Coronavirus: Aged care languishes in our harbours of neglect

Flowers and tributes outside the Anglicare Newmarch House. Picture: Christian Gilles

When we look back on Australia’s response to the COVID pandemic, the catastrophic situation unfolding at Newmarch House will surely stand out as a singular failure.

The virus cluster — which began at the Anglicare aged-care facility less than a month ago, when a carer tested positive for the novel coronavirus, and now stands at a death toll of 16 residents, and 69 ­infections among residents and staff — has been a tragedy in slow motion. Blame for the explosion of cases at Newmarch House at Kingswood, in Sydney’s west, cannot and must not be sheeted home to the heroic nurses and carers who are working under unprecedented pressures. No doubt they are doing their utmost.

But as the weeks have passed, and infections have continued to spread in ever-­increasing numbers, serious questions must be asked about the facility’s screening processes and infection control measures, and the abysmally slow governmental and regulatory response to the ­crisis.

After a carer tested positive on April 11, cases quickly snowballed among residents and staff. According to federal Health Minister Greg Hunt, Anglicare initially rebuffed the federal government’s offer of extra staffing. In the meantime, distraught relatives looked on helplessly. Many camped outside the facility, desperate for news. Some complained that they were being excluded from significant medical decisions.

Inside, residents reported failures of care: meals were not being served, and showering and other basic needs were being neglected. Yet only after 42 infections of ­residents and staff, and three deaths, did the Health Minister ­belatedly insist the facility accept a surge workforce by private medical provider Aspen Medical; workers hired by the government on April 22.

Even after the federal government announced it was seizing control of the situation, a second wave of the virus had spread. Infection control measures put into place clearly have been ineffectual. Indefensibly, until earlier this week, infected residents still were mingling in the same areas of the home as uninfected residents. Daily testing of staff only will begin this Monday. And during the course of the past disastrous month, not a single healthy resident has been evacuated from Newmarch House to nearby ­Nepean Hospital.

Finally, after scores of infections and 16 tragic deaths, the sluggish regulator — the Aged Care Quality and Safety Commission — finally has stepped in, forcing Anglicare to appoint a government-approved manager and threatening to revoke its licence. This same toothless regulator has allowed repeat offender Bupa — which was failing basic care standards in more than half of its aged-care facilities last year — to continue operating through repeated scandals and sanctions. If the grim outcome at Newmarch House is what it takes for the regulator to act, it’s no wonder the Royal Commission into Aged Care Quality and Safety’s interim report released last October castigated the ACQSC as fundamentally “unfit for purpose”.

It’s far too little, too late.

The stress these residents and family members of Newmarch House have endured is unimaginable. The grief of those who’ve lost loved ones in these circumstances is unfathomable. They deserve answers and accountability.

There already are calls for an inquiry into how the situation at Newmarch House has escalated to its current disastrous proportions. The aged care royal commission presumably will play a central role in whatever investigation ensues. The commission has suspended its hearings because of the pandemic, but the commissioners released a rare public statement on Wednesday expressing concerns about deaths in Australian aged care, and noting that their final report will take in the “lessons learned” from Newmarch House.

But the brutal truth is that Australia did not need to learn these lessons from Newmarch House.

We could have, and should have, heeded these lessons from the disasters that have already played out in Britain, Spain, France and the US, where there have been tens of thousands of deaths in nursing homes. We already know aged-care residents — because of their physical frailty, comorbidities, high-contact care requirements and age — are uniquely susceptible to the virus, and are likely to have disastrous outcomes once they contract it. We’ve had ample warning.

The government and the regulator should have been prepared to act decisively to avert a disaster such as Newmarch House. Instead, there has been mass confusion and contemptible buck-passing between different levels of government, Anglicare and Aspen Medical.

While Australian aged care has been spared the full extent of the horrors that have unfolded overseas, we cannot become complacent. Federal Aged Care Minister Richard Colbeck told Sky News this week that if the royal commission focused its attention on Newmarch House, “they’re not doing a service to the aged-care sector because I think that across the board they’ve done quite well”. This rose-tinted assessment may prove naive.

While the sector — with the tragic exceptions of Dorothy Henderson Lodge in Sydney’s Macquarie Park and Newmarch House — appears to have controlled the spread effectively so far, we don’t yet know what the effect of time-consuming infection control measures has been on the standard of basic care. We don’t know how well providers have responded to the significant vacuum left by volunteer carers and relatives, who usually supplement their workforce by helping feed residents and undertaking other duties. We don’t know how residents’ mental health and wellbeing — already areas of grave concern — have been affected during punitive lockdowns, in which residents have been cooped up in their rooms, isolated and lonely. We don’t know whether the already alarming prevalence of physical and chemical restraint has increased further because of additional pressures on staffing.

The sector’s general performance is difficult to gauge in part because the regulator has suspended unannounced inspections in the middle of a pandemic: an abrogation of its duty by any standard. The royal commission’s interim report noted that the sector already fundamentally lacks transparency. In the present climate, where providers have banned or severely restricted visitor access and the watchdog has abandoned spot checks, there’s less transparency than ever.

The royal commission and countless inquiries that preceded it have laid bare the endemic issues plaguing Australian aged care, including chronic understaffing, inadequate staff training and skill mix, over-reliance on chemical and physical restraints, malnutrition, medication mismanagement, phys­ical and sexual assault, and neglect. None of these issues has magically disappeared during the pandemic. Most are likely to have been exacerbated by it. The extra demands placed on providers to undertake time-consuming infection control measures will surely have knock-on effects for the general standards of care.

The government’s continuing failure to set any minimum requirements regarding staffing levels and skill mix in aged care was already unsupportable. It is tantamount to negligence in light of the pandemic. The fact there is still no requirement for aged-care facilities to have a registered nurse on-site around the clock is a national disgrace, and a great risk to residents. Aged-care workers do it incredibly tough: they are under­valued, underpaid and over­worked. They deserve safeguards to ensure they are adequately supported. It is equally untenable to leave the expenditure of $21.7bn of commonwealth aged-care funding entirely at providers’ discretion. Funding must be tethered to care provision and staff wages if we are to see any material improvements in care standards.

When I testified last year at the royal commission about the appalling neglect and abuse my father suffered in Australian aged care, I did so because my father couldn’t speak up for himself. We rarely hear the voices of aged-care residents, who are segregated from the general community. They rely on providers, the government and the regulator to act in their best interests. Too often, they are let down by a system that privileges providers’ profits over the human rights of the vulnerable people entrusted in their care.

It’s past time that we placed the wellbeing of the elderly at the centre of our national conversation about the coronavirus, not on the fringe. When we talk blithely about the inevitability of further COVID fatalities, we must remember the deaths the elderly are suffering during this pandemic are harrowingly lonely. I don’t know a single person who would elect to die alone, without loved ones around them. I don’t know anyone who would choose this desolating fate for their parent or spouse.

My father died early in March. He was lucky to die a good death in hospital, surrounded by family. I’m grateful he’s not around to hear the arguments in favour of sacrificing people like him on the altar of economic productivity. When we callously dismiss the rights of the elderly as less important than those of the young, we forget we are writing our own future: a dystopian and undemocratic one. In a true democracy, every­one is accorded equal worth, dignity and respect, including the elderly and aged-care residents. Our elders rely on us to act in their best interests and to value their lives as we value our own. This is the lesson Australia must heed. Any society that cannot learn it is not a society worth saving.

Sarah Holland-Batt is an associate professor at Queensland University of Technology and an aged-care advocate.