With no visitors or unannounced inspections, who knows what is happening in nursing homes during the coronavirus lockdown?

Updated

Merridy Eastman received a disturbing text message from her mother's nursing home in Hobart last Friday.

Key points: Many major aged care providers have stopped all visitors from entering their facilities, except for the families whose loved ones are close to death

The lockdown includes families who were providing regular, basic care to their loved ones to supplement low staff levels in nursing homes

The Federal Government has given the sector an extra $400 million to cope with the coronavirus crisis

"Dear relatives and friends, we have made the difficult decision to stop visits to Bupa care homes starting 5:00pm today. This is to protect against the growing risk of COVID-19 infection"

The text arrived at 12:13pm.

"It sent a chill down my spine," Ms Eastman told 7.30, saying she had been planning to fly from Sydney to Hobart to visit her mother the next day.

"But what I really had to think of at that moment was all the people … who were at work, who hadn't seen their parents that day, who wouldn't be able to pop in and see them for the last time in months. Maybe ever. Who knows? None of us know what's ahead of us at the moment."

"I know that they're doing the best that they can and they're in an extraordinary situation with them having to take such drastic measures but I just thought, 'What short notice'."

Adding to Ms Eastman's worries was that her mother's home, Bupa South Hobart, featured as a case study at the royal commission with evidence the company tried to save money by not replacing sick staff.

The Eastmans have been employing private carers at a cost of $10,000 per year to visit and care for their mother, as none of them live in Tasmania, but the lockdown means those carers were also banned.

"It was never explained to us why three professional carers with experience in infection control who knew exactly what to do should be stopped from visiting and helping out," she said.

Ms Eastman said that her 93-year-old mother Berenice had been crying on the phone, saying she was only allowed in her room and occasionally to the lounge area but was not allowed outside to the gardens onsite.



Ms Eastman said she had been told contradictory stories by the Bupa carers about her mother's movements.

"They always say, 'No, she's been out, she was out this morning,' or 'She was out yesterday'," she said.

"We actually don't know what's going on.

"All I can say is that it's a bit of a grey area and our mother definitely is convinced that she's a prisoner and she's not getting fresh air."

In a statement, Bupa denied Berenice Eastman was confined to her room saying an employee had been designated as Mrs Eastman's "companion carer" and that it was the company's first priority to protect the health of residents and employees.

'We don't have that same level of confidence in aged care'

The lockdowns in aged care facilities have affected hundreds of thousands of people across Australia.

Last month, the Prime Minister recommended aged care facilities restrict visits from family and friends to just 15 minutes per day to limit exposure to the coronavirus.

Within weeks, many of the big aged care chains like Bupa, Allity, Estia, Regis, Opal and Japara have instituted total lockdowns.

They said residents who were at the end-of-life would be allowed visitors and others could communicate via phone and internet.

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Adding to the turmoil in the already stretched sector, the government regulator, the Aged Care Quality and Safety Commission, is no longer doing unannounced inspections of nursing homes and the facilities due for a scheduled visit will have special provisions applied so their accreditation continues without an onsite visit.

Some facilities have locked out relatives who visit daily to feed their elders, as well as professional carers employed by families to provide top-up care for their loved ones in understaffed facilities.

"If we had trust in the system, people would not be as angry or upset about the lockdown," said Joseph Ibrahim, a geriatric medicine expert from Monash University.

"If it's a lockdown in an intensive care unit or at a hospital, people come to terms with that quickly and are very supportive because they have faith and belief in what's happening behind closed doors.

"We don't have that same level of confidence in aged care."

In a statement issued on Thursday night, the Minister for Aged Care Richard Colbeck said: "There has never been closer interaction between Government, regulator and the sector."

"The focus of all parties since the outbreak has been to ensure those most susceptible to the impacts of the virus have been protected and the sector prepared," he said.

The Minister said the department had undertaken a variety of initiatives including rolling out fact sheets and training modules on infection control for staff.

Extra carers refused access

Families who contacted the ABC had mixed views, with many supportive of the move to protect their relatives from the deadly virus.

News of a spate of coronavirus deaths in nursing homes in the United States and Spain, as well as five residents from Sydney's Dorothy Henderson Lodge, have made people acutely aware of the danger the virus poses to the elderly.

Are you worried about aged care in Australia? The aged care royal commission continues and so does our investigation. Let us know if you have a story or issue you'd like the ABC to look into. Email aged.care@abc.net.au to tell us your story.

But others who have parents or partners with dementia are concerned that the blanket ban will be more harmful to their mental and general health.

The horror stories coming out of the Royal Commission into Aged Care Quality and Safety about understaffing, neglect and chemical restraint do not help allay family's fears.

Last week, commissioner Tony Pagone issued a statement saying restricted visits and lockdowns may be causing harm to vulnerable elderly and called for more qualified staff to take the place of the many families who provide basic care such as feeding and toileting.

Professor Ibrahim said while lockdowns were necessary, they needed to be "humane".

"It's become apparent that a lockdown is essential, that older people are at the highest risk of dying," he said.

"But a lockdown that is so strict that you never see anyone or that there are no exceptions is not what we want. We need a humane lockdown."

Professor Ibrahim said the aged care sector was less transparent than ever because families have been banned and the regulator, the Aged Care Quality and Safety Commission, would no longer conduct unannounced inspections.

The Commission would undertake site visits only in "particular circumstances" and would contact the service in advance to arrange the visit.

"The danger with an absolute and complete lockout, with no oversight, with no external observer, is the possibility that people will resort to excess extraordinary levels of chemical and physical restraint, that the residents won't get the care that they need," Professor Ibrahim said.

'The home is understaffed … feeding is essential'

In South Australia, Anne McMenamin and her sisters have visited their 97-year-old father John at The Lodge in Adelaide every day for the past six years because he can no longer feed himself due to advanced dementia.

"We know that the home is understaffed and that our time that we put in two hours every day feeding is essential for Dad's wellbeing," Ms McMenamin said.

The family applied for an exemption from the lockdown, saying they would undertake all the necessary infection control procedures which staff use so they could continue their regime, but the home, owned by an affiliate of the Uniting Church called Eldercare, refused.

Ms McMenamin fears her father will become malnourished — like half of all aged care residents in Australia as found by the royal commission's interim report.

When she was unable to visit for a month due to a hip replacement in 2018, records provided by Eldercare show that the elderly man lost 3 kilograms.

"We are not unhappy with the staff. It's not a question of neglect. It's simply of time and knowledge and understanding," she said.

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Eldercare said the lockdown was necessary for residents' safety, that staff were working extra hours to feed residents and that John McMenamin would have his weight recorded and reported to his family.

Aged care advocate Stewart Johnston, whose mother was abused in South Australia's notorious Oakden aged care facility, said families who have provided daily care need to be given access.

"My biggest concern is with turfing out relatives who have an intimate understanding of the care needs and the need for infection control and then the industry is saying, 'Oh, but hang on, we're going on a mass recruitment because we need more people in the industry,'" he said, referring to reports the industry is employing untrained new staff to replace workers who may fall ill with COVID-19.

Although the Federal Government has given an extra $400 million to the sector to cope with the crisis, including money for a "staff retention bonus" to encourage workers to stay with facilities, it was unclear whether any money is being devoted to providing staff skilled in infection control, such as registered nurses.

There are no minimum staffing ratios in aged care nor any need to have a registered nurse on duty, except in Victorian state-owned nursing homes.

"What we have is already a chronically understaffed and under-resourced sector now having to deal with the additional burden of the COVID-19 health crisis," said Annie Butler from the Australian Nurses and Midwives Federation.

EDITOR'S NOTE: April 2, 2020: The ABC has amended a previous headline and paragraphs that stated no inspections were occurring in nursing homes and we have changed the text to fully represent the regulator's position regarding inspection visits to aged care facilities. While the Aged Care Quality and Safety Commission has stopped all unannounced inspections and scheduled accreditation visits at aged care facilities, it "will undertake site visits only in particular circumstances and based on the level of assessed risk by the Commission" and "will contact the service in advance of the visit".





Topics: covid-19, aged-care, carers, health, emergency-care, infectious-diseases-other, older-people, hobart-7000, sydney-2000, darwin-0800, brisbane-4000, adelaide-5000, canberra-2600, melbourne-3000, perth-6000, australia

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