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A September bottleneck is looming for Covid-19 vaccinations, as another at-risk group is revealed as having been essentially forgotten in the rollout plan. By Karen Middleton.

Home care and vaccination

Teresa Hetherington.
Credit: Supplied

Teresa Hetherington wants to warn the government. Hetherington is a carer for elderly people living at home. She visits about seven clients a day, each of whom also sees multiple other carers. It’s often close, physical work. Very few in either group have been vaccinated against Covid-19.

Hetherington fears that unless the government grasps the risk this poses and ensures workers and their clients are vaccinated, some among them are going to die. “I genuinely feel it’s only a matter of time, to be honest,” Hetherington tells The Saturday Paper from her home in Newcastle.

“I’d hate to think that it would actually take clients’ or workers’ deaths to make us a priority. Because it shouldn’t come to that.”

Last week it did. The Saturday Paper has confirmed that a woman who died of Covid-19 in Sydney was a home-care recipient. Her carers are isolating and being tested for infection. New South Wales Health will not reveal how she became infected or if carers were, too.

The woman’s death underscores concerns that this part of aged care was strangely and dangerously ignored in the national vaccination rollout plan.

For all the deserved focus on the risk in residential facilities, governments have done little to protect people in home-based care.

Catholic Health Australia estimates about 150,000 home-care workers provide various services to about a million people nationwide. The Health Department says it can confirm 11,375 home care workers are fully vaccinated and 24,863 have received one dose.

They are being deemed lower risk than residential workers, half of whom still haven’t received even one vaccine dose despite a looming September 17 deadline. After that, unvaccinated residential staff aren’t supposed to work. The deadline scramble is pushing the home-care workers further back in the queue for vaccines.

Many home-care clients are vulnerable. Some are wheelchair-bound and must be hoisted in and out of bed. Others have dementia or conditions such as cystic fibrosis, requiring sustained pummelling to loosen fluid in their lungs.

Workers are paid about $23 an hour. They sometimes spend the unpaid time between clients sitting in their cars and trying to keep warm. They work through outbreaks and lockdowns. Those going in and out of NSW hotspot areas – some several times a day – are supposed to be tested every 72 hours but it’s not clear who polices that requirement.

The nature of aged and disability home-care work makes it impossible for workers or clients to properly assess their Covid risk.

“When you’re visiting clients in their own home, you don’t actually know that,” says Anglicare executive director Kasy Chambers. “They could have had anybody through.”

Anglicare has 49,000 home-care clients and 2700 staff. Some of them now feel unsafe, given the highly infectious Covid-19 Delta variant.

“We have clients who are telling us, particularly in Sydney, they don’t want to have the services because they can’t guarantee workers have been vaccinated,” Chambers says.

Teresa Hetherington says most of her colleagues want to be vaccinated but have struggled to get appointments. Some feel pressure not to admit they aren’t vaccinated because clients might cancel and be left isolated without vital support.

“If one of us have Covid, we’ll have given it to each other,” Hetherington worries aloud. “And also to them.”

Federal health authorities recently confirmed there is no vaccination plan at all for home-care workers. Lieutenant-General John Frewen, who heads the government’s vaccine taskforce, told a senate committee hearing on July 23: “I’m specifically focused on the aged-care workers at this time.”

He meant residential workers. Chief medical officer Professor Paul Kelly and Health Department secretary Dr Brendan Murphy insisted home-care workers were “a priority”. Frewen appeared unaware of them.

“I will look to what the requirements there are,” he said. “It is not a focused effort at the moment.”

Kelly said home care was “not specifically” on national cabinet’s agenda. Murphy said the workers could “access” vaccines, but residential workers were the “biggest risk transmission environment”.

Residential workers have been issued letters authorising them to jump the queues for vaccination. Until this week, home-care workers have not.

On Wednesday, The Saturday Paper asked the Health Department why.

On Thursday, before responding, the department sent providers a letter template. It still does not specifically allow home-care workers to jump queues but confirms their vaccine eligibility under rollout phase 1b. The department says they’ve been eligible since March. The letter is workers’ first proof.

Also this week, the requirement that providers report weekly on residential care workers’ vaccination rates was extended to home-care workers.

Speaking before the letter template was sent out, Catholic Health’s chief executive, Pat Garcia, said he feared workers were being rated low risk simply because there hasn’t been an outbreak there yet. “We cannot leave it to chance with the Delta variant, which is highly transmissible, more virulent and is often asymptomatic in carriers,” he says.

Teresa Hetherington finally has a vaccination appointment – in two months.

“It all comes down to access,” she says. “My first shot is in late September. I am getting Pfizer. I would have had AstraZeneca had I been allowed. But I’m 48 and they didn’t recommend it to me.”

Hetherington says home-care workers don’t take overseas holidays or have mortgages or “nest eggs”. They don’t want much but can’t afford time off to queue.

“We’re asking for recognition and for access,” she says. “We shouldn’t be sitting for three months waiting for a vaccine.”

Employers are “strongly advising” vaccination, but many do little more.

“We’re getting emails once a week saying, ‘Have you been vaccinated?’ ” Hetherington says. “But they’re not facilitating it in any way. They’re not telling us where to go, giving us the time to get it done or paying us while we do it.”

Mel Gatfield, the NSW secretary of the United Workers Union, says the treatment of home-care workers is a disgrace. “They should be able to get the vaccination and they should be tested and paid. The testing should be provided.”

Hetherington recalls how, as the first Covid-19 wave peaked last year, a campaign to honour “home-care heroes” ignored those in aged and disability care. When some colleagues asked about a major fast-food chain’s free “heroes” coffee offer, they were told at the counter they didn’t qualify because they weren’t nurses.

Not only has the government not helped vaccinate home-care workers, in some cases it has actively discouraged it. Providers who established onsite nursing home vaccination hubs were told to prioritise residential staff.

Focused on the September 17 deadline, the federal government instructed them to exclude those working in home care.

It’s the same kind of exclusion that was applied to the residential staff when residents were first being vaccinated – the very thing that exposed nursing homes to outbreaks and led to the mandatory order.

But on Wednesday night this week, after the Sydney woman’s death and as media inquiries about Frewen’s evidence began, providers were told home-care workers could now be included.

Despite these efforts, residential workforce vaccination rates are still lagging.

Health Department figures show only 32 per cent have received two doses of vaccine and just over 50 per cent one dose.

The paperwork is lagging, too. National cabinet’s vaccination mandate requires public health orders from the states and territories. At time of press, none had been issued.

Navigating existing laws complicates the process, as does a federal government request for national consistency. The vaccination indemnity for GPs and now pharmacists does not include nurse practitioners. This may also be playing a role.

And jurisdictions have been awaiting chief health and medical officers’ advice on who should be exempt.

United Workers’ aged-care director Carolyn Smith calls it “an absolute shemozzle”.

“Imagine what will happen in six weeks’ time if 20 per cent of the workforce still isn’t vaccinated,” she said.

Even without aged care, September looks like a serious vaccination pinch point in NSW. Last week, Prime Minister Scott Morrison announced new medical advice on the recommended time between Pfizer shots for people in Sydney.

Worldwide, the recommended gap is three to six weeks, three weeks offering the best coverage. In NSW, the gap has been changed to six.

With the Delta strain raging, governments want to give more Sydney people a first shot ahead of giving the half-vaccinated their second. This is because there is not enough Pfizer vaccine to do both, some people refuse to have the AstraZeneca vaccine and one shot of either offers more protection than none. But without significantly larger Pfizer volumes arriving, the arrangement risks becoming a vaccine Ponzi scheme.

Whether in three weeks or six, everyone needs a second shot. Those receiving their first now will be due their second in early September. Unless more Pfizer is supplied, others seeking first doses may have to wait.

Council on the Ageing chief executive Ian Yates says residential workers must remain the highest priority, because last year showed what happens when Covid-19 gets into nursing homes. “We want to maintain strong pressure that aged-care staff go to the front of the queue,” he says. “Once we’ve got the residential staff vaccinated, then I certainly think there should be priority attention on home-care staff.”

But the front of the queue is crowded. At the July 23 hearing, chief medical officer Kelly reeled off his priority list.

“So I’ve got: respiratory technicians and doctors in private practice; teachers and their families; construction workers; FIFO workers; freight drivers; airline employees, and flight crews in particular; employees of Wesfarmers, Coles and Woolies; cleaners in various high-risk settings; front-line emergency workers; call centre staff; families of healthcare workers; distribution centre workers; and Uber drivers and taxi drivers,” he said. “I think the point is that everyone is a priority right now.”

These are either essential workers or a transmission risk or both. Teresa Hetherington and her colleagues are, too. But, she says, they are “Priority F-you”.

“Community care workers are unseen, unheard and nobody gives a rat’s arse,” Hetherington says. “We are an afterthought … The chances of us actually infecting some or all of our clients is only increasing.”

The senator who led the July 23 home-care questioning, the Greens’ Rachel Siewert, says she is worried by the situation. “I think partly it’s just good luck that we haven’t had an outbreak in home care.”

Teresa Hetherington says it’s more than good luck: the workers have prevented an outbreak. “It has only been because individuals have taken so much respect and care for themselves and their families and their clients.”

She’s not sure how long they can keep it up.

This article was first published in the print edition of The Saturday Paper on Jul 31, 2021 as "Vaccine bottleneck".

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Karen Middleton is The Saturday Paper’s chief political correspondent.