Vital COVID lessons ignored
A first responder nurse says the deaths of many nursing home residents could have been prevented.
During four weeks in quarantine, registered nurse Louise Molony had time to reflect on the events that led to her becoming infected with COVID-19 at a Melbourne nursing home.
Her infection, and the infection and deaths of many aged care residents, could have been avoided by heeding lessons learned at Sydney’s Newmarch House, Louise believes.
Louise, an NSWNMA member, was a first responder at Newmarch and two Melbourne facilities hit by the virus. Her experiences in these facilities were reported by the Sydney Morning Herald and The Age.
Louise worked as a public hospital and aged care RN for 30 years in regional NSW and Canberra before taking a contract job with Aspen Medical, an agency contracted by the federal government to help facilities deal with COVID-19 outbreaks.
Aspen sent her to Newmarch for three weeks, followed by a stint at Lynden Aged Care in the Melbourne suburb of Camberwell, a standalone, not-for-profit facility.
Her final assignment was at for-profit Estia Health’s facility in the suburb of Heidelberg. She quit at the end of the first day.
“Newmarch gave Melbourne the template but they didn’t use it,” she says.
“I never dreamed that Estia would be worse than Newmarch. It was just too dangerous to stay,” she says.
A week later she tested positive for COVID-19, contracted at Estia Heidelberg. It had recorded 118 COVID-19 cases and 10 deaths by 11 September.
By that date, a total of 554 aged care residents in Victoria had died from COVID-19 out of 581 deaths nationwide.
A Victorian government breakdown of 2281 healthcare-acquired COVID-19 cases (as of 10 September) showed that 61 per cent (1407) worked in aged care.
“I’m angry and frustrated that so much of this tragedy could have been avoided,” Louise says.
Louise quarantined at home, separated from her husband and son by curtains hung in a hallway.
The men had to walk out the front door and down the side of the house to get to the kitchen. Her husband Michael cooked her meals and pushed them under a curtain.
Out of quarantine, Louise told The Lamp she arrived at Anglicare’s Newmarch House on 2 May.
The facility had lost many of its employees and was struggling to provide care to about 100 residents, without adequate staffing and support, as an inquiry headed by Professor Lyn Gilbert found.
“PPE wasn’t being distributed properly and some of it wasn’t appropriate,” she says.
“Infection control was poor; people were working across both COVID and non-COVID wings, and bins were overflowing with used PPE.
“Communication and clinical organisation were poor.
“Aspen had no aged care experience and didn’t want to listen to their aged care RNs on the floor.
“It took over a week to fix Anglicare’s roster, which wasn’t able to coordinate the various staffing agencies and ensure that a person only worked on one wing.
“That was necessary to prevent cross-infection and get continuity so staff could become familiar with patients and report back to families.”
Louise said Anglicare Newmarch management expected nurses to keep track of how much PPE was used and write on a board how much would be needed each day.
“I told them we are supposed to be looking after patients and they should have at least two people just to keep track of how much PPE is needed and distribute it to each wing.
“It wasn’t until Commonwealth infection control liaised with NSW Health infection control that we got the right PPE, including N95 masks, and got PPE stations and distribution set up properly.
“Each of the Aspen RNs were put in charge of a wing but we had no input into the frequent meetings between Anglicare Newmarch, Aspen and government agencies in the front office.
“They all talked too much and wouldn’t listen to the people actually looking after the patients.”
Louise’s account is reinforced by Prof Gilbert’s findings.
She reported it was often unclear who was in charge at Newmarch.
A host of government agencies and providers were engaged in an “onerous” daily round of meetings that were “often not conducive to collaboration” and put further stress on frontline staff “attempting to manage an unprecedented crisis,” Prof Gilbert found.
Louise was shocked at the way doctors were treated at Newmarch by Anglicare.
“We had good doctors who were trying to get teams going with the nurses to get things done. That’s how I’m used to working.
“But Anglicare management would pull doctors and nurses aside and demand to know, ‘Why are you spending so much time doing this?’
“I was told off for interrupting a meeting to get a doctor to attend to a patient in pain who had waited a long time for treatment.”
The outbreak killed 19 Newmarch residents, with 17 deaths directly attributed to COVID-19 – a mortality rate of 46 per cent of infected residents.
At Lynden in Camberwell, Louise said she “got into trouble” with Aspen management for attempting to pass on lessons from Anglicare Newmarch.
“Lynden had PPE distribution working well but had lost almost all of its staff. Aspen wanted to send something to the effect of three AiNs and two RNs as the total surge workforce for about 100 residents.
“I said they needed double the usual staff levels to make sure PPE goes on properly and extra cleaning is done.
“Extra staff were also needed to spend time with residents who were locked in their rooms, with no companionship or opportunity to exercise.”
She said Aspen management reluctantly accepted her proposal that an RN be placed in charge of each wing of Lynden to ensure continuity and better communication.
The situation at Estia Heidelberg, which had lost all its regular employees, was even worse.
The Age newspaper reported on notes made by a doctor who attended the Heidelberg home the morning before Aspen and Louise got there.
The doctor wrote that cross-contamination was rife. By 11 am, no resident had been fed or given medication. Three patients who didn’t have COVID-19 needed to be transferred to hospital.
On the day Aspen took over Heidelberg there were only four staff – Louise, a recent graduate, an EEN and a care worker – plus two Estia managers, who were also RNs, who were doing admin and dispensing pills.
They were expected to care for 50–60 residents, including some infected with COVID-19. Some needed oxygen and intravenous fluids.
“They should have had five carers on each of the three wings to provide safe care,” Louise says.
Louise said more Aspen staff were available but confusion as to who should do the roster, Aspen or Estia, meant they did not arrive as they had not been given a roster.
There were no N95 masks and the wrong gowns.
Louise had to convince a young and uncertain doctor to send a woman with breathing difficulties to hospital to get oxygen.
Outside the building, families were clamouring for information.
Louise spent most of the day – 12 hours without a break – on the phone to relatives and the hospital.
N95 masks arrived later that day but Louise – and, she suspects, other workers forced to use inadequate surgical masks – had already been infected.