By Lee-Fay Low (University of Sidney)
Australia’s first COVID outbreak in long term care
Australia’s second and third COVID-19 deaths were 95-year old and 82-year-old residents of Dorothy Henderson Lodge, a residential aged care facility (i.e. nursing home) run by the Christian organisation BaptistCare, located in Sydney. They are believed to have been infected by a 50-year old staff member, who was immediately isolated when she developed symptoms. This was early in the spread of COVID in Australia, the staff member was the 16th case in the state of NSW, and within the first 40 in Australia. The staff member had not travelled overseas and it was not known where she contracted COVID, there has been a cluster of cases in that geographical area. The staff member had worked in the facility for more than twenty decades and cared for 13 residents, 11 of whom were self-isolated.
Staff were scared and refused to go to work in the facility, so NSW Health have funded the care of residents. Health agency staff, and staff from other areas of BaptistCare have been caring for residents as possibly affected staff self-isolated. The facility was put into immediate lockdown with no visitors, and personal and protective equipment is being used. This has been challenging. Residents are not locked into the rooms, and sometimes forget that they should be in their rooms. The residents have been ‘finding the ongoing isolation extremely difficult’.
BaptistCare is working closely with NSW Health to manage the outbreak and the course has been documented on their website. As at the 21st of March eight residents from the facility had tested positive for corona virus, of these three residents have passed away, and one resident recovered. Four staff tested positive, all are recovering at home in self-isolation.
There have been questions about adequate testing of other residents in the facility.
Preparation for further COVID outbreaks in long term care
Preparedness of the aged care sector for COVID has been a very high priority for the health minister.
On the 11th of March, the Commonwealth Government announced $440 Million Australian dollars to upskill aged care workers in infection control, boost staff numbers, telehealth for people over 70 years, specialist onsite pathology services in aged care facilities, and additional funds for the Aged Care Quality and Safety Commission to improve infection control. This includes $234.9m for a COVID-19 “retention bonus” to ensure the continuity of the workforce (i.e. a payment of up to $800 after tax per quarter for two quarters for direct residential care workers and two payments of up to $600 after tax per quarter for two quarters for home care workers). There is also $78m for workforce supply funding and $27m to supplement the viability of some residential aged care facilities. Almost $100m is being provided to home care and home support providers to support people in self-isolation such as with shopping and meal delivery. There is also an extra $12.3m to support the My Aged Care information website and phone service.
Context: Australia spends $18.4 Billion dollars on aged care a year, the additional funds are 2.4% additional funding. There are approximately 220,000 nursing home residents and home care clients in Australia, so an additional $2000 is being spent per aged care resident. The aged care sector has been under public scrutiny with a Royal Commission into Aged Care Underway, and financial stress with closures and consolidations in the last few years. COVID-19 is an additional stressor to the industry.
‘Surge’ staff resources have been discussed in the event of outbreaks in facilities. This means asking part-time staff to work more hours, allowing staff with restricted work visas to work more hours, and recruiting recent graduates and health students.
Context: In Australia aged care is the responsibility of the Commonwealth (i.e. national) government, whereas health care is under the responsibility of state and territory governments. The quality of clinical care in residential care is inadequate there are no mandatory registered nurse ratios (meaning that in some facilities there is not always a nurse present on site) and my opinion is that our current aged care workforce will not have the skills to manage COVID-19. Cooperation between the Commonwealth and states will be required to ensure sufficient skilled staffing during facility outbreaks, and staff with greater health expertise will be required.
The government published National Guidelines for the Prevention, Control and Public Health Management of COVID-19 Outbreaks in Residential Care Facilities in Australia on the 13th of March. The document states that the “primary responsibility of managing COVID-19 outbreaks lies with the residential care facility, within their responsibilities for resident care and infection control. All residential care facilities should have in-house (or access to) infection control expertise, and outbreak management plans in place”. Further the document states “It is therefore essential for the residential care facility, in coordination with local and state/territory governments, to ensure that they can manage residents with COVID-19 while maintaining the level of care required for all other residents. This might include caring for residents who would usually be managed in the hospital setting.”
Context: This puts immense pressure on residential aged care providers, many of whom would not have the workforce, expertise, protective equipment or systems to manage an outbreak.
To reduce the risk of aged care facility outbreaks new visiting rules were introduced on the 18th of March. People who have travelled overseas within 14 days, who have been in contact with a confirmed case of COVID-19 in the last 14 days, and with fever or respiratory symptoms cannot visit aged care facilities. Only two visitors at a time including general practitioners, visits must be in private areas, no social activities or entertainment, no children under 16 unless under special circumstances. Information for visitors is available here.
The government has said that rapid response teams will be sent out to home care providers. They have also said that there will be enough personal and protective equipment as the aged care sector will be given priority access to the national stockpile. A two hour webinar run by the Department of Health for the home care sector on preparing for COVID-19 presented on 13th March is available here.
BaptistCare, Japara, Opal, Regis, Catholic Healthcare and nursing home providers have gone into lockdown in the last week, stopping all but ‘essential’ visits. Providers have varying definition of lockdown. For instance Anglicare are requiring any resident leaving for an external medical appointment to self-isolate in their room for 14 days. BaptistCare are allowing visitors during restricted hours and they must wear a mask and gloves. Facilities are trialling technologies such as video-conferencing to help residents and families stay connected.
Providers have also indicated that they are preparing for additional workforce including asking staff to reconsider leave, and preparing for community care staff to work in residential aged care.
Context: We have as yet not seen reports of the impact of lockdowns on residents, staff and families. We can guess that it will result in increased anxiety, stress, low mood, boredom and behavioural expressions of distress.
Other cases in Australian aged care
A resident in Quakers Hill Nursing home was confirmed as having COVID-19 on the 23rd of March.
An allied health staff member who attended residents at St Louis Nursing home in Adelaide tested positive on the 19th of March date. The facility is in lock down, no further cases has been announced.
A staff member in Aegis Transitional Care in Perth has tested positive on the 16th of March and the facility is in lockdown.
A staff member of st John’s Care in Canberra was potentially exposed, the facility shut down until the staff member tests were returned negative and then reopened.
Low L-F (2020) Report: COVID-19 in nursing homes and policy responses in Australia. Article in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE. Available at https://ltccovid.org/2020/03/24/report-covid-19-in-nursing-homes-and-policy-responses-in-australia/