Passing The Test
Unlike in Europe, the safest place for the elderly in Australia is in an aged-care facility. This will be news to those who say the industry is in ‘crisis’. By Nick Cater.
The Royal Commission into Aged Care Quality and Safety is in hibernation until COVID-19 passes. When the commissioners return, they might ask why a supposedly broken aged-care system performed so well in the crisis.
When Spanish soldiers were deployed to disinfect nursing homes three weeks ago they found residents who had been left to die in their beds.
In France, infected aged-care residents were imprisoned in their rooms for more than six weeks, unable to be transferred to hospital and barred from receiving visits from family.
COVID-19: Read the MRC’s coverage of the debate in Australia and around the world
Their deaths went unrecorded in the official COVID-19 death toll at first. Now the authorities admit that more than a third of the country’s 980 deaths from the virus were in nursing homes.
Nursing homes have become COVID-19 incubators across Europe. Italy’s death toll in nursing homes stood at 3859 on Sunday.
In Sweden, the poster child for the welfare state, 94 of Sweden’s 290 local municipalities have reported confirmed or suspected coronavirus cases in elderly-care homes. More than half the 345 deaths in Canada occurred in long-term aged-care homes. In one facility in Bobcaygeon, Ontario, 27 of 65 residents died.
In the US, a Wall Street Journal investigation has identified more than 2300 deaths in nursing homes. An official inquiry has been launched into a particular case in Massachusetts where 32 residents died at a government-run home for veterans.
And Australia? A country in which the aged-care industry is “in crisis”, according to our national broadcaster. Where the host of its flagship investigative documentary series declared government regulation to be “an abject failure”.
On Sunday there were 12 active cases of COVID-19 from Australia’s 2672 residential aged-care homes in Australia, all but one of them in NSW. Sadly, nine elderly residents have died, six of them from the Dorothy Henderson Lodge in Sydney.
When the history is written of Australia’s victory over coronavirus, the early decision to lock down aged-care homes and the dedication of management and staff in protecting those in their charge will provide a template for the rest of the world.
It should serve as a template for the protection of all our elderly, particularly those in poor health.
Unlike most other countries, the elderly are safer inside an Australian aged-care home than out. They are four times less likely to catch the virus than those over 70 in the community.
Until a vaccine is found for COVID-19, there is a caveat attached to every good-news story. It takes only one person to carry the virus into an aged-care home to light a virological bushfire.
Approximately six out of 10 aged-care residents are over 85. Not unexpectedly, they tend to be more frail than their contemporaries outside.
Public health authorities in Australia are now exceptionally well equipped to deal with any outbreak. The outbreak at Dorothy Henderson Lodge began in late February when there were fewer than 10 confirmed cases of infection in NSW and Australians were preoccupied with bushfires.
The response from NSW Health to the outbreak at the lodge was swift and followed a well-planned, rehearsed drill. Unlike Italy or Spain, there were hospital beds available.
The tone of some of the ABC’s reporting of this outbreak suggests they were looking for confirmation of their conclusions. It was largely the ABC’s reporting of the “crisis” in Australian aged care that prompted the royal commission. The critical findings in the commission’s interim report were hardly surprising — even the best-run institutions can sometimes fall short of the required standards of care.
Yet even before its adjournment, the commission was struggling to find examples of systemic failure. Failures in the system were once the only thing royal commissions were there to establish.
Today, however, they are more often forums for multiple individual complaints that occasionally lead to prosecutions, but more often fail to meet the threshold required for criminal conviction.
On the evidence so far, the aged-care system has stood up well to the test of a virus that is especially cruel to its clients. Infection control measures commonly imposed during flu seasons were activated at many facilities long before the federal government issued tougher guidelines a week ago.
Many nursing homes have taken additional measures, according to those in the industry. Some aged-care workers are effectively self-isolating between shifts. Most are restricting contact with anyone outside work except immediate family.
The frontlines of aged care and healthcare are where the battle is being won, not on our parks and beaches where the police are moving people on. If you can stop a person over 70 catching the disease, you are 20 times more likely to save a life than if you keep someone in their 20s or 30s virus-free.
Good news is not hard to find these days as we contemplate the achievements of the past four weeks. When infection rates were doubling every two to three days late last month, our chance of avoiding the Italian route was by no means certain. Closing our borders, social distancing, testing and tracing have worked wonders.
Of the 32 countries with more than 5000 identified cases, Australia has the second-lowest case fatality rate. The lowest is the Russian Federation, whose figures cannot be trusted.
The federal government is tripling the number of ventilated acute care beds to 7500. On Sunday 1 per cent of them were occupied by COVID-19 patients.
The risk of a second wave cautions against complacency. We must live with this virus until a medical solution is found, which could be 18 months.
It’s all the more reason to redouble our efforts to protect those most at risk of serious illness or death while allowing the rest of the country to go about its business as cautiously as we can.