ‘knew clinical care audits showed ability to manage infections was sub-optimal’
- Decision makers ignored or overlooked the need to seek ‘expertise of people that work in the sector not just peak bodies’
- Strangely Governments tasked the regulator of aged care services to manage the pandemic – this is a role misfit, and this body “don’t have sufficient senior clinical staff to inform pandemic response” in aged care.
- The aged care built environment is not always suitable in tackling Covid-19
- The built environment is not designed to minimise spread of infections
- You need appropriately designed built environment to manage airflows – unlike hospitals, ‘aged care facilities are not up to that level’.
- There are ‘no filters to prevent particles to escape… So when you open door they escape’ to adjacent rooms with negative residents. So it spreads.
- Strategy need to recognise that as things stand, nursing homes are structured as ‘shared spaces - these are like homes’
- Also important that there are ‘no shared staff at all’ working across residents with Covid-19 and those that are negative
- These ‘Lessons need to be learnt again….. Newmarch, Spain, Italy, France, UK, Canada, USA – we should have been far advanced in planning and incidence control’
- ‘Too many people involved and no one giving direction’
Call
for analysis and strategy – How will Government respond?
Concerns from sector
staff that they are not allocated adequate time to provide basic personal care,
let alone deal with Covid19 issues. The Feds as funders and regulators, how do
they deal with this issue in the short term & long term? What is the policy
and strategy they use to underpin the funding and regulation framework?
- Government are best advised to obtain additional expertise as suggested by experts mentioned above.
- Built environment and challenge of managing cross infections in such settings – what is the strategy in dealing with challenge? Is this pro-actively discussed with families before outbreak occurs
- What are available options (and risks) if there are families needing to evacuate their loved one prior and during Covid-19 outbreak; and overall communication strategy with families.
- Who is the central person giving directions for aged care as some healthcare experts have asked?
- What strategic measures across the country are put in place by Feds and sector providers to ensure we address risks of having support workers moving across multiple sites that involves contact with more vulnerable people?
- Enhance sector preparedness in other states
- Covid-19 safety training strategy needs attention
- Is the Government planning any long term workforce development strategy or are we going to let the market continue its own way? Put another way, here you can clearly see the limitations of adopting Thatcherism or Reaganomics! There are consequences.
- Lessons learnt need to be shared by the Government as suggested by experts – this is essential for future learning, improvement and interrogation of facts and assumptions
Reference
Links
ABC, Afternoon
Briefing Program, ABC Interviews Profs Joseph Ibrahim &
Mary-Louise McLaws. 28 July 2020 https://iview.abc.net.au/show/afternoon-briefing/series/0/video/NU2020H103S00
ABC Radio, AM
Program, Aged Care COVID-19 Survey Reveal Big Gaps in Preparations and Resources,
27 July 2020
Pandemic Failures in Aged Care Revealed in
Survey, Media Release, United Workers Union. 27 July 2020 https://www.unitedworkers.org.au/pandemic-failures-in-aged-care-revealed-in-survey/
Department of Health,
Health Workforce
Australia Transition to the Department of Health. 21 June
2016. https://www1.health.gov.au/internet/main/publishing.nsf/Content/hwa-archived-publications
