On March 16, Premier Daniel Andrews declared a state of emergency in Victoria. My family – like thousands around the state and indeed Australia – were soon after informed that my grandmothers’ aged care homes were banning visitors for two weeks. Both of my grandmothers had gradually progressing dementia but no other underlying health concerns. We had just celebrated a milestone birthday for each of them. I never imagined this would be goodbye.
Four weeks later, with the ban on family visits still firmly in place, we were informed that my paternal grandmother’s health was rapidly declining. In the circumstances, her aged care home agreed that immediate family members could visit under severe restrictions. If we had received the 2019 flu shot and passed the temperature and symptom check, they would let us see her in pairs for fifteen minutes at a time. But we never had a chance to say goodbye. She died in the early hours of the following morning, and we were left to seek closure through a socially-distanced funeral, without many of the Jewish customs that had been so important in her life.
Even as we buried and grieved her, the lockdown at my maternal grandmother’s aged care home remained in place. When we were finally allowed to visit, at the end of April, she had almost entirely lost her ability to speak. The reprieve was brief. When Victoria went into Stage 3 lockdown in early July, aged care homes around the state again moved to ban visitors. Ironically, my gran’s health had declined so much during the first lockdown that her home granted us compassionate end-of-life visits. Three times a week for thirty minutes, we were allowed to visit in pairs, so long as we had received the 2020 flu shot and passed the temperature and symptom check. After two weeks, they loosened these restrictions to allow us to visit more often and for longer, until she, too, died, just three weeks after Stage 3 was implemented. We organised another ten-person, socially-distanced funeral, this time with mandated masks.
My grandmothers are only two of the aged care residents who have died during the coronavirus pandemic. They didn’t die of Covid, and don’t appear in the daily tallies released by the state and federal governments. In fact, they are barely mentioned at all. But their deaths were nevertheless the result of a failed public health response and were caused by the pandemic as much as any Covid-attributed death. As Melbourne starts to reopen and we look to put the last seven months of lockdown behind us, these residents risk being forgotten entirely.
Much has been written about failures in the aged care sector which have resulted in over 690 coronavirus deaths. Nurses were ‘begging for help’ at the peak of the outbreak and denouncing the failure to provide necessary training in using personal protective equipment. Nightmarish footage showed residents left to languish in locked-down facilities. And family members shared the heartbreak of being told their relatives were safe in their rooms when they were in fact dying in hospital. State and federal governments and individual aged care providers are yet to answer serious questions about devastating major outbreaks. Families are rightly outraged that their relatives continue to be politicised in death. And the Royal Commission into Aged Care Quality and Safety recently released a special report that called attention to insufficient coronavirus preparations.
As my grandmothers’ deaths vividly show, the toll of the pandemic goes beyond even these heavily reported tragedies. Coronavirus cases at over 126 aged care facilities around Australia have led many to believe that banning all visitors is the only avenue to protect residents from this disease. But even if you accept this premise (and the Royal Commission noted that the Department of Health could not identity ‘any cases where visitation resulted in a case of COVID-19’), the bans themselves have directly caused declining health and avoidable deaths. The lives and wellbeing of my grandmothers, and many like them, were sacrificed to keep the majority safe. The fact that aged care facilities felt this was a reasonable infection control strategy is reflective of the broader crisis of funding and staffing throughout the sector.
In their report, the Royal Commission addressed visitor ‘blanket bans’, writing:
The understandable restriction of visits between older people and their friends and families has had tragic, irreparable and lasting effects which must immediately be addressed as much as possible. […] In all but extreme cases, blanket bans on visitation are unacceptable and should be both explained and justified.
The Commission included the case study of an aged care resident referred to as ‘UY’ who had motor neurone disease and ‘relied on physical touch to communicate’. His home went into lockdown in March and he died in June. His daughter told the Commission: ‘I believe Dad gave up wanting to live because his family support and connection was disconnected.’ This matches the experience of my grandmothers, whose dementia rapidly deteriorated after weeks without social contact and care from family.
It’s not surprising that aged care homes banned visitors in an attempt to keep COVID-19 out, as these facilities are even less equipped for infection control than standard hospital wards. The prime minister could demand that facilities accommodate visitors but without additional staff or support, many homes still felt they had no choice but to enact blanket bans. They believed there would be no way to limit the spread if coronavirus got inside.
Staffing shortages, a result of the gutting and corporatisation of the sector by successive governments, meant that most homes simply employ too few staff to provide adequate care to residents. Private facilities, like those in which my grandmothers lived, are operated federally and have extremely lax staffing guidelines and almost no oversight, instead relying on self-assessment. There are no mandatory staff-to-resident ratios, and no minimum daily requirements for the amount of time carers should spend with each resident. For many residents, visits from family and friends fill these gaps in care. For years, a member of my family visited one of my grandmothers almost every day, and the other one at least three times a week. These visits acted as informal caregiving, during which we could offer physical and social connection. They also allowed us to check on their ongoing health and wellbeing, and assisted with accountability.
When their homes locked down, they went from regular contact to nothing, and we lost the ability to check on them. The pandemic only exacerbated existing problems, with 64 per cent of aged care nurses reporting staffing cuts or a reduction in hours. Even at facilities that weren’t hit by staffing shortages, there weren’t enough carers to make up for the lack of visitors. Despite their best intentions, care staff and nurses labour at the behest of a broken system which prioritises revenue over service. You need only look to the fact that you can buy shares in several aged care juggernauts on the Australian Stock Exchange to see how lucrative a business it has become.
Despite hundreds of reported coronavirus deaths and countless more from these blanket bans, there is no sign of addressing weaknesses in the sector. Experts have criticised the royal commission’s report as ‘pretty benign’. Victoria does now permit ‘essential care and support’ visits, but leaves it to the discretion of individual facilities to determine whether this care ‘cannot be reasonably delivered by via electronic means’ (adding to the confusion, the federal government has its own visitor guidelines). Federal Aged Care Minister Richard Colbeck has dismissed calls for crucial staffing improvements as ‘the narrow focus of the union movement’. And, as of October, two-thirds of aged care providers nationally still have not received an infection control check from the Aged Care Quality and Safety Commission.
We are constantly told that Australia has been lucky during the pandemic, and in some ways we have been. But while the emphasis on declining numbers is useful politically, it provides little comfort to those who have lost relatives as a result of an utterly mismanaged aged care response. The human toll of this pandemic can’t be contained in political soundbites or daily death figures. If the government actually cared, it would properly fund and equip aged care homes to protect residents from illness without sacrificing the lives of the most vulnerable. It would work together with the states to ensure cohesion in approach. It would not treat aged care as a business intended to generate revenue for stakeholders by cutting costs in the form of staff and services. It would not put responsibility on individual families to supplement inadequate care or hold facilities accountable. Until then, the pandemic might end, but the crisis in aged care will remain, invisible to most, until the next emergency.
Image by Cristian Newman