Choice has produced a number of guides to assist with choosing aged care services.
Is it time these were reviewed and updated. It is a moving target with the RC. Most of the articles date from 2016 or older. Is it true those seeking aged care services for in home support have a 12 month wait for approval? This forces the decision towards entry to a permanent aged care facility.
Our recent personal experiences highlighted a number of issues. These include the lack of options if you are not living in a big city, unreasonable delays in access to in home care packages, and doubtful specialist financial advice services. The accommodation charges which are out of pocket also defy reason.
It is also a reality that many ageing Australians find themselves without options due to personal circumstance or fail to plan well for old age.
Public support for the RC has been overwhelming.
The response from the regulators questionable, although.
BUPA has been in the news with many other concerns raised. One comment has been it is too big for it’s license to be cancelled!
Covid Response Failure, Aged Care Failure, dare I suggest Government Failure?
A consumer issue?
If you are in aged care and like many paying for it (minimum85% of the pension, plus accommodation plus means tested care fee)
Around $44,000 yearly for our mum plus out of pocket medical and pharmacy and …
We all need to ask if this is value for money. Many are trying to follow the opaque (deliberately so) money trail.
Is being locked in your room with less freedom than the general community because of decisions made by the providers and government a loss of service under ACL? It may be a strategy that suits the Senior MO’s, or not. Should all aged care residents receive compensation for the trauma and loss of service they have been paying for?
Aged care facilities are not infectious disease hospitals, nor are their wonderful staff trained as acute care or infectious disease nurses. Our failure to keep COVID out of Aged Care is likely the most significant lesson to learn from the Pandemic.
For many infected younger Australians Community self isolation has been common, even in mixed households. Travellers are now quarantined because self isolation has failed in notable examples. The risks in isolating large groups of older Australians, many with under lying condition in their facilities because some have a Covid-19 are many time’s greater. One excuse that some with the infection do not want to leave for hospital is inconsistent with the enforced decisions to direct even healthy Australians into hotel Quarantine.
Forget about aged care … a wide cross-section of society could ask the same question … and the answer would generally be “no” because there is probably a “force majeure” (circumstances outside the control of the contracting party) clause in the contract.
It’s really a no win situation for aged care providers. If they don’t enforce fairly strict conditions and COVID gets into the facility, well, we’ve all seen how that can go really bad really quickly … and then people will no doubt be clamouring for compensation for the trauma of “death”.
At least some aged care residents are being granted a temporary reduction in total daily fees, while restrictions mean that otherwise standard services are temporarily unavailable.
They are however an excellent place for COVID to spread and kill … due to the presence of many immune-compromised people and lots of shared, multi-touch surfaces.
It is certainly one major lesson, in Australia and in other countries.
I don’t know exactly what could have been done differently though.
IIRC of the 816 deaths to date 604 were in aged care facilities. Obviously there are many aged and infirm people there who are more susceptible but it would be interesting to compare the death rates to a cohort of persons of similar age and unwellness not living in aged care. My bet is that being in aged care in itself is highly significant but not evenly distributed. That is some facilities handled it much worse than others.
However, the total death rate in aged care this year compared to the same period last year is well down. That’s right, despite the deaths due to COVID those in care died significantly less. In part this was due to flu deaths being down.
On the other hand we re told that residents in such facilities are suffering from depression due to isolation. So quicker, stronger isolation is no magic wand to fix this.
There is much to be pondered about pandemic management and the way that aged care facilities are funded and managed will need to be part of that.
I wonder if it is also due to other communicable diseases such as rotavirus, noravirus, common cold (which can lead to pneumonitis) and other viruses/bacteria which lead to acute secondary acute infections and severe complications.
Isolation due to covid-19 may have had unintended beneficial effects.
The most vulnerably affected by COVID-19, yet the Victorian government refused to provide PPE to aged care facilities as they though the PPE would be stolen by centre staff.
Regardless of the government of the day, or the level of government, they regularly operate as if the only reason any public servant takes the job is to rort taxpayers, and they treat the public servants accordingly. By extension it is not so surprising for Victoria or any other government to react similarly when they are providing a ‘valuable item’ that may have intrinsic or resale value, or as is so often happens, just an ask competitive pay.
Get to the SES (federal, or equivalent reference for states) levels and it is like Alice in Wonderland looking down through a looking glass as instead of rorting one suddenly owns many of the keys.
It may save cost and time to simply ask those who have family in aged care or those in aged care.
Some have few contacts or family other than those in care with them. Being constrained is one loss. The volunteers that no longer are permitted daily with their activities and support another. And for those not bed bound the loss of excursions and days out the last loss.
Those with caring family who visit nearly every day, and where they can take their loved ones for little outings etc see loss for both. Care packages can only deliver small thoughts.
Some family care little aside from the annual birthday visit to see Uncle or Auntie. Knowledge that they are another’s burden is comforting. Self fulfilling?
In some ways even the staff are in isolation, needing not only to be extra cautious of the risks, but also lacking the smiles and appreciation of visitors or help of volunteers.
Small compensation for the families and those in care that the virus may have reduced deaths from other causes. Living longer may not be aspirational if it’s spent mostly in isolation.
Everyone in aged care and around them has taken one big hit for the team and many are still doing so IMO.
The Commissioners in the RC into Aged Care handed a special report into Covid to the GG on Thursday. As the ABC notes it’s findings are likely to be lost in the noise around the upcoming budget.
One is left to ask how much longer will those in aged care continue to be in the forefront of the impact of the crisis. Those in full time care have already surrendered typically 85% of their pension payments to the government. If they had one they may have also given up the value of their prior owned home to help fund their daily needs. With nearly all their assets and income committed should the quality of care be assured, irrespective of the extra demands of Covid? There is no more that they have to give, except …?
A fair question but you can prove just about anything with statistics.
The first question that I would have is:
for a given age and health status … is the case rate / case fatality rate higher or lower for a person in an ACF as compared with a person in other residential scenarios (typically either retirement village or own home)?
The point is … people in an ACF fundamentally have problems, otherwise they wouldn’t be there. By law. So it is a highly biased sample - a sample of people who are in any case at the highest risk from COVID (old and with co-morbidities).
The next question that I would have is:
considering health outcomes and mortality overall, for a given age and health status, is a person better off in an ACF than in other residential scenarios.
The point is … yes, you are probably safer in your own home as far as the spread of a highly contagious disease goes but you will probably kill yourself via some other means.
As a general comment, I am pretty sure that all ACFs (and both levels of government) had defective or non-existent plans for dealing with a global pandemic. All ACFs already had some basic lockdown protocols for dealing with e.g. a flu outbreak - but those protocols have been found wanting by COVID.
We can do better. We can learn lessons. I hope those lessons never come into play again in my lifetime.
In some respects, I would have preferred that the RC ignore COVID and look at the bigger picture of what’s going on in ACFs, last year, the year before, next year, the year after - rather than getting sidetracked on what is (hopefully) a once in a hundred years event. COVID was a tacked on afterthought.
Final comment: Almost all of the deaths are in Victoria. So it is as much about how good the care in the ACF is as it is about what is going on in the wider community. We all play a role.
If hotel quarantine had worked better in Victoria, the number of deaths in ACFs would have been lower. (For NSW) If the Ruby Princess debacle had not happened, the number of deaths in ACFs would have been lower.
The risk from the wider community is greater, the more mobile and independent we are. This in part explains why only harsh measures such as lockdowns, social and employment restrictions seem to work to control the infection rate in the wider community. It’s convenient to blame an individual event for each surge of infection. It takes a community to do spread it.
For Aged Care and other vulnerable groups it doesn’t matter how each surge in spread is triggered. They are always at risk.
On the need for real reforms in the Aged Care System and delivery of quality care for those who need it most.
Some horrific examples of the failures.
Some Aged Care Businesses have no respect for anything more than a profitable bottom line, or are they just being … ?
In this instance, perhaps I am too quick to judge.
The community of Longford owns the Toosey complex on land leased from the state government. It is a Company limited by guarantee, and the responsibility for the maintenance of the facility rests with the community appointed Board. Members of the Company include over 300 community minded members of the Longford district.
Covid-19 has made visiting in aged care more difficult in the past. But even our mum’s provider, a profit making business, (noting also we are in SE Qld) has long lifted visiting hour restrictions. Signing in checks are still part of the routine. Likely to be with us for as long as Covid is an unacceptable risk.
Back in 2009 when my wife’s late father was in a nursing home in Cairns, visitors were required to sign in and out in the visitors’ book with date and time.
Back then, the staff advised it was in case of a fire so they could quickly account for anyone still on the premises but it would have boded well for the pandemic.
The care standards were exemplary. It was named Mary Potter but is now called Mercy Place Woree.
The wording in the article which may indicate what is going on is:
Michelle received a lawyer’s letter alleging she had been abusive to staff
It is likely that the visitor policy has been vetted/set by the centres lawyers and the policy taken is to be highly risk adverse in order to defend themselves in the event that an outbreak occurs within the centre. The first question in the event of an outbreak will be ‘did they take all reasonable and practicable measures to prevent the outbreak’…and the assess policy taken possibly provides them with a defence when under legal, media or community scrutiny.
It is unfortunate that Australia has ended up in such a position…which has been possibly driven by the ‘blame game’…that being someone is legally responsible for everything.
Sometimes a legal position may not be sympathetic to the needs of the individuals involved. In an ideal world when such does occur, the centre and their lawyers need to look at their ‘social licence’ and determine if their position in balance is in the best interests of all involved.
The final report is out. It’s received scant comment past the first few days. There are so many current political distractions, while it’s recommendations are divided. The following includes links to the full report.
I’ve a feeling that little is genuinely going to be reformed. The following short story reflects well our own first hand experiences in many ways.
The one observation to add that stands out in our experience. The system mixes residents with bright and alert minds with loved ones whose capacity has been ravaged by time. It’s not so much of a happy social setting. It’s more one of being surrounded by those less able and fortunate than yourself. As though you are being asked to adopt the role of team member/leader if more alert and mobile. Some of us might be better equipped (resilience) to adapt or cope. It’s easy to understand why those who are less resilient can so easily drop their bundle and wish the end was nearer.
The system is not sustainable as is. We all deserve better. I’m all for developing more and improved home care options.
There is an assumption in this assessment that Aged Care is still going to be delivered in 30 years time the same as it is today, while over the same time medical science will have extended life but not addressed loss of function.
The elephant in the room is euthanasia. Suffering may/will not be an option. It might become a survival skill if it continues to be blocked by politicians who are out of touch with those whom it most impacts. Is this why we needed a Royal Commission, because they are not in touch?
The RC has shown there is a lot wrong with aged care. Suggesting more of the same, even with extra staff with greater skills will not change the fundamentals. The rosey pictures of older Australians getting about with minimal assistance and enjoying sitting around the tea and scones is the exception. Most in aged care really need higher levels of support while accelerating down the long and winding road past any level of basic physical or mental agility.
When every time one passes wind one needs your pants liners changed, or that wonderful carer to wipe and clean, to dress you, to undress you, to wash and bath you, to cut up your meal, to mix you thickened fluid, to … There is a difference between having a life that brings pleasure, and just waiting!
I can envisage a large portion of the care tasks being transferred to technology. From voice ordering meals online for the auto cooker (cross between a convection microwave and fridge robot), to the Japanese Toto inspired auto shower (complete with Karaoke selection). For those of us with the mental agility, lack of pain and desire to carry on, independence might be a great achievement. Importantly the last thing we might want is to move into a palace full of others more broken down than we are. Redesigning accommodation to assist ageing Aussies stay in their local communities might actually become the future, most of us oldies want.
Those who watched the last documentary on Bob Hawke and how he was prepared to be cared for at home is how it can be.
