RESEARCH PAPER SERIES, 2019–20              16 June 2020

COVID-19 and aged care: a quick guide

Alex Grove

Social Policy Section

Older Australians and aged care residents are more vulnerable to serious complications if they are infected with COVID-19. This quick guide presents statistics on COVID-19 in aged care in Australia and overseas. It outlines the responsibilities of the Australian and state and territory governments and aged care providers in responding to COVID-19. It focuses on key measures taken at a national level to support the aged care response, and avenues for scrutiny of the response.

Statistics

Australia

The Department of Health publishes daily updates on the number of COVID-19 cases and deaths in Australia. As at 8 June 2020, there had been 99 cases of COVID-19 among people receiving Australian Government subsidised aged care. Sixty-eight of these were nursing home residents and 31 were people receiving care in their own home. Of these cases, 27 nursing home residents and three home care recipients had died. Aged care recipients accounted for 1.4 per cent of all COVID-19 cases in Australia, but 29.4 per cent of COVID-19 deaths.

To date, the majority of COVID-19 aged care deaths have occurred in clusters at two Sydney nursing homes: Newmarch House in Kingswood and Dorothy Henderson Lodge in Macquarie Park. A number of staff in both nursing homes were also infected. As at 26 May 2020, 31 nursing homes had had cases or outbreaks.

International

Nursing home outbreaks and deaths have been a feature of the COVID-19 pandemic in many countries. The London School of Economics publishes regular reports summarising international data on COVID-19 related deaths among care home residents. Its 21 May 2020 report notes:

•        international comparisons are difficult due to variations in testing, recording deaths and publishing data

•        Hong Kong has had no infections or deaths among care home residents

•        in countries with at least 100 COVID-19 deaths in total and where official data are available, care home residents have accounted for between 24 per cent (Hungary) and 82 per cent (Canada) of total deaths and

•        there have been large numbers of deaths of care home residents in countries such as Belgium, Canada, France, Germany, Spain, the United Kingdom and the United States.

Roles and responsibilities

The Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) outlines the roles of the Australian Government Department of Health, state and territory health departments and non-government parties (such as health professionals, aged care providers and peak bodies) in responding to COVID-19. The plan notes that the ‘Australian Government and state and territory governments will work together to provide advice and leadership on the appropriate methods and timing for implementing public health measures’ (p. 17). Specifically for aged care:

•        the Australian Government will work with providers to set standards to protect people in aged care, establish infection control standards and safety and quality standards, and disseminate tailored information to aged care facilities

•        state and territory governments are responsible for operational public health responses, and will establish systems to protect people in aged care and support investigation and management of outbreaks in aged care facilities and

•        other health sector stakeholders (presumably including health professionals and aged care providers) will implement infection control guidelines and safety and quality standards, and put in place protocols and procedures to protect people in aged care.

Further information on provider, state and territory and Aged Care Quality and Safety Commission (Commission) roles in managing outbreaks in aged care is available in the Coronavirus (COVID-19) Guidelines for Outbreaks in Residential Care Facilities, published by the Communicable Diseases Network Australia (CDNA). The Commission’s role is discussed further below.

State and territory government response

Information on measures taken by individual states and territories (such as issuing public health directions) is available at the following links:

•        New South Wales: COVID-19: advice for aged care services

•        Victoria: Aged care sector—coronavirus disease (COVID-19)

•        Queensland: Aged care direction (No. 4)

•        Western Australia: COVID-19 information for aged care and community care providers

•        South Australia: Aged care facility visitation in South Australia—COVID-19

•        Tasmania: [Coronavirus disease (COVID-19)] Aged care facility visits

•        Australian Capital Territory: [COVID-19] Aged care

•        Northern Territory: [Coronavirus (COVID-19)] Residential aged care

Australian Government response

The Australian Government is the primary funder and regulator of the aged care system. As such, it has a key role in addressing COVID-19 in aged care, in addition to its broader public health crisis responsibilities.

Following is an outline of key aged care measures that the Australian Government has announced to date. The list should not be regarded as comprehensive. The Department of Health website has up-to-date information on providing aged care services during COVID-19 and news and announcements for the aged care sector.

Increased funding for aged care providers

Additional funding has been announced for providers of aged care:

•        $101.2 million for aged care preparedness to:

–      provide COVID-19 infection control online training

–      provide emergency response teams, remote locums and a surge workforce, and reimburse expenses incurred due to COVID-19 cases through the COVID-19 Aged Care Support Program

–      provide access to telehealth consultations

–      provide onsite pathology services to allow residents to be tested in nursing homes and

–      fund the Commission to work with providers on improving infection control.

•        $444.6 million to ensure continuity of the aged care workforce including:

–      $234.9 million for a quarterly COVID-19 ‘retention bonus’ to be paid to care workers in residential and home care

–      temporary increases to residential care subsidies (worth $78.3 million); supplements for rural, remote and homeless service providers ($26.9 million); and home care package subsidies ($22.0 million), enacted by the Aged Care (Subsidy, Fees and Payments) Amendment (Workforce Continuity Funding) Determination 2020

–      $70.2 million in emergency COVID-19 grant funding for Commonwealth Home Support Programme (CHSP) providers to fund services such as shopping and meal delivery for people in self-isolation and

–      $12.3 million for additional My Aged Care staff to handle COVID-19 enquiries.

•        a further $50 million for Meals on Wheels and similar CHSP service providers, and a further $9.3 million for My Aged Care, to help older Australians access food and meals

•        $205 million for a one-off COVID-19 payment for residential aged care providers recognising additional costs that have been incurred during the pandemic. Facilities in major metropolitan areas will receive around $900 per resident and facilities in all other areas will receive around $1,350 per resident. This COVID-19 support supplement is enacted by the Aged Care Legislation Amendment (Subsidies—COVID-19 Support) Instrument 2020 and

•        a one-year extension to the Business Improvement Fund, which gives short-term grants to residential aged care providers at risk of severe financial difficulty.

Visa changes and skill sets for aged care staff

Changes have been made to conditions for aged care workers who are temporary visa holders, to address potential staff shortages:

•        International students already working in aged care will temporarily be allowed to work more than 40 hours per fortnight and

•        Working Holiday Makers (WHM) will be exempt from the six-month work limitation with the one employer and eligible for a further WHM visa to keep working in critical sectors (including aged care) if their current visa is due to expire in the next six months. If they are working in a critical sector but are not eligible for a further WHM visa and are unable to return to their home country, they can apply for a Temporary Activity (subclass 408) Australian Government Endorsed Event stream visa.

A new skill set for aged care and disability staff, Entry into Care Roles, has been developed to train staff for entry-level roles during the pandemic, with a focus on safe work practices and infection control.

Equipment and resources

Aged care providers can request personal protective equipment (PPE), such as masks, from the Department of Health, with priority given to services with a confirmed case of COVID-19. Guidance is also available on how and when to use PPE in aged care.

The Department of Health has published a collection of COVID-19 resources for health professionals, including aged care providers. Key aged care guidelines include:

•        Coronavirus (COVID-19) Guidelines for Outbreaks in Residential Care Facilities [mentioned earlier]

•        Coronavirus (COVID-19) Guidelines for Infection Prevention and Control in Residential Care Facilities and

•        the Coronavirus (COVID-19) Guide for Home Care Providers.

Visitors and other supports for aged care recipients

To minimise the risk of infection, the Australian Health Protection Principal Committee (AHPPC) recommended in March 2020 and again in April 2020 that:

•        there should be a limit of two visitors, once per day, for aged care residents and

•        all visitors and staff should be vaccinated against influenza (from 1 May 2020).

As noted by the Minister for Aged Care, states and territories have issued directions to give effect to the above requirements. The Commission also released guidance on providing safe and quality care during visitor restrictions, and advised facilities to conduct routine screening of staff and visitors on entry. Some providers imposed stricter restrictions on visitors, resulting in some tension between providers and the Australian Government. An Industry Code for Visiting Residential Aged Care Homes during COVID-19 has since been released by a group of aged care providers and consumer peak bodies, and welcomed by the Government.

The Australian Government has announced measures to support aged care recipients and older Australians, including:

•        $10.0 million for the Community Visitors Scheme for extra staff to train volunteers to connect with people in aged care online or by telephone

•        an Older Persons COVID-19 Support Line

•        access to personal monitoring systems for people receiving aged care at home

•        welfare checks for people who have suspended their home care visits over concerns about contracting COVID-19

•        free eSafety webinars for older Australians provided by the eSafety Commissioner

•        $19 million to Primary Health Networks for mental health nurses to deliver in-reach mental health services to older Australians and

•        $6 million to expand the Friend Line telephone support service for older Australians and fund grants to community organisations to provide isolated seniors with mobile phones and laptops.

Legislation

On 14 May 2020 the Australian Parliament passed the Aged Care Legislation Amendment (Emergency Leave) Bill 2020. The Bill amended the Aged Care Act 1997 and the Aged Care (Transitional Provisions) Act 1997 to create a new type of emergency leave for aged care residents, which can be activated during epidemics, natural disasters and other emergencies.

Some non-COVID-19 related aged care initiatives have been delayed due to the pandemic. This includes the trial of a new funding instrument for residential care, the 2020 Aged Care Approvals Round (ACAR) issuing new government-funded aged care places, and changes to home care payment arrangements. The latter means that the passage of the Aged Care Legislation Amendment (Improved Home Care Payment Administration No. 1) Bill 2020 may be delayed.

Aged Care Quality and Safety Commission

The Aged Care Quality and Safety Commission is the national regulator of Australian Government-funded aged care. The Commission approves providers; assesses and monitors services for compliance with the Aged Care Quality Standards; takes action (such as imposing sanctions) to resolve non-compliance; and handles complaints.

Updates on the Commission’s response to COVID-19 are available from its COVID-19 (coronavirus) information page. The Commission has been contacting all residential and home services providers to monitor and support them in preparing for a possible COVID-19 outbreak. The Commission has also taken regulatory action in response to the Newmarch House outbreak, including requiring the provider to appoint an independent adviser.

Routine residential re-accreditation site audits and home services quality audits have been temporarily suspended due to the outbreak, but may recommence before the end of June. Short-notice site visits are continuing, with a focus on infection control and services where there are concerns about the quality of care provided.

Royal Commission into Aged Care Quality and Safety

The Royal Commission’s hearings, workshops and group consultations are currently suspended due to the COVID-19 pandemic. The deadline for submissions has been extended until 31 July 2020, in recognition of the fact that the aged care sector cannot meaningfully engage with the Royal Commission during the pandemic.

Updates on the Royal Commission’s work during the pandemic are available on its webpage, About the Coronavirus and the Aged Care Royal Commission. The Royal Commission will inquire into the response to COVID-19 in aged care, with a focus on lessons that can be learnt to guide responses to future infectious disease outbreaks.

Senate Select Committee on COVID-19

The Senate Select Committee on COVID-19 was established on 8 April 2020 to inquire into the Australian Government’s response to the pandemic. The Committee has held a number of public hearings. The Committee heard aged care evidence from the Department of Health on 23 April 2020, and from both the Department and the Aged Care Quality and Safety Commission on 26 May 2020.

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