Confusion about which state or federal government health authority had decision-making power plus a lack of staff worsened the deadly Covid-19 outbreak at the Newmarch House aged care home in Sydney’s west, an independent review has found.
In a blistering final report on the outbreak – 19 residents died and there were 71 cases among staff and residents between early April and mid June – the facility’s hospital-in-the-home approach was found to have been “compromised by inadequate staffing”.
The review, conducted by infectious diseases physician Prof Lyn Gilbert and health and aged care consultant Alan Lilly, also blasted the leadership of Anglicare, Newmarch’s operator, as being “generally invisible to external parties interacting with them”, which ultimately justified the intervention of the regulator, the Aged Care Quality and Safety Commission.
There were failings in communication to residents’ families, which led to heightened isolation among residents who were already suffering from “severely depleted” staff shortages.
Shortcomings in infection prevention and control “identified in the early, crucial phases” of Newmarch’s outbreak were also found, and exacerbated by the facility’s architectural and interior design.
The review recommended a specific infection control expert be assigned to aged care facilities.
One medical professional who worked at Newmarch as part of the surge workforce provided by Aspen Medical told the review: “I couldn’t believe this was happening in my country.”
The review also found Anglicare could source only four “suitable” staff from the 64 expressions of interest made via the federal government-provided Mable staffing platform.
It highlighted how significant the effect of Newmarch’s staffing shortages was on the success of hospital-in-the-home approach, infection control and resident isolation. Staffing shortages were at their worst nine days into Newmarch’s outbreak, when 87% were furloughed because of isolation or quarantine.
“The skills and experience of staff provided by different agencies were highly variable and the numbers available unpredictable from day to day,” it said. “Some staff were not aware that there was Covid-19 at Newmarch House and left soon after arriving for duty.
“Whilst most remaining staff continued to provide care, it was reported consistently that many were fearful of entering a Covid-19 outbreak workplace. This led to increased absenteeism …”
Food services were threatened and meal quality was affected as contractors who supplied food required Covid-19 workplace compliance documents to allow labour hire chefs to fill roster gaps.
The aged care minister, Richard Colbeck, who made headlines last week when he was unable to tell the Senate select committee on Covid-19 how many aged care deaths had occurred as a result of coronavirus in Australia, said on Monday: “We continue to integrate the learnings from Newmarch and infections in Victoria into the national response as outbreaks occur.”
Labor’s aged care spokeswoman, Julie Collins, said the report “confirms the Morrison government learnt nothing from tragic outbreaks of Covid-19 in New South Wales before the disease tragically tore through Victorian aged care homes”.
“It is heartbreaking and completely unforgivable that history has repeated itself across multiple Victorian aged care homes,” she said. “It is time the prime minister took full responsibility for this failure.
“Issue after issue identified in the report … was not fixed by the Morrison government in the critical weeks before Covid-19 hit Victorian aged care homes.”
The review also recommended other aged care homes prepare for “a minimum of 50% of its staff” to be furloughed in case of an outbreak, and urged the health department to consider expanding its surge workforce.
Although the report noted the hospital-in-the-home approach “has many advantages for elderly residents and the health system”, it found it will be effective only “if the outbreak is limited to a small number of cases in residents and staff”. It called for an expert panel to be convened and make decisions about transferring individual residents to hospital when an outbreak occurs.
“Emergency response and interagency operations were characterised by a lack of clarity in the relationships and hierarchy among government health agencies, including Nepean-Blue Mountains local health district, NSW Health, the commonwealth Department of Health and the Aged Care Quality and Safety Commission,” the review found.
“This created confusion for Anglicare board and managers who were unfamiliar with the state agencies and the hierarchy of decision-making in the context of a Covid-19 outbreak.
“Leadership and management at Newmarch House and in the broader Anglicare organisation was generally invisible to external parties interacting with them.”
Source: The Guardian