Why is it only a crisis can drive much needed change in residential aged care?
COVID-19 has infiltrated more than 60 aged care facilities in Victoria – and people are anxious, angry and confused. The terrible toll of COVID-19 on these facilities has already been documented in Italy, United Kingdom, Sweden and the USA – where many elderly people have died.
We now find ourselves in a similar situation.
The Commission’s Interim Report submitted in October was damning:
“This cruel and harmful system must be changed. We owe it to our grandparents, our partners, our friends. We owe it to strangers. We owe it to future generations. Older people deserve so much more.”
Now here we are again.
It is important to remember that aged care facilities aren’t hospitals. They provide a home for people who can no longer live independently in the community.
On any given day in Australia, there are more than 200,000 people living in around 2,672 facilities across Australia. This equates to an average of around 75 beds per facility.
As University of Technology Sydney researchers have reported, the sector received $A11.4 billion in government funding in 2017, and generated $A21.5 billion in revenue.
The facilities are run by state governments, not-for-profits and for-profit organisations, but the bulk of funding is provided by the Commonwealth Government, alongside contributions from the residents.
These contributions can include a bond upon entry for those residents who are assessed as being able to make this payment.
What is perhaps not well appreciated is that residential aged care services depend on families to provide support to residents and – as I’ve found in my own research and personal experience – residents want partners, families and friends to visit.
For many residents, this is their lifeblood. But COVID-19 threatens to sever this connection.
Communication is vital in a time of crisis and over the last few days it has been heartening to see how quickly our health care system has responded. Health care workers, including Australian Defence Force medics, are being redeployed in Victoria to assist with care in these facilities, with a particular focus on infection control and public health measures.
I always say to my students when I am teaching: “Ignore families at your peril.”
A vital public health strategy here is communicating effectively with family members, and it needs to be led by government providing consistent messaging for the relatives and friends of people in residential aged care.
But imagine what might happen in a typical 200-bed facility if a resident or staff member is infected with COVID-19; the word gets out and suddenly the manager has to deal with potentially hundreds of calls, texts and emails from relatives and friends wanting to know what is going on.
Under the current staffing culture, there is unlikely be enough staff to do this work.
Residents of these facilities often have large numbers of family and friends who love them, and they have lived full and purposeful lives, before going to aged care.
We need to develop new and innovative ways of continuing to help people communicate with residents, like harnessing technology like videoconferencing and virtual reality.
Aged care facilities haven’t in my experience been good at using these new technologies to help people connect, and this is often left to families to negotiate.
Staff are under pressure and staff training is often basic – there are fewer registered nurses available in aged care than in the past.
Each facility is allowed to decide their staffing mix or ratios, something that is hotly debated in the sector. But in this crisis, the system has been shown to be lacking in the provision of infection control as well as in effective and compassionate communication with families.
In Australia, our residential care facilities are largely staffed by nurses and personal care workers.
A crisis like this is a reminder that perhaps we need social workers in these facilities too, as is the case at most facilities in the United States. Social workers can play a key role on working with both residents and their families.
Social workers can also go someway towards filling the vacuum left when in a crisis like COVID-19 when there are restrictions on families and friends visiting.
Families, along with carers, play a key role in keeping residents active and engaged – research has shown that this is important for maintaining physical and mental health.
Being isolated in your room, with only one person to visit at a time can hit residents and families hard.
What is needed now is a public health response that is clear and easy to understand, which focuses not just on infection control, but also on communication and ensuring residents are provided with warmth, connection and compassion.
If we don’t do this the backlash will be harsh and damning, as it should be.
On the upside – COVID-19 will ask us all to consider what we want these facilities to look like in the future. Over the past 20 years, there have been numerous enquiries which have all concluded that the system in broken.
COVID-19 has again reminded us of this. But now, surely the time for reminders is over?
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