COVID-19 has now had a devastating impact on parts of residential aged care in Australia, particularly in the state of Victoria. The ‘second wave’ of the disease expanded rapidly through greater Melbourne leading to outbreaks in over a hundred aged care facilities and substantial numbers of deaths in a number of them.
After the first wave of the pandemic, Australia could argue that it was the envy of the world with the relative number of cases and deaths low after high levels of testing. Aged care provider peak bodies were highlighting the alleged excellent infection control efforts and outbreaks in aged care were limited to a small number of facilities. As the preface in our first COVID-19 submission states, COTA’s view was that the “jury was out” due to the low rate of community transmission at that time. Our caution at being too congratulatory has unfortunately and regrettably proven to be correct.
In our first submission to the Royal Commission on COVID-19 we indicated that it was likely that we would be writing a second submission. Recent events have highlighted the importance of clarifying and strengthening arguments addressed in the first submission as well as discussing new issues that have arisen during the second wave of the pandemic in Victoria.
The COVID-19 pandemic and its severe impact on aged care comes at a time when the Royal Commission is finalising its public hearings and is beginning to draft its final report with key recommendations for reform. The circumstances of COVID-19 do highlight some important reform issues, particularly inconsistent approaches by providers to residential care visits by families, vastly different success at infection control by aged care providers, variable implementation of communication strategies by providers, variable demonstrated preparedness for health emergencies, clinical decision making in residential aged care particularly related to potential hospitalisation, the relationship with state health systems, and workforce shortages, capacity and skills.
However, the pandemic experience should influence but not overshadow or dominate the final conclusions of the Royal Commission. It is possible that large scale public health emergencies will become more common in the future, but it is also true that this pandemic is unprecedented. In terms of the long-term reform challenges for aged care, these preceded COVID-19 and it should be placed into context.
It is also important to consider that older Australians are currently living with the physical health, emotional and psychological impacts of COVID-19, in both residential care and in the community, and will continue to do so long after the immediate severity of the pandemic has passed. While the deaths of older aged care residents is tragic (and many could have been prevented – but not all), there are thousands of older consumers of residential care and home care who are isolated and experiencing the emotional toll of experiencing current events, with many not receiving adequate ongoing health care. Older people are at the centre of this crisis and of reform of aged care in this country. The message that the voice of aged care consumers is critical to aged care reform seems to require constant repetition as it is often being lost. The current public debate about aged care generated by the pandemic, combined with the hearings of the Royal Commission, needs to be reminded of this.
Older Australians, whether they are living in residential aged care, receiving home care packages or living in the community, bear among the largest burdens of this pandemic in various ways, both now and for many years after the severity of the disease has subsided.