. I'm referring to the current outbreaks at non-government nursing homes in Victoria where some don't appear from media reports (which may be flawed} that many homes had no PPE, some homes were not or insufficiently prepared at all for an outbreak, some homes where PPE was supplied conducted little or no or insufficient training, some homes where vision is in the media of used PPE lying around on tables and chairs and floors and there is obviously insufficient supervision or monitoring, homes where symptomatic staff who were ill were allowed to come to work and work across multiple sites, or more. These things are all the responsibility & accountability of the administrators of the homes.
It is the responsibility of the Residential Care Facility under the CDNA National Guidelines for the Prevention, Control and Public Health Management of COVID-19 Outbreaks in Residential Care Facilities in Australia, 13 March 2020 (though there may or may not be an updated version of this).
The checklist below is from these Guidelines:
While my comments the other day were on oversight of Age Care as a whole, as opposed to just Aged Care Health which is but part of Aged Care, if you look just at Aged Care Health the responsibility is spread through Federal, State, Health Services, GPs and the Residential Aged Care Service/ Residential Care Facility as well as individuals . Though some individuals are not capable of making their own decisions. And health care is not just about pandemics. In a pandemic yes the relevant state government does need to step up with various measures, but these are not really meant to include taking over running all functions of the facility, but if need be it will have too.
Residential Aged Care Services/ Residential Care Facilities are required to ensure appropriately skilled nurses and other staff are available to meet the clinical and other care needs of the resident. The Federal Government has oversight of this.
Now all of the above and other matters are not done well enough in many facilities. That is why there is a Royal Commission. It is also why each flu season you normally see many flu outbreaks and deaths in such facilities.
These problems have long been there and this pandemic has just exposed these problems for all to see and the consequences are much worse than with flu outbreaks. Though some homes have had large loss of life in flu outbreaks.
Now there are many excellent facilities, but equally there are many that are not well run.
My personal experience
- MIL who is a widow has a number of growing and ongoing health issues plus has a having had colon cancer now has a colostomy bag. An environment with 24/7 medical care and good social opportunities was important.
- We looked around extensively, and the standard of most places was not adequate. Indeed quite a number were downright depressing to visit. It was the first time that I had examined such facilities in detail and what I saw and did not see certainly made me aware of how poor in general many of these facilities are.
- In the end we found a good match, and most since been happy with them and there care. There performance in past flu outbreaks has been mirrored in their current protocols in the pandemic, which have stepped up several levels. MIL very much enjoys the lifestyle that it provides to her.
- My daughter as part of her two nursing qualifications had to do many placements. 3 were in aged care. At all of her placements she was scathing, and quite depressed, about the practices there. One was so poor that she lodged an official complaint after her placement. The placements were meant to help educate the student nurses. At two of the placements my daughter's view that the facilities had basically taken them in as free labour with only minimal supervision/training occurring.
- My eldest brother (now 66) is unfortunately no longer able to make his own decisions and my sister and I have medical power of attorney for him for last 6 years. We agonised over how best to care for him and ruled out any of the RACS, and instead bought a unit for him in a retirement village with some federally funded home care services and also with ongoing visits from my sister and I. With the home care we vetted the people doing the caring and meet with them regularly (it was weekly) to discuss our brother's care. Initial support was via the Federal Government, and also some Local Government Services. Now come the pandemic, and my sister now having to home school grandchildren and myself have a daughter who often treats Covid 19 patients which meant that as we both became "Covid Possibiles", that we needed to minimise contact with both my brother but also our parents (both in their late 80's) . Plus my parents also had to minimise contact with my brother. This was quite a worry and dilemma. My sister negotiated with the federally funded care to allow more hours for paid home care , which then meant my brother could have a home visit 6 days per week. This is also important to monitor his medications. The retirement village also provides basic care and support, and does all maintenance.
- With my parents getting on they both have health issues. Dad is pretty good, but mum cannot be left by herself for any length of time, and so if dad has to go into hospital mum did to be cared for. Manageable pre-pandemic, but post pandemic a real problem for the same reasons as with my brother. So again we review RACS but this time near them. Same story as before. Some we simply do not believe to be adequate. We found one that we were happy with and have had her there for respite care twice in this pandemic.
Having looked at many aged care facilities now over recent years, plus having spoken to many of my friends who also have elderly parents and have like myself reviewed what is on offer, as the Federal Government is responsible for Age Care they really need to lift their game. The current pandemic has just made this all the more obvious, and the consequences have also been unfortunately more serious.
Now one could argue that that the State Governments could have stepped up and improve the aged care facilities after the pandemic started. Perhaps they should have, but the real responsibility lies with the Federal Government to have done so as the provision of appropriate age care is their responsibility.
I very much doubt what I have seen in Victoria is only the case In Victoria.
A count of one death has to be translated to an impact many times larger (in most cases) of partners, children, grandchildren, in laws, ex workmates, friends, neighbours etc al.
