COVID-19 and Long-term Care

The COVID toll in aged care services has been devastating in many developed economies. A review of evidence by the International Long-Term Care policy network has found that the share of care home residents whose deaths have been linked to COVID-19 tends to be lower in countries where there have been fewer deaths in total. This is clearly the case in Australia where the COVID related death of aged care residents is 29% of all COVID related deaths. This is well below the rate for Canadian aged care homes which make up 82% of all COVID-19 deaths in that country. In the US, based on data from 45 of the 50 states, COVID-related deaths in care homes make up 41% of all COVID deaths. In the UK, care home deaths have only recently been included in national COVID data. In Scotland it is estimated that last week 55% of all COVID-related deaths occurred in care homes.

Reports on the impact of COVID-19 in long-term care have focused overwhelmingly on its impact in residential aged care. We know surprisingly little about what is happening to those frail older people who rely on home care services, although the Australian Department of Health has reported that as of May 18, there were three COVID related deaths among people who used publicly subsidised home care. While in the UK and US there has been some public recognition of the large numbers of hospital workers dying due to COVID 19, very little attention has been given to COVID related deaths of aged care workers. We do know, however, that by mid-May in England and Wales there had been some 136 COVID related deaths of social care workers, a death rate double that of the general population and indeed double that for NHS workers. To date there have been no aged care worker COVID-related deaths in Australia.

Clearly Australia’s public health response in long-term care has been exceptional in international comparison. While there have been some outliers such as Newmarch House in Western Sydney, early response and intervention has prevented the catastrophic outcomes seen in the UK, US and Canada. There has been widespread testing and transparency of information, with the names of aged care facilities, where even one resident or worker has contracted COVID, made public.

Once-off COVID government funding has also been provided to the sector.  For example, the federal government announced on March 20 that direct aged care workers will receive a ‘retention bonus’. Full-time residential care workers are to receive $800 for each of 2 quarters, that ending in June and that ending in September if they are still with their employer. Pro rata payments will be made to eligible part-time and casual workers.  Inexplicably, eligible home care workers will be paid only $600 on a pro rata basis for each quarter. Despite this initiative, a recent survey (run early May) by the Australian Nursing and Midwifery Association (ANMF) of just under 2000 aged care workers indicates that some 83% of respondents reported that their employer had not yet discussed this retention bonus with them.

Notwithstanding the excellent public health response here, COVID has exacerbated some severe structural issues in aged care sector.  Understaffing is a major issue in residential aged care as is the limiting of ‘time to care’ in home care services. In many ways, work organisation in aged care has been increasingly based on a lean, ‘just in time’ manufacturing model. Given this, what is baffling in the COVID era, however, is the loss of staffing and hours. Since the beginning of March 2020, the ANMF survey found 43% of respondents in home care reported staffing cuts, and in residential aged care almost a fifth reported recent cuts to staffing. Further, up to 80% of respondents in residential aged care reported that no staffing increases had occurred in preparation for a potential COVID-19 outbreak.  In home care, more than half the workers surveyed reported insufficient supply of PPE by their employer. Indeed staff working in the home-care sector were most likely to report not receiving recent information or training for PPE use.

We won’t ever have good quality aged care in Australia without addressing some fundamental decent work deficits in the sector, laid bare in the COVID crisis. We need wage rates that properly value the skills and experience used by aged care workers to ensure workers retention in the sector, not a once off retention bonus. We need to ensure far better working time security to provide the basis for the continuity and sustainability of care so critical in aged care.  Underemployment is already high in the aged care sector and yet during COVID many of these ‘essential’ workers have lost jobs and hours of work.

COVID-19 has shown that we need to build in decent conditions of work in long-term care, as well as the time, the staffing numbers and skill mix– not only to support the provision of high quality care, including social and emotional support for service users, but also to meet the regular demands of and the inevitable ‘regular irregularities’ that are part of the everyday life of aged care outside a pandemic.