Royal commission: Urgent call to fix ‘deplorable’ aged care homes

The royal commission criticised ‘deplorable’ infection control, found a ‘traumatised’ workforce and urges a funding boost.

Aged Care Minister Richard Colbeck accepted the report’s six recommendations. Picture: Sean Davey.

The aged care royal commission has criticised “deplorable” infection control regimes at some nursing homes, found a “traumatised” workforce, and recommended an urgent funding injection to bring in new staff in the wake of more than 660 coronavirus deaths in the sector.

In a special report, the royal commission called for a new national COVID-19 plan for nursing homes and said the federal government needed to ensure the urgent deployment of infection prevention and control experts in every facility to prevent more deaths during the coronavirus pandemic.

It also said immediate measures needed to be put in place to let families visit their elderly relatives, and said existing restrictions had “tragic, irreparable and lasting effects which must immediately be addressed” because of their toll on residents’ physical and emotional health.

“It is now clear that the measures implemented by the Australian government on advice from the (key health committee) were in some respects insufficient to ensure preparedness of the aged care sector,” the report reads.

Aged Care Minister Richard Colbeck accepted the report’s six recommendations — including for the establishment of a national aged care plan and an immediate funding increase — with a commitment to an additional $40.6m for the sector.

Despite accepting the recommendations, the issue of a specific national coronavirus plan for aged care remains contested. Senator Colbeck said the government had a plan — the Communicable Disease Network Australia guidelines — which the government had been “continuously building and adapting” since January 2020.

The report said the pandemic had been “the greatest challenge Australia’s aged care sector has faced”.

“Thousands of residents in homes that have not suffered outbreaks have endured months of isolation, which has had and continues to have a terrible effect on their physical, mental and emotional wellbeing,” it read.

The commission’s interim report last year found an aged care workforce that was “under-resourced and overworked”.

“It is now traumatised,” its latest instalment read.

“All too often, providers, care recipients and their families, and health workers did not have an answer to the critical question: who is in charge?”

“At a time of crisis, such as this pandemic, clear leadership, direction and lines of communication are essential.”

In particular, Victoria’s second coronavirus outbreak has had a devastating impact on the state’s nursing homes.

The death toll related to the state’s aged care sector stands at 634, with two deaths recorded on Thursday.

The Australian in August revealed elderly people in some facilities were being refused hospital admission and were instead being heavily sedated by understaffed homes.

Julie Collins, Labor’s aged care spokeswoman, said the royal commission had “confirmed the government had no plan for COVID-19 in aged care”.

“The result of the Morrison government’s catastrophic failure is a national tragedy,” she said.

“Some families and loved ones were forced to say goodbye over FaceTime.”

“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.”

But the commission’s report took a more conciliatory tone than counsel assisting Peter Rozen, who during an August hearing accused the government of displaying “a degree of self-congratulation and even hubris” about the aged-care sector in the lead-up to the COVID-19 outbreak in Victoria.

Mr Rozen said Australia had one of the highest proportions of coronavirus-related deaths in nursing homes compared to total deaths in the world — around 74 per cent.

“Now is not the time for blame,” Commissioners Tony Pagone and Lynelle Briggs wrote in their report.

“There is too much at stake.

“We are left in no doubt that people, governments and government departments have worked tirelessly to avert, contain and respond to this human tragedy.

“However, the nation needs to know what lessons have been and can still be learnt.”

The report called on the government to ensure there were adequate staff available to safely deal with external visitors “to enable a greater number of more meaningful visits between people receiving care and their loved ones”.

“(And the 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,” it reads.

The report recommends all nursing homes have at least one trained infection control officer as a condition of accreditation, having heard multiple accounts of facilities with insufficient personal protective equipment and poor infection control training.

“We heard of workers being told they could only use one glove rather than two, and a guideline at a residential aged care facility that only permitted two masks per shift,” the report said.

“This is deplorable.”

The report pointed out the hazardous and trying conditions that aged care staff were working in during the pandemic.

“We heard concerning evidence about unsafe conditions for aged care workers,” the report reads.

“Large numbers of aged care workers have contracted COVID-19.

“Nurses, personal care workers, cooks and cleaners are required to work in proximity to residents who are, or may be, COVID-19 positive.”

National Seniors chief advocate Ian Henschke said the recommendations were welcome, particularly those that provided nursing home residents with more human contact.

“We have said all along the unnecessary lockdown of facilities where residents have had no physical contact with their loved ones was inhumane,” Mr Henschke said.

The chief executive of provider advocacy group Aged and Community Services Australia, Pat Sparrow, said she supported the recommendations.

“The interface between aged care and the health system has been broken for some time. Older people should not have health care rationed,” she said.

The government has been asked to report to the commission by December 1 on the progress of the implementation of the recommendations.