industry & reform
Lessons learned
How far should we go to protect older people who need ongoing care ?
By Michael Fine
December in Australia is always a time of hope and enjoyment . While this year the celebrations may continue to be muted by the ongoing presence of the pandemic and the uncertainty it brings , there are at least a few signs of hope that better times are coming again .
For those who work in , receive care or have family in aged care facilities , there is another good reason to celebrate . An important research report for Australian aged care was recently launched , online , in London .
The report , with the catchy title Care home visitor policies : a rapid global scan of the latest strategies in countries with high vaccination rates , was written by 11 international authors and is published by the International Long-Term Care Policy Network , based at the famous London School of Economics ( LSE ). The lead listed author of the team is one of Australia ’ s best aged care researchers , Lee-Fay Low , Professor of Ageing and Health at the University of Sydney – one who certainly deserves a few days in the sunshine over the coming months .
The report raises a vital question we should all consider carefully as we seek relief from the past year : how far should we go to protect older people who need ongoing care ?
The research , based on a detailed review of international policy and its outcomes , carefully examines a mountain of evidence on the impact of visitor policies in care homes over the first two years of the pandemic .
It also provides detailed case studies of policy developments in six countries : Australia , Canada , Iceland , Israel , Norway and The Netherlands . Like Australia at the end of 2021 , each of these countries currently has a high vaccination rate . But this was not possible anywhere in the world before the development and distribution of the new vaccines , which only commenced earlier this year .
In each country the approach developed and changed over a period in which the mortality from the pandemic was particularly high in residential care settings . During the first and second waves of the pandemic in particular , drastic yet often ineffective measures were implemented by care home managers who were frequently left to their own resources by governments .
There was much to learn from the
international experience . It is clear that many mistakes were made along the way , not just in Australia . Our politicians like to tell us that they have followed the scientific advice throughout the pandemic , rather than playing politics . But the science was uncertain in the early months of 2020 , and advice has changed considerably over the past two years .
“ It is possible to support ongoing social contact while preventing transmission of the virus .
The painful , lonely , premature deaths of so many residents of residential aged care facilities , worldwide , remains etched in our memories – as the ongoing public enquiry into the deaths at St Basil ’ s homes in Melbourne over the past fortnight have again reminded us .
Almost as tragic has been the desperate loneliness and lack of contact inflicted by policies that denied residents any personal contact with family members or loved ones for many months .
A few of the key recommendations from the study demonstrate how it is possible to both support ongoing social contact while preventing transmission of the virus . On the issue of resident ’ s rights , for example , the report recommends :
• The rights of care home residents to receive visitors and participate in community-based activities should be recognised and upheld . They should be no more restricted than communitydwelling people in the same jurisdiction .
• The views of residents or their proxy decision-makers should be considered when determining individual care home visitor policies . Importantly , the researchers emphasise the duty of public authorities to enforce these rights . “ Agencies that accredit or monitor the standards of care in homes ” the authors emphasise , “ should investigate and report on whether the rights of residents to receive visitors are met ”. In another recommendation that speaks to the policies needed in Australia in the coming months , the evidence compels the authors to point out that pre-designated family carers who have a history of routinely providing physical or emotional support to the residents should be permitted to continue visiting , even if casual social visitors are not allowed . The pharmaceutical development of vaccines in less than 12 months has been hailed as a modern medical miracle . The policies and advice intended to prevent transmission of the Covid virus have also evolved and developed , informed by high quality international evidence . ■
Michael Fine is honorary professor in the School of Social Sciences at Macquarie University .
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