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Vaccination, workforce and collaboration the key to reducing COVID-19 deaths in aged care

In the first article below, Croakey editor Jennifer Doggett unpacks some of the political and policy concerns around aged care and COVID, including the Chief Medical Officer’s use of the term “reaping” to refer to deaths in vulnerable populations.

In the second article, Emeritus Professor Hal Swerissen suggests that if the COVID situation in aged care continues to deteriorate, this will have to become a major priority for National Cabinet, “and the already stretched state health systems will have to play a greater role to fix the immediate problems”.


Jennifer Doggett writes:

At a media briefing on 27 July, the Director-General of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, stressed the importance of vaccinating vulnerable populations against COVID-19. He said:

We continue to urge all countries to strive for the target of 70 percent vaccination coverage, with a focus on targeted vaccination strategies that prioritise the most vulnerable, which is the most effective way to save lives.”

This is timely advice for the Australian Government, given that last week the number of COVID-19 cases in aged care residents rose to its highest level since the start of 2022, raising concerns among advocates and experts.

Tweet sent on 3 August, 2022
Tweet sent on 2 August, 2022

The new Labor Government has been keen to promote its commitment to age care reform to support the delivery of vaccination programs and other healthcare services to residents. These reforms include requirements for registered nurses 24/7 in residential aged care facilities, mandated minimum number of care minutes and staff and improved wages for aged care workers.

Minister for Aged Care, Anika Wells, has also announced changes to increase transparency and accountability in the aged care sector, including publishing statistics on vaccinations, a move welcomed by aged care expert, Professor Kathy Eagar.

In an interview recently with the medical publication Insight+, Eagar described every COVID death in aged care as potentially preventable, and said that “a lot of the commentary about COVID-19 has almost had a eugenic undertone”.

Subsequent comments from Chief Medical Officer, Professor Paul Kelly, have raised concerns among stakeholders about his views on the current high level of aged care infections and deaths, with some anger and confusion about his intended meaning in using the term “reaping” to refer to deaths in such groups.

The term “reaping” has come into popular usage from the young adult novel ‘The Hunger Games’, referring to the practice of choosing some members of the community as a sacrifice in order to save the majority.

When Croakey asked the Department of Health to clarify Kelly’s comment, a spokesperson said it was not a pop-culture reference, and provided some additional context to his remarks:

Professor Kelly’s use of this description, in context, was reflecting on the experience of past pandemics and plagues, particularly those of the middle ages. Where the plague was depicted as a ‘grim reaper’.

As Professor Kelly reflected, this imagery is what had been seen elsewhere around the world in 2020 and 2021, where COVID-19 moved unchecked through the population. However, the recent spread of the Omicron variant and subvariants has changed what we are seeing in the Australian experience. He also reflected on his work as the Chief Medical Officer advising the Australian Government, that every action and decision is taken with the goal of protecting vulnerable populations.

Professor Kelly expressed at the time the terrible toll the pandemic has taken around Australia and around the world, and in his remarks extended his condolences to families and friends who had lost loved ones to COVID-19.”

With infection and death rates continuing to rise, it’s vital that the Government work quickly and effectively to improve vaccination rates in aged care facilities while also implementing reforms to improve the overall standard of care for residents.

This will require a robust understanding of the factors driving the failures in the aged care sector to prevent the spread of COVID and a commitment to working collaboratively with local health service providers, including GPs and state hospital systems.

Below, Hal Swerissen, Emeritus Professor, La Trobe University, discusses these issues and warns that without a significant increase in the aged care workforce and buy-in from state and local authorities, the Federal Government will struggle to deliver on its election commitments in this area.

The article below was originally published in The Conversation and is re-posted here with permission.


Hal Swerissen writes:

Around three percent (6,100) of the 200,000 residents in Australia’s aged care facilities had COVID, as of July 22, in addition to 3 400 staff.

About 1,000 facilities – nearly 40 percent of the total – had an outbreak.  [Ed: updated figures for 29 July are 6,360 active cases among residents and 3,546 among staff at 1,064 facilities.]

Aged care residents are also disproportionately dying of COVID. Those in nursing homes account for nearly 30 percent of the 11,000 deaths from COVID in Australia throughout the pandemic.

Age is a major risk factor for COVID. People aged 70 and over make up 85 percent of all reported COVID deaths.

People in residential care are the most frail and at risk. Aged care residents make up around 40 percent of the deaths of older Australians, but only about five percent of the population aged 65 and over live in residential care.

Effective responses

We’ve long known how to reduce the spread of COVID and unnecessary deaths. Effective responses throughout the aged care sector include:

  • all residents and staff being fully vaccinated
  • appropriate availability of personal protective equipment and rapid antigen tests (RATs)
  • mask mandates for staff and visitors
  • widespread use of antiviral treatments for those who catch COVID
  • rapid responses to outbreaks, including a surge workforce and coordination with home care, GPs and hospital services.

But while mask mandates remain a requirement in residential aged care for staff and visitors, and RATS and PPE are now generally available, the other responses are still patchy, piecemeal and poorly coordinated.

Vaccination is the most important protection against COVID. People who are unvaccinated are about 50 times more likely to die from COVID compared with those who are fully vaccinated.

Yet, vaccinations in residential aged care has been a shambles. Early on in the rollout for aged care, staff weren’t fully vaccinated, there were squabbles over staff vaccination mandates, vaccination data was unavailable, and it was unclear who was responsible for making sure vaccination occurred.

While mandates have lifted worker vaccination rates, in June this year, only 50 percent of aged care residents were fully boosted with fourth doses.

That has improved following pressure from the new Government. But even now, a quarter of residents are still not fully vaccinated with recommended boosters.

Additional strategies

More needs to be done to systematically follow up facilities with low vaccination rates.

Early use of antivirals significantly reduces the risk of hospitalisation and death from COVID, possibly as much as 80 percent.

It has been clear for about six months that antivirals are a safe and effective COVID treatment. However, it wasn’t until July 11 that the Commonwealth Chief Medical Officer advised that all Australians 70 or older should be offered antiviral treatment within 24 hours when they test positive for COVID (where clinically appropriate).

The reality is that many older people who could benefit from antivirals aren’t getting them and they are going to waste, with thousands of doses nearing their use-by dates.

A “Winter Plan”

The new Federal Government appears to be tackling the issue with new urgency. The new Aged Care Minister, Anika Wells, has released a “winter plan” to try to address the aged care crisis.

The plan includes prevention, outbreak management and recovery. But the plan continues to put most of the responsibility of prevention and management on individual providers – a strategy that has been ineffective in the past.

The Federal Government has almost no capacity to effectively coordinate a winter response across residential care, home care and health and support services within local service networks where it is needed.

Ideally, this would see close working relationships between aged care facilities, GPs and local hospitals, including the redeployment of clinical and support staff across facilities as required. This happened in Victoria during the 2020 outbreak.

But despite the recent Royal Commission’s recommendation to do so, the Federal Government has not put in place local or regional bodies or authorities to plan, coordinate and manage aged care.

Workforce pressures

These pressures are hugely exacerbated by staff shortages. The over-reliance on a privatised market model for aged care and the decades-long under-investment in training, supervision, pay and conditions for aged care workers has come home to roost at the worst possible time.

Estimates suggest there is a shortfall of 35,000 workers in aged care, double the problem last year.

The industry is hoping the work value case before the Fair Work Commission will make a difference on these issues. Personal care workers in aged care are paid about the same as workers at McDonald’s – in some cases, less. Unions are arguing for a 25 percent increase in pay, which should make aged care a more desirable job, but this case won’t be determined for months.

In the meantime, the industry still does not have a realistic workforce strategy. The Federal Government is scrambling to implement short-term measures through a “surge workforce”, including the recent deployment of 200 military personnel.

But this is unlikely to be enough to address the staff shortages associated with the winter wave. Some providers are now reporting they are down 20-40 percent of staff.

The result is excess hospitalisation and death, misery for residents and their families, and stress for staff and providers. If the situation continues to deteriorate, this will have to become a major priority for National Cabinet.

And the already stretched state health systems will have to play a greater role to fix the immediate problems.


See here for Croakey’s archive of stories on aged care.

 

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