What is understood as Long-Term Care in Australia?

In Australia the term ‘long term care’ is seldom used.  ‘Aged care’ is the more common term. Unlike many other countries older Australians needing support and people with disabilities aged under 65 are funded and supported under two distinct Australian government policies and funding arrangements: Aged Care and the National Disability Insurance Scheme (NDIS).

Aged Care

The two main forms of government-subsidised aged care (LTC) are residential aged care and home care. The Australian government is the primary funder and regulator of the long-term care system. The government subsidises both home care and residential care for people of all ages who have been assessed as needing care and support. There are four main types of services under aged care: the Commonwealth Home Support Programme (CHSP) Home Care Packages (HCP), residential care and flexible care. More than 1.2 million people received aged care services during 2017–2018. 77% received support in their home or other community-based settings. Of Australians over the age of 65, 7% accessed residential aged care, 22% accessed some form of support or care at home, and 71% lived at home without accessing government-subsidised aged care services (sources: Care, Dignity and Respect report; Aged Care and COVID-19 report).

The National Disability Insurance Scheme (NDIS)

The NDIS, implemented from 2013 to 2020, has established a needs-based system of care and support for people with disability with ‘permanent and significant’ disability, with assessment of need based on level of impairment. The NDIS provides individualised support for approximately 500,000 people across Australia (Hamilton et al forthcoming).

Australia has a population of just over 25 million people. In 2019, 15.9% of Australia’s population were over the age of 65 and 2% of the population is over the age of 85.  Australians are living longer than ever before. The number of Australians aged 85 years and over is expected to increase from 515,700 in 2018–2019 to more than 1.5 million by 2058 (sources: Statista; Royal Commission into Aged Care Quality and Safety).

Australia is a federation and LTC is primarily the responsibility of the federal (Commonwealth) government which sets LTC policy, provides funding, oversights quality standards etc. Within the states, while funded by the Commonwealth and having to comply with Commonwealth standards, there are some nursing homes run by state governments  (e.g. Victoria runs 178 nursing homes) and some home care is provided by local government (e.g. in Victoria).

There is central oversight from the Australian government, as it is responsible for regulating and funding the majority of aged care services. However, state and territorial governments also have jurisdiction over the provision of aged care, which increases the complexity of the system and leads to a division of power.

The Australian Department of Health is responsible for the development and implementation of aged care policy, including advising the Australian Government, funding, and administration. The Aged Care Quality and Safety Commission is responsible for aged care regulation. State and Territory Governments, along with the private sector, are responsible for the delivery and management of health care, including aged care.

The Australian government’s Department of Health created the Royal Commission into Aged Care Quality and Safety in 2018 to evaluate the current Aged Care sector and to provide recommendations for reform. A group of experts in this commission have identified several weaknesses of the sector and have issued their final report (Royal Commission, 2020).

References:

Royal Commission into Aged Care Quality and Safety (2020) Aged care and COVID-19: a special report. Commonwealth of Australia. https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf 

Long-Term Care Financing mechanisms

Australia has universal public health care through Medicare. The Australian government subsidizes aged care services so anyone who received aged care is eligible for financial support. In 2018-2019, $27.0 billion was spent on aged care, $19.9 billion of which came from the Australian Government (Royal Commission, 2020a).

Reliance on unpaid carers

There is significant reliance on unpaid (mostly family) carers in the community, to reduce the need for formal care. In 2018, there were around 428,500 unpaid primary carers providing support to someone aged 65 years or older (sources: health.gov; Care, Dignity and Respect report; Parliament of Australia; myagedcare.gov).

Family carers have access to shared care planning tools. Professional carers are also increasingly asked to collaborate with family carers, providing skills training and directing family carers to the services available for them (source: OECD).

Public Long-Term Care coverage:

In Australia 80 per cent of older people will access some form of government funded aged care service before death (2012-2014) (AIHW, 2018).

In 2019-20, over one million people received support from aged care services, around 840,000 used the Commonwealth Home Support Programme, and around 245,000 people lived in residential aged care facilities at some point during the year (AIHW, 2021).

Co-payments

People who use aged care are expected to contribute in the form of co-payments and means tested fees. People receiving aged care services contributed $5.6 billion to the cost of their aged care in 2018–2019 (Royal Commission, 2020a)

Aged care homes are subsidised by the Australian government. The subsidies are paid directly to the aged care home and the amount of funding that a home receives is based on an assessment of individual needs by the home using a tool called the Aged Care Funding Instrument (ACFI) and how much an individual can afford to contribute to the cost of their care and accommodation (using a means assessment).

Access to publicly funded aged care

Aged care services are rationed and access is determined by where people live, their needs, and availability of services. The Royal Commission into Aged Care Quality and Safety highlighted that in practice there is no universal entitlement to aged care as services are strictly rationed and access is determined by where people live, their needs, and availability of services (Royal Commission, 2020b).

Public spending on Long-Term Care

In 2019-20 government spending on LTC in Australia was estimated to be $21.5 billion, 65% on residential aged care and the remainder on home care and support or other forms of care.  This is equivalent to 1.2% of Gross Domestic Product (Treasury, 2021)

References:

Royal Commission into Aged Care Quality and Safety (2020a) Financing Aged Care, consultation paper 2. Commonwealth of Australia. https://agedcare.royalcommission.gov.au/sites/default/files/2020-06/consultation_paper_2_-_financing_aged_care_0.pdf

Royal Commission into Aged Care Quality and Safety (2020b) Aged care and COVID-19: a special report. Commonwealth of Australia. https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf 

Treasury (2021) 2021 Intergenerational Report. Australian Government. https://treasury.gov.au/publication/2021-intergenerational-report

The Aged Care Financing Authority (ACFA) produces a report providing an overview of the funding and financing of the Aged Care Industry.  In 2019-2020, there were over 3,000 providers; 845 of these were residential services, 920 were home care providers, and 1,452 were Commonwealth Home Support Programme providers (ACFA ,2021).

The number of residential care providers has decreased from 1,121 in 2010-11 to 845 in 2019-20. The number of beds has increased from 182,302 to 217,145 in the same period of time, in 2019-20 36% of all beds were from providers with more than 20 facilities. With regards sector ownership, 56% of residential care providers are not-for profit (with 55% of the beds), 33% are for-profit (41% of the beds) and 11% are public (4% of beds). Of home care providers, 12% are government owned, 36% are private for-profit and 52% are not-for profit (ACFA, 2021)

References:

Aged Care Financing Authority (2021) Ninth Report on the Funding and Financing of the Aged Care Industry – July 2021. https://www.health.gov.au/resources/publications/ninth-report-on-the-funding-and-financing-of-the-aged-care-industry-july-2021

The Aged Care Quality and Safety Commission, under the Australian government, is the national regulator of aged care services. It is responsible for approving subsidies for providers, accrediting services, monitoring quality of care, providing education, handling complaints and imposing sanctions. Providers must comply with the Aged Care Quality Standards set by the Aged Care Act and the Aged Care Principles.

The Royal Commission into Aged Care Quality and Safety’s report highlighted instances of sub-standard care, concluding that the current mechanisms of oversight and market shaping have not been able to respond to changes in the provider market, arguing the need for a less centralised regional and local market governance system (Royal Commission, 2021).

References:

Royal Commission into Aged Care Quality and Safety (2021) Final Report: Care, Dignity and Respect, volume 1. Commonwealth of Australia. https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf

The aged care system is difficult to access and navigate. The Royal Commission into Aged Care Quality and Safety found that people needing care found the experience to be time-consuming, overwhelming, and intimidating. The Royal Commission also expressed concern regarding the ability for people to make informed decisions due to the lack of information available.

LTC sector has been found to have less access to services, including health services. The Royal Commission into Aged Care Quality and Safety recommends the Australian Government to increase coordination by creating Medicare Benefits Schedule items to increase the provision of allied health services, including mental health services (Royal Commission, 2021).

References:

Royal Commission into Aged Care Quality and Safety (2021) Final Report: Care, Dignity and Respect, volume 1. Commonwealth of Australia. https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf

There are approximately 845 residential care providers in Australia, operating across more than 2,720 sites. In terms of ownership (ACFA, 2021, table 6.1):

• – 56% of providers and 55% places are in for not-for profit residential homes (ACFA, 2021)
• – 10 % government operated
• – 34% are for profit/private

The number  of residential aged care providers has been decreasing due to industry consolidation while the number of government-funded places (beds) in aged care has gradually been increasing.

Industry consolidation has seen a reduction of one owner/one-site facilities and a corresponding increase in large for-profit providers building large facilities across multiple sites.

Other contextual data:

• – 245,000 people lived in aged care facilities at some point in 2019/2020
• – 65% of residents in aged care are women.
• – Average age of residents is 85
• – NB: 4,900 aged care residents are aged under 65.

Data from: Aged care snapshot 2021  (AIHW, 2021, accessed 25 Oct 2021).

References:

Aged Care Financing Authority, ACFA (2021) Report on the Funding and Financing of the Aged Care Sector. https://www.health.gov.au/sitesreport

Australian Institute of Health and Welfare, AIHW (2021) Australia’s welfare 2021, Aged care. Australian Government. https://www.aihw.gov.au/reports/australias-welfare/aged-care

The majority of older people who use government-subsidised community care receive services through two major programs:

• The Commonwealth Home Support Programme (CHSP) which provides entry level services. This is the largest program, and remains block-funded, with the government directly funding providers based on client numbers and services delivered.
• The Home Care Packages Program (HCPP) was introduced in 2017 for individuals at four levels of assessed need.

The CHSP provides entry level care for Australian aged 65 older and indigenous Australian aged 50 or over to live independently at home. Services include some personal care, shopping, help with meals, taking people to appointments and community nursing. In 2018-19 there were:

• 1,452 CHSP providers
• 840,984 clients in the CHSP
• Approx. 209 individuals per 1,000 people in the target population

The HCPP provides support for people who need higher levels of care, especially personal care. It is an individualised cash for care scheme, where the government subsidy is reduced by means-tested contributions from ‘consumers’  which depend on that person’s assessed income. These fees vary between $15.81 to $31.63 per day. People may also be asked to pay a ‘basic daily fee’, the level of which depends on the package level. Where the daily fee is charged, it  is added to the government subsidy.

At 30 June 2021 there were

• 939 approved HCPP providers
• 195,699 people had access to a Home Care Package (HCP)

Accessing services:

Older people must be first assessed by an aged care assessment officer  to determine the package level. There are four levels of packages which range from Level 1 –  to Level 4  per annum. There are price differences between providers for various services (although records of median prices charges are kept (see Duckett et al., 2021, figure 2.3 and the national summary of home care prices) and there are differences in the amount of administration and care management fees charged. Such fees average 25% of the total value of a package and they be up to 50% of the HC package in some instances.

The number and level of packages in the HCPP are effectively capped and there are long waiting lists for both assessment and for access to services when a person has been allocated a package. As at June 2021, there were  53,203 older people waiting for a HCP at their approved level (Department of Health, p.15).

References:

Deloitte Access Economics (2020) Commonwealth Home Support Programme Data Study. Department of Health, Australia. https://www.health.gov.au/sites/default/files/documents/2021/06/commonwealth-home-support-programme-data-study_0.pdf

Department of Health (2021) Home care packages program. Data report 4th Quarter 2020-21. Australian Government. https://gen-agedcaredata.gov.au/www_aihwgen/media/Home_care_report/Home-Care-Data-Report-4th-Qtr-2020-21.pdf

In 2016, there are 366,000 paid workers (84%) and 68,000 volunteers (16%) delivering aged care. 66% of the paid workers were in direct care roles, including nurses and personal care workers (source: Care, Dignity and Respect report).

Australia has trained and supervises care workers to assist nurses with medicine management. Self-managed teams to give workers more flexibility and control have been shown to boost job satisfaction and reduce turnover (source: OECD).

Informal carers play an important role in Australian society.  In 2018, around one in nine Australians provided unpaid care to an elderly person or somebody with disability  (Australian Bureau of Statistics, 2019).

References: 

Australian Bureau of Statistics (2019). Disability, ageing and carers Australia: Summary of findings, Australian Bureau of Statistics: Canberra, ACT, Australia

My Aged Care is the single point of entry for government subsidised care in Australia, operating through a phone line and website. It provides information about the different types of care available, an assessment of needs, provides referrals and support to find service providers and information on the fees people are likely to face.

People who use aged care may choose between different types of aged care services, including care within their own home, community, or in residential aged care settings. Home Care Packages allow people to choose the care bundle that they require, along with their preferred providers and services.

The Royal Commission report found that users of aged-care found the experience of seeking services to be “time-consuming, overwhelming, frightening and intimidating” (Royal Commission 2021, p. 65) and argues that the current My Aged Care system does not provide the personalised information and support that is required for people to be able to make decisions about their own care.

References:

Royal Commission into Aged Care Quality and Safety (2020) Aged care and COVID-19: a special report. Commonwealth of Australia. https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf 

In a study analysing pandemic preparedness in the context of the 2009 influenza pandemic, researchers found that pandemic plans varied in detail, consistency, completeness, and usability depending on the state that issued it. Crisis communication and pharmaceutical interventions were completely missing in some states (Itzwerth et al., 2018).

Another study found that residential care staff reported issues with infection prevention and control strategies. It identified scepticism towards staff influenza vaccinations, effort required to read national guidelines, and lack of infrastructure to physically separate residents during an outbreak as the three main barriers to the management of outbreaks (Huhtinen et al., 2019)

Overall, the aged care sector in Australia struggled with pandemic preparedness even before COVID-19 – the pandemic only exposed the sector’s vulnerability (source: The Guardian).

In April 2020, the Aged Care Quality and Safety Commission contacted all aged care providers to complete an online self-assessment survey that asked about infection control systems and preparedness for a COVID-19 outbreak. 99.5% of providers claimed that their infection control and respiratory outbreak management plan covered all areas identified in the survey. The same proportion assessed their service’s readiness in the event of a COVID-19 outbreak as either satisfactory (56.8%) or best practice (42.7%). Interviews carried out for the Royal Commission found that, in hindsight, providers who experienced COVID-19 outbreaks did not think their previous self-assessments of preparedness were accurate (Royal Commission, 2020).

References:

Huhtinen E., Quinn E., Hess et al. (2018) Brief Report. Understanding barriers to effective management of influenza outbreaks in residential care facilities. Australasian Journal on Ageing 38(1):60-63. doi: 10.1111/ajag.12595

Itzwerth R, Moa A, MacIntyre C.R. (2018) Australia’s influenza pandemic preparedness plans: an analysis. J Public Health Pol 38:111-124. https://doi.org/10.1057/s41271-017-0109-5

Royal Commission into Aged Care Quality and Safety (2020) Aged care and COVID-19: a special report. Commonwealth of Australia. https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf 

The first COVID-19 outbreak in Australian residential aged care occurred on 4 March 2020 at Dorothy Henderson Lodge, an 80-bed facility in Sydney. A second cluster followed in April 2020 in Newmarch House, a 102 bed facility in Sydney.

After the initial containment of COVID-19 in Australia in May 2020, in June 2020 a second wave in Victoria spread rapidly through Melbourne-bases nursing homes.

During 2020 and 2021 case numbers and deaths have been concentrated the in two most heavily populated states, NSW and Victoria.

Overview

Between January 2020 and July 2021 there were just over 30,000 COVID cases in Australia with 910 deaths (58% of the deaths were in people over 85 years of age). Most of the COVID cases during this period were concentrated in two major waves of COVID in Australia interspersed with periods of low or zero community transmission with occasional localised COVID outbreaks. During this time, Australia states were either for the suppression and/or elimination of COVID control achieved by tight border restrictions, hotel quarantine, lockdowns, density limits in venues, mask wearing (in 2021), high levels PCR testing, contact tracing and isolation. Between November 2020 and July 2021 Australia had largely eliminated community transmission of COVID with the exception of localised outbreaks.

A third wave started in July 2021 in NSW which spread to Victoria.

From November/December 2021, following a vaccination program with targets of at least 80% vaccination for adults, the national focus changed from suppression/elimination to “living with COVID” and managing it like any other disease. This resulted state governments lifting most restrictions in most states (excluding Western Australia) including border restrictions and hotel quarantine and reducing contact tracing and isolation requirements for both COVID positive people and their close and casual contacts.

In late November the Omicron strain was sequenced in Australia. In December 2021 and January 2022 there was a rapid acceleration of COVID cases in all states in Australia (except Western Australia), with NSW and Victoria most affected.

As of the 23rd March 2022 there have been 3,868,171 confirmed COVID-19 infections in Australia, and 5,789 deaths, according to the Australian Department of Health. There are currently 402,837 estimated active cases in Australia. So far, deaths amount to 223 per 1 million population.

Although case numbers declined in January and early-mid February in NSW, Victoria, ACT, the Northern Territory, South Australia and Tasmania case numbers have started during late February to early March in all states except for the Northern Territory. From the beginning of February cases began rising in Western Australia which, as a result of strict internal and external borders and quarantine policy, has been largely free of community transmission of COVID. Both international and interstate borders were lifted on the 3rd of March 2022.

More details about the spread of COVID in Australia are given below.

The first wave

The first case of COVID-19 in Australia was identified on January 25, 2020, from a man who travelled from Wuhan to Melbourne.  Prime Minister Scott Morrison announced the Australian Health Sector Emergency Response Plan for Novel Coronavirus on February 27, 2020, and the first economic stimulus package on March 12, 2020. By mid-March, most states and territories were in lockdown. Cases began falling across the country in April, and on May 8, 2020, the government announced a three-stage plan to ease lockdown restrictions.

The second wave

The second wave was limited mostly to Victoria (June – October) and was managed with a strict lockdown.

Localised COVID outbreaks

Despite Australia’s suppression/elimination strategy, there were some leaks out of hotel quarantine.  Australian states used contact tracing and “snap lockdowns” to halt community transmission of the virus during smaller outbreaks.

Third wave (Delta strain)

In July 2021, an outbreak of the Delta strain started in Sydney resulting in a third wave of COVID infections. NSW implemented a strict lockdown. The outbreak spread to Victoria where a lockdown was also implemented. The case numbers decreased substantially through November and early December.

Omicron and “living with COVID”

From mid-December 2021 and early January 2022 introduction of the Omicron strain of the virus, the concomitant easing of restrictions in most states and a change in policy directions which focus on “living with COVID” there has been rapid acceleration of COVID infections.  Limitations on PCR testing capacity, extensive delays for PCR testing and lack of access to rapid antigen tests in the community has meant that the available case data is likely to be an underrepresentation of the number of active cases.

Hospitalisation rates and death among recipients of aged care services have been lower during 2021 than in the 2020 waves.

As of the 18th March 2022 there were 360 active outbreaks in residential aged care in Australia, with 1,613 residents and 1,542 staff affected.

As of 18th March 2022, there have been 20,154 confirmed cases of COVID-19 among subsidized residents in aged care facilities. There have been 1,879 deaths so far. Among people who use government-subsidized home care, there have been 192 confirmed cases of COVID-19 and 13 deaths. As of 18th March 2022 there have been 5,736 deaths among the whole population suggesting that 32.8% of all COVID-19 deaths in Australia have been among care home residents. These figures are based on people who have tested positive for COVID-19 and are for the place of residence, not place of death, so may include residents who died in hospital. In 2020, there were approximately 208,500 people living in aged care residential accommodation in Australia. Therefore, the numbers of care home COVID-19 deaths would amount to 0.90% of this population (source: AIHW).

A weekly report publishes data on the number of outbreaks and staff infected in care homes. As of 18th March 2022, there have been 24,216 cases of staff with COVID-19 infections.

About the data:

The Australian Department of Health first published deaths linked to COVID-19 in care homes and among users of home care services on April 15, 2020.

Impact on access to good quality care for people living in residential aged care

The pandemic has had implications for the quality of care delivered in the residential facilities with and without outbreaks. The Royal Commission into Aged Care Quality and Safety’s Special report on Covid 19 found several weakness in the Government’s preparation for the pandemic which had impacted the quality of care. These included:

• – Initial confusion and disagreement over whether residents with COVID-19 were best cared for by ‘hospital in the home’ services or being transferred to an acute hospital.
• – Fear among staff of working on site with infected residents.
• – ‘Surge staff’ new staff brought into facilities were ‘unfamiliar with the care needs of residents’
• – Inadequate infection prevention and controls in place leading to increased infections.

Impact on access to good quality care for people using home-based care

In the early stages of the pandemic, home care providers  reported high level of anxiety among home care clients and isolation stemming from fears around catching COVID-19. This was exacerbated by some difficulties with home care staff accessing PPE in the early stages. Initially some home care clients stopped all or some of their scheduled home care visits. The Australian Government prepared ‘it’s ok to have home care’ information sheets and client demand did pick back up in home care. Many home care providers stopped group services such as bus outings, group exercise classes and social groups. Providers have been given the flexibility to redirect the funds to other services such as ensuring clients have access to meals and groceries, undertaking welfare checks, and undertaking phone/video call social interactions (Charlesworth and Low, 2020).

References

Levels of depression, anxiety, confusion, loneliness, and suicide risk among aged care home residents have increased since March 2020. Some of this can be attributed to missing family, changed routines, concern about catching the virus, or fear of being isolated in their rooms. In some cases, people living in aged care homes are no longer doing the incidental exercise they were previously doing (source: Aged Care and COVID-19 report). Dementia Australia reported that people living with dementia and the people that care for them, especially family carers, have reported adverse effects of COVID-19 on their physical, cognitive, social, and mental wellbeing.

A national online survey carried out in September and October of 2020 asked 288 senior staff working in residential aged care homes about the impact of COVID-19 on the mental health of residents and staff. The study aimed to identify the perceived impact of the pandemic on mental health, the restrictions and stressors that staff identified as affecting mental health and the views of staff about programmes and resources to support mental health. The study used mixed methods, using qualitative narratives to complement the quantitative findings. It found that the mental health of both residents and staff has been severely affected, with high rates of residents reported to be experiencing poor mental health, increased loneliness, stress and anxiety, increased behaviours considered challenging, and increased thoughts about death and suicide. In terms of the reasons identified for these high rates of poor mental health for residents, staff suggested visiting and outing restrictions, media exposure to COVID-19 outbreaks and concern for the safety of family and friends. Staff identified training in supporting the mental health of residents, on-site and tele-health counselling and having technical support for video conferencing (Brydon et al., 2021).

References:

A report from Australia suggests increased care needs and reduced availability of paid services. Some retired carers experienced a drop in their funds. Unpaid carers of people living in residential care settings were concerned about their well-being (Lorenz-Dant and Comas-Herrera, 2021).

A six-wave longitudinal study by Abbasi-Shavazi et al., (2022) also illustrated that COVID19 had a more sever impact on carers relative to non-carers in terms of life satisfaction and psychological distress. However, the study also noted that free childcare was important to carers’ wellbeing (more than to non-carers) as the additional burden of caring for young children and older person/person with disability may have explained the greater deterioration of life satisfaction and psychological distress of carers.

Positive impacts for unpaid carers of people living dementia

A study by Tulloch et al., (2021) sought to identify positive impacts of the pandemic for unpaid carers of individuals with dementia. Interviews were conducted between June and August 2020 (during the second wave of the pandemic), and participants were asked about their experiences and perceptions of care before, during, and moving forward from COVID-19. Interestingly, when asked about their perceptions of care prior to the pandemic, interviewees tended not to discuss aspects of care that related to their own strengths or benefits: answers revolved around perceptions of the experiences of the person with dementia for whom they were providing care. In contrast, when discussing the provision of care during the pandemic, participants elaborated on their own caregiving experiences and what they saw as important values in the act of caregiving. In addition to these metacognitive elements, changes in behavioural approaches to providing care during the pandemic were reported, such as engaging in self-care strategies and seeking and accepting additional help when needed. Furthermore, participants expressed a desire to continue to engage with these behaviours beyond the pandemic. This research suggests that the pandemic may have provided those who provide informal care to people with dementia with an important opportunity to find profound meaning in the care they provide, and a recognition of the importance of looking after themselves to strengthen their provision of care.

References:

Abbasi-Shavazi, A., Biddle, N., Edwards, B. and Jahromi, M. (2022) Observed effects of the COVID-19 pandemic on the life satisfaction, psychological distress and loneliness of Australian carers and non-carers, 6(1-2): 179–209, International Journal of Care and Caring, DOI: 10.1332/239788221X16323394592678

Lorenz-Dant, K. and Comas-Herrera, A., 2021. The Impacts of COVID-19 on Unpaid Carers of Adults with Long-Term Care Needs and Measures to Address these Impacts: A Rapid Review of Evidence up to November 2020. Journal of Long-Term Care, (2021), pp.124–153. DOI: http://doi.org/10.31389/jltc.76

Tulloch, K., McCaul, T., & Scott, T. L. (2021). Positive Aspects of Dementia Caregiving During the COVID-19 Pandemic. Clinical Gerontologist, 45(1), 86–96. https://doi.org/10.1080/07317115.2021.1929630/SUPPL_FILE/WCLI_A_1929630_SM0674.DOCX

Workload

An Health Services Union (HSU) survey of 1,000 aged care workers released on 13th January 2022 found 90% of respondents reported they were experiencing understaffing, 84% reported excessive workloads, 82% thought that their aged care facility was unprepared for the Omicron wave and 36% were working in facilities that had implemented 12-hour shifts.

(p. 71 – The Senate (October 2021), Select Committee on Job security, Second Interim Report)

https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/024764/toc_pdf/Secondinterimreportinsecurityinpublicly-fundedjobs.pdf;fileType=application%2Fpdf

The Royal Commission’s September 2020 special report into COVID-19 noted evidence from unions that pointed to a lack of acknowledgement of the increased staffing numbers required to support the measures in the Visitation Code and the workload this created.

Financial impacts

The Australian Services Union submission to the Royal Commission reported on a survey on the impact of COVID on its members in home care. It noted that almost half of the respondents lost hours of work due to COVID restrictions and that the situation was worse in non-local government employment.

At various points in the pandemic, workers have been prevented from working across more than one private residential aged care site. While the Commonwealth government provided providers with additional funds to allow workers to be employed for at least their normal total hours (see  https://www.health.vic.gov.au/covid-19/supporting-the-aged-care-workforce-during-covid-19), however there has been considerable variation on how this has worked in practice and there have been some industrial disputes where employers did not honour pre-single site working arrangements.

Evidence of impacts on mental health of aged care workers

A national online survey carried out in September and October of 2020 asked 288 senior staff working in residential aged care homes about the impact of COVID-19 on the mental health of residents and staff. The study aimed to identify the perceived impact of the pandemic on mental health, the restrictions and stressors that staff identified as affecting mental health and the views of staff about programmes and resources to support mental health. The study used mixed methods, using qualitative narratives to complement the quantitative findings.

It found a high prevalence of staff who demonstrated poor mental health, in particular loneliness, anxiety and stress. The most commonly identified stressors where related to media exposure to COVID-19 outbreaks, concerns about their own safety as well as the safety of residents and their own families, and fear of inadvertently infecting residents. Staff identified potential helpful having training in supporting the mental health of residents, on-site and tele-health counselling and having technical support for video conferencing (Brydon et al., 2021).

References:

Staff shortages

Care providers have experienced staff shortages. As of 14th January, workforce surge staff have filled around 60,000 shifts in aged care facilities due to COVID-19.

The Royal Commission into Aged Care Quality and Safety’s special report on COVID-19 identified the following factors in terms of the ability of the aged care sector to respond (Royal Commission, 2020):

Factors linked to preparedness

In the residential facilities that have suffered the largest number of infections and deaths that have been the subject of inquiry (e.g Newmarch, St Basils) or used as case studies in reports (Epping Garden Gardens) the follow conclusions/points were made about their preparation or lack of preparedness (Royal Commission, 2020):

• – Insufficient PPE provided residential care and home care providers
• – Staff were excluded from the vaccination rollout.
• – Lack of understanding that workers bring the infection into the homes as well as taking it out and infecting family members.
• – Individual homes expecting to transfer large numbers of residents to hospital at short notice
• – There was no National COVID Plan for Aged care. The National Covid plan was adapted.

Structural problems in the LTC system

• – The effective casualisation of the workforce resulting in some personal care workers working across several facilities.
• – Chronic understaffing
• – The lack of clinical skills with the declining ratio of nursing qualified staff
• – The outsourcing of support services such as such as cleaning  and food preparation with workers working across several sites
• – Contested lines of responsibility between state and Commonwealth department

Academics, aged care peak bodies and unions agreed that the casualisation of the workforce, and outsourcing of some services (e.g. cleaning) resulting in a number of workers moving between aged care sties was considered to exacerbate the spread of the virus (Senate, Oct 2021 section 4.14).

References:

Royal Commission into Aged Care Quality and Safety (2020) Aged care and COVID-19: a special report. Commonwealth of Australia. https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf 

The Senate (2021) Select Committee on Job Security. Commonwealth of Australia.

The first case of COVID-19 in Australia was identified on January 25, 2020, from a man who travelled from Wuhan to Melbourne. Prime Minister Scott Morrison announced the Australian Health Sector Emergency Response Plan for Novel Coronavirus on February 27 and the first economic stimulus package on March 12. By mid-March, most states and territories were in lockdown. Cases began falling across the country in April and on May 8, the government announced a three stage plan to ease lockdown restrictions. Victoria entered its second wave in late June and by October 26, it reported no new cases or deaths. COVID-19 cases have been stable nation-wide since October 2020 (sources: WHO; health.gov; Lupton, UNSW).

A report was published by the Parliament of Australia, which provides a chronological overview of the measures implemented across states and territory governments in response to the COVID-19 pandemic as well as when these measures were eased again (until June 2020). Measures included border restrictions, visiting restrictions at health sites, closure of non-essential businesses and activities, and remote learning for pupils.

A National Plan to transition Australia’s National COVID-19 response was agreed in August 2021, with transitions to less restrictive measures being triggered by the rates of vaccination, with a plan to move to a Phase C, with only very highly targeted lockdowns and re-opening of borders, once 80% of the population aged 16 and over are fully vaccinated (with two doses). It was expected that all jurisdictions in Australia would reach this threshold and enter phase C by the end of 2021.

Professor Deborah Lupton has characterised six phases in the management of COVID-19 risk in Australia:

• – ‘A distant threat’ January 2020 to February 2020
• – ‘The National Lockdown’ March 2020 to May 2020
• – ‘COVID Zero’ June 2020 to January 2021
• – ‘Vaccine Dilemmas’ February 2021 to May 2021
• – ‘Delta Response’ June 2021 to September 2021
• – ‘Living with COVID’ since October 2021

Since October 2021 the Government’s policy has been to ‘learn to live with COVID-19’, accepting higher case numbers, hospitalisations and deaths, particularly for people not yet fully vaccinated.

The Australian Health Protection Principal Committee (AHPPC), made up of the Chief Health Officers from each state and territory, the Chief Medical Officer, and representatives from key departments coordinates the pandemic response. The Australian government is the main funder and regulator of aged care services. Therefore, it has a key role in coordinating a response to COVID-19 in aged care services. State and territory governments also have responsibility for acute care and managing health emergencies within their jurisdictions. Responsibility was fragmented between the federal and state governments. Within the states, while funded by the Commonwealth and having to comply with Commonwealth standards, there are some nursing homes run by state governments  (eg Victoria runs 178 nursing homes) and some home care is provided by local government (eg in Victoria). (Charlesworth and Low, 2020).

The federal, state, and territory governments established a COVID-19 health sector response plan but this plan has been criticized for not specifically addressing the aged care sector. There is a need for a national COVID-19 aged care advisory body to establish protocols between the national and state governments (sources: Royal Commission, 2020; Charlesworth and Low, 2020).

Fragmentation between the Australian Government, state, and territory governments led to confusing and inconsistent messaging. It was not clear to providers and recipients who was in charge and what communication to follow. The Commission into Aged Care Quality and Safety recommended a specific aged care advisory body for COVID-19. The Australian Health Protection Principal Committee is responsible for responding to health emergencies. While they released a response plan in early in the pandemic, none of the committee’s members are aged care specialists.

Public health is a shared responsibility between the Commonwealth and the states. In respect of COVID the Commonwealth oversees whole of government (Commonwealth & state) coordination measures and the COVID national communication plan. In aged care the key COVID-19 Commonwealth roles are:

• upskilling and supporting aged care providers to practice robust infection control—for example, stand-by infection control teams to be deployed if an aged care facility requires assistance with managing an COVID-19 outbreak
• easing contractual restrictions on funding for services delivered in the community—for example, having the flexibility to cease group activities
• increased funding for aged care providers—for example, additional funding to services that provide meals to people in the community
• temporary delay in introducing new reforms and programs—for example, the introduction of payment administration changes for home care packages has been delayed
• cross-portfolio arrangement to ease international student visa working arrangements within aged care, so they can work additional hours
• coordinating with state and territory governments in the event of an outbreak
• developing and making available communication material and resources for older people—for example, Coronavirus (COVID-19) advice for older people
• funding grants—for example, the Commonwealth Home Support Programme (CHSP)—emergency support for COVID-19 and
• introducing telephone options to support older people—for example, establishing a dedicated telephone line.

However, the states have the key responsibility for declaring and responding to emergencies, including public health emergencies such as COVID-19. “At the State level, each State has its own public health legislation to deal with a pandemic. It also has emergency legislation to deal with emergencies, including a pandemic. The States have exercised their powers to impose lockdowns, prohibit mass gatherings, limit the movement of people, close down non-essential businesses, and close schools, libraries and public facilities.” See  https://law.unimelb.edu.au/__data/assets/pdf_file/0003/3473832/MF20-Web3-Aust-ATwomey-FINAL.pdf

While cooperation during COVID between the Federal and state governments has been seen to be generally successful at a broad constitutional level, one major area of failure has been the lack of coordination between LTC run by the Commonwealth and the public hospital system run by the states: thus not “preventing the spread of coronavirus in aged care facilities… when nursing homes became infected with COVID-19, questions arose as to whether residents should be moved to hospitals, or treated in the nursing home, and who was responsible. After a number of crises in nursing homes, particularly during the second wave of the pandemic in Victoria, the Commonwealth and the State established the ‘Victorian Aged Care Response Centre’, which includes representatives from Commonwealth and State health departments, the aged care regulator, State and Commonwealth emergency management bodies and the defence force.”  See  https://law.unimelb.edu.au/__data/assets/pdf_file/0003/3473832/MF20-Web3-Aust-ATwomey-FINAL.pdf However this body has not been emulated in other states and is set to only exist until June 2022.

Other areas of state/federal jurisdictional tension in LTC have been in respect of the supply of PPE, the slow pace of the vaccine role out (and now booster role out) by the Commonwealth including of staff in LTC, adequate testing and tracing measures.

References:

Charlesworth, S & Low, L-F (2020) The Long-Term Care COVID-19 situation in Australia. Report in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 12 October 2020 (click here)

Royal Commission into Aged Care Quality and Safety (2020) Aged care and COVID-19: a special report. Commonwealth of Australia. https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf 

The federal, state, and territory governments established a COVID-19 health sector response plan but this plan has been criticized for not specifically addressing the aged care sector. There is a need for a national COVID-19 aged care advisory body to establish protocols between the national and state governments (sources: Aged Care and COVID-19 report; Charlesworth and Low, 2020).

References:

Charlesworth, S & Low, L-F (2020) The Long-Term Care COVID-19 situation in Australia. Report in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 12 October 2020.

The Australian government announced $440 million Australian Dollars to train aged care staff in infection control, increase the number of staff, and for telehealth services. Additionally, $234.9 million Australian Dollars was included as a COVID-19 retention bonus to ensure adequate staffing in the workforce (source: Charlesworth and Low, 2020).

References:

Charlesworth, S & Low, L-F (2020) The Long-Term Care COVID-19 situation in Australia. Report in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 12 October 2020.

The Department of Health publishes weekly traffic light reports of the COVID-19 situation across Australia, which includes details about cases, testing, and capacity nationwide and in individual states. Specific systems have been developed in individual states. For example, the Victorian Aged Care Response Centre brings together Commonwealth and Victorian state government agencies in a coordinated effort to manage the impact of the COVID-19 pandemic in aged care facilities.

On March 11, 2020, the Australian government announced $440 million Australian Dollars (AUD) to train aged care staff in infection control, to increase the number of staff, and for telehealth services. Additionally, $234.9 AUD was included as a COVID-19 retention bonus to ensure adequate staffing in the workforce. Additional funding was announced on August 31, 2020, where $563.3 million (AUD) was provided to reinforce the aged care sector’s response to COVID-19. This second phase of funding included $245 million AUD for COVID-19 support payments to aged care providers. The government also introduced an entitlement of up to 2 weeks of paid pandemic leave for aged care workers as well as a pandemic leave disaster payment, which is a lumpsum of $1500 to help staff after isolation or quarantine (Charlesworth and Low, 2020).

The Australian Aged Care Quality and Safety Commission phoned all home care services to offer support during COVID-19. There has been $59.3 million AUD of funding from the government allocated to meals on wheels, $50 million AUD to fund home-delivered meals, and $9.3 million AUD on emergency food supply boxes. Additionally, $10 million AUD has been allocated to the Community Visitors Scheme, which facilitates telephone calls and virtual friends for socially isolated people in community based aged care (Charlesworth and Low, 2020).

References:

Charlesworth, S & Low, L-F (2020) The Long-Term Care COVID-19 situation in Australia. Report in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 12 October 2020.

The Australian Government’s Aged Care Quality and Safety Commission is responsible for providing COVID-19 information and recommendations to aged care providers and facilities. However, state and territory health agencies also have the ability to implement policies in the aged care sector. With both the federal, state, and territorial governments having some oversight over aged care providers, there is a fragmentation of power leading to ineffective and often confusing protocols (source: Aged Care and COVID-19 report).

Recruitment drives

In April 2020, the Australian government announced the use of an online platform, Mable, which recruits workers in nursing, allied health, personal care, domestic assistance, and social support service. While Mable generates additional staff in the event of staffing shortages, concerns were raised about the inexperience of surge staff and their ability to provide adequate care. International students were allowed to work for up to 40 hours. The maximum number of hours worked was increased in order to better supply the health care workforce (sources: Charlesworth and Low, 2020; DoH).

Due to surge of Omicron, is also stipulated that to the extent reasonably possible, personal care workers must not provide personal care to residents at more than one aged care facility  in South Australia.

References:

Charlesworth, S & Low, L-F (2020) The Long-Term Care COVID-19 situation in Australia. Report in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 12 October 2020. https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf

Surge staffing arrangements

To supply ‘surge’ staffing to residential aged care during COVID outbreaks, in early April 2020 the Australian government initially employed healthcare delivery provider Aspen Medical and care staff platform Mable to provide rapid response teams to residential and community care. As of 2 October 2020, significant surge workforce assistance had been provided by both state and National Aged Care Emergency Response (NACER) teams, with many workers deployed from interstate.

The Government’s National Aged Care Emergency Response (NACER) was introduced, during Victoria’s second wave, to mobilise experienced aged care workers from areas across Australia without community transmission of coronavirus (COVID-19) to help care for residents in care facilities that face staff shortages because of COVID-19. Staff recruited include registered nurses, enrolled nurses, personal care workers and cleaners. These workers can be deployed to care facilities for a four week period, followed by two weeks of quarantine and are supplied with uniforms and PPE, regular COVID-19 tests during their placement and have access to pastoral and mental health support.

Scale of use of surge staffing

By 14th January 2022 these labour hire firms had supplied staff for around 60,000 shifts in aged care services affected. This included 39,104 shifts through the Recruitment, Consulting and Staffing Association (RCSA). Aspen Medical had provided staff to fill 1,245 staff as clinical first responder deployments and Mable had filled 2,711 shifts.The State and NACER Teams have played a relatively small role (204 personnel were deployed).

How has this worked?

In evidence before the Royal Commission into Aged Care Quality & Safety, concerns were raised about the minimal experience many of the surge staff had in residential aged care.

An Independent Review COVID-19 outbreaks in Australian Residential Aged Care Facilities published in April 2021 found that, during the second wave in Victoria and staffing levels became depleted there was not enough supply of qualified and or experienced staff, the review found that some of the surge workforce did not have appropriate skills and experience, had not had sufficient training in Infection Prevention and Control, or did not speak English well enough, managers struggled to work with surge staff and many care homes preferred to avoid using workers they did not know.

This experience shows that organising and mobilising a surge workforce is a major logistical challenge that requires an extraordinary collaborative effort to deliver staff where they were needed. Some large providers with capacity to engage their own interstate
staff, also organised similar programs and incentives for staff to work in other states.

The Independent Review by Lilly and Gilbert also highlights that, in order to repond to the situation some care homes redesigned roles, so that staff without care skills and experience were deployed to roles such as helping residents communicate with their familes and updating families, and in some cases staff who were isolating at home would support remotely the surge workers, sharing their knowledge about the residents and their needs.

References:

Charlesworth, S and Low, L-F (2020) The Long-Term Care COVID-19 situation in Australia. Report in LTCcovid.org, International
Long-Term Care Policy Network, CPEC-LSE, 12 October 2020. https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf

Lilly A. and Gilbert L. (2021) Independent Review: COVID-19 outbreaks in Australian Residential Aged Care Facilities – No time for Complacency. https://www.health.gov.au/resources/publications/coronavirus-covid-19-independent-review-of-covid-19-outbreaks-in-australian-residential-aged-care-facilities

The Australian government provided over $1.5 billion to the aged care sector for COVID-19 support, a portion of which were to be used for IPC training. However, the Royal Commission into Aged Care Quality and Safety found that high-level infection control expertise was still lacking in the aged care sector and further systematic training is required. Additionally, they found that, while the Aged Care Quality and Safety Commission issued infection control self-assessment checklists, they did not conduct comprehensive on-site visits (sources: Care, Dignity and Respect report; Charlesworth and Low, 2020).

References:

Charlesworth, S & Low, L-F (2020) The Long-Term Care COVID-19 situation in Australia. Report in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 12 October 2020.

Approaches to hospital transfers vary depending on the state and individual aged care home. Some experts suggested not transferring COVID-19 positive residents to hospital unless it is the only solution to improve their survival rate and reduce risk of transmission. However, South Australia has an automatic transfer policy in which a resident who tests positive will immediately be transferred to a hospital. As of October 2020, the Communicable Diseases Network Australia (CDNA) has yet to introduce a specific recommendation on hospital transfers (source: Care, Dignity and Respect report).

Guidance

If the COVID-19 positive person is a staff member, they must apply a surgical mask and leave the aged care facility by isolating at home. If the COVID-19 positive person is a resident, they must be moved to a single room, preferably with an en-suite, to isolate. The residential home may also be placed under lockdown for further testing. The local public health unit is responsible for contact tracing and the monitoring of residents (source: health.gov).

Dementia Support Australia provided guidance to support people with dementia during COVID-19. They suggested 1:1 residential support as the ideal way to help a resident isolate (source: Dementia Support Australia).

First waves

The Australian government introduced visitor restrictions on March 18, 2020, which limited to two visitors at a time. Visits must be in private areas with no social activities. Children under 16, people who have travelled overseas, and people with COVID-19 symptoms were not allowed to visit. Individual state governments introduced their own visiting policies and restrictions. Queensland, Victoria, and NSW both implemented prolonged personal visitor bans and lockdowns. The Royal Commission into Aged Care Quality and Safety found that aged care residents were severely impacted by the loss of contact with loved ones and that the restrictions inside aged care facilities go beyond the restrictions for the general public (sources: Charlesworth and Low, 2020; Aged Care and COVID-19 report).

In June 2021 Australia was almost ‘back to normal’ in terms of social distancing requirements, except during outbreaks and lockdowns (which by Australia’s definition means almost any case of Covid-19 with incidence of community transmission).

During lockdowns, there are restrictions on visitors. In early August 2021, New South Wales (Greater Sydney and some parts of regional NSW), Victoria, and South East Queensland (Brisbane) are in short lockdowns due to the Delta variant outbreak. In Greater Sydney all visitors are excluded, except those providing essential caring functions and end of life visits, and masks need to be worn). Guidance is state/territory specific, with visitors still having to follow Covid-19 precautions, prohibiting those with Covid-19 symptoms or those who have recently returned from international travel.

Prior to the most recent lockdown, in NSW, Greater Sydney, all essential visits took place in residents’ rooms, with residents being provided with appropriate PPE and infection control advice if they needed to leave the facility for essential purposes. However, guidance now states that no visitors or non-essential staff are permitted, and residents should avoid leaving the facility, except for essential reasons. For all other facilities located in NSW, only two visitors are allowed each day and visits should take place in the residents’ rooms or another suitable location in the facility. Furthermore, according to guidance in NSW, from June 1 to September 30, 2021, visitors should not enter aged care facilities if they have not received a dose of the 2021 influenza vaccine, unless they meet the criteria under the exceptional and special circumstances.

In Victoria during the lockdown visitors are limited to 2 people and masks are mandatory. Previously there were no restrictions to number of visitors.

In South East Queensland, except for end of life care, no visitors are allowed. Residents are not allowed to leave except for healthcare, emergency or compassionate reasons.

In Western Australia, visitors must wear a mask, with two and four visitors allowed per resident per day respectively. In some states/territories, such as Australian Capital Territory, Northern Territory, and South Australia, care home visits are ‘back to normal’, with no restrictions to visitors. In Queensland the flu vaccine is required for visitors after May 31, 2021, whereas in Tasmania this is only strongly recommended.

The Omicron outbreak

Data released on the 8th January 2022 shows that nearly 500 aged care facilities are affected by COVID-19, with 1,370 infections among residents and 1,835 among staff, resulting in residents being placed in lockdown.

On December the 8th 2021, a Direction was issued under the Emergency Management Act 2004 to limit entry into residential aged care facilities (RACF) in South Australia, a person is not permitted to enter or remain on the premises unless they have received at least two doses of COVID-19 vaccine or, all dosages of a recognised COVID-19 vaccine in accordance with dosage schedule recommended by ATAGI for that vaccine. Some exemptions apply to children under the age of 12, and people who have exemptions from vaccinations for medical grounds.

References:

Charlesworth, S & Low, L-F (2020) The Long-Term Care COVID-19 situation in Australia. Report in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 12 October 2020.

There has sufficient access to COVID-19 tests – testing has been available for all residents and staff in aged care facilities. Testing is typically only done if an individual shows symptoms or is suspected of having COVID-19. Regular testing for all staff and residents has not been introduced (source: DoH).

The Australian government worked with state and territory governments since the beginning of the pandemic to provide aged care facilities with PPE. As of October 2, 2020, 17 million masks, 4 million gowns, 11 million gloves and 4 million goggles and face shields had been provided to aged care facilities. But, even with this support, unions consistently reported PPE shortages within the facilities (Charlesworth and Low, 2020).

References:

Charlesworth, S & Low, L-F (2020) The Long-Term Care COVID-19 situation in Australia. Report in LTCcovid.org, International Long-Term Care Policy Network, CPEC-LSE, 12 October 2020.

The government of Australia announced over $1.5 billion AUD in funding for the aged care sector during the pandemic. A portion of this amount has gone towards telehealth development for people over the age of 70. The Department of Health also recommends that older people opt for telehealth appointments instead of in person appointments (source: DoH).

Vaccination rollout:

COVID-19 vaccination in Australia began in late February 2021 with people living in care homes and staff working in health and aged care included in phase 1a of the national rollout strategy. From 17th September 2021, residential and community-based aged care workers were required to be vaccinated against COVID-19 as a condition of employment (source: DoH). By this date, 95.8% of residential aged care workers had received their first dose, and 76.9% had received both doses (source: health.gov). As of 6th January 2022 99.4% of staff were double vaccinated. Approximately 85.9% of care home residents had received two doses, and 89.3% had received one dose.

At 9th January 2022 92.0% of the population aged over 16 and 74.04% of 12-15 year olds were double vaccinated. 3,565,888 people aged 16 and over had had more than two doses. The rates of vaccination for aboriginal and Torres Strait Islander peoples are lower, with 71.8% of people aged 16 and over having had two doses and 59.9% of people aged 12-15 having had at least one dose.

Booster/third doses:

The booster program for residential care began on 8^th November 2021, with in-reach teams visiting care homes which have been prioritised in each rollout. Booster data are not being routinely reported (source: health.gov). As of 7^th January 2022, a total of 425,273 vaccine doses had been administered to care home residents.

Impact of the COVID-19 vaccination on care home infections and deaths:

There have been no formal studies of the impact of vaccination on care home deaths. From official government data, up until 17^th December 2021, 206 residents had passed away from 1,601 infections. This contrasts sharply with data from 2020, when – as of 20^th November – there had been 678 deaths and 2027 COVID infections in residential care homes (source: DoH). This could be attributed to better healthcare and vaccinations. However, it seems that there is a similar rate of death per infection in residential aged care, despite lower numbers of deaths: as of 21^st November 2021, the total Australian death rate was 0.46% against the total number of residential aged care bed across the country. By comparison, this figure was around 0.37% in November 2020.

Mandatory vaccinations for care home staff:

All states and territories have mandated COVID-19 vaccinations for staff in residential aged care through public health orders.

Visiting in care homes and vaccination requirements:

In relation to mandatory vaccination for long-term care facility visitors, advice from the Quality and Safety Commission is given. This does not mandate vaccination, but heavily encourages it. In the advice, Industry Code is mentioned, whereby level of risk is used to provide or deny access to visitors.

 

Carers Australia have published resources and guides to help informal carers throughout the pandemic. The government has not introduced specific funding support for unpaid carers, however, unpaid carers are eligible for the Australian Government’s Coronavirus Supplement.

Funding for the My Aged Care website and phone services was boosted through an extra $12.3m to support. The Carer Gateway website also provides information for family carers.

Most unpaid carers are eligible for COVID-19 vaccines as part of the phase 1b of the vaccination rollout (which started in March 2021).