Morrison government needs to improve, rather than defend, its poor COVID aged care performance

The state of aged care preparation in the era of COVID-19 is, it seems, in the eye of the beholder.

Vastly different claims emerged this week, when the royal commission examining the sector turned its attention to the handling of the pandemic.

According to the senior counsel assisting the commission, Peter Rozen, QC, federal authorities had no COVID-19 plan specifically for aged care, always potentially a major risk area. And, Rozen noted, compared with many countries, residents of facilities form a very high proportion of Australia’s deaths.

The government disputes the lack-of-plan allegation and has a different take on the statistics.

Brendan Murphy, secretary of the health department and until recently Australia’s chief medical officer, appearing before the commission^[1], insisted there had been proper planning, and said the death proportion reflected not a failure in aged care but the low number of fatalities in the general community.

If you were taking a bet on who most people would believe, Rozen would be short odds.

Morrison knows the government is highly vulnerable on the issue. Aged care is a federal responsibility. It affects millions of Australians, counting those with relatives in homes. People’s anger buttons are easily triggered when things go wrong.

Some around the government might like to discount Rozen’s attack as being what counsels-assisting do at royal commissions. But his claims were backed by witnesses, from highly regarded geriatrician Joseph Ibrahim of Monash University to union officials with members on the front line.

They also resonated after the numerous first-hand accounts in the media from families as the virus has ripped through well over 100 facilities in Victoria. Currently, there are more than 1,000 cases among residents and over 1,000 among staff, linked to these homes.

Politicians have been congratulated during the pandemic for listening to experts, but according to Ibrahim, there was not enough aged care expertise applied in the preparations to firewall the sector.

It’s hard if not impossible, anyway, to build adequate safeguards when the structure itself is so compromised, due to bad decisions and neglect over many years.

Read more: Royal Commission into Aged Care reminds Health Department Secretary Brendan Murphy it sets the rules^[2]

A sector operating with low paid, often short term, casuals who pick up work across facilities and often have inadequate English (complicating even basic training) was always inviting disaster.

Health Minister Greg Hunt declared recently, after Victoria Premier Dan Andrews said he wouldn’t want his mother to be in some of these places:

The idea that our carers, that our nurses are not providing that care, I think, is a dangerous statement to make. They are wonderful human beings and I won’t hear a word against them.

This misses the point. No one doubts the commitment the majority of the carers have to their work. But the nature of the workforce brings dangers for residents.

Many facilities run on narrow financial margins. The rules allow them to keep their staffing to a minimum, in terms of numbers and skill.

Nor has regulatory oversight been adequate. Often it is families and the media that have exposed neglect and abuses. Morrison announced the royal commission in September 2018 a day before an ABC Four Corners investigation was to air.

The for-profit system emphasises the idea of facilities being “home-like”, which sounds great but can mean inadequate specialised care and challenges for inflection control.

The word “tragic” is thrown around too much by politicians and media. But what’s happened in aged care during COVID-19 has indeed been a tragedy.

It’s just possible if the pandemic had come two years later, after next year’s final report of the royal commission had forced some reform, that fewer lives would have been lost. But even with the system as it is, the evidence indicates better planning could have saved lives.

That’s certainly Ibrahim’s view. In his precis of evidence^[3], he argued “hundreds of residents will die prematurely because people failed to act”.

We had enough knowledge to do better. We failed because when residents are treated as second class citizens there is an absence of accountability and consequences for those responsible for aged care in Australia.

There was “failure to provide the same health response to residential aged care that was delivered to the rest of Australia.”

The government has been playing catch-up on aged care all through the pandemic. It had to put substantial money in to help with staffing; it was slow to acknowledge the importance of masks; it set up a co-ordinated response in Victoria belatedly; National Cabinet only a week ago stepped up preparations in other parts of the country.

Morrison is now confronted at two levels: there must be root and branch reform after the royal commission, and his government is under immediate pressure over this week’s indictment.

The government’s tactic of inserting Murphy into the commission’s witness list was a miscalculation.

It seemed to assume the commission would defer to Murphy when he sought to make a statement to reject Rozen’s claims. But he was refused permission to commence with the statement (which he delivered at the end of the session) and all his appearance did was highlight the government’s sensitivity.

When he summed up the hearings on Thursday, Rozen did not resile from his initial criticisms. He concluded the problems in aged care had been foreseeable; “not all that could be done was done”; and the challenge remained.

Picking up a recommendation from Ibrahim, Rozen urged an “age-care specific national coordinating body to advise government”. It would bring together expertise in aged care, infection control and emergency preparedness.

With such a body, “a national aged care plan for COVID could still be put in place,” Rozen said.

Read more: Government rejects Royal Commission's claim of no aged care plan, as commission set to grill regulator^[4]

Although the advisory body is not a formal recommendation, commissioner Tony Pagone endorsed it among “practical things that perhaps should not wait.”

The virus doesn’t wait and nor should the measures that need to be implemented to deal with the virus wait either.

The government, which has previously signalled more assistance for aged care in the budget, should stop insisting it has done everything well and act immediately on this and some of the other suggestions made in the COVID-19 hearings.

Morrison said this week in a Facebook message, “I want to assure that where there are shortcomings in these areas they’ll be acknowledged. And the lessons will be learned.”

The government likes to talk about wanting a reform agenda, but this should not be just an economic one. Aged care must be near the top of any serious “reform” to-do list, and vested interests should not be allowed to limit necessary changes.

In his end-of-year ministerial reshuffle, prompted by Mathias Cormann deciding to quit parliament, Morrison should elevate the aged care portfolio from the outer ministry to cabinet.

Having the post in cabinet would send a positive signal but, more importantly, it would encourage a wider range of ministerial eyes on an issue that’s been mishandled for as long as anyone can remember.

Veterans’ affairs is in cabinet, and most families would think aged care is just as worthy of a place.

References

1. ^{^} appearing before the commission (webstreaming.lawinorder.com.au)
2. ^{^} Royal Commission into Aged Care reminds Health Department Secretary Brendan Murphy it sets the rules (theconversation.com)
3. ^{^} precis of evidence (agedcare.royalcommission.gov.au)
4. ^{^} Government rejects Royal Commission's claim of no aged care plan, as commission set to grill regulator (theconversation.com)