Aged Care Insite Issue 120 Aug-Sep 2020 | Page 19

industry & reform Rethinking care Has the pandemic given us a chance to consider an alternative future? By Michael Fine The coronavirus has been described as a cunning and invisible enemy by virologists and politicians. They should know what it takes! As its genetic code compels it to continually reproduce to survive, the virus effectively seeks out whatever opportunity it can to continue to reproduce. With the now well-known impact on older people, it seems inevitable that aged care homes would be a focus for the disease. And so it has come to pass, our past failings in aged care, as in many other areas, have been exposed. Data compiled by the Canadian Institute of Health Information in late May 2020 shows that Australia is not unique. Deaths in aged care homes made up 42 per cent of all COVID 19 deaths reported across the OECD. In Australia, 28 per cent of all deaths from the coronavirus at that time were from residential aged care. Germany reported 34 per cent and the Netherlands 15 per cent, a figure that has since increased significantly. The US reported 31 per cent, the UK 27, Italy 32, France 48 and Spain 66 per cent. Highest of all was Canada, where deaths in aged care homes represented 81 per cent of the comparatively large national total of deaths due to COVID-19. These figures probably under-report the extent of such coronavirus deaths. Other data problems mean that the full extent of such miserable and untimely deaths may remain hidden for many months, possibly years. The reported death rate in aged care homes, however, is clearly remarkable, especially when we know that such homes have only a small proportion of all older people. In Australia, this residence rate is approximately one in twenty older people, around a sixth of the death rate. In Australia, much of the anger at the failure of authorities to prevent the high incidence of such foreseeable fatalities has been directed at government. The rationale is not hard to find: the marketised, privately operated system of aged care facilities, funded and licensed by the Commonwealth; and the high proportion of the workforce that has been casualised or outsourced under Commonwealth employment legislation, so that vital staff often need to work even when sick and employed in a number of different facilities. Similarly, problems of poor-quality care have been documented over many years, most recently by the Royal Commission. Yet there has been no effective action. Worse still, there was a failure in Victoria in July to learn from the earlier NSW experience in April and May. Prime Minister Morrison tried to deflect the blame to the Victorian government when on Wednesday 30 July he pointed out that “In every country where there is sustained community transmission this will find its way into aged care facilities … and that is what we’re seeing … in Victoria”. If that was so well known, why were effective preventative measures not taken? Why was there no Commonwealth response for nearly a month? Under the legislation, the Commonwealth, it can be argued, has a duty of care that it failed to exercise. Might there be also be other factors beyond politics at play here? One feature noted by epidemiologists is the closed nature of care homes. Just like the Ruby Princess and other infectious cruise ships, the institutional model of care, as we used to call it, provides a ready breeding ground for such hidden viruses. This is a situation easily exacerbated by regulations and rules that limit access to hospital care and risk spreading contagion between residents and staff. But is there an alternative? Clearly major reform of aged care policy in Australia as in many other comparable countries is required urgently. It is also important to implement the pandemic approach recommended by the WHO and other health authorities. Ensure expert infection control teams are available to supplement and supervise care home staff. Isolate any person who is infected (resident or staff member) by removing them at the first opportunity to hospital or otherwise physically isolating them from non-infected residents. Beyond that, the pandemic evidence suggests that community care also offers massive protective benefits. Government figures from 8 August show just 2.5% of all COVID deaths were people getting subsidised care at home, while deaths of those in residential care made up 71.6%. Yes, there are problems – not least the lack of data on the current operation of community care services. Add to this the huge waiting lists in Australia for Home Care Packages and the low level of intensity of services currently available in this country. Community care also typically imposes significant stresses on unpaid family carers, as research undertaken in Germany during the pandemic has documented. But the broad outlines of an affordable alternative approach are clear. Improve community care, invest in making it more widely available and capable of providing levels of support that will really enable its users to remain at home. There is an alternative. Let’s not pretend the cunning virus is the only one capable of adapting. ■ Michael Fine is Honorary Professor, Sociology at Macquarie University. agedcareinsite.com.au 17