COVID-19
Omission of nurses ‘a major pandemic failure’
Failure to involve nurses in planning for Covid-19 in aged care was a major flaw in Australia’s preparation for the pandemic, says a leading geriatrics specialist.
Professor Joseph Ibrahim of the Department of Foren-sic Medicine at Monash University has criticised the exclusion of nurses from the planning of the aged care sector’s response to COVID-19.
Professor Ibrahim said involvement of nurses was “the major thing that was missing” from official pandemic planning for aged care.
“No nurses that actually worked in aged care were represented on any of those groups that were making the decisions,” he told the NSWNMA’s professional day in August.
Professor Ibrahim is a practising senior specialist in geriatric medicine with over 30 years of clinical experience with elderly people.
He has been an expert witness in criminal and coroner’s court cases and a witness at the Royal Commission into Aged Care Quality and Safety.
Professor Ibrahim questioned the federal government’s decision to put the aged care regulator – the Aged Care Quality and Safety Commission – in charge of leading the sector through the pandemic.
“Why did they (the Morrison government) choose a regulator to lead a public health initiative?” he asked.
“Why was there not a single geriatrician, let alone a senior nurse in geriatrics, on any of the planning groups?”
Sector’s weaknesses a result of deregulation
Professor Ibrahim said structural weaknesses in the aged care system were well known even before the royal commission, which preceded the pandemic.
He said the sector’s structural flaws were brought about by the deregulation of the sector in 1997.
The 1997 legislation created a “free market” in aged care and was “the downfall” of the sector.
It led to reduced staffing, removal of restrictions on who could do what work, a substantial loss of registered nurses from aged care, work becoming more casualised and “staff having to work at multiple places to earn a livable income”.
The royal commission highlighted these problems and the fact that 10 per cent of aged care homes were “unable to fully staff for everyday business”.
“We knew from the royal commission that the aged care sector was not equipped to manage day-to-day business,” Prof. Ibrahim told conference delegates.
“But for some reason the Department of Health, the federal government and the regulator all seemed to think that the sector could step up and also manage a pandemic – despite these underlying foundational and structural issues.
“The regulator knew before the pandemic that a substantial number of homes were having trouble with governance (such as) infection control and escalation of clinical care.
“(The regulator) knew the places that had those problems and they knew this was not a one-off but another structural issue.”
Prof. Ibrahim said providers who did what the regulator told them to do were “well under-prepared for the pandemic when it hit because the regulator’s plans were pretty thin – if you want to call it a plan”.
“They essentially put the respon-sibility for managing an outbreak on the provider.”
Strategy based on a fantasy reading of workplace reality
Prof. Ibrahim said the relationship between staff and management “wasn’t well thought through” in making plans to deal with the pandemic.
Had more control been delegated to senior nursing staff in aged care facilities, “you would have a far better outcome around rostering, managing workforce shortages and talking the talk about reducing the number of places people would work at”.
He said even now, it was “very hard” to find out “how many senior working nurses are involved at a state or regional level in advising what’s happening on the ground and what needs to happen, so that we’ve got proper field intelligence so that we can prepare better”.
Professor Ibrahim said aged care was characterised by a mis-match between “work as imagined versus work as done”.
“What’s written down in policy, what’s on organisational charts, what people put on their flow diagrams, what’s set down from above … doesn’t make a whole lot of sense about how the real world works.
“The greatest failure with this pandemic across the country and across the world, is a failure to understand how work is done.
“There has been a real mismatch between how senior leaders and advisers thought versus what was real.
“People in senior positions and senior roles in decision-making were living in or working from an imaginary place (where) every shift is filled, every nurse is well and able to do the allocated work, if you need a doctor they’re around and are kind, thoughtful and responsive should you ask them any questions; the equipment you need is there, the space for bins is there, the rubbish will be taken out on time [and] that no-one will call in sick.”
COVID toll mounts in aged care
When Professor Joseph Ibrahim addressed the NSWNMA 77th Annual Conference Professional Day in early August, there were about 10,000 active COVID-19 cases in about 1000 residential aged care facilities.
This meant more than one third of Australia’s 2700 aged care facilities were battling outbreaks, Professor Ibrahim pointed out.
He said that since 2020 there had been 2670 outbreaks in residential care facilities, meaning almost every single facility in Australia had suffered an outbreak.
About 77,000 residents had contracted COVID-19, which had resulted in the deaths of 3394 residents.