Aged Care Managed Facilities - medical care provided

Services
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Topical:

  • Covid-19 is highlighting a number of concerns.
  • For anyone needing to make the decision, understanding how facilities and their management deliver medical services.
  • With reference to the RC (separate community topic) a system under resourced and stressed even before Covid-19

Our reality (recent first hand), although we have numerous older family members experiences spread over the prior decade or two as a baseline.

Aged care facilities are “not nursing homes”. Any notion that the majority are medical facilities is far from factual. Perhaps back in the olden days post each WW they were run by medical professionals and staffed predominantly by qualified nurses.

In Aged Care the level of care, support and services delivered is different from the high level of medical care provided in hospital, in rehab accommodation, or in state hospital run temporary accommodation for those waiting for placement or home care.

The facilities deliver residential services for our aged family who cannot live independently. And for those who for any one of a number of reasons cannot remain at home with the assistance of a residential care package. Staff have various levels of training to assist residents and provide basic care. Registered nursing staff are a small number.

Medical professional services (Doctors) come on a scheduled basis or on call. Any non routine treatment or services requires residents to attend external providers or hospital. Some facilities are set up to deliver palliative care (end of life).

By whom and how the responsibility for the medical care of each resident is assigned, is for us an important consideration. There are many fingers in the pie. Including Federal Govt Aged Care Services, State Govt Medical Orders and Registration of staff, Facility Management/staff, Individual Residents (of sound faculty), and nominated family (EPA, AHD etc).

What is very evident is the facility we are most familiar with and those we reviewed recently - ARE NOT HOSPITALS!

  • They are not designed to function as infectious disease wards,
  • Residents live in close proximity with minimal social distancing,
  • Containment is only possible by restricting residents to isolation in their own rooms, even if they are not infected.
  • Staff are not trained or equipped to work in an infectious disease type hospital environment.

Our general experience with the staff at our mum’s facility is very positive. The majority are just as concerned for the residents as we are. The management have also advised that any residents who fall ill will be transferred to hospital. While this is reassuring, to date the evidence at facilities in other states has been very different.

Our part of Queensland has also moved to lock down Aged Care Facilities. It makes it more difficult for family to exercise any control over the care or medical needs of family members. No different to some other states for now.

We wonder whether despite best intents of all, the systems in place are serving the communities needs in the best way?

What are your experiences, concerns and suggestions?

P.S.
Residents of all facilities are most reliant on the facility staff to stay Covid free. This may be the greater challenge for the community. Especially given the high level of community transmission now evident in some parts of the nation.

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Your description mirrors our experience with my wife’s late father.

The nursing home provides a bed, bathing, meals and a TV room and assists residents with these and in taking their medications.

There were no medical staff and his GP would call as necessary.

The word “nursing” is not applicable as it is actually “aged care”.

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The quality of aged care has diminished over the years as a consequence of:

  1. the Commonwealth actively defunding aged care over the course of years
  2. failure by the Commonwealth or States to mandate adequate levels of staffing, either medical or support workers.
  3. failure by the Federal and State regulators to maintain any meaninful oversight of the activities carried out in facilities
  4. failure by many/most operators to spend money harvested from their clients on the clients, including charging for non-existent services.
  5. profit returns to investors was seen as more important than looking after clients properly.
  6. deregulation resulting in aged care facilities no longer being viewed as an essential service but rather a profit making enterprise for private industry.
  7. failure to require madatory minimum qualifications, training, or skill levels for staff working in aged care
  8. as with other ‘care’ professions, failure to set pay awards at a level that would reflect the actual responsibilities of the roles.

Having said that, the actual staff can be lovely and caring, but their time, resources, and availability are limited by the above.

The wife woman used to visit several aged care facilities on a regular basis (and occassionally I went with her), and my grandmother was in one for many years, which we visited frequently. The quality and service varied with what clients could afford; from being aged sterile holding cells with next to no support, right to quality accommodation with medical (nursing and doctor) assistance not too far away if needed. At the bottom end, sometimes we commented that pets would treated more humanely.

Despite the Royal Commission, just as with the finance sector, there were many promises but little action to improve the situation. The deaths as a result of COVID have further highlighted the crisis in aged care.

Sadly, the crisis in aged care has multiplied manyfold the number of COVID illnesses and deaths compared to what might have been in a ‘healthy’ aged care sector. But hey, the very Government that stripped away all that funding is saying that they are doing all they can, and expecting us to be grateful. I for one am not.

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I walked out of my Nursing workplace (of more than 15 months) over a week ago - metro Melbourne. I then resigned, with the help of the union so kept all of my annual leave etc. I’m not risking my life. All because they refused to supply the correct PPE.
Also a primary care facility.

I’ve spoken to countless MPs and also the local mayor - everyone. No one can help.

I can’t fix this, and it’s not on me to fix it, and I need to let it go (the PPE issue)

I’m not the only health professional currently in crisis - there are many, and it’s not fair; but none of us are coping with the policies and procedures that are binding us and preventing us from our best practice and too “first do no harm”
There is harm being done, and we are helpless
Because the govt are incompetent

I have to let it go
I can’t change it
And many more are going to die
Just like it took until last week for masks to be mandatory when it should of been from the start

Healthcare workers should have N95 or P2 respirators for swabbing or When working with suspected or confirmed covid cases, but we don’t - because our incompetent govt haven’t updated the policies that bind us. And private companies like mine and aged care - hide behind them

And that’s why there is a 28 year old doctor currently ventilated in ICU from covid. And around 15 nurses.
Over 1050 healthcare workers positive for covid, and thousands more isolating as close contacts waiting to see if they get symptoms

It’s a mess
So I’m stepping back
Because I can’t do anything
I’m not alone, I have been assured. Many more health professionals like me are struggling with this incompetence of the govt - but have taken their lives

It’s a disaster

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:+1:
It’s a concern more widely expressed in the following two recent items published by the ABC.

It would appear essential staff in Aged Care need to use PPE (masks and gloves) as a preventative measure if they are to prevent cross infection within facilities. Also to ‘Minimise Harm’, unintentional though it may be of staff who have been exposed unknowingly to Covid-19 in the broader community.

Locking down facilities is not going to work if the staff are also not looked after. This Covid-19 has a high percentage of asymptomatic infections, and the ability to be communicable prior to any signs of infection.

Self explanatory, when you read it?
Lock downs and PPE!

And what did the following highlight, closer to home?

Gilbert’s report also highlighted two key pressure points: a lack of confidence and competence in infection prevention and control, and insufficient preparation to ensure “outbreak surge capacity of appropriately qualified and experienced staff”.

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The only thing the governments of the day can ‘hide behind’ is their misguided attempt to keep the average citizen from panic buying the N95/P2 level masks. Their rationale was that they were needed for the medicos.

As happened with pink batts, hotel quarantine, and supply of PPE one ideological bent is that one can always trust business. There can be some finger pointing at Home Affairs (not our problem), NSW Health (flu vs COVID-19 tests), and others, some pushed and then pushed harder to open up. They did, it hits the fan, yet it is government’s fault? In a way it is, but.

OTOH those same trustworthy businesses prioritise profit over training and dedication to good OHS practices, and hiding behind the minimum possible standard to maximise their profit.

Governments have made missteps, but some of them happened because they trusted private enterprise, who are managed by accountants and have the sole purpose of maximising shareholder value and returns.

A reality is that it is long past time for all governments to recognise that, and operate to a different mode before it hits the fans.

edit:

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Constantly. The problem seems to be that the Federal and State Departments of Health are laggards when it comes to the rapidly evolving research to do with COVID. They are providing contradictory, conflicting, and out of date information.

Yesterday, our (Qld) CMO made statements on air about people not needing to wear masks anywhere unless they could not ‘social distance’. The last I heard, the same advice is being put out by the Commonwealth CMO. This ignores research from as far back as April/May when the researchers were finding aerosol spread, not just droplet.

Back as far as May/June, using contact tracing, cctv, and other methods researchers showed that air conditioning and other ventilation systems such as fans were the cause of spread when there was significant physical seperation between patients. Based on this, the researchers recommended that masks be worn indoors when away from home, unless there is only ventilation is natural through open windows/doors and physical seperation can be maintained.

After over 200 scientists wrote them an open letter, The WHO finally published aerosol as a possible source of contamination at the beginning of July. So if this is the case, a month later why isn’t this taken into account when telling people when to wear masks?

Surely it is behoven on all the Departments of Health to be constantly researching the best information from around the world including the latest developments, and disseminate information based on that.

The current sluggard approach is costing lives and illness in hundreds if not thousands.

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That would be noble, excepting there is politics pandering to freedom lovers, conspiracy theorists, and many other fringe elements who dismiss it all as either a flu or a hoax.

The result is that conflicted, conflicting positioning. The pandemic is more partisan and political in many jurisdictions than it is about life and health.

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Don’t blame the accountants for how modern privately owned enterprises operate! It is owners (board of directors) and the C-suite (CEO, COO, CFO (oops) etc.) that make these decisions.

Of course, now government entities are supposed to apply the same principles as private businesses we get much the same outcomes.

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Fair point, but those who may have ever dealt with a US health fund will understand my perspective.

The accountants can be ingenious at providing advice that most would never perceive could be legally done yet profitable, but their advice is, as you note, accepted by the ‘owners’. Often the ‘owners’ are or delegate to accountants in senior management roles so are one and the same.

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That is still not the accountants’ fault - it is the fault of politicians who have accepted patronage in order to solidify the most expensive and one of the least effective health systems on Earth.

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My comment, intended as being an age-old and throw-away line, seems to be a sensitive area. You once posted you are (were?) not a tax accountant. Might I enquire if you are (were) any kind of accountant?

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Yes.

And in anticipation of your next question, yes.

There are plenty of bad accountants, just as there are bad lawyers, doctors, plumbers, politicians, economists etc. I have worked in places where people have wanted things accounted for in a manner that does not align with the standards, and very quickly said my goodbyes if we could not resolve the issue. In other places, the accounting has been scrupulously clean - or my job has been to clean it up.

Oh, and I am not a tax accountant - I’m in it for the numbers, not the nitpickery.

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Thanks for that. I had not intended to disparage accountants, just a not so oblique reference to the profit motive as it is often practised by the ‘owners’ thse days, regardless of their backgrounds.

Cheers,

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Covid - but very specific to how Aged Care responds to medical needs and outbreaks.

There are several concerns raised. The most pressing is the decision to keep Covid positive residents in the facility along side healthy residents.

There are pros and cons for our aged loved ones remaining in familiar surroundings. As the Omicron strain has demonstrated, it spreads many times more readily than previous strains. It appears neither the facility manager BUPA, Commonwealth Aged Care, or State Govt (NSW in this instance) has a plan B. The residents and staff are now reliant on vaccinations completed more than 7 months prior. 22 of the 140 residents are reported as not being double vaccinated. Prior to the outbreak identified as of 21st Dec the Commonwealth managed booster program had been scheduled for the facility in mid January.

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While many of us have been focused on ruined holidays, hours in testing queues and days spent isolating at home or sick in bed, what’s happening to our elderly in Australia right now is flying under the radar.

Most tragically, this crisis was extremely predictable.

The Aged Care Royal Commission set out comprehensive recommendations to avert such a disaster by increasing staff numbers and paying proper wages, ensuring up-to-date vaccinations and giving families regular access to their loved ones.

Its report was handed to Prime Minister Scott Morrison just 10 months ago.

Few of those measures have been put in place.

Aged Care for us is a very personal concern with one elderly and frail close family member once again locked in relative isolation due to Covid. It’s difficult to relate how it must be for those who depend on the services of the aged care system.

One first hand on the scene daily put it aptly. The returned looks and smiles of those in care now more often remind one of a startled deer caught in the head lights.

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Another failure for aged consumers in the Covid response.

Aged care was a priority for booster shots when

Minister for Health and Aged Care Greg Hunt announced plans to provide aged care residents with booster vaccines from the second week of November if approved by the Therapeutic Goods Administration and Australian Technical Advisory Group on Immunisation.

The issue of TGA approval was subsequently resolved and supposedly supply following on from.

It is “unlikely” there will be priority groups for booster shots like the initial vaccine rollout because there is sufficient vaccine supply, Mr Hunt said.

However, aged care residents are “first in line because they are now six or more months after that second dose,” Chief Medical Officer Professor Paul Kelly told the press conference.

“It’s likely that they will be the first ones to get it, but let’s see what ATAGI comes up with,” Professor Kelly said.

It’s nearly 3 months since the 21st Oct 2021 announcement and half way through January 2022. As customers of the Commonwealth Aged Care Services, there are still many older Australians including those in managed facilities who have not received their boosters. The greater number did as asked and were vaccinated, receiving their second dose up to 7 months ago.

There are approx 200,000 aged Australians in managed aged care and approx 150,000 outside receiving in home care. NSW and VIC showed they could collectively hit 1.0M vaccinations per week. The TGA approved boosters on 27 Oct 2021.

One facility we are familiar with cannot provide a date for it’s booster shots to be delivered. The original advice of end of Jan or early Feb 2022 has not been updated with that booking cancelled by the provider. 12 weeks since TGA approval excluding 1 week for Xmas would seem more than enough time to deliver 350,000 boosters plus a similar number for the staff.

Does delivering boosters as quickly as possible make a difference? Each state and territory has a story.

Ms D’Ath said in the 29 deaths since December 13, only one person had received a booster shot. She said she understood the federal government had made booster shots available in about two thirds of the country’s aged care facilities.

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Aged Care facilities are not designed, or intended to be used as hospitals. It’s a difficult situation whether residents infected with Covid-19 should remain in their room at a facility. Such decisions result in all other residents being locked in their rooms, despite being free of Covid. The supporting staff are required to step up a level, and ensure the infection is limited.

History is repeating itself in this instance.

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More instances of failures within individual facilities. Note the ABC is continually seeking confidential input of first hand experiences with Aged Care Providers.

One of the challenges when there are issues within a facility concerns privacy protection for the affected individual/s. It makes speaking out as or for a resident difficult for some, while the provider has a ready made reason to limit comment.

Addressing all concerns within the system relies on the Australian Govt, Aged Care Quality and Safety Commission.

The ABC points out that failures to meet certain standards can cause a facility to loose temporarily it’s Government funding. Does this fix the problem. An uninformed outsider might ask how does the provider subsequently keep the facility running or pay to rectify deficiencies? One solution is it uses funds intended for the operation of other facilities under it’s control. A no win outcome for all?

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For those looking to find an Aged Care facility close to home and not in a City or larger urban area the options are limited.

The challenge of keeping smaller and community funded Care facilities faces many challenges. Note the Guardian points to several including past government policy that favours larger and fewer operators in a sector dominated by larger private and pseudo private nationally run ‘not for profit’ operators.

In comparison there are staffing and administration cost premiums for small rural community based operators.

The following was also enlightening, knowing first hand a modest Aged Care facility providing full care can cost a pensioner $140+ per day or more. It’s subject to a means test and without a DAP. That cost is on top of what the government funds.

“The average care funding for an older person in residential aged care is around $250 per day, compared to a person in disability funded at $500-plus per day, or compared to care funding in a hospital setting of at least $800 per day,” he tells Guardian Australia.

I’ve found it distressing and difficult at times realising that many in Aged Care facilities are effectively disabled as they loose personal mobility. The care level available confines most to their beds and rooms. One becomes 100% dependent on staff being available to respond to a buzzer call 24 x 7. It’s equally difficult for the staff given how their numbers are allocated.

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