The Royal Commission into Aged Care Quality and Safety (Royal Commission) has today released its report Aged care and COVID-19: a special report (Special Report), dated 30 September. The Minister for Aged Care and Senior Australians, Senator Richard Colbeck, has stated that the Commonwealth Government welcomes and will accept all of the recommendations of the Royal Commission.
The Special Report is the result of the Royal Commissions hearing on the impact of COVID-19 on the aged care sector. The Royal Commission acknowledged that the aged care sector in particular, has never faced a challenge like this and that the pandemic requires an immediate response.
It is clear to us that people receiving aged care services, their loved ones, those providing care and the aged care sector itself need immediate support and action”
Royal Commission
The Royal Commission has called for immediate action from the Australian Government across four key areas, to support the aged care sector:
- Modifying the Industry Code for Visiting Residential Aged Care Homes during COVID-19 (Visitation Code) to enable increased and more meaningful visits to people receiving care, and increasing funding to ensure that adequate staff are available to permit these visits;
- Creating expanded Medicare Benefits Schedule items to allow for increased access to allied and mental health services for people living in residential aged care to prevent the deterioration of physical and mental health;
- Publishing a national aged care plan for COVID-19 and the establishment of a national aged care advisory body;
- Facilitating the deployment of accredited infection prevention and control practitioners into residential aged care homes.
In this update, we examine the six recommendations made by the Royal Commission in its Special Report. In our view, these recommendations are well considered and represent a measured and sensible response to an unprecedented challenge for the aged care sector.
Whilst the 'devil is in the detail', it is critical that the sector fully engage with government on the implementation of these recommendations to ensure it is best placed to respond effectively to the ongoing challenge posed by COVID-19.
View the Special Report into COVID-19.
Recommendations
Recommendation 1: The Australian Government should report to Parliament by no later than 1 December 2020 on the implementation of these recommendations.
Imposing tight timeframes is critical. It ensures that immediate action is taken regarding the implementation of Recommendations 2 to 6 and that the Australian Government is held to account.
Recommendation 2: The Australian Government should immediately fund providers that apply for funding to ensure there are adequate staff available to allow continued visits to people living in residential aged care by their families and friends.
The Royal Commission has prioritised measures it considers necessary to restore physical connection between older people in aged care, their families and loved ones observing 'we do so, because older people must always be at the heart of the aged care sector and of any response to any event affecting their physical and mental wellbeing'. Isolation and loneliness is a key issue and of 'vital importance' to the personal welfare and mental of care recipients.
Maintaining the quality of life of those people living in residential aged care throughout the pandemic is just as important as preparing for and responding to outbreaks”
Royal Commission
We acknowledge that while steps taken by providers to restrict visitor access was a key step to ensuring resident, staff and community safety, the Royal Commission has noted that care recipients have endured restrictions that go beyond those imposed on the greater community, and that 'blanket bans on visitation are unacceptable and should be both explained and justified'. That being said, we are aware of many providers who have surveyed their care recipients and reported strong support for the steps taken to keep them safe. There is no 'one-size-fits-all' approach, and this has been acknowledged by the Royal Commission, which notes that the circumstances of the home and the level of community transmission in the location will impact the position of a provider on visitation.
The Royal Commission has recognised that a balance must be struck between reducing the likelihood of an outbreak of COVID-19 within the home, whilst ensuring that care recipients can receive visitors. They have strongly indicated that more can be done to strike this balance, including making necessary amendments to the Visitation Code. These initiatives are dependent on necessary funding to ensure that providers can afford to increase staffing levels to facilitate additional visitors without compromising the safety of care recipients in their homes.
Recommendation 3: The Australian Government should urgently create Medicare Benefits Schedule items to increase the provision of allied health services, including mental health services, to people in aged care during the pandemic. Any barriers, whether real or perceived, to allied health professionals being able to enter residential aged care facilities should be removed unless justified on genuine public health grounds.
There is no doubt that the COVID-19 pandemic has had both a physical and mental toll on care recipients in residential aged care homes, as it has many members of the community, particularly the most vulnerable. Preventing the deterioration of the physical and mental health of care recipients is critical.
Recommendation 4: The Australian Government should establish a national aged care plan for COVID-19 through the National Cabinet in consultation with the aged care sector. This plan should:
- establish a national aged care advisory body
- establish protocols between the Australian Government and the States and Territories based on the NSW Protocol but having regard to jurisdictional differences
- maximise the ability for people living in aged care homes to have visitors and to maintain their links with family, friends and the community
- establish a mechanism for consultation with the aged care sector about use of Hospital in the Home programs in residential aged care
- establish protocols on who will decide about transfers to hospital of COVID-19 positive residents, having regard to the protocol proposed by Aged and Community Services Australia
- ensure that significant outbreaks in facilities are investigated by an independent expert to identify lessons that can be learnt. The results of any such investigations should be promptly disseminated to the sector.
The Royal Commission concluded there was no COVID-19 plan for aged care. The Health Sector Plan was silent on the known gaps in the aged care system. Aged care requires a bespoke plan which the Royal Commission proposes be created by the national aged care advisory body having regard to the needs of the sector.
There must be clear operating protocols in place, outlining the relevant stakeholders, roles and responsibilities and the hierarchy of decision making. This was highlighted by Professor Lyn Gilbert AO and Adjunct Professor Alan Lily, in their independent review of Newmarch House. The absence of these protocols was a significant issue for the effective management of the COVID-19 outbreak at Newmarch House. The Royal Commission agreed with Prof Gilbert and A/Prof Lily that the formation of a National body, responsible for formulating a sector specific COVID-19 plan, would achieve this outcome.
Importantly, the Royal Commission notes the formation of the Aged Care Advisory Group within the AHPPC. The Royal Commission recommends that this group should not be time limited, as it is important to have continuous monitoring of future health emergencies and challenges in the aged care sector.
The decision whether to transfer a COVID-19 care recipient to hospital is complex and subject to a range of factors. These include the relevant State-based public health approach, the size and capabilities of the home, the protection of workers caring for the care recipient and the needs and preferences of both the care recipient with COVID-19 in addition to other care recipients, who have a right to not be exposed to the disease where this is preventable.
COVID-19 outbreaks have been able to be more effectively contained where care recipients have been immediately transferred to hospital. While the implementation of Hospital in the Home may be effective in smaller outbreaks, the extent of an outbreak is not known until the final positive case has recovered, generally some weeks after the initial infection. There can be no doubt that the equal rights of all Australians to access the hospital system must be recognised and that the preference of the care recipient must be a key consideration in the decision to implement a hospital transfer.
Recommendation 5: All residential aged care homes should have one or more trained infection control officers as a condition of accreditation. The training requirements for these officers should be set by the aged care advisory body we propose.
Recommendation 6: The Australian Government should arrange with the States and Territories to deploy accredited infection prevention and control experts into residential aged care homes to provide training, assist with the preparation of outbreak management plans and assist with outbreaks.
The Royal Commission has highlighted the assumption previously held by the various levels of Government and aged care providers that COVID-19 was akin to influenza. Reliance on infection control plans already in place for influenza failed to account for the particular challenges associated with the virulent nature of COVID-19. As our state of knowledge has continued to evolve, we now know that in responding to an outbreak a higher degree of vigilance and a more rapid response is required. The Royal Commission has recommended that each home have at least one dedicated infection control champion and that training in the appropriate use of PPE be compulsory and to a 'much higher standard'. The government must deploy accredited infection prevention and control experts into residential aged care to provide training and assist with the preparation (and ongoing review) of outbreak management plans.
There is nothing more important to help providers prepare for and respond to COVID-19 outbreaks than access to high level infection prevention and control expertise”
Royal Commission
We acknowledge that this will necessarily require adequate government funding and support and better relationships between stakeholders.
Where to from here?
The Royal Commission has acknowledged 'the COVID-19 pandemic has been the greatest challenge Australia’s aged care sector has faced'. Not only is the aged care sector overworked and under resourced, they are now 'traumatised' by COVID-19 and grieving the loss of many aged care residents.
The aged care sector must look to key lessons learned from the COVID-19 pandemic and move to quickly effect meaningful change. It will be essential for providers to engage with the government to ensure that the measures implemented in response to this Special Report are fit for purpose and create a lasting impact in the sector.
If you would like further information or assistance in relation to the Special Report or your response to the COVID-19 pandemic generally, please do not hesitate to contact us.
