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Australia Deadly mistakes in aged care outbreak

01:27  08 august  2020
01:27  08 august  2020 Source:   theage.com.au

Emergency response team dispatched to Australia coronavirus outbreak

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In countries like the United States - a country that health experts advised was the best-prepared in the world to handle an epidemic outbreak just a year ago - health care systems are overtaxed and understaffed, so-called “frontline” workers in essential businesses are underpaid and under-protected

(Marco Polo Aged Care ). Twenty staff members from the aged care home have also been off sick with flu symptoms. Marco Polo Aged Care Services manager Robert O’Shea told the ABC families have been informed about the outbreak and have been urged not to visit.

The Age, News, 31/07/2020 photo by Justin McManus. Residents of St Basil's Aged care home are evacuated to hospitals after the cluster of Covid-19 cases and deaths from the home. . © Justin McManus The Age, News, 31/07/2020 photo by Justin McManus. Residents of St Basil's Aged care home are evacuated to hospitals after the cluster of Covid-19 cases and deaths from the home. .

For the past three weeks, Louise Molony has lived apart from her husband and adult sons while sharing their Melbourne home. She has the virus and they don't.

To keep things that way, their house is divided into COVID-19 red and green zones. To get to the kitchen, the men must walk out the front door, down the side of the house and enter round the back.

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An aged care home in north-east Victoria at the centre of a deadly flu outbreak had serious management failures and inadequate infection control, an investigation has An audit by the Australian Aged Care Quality Agency found the facility failed to meet 12 of the 44 accreditation standards.

But there are other viruses out there that are equally deadly , and some that are even deadlier . The known strains vary dramatically in their deadliness , Elke Muhlberger, an Ebola virus expert and associate professor of microbiology at Boston University, told Live Science.

This snapshot of domestic quarantine - a lockdown within a lockdown in a house on a suburban street - is emblematic of a city enduring some of the world's most severe restrictions.

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Never ever put new babies in with older hens. The big ones will always beat up the little ones and kill them. When you put chickens together they have to be the same size. Chickens don’t know age they just know size.

Spotlight on Victorian aged care amid outbreaks . Queensland aged care home on high alert after coronavirus case.

Melbourne is under house arrest. All but "permitted" businesses have been forced to a chaotic halt. The cost is only guessed at: a forecast $12 billion hit to the economy; statewide unemployment nudging 15 per cent; a deep, prolonged recession that will shape all our lives.

Molony is angry. Not because she is sick and can't see her loved ones - she has seen enough in 30 years working as a nurse to keep her situation in perspective. Rather, she is angry because she knows that some of the deaths and anguish caused by Victoria's second wave of the epidemic need not have happened.

Molony works in aged care. Until recently, she worked as a clinical first responder for Aspen Medical, an international agency contracted by the federal government to help nursing homes deal with COVID-19 outbreaks.

In April she was sent into Newmarch House, the western Sydney nursing home where 19 residents died with the virus. On Monday, July 20, she was sent to an Estia aged care facility in Heidelberg. After experiencing what she did that day, she says she will never work a shift for Aspen again.

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Flu vaccinations could soon be compulsory for aged care workers, following a deadly outbreak of the virus at a number of facilities around the country. Currently there is no legal requirement for aged care workers to have a flu vaccination, but Health Minister Greg Hunt said he wanted to change that.

The Victorian premier has been interrogated by the media as the state reported 471 new coronavirus cases and eight more deaths.

There were more than 40 residents in the home, many of them infected with COVID-19, and the home's regular staff and management were not at work.

Some had tested positive for the virus. The rest were deemed close contacts and had been sent home by the Victorian DHHS. When Molony arrived, she realised the full care team comprised her, one recently graduated nurse, one nurse still in training and a personal care assistant. Two Estia front-of -house staff had been brought in from another home to help with admin.

No one seemed to be in charge. They were given the wrong masks to wear. Some of the residents were in need of oxygen, others intravenous fluids. A doctor came from the local hospital but according to Molony, he was young and uncertain. "There was a lady yelling out ???help me, help me, I can't breathe','' she says. "I said to the young doctor there ???she has got to go, she can't stay here.' He said ???but my bosses ???' I said ???no, she needs oxygen and she needs to go'."

Vital lessons were learned at Newmarch about responding to an aged care outbreak, she says: The need for extra staff to help with the careful donning and doffing of PPE gear; the importance of good communication with families of residents; the need to take charge of PPE distribution, rubbish control and laundry.

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A large coronavirus outbreak at an aged care facility in Melbourne's READ MORE: Coronavirus hits Melbourne's aged - care facilities. "That's been intensively © Provided by Today Victorians will not be mandated to wear face masks in public despite the deadly surge in coronavirus cases, Deputy Chief

It comes as two more people at the aged care facility have been diagnosed with coronavirus.

That day at Estia, there was none of this. The two admin staff ended up dispensing pills and Molony spent most of her 12-hour shift answering the phone. This is how she thinks she was infected: from a contaminated telephone mouthpiece that no one thought to wipe down, through an inadequate surgical mask rather than the N95 antiviral mask that should have been supplied.

a group of people standing in front of a sign: The Age, News, 31/07/2020 photo by Justin McManus. Residents of St Basil's Aged care home are evacuated to hospitals after the cluster of Covid-19 cases and deaths from the home. COVID-19 CORONAVIRUS © Justin McManus The Age, News, 31/07/2020 photo by Justin McManus. Residents of St Basil's Aged care home are evacuated to hospitals after the cluster of Covid-19 cases and deaths from the home. COVID-19 CORONAVIRUS

Nearly 900 aged residents in Victoria have been infected with COVID-19 and 109 have died.

"They could be doing it better,'' Molony tells The Age and Sydney Morning Herald from her quarantined bedroom. "They have had practice. It shouldn't be happening. If you want to know why I'm really frustrated and angry it is because they really should have known what to do and they didn't do it.''

Throughout our long COVID winter this has become a familiar refrain. The Victorian government and health authorities have made it clear that, had more of us taken their stay-at-home directions more seriously and done what we were supposed to, the fatal consequences being tallied daily in nursing homes could have been mitigated.

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Premier Daniel Andrews, on the day he announced Melbourne would be entering stage 4 restrictions, noted the staggeringly high proportion of COVID-positive people - about one in four - who weren't staying home.

"I don't want to be reflecting negatively on any fellow Victorians but we have seen some behaviour that is just not on,'' he said. "Some selfish behaviour, some choices that put us all at risk. I don't think it is too much to call that out.''

It is one thing to call it out, another to understand why it is happening.

You've probably seen videos of self-styled libertarians who object to the COVID-19 restrictions on spurious ideological grounds. There is another part of Melbourne that feels disconnected from the public health response for other reasons.

Some live in suburbs in the city's north and west where the virus has spread fastest. Some work in insecure, poorly-paid jobs such as security and cleaning and aged care. These are people who don't spend an hour a day listening to Andrews and Chief Health Officer Brett Sutton reciting the day's infections, deaths and latest edicts.

These are people whose trust in government has already been sorely tested during the pandemic.

"There is something wrong here,'' says Berhan Ahmed, an African-Australian community leader and University of Melbourne adjunct professor. "People in my opinion are not interested to listen because they don't feel like they are being given the chance to be engaged with the process. We are looking at this crisis as young people being complacent. They are not. The message is not getting to them.''

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Saeed Ali lives a block away from the Alfred Street housing commission tower in North Melbourne. The tower is one of nine where, a month ago, residents were placed in home detention by public health order, without notice or consultation, to contain a COVID-19 outbreak.

Ali is also deputy director of a youth program run by the Australian Muslim Social Services Agency (AMSSA). He saw first hand the government's slowness to engage with a community it was trying to protect.

"We do our shopping on Saturday and Sunday for the whole week,'' Ali says. "When they locked down on Saturday, no one had shopping for the week and people could not go out. That was one of the main problems. The government had a plan of locking down the building but they didn't have a plan to ensure people got the support they needed, like food and essential items.''

It took until Tuesday for the first food parcels provided by the government's chosen relief organisation to arrive at the towers. When they did, they included food the predominantly Muslim residents of the towers couldn't eat.

"I was getting hundreds of calls from residents saying where has this food come from?'' Ali says. "The food had expired and it was not halal. It had bacon in it as well. The trust between the residents and the government fell apart. That is where we had residents saying they would only take food that came from AMSSA.''

By that stage, AMSSA was already providing about 1500 of its own food packages to the towers each day. Five days into lockdown, Police Minister Lisa Neville announced that AMSSA would be responsible for all food delivery. It took that long for AMSSA to find the right people to talk to in Victoria's emergency response.

"We told them look, you guys are not doing a good job,'' Ali says. "We know what we are doing so you should support us to do what we are doing.''

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Cameron McLeod is the chief executive of The Huddle, a project established 10 years ago by the North Melbourne Football Club which runs education, career and health and wellbeing programs for young people in the surrounding, multi-ethnic communities.

He says there was "lack of cultural competency'' in the government approach towards the towers, which could easily have enlisted community influencers early in the emergency intervention.

McLeod accepts the government needed to act fas but says it had plenty of notice that the towers could become a viral hotspot. About eight weeks earlier, at the height of the first wave of infections, at least six tower residents tested positive.

"Within five hours of the announcement from the Premier that the nine towers would be locked down at least for five days, you have got 500 police officers surrounding those towers,'' McLeod says. "There is an image there that many of these people have been confronted with in the past. Then to have instructions over a PA system or megaphone telling people they must stay in their homes, people literally thought they were at war.''

Three separate inquiries are now running into aspects of Victoria's COVID-19 crisis. Retired Family Court justice Jennifer Coate is examining the hotel security debacle that seeded the second wave epidemic and Victorian Ombudsman Deborah Glass is investigating the treatment of tower residents. Victorian Coroner John Cain this week launched an investigation into the deaths of five residents at St Basil's Home for the Aged in Fawkner, the site of Australia's deadliest outbreak.

The Coate inquiry is the most politically charged, with Andrews vowing to accept personal responsibility for whatever she finds. The coroner's task is similarly fraught, as he seeks to explain to grieving family members what happened to their parents or grandparents, at the height of Victoria's aged care outbreak, in the final days of their lives. It is unlikely that any of the agencies, aged care operators or government departments involved will emerge with their reputations enhanced.

Heading here pls

Aspen Medical describes itself as a provider of last resort. It doesn't see itself as a labour hire company and doesn't run nursing homes. Its primary role in the pandemic is crisis triage; to send clinical first responders to aged care facilities where staff or residents have tested positive, to conduct a rapid audit of the capacity of the facility and its staff to contain an outbreak and to provide specialist staff to centres critically in need. For this and other services, it is paid $15.7million by the federal government.

Former federal health minister Michael Wooldrige, a lobbyist for Aspen, this week defended the company's involvement at St Basil's, telling The Age and Sydney Morning Herald that conditions at the home were terrible when it was called in. "Aspen has been exceptionally brilliant without exception, except at St Basil's, so what does that tell you?" he said.

This is difficult to reconcile with what Louise Molony experienced when she was sent to Estia in Heidelberg by Aspen. It also does not square with what another Aspen first responder reported when she was sent to assess St Basil's on July 16.

Her notes from that assessment, obtained by The Age and Sydney Morning Herald, show that when she visited the home she found an aged care provider responding by the book to what was then a single confirmed case. "Management strong and on floor supervision daily clinical oversight very strong ... Infection control PPE well stocked ... workforce very good at this stage.'' She described the infection control protocols as "exemplary''.

This report is consistent with what the Commonwealth's Chief Nurse Alison McMillan found a week later when she visited St Basil's on the morning of July 22. At the time, 51 cases had been linked to the outbreak and St Basil's staff and management had been ordered into quarantine by DHHS and were preparing to hand over care of the residents to a replacement staff, including Aspen personnel.

"I saw only excellent standards in that facility, and many staff who were very sad and disappointed at what had happened in the facility and they were required then to go and isolate for 14 days,'' McMillan said. The distressing events that followed, culminating in the evacuation of all residents to hospital and temporary closure of the home, happened after Aspen was brought in. St Basil's chairman Konstantin Kontis says Aspen is where blame lies.

At Estia, the problems were not of Aspen's making. The account of a doctor who attended the Heidelberg home the morning before Molony went described a chaotic scene. Cross-contamination was rife. By 11am no resident had been fed or given medication. Three patients who didn't have COVID-19 needed to be transferred to hospital because of neglect.

The account ends with a warning about what happens when you empty an entire nursing home of its regular staff and management. "If St Basil's go down this path ??? this will be disastrous,'' the doctor wrote.

Three days later, that is exactly what was done.

Pictures: Coronavirus (COVID-19) outbreak around the world

Aged care sector 'not equipped' for coronavirus outbreaks, royal commission told .
A royal commission is told the aged care sector is still not properly prepared to deal with the challenges posed by coronavirus, and learnt little from deadly outbreaks early in the pandemic.Senior counsel assisting the Royal Commission into Aged Care Quality and Safety, Peter Rozen QC, today said none of the problems caused by the coronavirus pandemic were unforeseeable.

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