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Australia Why are there are more COVID-19 cases in private aged care than the public sector?

02:55  01 august  2020
02:55  01 august  2020 Source:   abc.net.au

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The tragedy unfolding in Victoria's aged care homes, as coronavirus claims the lives of more older Australians, has prompted questions about the embattled sector.

There are currently 928 active cases linked to aged care in Victoria, including residents, staff and close contacts.

There have been a total of 61 deaths to date tied to aged care in Victoria, including four of eight deaths from COVID-19 in the past 24 hours.

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Yet the overwhelming majority of infections have been in private and not-for-profit aged care homes, not public facilities.

There are just five active cases in one publicly run facility — Bill Crawford Lodge in Ballarat.

The private-public divide was thrust into the spotlight after Victorian Premier Daniel Andrews responded to a journalist who asked whether he would want his mother in a private aged care home.

"Some of the stories we've seen are unacceptable and I wouldn't want my mum in some of those places," he said.

Aged Care Minister Richard Colbeck described that as "a really unfortunate comment" and said the public versus private comparison was "a furphy".

So why are there more COVID-19 cases in non-government facilities, and is it a fair distinction to make?

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One in 10 beds are state-run

One reason there are more coronavirus cases in private and non-profit aged care is that most residences in Victoria are not run by the state.

There are 800 aged care facilities in Victoria, comprising 56,000 beds.

Of those, 622 facilities are privately run and not-for-profits — regulated by the Commonwealth — and 178 are run by the Victorian Government.

About 10 per cent of all aged care beds in the state are publicly-owned.

Another key factor is geographical location.

The vast majority of aged care facilities in metropolitan Melbourne are run by the private and non-profit sector, whereas most of the state's aged care homes are in regional areas.

The majority of COVID-19 cases in Victoria are centred in the city — of the 10,577 cases recorded since the pandemic began, 595 are from regional Victoria.

Joseph Ibrahim, head of the Health Law and Ageing Research Unit at Monash University, told ABC Radio Melbourne that "a lot of public homes are in regional areas where the private providers will not go".

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Professor Ibrahim said many government-run centres often had older infrastructure with more shared rooms, which could foster transmission if the virus got in.

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"So in a sense it doesn't make sense looking at just structure why those outbreaks would be greater in private, it makes sense when you look at the staffing and staffing qualifications," he said.

In Victoria, state-run facilities have mandated nurse-staffing ratios.

In high-care residential aged care wards, there needs to be one nurse to seven residents and one nurse in charge for the morning shift, and one nurse to eight residents in the afternoons with one nurse in charge.

On night shift, it's one nurse to every 15 residents.

Privately run centres don't have to abide by the same ratios, but Ian Yates, chief executive of COTA Australia — a peak advocacy body for older Australians — pointed out some institutions had enterprise agreements with nurse-to-resident staffing requirements.

"You will find that larger providers, whether they're not-for-profit or for-profit, do have ratios in their industrial agreements with the unions," he said.

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"So they're not law in that sense, but they are actually requirements in their agreements with the unions."

Mr Yates warned staffing levels didn't always guarantee better quality of care, and said there were good and bad providers across all systems.

There were also fewer casuals hired in government-run centres, he added.

'Not a useful comparison'

Mr Yates said the bulk of aged care was run by non-profits who would object to being called "private".

Many facilities were run by church organisations, he said, or Aboriginal health groups in remote areas.

He said distinguishing the sector along private and public lines was "just not a useful comparison".

"I know some major for-profits where the owners are investing heavily in the business to grow it and are producing quality outcomes, and are more transparent about what they're doing than some non-profits," he said.

Tim Hicks, policy and advocacy general manager at Leading Age Services Australia (LASA), a national association of aged care providers, said comparing state-run aged care facilities with non-state facilities was "unnecessary".

"It has been disappointing and hurtful for many aged care providers and their dedicated staff who are working tirelessly around the clock to protect residents," he said in a statement this week.

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He pointed out the state-run facilities made up a fraction of aged care providers in the city.

"The Premier's comments about not wanting his own mother in some of the affected homes was unhelpful and will deepen fears, when local providers, state and federal authorities and the Australian Defence Force are working so hard to save lives," he said.

Aged Care Minister Richard Colbeck said he didn't "take to this concept of 'private aged care'".

"It is aged care across the board, there is no difference between any form of facility as to the infection rate in Victoria at the moment," he said.

'The failures are at the senior level'

Health Minister Greg Hunt said the Australian Defence Force had been sent in assist aged care centres, particularly supporting Epping Gardens in Victoria.

More than 200 residents have been evacuated out of aged care centres and into hospitals.

"Aged care around the country has been immensely prepared," Mr Hunt said, saying the Victorian outbreak was affecting a range of workplaces, including meatworks and schools.

Australian Medical Assistance Teams (AUSMAT) nurses, who are normally sent to disaster zones overseas, arrived in Victoria on Thursday to help with the coronavirus response.

Joe Buffone, the executive leader of the Victorian Aged Care Response Centre which has been set up at the State Control Centre, said they would support aged care facility owners to ensure residents were looked after.

"They will bolster our rapid intervention so that when we have these complex outbreaks that escalate quickly, we have the leadership team, the multidisciplinary team to help stabilise the situation," he said.

Professor Ibrahim said the aged care sector was not prepared to manage any crisis, and there were problems with operations that prioritised free-market principles and lacked accountability.

"So much has gone wrong it's difficult to put it in a sentence," he said.

"My fear is twofold — one, we forget how we got to this train wreck, and [two], once the train wreck is over, we don't investigate and look into it.

"The heart and soul of aged care sits with the workers and the nurses … the failures are at the senior level."

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