industry & reform
‘Unprecedented’
Can we continue with the
same old, same old?
By Michael Fine
Before going further, I’d like to join with others to offer
my gratitude and praise to those who have worked
with older clients through the COVID-19 pandemic.
Your vital contribution has been, and continues to be, way
beyond important.
Nurses, care assistants, other care workers, paramedical
support staff, along with domestic support staff, delivery staff
and others, have been acknowledged over the past months as
essential care workers and finally recognised for what they are
– inspiring, hardworking, skilful and dedicated. Under ‘normal’
conditions, your work is too often just taken for granted.
In North America, Europe and China, the health and aged care
workers have been called heroes. Here, we are less demonstrative
– but there’s a quiet mood of gratitude and recognition. You’re
just brilliant and we love you all. It’s time we acknowledged that
without your contribution we could not continue.
The number of deaths across the globe from COVID-19 so
far remains much lower than the 30–35 million of the HIV/AIDS
infections or of other 20th century pandemics such as polio in the
1940s and ‘50s and the Spanish Flu in 1918–19. But as is clear from
the experience of shutdown and social isolation we have all been
through, the social, political and economic impact of the current
pandemic is greater than almost anything else in living memory.
In this global event, we share a common experience of fear
of contagion, lockdowns, the horror of the vast numbers of
unnecessary deaths and the consequences of economic crisis.
Indeed, there is just one word used to describe the massive
impact of COVID-19. It is simply ‘unprecedented’.
One of the most horrific aspects has been the death rate in
aged care homes across the world. In most of the other countries,
many which have served as models for recent aged care policy
here – the UK, Ireland, Canada and the USA – residential aged
care facilities have become centres of cross-contagion and death
for both residents and staff.
The experience in most western European countries has
been no less frightening – in the Netherlands and Sweden,
France, Spain and Italy, the deaths of both residents and staff
have often been impossible for authorities to measure. It is only
retrospectively that they have been able to include the numbers
in the national death tolls. Estimates as high as 60–70 per cent of
total national deaths have been circulated in Canada; elsewhere
they are commonly 40–60 per cent.
In Australia, too, we have not been spared some of that tragedy.
In the home most affected, Newmarch in Sydney’s west, it was
reported in the Sydney Morning Herald that so many of the
regular personnel were either infected or exposed to infection,
that despite calling on agency staff, it was not possible to recruit
anywhere near enough to replace those missing.
Whether or not there were deaths where you work, there have
been massive disruptions across the aged care system in Australia.
Perhaps most difficult have been the regimes of isolation imposed
that have in many cases stopped family visits in residential aged
care facilities. Where select visits have been allowed, many family
members have complained about the restrictive conditions and
the arbitrary conditions such as requiring evidence of current
flu vaccinations.
Much less transparent have been the changes introduced to
community support and home care services. It appears that some
services involving home visits were cancelled, although many
agencies continued to provide personal support to those clients
who needed it.
While we have been lucky to escape the worst ravages overseas,
we would be foolish not to learn some of the lessons. Clearly,
decisive policy initiatives by state and Commonwealth authorities
were crucial to Australia’s successful response. Yet when it came
to aged care, the approach has been far from accepting the
need for central responsibility. Each service management has the
authority to determine its own response – a generous and flexible
intention, no doubt, but inadequate as Australia’s and international
experience with residential care has shown.
The Industry Code for Visiting Residential Aged Care Homes
during COVID-19, negotiated in May by COTA and OPAN following
a huge outcry from residents and family carers, was officially
adopted by aged care providers. Amazingly, it was not mandatory,
and its implementation has been left to the management of homes.
Like funding and quality assurance, the rights of visitors
need to be enshrined in law or least enforced as a matter of
national regulation.
Even before the virus hit, staffing levels for residential care
in Australia had been found to be well below acceptable
international standards. As an important article by Professor Kathy
Eagar and colleagues published in the Medical Journal of Australia
online has recently confirmed, the Australian average is well below
even that in the US in staffing. Yet there is little alternative for most
older Australians, as waiting lists of over a year for Home Care
Packages continue.
If we are to be serious about aged care quality and ensure we
can feel confident about our capacity to respond to COVID-19
and future biosecurity risks, we need not just more staff, but
much better conditions of employment, more job security and,
especially for the personal assistants responsible for direct client
care, better pay and educational support.
If we truly want to recognise the inspiring contribution of those
who currently work in aged care, we must take this opportunity
to learn the lessons from the current pandemic. There will be
many more learnings to come as research and data emerge over
the coming months and years. But one lesson is already clear: the
urgency of changing what we do now is simply unprecedented. ■
Michael Fine is an honorary professor at Macquarie University.
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