Sydney aged care facility Newmarch House gave itself full marks in a pandemic readiness self-assessment 18 days before an outbreak of COVID-19 that killed 17 residents.
On March 24 the facility answered ‘yes’ in response to 23 questions from the federal aged care regulator on whether they routinely screened residents, if staff had training in infection control and whether it had sufficient PPE.
When asked to rate its readiness in the event of a COVID-19 outbreak, it responded “best practice”.
Every one of Anglicare’s 22 nursing homes in the greater Sydney region also answered yes to every question, the commission heard.
Less than three weeks later Newmarch House – the second in Australia to experience a COVID-19 outbreak – recorded its first infection and on Easter Sunday the Anglicare-owned nursing home went into lockdown.
Aged care facilities had been told to expect a flu-like illness, but COVID-19 proved far more virulent and much harder to control, Newmarch House executives told the Aged Care Royal Commission on Safety and Quality.
Anglicare chief executive Grant Millard described the period after the first outbreak as an “extremely difficult time” that had been” traumatic for everyone”.
NSW and the Federal Government officials gave conflicting advice, in particular about whether patients should receive treatment in aged care facility – known as hospital in the home – or be “decanted” to hospital.
The “level of dysfunction or disagreement” became so intense in the first two weeks of the outbreak that Mr Millard called the federal aged care minister, Senator Richard Colbeck, to intervene.
Mr Millard wanted Dr James Branley, head of infectious diseases from Nepean Hospital, who had successfully limited the spread of the virus at Dorothy Henderson Lodge and had been part of the Wuhan response team, to call the shots.
Within six hours of talking to Senator Colbeck, Dr Branley ‘s role was confirmed.
The commission heard Newmarch couldn’t get PPE and there was disagreement over whether it should be worn by all staff or only those dealing with residents who had tested positive.
Their pandemic plan estimated they’d need a surge force of about 40 per cent to replace those who were ill. “Within a number of days we lost … 87 per cent of our workforce,” said Mr Millard.
And it was hard to find replacements. Many of the “surge” staff they hired from an agency had no experience in an aged care facility and none knew how to use PPE.
“It wasn’t as if they (the agency) had a magic quarantine number of workers. We were all scratching around and people were scared. They were terrified of COVID and it was difficult to get people,” Mr Millard told the commission.
Of the 37 residents who tested positive to COVID-19 at the Newmarch House, only two were transferred to hospital. One of those died. The other 16 residents who died of COVID-19 were all treated at Newmarch House, the royal commission heard this week.
Anglicare service development and practice governance general manager Erica Roy said, with the benefit of hindsight, the statement about its pandemic readiness “was not accurate”.
“In particular I acknowledge with sadness ….. during the outbreak, especially with keeping family members updated about their loved ones at a time of great anxiety and distress and maintaining care standards for our residents at a time of huge challenges with the staffing numbers,” she told the commission.
She also said the guidelines by Communicable Diseases Network Australia “drew us to treat COVID as a flu-like illness”.
“I think, in hindsight, we realised that it’s a lot more virulent and a lot more, has a lot more of an impact,” Ms Roy told the commission.
Anglicare’s Newmarch was not the only aged care facility to overestimate its readiness.
Of the 313 Australian COVID-19 deaths reported as of Monday, Commonwealth data shows 220 were from an aged care facility. Of those, 189 were in Victoria where some of the outbreaks have resulted in more than 100 cases in many care homes.
According to statistics obtained by the Commission from the Aged Care Quality and Safety, 99.3 per cent of services who did the self-assessment said they had an infection control respiratory outbreak plan, 92.6 per cent said staff had been educated on infection control, and 99.5 per cent said they had a plan for communicating with staff and families during an outbreak.
Virginia Clark’s experience disagrees that they were prepared. Her dad Ron Farrell was one of those who died of COVID-19 at Newmarch House.
Ms Clarke told the Commission that there was not enough staff to manage an outbreak, they weren’t sufficiently trained, and communication with families was poor. She claimed she had not been told that Newmarch was implementing ‘hospital in the home’.
When Mr Farrell tested positive for COVID-19, nobody told him or his daughter.
A few days after the facility went into lockdown on Easter Sunday, when a staff member tested positive, Ms Clarke was told all residents were being tested.
She told the Aged Care Royal Commission on Tuesday that she kept asking if her 94-year-old father’s results had come back, but kept being told they hadn’t yet.
When they got the results, nobody told her until a chance call from the residential manager of Newmarch where her father had happily lived for seven years.
“I was in shock. I didn’t know what to say,” said Ms Clarke.
Until the COVID-19 lockdown, Ms Clarke said her dad – an alert father of seven, a former war veteran, and a stock and station agent – had been happy at Newmarch.
It had become his home and he made many friends. Despite her questions and calls about what would happen next, she heard little.
“We didn’t have any more communication … even though I sent messages to say, ‘Well, what happens now?’”
Despite asking Newmarch staff whether they had told her father about his results, she got no reply.
“Do I tell dad? Do I not,” she asked.
“I didn’t want to upset him, if he didn’t know, he was by himself in a room. I didn’t want to tell him why he was by himself.”
Staff needed better training, she said.
“I do not believe having a carer without a lot of training is appropriate, especially in this situation when the NSW government insists on having ‘hospital in place’ for the aged care facilities, then … the facility would need doctors and nurses, and all the equipment of a hospital,” she said
“Nobody actually told me what treatment dad was getting. I think that more communication, ringing up, giving a daily or even twice a day, ringing up in the morning and saying your dad slept well last night. He has had his medication, tell you how he went. If he is eating, what will be happening to him during that day and then at night ringing up and saying, you know, he is okay, he is going to bed.
“Just giving us more information about what was happening within the facility, because I didn’t have access to any of that,” she said.
Mr Millard said aged care facilities could not respond to a pandemic without help from commonwealth and state governments.
Mr Millard told the commission that he wanted to “express my regret that organisationally we were challenged in communicating with families. We were absolutely overwhelmed with the challenges of dealing with with COVID-19. And we have had some learnings from that, particularly about communication… to families because families missed their loved ones.”
In contrast, six residents died at Dorothy Henderson Lodge, the first aged care facility to experience a COVID-19 outbreak. And 13 of the 16 positive cases were sent to hospital.
The commission heard on Monday that Dorothy Henderson Lodge had appointed two specialists in infection control within 24 hours of an outbreak, and the initial response was to move even those residents with mild symptoms to hospital. In contrast, there was a delay of nearly two weeks at Newmarch in getting infection control experts.
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Julie Power is a senior reporter at The Sydney Morning Herald.