Characteristics and Preparedness for COVID-19 Outbreaks of Australian Residential Aged Care Facilities: a Cross-sectional Survey

Abstract

Objective. To provide an overview of the COVID-19 outbreak preparedness and responses of Australian residential aged care facilities (RACFs), 12 months after the pandemic began in early 2020. Methods. A cross-sectional survey of RACF managers was conducted as part of an overview of COVID-19 experience during 2020. Survey questions were based on findings of previous outbreak reviews. Results. Comparison with available data from the Australian Institute for Health and Welfare suggested that survey respondents (n=331) were a representative sample. Almost all RACFs had outbreak management plans, including provision for a surge workforce. However, anticipated staff replacements fell short of those often required during outbreaks. Staff of most (83%) RACFs had completed online infection control training, and a smaller proportion (73%) face-to-face training, by the time of the survey. Exploratory analyses to identify RACF characteristics associated with increased outbreak risk found a strong association with location in Victoria (adjusted risk ratio [aRR] 12.8) where most community transmission occurred during 2020. The only other association was an increased risk in facilities where all staff had not completed face-to-face infection control training (aRR 2.1). Respondents ranked leadership and management; planning and preparation; and infection control as the top three of seven critical lines of defence against COVID-19. Conclusion. Survey results suggest that, in early 2021, most Australian RACFs were better prepared for the ongoing risk of COVID-19 than in 2020. Continued implementation of recommendations from the Aged Care Royal Commission is needed to ensure the aged care sector is prepared for future infectious disease emergencies.

Crisis accountability and aged “care” during COVID-19

“…Anglicare is registered under the Aged Care Act (1997), which confers specific responsibilities regarding the quality and accountability of care provided to the organisation. Anglicare’s board appointed CEO Grant Millard had overseen four years of “exemplary accreditation history” (Gilbert and Lilly, 2020a, p. 6) by the start of 2020. The capacity for Anglicare to continue such quality services was questioned following the rampant outbreak of COVID-19 at the facility.…”

“…Newmarch House was, after all, a residential care facility, not a hospital with infectious disease controls. Anglicare also exhibited confusion as to who was in charge of the situation at Newmarch House, with various sources indicating at different points it was the Board of Anglicare, given their responsibilities under the Aged Care Act , the Federal Government as administrators of aged care, NSW Health as administrators of health, and the local hospital as the designated respondent from NSW Health (ACQSC, 2020b; Gilbert and Lilly, 2020a; Visontay, 2020). Meanwhile, the conditions within Newmarch House worsened, and questions were raised as to whether residents should be removed from the hospital-like care provided within the facility – the “Hospital in the Home” scheme – and placed into more specialised hospital care.…”

“…[…] because of the potentially traumatic effects of transfer on residents, the heightened risk of spread of COVID-19 [to the wider community] and difficulty accessing appropriately skilled staff in other facilities. (Gilbert and Lilly, 2020a, p. 11, emphasis added)…”

“…17 of these deaths were directly attributed to COVID-19, a mortality rate of 46% of the COVID-19 positive residents at Newmarch House. (Gilbert and Lilly, 2020a, p. 8)…”

“…The independent report into Newmarch uncovered disturbing details concerning this lack of care, including residents who experienced “weight loss, dehydration, pressure sores, increases in urinary tract and skin infections and general deconditioning” (Gilbert and Lilly, 2020a, p. 27) [6]. Families who could talk to residents using video calls were upset to observe “cognitive or physical decline or apparent lapses in care” (Gilbert and Lilly, 2020a, p. 26, see also ABC, 2020).…”