Around Australia, thousands of people are mourning a 96-year-old woman who died in her own home, surrounded by family, having been active until the last days of her life. While she deserves to be honoured for her lifetime of service, I wonder who is mourning the older Australians dying every day with Covid-19 in residential aged care facilities across the nation?
People like “Maria”, who I met for the first time a month ago. She had chronic lung disease and a newly diagnosed lung cancer and knew that her prognosis was likely only months. She was exhausted with the effort of living – unable to leave her bed due to fatigue and breathlessness. She was anxious and frightened.
The reason for her fear was not that she would die – it was that she had just been told there was a Covid-19 outbreak in her area of the facility. She said she was frightened of contracting a respiratory virus that would worsen the unbearable symptoms she already had. She worried about how uncomfortable she would be as she died. She still had some unfinished business and was hoping for a bit more time with her family. We talked about adjusting her medicines to get better symptom control, and about her wishes for end-of-life care. We prepared for the worst and hoped for the best.
One week later her biggest fear had materialised. She had been diagnosed with Covid-19. Her GP prescribed antiviral medicine, but she had no reserves to fight off the virus. At the door to her room, I hesitated. The sign on the door warned that infection control precautions were required. I expected to see a trolley laden with gowns, gloves, masks, face shields, goggles, cleaning wipes and hand sanitiser, yet there were only a few masks. No gloves, no gowns, no face shields, no hand sanitiser, no wipes. No infectious waste bin. It took me 20 minutes to find a staff member and get them to bring supplies. Valuable time, when you know the person on the other side of the door is struggling for every breath and time is limited.
When I entered she was in severe respiratory distress. With her eyes, she begged me for help. “Please, please …” were the only words she could whisper. We both knew this was the end. She died within 24 hours. Some might say it was inevitable, yet it needn’t have been.
As Omicron emerged and was dubbed a “milder” version of the virus, Covid-19 restrictions in the general community began to ease. In December 2021 we were urged by the then prime minister Scott Morrison to “live with the virus”; people returned to their offices, went shopping, dined in restaurants, celebrated Christmas and took holidays. The outbreaks in residential aged care facilities began to increase exponentially. The deaths of older people in aged care began to rise. Who noticed?
Those of us working on the frontline in aged care were already exhausted. We cancelled our long-awaited summer holidays and continued to work long hours day in, day out. The referrals for palliative care literally flowed in and we struggled to meet the demand. We had a brief surge of hope in May when a new government was elected, having promised during the election campaign to “fix the crisis” in aged care. We hoped that the new prime minister would be different, that this government would value the lives of older people and act urgently to protect them. Yet nothing has changed.
Life in 2022 (for those who don’t work in healthcare) has largely returned to normal, however Covid-19 outbreaks in residential aged care have been a constant reality. Facilities have struggled to provide care to residents as staff have been ill or isolating. The aged care workforce is mobile – they are mixing in the community, many have young children, extended families and active social lives. They come and go on shifts around the clock to care for the most vulnerable, and they are one of the highest risk factors for outbreaks in residential aged care facilities. Rapid antigen testing may be mandatory prior to entry to most facilities – but no one is observing or monitoring to make sure the tests are being conducted properly. Masks are often removed to allow for better communication, particularly with someone who has dementia or hearing loss.
The mandatory Infection Prevention and Control Leads at facilities are busy covering unfilled shifts for sick staff, providing direct care to residents, with no time to check that the PPE trolleys are stocked or correct procedures are followed. Perhaps there is now a level of complacency, not helped by public messaging that the pandemic is all but over.
Across Australia, more than 3,000 people living in residential aged care have died with Covid-19 this year. This is three times more than in the first two years of the pandemic when tight lockdowns prevented families from spending precious time together and negatively impacted mental health, cognitive and physical wellbeing. To what end?
The residential aged care facilities Covid-19 data is quietly reported weekly on the Department of Health and Aged Care website. If you didn’t know to look for it, you wouldn’t know it was there. To date there have been a total of 81,585 residents and 56,217 staff cases reported. The figures over the past month have ranged from 53 to 143 deaths a week. The current death toll in residential aged care stands at 3,559. These are people, not numbers.
Where is the action from the government which promised us aged care reform? What advice are the chief health officers giving to national cabinet, and is it being followed?
As the nation continues to be told we are “living with Covid-19”, older Australians in residential aged care facilities continue to die with it. Where is the national outrage and the collective outpouring of grief?