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Australia still lacks a large enough surge workforce to prevent deaths in aged care if there are more coronavirus outbreaks, an independent review has found.
The review into a deadly outbreak at Melbourne’s St Basil’s and Epping Gardens aged care facilities, released by the Morrison government on Monday, paints a bleak picture of failed preparation for Covid-19 outbreaks and poor communication with residents and their families.
It was conducted by Lyn Gilbert and Alan Lilly, who found in August that the Newmarch House outbreak in New South Wales was exacerbated by confusion about whether the state or federal government was in charge.
At St Basil’s, 94 residents and 94 staff members were infected and 45 residents died, and at Epping Gardens 103 residents and 86 staff were infected, and 38 residents died.
“These stark numbers do not begin to convey the trauma and grief suffered by all residents, whether or not they developed Covid-19, and the enormous impact on their families,” Gilbert and Lilly said.
Handling of the outbreaks at the two centres shared common flaws including “inadequate” emergency planning, “suboptimal” infection prevention capability, and leadership that “faltered” when staff faced “situations they had never experienced before or for which they were (and/or felt) inadequately prepared”.
The report describes how on 22 July when St Basil’s was put in the control of new managers, old staff were “very distressed” about being stood down, then failed to provide “ongoing guidance” to new staff.
The replacement workforce had “limited understanding” of infection control, faced language barriers because most of the residents spoke only Greek, and at times could not identify residents.
By 24 July external providers reported concerns that residents were not receiving meals until late or food was left untouched. They also raised concerns about residents not being washed or showered, sometimes left in soiled beds, going without medication and becoming dehydrated.
The decision to stand down 100% of St Basil’s staff was “consistent with public health requirements at the time and based on assessment of unacceptable risk to residents of further exposure”.
But the policy failed without “full cooperation from the team handing over, adequate time and documentation and a suitable replacement workforce to hand over to”.
It suggested a select group of staff should have stayed, reflecting the new Victorian policy that allows exceptions to a complete stand-down of staff.
The report found that Epping Gardens “did not have a formal surge workforce plan in place other than a reliance on its own casual staff pool” and its staff capacity was “quickly depleted”.
It said the shortfall was due to the lack of personal care assistants and nurses experienced in aged care.
“Lack of surge workforce planning limits the facility’s capacity to manage and contain an outbreak without outside support.
“Whilst the commonwealth and state surge workforce planning and capacity have improved, demands on their combined resources, are still likely to exceed supplies during … large outbreaks.”
As well as workforce issues, the report cast blame on the capacity of contact tracing, testing, and hospitals.
“Managing Covid-19 outbreaks in these two [residential facilities] during the early stages of Victoria’s second wave was often complicated by delayed results from overextended contact tracing and laboratory testing services,” it said.
“In the context of rapidly increasing hospital admissions for Covid-19 and depleted staff numbers, acute care hospitals’ capacity to accept transfers from residential aged care facilities were necessarily limited to definite medical indications.”
Labor’s aged care spokeswoman, Julie Collins, said the report confirmed the “Morrison government’s tragic failure to keep older Australians in aged care safe”.
“The litany of failings identified across the two facilities reflect the aged care royal commission’s finding that the Morrison government did not have a plan for Covid-19 in aged care,” she said.
Despite Australia’s success suppressing the coronavirus, aged care has been a weak spot in the response, with 685 deaths in residential centres.
Outbreaks in Victoria prompted blame-shifting between the federal government, which is responsible for aged care, and Victoria, which the commonwealth blamed due to the level of community transmission.
In Friday’s reshuffle, health minister Greg Hunt gained direct responsibility for aged care, which prime minister Scott Morrison claimed was designed to elevate the portfolio to cabinet, but also effectively demoted Richard Colbeck, who retains responsibility for aged care services.
Hunt said: “In extending our sincere condolences to the families of those who died, this investigation serves as a platform for understanding and action.
“The health and wellbeing of senior Australians – and the workers who care for them – is of the utmost importance to the Australian government. We continue to work day and night to safeguard the most vulnerable in our community.”
Source: The Guardian
Keyword: Australia lacks aged care surge workforce to deal with Covid outbreaks, review finds | Aged care (Australia)