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At the same time as the government was failing to deliver vaccines to aged-care homes, it scrapped the support payment designed to stop staff working at multiple sites – a key source of transmission. By Rick Morton.

‘You had one job’: inside the botched aged-care rollout

The minister for Health and Aged Care, Greg Hunt.
Credit: AAP / Lukas Coch

Health Minister Greg Hunt was backed into a corner. It was the end of April, months after the aged-care vaccination program had lurched into disaster, and the Coalition’s point man on the rollout was being pressed by aged-care sector officials about the failure to vaccinate nursing home staff.

He told them the government would “continue” to inoculate these staff in their workplaces.

This surprised many at the meeting.

The so-called “in-reach teams” being sent to nursing homes were not, as a matter of policy, vaccinating aged-care staff. The contractors were paid only to inoculate residents, and told to give any leftover doses to workers. It did not appear there were any new contracts on the horizon for a worker-focused vaccination drive.

“It didn’t make any sense,” one source who was at the meeting tells The Saturday Paper, “until we realised, they had to go back and ‘mop up’ the rest of the country’s aged-care residents who were still waiting for their first or second doses.”

In other words, there wouldn’t be any discrete program for aged-care staff. They would remain, as they had been since the start of the rollout, an afterthought.

 

Last Saturday, one month after Hunt’s panicked thought bubble, an aged-care worker in Melbourne who had received one dose of the Pfizer vaccine tested positive for Covid-19.

Then on Monday, a resident of Arcare Maidstone, where the positive employee worked, also tested positive. The woman, in her 90s, was transferred to hospital. The worker’s son also contracted the virus, as did a second worker at Arcare Maidstone. This worker, unvaccinated because she was on personal leave the day vaccine teams arrived at her workplace, had also staffed shifts at BlueCross Western Gardens in Sunshine late in May, sending that facility into lockdown.

By Wednesday, a second resident of the Arcare nursing home had tested positive.

As was the case in 84 per cent of aged-care Covid-19 outbreaks last year, when more than 680 nursing home residents died because of the virus, the pathogen was seeded into Arcane Maidstone by staff members who didn’t even know they were sick.

This was history repeating.

As senate estimates heard this week, the federal government still had not finished offering first vaccine doses to every aged-care resident in the country. If officials are to be believed, that first-round offer will have been made to all residents by Saturday.

Currently, only 64 per cent of nursing home residents across the country have received two doses of a vaccine. In Victoria, it’s just 57 per cent.

“The priority vaccine groups in 1a were all things the Commonwealth said they had responsibility for, which was quarantine, front-line health workers, aged- and disability-care residents and staff,” one official with knowledge of the aged-care sector vaccine rollout tells The Saturday Paper.

“But they really only had one job. Vaccinate the aged- and disability-care cohort. That and procurement of the vaccine itself. That’s all they had to do.”

This week, Department of Health bureaucrats told senate estimates they do not know how many aged-care workers have been fully vaccinated.

They offered an estimate of at least 33,000 employees, which would be less than 10 per cent of the 366,000 staff in the sector.

 

 

To understand how the aged-care sector once again teeters on the brink of crisis after the horrors of last year, it is helpful to go back to October 1, 2020, when the Royal Commission into Aged Care Quality and Safety released its urgent Covid-19 report.

“We do this now because we do not know how long the pandemic will last. Its end is impossible to predict. However, aged-care residents continue to suffer and, tragically, some more may die as a result of COVID-19,” the commissioners wrote in that report.

“The nation needs to know what lessons have been and can still be learnt. The nation needs to know what is being done, and what will be done, to protect those people receiving aged care services – those who this virus has affected disproportionately.”

Less than two months after this scathing indictment of the federal government’s lack of oversight, the Coalition quietly removed a crucial element of public health control. It was a scheme that boosted the pay of aged-care workers as compensation for not moving between multiple jobs at different locations.

The withdrawal of support came on November 30, months before any vaccine was available in Australia. It seemed government policy was being made on hope. This would be a crucial error in a catalogue of mistakes in the lead-up to the positive cases at Arcare Maidstone.

On Tuesday night, the operator of Arcare Maidstone provided a briefing for residents’ family members and friends regarding the serious Covid-19 situation inside the nursing home.

On the Zoom call were officials from the Department of Health – texting with Greg Hunt, who was not on the call – and the acting chief medical officer, Michael Kidd. They were joined by Anthony Speed from the nursing home regulator, the Aged Care Quality and Safety Commission.

According to people on the call, who have briefed The Saturday Paper, the managers of Arcare highlighted the fact they were unable to prevent staff working across multiple sites until the federal government recognised Melbourne as a Covid-19 hotspot, which happened on May 27.

But by then, it was too late.

It was a similar story in the disability sector. While the two are not identical, disabled people living in group homes or congregate care settings were included side by side in phase 1a of the vaccination rollout due to the high-risk settings in which they live.

On January 11, Victoria’s minister for Disability Services, Luke Donnellan, wrote to his then federal counterpart, Stuart Robert, and asked for the Commonwealth’s disability worker mobility reduction payment to be extended, at least until the end of February.

As in aged care, the goal of this scheme was to keep support staff working at only one or two sites and hopefully reduce the spread of Covid-19.

Robert was confident the support was no longer needed.

“The Covid-19 vaccine rollout is due to commence at the end of February 2021. Workers and residents of group disability accommodation settings are included in Phase 1a as a priority cohort and will receive the vaccination through in-reach services being coordinated by the Australian Government Department of Health,” he wrote to Donnellan.

“As Australia moves into a Covid-safe period, the focus should be on ensuring disability providers have a current preparedness plan in place and are adhering to all guidance about reducing risk of spreading infection. Further, the vaccine will provide additional protection to reduce transmission in accommodation settings.”

That last line, about the reduction of transmission, is critical. Before senate estimates this week, officials from the Health Department and Aged Care Services Minister Richard Colbeck stated the opposite, and they used this to explain the aborted staff vaccination program in nursing homes.

“The target of vaccination is to protect,” Health secretary Brendan Murphy said on Wednesday this week.

“We don’t yet know how effective we’ll be at preventing transmission.”

In any case, the completion rate for disability resident vaccinations by May 29 was almost unbelievable: only 355 people had received two doses, while altogether 3500 had received at least one. There are some 26,000 residents.

When asked by the Greens senator Jordon Steele-John who was at fault for the “abject failure” of the program, Minister Colbeck was defiant.

“Senator, it’s not my responsibility to hold anyone responsible,” he said.

 

Here’s what we do know.

Both disability and aged-care residents and staff were afforded equal priority in phase 1a for the vaccine rollout. Some time in March, the government dropped the commitment to disabled people so they could “refocus” resources on getting the aged-care job done. Then, when that mission looked doomed, the Commonwealth all but abandoned aged-care workers to refocus on residents. That work is still not complete.

What changed?

On February 16, Minister Greg Hunt proudly announced that “vaccinations for residents and staff will be made available through residential aged-care facilities where they live and work”.

“It will be administered through an in-reach workforce provider,” he said.

But as senate estimates heard this week, the key contractor in this case – Aspen Medical – says it was never contracted to vaccinate aged-care staff.

At some stage between the minister’s press release on February 16 and the contract work orders being agreed, the Australian Technical Advisory Group on Immunisation (ATAGI), which comprises health and vaccine experts, allegedly provided advice to the government that residents and staff should not be immunised on the same day.

“For the experience that the United States had seen where they were doing both at the same time … was that this can be quite disruptive if a number of staff had adverse events to the vaccine and were unwell, it could actually cause problems for the facility,” Murphy told the parliament this week.

“So that was the advice that ATAGI took, and they agreed that it would be best to separate them.”

The Australian Council of Trade Unions, which was involved with negotiations regarding the vaccine rollout, has repeatedly asked to see this health advice but has not been made privy to it. When senators asked for the evidence in estimates, officials said it would be provided.

Crucially, however, Health Department bureaucrats could not say whether the advice said anything about deprioritising staff altogether.

“There was never any ATAGI advice to say that aged-care staff were such a low priority that four months after the vaccination rollout we can still be looking at fewer than 10 per cent of the aged-care workforce being vaccinated,” Labor’s Senator Murray Watt said during senate estimates this week. “There is not advice to support that. It’s on the government to have not done any better.”

Brendan Murphy said: “I can’t tell you whether there was specific ATAGI advice on that, we’d have to go back and take that on notice.”

Colbeck was more resolute.

“We never said that aged-care workers were a low priority – they’ve always remained in category one – but we had to pivot to a different process,” he said.

Aged-care staff found out about this pivot only by accident. “We were initially told that our staff would be vaccinated at the same time as the residents as part of the 1a priority group via contractors that would form in-reach vaccine teams,” one aged-care worker tells The Saturday Paper on condition of anonymity.

“Great, until we received vaccination dates for our residents with no mention of what to do for staff. Zero communication there.”

While the staff were originally told residents would be vaccinated in March, these new dates were for April.

“At the same time, the government made a big song and dance about opening up vaccinations for group 1b before our residents had even received their vaccines,” the aged-care worker says.

“I remember being quite bemused by the media coverage and how much the government were really highlighting this as a success. Staff who were rostered on the day could receive leftover vaccinations as part of the resident vaccination clinics. Everyone else had to hunt down their own vaccination.”

 

In February, executives at the Victorian aged-care provider TLC Healthcare got their first glimpse of just how the federal government intended to roll out its vaccination program.

It was a mess.

“TLC’s location in Wallington was the first aged-care home in Australia to be visited by the government’s vaccination team,” Lou Pascuzzi, chief executive of TLC Healthcare, tells The Saturday Paper.

“Although our residents at Homestead Estate were thrilled to receive their first vaccine doses, it soon became clear that the schedule for the teams to visit our other homes, and for staff to receive their vaccinations, had yet to be confirmed.

“It was at that time that I decided that TLC would need to take a proactive, rather than reactive, approach to vaccinating our people before winter. It was critical for me to ensure that everyone at TLC was fully vaccinated before the onset of winter.

“I didn’t want my residents, staff and contractors to have to endure another winter of nervousness and trepidation regarding this virus.”

But this nursing home operator is not like most in the critically mismanaged and poorly funded sector. For a start, it has primary medical and allied health services located onsite at every one of its residential homes. So, when it asked the Department of Health for 7000 Pfizer doses to be set aside, and for permission to vaccinate its own residents, the federal government agreed.

On May 4, it finished the job. Every staff member and resident who consented has received both doses of the vaccine with just 0.3 per cent wastage. TLC remains the only aged-care provider in the country to be in this position.

Pascuzzi is ferocious in his criticism of the rest of the sector.

“For too long the executives and boards of the aged-care industry in Australia have sat back and expected the government to spoonfeed them,” he said. “And their lack of traction on the Covid-19 vaccination rollout is a perfect example of why that approach is not acceptable or sustainable.”

Still, this was the government’s No. 1 priority. Staff who were told the vaccine would come to them waited because that was what they were told.

“Before the state governments opened up their vaccine hubs, which was announced at the end of April, you could not even get a vaccine if you were an aged-care worker unless it came from the Commonwealth,” a union official says.

This week, both Victoria and Queensland announced they would fast-track access to the vaccine for aged and disability care workers through their own state hubs.

“They’re doing your job,” Labor’s Katy Gallagher told Richard Colbeck on Tuesday.

Murray Watt said the two states were “taking over”. Colbeck managed only a polite rewording.

“Well, they’re not taking it over, senator, they’re making a contribution to it,” he said.

On Wednesday, the Victorian branch of the Australian Nursing and Midwifery Federation called for Colbeck to resign. It had never done so before, but failure upon failure last year and more alarmingly after the blistering royal commission report forced their hand.

They were angry.

“We need a minister who gets things done with a sense of urgency, care and respect for the residents and the dedicated staff,” Victorian branch secretary Lisa Fitzpatrick said.

“The Morrison government has abandoned Victoria’s private aged-care nurses and personal care workers.”

But it is Greg Hunt who is the cabinet minister responsible for Health and Aged Care. And by his own admission, he’s had a shocker.

This week he mistakenly claimed 70,000 workers had been fully vaccinated. But that figure was referring to the number of doses administered. And on Monday, he told the media only six nursing homes in Australia were yet to be visited by a vaccination team.

The real number was 21.

This article was first published in the print edition of The Saturday Paper on Jun 5, 2021 as "‘You had one job’: inside the botched aged-care rollout".

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Rick Morton is The Saturday Paper’s senior reporter.