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.
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