industry & reform
Who is responsible ?
Lessons from the high rate of COVID-related residential aged care deaths .
By Michael Fine
Perhaps the most frightening feature of the pandemic year of 2020 for those with an interest in age care was the COVID-19 mortality rate amongst the residents and staff of care homes .
Governments of most of the advanced economies struggled to bring community contagion under effective control , and residential care facilities proved to be particularly vulnerable .
Mortality figures have recently been published by the International Long-Term Care Policy Network , based in London . They show that in the 22 countries for which reliable figures are available for the first year of the pandemic ( January 2020 to January 2021 ) on average , 41 per cent of all COVID-19 deaths in each country occurred among care home residents .
Deaths in care homes due to COVID-19 were a disproportionately high proportion of all pandemic deaths in almost all countries for which reliable data is available . The highest care home mortality to national total was in Australia , where 75 per cent of all COVID deaths occurred in such facilities .
Although the rate was somewhat lower in other comparable countries , the number of such deaths and the proportion of care home residents who died was typically much higher . In Canada , for example , 59 per cent of all COVID deaths were in care homes . In the Netherlands it was 51 per cent , Sweden 47 per cent , Austria 44 per cent and the UK 34 per cent . In the US , there were 139,699 deaths in aged care homes : 39 per cent of the total deaths due to the pandemic in its first full year .
Care home deaths served as a test case of the effectiveness of public health policies to offer protection from contagion to some of their most vulnerable citizens . As the pandemic exposed their vulnerabilities at local , national and global level , the strength of existing social infrastructure was tested .
Care homes should have proven to be safe havens from contagion , offering quarantine-like conditions of a sort , providing protection for their residents . Instead , they became centres for the spread of infection amongst the most vulnerable age group , and evidence of the widespread failure of public policies .
The failure of the homes cannot be attributed to either the age or chronic illness of their residents . Nor can it be blamed on individual members of staff . Although a number of specific , local factors played a part in each episode of contagion , we also need to ask a fundamental question : are there any common lessons to be learned and shared that should inform future policy decisions ?
One clear lesson appears to be the importance of clear government policy and the exercise of public responsibility . As the Royal Commission found in the Australian case , competitive care markets did not prove conducive to providing safety .
Over the past 30 years or so , care markets have been deliberately introduced into aged care by governments in Australia and elsewhere . In Australia , competitive market pressures apply regardless of legal ownership status . This has fragmented the system , as authority has been increasingly delegated to the corporate business level where managerial prerogative takes priority over system integration and collaboration . Public hospitals , operating under state governments , were kept quite distinct , charged with other priorities and responsibilities .
In Australia , it took a long time before the Commonwealth government realised it needed to exercise its responsibilities . Despite the earlier relatively successful experience in NSW , the Federal Government – responsible for aged care policy , funding , governance and regulation – has been accused of ignoring its responsibilities in Victoria for months while the pandemic exploded .
A second hard-learnt lesson from 2020 is that the conditions of employment for staff directly impact the safety of care provided . The reliance on low-paid staff with insecure jobs who often work in a number of different jobs proved dangerous . This was clear internationally , not just in Australia , with numerous epidemiological studies and reports by health authorities pointing to the link between the insecure employment of these essential workers and the spread of contagion within and between homes .
Many of the same failings seem to be on replay in 2021 , only this time it has been problems with vaccination supply and coverage affecting both residents and , alarmingly , care staff . And in the government ’ s comprehensive response to the Royal Commission , there is nothing about ending a reliance on casualised care staff in residential care or elsewhere .
But there was some good news . While deaths in Australian care homes from COVID represented a mortality rate of 282.0 per 100,000 care recipients , in home care the mortality rate was much lower – just 0.82 deaths per 100,000 home care recipients . ■
Michael Fine is an honorary professor in the School of Social Sciences at Macquarie University .
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