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As the coronavirus crisis in aged care worsens, the federal government is withholding key information and denying it is responsible for surge staff in nursing homes. By Rick Morton.

Federal government holds back vital Covid-19 spread data

In mid-July, an aged-care worker hired under the federal government’s Covid-19 surge workforce was tested for the virus. Instead of quarantining, they then continued to work at a nursing home in Melbourne’s south-west.

Three days after the test, the employee was called and told they were positive for the coronavirus. The outbreak that followed at Benetas St George’s in Altona Meadows has killed four residents, two of whom died on August 12. The centre believes the agency staffer had worked at another home where an outbreak was reported – although the centre was not told.

“[The employee] knew they had been tested and they were called onsite … They were positive and subsequently spread it throughout the home and they’ve now had deaths,” an aged-care sector source tells The Saturday Paper.

“The provider was obviously unbelievably angry and distressed and it was raised formally with the minister and part of what they got back was ‘it’s the provider’s contract’.”

Essentially, the federal government was saying it was not responsible – the private contractor was. The head contract, though, is with the federal government.

One thing that would have helped control an outbreak here and across Victoria, sources say, is the release of detailed information held by both the federal Department of Health and Victorian authorities about outbreak notifications in nursing homes.

“If you have an outbreak in your home, you have to, within 30 minutes, report it to the state Department of Health and the federal department,” says another, senior aged-care sector worker. “So the federal department unequivocally has a list of every single facility that has an outbreak. We cannot get this list. We have been asking for local heat maps of community transmission so providers can understand, geographically, if it is in their area.

“And we have been particularly asking for the list of infectious facilities because it helps track staff. Not just on-ground staff, but catering professionals and laundry services. We cannot get it. They won’t give it to us. They keep saying it is the state’s fault and we keep saying, ‘You have this list. We have to call it in to you.’

“And it is literally resulting, in Victoria, with providers having staff and other people turning up who are subsequently shown to have worked at a positive site and are positive. I’m serious. They absolutely have the data.”

Despite agreeing to release heat map data in the first wave of the pandemic, Aged Care Minister Richard Colbeck changed his tune at a senate committee hearing earlier this month, during which he said providers did not want the data released.

“I’m reluctant to have a public hit list of facilities that have been unfortunate enough to have a Covid outbreak within them,” Colbeck said.

The senior aged-care sector source says this is “100 per cent not true”. Speaking on behalf of a co-ordinated effort from all three peak bodies in aged care, they said: “None of us have said that, not one. None of our members have said that, we are desperate for that data. Desperate.”

The Saturday Paper asked Minister Colbeck for evidence of his claims but he did not respond to a request for comment.

Even with a Commonwealth-funded surge workforce, it is aged-care providers who contract the agency workers – but head contracts with all companies, such as Aspen Medical, Mable and Healthcare Australia (HCA), are struck by the federal government.

“There is a mandatory notification protocol in place for all staff regarding symptoms and testing for Covid with a requirement for them to self-isolate. This protocol is consistent with all Commonwealth and state health directives,” an HCA spokesman said.

“The protocol does, however, rely on the honesty and compliant behaviour of individuals to make the notification and not attend work while symptomatic or awaiting results.”

After months of ignored warnings about moving coronavirus patients out of aged-care homes and into hospitals to control the spread of the pathogen, there are now more than 2000 cases of the virus connected to nursing homes in the state.

Instead of dealing with the relatively simple logistics of caring for Covid-19-positive residents in the better-funded and -resourced hospital system, federal and state authorities face overwhelming numbers of patients who need care.

The Saturday Paper spoke with a Melbourne emergency department physician who said aged-care residents had spent as long as 24 hours waiting on stretchers for space in the hospital to open up.

“Things are tight at the moment, we are suffering from access block, which means people are staying in emergency longer than they should,” the physician said. “If you’ve got people in there for more than 24 hours, that is a red flag. It is happening. I know some beds have had to be closed because of the gaps in rosters, more with nurses than doctors at the moment. That translates to places where you haven’t got the nurses to treat.”

Australian Defence Force and Australian Medical Assistance Teams (AUSMAT) personnel have been sent to Victoria to help. Teams of six from Perth, South Australia and north Queensland have also flown into the state to relieve overwhelmed services. Victoria’s state healthcare workforce has covered more than 2240 shifts in nursing homes.

As recently as Wednesday, however, services were still struggling.

Jewish Care Victoria, which at the time had 30 positive residents and 20 infected staff, issued a media release warning “homes continue to face unprecedented difficulty in sourcing staff”.

“Throughout this pandemic we have advocated to both the Victorian and federal Aged Care and Health ministers and government departments about the urgent need for staffing solutions for aged care,” it said. “We continue to do so.”

 

Last Friday, staff at Caulfield Hospital in Melbourne’s south-east were told to prepare for a transfer of 30 aged-care residents. It was interpreted as a directive from the state Department of Health and Human Services (DHHS).

Senior health workers were told DHHS had belatedly decided the facility’s Covid-19 patient surge capacity wasn’t being used and its beds could be turned over to “private centres that did not have adequate patient safety procedures in place”.

In other words, unsafe nursing homes and residential institutions.

Although officials say the transfer never happened, this was a startling admission of something that must have been known by state and Commonwealth health authorities since the back-to-back viral outbreaks in New South Wales at Dorothy Henderson Lodge and Newmarch House in March and April. Nursing homes had entered the once-in-a-century pandemic crippled by years of funding cuts and the gradual erosion of care overseen by successive governments.

In an extraordinary exchange on Wednesday, Prime Minister Scott Morrison told ABC News Breakfast that the federal government “regulates” aged care, “but when there is a public health pandemic … whether it gets into aged care, shopping centres, schools or anywhere else, then they are things that are matters for Victoria”.

It is true that Victorian health authorities take the lead on the hospital system and public health, as they did in New South Wales during the worst of the coronavirus first wave, but much of what has happened to aged care occurred in a federal leadership vacuum.

When asked by the Royal Commission into Aged Care Quality and Safety what her agency’s primary mission is in responding to a pandemic or another emergency, the federal aged-care regulator, Janet Anderson, said it should be “to protect and enhance the safety, health, wellbeing and quality of life of aged-care consumers”.

This might explain why, in the throes of a devastating and fatal Covid-19 outbreak at Sydney’s Newmarch House in April, senior staff from the Aged Care Quality and Safety Commission, including Anderson herself, repeatedly raised the prospect of emergency takeovers of private hospital beds.

Five days after the first case was recorded, Anderson emailed federal Health Department senior official Amy Laffan and put this option on the table. Detail from these emails has not previously been reported.

“The Private Hospital NPA [national partnership agreement] with States and Territories explicitly contemplates making private hospitals available to care for vulnerable people including aged care consumers,” Anderson wrote.

“It’s not just the health of the virus-positive residents that is of concern. We are equally concerned about the impact on the physical, mental and emotional health and wellbeing of the virus-negative residents because of the need for self-isolation, extensive PPE use, etc etc.”

That same day, NSW Health infectious disease physician James Branley, who had been acting as the chief clinical lead at Newmarch House, resisted this idea, saying they would “run the risk of a Ruby Princess” if they “disseminate patients who are likely to be positive”.

Anderson’s chief clinical adviser, Dr Melanie Wroth, said this simply wasn’t true, noting that residents would be moved into “a quarantined situation” and “any impact would be temporary [and] lower impact than people dying”.

Dr Branley said he was willing to consider a move to a specific facility, but the Commonwealth never came back with any options.

“I continued to give consideration to evacuating patients elsewhere but asked for the detail so infection risk could be assessed,” he wrote in his signed statement to the royal commission on July 24. “This detail was not provided.”

 

The concern about the failing health of Covid-19-negative residents was not theoretical. At Newmarch House, case notes from multi-agency meetings refer to discussions about one resident who was taken to hospital – for a broken ankle, not for Covid-19 – and whether they should return to the nursing home.

A doctor, whose name has been redacted, said “no, Newmarch is an unsafe environment”.

Daily updates emailed to federal officials from the Department of Health’s NSW and ACT manager in the health grants and network division, Lisa Peterson, showed on May 13 that information “indicates that a number of residents have experienced significant weight loss”.

“There are also issues associated with pressure areas and poor skin condition,” she wrote.

On May 22, Peterson wrote that a psychologist had reviewed two residents and referred them for “further medical assessment”. By June 1, she noted there had been “six residents referred to psychologists for more intensive counselling due to impact of isolation”.

As revealed by The Saturday Paper last weekend, the Commonwealth agencies walked away from these early positions and by June 10 had backed in a NSW Health protocol that kept Covid-19-positive patients in aged care despite strong concerns from the sector.

When Victoria’s community transmission of Covid-19 took hold, arrangements that could have saved lives and hundreds of infections, according to those in the sector, simply were not in place.

Private hospital beds were not secured for “index” cases. By the time more than 400 private beds in Victoria were made available – in addition to about 300 in the state-controlled public system – the pathogen had swept through scores of nursing homes and was out of control. Questions about this issue were emailed to the federal Department of Health, but it did not respond by deadline.

This article was first published in the print edition of The Saturday Paper on Aug 22, 2020 as "Federal government holds back vital Covid-19 spread data".

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Rick Morton is The Saturday Paper’s senior reporter.