Aged care industry needs a massive shake-up

The tragic premature loss of life in many of Australia’s nursing homes continues to grow. The daily death toll, particularly in NSW, is shocking, and saddening. The grief of family and friends is turning to anger when some commentators infer these deaths matter less because residents were already palliative, or on the other hand try to exploit the tragedy for political point scoring.

Scapegoats I often hear are the shortage of Rapid Antigen Tests (RATs), the delivery of vaccine boosters, and sometimes blame-shifting onto families and other visitors. RATs were approved very late in Australia, and there is a global shortage. Most of the vaccine booster program was delivered in record time over December and January. Those things were easily predictable when all the States and Territories (except WA) “opened up”.

The fast spread of the Omicron variant took everyone by surprise, but leaders knew the risk of a new variant when they decided to open up. It is an example of ageism in our society, and the lack of priority for people in aged care, that nobody made sure we had enough RATs for residents, staff, and visitors before making the decision; or reconsidered how much we opened up and stepped back somewhat  after Omicron hit. After two years of Australians giving up so much, just a few weeks more could have seen the extra booster shots delivered and the RATs obtained, to make a big difference. We could never prevent all COVID deaths in aged care after opening up, but we didn’t need to have it be this tragic.

At the same time, we know that some providers have managed outbreaks well and kept them to a few cases, while others have not coped and had to be managed to protect remaining residents. Many of the differences are due to the same reasons as we saw in 2020.

Many nursing home operators have also been ignoring the Residential Aged Care Visitor Code, and so have State Heath Units who recommended locking residents in their rooms for weeks. Essential visitors, those who help with regular care for their loved ones, have been locked out in parts of the country, making a bad situation much worse. These lockouts have caused suffering, significant declines in nutrition, mental health, and general health, leaving residents even more vulnerable to COVID-19. Thankfully a number of good operators found ways around these restrictions and have respected resident’s human rights and mental health.

People are dying of COVID in nursing homes, who neither wanted, nor needed to move there. They moved there, or were moved there by families, because they could not get the help they needed at home. Past governments prioritised funding nursing homes, when care at home is most importantly what older people want,  it’s proved safer, and it’s also cheaper because government is not paying some residents accommodation costs.

Most nursing home executives and staff are diligent, hardworking, and compassionate. But facilities are often unsuitable, have too few staff, and those staff are not skilled enough, not trained enough, and not paid enough. When Omicron struck, and staff had to isolate, there was nobody left to help. Especially after two years of closed borders which blocked off a key source of aged care staffing – immigrants, working visa holders, and students working part time.

After decades of trying to do things on the cheap and squabbling between levels of government we need a massive shake-up of this industry. Many operators need to leave the system: their financial governance, clinical governance, staffing practices and facilities are not up to the job, as the Royal Commission showed, and never will be. Government money should be allocated to the older person receiving care (or their guardians), rather than the provider. Give people choice and control of their care and they’ll choose not to live in sub-standard nursing homes. The Aged Care Royal Commission supported this change but it’s too late for those who’ve died, and for those whom Omicron will kill in coming weeks.

There are providers who have done residential care well, but often on their terms rather than because they have designed services with residents. Some have delivered innovations such as cottage style accommodation, which has performed much better with COVID than more traditional facilities.

Thankfully the Government has accepted the Royal Commission recommendations for a huge increase in funding for care at home, a new Aged Care Act, and major reforms of aged care that will lift standards. We will continue to pressure them to keep up the timetable for implementation. They should also do more to support good providers rebuild their workforce and commit to increase wages by fully paying the increase being adjudicated by the Fair Work Commission. With an election coming soon, Australians should be asking all parties if they will do the same.

An edited form of this column appeared in the Daily Telegraph 10 February 2022.