By Lee-Fay Low (University of Sidney)
Last update: 3rd April 2020
Background
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.
Impact of the COVID outbreak so far on people who use long-term care services and staff:
At time of writing there were 5118 COVID19 cases and 24 deaths in Australia.
There have been 41 staff and residents in 17 nursing homes diagnosed with COVID-19 and 5 deaths (all of residents in Dorothy Henderson Lodge), 10 of these facilities have not been publicly named. Staff were scared and refused to go to work in Dorothy Henderson Lodge, so NSW Health have funded the care of residents.
Existing guidance and policy and practice measures:
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, make telehealth available for people over 70 years, provide 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 $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 (details below). There is also an extra $12.3m to support the My Aged Care information website and phone service. 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.
The number of working hours a week allowed by international students will be temporarily lifted to 40 hours a week to fill shortages in residential and home care.
Aged care reforms relating to financing of residential and community care have been put on hold.
Residential aged care
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.”
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 are allowed, 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.
Large nursing home chains such as BaptistCare, Japara, Opal, Regis, Catholic Healthcare and many others have gone into lockdown, stopping all but ‘essential’ visits. There is variability in how lockdown is defined between organisations. There have been concerns about the quality of care during lockdowns in nursing homes with families unable to visit, and the aged care regulator no longer making unannounced visits.
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.
The Coronavirus (COVID-19) outbreak management in residential care facilities government factsheet states that an outbreak is considered to have started if 2 people in 3 days become sick with the symptoms and at least one of these has a positive test for COVID-19. Advice includes isolating unwell residents in single rooms and assigning dedicated staff to these residents as well as, use of infection prevention control measures and PPE.
Dementia Support Australia, the national provider of support to manage behaviours in people with dementia released a factsheet on restrictive practices suggesting 1:1 staff:resident support is the ideal way to help a resident to self-isolate, rather than physical or chemical restraint. Rather Aged care providers have been told to notify the government if they have confirmed COVID-19 cases and the government will assist with PPE and staff supplementation and reimbursement.
Community care
The government has said that rapid response teams will be sent out to home care providers.
The Australian Aged Care Quality and Safety commission have been phoning all home care services to support them in preparing for COVID19.
$59.3 million has been allocated to meals on wheels -$50 million will fund 3.4 million home-delivered meals, and $9.3 million on 36,000 emergency food supplies boxes.
$10M has been allocated to the Community Visitors Scheme (CVS), focusing on telephone and virtual friendships to older socially isolated people including those in aged care where face to face visiting isn’t possible.
Online training on infection control has been provided for aged care staff.