Covid-19 outbreaks in aged care
On July 17, all residents at Menarock Life’s Essendon aged-care home were transferred to La Trobe Private Hospital “to ensure their ongoing safety and wellbeing”, according to the aged-care watchdog.
By the time the order had been made by the Aged Care Quality and Safety Commission (ACQSC), more than 30 older Australians at the home had already tested positive for coronavirus. And at least two residents at the facility had died.
The day after the death of 89-year-old resident Alfred Hickey, the commission found Menarock had breached half of its required aged-care standards. The commission issued a notice to the provider “because of significant concerns about the provider’s response to the outbreak and the safety, health and wellbeing of the residents at the service”. The aged-care regulator has also taken compliance action against Estia Health’s Heidelberg West facility, which had 34 Covid-19 cases linked to it as of Friday.
As coronavirus cases soared across Victoria, reaching a record high of nearly 500 in a single day on Wednesday, 55 cases were linked to Menarock Life in Essendon, and more than 400 active infections were linked to aged-care facilities across the state. About half of these were residents and the other half workers; low-paid, often casual healthcare staff who fill multiple shifts across different sites to make ends meet.
Each nursing home cluster – there were 45 homes affected by mid-week – presented a clear and present threat for Victorian authorities, but the situation at Menarock Life was uniquely troubling.
The facility’s operator had faced penalties before, and issues of the past had come back to haunt them.
The Saturday Paper understands that safety assessors who went into the facility after the recent Covid-19 outbreak found residents at the end of their life who were meant to be receiving palliative care but were not.
Breaches published late on Thursday show Menarock’s Essendon home failed to provide “safe and effective” personal and clinical care and had poor systems to “prevent and control infection”. The regulator also found the facility was not properly “identifying and responding to abuse and neglect of consumers”.
Menarock Life declined to comment but said in a statement released on Friday, July 17: “The care and wellbeing of our residents remains our top priority.”
In October last year, the Royal Commission into Aged Care Quality and Safety heard damning evidence about staff shortages at another Menarock Life facility, Greenway Gardens in Melbourne’s eastern suburbs.
One resident, Giovanna Buda, complained of being slapped and having her leg twisted when she was not getting dressed fast enough. A wound developed near her pelvis, which was not monitored and became so serious Buda was “hospitalised for a considerable period of time” and her family decided to relocate her to another nursing home not owned by Menarock Life.
Another male resident, known to the royal commission only as UG, died on November 28, 2018, just days after suffering a stroke while being lifted by a single personal care worker. A secret camera captured what happened.
A transcript of the video, read into evidence at the royal commission, outlined what happened: “Mr UG appeared to collapse and be unresponsive. The staff member lifted him up by the shirt to the bed, tapped his face, called his name, asked if he was all right. Commented that he was not right when he was unresponsive. Put him back to bed, changed his continence aid and turned him.
“No other staff attended to assess Mr UG’s condition.”
Counsel assisting Paul Bolster, QC, and Zoe Maud said in their submissions that when UG died “his palliative care plan had not been activated and he was not receiving palliative care at the time of his death”.
Emails tendered to the inquiry from then chief executive of Menarock Life Brendan Coulton showed that three weeks before UG’s death, management was frustrated by the time taken to move the staff roster to the “Menarock model” after its purchase of the Greenway Gardens facility in April 2018.
“The workforce plan and roster at GG has taken too long already,” Coulton wrote to two senior staff, including group operations manager Fiona van den Berg.
“Let’s discuss further but Yvonne [Henderson, director of nursing] appears to need some very clear direction and support with this, she has not prioritised it appropriately, we have been making monthly financial losses at GG so critical we get it sorted.”
Total staff hours at the facility were capped, despite the growing frailty of residents. Meanwhile, between 2017 and 2019, Menarock Life’s profits rose from $4 million to $6.2 million, according to the company’s director Craig Holland.
The royal commission heard that Yvonne Henderson, who no longer works with Menarock, was told by Coulton that “the budget and roster and staffing levels would be applied as I was advised by head office”.
In their own careful way, the words of royal commission counsel assisting Bolster and Maud are illuminating. As their submission reads: “It is open to the Commissioners to find that Menarock’s system of determining staffing levels in the relevant period was based on fixed hours and bed vacancy rates, rather than on residents’ care needs.”
In early 2019, the ACQSC sent assessors into Menarock’s Greenway Gardens facility. The home failed to meet almost half of their accreditation standards and was placed under strict sanction for nine months. These sanctions freeze Commonwealth funding for any new residents and require an independent adviser be employed at the company’s own cost to oversee a return to compliance.
Menarock appointed its former CEO, then current group operations manager, Fiona van den Berg, to the independent adviser position.
On July 4, the federal Department of Health removed the sanctions from the facility, four months before they were originally due to expire.
Just a few months later, the day after the royal commission’s hearing into Menarock’s Greenway Gardens facility on October 15, the aged-care watchdog issued non-compliance notices against another of the company’s nursing homes in Beaconsfield Upper.
This facility in particular failed standards governing infection control. It came less than a year after another Menarock facility, the Gardens in Bentleigh, south-east of the Melbourne central business district, failed standards on skin care for its residents.
The ACQSC confirmed that the company’s Essendon facility, now the subject of a coronavirus outbreak, breached the standards in a December 2018 check – but this was not published on the public register of non-compliance notices because it “didn’t result in a notice of non-compliance being issued”, a spokeswoman said.
The Essendon facility was subject to an unannounced visit in November 2019 and received another visit, this time with notice, in March 2020. On both occasions, the regulator found no issues to report.
Menarock Life’s Essendon facility is so far the only nursing home in Australia to have all of its residents taken to hospital by the ACQSC for safekeeping. Victoria has been reluctant to do this as a matter of policy. And as it stands, South Australia is the only state that has an automatic policy of moving positive Covid-19 cases from aged-care homes to hospital straight away.
The Saturday Paper has learnt that on Wednesday a non-profit nursing home in Melbourne attempted to have one of its Covid-19-positive residents moved to a hospital. The hospital refused, as they are allowed to do. Without state government intervention, aged-care homes are left with limited options for proactive infection control.
St Basil’s Homes for the Aged in the Melbourne suburb of Fawkner told Neos Kosmos a week ago that it had requested all Covid-19 residents be moved to hospital but was denied. On July 22, everyone who had worked at the home “during early July” was ordered to quarantine. By Thursday this week, at least 73 cases had been linked to the home.
Aged and Community Services Australia chief executive Pat Sparrow said her organisation’s position is that all “first cases” should be transferred immediately to hospital to protect other residents.
“Hospitals can say no, but this is the best chance we have at stopping the spread in those services,” she says.
The deadly resurgence of Covid-19 in Victoria has thrown into sharp relief a problem that has vexed the industry for decades: the broader health system’s reticence to engage with aged care.
“What we have here is a chronically underfunded sector staffed by unskilled or inadequately trained workers who are not equipped to deal with high-grade medical issues, and certainly not infection control, and all of a sudden they are asked to turn into proxy hospitals,” says health and aged-care lawyer and advocate Catherine Henry.
“Victoria has obviously learnt nothing from the situation at Newmarch House. All of the cases I deal with, they involve preventable death.”
Sydney’s Newmarch House disaster, in which 19 residents died after contracting the virus in the facility, prompted the Coalition to develop a special protocol with the New South Wales government that required the Commonwealth to “facilitate relocation of cohorts, where appropriate” and the state government to “facilitate hospital transfers, where needed”.
It remains the only such protocol in the country. Neither the federal Department of Health nor the Victorian department responded to a request for comment.
On Thursday, three more aged-care residents died in Victoria from Covid-19. Nursing home fatalities from the virus are now approaching 50, representing more than a third of all Covid-19 deaths in Australia.
This viral crisis has shattered an institutional delusion that staffing numbers in aged care are appropriate, that funding is appropriate, and that aged-care management is always experienced in healthcare. Menarock Life stands out as an example of yet another provider caught unprepared and unable to adapt to the unfolding pandemic.
On July 14, as the outbreak at Menarock’s facility in Essendon gathered pace, the partner of a 72-year-old man at the nursing home begged the company’s chief executive, Kath Warren, to do more to protect residents.
Lisa Swiety described a home that was not clean and residents who felt they had been forgotten. Hers was an anguished call to move loved ones to hospital with so much about the situation seeming out of control.
“My partner … hasn’t been washed for three days, not even a body wash,” she said. “All initial staff left the premises with agencies replacing them … My partner’s roommate was taken to hospice. The room was not cleaned afterward. He was left half undressed.
“If my partner passes at a young 72 [with] no underlying issues, I hope you hide your head in shame.”
This article was first published in the print edition of The Saturday Paper on Jul 25, 2020 as "Forgotten lives".
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