‘For some, it’s been too much’: COVID’s impact on aged care

Few sectors have felt the effects of the pandemic as closely as residential aged care, both in Australia and overseas.
 
It was the area most affected in 2020 when health authorities in Victoria worked to contain the outbreak. Here, in aged care facilities the fiercest battle against the spread of the virus played out – and the lessons are still being learned two years on.
 
On Monday, Worksafe Victoria announced charges were being brought against the St Basil’s aged care facility in Fawkner, Melbourne for the 45 deaths that occurred during winter of that year.
 
Now, with the SARS-CoV-2 virus in its different forms in almost every corner in the country, the mortality rate is more evenly spread across the population, but the official statistics are cold, dry proof that the disproportionate impact on aged care remains. 
 
The total number of deaths has now moved into beyond 10,000 in Australia. More than a quarter of those – 2881, according to the latest count – have been registered in residential aged care facilities.
 
The context of the overall mortality rate and the specific figures in aged care is of course important. Given Australia’s success in blocking the virus out, there have been many fewer deaths reported both across the board and in residential facilities.  
 
The US, for example, has an official death toll of more than a million, with more than 300 deaths per 100,000 people. In the United Kingdom, those figures are close to 190,000 with around 267 deaths per 100,000 people. Australia’s mortality rate per 100,000 is just 39.
 
In aged care, the comparisons are similar. Long-term care facilities in Canada, for example, have had 17,209 deaths attributed to COVID, in a permanent residential population that is only a little higher than Australia’s at an estimated 198,000 (Australia has approximately 176,490 living in aged care facilities, according to the official vaccine rollout numbers).
 
For Dr Khayyam Altaf, Chair of RACGP Specific Interests Aged Care, the impact has been clear but in relatively limited numbers so far.
 
‘I have a lot of patients in residential aged care facilities,’ he told newsGP.
 
‘I’ve lost a few of my patients with COVID-related conditions, or they have had COVID quite close to their death so it’s been marked on the death certificate.
 
‘It’s not been huge with my patient base and there’s only a few that have passed away. The majority of them have been patients who have obviously been elderly, most of them in their 90s with multiple comorbidities and already very frail.’
 
He has seen vaccination have a noticeable impact, and points to many of his patients having mild symptoms and a swift recovery.
 
‘I had an outbreak in one of my aged care facilities pre-vaccinations, and the outcome was a lot worse than it has been now – so there’s definitely been significant benefit from the vaccines,’ he said.
 
With aged care vaccination largely being carried out by external companies, he has not personally noticed much of an increase in the administrative burden due to COVID-19. That includes the extra work prescribing oral antiviral treatments that are recommended for vulnerable people who contract the disease.
 
However, where he has seen a profound difference is on the morale of the workforce within – and it gives him great cause for concern.
 
‘I’m seeing in facilities that I attend, one in particular, where staff have been for five, 10, 15 years, really good quality nurses and care providers, who’ve been really dedicated, it’s just been too much for them.
 
‘They’re leaving to go to other fields or other locations. Some are just leaving and they’re not sure what they’re going to do because they’re just exhausted.
 
‘The impact has been massive on staff of aged care facilities, it’s not something that we are recording. We always talk about the impact to our patients, but actually the carers have had a big hit as well.’
 
It is a universal theme across all the GPs working in aged care who talked to newsGP.
 
For GP Associate Professor Paresh Dawda, the combination of vaccination, having to do more assessments for prescribing COVID-19 treatments, and fielding more anxious calls from concerned relatives is having a ‘cumulative effect’ on primary carers.
 
‘One of the problems we have at the moment is we’re observing more death and more pressure as individuals,’ he told newsGP.
 
‘Practice teams are sensing that and the degree to which the system is supporting [them] is really variable.’
 
Future impacts
Associate Professor Dawda describes the aged care sector as ‘under-doctored’ even before the pandemic, and believes the difference between domestic and international mortality figures reflects earlier successes but not the present reality in which Australia is catching up in a race no country wants to lead.
 
He believes dealing with COVID as just one possible issue among many is the likely reality in years to come.
 
‘The issue really is how do we create resilience in the system and in the healthcare professionals who work in that system to be able to be flexible and agile enough to respond to the surges in demand that occur with communicable diseases in particular,’ Associate Professor Dawda said.



The issue of dealing with acute conditions in residential aged care facilities is one that Dr Sachin Patel, founder of Aged Care GP, a company that provides medical services to the sector in Melbourne, is keen to draw attention to.
 
‘What appears to be happening is some type of rationing of care,’ he told newsGP.
 
He says there are situations where aged care is being expected to manage ‘significantly acute conditions’ and believes there is not enough transparency about the current approach.
 
‘Even at the best of times, it would have been tough to do,’ he said.
 
‘What would have been expected to be provided maybe two years ago is no longer the case. If there’s no capacity in the system to help people who live in aged care in the hospital system that needs to be told to the public.’
 
The role of general practice
In the meantime, Associate Professor Dawda says the pandemic has also proved a positive boost to the role of general practice, both in the general population and in aged care.
 
‘The thing I’d emphasise is the crucial role and value of general practice and a reminder to the system to involve GPs early,’ he said.
 
As for whether change will come – given the new government has promised to fix the ‘broken’ aged care system – Associate Professor Dawda is upbeat.
 
‘I’m a glass half full person,’ he said. ‘I’m optimistic.’
 
So too is Dr Altaf, although he says it can be hard to be positive in the middle of a difficult winter.
 
‘I’m not a virologist,’ he said. ‘So I don’t know what’s going to happen with COVID-19 going forward. But I have gone through winters before where viruses have caused big catastrophes as well.’
 
He believes exposure to viruses is likely to present a significant challenge every few winters in the aged care sector. As part of a preventive strategy, Dr Altaf has recently been offering pneumococcal vaccines against pneumonia.
 
‘We just need our scientists to stay on top of that with vaccination to try to prevent that, and the rest of us do what we do best which is to treat signs of severe illness early and do what’s appropriate for that individual,’ he said.
 
‘But we need the staff and resources to be able to do that.’
 
Dr Patel is more cautious but strikes a similar note.
 
‘We need boots on the ground,’ he said. ‘Then I’ll be encouraged but until I see that, it’s just words.’
 
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