On 29 October, the Prime Minister released the COVID-19 Response Inquiry Report (Report) which examines the national experience of the COVID-19 pandemic and offers learnings and recommendations. The Report considers 'priority populations', which recognises certain populations, such as older Australians and people with disability, are likely to be at greater risk in a pandemic and experience 'inequitable burdens of disease and disparities in health and economic outcomes'. The Report emphasises the importance of building capacity to ensure preparedness and a robust response to future outbreaks. As the aged care sector continues to implement learnings from the pandemic, we provide a brief overview of the Report's commentary on the aged care sector:

Before the pandemic

The Report acknowledges that aged care providers regularly deal with virus outbreaks, particularly influenza, however, considered that the sector was unprepared to deal with the pandemic. The Report found that providers unpreparedness resulted from a combination of factors including 'pre-existing structural weakness' which the Report attributed to insufficient staffing and inadequate infection prevention and control, and 'a lack of planning and underdeveloped sector representation to government'. As part of consultations, providers noted that 'no one felt they were fully prepared for the magnitude of what they encountered'. The Report found that emergency plans implemented by providers prior to the pandemic were often nonspecific and were designed to deal with single-facility outbreaks only, which did not recognise that many aged care workers worked between multiple facilities. The Report emphasises that, in order to be effective, emergency plans need to be detailed and consider building design, the impact of the layout on the ability to deliver services, individual residents and their needs, and the availability of local service providers and contractors.

During the pandemic

The Report found that, during the pandemic, most workers in the aged care sector earned as little as $2 above the minimum wage. Additionally, 93% of direct care workers were employed part-time and were working across multiples sites and providers, inadvertently becoming transmitters of the virus.

Impact of the pandemic

The Report acknowledges that, from the outset of the COVID-19 pandemic, it was evident that older Australians were at a particularly high risk of severe illness and mortality from the virus, a susceptibility that resulted from age and the presence of comorbidities, which emphasised the need for preparedness. Consequently, the pandemic had a disproportionate effect on residential aged care facilities, and that the aged care system was not prepared for the COVID-19 pandemic due to understaffing and inadequate planning and resourcing. The Report also found that new introductions of the virus into the community via hotel quarantine 'triggered devastating outbreaks in aged care facilities that resulted in the tragic loss of life'.

Other learnings from the Report

The Report highlights a range of other learnings from the pandemic including that:

• older Australians are highly dependent on a broad support network, including carers, family, and friends, meaning the restriction of visitation access should only be used as a short-term protection measure. Any implementation of visitor restrictions must be weighed against the impact on the mental (and subsequent physical) health of older Australians and their families;
• the aged care workforce is essential to maintain continuity of care during outbreaks, and a surge workforce cannot be solely relied upon in a public health emergency;
• infection prevention and control measures are crucial in aged care settings for effectively responding to and averting outbreaks of infectious diseases; and
• changes to the physical design of residential aged care facilities will reduce transmission risk and allow for more flexible responses to pandemics.

Recommendations from the Report

The Report makes nine guiding recommendations and proposes 19 immediate actions to be undertaken over the next 12 to 18 months. Relevantly, the immediate actions recommended, include:

• Management Plans: updating health emergency planning and response arrangements in conjunction with States and Territories, which requires the development of management plans under the National Communicable Disease Plan for priority populations. Management plans should address the 'unique needs of priority populations and co-design with communities and experts' from the aged care and disability sector. The Report recommended the Management Plan for older Australians should account for those in residential aged care facilities and in their own homes. Further, the Management Plan for older Australians should mitigate isolation and loneliness whilst prioritising surge workforce requirements. Crucially, the Report emphasises that compassionate exemptions should be made to ensure people at the end of their lives are not denied visitation by family and friends.
• Modular operational plans for specific sectors: these plans should be developed by relevant agencies in conjunction with states and territories and service providers. The Aged Care plan should document an agreed escalation response model for sector-wide crises, include clearly defined triggers and criteria for escalation and identify the data required to inform a response.
• Plans: response plans should document an agreed escalation response for a sector-wide crisis, define triggers and criteria for escalation, cover the clinical response, surge workforce capacity, infection prevention and control strategies, personal protective equipment and outbreak management strategies, whilst considering the interface between aged care and health services.
• Communication: a communication strategy should be developed to ensure priority populations, their families and the sector have the information they require to manage their social, work and family lives. The communication strategy should address distinct communication preferences and should reflect the key role of representative and peak bodies. The Report also acknowledges the importance of genuine engagement with aged care sector stakeholders from the start of a pandemic.
• Government actions: several recommendations aimed at the governments to improve coordination, transparency and access to expert advice. The Report recommends the implementation of legislative and policy frameworks which support a pandemic, including provision for essential services and essential workers.

More generally, the Report called for 'strong leadership' within providers and greater 'sector representation' at the Government level. The Report emphasised the need for clear roles and responsibilities between providers, the health system and the Government to ensure consistent and coordinated response and management of outbreaks.

It is clear from the Report that preparedness stands as the cornerstone for the effective management of future pandemics. The Report underpins the need for robust and adaptable systems designed to manage the range of evolving risks that pandemics present, particularly to priority populations.

Since the pandemic, we have been working with our clients to implement strategies to minimise risk and ensure compliance with their legislative obligations as approved providers of aged care. If we can be of any assistance to your organisation, or you have any questions about this update, we would be delighted to hear from you.