The safety of people in residential aged care remains at grave risk, with evidence of wide-ranging failures to protect them from COVID-19, reports Jennifer Doggett in a special Croakey investigation.
The current review of Australia’s COVID response provides an opportunity for driving improvements, and “may be the best chance for residents, families and others to highlight the ongoing failure to protect one of the most at-risk groups in the community”, Doggett writes.
Jennifer Doggett writes:
Since the start of the pandemic in Australia, residential aged care facilties have been the site of some of the most deadly outbreaks of COVID-19. Deaths in aged care account for around 30 percent of all reported COVID-19 deaths in Australia despite the fact that less than one percent of the population lives in permanent or temporary residential aged care.
Older people are already at higher risk from COVID, regardless of their living environment. The COVID-19 Mortality Working Group of the Actuaries Institute found that over the first seven months of 2023, people aged 65-84, experienced significant excess mortality, of which around 40-50 percent could be explained by COVID-19 deaths. In the 85-plus age band, there was a significant excess that is wholly attributable to COVID-19.
Older people living in residential aged care facilities are at even higher risk due to the density of living arrangements and the requirements of many residents for personal assistance and care from aged care workers.
Even with vaccinations and anti-viral treatments, COVID-19 has a mortality rate of just over four percent for residents of aged care facilities, compared with 0.1 percent in the general population. This highlights why it is so important to prevent infections from entering and spreading in aged care facilities in the first place.
This has proven difficult to achieve since the relaxing of public health measures in the broader community. The most recent statistics from the Department of Health and Aged care show that between 5 January and 30 November this year, there have been over 6,000 outbreaks of COVID in aged care facilities, resulting in around five deaths per day of an aged care resident.
COVID-19 deaths in aged care facilities are sometimes presented as an inevitability by governments and health authorities. Commonwealth Chief Medical Officer, Professor Paul Kelly, has previously referred to aged care deaths as a “reaping delayed” and recently, in giving evidence to a Senate Estimates Committee, stated that:
“We know from the beginning of [the] COVID period, whenever there are cases in the community and we are continuing to have cases and we’re probably in another wave of Omicron right now, there will be cases in aged care, and that’s the reality of living with COVID.”
However, evidence shows that there is significant variability in outbreak duration, attack rate and case fatality rate across aged care settings and that the mitigations introduced by the facility play a significant role in the impact on residents. In the first wave of the pandemic more than 40 percent of Victorian coronavirus aged-care deaths were residents in just 10 homes.
International data also demonstrates that while older people are over-represented in aged care deaths in all countries, the rate of deaths in Australia’s residential aged care facilities is one of the highest worldwide.
Evidence-based mitigations
We don’t know everything about COVID but there is sufficient evidence to identify some modifiable factors that have increased the mortality rate among aged care residents, including low rates of hospital transfer, poor infection control practices, inadequately trained relief staff and low staffing ratios.
We know that broader population health measures to reduce the spread of COVID-19 have a significant impact on transmission in aged care facilities. This is evident from the sharp rise in death rates since the removal of border controls, quarantine and other mitigations around the end of 2021 and start of 2022 (depending on the jurisdiction). In fact, Department of Health figures show that 87 percent of all the pandemic deaths in aged care facilities have occurred since this time.
There is also robust research supporting the complementary role played by different mitigations in reducing the risk of transmission of COVID in the aged care sector. As every individual intervention has limitations, the optimum results are achieved through implementing a combination of evidence-based measures which together can work to reduce the risk that a failure in one area will result in transmission.
An independent review of COVID outbreaks in residential aged care facilities, commissioned by the Department of Health and conducted in 2021 by Professor Lyn Gilbert AO and Adjunct Professor Alan Lilly, described this as a “Swiss cheese” approach. This concept was developed by virologist Adjunct Professor Ian Mackay, drawing upon work by Professor James Reason in reducing human error.
Official responses
Neither the Department of Health nor the Aged Care Quality and Safety Commission (ACQSC) would provide comments to Croakey on the numbers of COVID deaths in aged care but both described the actions they are taking in response to the ongoing threat posed by the pandemic.
The Department of Health outlined the support it is giving to aged care providers to prepare for, prevent and manage cases and outbreaks of COVID-19 through:
- access to personal protective equipment (PPE) and rapid antigen tests (RAT) though the National Medical Stockpile
- a summer deployment of PPE to all aged care homes was completed on 10 November 2023 with 64 percent of services opting in to receive PPE packs.
- outbreak packs and emergency packs continue to be deployed as needed
- weekly supply of rapid antigen test (RAT) kits for screening staff and visitors
- access to a temporary surge workforce to help providers if they are unable to fill critical staff shortages due to COVID-19 and emergency response teams, which can be deployed to assist if there is a significant outbreak in a residential aged care home.
- access to antiviral medications, through community pharmacy, and from the National Medical Stockpile where homes are unable to access from a pharmacy
- access to COVID-19 PCR testing through standard Medicare arrangements, where GPs and nurse practitioners directly request from a pathology provider
- reimbursing providers for the costs associated with managing outbreaks through the COVID grants process
- delivery of fit-for-purpose IPC education, resources, and communications both sector wide and for targeted provider cohorts.
- regular updates to the aged care sector, primary care providers and older people on latest COVID information and the importance of boosters, treatments, masks and COVID-19 safe behaviours through webinars, social media, stakeholder networks and newsletters.
The ACQSC said that aged care providers are required by law to provide safe and quality aged care at all times, in accordance with the Aged Care Quality Standards. Infection prevention and control is a vital part of delivering safe and quality care.
“Providers must remain vigilant to the risks that COVID-19 and other infectious diseases present to older people, and be ready to manage outbreaks when they occur,” the spokesperson said.
ACQSC identified the following responsibilities for providers of aged care in relation to COVID prevention and management:
- maintaining and auditing infection prevention and control practices
- maintaining up to date information on residents’ vaccination status
- paying close attention to screening and monitoring of staff and visitors
- regularly checking staff and residents for clinical symptoms of infection
- ensuring easy access to doctors for antiviral prescriptions which are effective in reducing severe infection
- checking that local pharmacies have immediate supplies of antiviral medications
- confirming sufficient stock on hand of essential supplies including PPE and rapid antigen tests
- staying up to date with public health requirements and information in their respective state/territory.
The spokesperson said ACQSC supports providers to meet their Infection Prevention and Control (IPC) requirements, citing the specific education programs and resources that are available on the Commission’s website as examples of the support they provide to providers in this area.
ACQSC also undertakes IPC spot checks conducted by the Aged Care Quality and Safety Commission and in-reach IPC appraisals for higher risk residential aged care homes. The 30 November update from the Department of Health and Ageing reports that the Commission has conducted 5,885 spot checks to observe infection control practices and PPE protocols in residential aged care facilities.
Both the Department and the ACQSC referenced sources of advice and information provided by government bodies which highlight the importance of a multi-faceted approach to COVID-19 mitigations for residents of aged care facilities and other groups at high risk.
These include the National Covid-19 Community Protection Framework, the National COVID-19 Health Management Plan for 2023, the Infection Prevention and Control Expert Group (ICEG) advice document, the National Guide for Safe Workplaces – COVID-19 and a range of other information on the Department of Health website.
Implementation failures
The Department and the ACQSC did not comment on why these efforts have not been successful in preventing ongoing COVID outbreaks and deaths in aged care facilities, but some insight were provided by the families of aged care residents and experts interviewed by Croakey.
Family members who contacted Croakey described how guidelines on infection control are not being consistently implemented by providers. This includes inconsistent or non-existent mask wearing, even during COVID outbreaks.
One family member of a vulnerable resident told Croakey that aged care staff had informed her that masks were no longer required, despite a recent social event resulting in an outbreak at their facility, which subsequently resulted in the deaths of two residents.
After complaining to the Aged Care Quality and Safety Commission, she was advised that the facility appeared to be acting within current guidelines. On other occasions she has been told that staff are allowed to remove masks to prioritise their morale, despite putting residents at increased risk.
After repeated incidents where staff members entered her family member’s room without a mask, she said she no longer has any confidence in the ACQSC’s ability to fulfil its stated purpose “to protect and improve the safety, health, wellbeing and quality of life of people receiving Australian funded aged care”.
Croakey interviewed five people with family members in aged care facilities across three states who expressed their concern about the care being provided, including poor infection control practices and difficulties in accessing anti-viral medication once their family member was infected. This reflects concerns raised in the Aged Care Royal Commission Special Report on COVID-19 and reports from consumer organisations and other information sources from the sector.
Part of the problem is that many of the guidelines and expectations provided by government are not mandatory. Even when there are clear regulations in place, it is difficult for authorities to have oversight of how the estimated 2,600 aged care facilities in Australia are interpreting and implementing the required measures.
This is compounded by the fact that it is understandably difficult for many residents to advocate for themselves; as well, families of residents often are not present when potentially risky situations occur, such as staff interacting with residents without appropriate PPE.
Experts and stakeholders interviewed by Croakey have also identified some failures of policy and implementation in key areas, including ventilation, vaccines, treatments and RATS.
Ventilation concerns
Ventilation is one option for mitigation with untapped potential to reduce the spread of COVID-19 in aged care facilities.
This was noted by the Federal Parliament Inquiry into Long COVID and Repeated COVID Infections, which found there was “compelling evidence that poor indoor air quality and ventilation leads to increased risk of COVID-19 infection” and concluded that it was “convinced of the role that good air quality and ventilation play in preventing the transmission of COVID-19, and therefore in preventing long COVID and repeated COVID infections”.
Adjunct Professor Geoff Hanmer, a Director at OzSAGE, described to the Committee the role that poor ventilation played in the 700 deaths in residential aged care during the second wave of the pandemic in Melbourne. He said the number of COVID-19 related deaths in aged care in Australia was unacceptable and suggested that poor ventilation in aged care facilities was playing a part:
“In the cold Melbourne winter, windows were shut, ventilation was minimal and COVID was able to accumulate in the air, a bit like smoke. When an infected person entered a facility it proved impossible to stop the infection spreading.”
Multiple sources of advice and recommendations are now provided to facilities on how to improve air quality and reduce transmission risk (SWA, ACSQHC, APPHC Protecting Older people C-19 update 3 Feb 2022 Cwth DoH, Aged Care Qual Bulletin 48 Protecting Older people C-19 update 22 Apr 2022 Cwth DoH (air scrubbers), Ventilation strategies reduce C-19 transmission RACFs Vic DoH National Aged Care Design Principles Guidelines). There is also evidence showing that the effectiveness of HEPA air cleaners is significantly enhanced by universal masking.
However, in the absence of mandatory and enforceable standards, there is little regulatory authorities can do if providers choose not to follow this advice.
A spokesperson for the Aged Care Quality and Safety Commission told Croakey that aged care providers are “encouraged to consider ventilation as part of their outbreak planning and response which should be part of their risk assessment to manage hazards in a service, including those for workers in line with state-based workplace safety requirements”.
He added that ACQSC monitors providers’ compliance with IPC requirements through targeted Infection Control Monitoring spot checks, in addition to other site visits and monitoring activities, and that a slow or ineffective response by a provider to an outbreak will result in the Commission taking some form of action.
A Department of Health spokesperson told Croakey that some aged care providers have been supported by the Government to improve ventilation in their facilities through grants, which reimburse them for the cost of buying or hiring air purifiers and scrubbers.
For example, the 2023 COVID-19 Aged Care Support Grant provides up to $15,000, which can be used for the purchase and hire of ventilation-related items including air scrubbers, air purifiers, and the associated cleaning of air-conditioning units. The spokesperson did not have information on the number of facilities that had used these grants to upgrade their ventilation.
One reason for the lack of understanding within the aged care sector that COVID is an airborne virus may be because some of the information being provided to them is out of date and does not reflect current scientific consensus.
For example, the slide below was part of the training on infection prevention and control provided to Residential Aged Care Facilities in February 2023.
The Department of Health told Croakey that this slide related to the Foundations of IPC e-learning course developed by Aspen Medical, and referenced this statement from the Australian Health Protection Principal Committee as the most current information on COVID transmission.
Other stakeholders suggest that underlying ageism is behind a lack of action to improve air quality in aged care facilities.
Some hope that regulations on clean air standards may be strengthened in the future comes from a randomised control trial currently underway in NSW to assess the role of air purifiers in reducing the transmission of respiratory infections in aged care facilities.
However, some experts have criticised the trial design, as it only includes devices in residents’ bedrooms and not in communal areas, and does not appear to also include measurement of ventilation levels, so the results may not provide a comprehensive picture of the role of clean air in infection control in these settings.
Also on the horizon are new promising technologies, such as germicidal ultraviolet light, which have been used in other settings to prevent airborne pathogen transmission and are also being trialled in Australia.
Vaccination flagging
Vaccines are a vital strategy to reduce the risk of severe illness, hospitalisation and death from COVID-19 in aged care residents.
The Department of Health outlined to Croakey the strategies it is using to increase vaccination numbers in aged care, including:
- proactively calling homes with the lowest COVID-19 vaccine uptake to identify and address any barriers
- working with Primary Health Networks (PHNs) to support residential aged care homes and provide assistance with accessing COVID-19 vaccine providers
- providing targeted communication products for the aged care sector, including how to arrange vaccinations
- engagement with the sector through the Aged Care Advisory Group, which has representatives from aged care sector peak bodies, clinicians and consumers
- messaging to reinforce the importance and benefits of vaccinations for older people, particularly focussed on reaching priority and vulnerable audiences and connecting people with credible information sources.
Despite these efforts, progress in vaccinating residents in aged care facilities has slowed. The most recent figures from the Department show that as at 30 November only 32.5 percent of eligible aged care residents have received a booster dose in the past six months.
As the graph below indicates, this contrasts with the faster rollout of the initial vaccination program. In 2021 it took around 11 weeks to vaccinate 100 percent of eligible residents with a third vaccine but 22 weeks after the start of the 2023 booster program, only 63.5 percent of eligible residents had been vaccinated.
An internal briefing paper produced in August by the Department of Health and obtained by Croakey (see tables below), shows that there is significant variation in vaccination rates across the states and territories, ranging from 72 percent in the ACT to 45 percent in the Northern Territory.
Overall, the figures show that a quarter of residential aged care facilities nationally had vaccinated 50 percent or less of eligible residents by August 2023. In the Northern Territory, 25 percent of the twelve residential aged care services had not vaccinated any of their residents.
Additional information produced by the Department shows there is significant variation at the local government area (LGA) level, with 10 LGAs accounting for 10 percent of eligible residents without a 2023 booster – a total of 11,006 people.
There is no clear reason for the low rates of vaccination in aged care facilities and it is impossible to tell from these figures whether unvaccinated residents have given informed refusal.
The Department told Croakey that it does not publicly report on residential aged care residents’ consent or refusal to receive a vaccination as this information is covered under the Privacy Act 1988 and is to remain protected with the aged care facility. The spokesperson said that a recent survey of the sector received a “strong response”, indicating people were choosing not to receive additional booster doses.
Given that vaccination rates in the general community have dropped, it is likely that this is one reason for the low uptake of the vaccine among aged care residents.
However, the inconsistency across states and local government areas suggests that there are likely other factors involved. For example, the table below shows that in August 2023 just ten out of the 537 local government areas in Australia account for 20 percent of unvaccinated eligible aged care residents. 
See The Herald Sun article (paywalled)
Also concerning is the apparent lack of communication between federal and state governments on the vaccine status of aged care residents, critical in part because state governments are responsible for many of the public health measures that could help protect residents, including mask mandates.
At a press conference last week, Queensland’s Chief Health Officer Dr John Gerrard said he did not have the exact figures on vaccination rates of residents in aged care facilities in Queensland:
“The majority of people in hospital are over 65 and have not received a booster in 2023. The average time of boostering for this group is 15 months. They should have received a booster this year…the focus on the public health approach is very clear – ensuring people over 65 have received a booster this year. I have been told that numbers in aged care facilities have fallen behind – I do not have specific numbers.”
Despite not knowing how many care residents were vulnerable to COVID due to their vaccination status, Gerrard did not recommend mask wearing in health or aged care facilities.
“I am making no general recommendation about mask wearing in public, or in healthcare facilities; that would be disproportionate to the level of risk,” he said.
Vaccine questions
There are also issues with the types of vaccinations being provided to those residents who have received a 2023 booster. The XBB Omicron sub-variant is now the dominant descendent lineage of SARS-CoV-2 globally and the WHO has recommended that to improve protection against severe disease from this sub-variant, vaccines should aim to induce antibody responses that neutralize XBB descendent lineages.
This is based on research which has shown that older vaccines, including the bi-valent mRNA vaccines ,do not offer significant protection against the emerging BA.2.86 “Pirola” sub-variant.
The researchers reported in The Lancet Infectious Diseases in September: “We then performed neutralisation assays using vaccine sera to assess the possibility that BA.2.86 evades the antiviral effect of vaccine-induced humoral immunity. The sera obtained from individuals vaccinated with third-dose monovalent, fourth-dose monovalent, BA.1 bivalent, and BA.5 bivalent mRNA vaccines exhibited very little or no antiviral effects against BA.2.86.”
The US Centers for Disease Control and Prevention has recommended all people over six months who have not received a COVID vaccine in the previous two months should get a dose of the newly approved monovalent (single strain) vaccines developed by Pfizer and Moderna to specifically target the XBB.1.5 sub-variant of Omicron. Health Canada has adopted similar recommendations.
These new monovalent vaccines are expected to be effective in preventing infection by recently emerging Omicron sub-variants, such as EG.5 and FL.1.51 derived from the XBB.1.5 sub-variant, and the newer highly mutated BA.2.86 (‘Pirola’) which arose from an earlier sub-variant and is a significant evolutionary leap.
These vaccines have approved by the Therapeutic Goods Administration and are recommended by ATAGI as providing a “modestly enhanced protection from severe disease compared to older vaccines”.
But according to a recent statement from Minister for Health, Mark Butler, they are not likely to be available in Australia until mid-December. This means that even residents of aged care facilities who are fully vaccinated now will not have optimum protection against some COVID variants.
Treatments
Antivirals are an important additional tool as part of a multi-layered response to COVID and these are available to people at risk, although there is evidence that some populations are less likely to receive them, even when eligible.
The two main drugs available to treat COVID-19 are Molnupiravir (Lagevrio) and Ritonavir-Boosted Nirmatrelvir (Paxlovid).
Research conducted by the Doherty Institute (not yet peer reviewed) found that both of these medicines substantially reduced risk of hospitalisation and death if given soon after diagnosis.
Paxlovid was the most effective, reducing the risk of hospitalisation by 32 percent and risk of death by 72 percent, compared with Lagevrio (26 percent and 54 percent respectively).
Despite Paxlovid’s greater efficacy, with a 20.7 percent and 28.6 percent greater reduction in hospital and death respectively, Lagevrio is far more commonly used to treat COVID infections in aged care residents.
The latest report from the Department shows that 82,412 doses of Lagevrio and 7,250 doses of Paxlovid have been issued in residential aged care settings between February 2022 and October 2023.
Paxlovid is not suitable for all patients due to drug interactions or impaired renal/ hepatic function but this factor alone is unlikely to account for the extremely low levels of use.
However, research shows that Lagevrio carries the risk of inducing additional mutations, leading to onward transmission. This means that while it may be reducing the risk of hospitalisation and death for individuals receiving the drug, it may simultaneously be leading to new mutations and contributing to viral evolution which will make current vaccines and treatments less effective in the future.
Testing questions
Another issue is the reliance on RATs to screen staff and visitors and to diagnose residents, despite the evidence (as outlined in the slide below from the Aged Care Quality and Safety Commission) that one in four RATs performed on a person with symptoms and a positive PCR will give a false negative result.
This suggests that 25 percent of people entering aged care facilities who are COVID-19 positive would receive a negative RAT and thus be allowed to mix with residents, often in very close proximity.
Expert and stakeholder perspectives
Experts and stakeholder groups have expressed their concern about the failure to prevent COVID infections and deaths in aged care, stressing the need for increased efforts to protect residents.
Patricia Sparrow, Chief Executive of COTA Australia, told Croakey that COTA Australia is concerned that more than half of aged care residents remain without full COVID-19 immunisation.
“This year, more than 1,300 people have died with COVID. Each one of those numbers is a person with a family and friends who have lost a loved one. It’s a stark reminder of the human cost that has come with this virus. Vigilance is key; we cannot afford to be complacent,” Sparrow said.
“It is so important that we redouble our efforts to encourage older Australians to have booster shots and stay protected against the spread of COVID-19. Part of this approach involves aged care providers stepping up to proactively facilitate timely vaccinations for older Australians, living in residential care facilities, as and when they are needed to ensure that residents remain protected,” she said.
Sparrow stressed the need for an increased focus on protecting older Australians from COVID through an “unwavering commitment to prevention” requiring “constant adaptation to the evolving situation”.
Andrew Hewat, from the Victorian Allied Health Professionals Association, described the current response to the COVID-19 pandemic in residential aged care facilities as an “unmitigated failure”.
“The Commonwealth Government has normalised the COVID deaths of elderly in care, and the general public are either unaware or apathetic to this unconscionable failure,” he said.
Hewat told Croakey that the early stages of the pandemic exposed the vulnerabilities of the aged care sector and that systemic failures lead to unprecedented death and disease amongst aged care residents.
Three years on, Hewat believes there is no excuse for what he described as “ongoing failures leading to thousands of aged care residents getting infected and many still dying as a consequence”.
“The [Federal] Government has not addressed the breakdowns and we are still failing our elderly in the care settings,” he said.
Hewat suggests that governments and regulatory bodies should focus on the mitigations that are the least onerous on the residents, but still achieve optimal protection with the aim of avoiding the wholesale lockdowns we have seen in the past.
Among the mitigations he suggests are regular testing for staff and residents, improving ventilation via open windows, HEPA filers and HVAC, onside vaccination programs with updated vaccines and access to anti-virals. He also highlights the role of workforce measures, such as paid leave for staff testing positive and measures to encourage staff to work exclusively at one site.
“We need to overcome the blatant apathy and disregard for the state of aged care facilities,” he said.
“There are many recommendations in the Aged Care Royal Commission that would greatly improve the standard of care in RACFs if implemented, but they need governments willing to enforce and in many cases, fund, the improvements necessary. Budgetary restraint is a major barrier but the will to implement is needed to overcome that hurdle. The money is there or could be found/raised if there was adequate appetite to make changes happen.”
Hewat cites a “culture of neglect” and a philosophy among governments all persuasions of “user pays, individual onus and personal responsibility” as underlying reasons for the failure to protect aged care residents of COVID.
“A community is judged by how well it cares for the most vulnerable members. We have not done well caring for out most vulnerable elderly in aged care. This reflects badly on the whole community, and we need to press our leaders to do much better,” he said.
Colin Kinner, Founder and Program Director of the Clean Air Accelerator, highlighted to Croakey the need to focus on ventilation and air filtration in order to reduce the risk of COVID spreading in aged care. “Sadly in many facilities there appears to be a profound lack of understanding about the mode of transmission and what can be done to reduce the risk of COVID spreading. We are about to enter the fifth year of the pandemic, and to witness aged care facilities providing hand sanitiser, but not addressing airborne COVID transmission, is staggering,” he said.
Kinner also stressed that while ventilation and air filtration are important in reducing long-range COVID transmission, masks need to be mandated in aged care facilities to prevent transmission from close contact.
“High-quality N95 or P2 masks (also referred to as respirators) provide protection both to the wearer (by preventing them from inhaling virus particles) and to others (by preventing the wearer from exhaling virus particles into the shared air if they have COVID). Since more than 50 percent of COVID infections come from people who are asymptomatic, it’s not hard to see why these measures are needed,” Kinner said.
The road ahead
Despite a drop off in media and political attention on the pandemic, concern levels in the community about the pandemic remain high.
A recent survey by Professor Deborah Lupton from UNSW found that a majority of respondents in all aged groups were concerned about the future threat of COVID and unsurprisingly this was highest among older Australians.
With a summer wave predicted and new variants on the horizon, it is understandable that residents and families are concerned. Preventable deaths in aged care facilities are likely to continue if Australia does not improve the current fragmented and poorly implemented approach to protecting residents from COVID and other airborne viruses.
This is likely to be further exacerbated by the planned phasing out of some of the current funding arrangements to support facilities deal with outbreaks from early 2024, through grants such as the Aged Care Worker COVID-19 Leave Payment and the COVID-19 Aged Care Support Program Grants.
The Commonwealth will also stop distributing PPE and RATs to aged care facilities but instead provide an annual per capital “outbreak management supplement” payment to providers on the basis that this should be factored in as a “business as usual” expense (some measures, including the surge workforce program, will continue).
Despite the many failures of the current approach, there are some opportunities for change, if strong advocacy from communities and stakeholders pushes governments to act.
Ongoing research into the transmission of COVID in aged care facilities provides some hope for strengthened policies and regulations in the future.
For example, this study highlights the use of a rapid, low-cost strategy to empirically identify potential ‘super-spreader’ zones within residential aged care facilities and the efficacy of targeted ventilation-based risk reduction measures.
Another research project conducted in a Sydney Local Health District investigated the use of an IPC scoring system for identifying facilities at greater risk of adverse outcomes from COVID-19 outbreaks, recommending that it could be used and adapted to improve planning, policy, and resource allocation for future outbreaks.
At the federal level, implementation of recommendations from the Aged Care Royal Commission and the capability review of the Aged Care Quality and Safety Commission should strengthen the governance and the accountability of the sector overall.
This is critical for improving the response to COVID and other future health threats but requires a greater degree of urgency and attention from the Federal Government (see here and here for previous Croakey articles on this issue).
The current review of Australia’s COVID response also provides another opportunity. While stakeholders have criticised the review for its narrow focus, in the absence of any other process, it may be the best chance for residents, families and others to highlight the ongoing failure to protect one of the most at-risk groups in the community.
See the Cleaner Air Collective Australia resource.
Croakey acknowledges and thanks Jennifer Doggett for providing this article as a probono contribution for Croakey readers.
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See Croakey’s extensive archive of articles on COVID
