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As Victoria was in the grips of a Covid-19 second wave that was killing hundreds of people in aged care, the acting chief medical officer, Prof Paul Kelly, said federal, state and territory governments would “redouble our efforts” to make sure the sector was “absolutely prepared” for outbreaks in the future.
On Monday – nine months after the federal government spent $9m to step up Covid preparedness checks in aged care homes, and after the aged care royal commission’s special report into Covid-19 – staff and residents in the sector in Victoria were once again being swabbed and locked down as the virus was detected in two homes.
By the end of the week, it seemed the latest aged care outbreaks in Victoria had been contained. But grave lessons were supposed to have been learned from the 655 Covid-related aged care deaths in Victoria throughout 2020, most of which occurred between July and September during the state’s second wave.
With so many aged care staff at the time either infected, or a close contact and forced to quarantine, aged care homes were forced to manage infection control and care while also severely depleted of staff. It meant residents were going without basic care including food, wound care and bathing.
It could have been disastrous. Those who lost loved ones to Covid in aged care last year were shocked to see aged care locked down once again.
Liz Beardon, whose parents died after contracting Covid-19 in the Menarock Rosehill home, says: “If what we went through last year didn’t provide the catalyst for reform, what is going to?
“Of course I’m still deeply traumatised and grieving the loss of my parents,” she said. “I’m still trying to prevent this from happening to anybody else, I gave evidence to the royal commission and I’ve asked for answers. But for some reason the elderly are still not considered as important, valued members of our society that we owe a duty of care to.”
The blame game
Why didn’t the Victorian government have tougher infection control procedures in place in hotel quarantine to prevent spread into the community, which sparked the second wave, and why couldn’t basic questions about who was responsible for the quarantine program be answered? Why did it take so long for the state government to acknowledge workplace spread in hospitals and aged care, or for masks to be made mandatory in aged care settings?
Why wasn’t the federal government doing more to safeguard the aged care facilities against Covid, and why was there seemingly no Covid-19 infection control plan or staffing plan in place in case of an outbreak?
A blame game played out, while exhausted aged care and health workers struggled to treat growing numbers of patients.
But as the latest Victorian outbreak spread into aged care over the past week, the key issues that led to the spread – a breach from hotel quarantine in South Australia that led to the virus entering Victoria, poor vaccination rates that left the vulnerable exposed, and an insecure workforce – all firmly landed at the feet of the federal government.
It was revealed on Monday that while Victoria ensured all staff across the handful of aged care facilities it manages no longer work across multiple sites, the federal government, which is responsible for the majority of aged care homes, scrapped the same policy back in November.
Guardian Australia confirmed the federal guidelines were also never mandatory, and nothing could be done to stop staff from working across sites to supplement their income. The only time the federal government makes the “one workplace” guidelines mandatory is during an outbreak, when the most vulnerable are already at higher risk.
The geriatric specialist and aged care researcher Prof Joseph Ibrahim says the federal government has failed to address the underlying problem.
“And the underlying problem is you don’t make enough money in aged care to work in one place,” Ibrahim says.
“If you’re a worker, you have to work multiple shifts in multiple places to make up a liveable wage. You don’t fix the problem by saying: ‘You’re only allowed to work at one place’. That’s a really very narrow vision. What needs to happen is aged care workers need to be better rewarded with proper wages for their work, and these problems have been known for years and haven’t really been responded to in any substantive way.”
In August, the federal aged care minister, Richard Colbeck, did not know how many aged care residents had died from the virus, and on Tuesday, he did not know how many residents or staff in the sector had been vaccinated. Despite federal government promises that the most vulnerable Australians would be vaccinated by Easter, by the end of May there were 16 aged care homes in Victoria where no resident or staff member had received a dose.
About one-third of residents are still not fully vaccinated. A government survey of aged care providers suggested only 11% of the aged care workforce has received a first dose.
Vaccination of aged care staff and residents is a federal government responsibility.
Reliance on private contractors
But it has farmed out much of the work to private contractors, relying on four companies – Aspen Medical, Healthcare Australia, Sonic Healthcare and International SOS – to vaccinate aged care residents in their facilities.
The contractors have collectively been paid about $76m, according to Senate estimates, where health department officials finally revealed the full contract values, despite rejecting multiple requests from the Guardian for the same information on commercial-in-confidence grounds.
Even still, there are conflicting accounts among the contractors about whether they are responsible for vaccinating aged care staff. Aspen was reported earlier this week to have denied any contractual obligation to vaccinate staff, but later told the Guardian its contract did cover workers. Sonic said it had not been contracted to vaccinate workers, and HCA initially told the Guardian the same, before clarifying that it did, in fact, have contractual responsibility to vaccinate workers.
Some groups, including the Royal Australian College of General Practitioners, believe too much reliance was placed on the private contractors, who had little experience in delivering vaccinations to residential aged care.
‘A dog’s breakfast’
Ian Yates, the Council on the Ageing chief executive, says he has held concerns about the staff rollout for some time.
“We fully understood when plan A, to do them all together, fell over,” he says. “But it took them a while to get plan B up.”
The government also promised to set up dedicated “pop-up” Pfizer hubs for younger aged care workers, again relying on contractors for the work.
But the initial deadline of April for the pop-up hubs came and went without any further detail and the aged care workforce was left in the dark.
The health department later promised 13 pop-up hubs would be set up in May. So far, only three have been established, and they are all in Sydney, which is well-served by state-run mass vaccination hubs offering Pfizer. Just 1,887 staff have been vaccinated through the hubs.
The government is now telling aged care staff to get a vaccine wherever they can, like the rest of the population.
On Friday, three months after the rollout began, it flagged an in-principle agreement with the states and territories to make it mandatory for aged care workers to be vaccinated.
One aged care chief executive did not hold back when asked about the government’s efforts to vaccinate staff this week.
“It’s a dog’s breakfast, it’s a bunfight, it’s a shitfight – it’s all of those things,” he said.
State governments are now having to pick up the slack, running targeted blitz programs to increase the aged care worker uptake.
The problem is not isolated to residential aged care, either.
Cath, a community care nurse based in Melbourne, told the Guardian that the vast majority of frail and aged Australians she looks after in their own homes still have not been vaccinated.
“I would say out of 50 clients, maybe one or two have had their first shot,” she says. “I’ve said it to them every time, part of it is how they are going to get to the GP, part of it is hesitancy.
“There’s no official information or campaign from the government to encourage it.”
While the outbreak in Victoria was a result of failures in South Australia hotel quarantine, a state responsibility, the Australian Medical Association (AMA) has been calling on the federal government for months to fund more appropriate purpose-built hotel quarantine facilities.
The AMA argued that while hotel quarantine made sense as a quick response early on in the pandemic, there had now been enough breaches throughout the country to show it is not a long-term solution.
The AMA president, Dr Omar Khorshid, said: “In our mind, quarantine is with us for the foreseeable future.
“We can’t see a situation where there is no need for quarantine,” he told Sky News in May. “Even as we start to open up the borders, even with a vaccinated community. We’re still going to need some form of border controls, particularly with people arriving, we believe, from high-risk places or where there’s new variants of these viruses.”
While there have been calls for Colbeck to resign over the situation in Victoria, Ibrahim says the failures extend beyond one minister.
“This is a whole-of-government responsibility,” Ibrahim says. “And there’s no point replacing one minister with another minister if the underlying problems have not been addressed.”
Source: The Guardian
Keyword: From blame game to dog’s breakfast: how Australia’s aged care homes were left open to Covid again | Aged care (Australia)