Michael Pascoe: Every aged-care home on track for lockdown within weeks
At the current rate of infection, every aged-care home outside of Western Australia will be suffering COVID-19 outbreaks in a little over two weeks.
In round numbers, 180,000 residents will be locked down in 2400 homes.
Under current policies, they effectively will not be allowed to leave the home, not be allowed to have visitors, and many will be confined to their rooms for weeks.
That’s the reality of “letting it rip” for elderly Australians requiring residential care. And there’s no end to it in sight.
Despite the best efforts of over-stretched staff, lockdowns are distressing for residents, confusing for many.
Stories of deteriorating mental health aren’t just commonplace, they’re standard.
Yet some homes don’t even have a date for the promised booster clinics for residents and staff.
Remember when COVID-19 was new and “exponential” became the word of the year?
Well this is exponential:
On December 17, 54 homes had outbreaks.
On December 23, 105 homes had outbreaks – a near doubling in six days.
That number doubled in the next week and more than doubled again last week.
Aged care unprepared for Omicron
As infections in the community continue to rise, as staff must come and go, the number will more or less double this week to about 1000 and double again next week to 2000 and mop up the few hundred remaining homes over the next couple of days.
Homes will resolve outbreaks but get new ones.
Good people and/or scared people are trying to minimise the cases among residents and staff – RATs and PPE and confinement – but this still boils down to one of the worst aspects of letting the virus rip before the community was prepared for Omicron.
Given the longevity expectations of many in aged care, hundreds of people, perhaps thousands, will spend their last days with the prospect of just one “compassionate” visit by a family member under layers of plastic, if that.
For nearly all the residents, there is no autonomy involved, no say in their treatment, no choice in their lives – human rights signed away the day they entered the home.
Health Department regulations have assumed the power of legislation over them.
And those regulations can vary somewhat randomly from one local health area to the next, some more flexible than others.
Confined to their rooms
Although residential aged care is the federal government’s responsibility, implementation of pandemic regulations is in the hands of each local health area’s public health unit.
It’s the local PHU that takes control of a home once an outbreak is defined – either two staff or one resident testing positive. That means a Tier 0 lockdown – generally residents confined to rooms with no visitors.
If the PHU decides there is high COVID activity in the local community, it rules a Tier 1 lockdown – residents allowed out of their rooms but confined to the home and no visitors, unless the home management can convince the PHU limited visitations can be safely made.
As explained in a Catholic Healthcare webinar on Friday for residents’ families, the Tier 0 stage theoretically could be as short as seven days if all residents and staff test negative twice – but in practice is usually 14 days given the time PHUs take to investigate, test and obtain results.
Different providers have different rules beyond those two PHU levels.
Catholic Healthcare’s Tier 2 allows one adult visitor a day with the now-usual precautions and limitations.
Catholic Healthcare has 43 residential aged-care facilities in New South Wales and southern Queensland.
On Friday, 19 homes were in Tier 0 with outbreaks, 14 homes in Tier 1 given the virus rampant in the local community, nine on Tier 2 and just one, in Forbes, enjoying the greater freedoms of Tier 3. That wasn’t expected to last.
The homes are dependent on the Health Department for vaccine boosts.
Booster program falling behind
As an example of the government’s preparedness, slightly less than half Catholic Healthcare’s 2500 residents had received their boosts by Friday.
Most homes had been given a date for their booster clinic, but five had not.
The webinar also was told of staff having to drive interstate to acquire RATs. Most of the staff in the outbreak homes have not had a day off since December 20.
The Catholic homes had been relatively fortunate so far – only 23 residents were active cases on Friday.
Some other providers have much worse figures, making it much harder to cope given the extra care and caution required.
The powers of the PHUs mean the care providers have no or little discretion at Tiers 0 and 1.
Beyond that, the providers are caught between their primary duty of keeping residents healthy and the desire of some residents and families to allow more freedom, to be allowed more visits or to take residents out of the home for a meal or drive – but with the virus everywhere, that would mean more outbreaks in the homes.
The aged are not the only group suffering from the virus getting out of control.
The disabled and immunocompromised come off as second-class citizens, but the elderly are on a lower level again.
Two decades of activism have secured recognition of human rights for the disabled – basic rights aged-care residents lack.
Consultant and activist Daniella Greenwood hopes a new consumer-focused Aged Care Act resulting from the Royal Commission will bring change from the paternalism that presently characterises aged care.
“There has to be recognition that older people have the right to make their own decisions on an equal basis as everyone else,” she says.
As a matter of human rights, older people deserve the necessary support to be able to continue to live as citizens.
Not providing vital vaccine boosters when the pandemic is rampant is failing to provide that support.
Inadequate pay for staff, leaving the sector scrounging for people and overworking them, is not providing that support.
And it’s getting worse.