things never really do stay the same – we can and will adapt to the new normal
Toward the end of my previous essay I indicated that I would focus on KPIs in this Blog Piece. I will get to that next time – I feel it important to make some commentary on the impact that COVID-19 is having on the services of our aged care colleagues in Victoria. This week saw a specific focus by the Royal Commission into Aged Care Quality and Safety on the management of, and planning for, COVID-19 outbreaks in New South Wales and Victoria. The following dot points are some of a tweet thread I made on Saturday morning summarising my take on the week’s evidence:
- Surely what we are seeing is just the unintended consequence of an uncontrollable pandemic virus? No! Early “antidotes” to this situation could have been planned as proactive mitigation action;
- In February 2020 we could already see the impact of COVID around the world. When Dorothy Henderson Lodge and Newmarch House hit in March and April in NSW, who indeed was occupying the empty hospital beds? Why not admit COVID+ residents;
- But it is more than that. For almost two decades there has been calls for regulated 24X7 RN coverage and mandated staff mix and supply. The benefit to care quality/safety has been demonstrated;
- Others have relentlessly advocated for greater transparency in reporting of complaints and poor quality outcomes, knowing that incremental improvement can lead to better care outcomes;
- Others have lobbied for increased funding for provision of services based on wage inequality for care staff vs the health care sector. Aged care lags behind Health as a poor cousin – again negatively impacting care;
- We are left with residents dying and families in despair. Tragic outcomes from known, foreseeable, and preventable failure of over 20 years of aged care policy and funding.
In Australia at 10 August 2020 we have had a total of 313 COVID related deaths in Australia, of which 220 (~70%) have occurred in residential aged care. (People aged 70 years and over had by 14 August 2020 accounted for 90% of COVID related deaths in Australia but not all emanating from residents in aged care facilities. The 70 per cent COVID death rate is very high compared with the rest of the world. Devi et al write that between 28 December 2019 and 12 June 2020 in England and Wales, 47 per cent of all excess deaths in care homes compared to the same six month period in the previous year were directly caused by or attributed to COVID-19. I understand that we are still early days into this pandemic and the manner in which it is affecting Australia and the rest of the world. However, our previous behaviour to minimise the impact of COVID-19 suggests that when compared to the much more affected United Kingdom, our death rate for the frail and vulnerable residents in our aged care facilities is shockingly high at 70 per cent. Those people are at a dangerously high risk of infection and the adverse outcomes experienced by so many elderly after infection.
In a sense we knew this. Watching what was occurring around the world in January and February 2020 with our own returning travellers, we knew before the commencement of collecting case data that the likelihood of the pandemic hitting our shores was inevitably high, and the equal likelihood of a high death toll on frail and vulnerable seniors. About care homes in the United Kingdom, Burki wrote in May 2020 that by the time “the first patient develops symptoms, up to half the residents might already be infected.”
The Royal Commission into Aged Care Quality and Safety was scathing this week at the lack of preparedness (planning) of the Commonwealth and aged care providers, and indirectly various State Health departments for not having adequately planned as they ought to protect our elders by the time Victoria’s COVID-19 resurgence occurred.
The toll – our toll – over 70% of deaths of people in residential aged care in Australia due to COVID—19.
What then must aged care providers do now? There are at least three things:
- Be prepared – more prepared than the Commonwealth. Protect those currently in your care, and the workforce you have that are caring for them. Depending on your State there will likely be a COVID Outbreak Plan that prescribes, among other things, the timeliness of reporting of COVID positive cases to both your State and the Commonwealth Health Outbreak coordinators. This preparedness should include discussions with State Health, Commonwealth Health and collegiate providers about the need for a surge workforce. Ensure access to adequate PPE per facility and community service. Have access to an infection control expert who can describe their competence for the task of this beastly virus. Communicate with your residents, families, and staff – now and often – describing why visiting restrictions might be in place and how to manage current stage precautions;
- Plan for the next two to four years. The most rapid deployment of any previous vaccine took four years – for Mumps. It may take less than that for COIVD, but on the other hand, it may never happen. For example, and not for the want of trying, we have no vaccine against malaria or HIV-AIDS. How prepared are you to manage and control at a facility/service level an outbreak of COVID, say, two years from now.
- And plan ahead. Whilst we have a pandemic virus among us, aged care services do continue. They must! Yet, things never really do stay the same. We can and will adapt to the new normal. Think about delivering community and home based care services. Think about the design of your buildings. Build a strategy around building refit where practical to reduce airborne spread of this, and future, highly infectious viruses.
- In essence, plan and be prepared. Test your reinforced outbreak plan – often, and without warning – to ensure the robustness and appropriateness of what you have developed.
Because so many aged care services in Victoria, and to a lesser extent in NSW, have struggled with the impact of this virus, can I again refer you to a new strategic planning software platform with which I have been involved with the beta testing. Skeftô is a Melbourne built, web-based platform that looks like going to market in October 2020. I have written before that had I had this tool to use fifteen years ago there might have been little to stop me.
Next time – performance indicators, and how they might be used. I promise …
 Australian Government Department of Health, Be COVIDSAFE Infographic. At https://www.health.gov.au/sites/default/files/documents/2020/08/coronavirus-covid-19-at-a-glance-10-august-2020.pdf. Accessed Saturday 15 August 2020.
 Australian Government Department of Health, Coronavirus (COVID-19) current situation and case numbers. At https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers#cases-and-deaths-by-age-and-sex. Accessed Saturday 15 August 2020.
 Reena Devi et al, ‘The COVID-19 pandemic in UK care homes – revealing the cracks in the system’ 2020(6) (9 July 2020) Journal of Nursing Home Research 58. Accessed Saturday 15 August 2020.
 Talha Burki, ‘England and Wales see 20 000 excess deaths in care homes’ 395(10237) (23 May 2020) The Lancet 1602. Accessed Saturday 15 August 2020.