Cheryl Mcqueen feels like she is living on death row.
The 66-year-old is in the final stages of chronic lung disease: “If I get COVID-19 that’s it, I’m dead.”
But the nursing home she lives in – Arcare in Craigieburn – is riddled with the deadly virus.
As of July 31, there were 44 active cases at the home, including 20 residents, 21 staff, two allied health workers and a caterer. Seven residents have died.
“It’s terrifying,” Mcqueen says. “They are dying here, they are not dying in hospital.”
Mcqueen has been isolated in her room since July 12.
“It feels like solitary confinement. Originally we were told a fortnight but while they are still discovering more cases there is no end in sight – we could be locked in our rooms until Christmas. My window looks onto an empty courtyard, not even onto the street so I could see if there were still human beings out there.”
Mcqueen says the regular staff at Arcare are “beautiful – they would bend over backwards for you”. But agency staff have replaced many of the regulars who have become sick.
She says that once she wasn’t showered for four days. Her bed is often left unmade and the curtains not closed. One day her cornflakes were served on a plate instead of in a bowl.
Mcqueen says workers are supposed to change their gloves, gowns and masks every time they leave a resident’s room but “the guy who delivered lunch didn’t change”.
She worries that staff are disposing of personal protective equipment in the bin in her room. “I said I don’t want that in my bin, I don’t know what germs are there. The bins should be out in the hall.”
Arcare CEO Colin Singh said it had employed a full-time infection control specialist in February when it first became aware of the pandemic, who had been working closely with the Craigieburn facility.
“All of our members are required to wear full PPE and have completed training in the donning and doffing of PPE and infection control,” he said. “The requirement as to when to change PPE depends upon the task that is performed.”
Singh said PPE needed to be disposed of in a clinical waste bin inside the residents’ suite as it was viewed as potentially infectious or confirmed infectious whereas the halls were viewed as non-infectious.
Last week Mcqueen cried and cried. “I think I am all cried out now. You just don’t know what to do. It’s very lonely. It’s very scary.”
She is not alone in this ordeal. Elderly people across the state face a petrifying lockdown as the coronavirus rampages out of control in nursing homes.
There are now 928 active cases and at least 61 deaths linked to more than 90 aged care facilities in Victoria. Premier Daniel Andrews has warned more people will die and the “consequences could not be more grave”.
This week he announced Victoria would intervene in the crisis, despite private facilities being funded and regulated by the Commonwealth.
“Some of the stories we’ve seen are unacceptable and I wouldn’t want my mum in some of these places,” Andrews said.
He cancelled all non-urgent elective surgery and said residents would be transferred to hospital from facilities where the government had “no confidence in infection control”.
At St Basil’s Home for the Aged in Fawkner – which has now been linked to 124 COVID-19 cases – the entire workforce was placed in quarantine for the first time in Australia’s history at the behest of the Victorian government.
The Commonwealth was forced to hastily assemble a replacement team. It struggled to cope amid a shortage of staff, with horrific stories emerging of faeces in beds and residents dehydrated and hungry. Desperate families were left in the dark about their loved ones as some residents died and others were evacuated to hospital.
What went so wrong? Why were Victorian nursing homes caught flat-footed when COVID-19 outbreaks in aged care had been the canary in the coalmine all over the world?
The global picture
According to an analysis by the Burnet Institute, more than 40 per cent of all COVID-19 deaths in the United States have been staff or residents in nursing homes. This figure jumps to 58 per cent in Israel and Norway and 66 per cent in Spain.
Canada has the highest proportion in the world, with 81 per cent of all COVID-19 deaths in aged care centres. (The OECD average is 42 per cent.)
University of Toronto researchers blamed overcrowding, staffing shortages and a lack of personal protective equipment and testing at nursing homes.
There have also been warnings closer to home with deadly outbreaks at the Dorothy Henderson Lodge and Newmarch House aged care facilities in Sydney.
“The question I ask everyday of myself and everyone else is why were we not better prepared?” says Professor Michael Toole, an epidemiologist from the Burnet Institute.
Toole points to Hong Kong, which reported no outbreaks in nursing homes until July, when the city experienced its third wave of the virus.
He says Hong Kong, which has a population of 7.5 million, learned a tough lesson from the outbreak of SARS in 2003 which killed 300 people there. Nursing home residents were more likely than the general public to get SARS and 78 per cent of infected residents died.
Immediately after the 2003 outbreak the Hong Kong government announced every nursing home had to have a dedicated government-trained infection control officer and at least a month’s supply of face masks and personal protective equipment.
After an outbreak in two aged care homes in July, Dr Leung Chi-chiu, chairman of the Hong Kong Medical Association’s advisory committee on communicable diseases, said all care homes should immediately avoid sharing staff or even rotating them across different floors within an institution.
He was quoted in the South China Morning Post saying he was not opposed to on-site quarantine for care home residents, as moving them around might increase cross-infection risks.
However he said it was important that care homes had contained transmission before allowing on-site quarantine.
Anglicare CEO Grant Millard has said if he could have his time again he would have sent all Newmarch House’s COVID-positive residents to hospital after the calamity resulted in 19 deaths.
Toole says Australia should have learned from Hong Kong, especially after the Dorothy Henderson Lodge and Newmarch House catastrophes.
“We had that window of opportunity between April and July. It’s not rocket science – it’s just keeping the virus from getting from infected people to uninfected people. We don’t want to go the way of Canada.”
The question of transfer
The Burnet Institute recommends that if a resident tests positive – and the aged care home cannot effectively isolate them – they should be transferred to a hospital, even if asymptomatic.
This has been a constant source of tension during the crisis.
Only South Australia has adopted a state-wide policy of sending COVID-positive residents immediately to hospital – a measure that is backed by the aged care provider groups.
Federal Aged Care Minister Richard Colbeck said residents who test positive are moved out of aged care and into hospital, except in circumstances when medical advice is that they remain in place because moving them could cause significant distress, such as residents with acute dementia.
“In these particular cases, COVID-positive residents are placed in separated cohorts within the facility from COVID-negative residents.”
Glendale aged care facility in Werribee – which has now been linked to 58 cases – and St Basil’s both initially had their pleas for COVID-positive residents to be transferred to hospital refused by the Victorian government.
Jayne Erdevicki, whose father Boro Petkovic tested positive to COVID-19 at St Basil’s, says the doctor told her on July 21 that transferral to hospital was not an option.
“He told me if he needed oxygen and fluid it might prove difficult because it wasn’t an option to send him to hospital. I didn’t understand why not – of course I would have wanted him to get the best care. He didn’t say why. Under the circumstances I was a bit shocked.”
Erdevicki would never find out the reason her father could not be transferred to hospital. The following day St Basil’s staff were sent home to isolate and the phone rang out when she tried again and again to get through. “I rang and rang all of Wednesday [July 22], I wanted to know what’s his symptoms, is he getting worse or is he OK?”
On July 23 at midnight she was called by one of the replacement staff, who informed her father had passed.
“I started screaming and crying: ‘Why couldn’t someone call?’ She said: ‘Haven’t you organised everything?’ I just felt like she was pushing me to get the body out of there like he was a piece of rubbish to be disposed of. She also had the audacity to ask me if we were close, when I used to visit my father three times a week. What sort of a question is that? That phone call will torment me for years to come.”
Colbeck said the Commonwealth had to come in overnight and pull together a workforce that didn’t know the residents or St Basil’s. “The situation there was completely dire and some very unacceptable things occurred,” he told Channel 7’s Sunrise.
“I know people are upset, they are worried, they are angry. Nobody could predict an entire workforce of a facility was going to be entirely knocked out. That was a decision made by the DHHS … we have since discussed it with them and something like that won’t happen again.”
Lessons learned – and overlooked
The first major aged care facility outbreak in Australia was at Dorothy Henderson Lodge in Sydney, with the first case diagnosed on March 3. Altogether 17 residents were infected and five died.
Clinical Professor Gwendolyn Gilbert, the director of infection control for the Western Sydney local health district, says the outbreak provided important lessons.
The most important of these was the need for early, ongoing leadership by facility management and guidance from an experienced infection control professional.
“The COVID-19 outbreak, in Australia, has highlighted a widespread lack of infection prevention and control competence and confidence among healthcare and residential aged care facility workers,” she wrote in an article published in The Medical Journal of Australia.
Professor Joseph Ibrahim, the head of the Health Law and Ageing Research Unit at Monash University, says the federal government set up an online course on infection control in response to the pandemic.
“No one should have ever thought that was enough,” Ibrahim says. “Donning and doffing personal protective equipment is at least a 10-step procedure. You don’t learn to drive a car by watching someone driving.”
About 70 per cent of aged care workers are only qualified with a Certificate III, which requires as little as six weeks’ training.
“What happens is people come to Australia to study and the easiest way to get a job is to do a six-week course and work in aged care,” says one worker at a Melbourne nursing home who asked not to be named. “You can teach someone to make a coffee and serve meals but you can’t teach someone how to care for an elderly person in six weeks.”
Ibrahim says the aged care system in Australia was in trouble long before the pandemic.
“The government knew it, the Royal Commission knew it, the whole bloody world knew it. Why would you expect a failing system to perform really well under stress from an external disaster? You can’t expect the kid frying chips at KFC to fill in for Heston Blumenthal at a three-star restaurant.”
The Aged Care Royal Commission last year found the system failed to meet the needs of the elderly and was unkind and uncaring towards them. Its interim report, Neglect, said the sector suffered from severe difficulties in recruiting and retaining staff. Pay and conditions were poor and education and training patchy.
Premier Daniel Andrews has said “a bunch” of aged care workers are among those going to work when sick or while waiting for test results, which has seen community transmission burgeon.
“Let’s not judge them,” he said. “Let’s try to work out what is driving it.”
Dr Sarah Russell, the director of Aged Care Matters, says many casuals, who earn as little as $22 an hour, cannot afford not to work. She said they move between aged care homes, increasing the risk of transmission between homes.
“I’m really disgusted we didn’t learn from Newmarch House about the importance of teaching staff about infection control and having clinically trained staff in aged care homes,” Russell says.
She says there are no mandated staff-to-resident ratios in private aged care homes, which means some operate without a registered nurse on site 24 hours a day.
By contrast, she says, the state-owned nursing homes – which make up 180 of the 770 aged care facilities in Victoria – have prescribed ratios of registered nurses.
“We have had years to get this right,” Russell says. “It’s so sad this has happened.”
Royal Freemasons has had a COVID-19 outbreak at its Gregory Lodge aged care home in Flemington, with five staff and 23 residents testing positive.
Chief executive officer Kerri Rivett said staffing shortages had been an industry issue before COVID-19. Now, with infected staff and their close contacts in isolation, it was a real struggle to find aged care workers.
“We have found we are unable to fill all the shifts that are required,” Rivett said. “The surge workforce provided by the Commonwealth is fantastic, however they don’t have enough either.”
She said the Federal Government’s supply of personal protective equipment had been slow to arrive and Royal Freemasons had had to purchase its own, which was extremely expensive.
“Everyone is just overwhelmed because of the number of cases we have had in residential facilities.”
‘You can’t claim this is a shock’
Colbeck said $234.9 million was being allocated for a COVID-19 bonus to assist providers in retaining staff and further funding would be made available to ensure workers were supported to work at a single site.
Victoria has also announced a $300 payment for those isolating while waiting on test results and a $1500 quarantine payment to encourage people – including aged care workers – not to work if sick.
Ibrahim, who was named one of Good Weekend’s 2019 People who Matter for exposing the “astonishing” truth behind some nursing home deaths, said Australia’s initial response to the pandemic appeared to prioritise intensive care beds.
He believes the focus should have been on aged care and a national taskforce of experts should have been set up by March at the latest.
“You can’t claim this is a shock,” he says. “It was pretty obvious when you looked overseas what the problems would be.”
Ibrahim believes the COVID-19 preparedness of every aged care facility in Australia should be evaluated. (Colbeck says they are already required to have infection control measures and a COVID-19 outbreak plan.)
Ibrahim also wants independent officers – such as ADF personnel – to be appointed to liaise with homes in Victoria every week, allowing nursing home managers to raise any concerns they might have “frankly and honestly”.
The Victorian Aged Care Response Centre has now been established to coordinate the crisis, something critics such as Ibrahim argue is long overdue.
Cheryl Mcqueen was tested for the fifth time in a fortnight on Wednesday. She is still waiting for the results. “Every time they do it, it gets harder.”
She worries she is a sitting duck: “Am I going to sit here and test negative until I test positive?”
Mcqueen says the worst decision she ever made in her life was to move out of her Coburg housing commission flat into a nursing home.
“I can’t see my kids, I feel like I have got nothing. It’s no life for anybody, just locked in a room 24/7. There’s no end to it for us.”
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Jewel Topsfield is Melbourne Editor of The Age.