In a recent Senate estimates hearing the Aged Care Minister, Richard Colbeck shirked responsibility, citing the outbreak in Victoria as the cause of many deaths in aged care facilities during the Covid 19 outbreak. Aged care staff working across multiple sites arose as an issue during Victoria’s outbreak. Infection control was a major problem with staff moving between facilities, making it harder to keep up effective infection control. The reason staff was moving between facilities was the need for them to work at multiple jobs in order to earn a decent living wage.
Once identified as a problem through the Royal Commission into Aged Care Quality and Safety’s focus on the outbreak of Covid 19 within aged care homes the federal government provided more workforce funding and an industry program to reduce sharing staff.
The Senate hearing was told that as of September, 4.5 per cent of Victorian aged care staff now work across multiple sites, compared to seven per cent in June.
There have been concerns raised for some time about the number of carers and registered nurses on all shifts in aged care facilities. The Royal Commission and the emergency situation under the pandemic highlighted the deficiencies and the serious outcomes from a lack of staff and a lack of properly trained staff.
The carers and nurses that work in aged care facilities for the most part do their utmost to provide the level of care the residents need. These needs vary greatly between residents and at time each resident may need a different level of care, depending on the variations of their health. This creates a complex situation and it can be difficult to manage the correct level of staffing for residents’ needs whilst maintaining a viable operation.
It is encouraging to see the government making changes to support the aged care workforce. As the population continues to age the need for proper care for those older Australians whose needs are too complex to manage in a home setting will increase and it is imperative that aged care facilities are to the highest standard and able to cope with the growing demand. ,
The COVID-19 report from the Royal Commission into Aged Care Quality and Safety, was tabled in the Australian Parliament on October 1st 2020. It states that the COVID-19 pandemic has been the greatest challenge Australia’s aged care sector has faced and makes six recommendations to better prepare the aged care sector, its staff and residents for any future outbreaks. The Federal Government has accepted all recommendations.
The Parliament will report no later than 1st December to the Commission on the implementation of its recommendations.
The Government responds in its Media Release on 1st October 2020:
The Government accepts this recommendation.
The Australian Government should immediately fund providers that apply for funding to ensure there are adequate staff available to allow continued visits to people living in residential aged care by their families and friends.
The Government responds in its Media Release on 1st October 2020:
The Government has announced two packages to provide additional funding for staffingwhich supports visitations to aged care facilities by families and friends of residents.
In August, the Government committed an additional $245 million to support providers with COVID-19 related costs, including supporting communication with families and managing visitation arrangements, building on the first payment of the COVID supplement of $205 million announced in May.
The Government is also providing $12.5 million to support residents and their families with enhanced advocacy services and increased availability of grief and trauma services associated with a COVID-19 outbreak.
In addition, the Government will bring forward the introduction of the Serious Incident Response Scheme (SIRS) and invest an additional $29.8 million in the SIRS for residential aged care. Legislation to support SIRS will be introduced to parliament in the spring sitting for the scheme to commence in early 2021.
The Australian Government should urgently create Medicare Benefits Schedule items to increase the provision of allied health services, including mental health services, to people in aged care during the pandemic. Any barriers, whether real or perceived, to allied health professionals being able to enter residential aged care facilities should be removed unless justified on genuine public health grounds.
The Government responds in its Media Release on 1st October 2020:
The Government will provide additional funding to support increased access by residents to allied health services during the pandemic and will work with the sector to design and implement these measures.
While the Government has introduced a range of measures to support the mental health of residents of aged care facilities, it will continue to implement further measures.
The Australian Government should establish a national aged care plan for COVID-19 through the National Cabinet in consultation with the aged care sector. This plan should:
• establish a national aged care advisory body
• establish protocols between the Australian Government and the States and Territories based on the NSW Protocol but having regard to jurisdictional differences
• maximise the ability for people living in aged care homes to have visitors and to maintain their links with family, friends and the community
• establish a mechanism for consultation with the aged care sector about use of Hospital in the Home programs in residential aged care
•establish protocols on who will decide about transfers to hospital of COVID-19 positive residents, having regard to the protocol proposed by Aged and Community Services Australia • ensure that significant outbreaks in facilities are investigated by an independent expert to identify lessons that can be learnt. The results of any such investigations should be promptly disseminated to the sector.
The Government responds in its Media Release on 1st October 2020:
The Government has a specific national plan for aged care – the CDNA Guidelines for the Management of Outbreaks in Residential Care, which has been updated on two occasions, and which augments the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID‑19).
The national plan for aged care will continue to be updated incorporating the latest available information and released soon as Stage 7 of the National COVID-19 Aged Care Plan for the consideration by National Cabinet.
The Aged Care Advisory Group, established on 21 August 2020 under the Australian Health Protection Principal Committee (AHPPC), will be made permanent.
All residential aged care homes should have one or more trained infection control officers as a condition of accreditation. The training requirements for these officers should be set by the aged care advisory body we propose.
The Government responds in its Media Release on 1st October 2020:
Funding totalling $245 million will be paid to providers from October 2020 to support COVID-19 efforts.
It will mandate that aged care providers have trained infection control officers as detailed in this recommendation.
In addition, the Government today announces it will invest a further $10.8 million to enhance the skills and leadership qualities of aged care nurses to ensure older Australians receive the best care possible.
This investment will expand the Australian College of Nursing scholarship program, establish an Aged Care Transition to Practice Program, and create a skills development program for nurses and personal care workers in aged care.
The Australian Government should arrange with the States and Territories to deploy accredited infection prevention and control experts into residential aged care homes to provide training, assist with the preparation of outbreak management plans and assist with outbreaks.
The Government responds in its Media Release on 1st October 2020:
The Government has been working with state and territory governments to implement a decision of National Cabinet of 21 August to implement additional face-to-face infection control training and establish joint approaches to the management of outbreaks.
I am sure that everyone in the aged care sector and the community alike are hopeful the recommendations and the government’s response are adequate to better protect our older Australians in residential aged care going forward.
Patricia Sparrow of Aged & Community Services Australia (ACSA) has expressed concern about the protocols for hospitalisation of residents of aged care facilities who contracted the Covid-19 virus. In a recent article in Hello Care magazine she was quoted as saying
“Since early in the pandemic ACSA has been calling for a change in hospitalisation protocols for aged care. We want to see governments mandate that the first residents, or index cases, who test positive for COVID-19 be transferred to hospital as a matter of course. Only South Australia and Queensland have adopted the policy that ACSA believes, and international evidence supports, Australia must take forward.”
As The Department of Health announced the ban that prevents Victorian aged care staff from working across multiple facilities has been extended for one month from 25 September 2020 to 26 October 2020 and may be extended further, Patricia also commented that
“There wasn’t enough support, and that support wasn’t timely enough, to ensure that staff were able to take time off or isolate if they had the slightest COVD-19 symptoms. Support and appropriate payments for leave need to be in place for all staff so they don’t need to worry about how they will pay the rent or feed their kids.
She said that the COVID-19 pandemic also exacerbated workforce concerns that the industry has been raising with governments for years. She suggests that the one worker one site initiatives be evaluated, including ensuring that workers are not financially disadvantaged. She noted that during the pandemic it has become even clearer that there is not enough staff in aged care and more need to be trained and recruited. She feels it is time for the government to properly invest in a larger and more robust aged care workforce.
The ban was first put in place on 27 July with the aim of reducing the risk of COVID-19 spreading among aged care residents and staff. The government pays the staff their usual wage but the providers must apply for a grant to receive the monies.
In a Report by Caroline Egan in Hello Care Magazine about complaints the Aged Care Quality and Safety Commission received, she stated that a total of 2,199 complaints in the three months to June 2020 were received, an increase of 800 more than during the previous quarter.
Of those it received 340 complaints about infection control and 270 complaints about communicating with family. In the midst of these complaints, the Commission conducted 782 assessment contacts in the quarter, but no sanctions arose from those contacts.
The Commission put unannounced audits on hold during the June quarter, and instead conducted ‘short-notice’ inspections of aged care homes, with providers given 24-48 hours’ notice.
During the June quarter, the Commission issued three ‘notices to agree’, which set out certain actions a provider must take within a set timeframe. These include the appointment of an independent adviser to provide direction and advice to address any non-compliances and to immediately implement and comply with all advice, recommendations and directions of Victorian local health authorities. Providers are also required to give close, ongoing attention to keeping residents and families informed about the regulatory actions.
With the strong focus on the quality of aged care provision during the Royal Commission into Aged Care Quality and Safety it is hoped the industry will see changes for the better and more ongoing support to the sector in the near future.
The Royal Commission into Aged Care & Safety is presently looking at how to fund the future of aged care. With an increasingly ageing population as baby boomers advance in age the demand is set to grow.
Former TreasurerMr Keating
proposed a scheme similar to the HECS scheme he introduced as Treasurer for university pupils, whereby the government provides a loan to cover university fees, to be repaid at a later date when the pupil graduates and earns the threshold income. In the case of a person needing aged care he proposes the commonwealth government provide a loan which covers costs for home care support or moving to an aged care facility. This loan would only be repaid from the recipient’s estate upon their death. Mr. Keating stated that this scheme would help reduce the long wait times for the elderly waiting on home care support.
Former TreasurerMr. Costello
told the inquiry that income and assets tests should be part of future funding arrangements, but need to be simplified. He admitted he had trouble filling out aged care forms for his family.
“You all ought to do them you know, I think there are over 120 questions and 27 pages — I had a lot of trouble filling it in,” he said.
As a Placement Consultant,http://www.oasisagedcaresolutions.com.au/about.html assisting my clients to find suitable aged care accommodation, I find many have the same trouble filling in the forms. As part of the service I provide I fill in the forms for my clients when they are applying for a place in an aged care facility. My clients and their families are very grateful for this assistance.
Treasury secretary, Ken Henry
also addressed the inquiry,expressing similar sentiments.
“The system overall is horribly complex and it contains a very high level of uncertainty for people who are elderly, people who are vulnerable, people who are suffering emotional and psychological stress … and they’re bewildered” he said.
He stated he had long felt the system was underfunded, unsustainable and under resourced and that the baby boomers would not stand for it. He suggested a special levy earmarked to cover the expected increase in demand for aged care leading up to the peak in 2030.
The Association of Aged Service Professionals (AASP)
also made a written submission to the Royal Commission. Their submission was specifically in relation to the MPIR, the Maximum Permissible Interest Rate that can be applied as a daily converted amount (Daily Accommodation Payment – DAP) in relation to the advertised/negotiated cost of accommodation. With the fall in interest rates this amount has reduced from 6.69% in 2014 to 4.89% as at 30th June, 2020. With many residents now deciding to pay daily, the effective reduction in cash flow to facilities is becoming significant.
The Association recommended that the Minister, in order to ensure the viability of the sector, use his authority to review a revision to the current method of calculating the MPIR.
Arising from consultations, has recommended the appointment of an independent “Aged Care Pricing Authority”, responsible for care and other costs.
I am President of the AASP and fully support their submission. I sincerely hope to see effective changes to the current funding arrangements arise from the enquiry. All Australians deserve to be assured of quality and timely aged care support in their later years.
Dementia Australia CEO Maree McCabe said about the series “Offering the webinar series for free is our contribution to supporting the aged care sector through this difficult time to enable a greater level of engagement than would have been possible with the original event.”
Hospital, hotel or home? What does relationship-centred quality look like and how do you know you’re delivering it?was presented by Dr Lisa Trigg, Assistant Director of Research, Data and Intelligence at Social Care Wales (UK), on 25 August.
“A relationship-centred approach to quality is the best type of quality, where the person needing care is treated as an individual with his or her own personality, regardless of their health issues,” Dr Trigg said.
“It is being cared for by someone in a compassionate and supportive reciprocal relationship – even though someone may be in the late stages of dementia, they are still a person with their own individuality and personality.”
Dr Trigg has studied quality improvement in long-term care and currently supports people working in care in Wales with evidence and research to inform policy and service design. At the symposium she explained the concept of relationship-centred quality and gave delegates the opportunity to reflect upon the quality of care in their own organisation and how well it is being achieved.
Relationship centred care focuses on enhancing the care experience for residents together with family and staff, where relationships between them are built upon and nurtured. Residents feel a sense of security, feeling safe and receiving knowledgeable and sensitive care whilst staff feel safe from threat, working within a supportive culture and families are supported to feel confident in providing good care. A sense of belonging is established, residents are supported to make friends within the setting, family maintain valued relationships and staff feel like they are part of a team.
Residents have the opportunity to develop and meet goals, giving them a sense of achievement, which is shared with family and staff. A sense of continuity is built with residents receiving care from staff they know and staff have consistent work assignments. A shared sense of purpose is also achieved with the help of family in activities where residents have meaningful, purposeful functions and staff help with clear, shared goals. Importantly, residents feel valued and recognised, staff feel like their work matters and family feel valued by staff.
Tuesday 1 September at 4pm– Reconsidering Person-Centred Dementia Care: Can we make this an everyday experience for those living with high dependency needs and dementia? Presented by Professor Dawn Broker
Tuesday 8 September at 11 am– Leadership and the Challenge of Change by Ita Buttrose AC OBE and Addressing Leadership Blind Spots to Staff Engagement by Dr James Adonis
On Friday 22nd August the Senate Select Committee on COVID-19 in Aged Care Facilities interviewed the Aged Care Minister, Minister Colbek, for the second time.
He began well by thanking all workers in aged care facilities – personal carers, nurses, cleaners and cooks. He stated that they deal with confronting situations, that they can be scared for their own health but continue to turn up to work.
He said “We need them. They are at times unfairly scrutinised.” He went on to claim that the government …” can always do better.We will continue to work to be prepared to have resources as best we can, particularly to support the Victorian government to get the community transition under control.”
Then he stumbled. As he was being questioned about whether his department was doing its job protecting the elderly from COVID-19 in federally funded and regulated nursing homes the Senator was unable to answer how many residents had died in Victorian aged care facilities and how many current active cases there were.
Eventually a staff member told the inquiry that as of 8:00am on Thursday, 20 August 254 residents in aged care facilities had died due to Covid-19, there were 1811 active cases, with 239 recovered.
According to Anne Connelly of the ABC in her report today the Prime Minister claimed in Parliament Question Time on Monday (24th August) that of the 126 nursing homes affected by Corona Virus in Victoria only 16 have experienced a “significant” impact from COVID-19; four have had a “severe” impact and, as of yesterday morning, the number that have been “significantly impacted has been reduced to three”.
She also reported that Prime Minister Morrison and Aged Care Minister Colbeck spent yesterday’s Question Time arguing that the many plans, emails, guidelines and webinars which were sent to the aged care sector equated to effective preparation and that high levels of community transmission were to blame.
This was obviously in response to the question on Friday in the Senate Hearing where Minister Colbeck was quizzed about what support the federal government gave the aged care sector to help it prepare prior to the community spread of the Corona Virus outbreak.
Minister Colbeck mentioned at the hearing that the federal government were spending $171M for the aged care response to Covid-19 and they had set up a Disability Response centre in Victoria with $15M in funding split between the federal government and Victorian government.
The lives of those most vulnerable in aged care facilities must be given the respect and care they deserve. Ensuring the aged care providers have sufficient information, easy to follow guidelines, staffing support and adequate protective equipment is the job of the government. Both State and Federal governments have a critical role to play and they must work together in harmony to protect the elderly under their umbrella of care.
Since earlier in the year when Covid-19 made its way to Australia it’s been a roller coaster ride in my job as a Placement Consultantfor Aged Care Accommodation. In Melbourne all went quiet with families tending to keep their loved ones at home during the original lockdown in March and April and then it got very busy when restrictions were lifted in mid May. I was suddenly fielding multiple enquiries and arranging tours again as most aged care facilities had recommenced showing their homes to potential residents. They had also relaxed the isolation period for residents entering care on either a permanent or respite basis. Then lockdown restrictions were again enforced on 9th July.
Up To Date Information
Gathering information for my clients about care and fees for each aged care facility and arranging tours (when available) has became more labour intensive as each facility has different procedures for touring and admissions during these restrictions. As the health restrictions change so do the facilities’ procedures, making it an ongoing task. For prospective residents it is very difficult to navigate and they rely on my gathering the correct information and providing advice.
Of course they wonder if the different procedures will guarantee that they will be safer and less likely to catch Covid-19. It is very difficult to assess the likely outcome between the different procedures in each facility. One can only make an educated guess based on the Health Experts’ advice.
More Seeking Aged Care Accommodation
During this second lockdown I am finding there is a big difference in the number of enquiries I am receiving from families needing to place their loved ones in aged care. I think families held off from having their loved ones admitted to an aged care home during the first wave, and now that we have a second wave they can’t continue to hold out until we are Covid-free, as there is no knowing how long it will be.
However, with such a large developing number of aged care homes in Victoria reporting cases of Covid-19, clients who had chosen their new home last week are now questioning whether it is safer to stay at home until aged care homes are clear of the virus.
All aged care homes have a similar screening process for residents before entering a home. Everyone must show evidence of a current flu vaccination, submit to a temperature check and answer questions relating to general health and whether they’ve had contact with someone who might have Covid-19.
Restrictions on Touring Aged Care Faciilties
As Victoria is now in Stage 3 restrictions, most aged care homes have suspended all ‘meet & greet’ appointments for tours. Meetings can be arranged so that a client can speak to the staff over the phone, via Skype, Zoom or Face Time. Intending residents can view photos of the home’s interiors and suites and have virtual tours. There are still some aged care homes that provide restricted tours allowing viewing only of the resident’s proposed new bedroom with no interaction with other residents in the home.
I’m finding that now, more than ever, people are seeking my help as a Placement Consultant to find the most suitable aged care facility for their loved one or a client. With so many variables to consider now and a changing landscape it is a comfort to many to be able to use a professional to assist them.
For people either planning for their future or who are at a stage where they need the support of an aged care facility in my role as a Placement ConsultantI am often able to help with complex decisions and finding the right place that suits their particular needs.
For example, a couple I helped a few years back were planning for their future as they aged. They were selling their current home and considering moving into a retirement village, using the funds from the sale of their home. However, they were concerned that in the future one or both of them may need the higher level of care afforded in an aged care home and that they would not have enough funds left to buy into an aged care home that has the standard of living they enjoy.
They needed my servicesas they were confused by the vastly differing fees and charges, with inclusions that varied from village to village. I helped them by researching the different price ranges, exit strategies and cost of entering the next level of care. I felt the best solution whereby they could transition into aged care from retirement with the least disruption and loss of capital would be a retirement complex with aged care on site. I found the few facilities that offered this arrangement and set up visits for the couple to choose the option that suited them best geographically, cost wise and to their standard.
When a new aged care facility opened in Templestowe, Melbourne in April, 2019 I placed four of my clients there that year. They were all very happy with the single storey residence, and its lovely, large suites including double suites for couples. As a Placement Consultant,it has often been a challenge to meet my clients’ requests for a double suite as not many facilities catered to couples with shared room accommodation. Thankfully the new aged care facilities being built have rooms with couples’ accommodation, opening up the options.
Moving into aged care accommodation is often an emotional and stressful time for a person and their family, as they are suddenly in a situation where there has been a fall or deterioration to the point that immediate accommodation with high-level care must be found. They are often in hospital, waiting to be discharged and their needs are such high care they can only be supported safely in an aged care facility.
This is where I can offer my services as a Placement Consultant, helping on several levels. Firstly, I interview the client to find out what is important to them and what are priorities and, as I have a good knowledge of the accommodation available, can recommend a short list of the most suitable options. Secondly, I can help with negotiating fees, often saving my clients considerable amounts. Thirdly, I can fill out all the paper work and fourthly, I have counselling qualifications and can help ease the transition for all involved.
If you have a client or family member who needs help finding suitable aged care accommodation please contact me.
A group of design professionals, innovators, planners and seniors came together in a charrette (a workshop devoted to planning a design or solving a problem) to look at a new way of creating aged care facilities. Rather than design just for comfort, or looks, the group aim was to design to aid longevity. Hosted by The University of Queensland and DMA Engineers, the 120 assembled experts considered this a rare opportunity for teams of people from different fields to collaborate in some blue sky thinking.
DMA Engineers managing director Russell Lamb discussed the current dischotomy.
“It’s quite restrictive. In fact, it’s probably one of the most restrictive. I think that’s one of the struggles that the industry’s dealing with at the moment, where we hear terms about ageing in place, but if you go from a retirement living facility, where it’s in most regards an apartment that younger people in their twenties, thirties, forties may be happy to live in, to when you’re actually going to an aged care Class 9C patient room. The amount of services and facilities within that room are fundamentally different.
“One of the challenges the industry is really faced with is how we can have a space which transforms over a matter of years and transforms in a way that maintains the character of the place and doesn’t become too clinical, too quickly.”
The group was challenged to create visionary, innovative and highly connected designs to meet the needs of an intergenerational community in 2050. It was noted that too often aged care facilities are cut off from the wider community by virtue of cheaper land forcing providers to the outskirts of town.
The University of Queensland’s Director of the Healthy Ageing Initiative, Professor Laurie Buys, said
“Older people are thinking and acting very differently than ever before, and we know that future generations of older people will have very high expectations about maintaining their engaged lifestyles.”
The experts gathered into groups and took part in a design competition. The chance to throw the rule book out of the window was appealing for many of the designers who were able to think more generally about how the needs of older people can be met in a hypothetical way, rather than designing to a client’s brief. A common thread emerged of physical and social connectedness, key to promoting increased choice, economic development and job creation. Designs visualized spaces that enabled older people to be creative and productive rather than just existing in places with activities to pass the time away.
Thanks to Aged Care Insite for information used in this blog.
The Prime Minister went on national television last Tuesday to tell aged care facilities in Australia to go easy on their lockdown measures. He said the recommendation from the national cabinet was for a maximum of two visits per resident per day in the resident’s room. He was concerned for the welfare and health of residents in aged care if they were not receiving regular visits from their families.
Several things have come to my notice as an Aged Care Placement Consultant about the situation. Aged Care Facilities seem to vary from one to another with how they are dealing with COVID-19, as mentioned in my last blog. When it comes to visitors some are in strict lockdown, others are following the government recommendations. Staff are busier than ever, as they don’t have the help of volunteers and other support services; for example, they are having to conduct all the activities to keep residents occupied.
General Secretary of the NSW Nurses and Midwives Associations, Brett Holmes, said the government needed to provide additional staff to aged care facilities so they could screen visitors before allowing them in. I agree with this and can understand the difficulties aged care homes will face in monitoring visitors, I’m aware that even at the moment where families are allowed to visit their loved ones in palliative care, in some facilities it is only for 15 minutes, yet when asked to leave they ask for another 5 minutes, then another 5 – this all takes up staff time, adding an extra burden. There will be further calls on staff time when the directive starting in May that visitors must have the up to date flu immunisation comes into effect, as this will need policing.
Brett Holmes went on to say “There are qualified nurses out there looking for work and if the Commonwealth Government wants to open up the aged care facilities, then that should be done in the safest possible way.That should also mean of course the additional resources of PPE to allow that screening to be undertaken in the same way that our public health system is responding to this risk of people from outside the facility bringing in the COVID-19.”
I have noticed when that some aged care facilities are contacting families and asking them if they are content with the precautions the facility is taking and, to my knowledge, most families are generally understanding why the facilities have taken those precautions and that it is for the protection of residents.
Last week I placed a gentleman in an aged care facility and his wife was upset that she couldn’t visit him over the weekend. As I have said before, each facility is dealing with the situation differently. The same goes for retirement villages. I am helping a client to find a suitable retirement village and one place we were interested in would not allow a site visit but also won’t allow a resident to move in unless they have seen the facility in person. Another retirement village will allow a site visit, but only one person at a time.
I am finding that only people in an emergency are now seeking aged care accommodation as they don’t want to self isolate within the facility for 14 days once they move in, they don’t like the idea of no visitors and don’t want to spend the money and make a monumental move to a home site-unseen. Trying times indeed!