Report by Sara Charlesworth and Lee-Fay-Low, last updated 12 October 2020
- The first COVID-19 outbreak in Australian residential aged care occurred on March 4 2020 at Dorothy Henderson Lodge, an 80 bed facility in Sydney with a second large cluster in April in Newmarch House, a 102 bed facility also in Sydney.
- After the initial containment of COVID-19 in Australia in May, in June a second wave of COVID-19 in Victoria spread rapidly through Melbourne-based nursing homes.
- To date, there have been 2,050 nursing home residents diagnosed with COVID-19. Of those residents, 677 have died and 1,170 recovered with 52 active cases. Nursing home residents represent 7.5% of all COVID-19 cases in Australia and 75.3% of all COVID-related deaths.
- There have also been 82 confirmed COVID cases in Australian government-subsidised home care. Victoria accounts for 63.4% of all Australian home care COVID-19 cases. Of the Australian cases, 7 people, 4 located in Victoria, have died. There are currently 2 active COVID-19 cases, both in Victoria.
- As of 12 October, a total of 2,211 aged care workers in residential aged care facilities had been infected by COVID-19. Of these staff cases, 29 cases remain active with 2182 cases being resolved.
- The Australian government put in place a number of significant policy and funding measures to assist the aged care sector prepare for and manage COVID-19 infections. Australian government COVID-19 support to the aged care sector is now over $1.6 billion. This includes funding for a COVID-19 Support Payment provided to all residential aged care providers, and an aged care worker retention bonus designed to encourage direct care aged care workers to stay working in the sector. Recent additional COVID-related funding to facilities provides for increased staffing costs, including for managing visitations and infection control training, and for enhanced advocacy and grief and trauma services for aged care recipients and families impacted by COVID-19 outbreaks.
- Aged care providers have also had priority access to the national stockpile of PPE, as well as healthcare rapid response teams and surge staffing support when an outbreak occurs in residential aged care. In home care, the government has provided additional funding to support meals on wheels, televisitor schemes and allowed for some flexibility in usage of funding.
- Direct support for aged care workers has included paid pandemic leave of up to 2 weeks for eligible aged care workers introduced by the Fair Work Commission in July 2020. The Australian government has also instituted a pandemic leave disaster payment, a lump sum payment of $1,500 to help workers during the 14 days they may need to self-isolate, quarantine or care for someone. Victorian workers not entitled to paid pandemic leave or other leave may also apply for a $450 COVID-19 test isolation payment where they are awaiting test results.
- Despite government measures, on 2 October, the Royal Commission into Aged Care Quality & Safety found deficiencies in government planning around COVID-19 in residential aged care. The Commissioners found that infection control was inadequate, that PPE and testing was sometimes hard to access, and that surge staffing arrangements were not sufficient, resulting in poor care during COVID-19 outbreaks in Victoria. The Commissioners also found that the Australian government did not have a COVID-19 plan devoted solely to aged care. They recommended that the Australian government should publish a national aged care plan for COVID-19 and establish a national aged care advisory body. The Commissioners also recommended the Australian government should arrange the deployment of accredited infection prevention and control experts in residential aged care.
- Nursing home visiting rules were first introduced by the Australian government on March 18, limiting visitors to two people a day, to be held in private rooms. However, many nursing homes introduced stricter rules, locking down facilities so that there have been no visitors except for under special circumstances. In Victoria there have also been strict rules mandated by the State government which, until recently, have restricted visits to one visitor per resident for one hour per day in special circumstances only. Across Australia there is growing public concern about the ongoing impact of provider-and state-imposed nursing home lockdowns on the wellbeing of residents. The Royal Commission recommended that there should be funding for providers to ensure there are adequate staff to deal with external visitors to enable a greater number of ‘meaningful visits’ between residents and their loved ones.
Responses to Country Questions
PART 1 – Long-Term Care System characteristics and preparedness
- 1.01. Population size and ageing contextAustralia 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 (Source: https://www.statista.com/statistics/608088/australia-age-distribution/; https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf)
- 1.02. Brief description of LTC system
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. There are three main types of service under aged care: the Commonwealth Home Support Programme, Home Care Packages, and residential care.
- 1.03. Long-term care financing arrangements and coverage
Australia has universal health care through Medicare. The Australian government subsidizes aged care services so anyone who received aged care is eligible for financial support. However, the Royal Commission into Aged Care Quality and Safety found that there is no universal entitlement to aged care as services are strictly rationed and access is determined by where you live, your needs, and what places are available. Due to funding shortages and lack of resources, not everyone who needs aged care can receive it. (Source: https://www.health.gov.au/about-us/the-australian-health-system; https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf). There is significant reliance on informal carers in the community, as they reduce the need for formal care. In 2018, there were around 428,500 informal primary carers providing support to someone aged 65 years or older. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf)
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. (https://www.oecd.org/fr/publications/who-cares-attracting-and-retaining-elderly-care-workers-92c0ef68-en.htm).
- 1.04. Long-term care system governance
The Aged Care Quality and Safety Commissioner, under the Australian government, is the national regulator of aged care services. They are responsible for approving subsidies for aged care providers, accrediting aged care services, monitoring quality of care, providing education, and handling complaints. Aged care providers must comply with the Aged Care Quality Standards set by the Aged Care Act and the Aged Care Principles. (https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf). 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. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf; https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf). 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 aged care sector, especially in light of COVID, and have recently issued their final report, which can be found here: https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf. There is central oversight from the Australian government, as they are 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. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf).
- 1.05.Quality and regulation in long-term care
In 2018-2019, $27.0 billion was spent on aged care, $19.9 billion of which came from Australian Government. In 2019–2020, the Australian Government’s expenditure on aged care programs administered by the Department of Health was $21.2 billion. 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. 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 or ACFI) and how much an individual can afford to contribute to the cost of your care and accommodation (using a means assessment). (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf; https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1819/Quick_Guides/AgedCare2019; https://www.myagedcare.gov.au/aged-care-homes)
- 1.06. Approach to care provision, including sector of ownership
The majority of aged care providers are not-for-profits owned by community, charity, or religious organizations. The remaining are privately owned organizations, which are run as a commercial business. There is also a small group of government owned providers. Australia has seen a trend of aged care providers consolidating to just a few large-scale operators – in 2018-2019, 10 providers operated 39% of all aged care services. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf)
- 1.07. Care coordination and personalization
The Australian government’s Ministry of Health oversees both the health and aged care sector. States and territories are responsible for the actual delivery of care. The aged care sector has been found to have less access to services, including allied 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 specifically increase the provision of allied health services, including mental health services, to people in aged care. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.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. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf)
- 1.08. Information and monitoring systems
The Department of Health facilitates an Australian National Notifiable Diseases Surveillance System, which tracks a list of specific communicable diseases. The Department of Health also 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. (Source: https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-casedefinitions.htm; https://www.health.gov.au/resources/collections/coronavirus-covid-19-common-operating-picture)
- 1.09. Care home infrastructure
Care home infrastructure and design guidelines vary between states. Aged care homes are allocated through the online platform, My Aged Care, which advertises “hotel-type services” including furnishing and bedding, meals, laundry, and social activities. The Royal Commission into Aged Care Quality and Safety found that care homes lacked the appropriate infrastructure to provide adequate care as space was often limited and facilities did not have enough staff and allied health professionals. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf)
- 1.11. Workforce conditions: pay, employment conditions, qualification levels, shortages
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, included nurses and personal care workers. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf)
Self managed teams to give workers more flexibility and control have been shown to boost job satisfaction and reduce turnover (https://www.oecd.org/fr/publications/who-cares-attracting-and-retaining-elderly-care-workers-92c0ef68-en.htm)
Helix helps with monitoring users at home and supporting self management (https://www.oecd.org/fr/publications/who-cares-attracting-and-retaining-elderly-care-workers-92c0ef68-en.htm)
Australia has trained and supervises care workers to assist nurses with medicine management. (https://www.oecd.org/fr/publications/who-cares-attracting-and-retaining-elderly-care-workers-92c0ef68-en.htm)
- 1.12. User voice, choice and satisfaction
“My Aged Care” is the single point of entry for Australian government subsidized care. It is a completely virtual service, without face to face assistance, which decreases user satisfaction and leads to less personalized support. Users of aged care found the experience of seeking out services to be time-consuming, overwhelming, and intimidating. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf). In 2018-2019, there were over 3000 providers of aged care services. 873 of these were residential services, 928 were home care providers, and 1458 were Commonwealth Home Support Programme providers. 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. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf).
- 1.13. Equity
From a financial perspective, aged care services are subsidized by the Australian government and co-payments and fees are determined by a person’s means to pay. However, the Royal Commission into Aged Care Quality and Safety found that there is no universal entitlement to aged care as services are strictly rationed and access is determined by where you live, your needs, and what places are available. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf)
PART 2 – Impacts of the COVID-19 pandemic on people who use and provide Long Term Care
- 2.01. Whole population impact of COVID
As of the April 8, 2021, there have been 29,385 confirmed COVID-19 infections in Australia, and 909 deaths, according to the Australian Department of Health, corresponding to 3.56 COVID-19 attributed deaths per 100,000 population. 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. Victoria entered into its second wave in late June, and by October 26, it reported no new cases or deaths. As of April, 2021, COVID-19 cases have been stable nation-wide since October (Sources: https://covid19.who.int/?gclid=Cj0KCQiAvvKBBhCXARIsACTePW9yMx1R31Uav8H6oLh3wEAVV68EZmmy7lb_v-FDkgTaL5mwurWha24aApaFEALw_wcB; https://www.health.gov.au/resources/publications/coronavirus-covid-19-at-a-glance-27-february-2021; https://deborahalupton.medium.com/timeline-of-covid-19-in-australia-1f7df6ca5f23).
- 2.02. Deaths (in care homes and among people using care in the community and social care staff), showing change over time to identify potential impact of learning, vaccinations etc
There have been 2,051 cases of COVID-19 and 685 COVID-19 related deaths in Australian Government–subsidised residential aged care facilities. The majority of cases occurred during the first wave, with Victoria accounting for over 90% of the cases and deaths in residential aged care. (Source: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers#cases-in-aged-care-services)
- 2.02. Deaths (in care homes and among people using care in the community and social care staff), showing change over time to identify potential impact of learning, vaccinations etc
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. As of April 8, 2021, there have been 2,051 confirmed cases of COVID-19 among government-subsidized residents in aged care facilities, 97% of which were in the state of Victoria. There have been 685 deaths among residents, 95% of which were in the state of Victoria, suggesting that 75% 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. Among people who use government-subsidized home care, there have been 81 confirmed cases of COVID-19 and 8 deaths (Source: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers#cases-in-aged-care-services). 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 0.33% of this population (Source: https://www.aihw.gov.au/reports/australias-welfare/aged-care).
A weekly report includes data on the number of outbreaks and staff infected in care homes. As of April 1, 2020, there have been no active cases of COVID-19 among people living in care homes since October 28, 2020. In total, there have been 2,238 staff with COVID-19 infections (Source: https://www.health.gov.au/resources/collections/covid-19-outbreaks-in-australian-residential-aged-care-facilities).
- 2.03. Impact of long COVID among people who use LTC
Australia does not currently have rehabilitation centres to treat COVID-19 “long-haulers” and there is no data on the impact of COVID-19 in aged care specifically. (Source: https://www.abc.net.au/news/2020-12-23/long-term-effects-of-covid-study-in-medical-journal/13007498)
- 2.04. Impacts on access to health and social care services (for LTC population)
All elective surgeries were cancelled during Australia’s first lockdown in March. Only Category 1 cases, which covered cancer and other urgent patients, were allowed to continue. The reduction in COVID-19 cases by April allowed hospitals to stockpile PPE and allow for surgeries to continue. Due to the relative low number of cases across Australia throughout the pandemic, health and social care services were not impacted for long amounts of time. (Source: https://www.rcsed.ac.uk/news-public-affairs/news/2020/june/response-to-covid-19-in-australia-and-its-impact-on-elective-surgery)
- 2.05. Impacts of measures on health and wellbeing (LTC population)
Levels of depression, anxiety, confusion, loneliness and suicide risk among aged care 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. 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. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf; https://www.dementia.org.au/sites/default/files/2020-11/Media-Release_New-discussion-paper-highlights-the-mental-health-impacts-of-COVID-19-on-people-living-with-dementia.pdf)
- 2.06. Other impacts (LTC population)
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. (Source: https://ltccovid.org/wp-content/uploads/2021/01/Lorenz_Comas_COVID_impact_unpaidcarers_preprint.pdf)
PART 3 – Long-Term Care system characteristics and preparedness that may have affected the response to the pandemic
- 3.01. Brief summary of the overall pandemic response
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. 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. (Source: https://covid19.who.int/?gclid=Cj0KCQiAvvKBBhCXARIsACTePW9yMx1R31Uav8H6oLh3wEAVV68EZmmy7lb_v-FDkgTaL5mwurWha24aApaFEALw_wcB; https://www.health.gov.au/resources/publications/coronavirus-covid-19-at-a-glance-27-february-2021; https://deborahalupton.medium.com/timeline-of-covid-19-in-australia-1f7df6ca5f23)
- 3.02. Governance of pandemic response
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. (Source: https://www.health.gov.au/committees-and-groups/australian-health-protection-principal-committee-ahppc; https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf)
- 3.02.01. National or equivalent COVID-19 social care taskforce
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. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf; https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf)
- 3.02.03. Support/facilitate/compensate for access to health care?
The Australian government announced $440 million AUD to train aged care staff in infection control, increase number of staff, and telehealth services. $234.9 million AUD was included as a COVID-19 retention bonus to ensure adequate staffing in the workforce. (Source: https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf)
- 3.03. Monitoring impacts: data gathering and information systems
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. (Source: https://www.health.gov.au/resources/collections/coronavirus-covid-19-common-operating-picture; https://www.health.gov.au/initiatives-and-programs/victorian-aged-care-response-centre/about-the-victorian-aged-care-response-centre)
- 3.04. Financial measures to support LTC sector
On March 11, 2020, the Australian government announced $440 million AUD to train aged care staff in infection control, increase number of staff, and telehealth services. $234.9 million 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 was provided to reinforce the aged care sector’s response to COVID-19. This second phase of funding included $245 million 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. (Source: https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf). Community-based care: The Australian Aged Care Quality and Safety Commission phoned all home care services to offer support during COVID-19. $59.3 million AUD of funding from the government has been allocated to meals on wheels, $50 million AUD to fund home-delivered meals, and $9.3 million AUD on emergency food supply boxed. $10 million AUD has also been allocated to the Community Visitors Scheme, which facilitates telephone and virtual friends to socially isolated people in community based aged care. (Source: https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf)
- 3.05. Oversight and regulation functions during the pandemic
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: https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf)
- 3.06. Supporting care sector staff and ensuring workforce availability
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. (Source: https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf; https://www.health.gov.au/ministers/senator-the-hon-richard-colbeck/media/contingency-measures-to-ensure-continuity-of-aged-care-during-covid-19)
- 3.07. Infection Prevention and Control guidance, training and implementation support
The Australian government provided over $1.5 billion to the aged care sector for COVID-19 support. A portion of these funds 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. (https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1.pdf; https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf)
- 3.07.01. Transfers to and from hospital, from community to care homes and between settings
Approaches to hospital transfers vary depending on the state and individual aged care home. Some experts suggest 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: https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf)
- 3.07.02. Approach to isolation of confirmed/suspected cases in care homes
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 ensuite, 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: https://www.health.gov.au/sites/default/files/documents/2021/01/first-24-hours-managing-covid-19-in-a-residential-aged-care-facility-first-24-hours-managing-covid-19-in-a-residential-aged-care-facility.pdf). Dementia Support Australia provided guidance to support people with dementia during COVID-19. They suggest 1:1 residential support as the ideal way to help a resident isolate (Source: https://dementia.com.au/downloads/dementia/Resources-Library/Helpsheets/Managing-behaviours-during-a-pandemic.pdf)
- 3.07.03. Visiting policies
The Australian government introduced visitor restrictions on March 18, 2020, which limited 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 (Source: https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf; https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf)
- 3.07.04. Deployment of "squads" or rapid response teams to support care homes with outbreaks
In April 2020, the Australian government announced emergency response teams for major outbreaks in residential aged care facilities. The emergency response teams include nurse first responders on standby in every state and territory. (Source: https://www.health.gov.au/ministers/senator-the-hon-richard-colbeck/media/contingency-measures-to-ensure-continuity-of-aged-care-during-covid-19)
- 3.08. Access to testing and contact tracing
There is sufficient access to COVID-19 tests – testing is 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 be introduced. (Source: https://www.health.gov.au/node/18602/coronavirus-covid-19-advice-for-people-in-residential-aged-care-facilities-and-visitors)
- 3.09. Access to Personal Protection Equipment
The Australian government has 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 have been provided to aged care facilities. But even with this support, unions have consistently reported PPE shortages within the facilities (Source: https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf)
- 3.10. Use of technology to compensate for difficulties accessing in person care
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: https://www.health.gov.au/node/18602/coronavirus-covid-19-advice-for-older-people-and-carers#medical-appointments-and-medicines)
- 3.11. Vaccination
COVID-19 vaccination in Australia began in late February, 2021 and are currently in phase 1a of their national rollout strategy. Phase 1a includes quarantine and border workers, frontline health care workers, and aged care and disability care staff and residents. As of March 2, 2021, 41,907 doses have been given in Australia, which corresponds to 0.17 doses per 100 people. (Source: https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/when-will-i-get-a-covid-19-vaccine; https://github.com/owid/covid-19-data/blob/master/public/data/vaccinations/country_data/Australia.csv
- 3.12. Measures to support unpaid carers
Unpaid carers are represented by the organization Carers Australia. They 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 (Source: https://www.carersaustralia.com.au/coronavirus-information/social-security-announcements/) Funding for the my Aged Care information and phone services was boosted through an extra $12.3m to support. This website also provides information for family carers (Source: https://ltccovid.org/wp-content/uploads/2020/06/International-measures-to-support-unpaid-carers-in-manage-the-COVID19-situation-17-June.pdf)
PART 4 – Lessons learnt
- 4.01. Pandemic preparedness of LTC sector
The Aged Care Quality and Safety Commission developed an online self-assessment survey to providers to review their infection control systems and to evaluate their 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%). This survey suggests that providers believed that they were more prepared than they actually were. The commission also found that most providers required further IPC and PPE training throughout the pandemic. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf)
- 4.02. Governance of pandemic response, priority and visibility of LTC and speed of response (including expertise on LTC in decision making bodies)
Fragmentation between the Australian Government, state, and territory government 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 recommend a specific aged care advisory body for COVID-19. Australian Health Protection Principal Committee is responsible for responding to health emergencies. While they released response plan in early in the pandemic, none of the committee’s members are aged care specialists. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf). The New South Wales Protocol became a guide for other states to set up their own protocols with the Australian government. The Commission found that establishing protocols between the Australian Government and individual States and Territories would be beneficial as such protocols would leave no doubt about coordination arrangements. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf; https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf)
- 4.03. Data systems performance in monitoring impacts of the pandemic and supporting decision-making
Australian Health Protection Principal Committee is responsible for responding to health emergencies. While they released response plan in early in the pandemic, none of the committee’s members are aged care specialists. Despite acknowledging the significant health risk that COVID-19 poses to elderly populations, the response from the Australia Government and AHPPC were insignificant. Individual states have been able to coordinate a more effective response. During Victoria’s second wave, they declared outbreaks very quickly and put the state or certain cities into short term lockdowns to prevent further spread. (Source: https://agedcare.royalcommission.gov.au/sites/default/files/2020-12/aged-care-and-covid-19-a-special-report.pdf; https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf)
- 4.05. Speed and effectiveness of testing roll out
Australia experienced PPE shortages at the start of the pandemic. Once cases started to decrease, the National Medical Stockpile was effective at supplying PPE. The National Medical Stockpile contracted suppliers from both Australia and overseas. All products meet the National Medical Stockpile quality assurance measures by ensuring products deployed are safe, effective and fit for purpose. (Source: https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-advice-for-the-health-and-disability-sector/personal-protective-equipment-ppe-for-the-health-workforce-during-covid-19#accessing-ppe)
- 4.06. Use of financial support
No evidence suggesting inadequate testing; however, this could be due to the limited number of cases across the country. Australia used a decentralized point of care testing model, which worked well in remote areas and Aboriginal and Torres Strait Islander communities. (Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30859-8/fulltext#seccestitle10)
- 4.07. Speed and effectiveness of vaccination rollout among the LTC population
The Australian government provided over $1.5 billion of funding to the aged care sector specifically. This included funds for aged care worker retention bonuses and aged care provider payments. (Source: https://ltccovid.org/wp-content/uploads/2020/10/Australia-LTC-COVID19-situation-12-October-2020-1-1.pdf)
- 4.08. Lessons on the continuity of services
Limited discontinuity of services due to very low transmission within the community.
- 4.09. Lessons from the vaccination rollout among the LTC population
Aged care and disability care staff and residents are in the first priority group to receive vaccines. Australia received its first batch of vaccines on February 15. However, rollout is significantly behind schedule. In early March, Italy blocked the export of 250,000 doses of the AstraZeneca vaccine to Australia, which further delayed the rollout. (Source: https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/when-will-i-get-a-covid-19-vaccine; https://www.theguardian.com/world/2021/mar/04/italy-blocks-export-of-250000-astrazeneca-vaccine-doses-to-australia)