Welcome to Coronavirus Government Global Briefing, Mandarin Premium’s coverage of COVID-19 policies both local and global.
On the public-private divide at the heart of Victoria’s aged care crisis
The wave of COVID-19 clusters across Victoria’s aged care facilities has led to a relatively-rare fracturing of mid-pandemic relations between the federal and state governments, with Premier Dan Andrews and Health Minister Greg Hunt — both of whom, it should be noted, have become visibly distressed amidst the tragedy — trading barbs over privatised facilities.
The spar — Andrews’ declared he had “no confidence” in infection control across some homes, a statement Hunt characterised as “a dangerous statement” about nurses — comes as Victorian, interstate and ADF nurses work to fill staffing gaps and residents are, with significant difficulties and exceptions, being evacuated to hospitals. Hunt also announced that crisis Australian Medical Assistance Teams (AUSMAT) — the “SAS of the medical world” — will be brought in, as the sector faces controversies including but not limited to:
- the federal government’s takeover of St. Basil’s Home for the Aged leading to inexperienced staff being brought into the facility caused general confusion and allegedly led to incidents of patients not being fed and being left lying in soiled sheets;
- miscommunication with relatives of dying patients;
- low PPE and healthcare capacity; and
- delays — or, according to last weekend’s Saturday Paper $), outright refusals — over requests to transfer sick residents to hospitals.
Significantly, Andrews emphasised that while the 769 cases have been identified across more than 80 aged care homes, just five cases were from state-owned facilities, which in turn make up just under 200 of Victoria’s total 750 sites.
How federal-state regulation determines staffing ratios
Here, it should be stressed that the exponential nature of the virus means any clusters involving community transmission will significantly dwarf more-isolated cases; as the AFR ($) noted on Monday, more than 460 of the then-683 identified cases centre on just six private homes.
Still, the massive contrast between private and publicly-owned clusters elicited immediate criticism on the lack of commonwealth-mandated staffing levels and ratios from federal Labor MP for Cooper (and former nurse and ACTU president) Ged Kearney.
Of 769 cases of COVID in Vic aged care only 5 are in public sector aged care. So what’s the difference? There's no minimum mandated staffing levels or ratios in private aged care. I am so frustrated – aged care workers & their unions have been raising this for years.
— Ged Kearney (@gedkearney) July 28, 2020
Conversely, Victorian-owned homes currently operate under the Safe Patient Care Act 2015, which mandates ratios for registered nurses; one nurse for every seven residents on the morning shift, one for every eight in the afternoon, and one for every 15 on the night shift.
As public health researcher Dr Sarah Russell explains in a piece trashing the “marketisation” of aged care at Michael West Media, the lack of similar Commonwealth legislation means that private homes can see a single nurse “look after more than 100 residents”.
Russell called for a federal version shortly after the bill’s passage all the way back in 2016, and, in the new piece, takes aim at peak bodies representing aged care providers successfully lobbying the federal government for “flexibility in staffing”:
“It is all so sad – and so avoidable,” Russel writes. “If governments had acted on the recommendations from numerous inquiries over the past decade – if they had listened to residents, relatives and staff – we would not have this horror story unfolding.
“…Aged care advocates and relatives of residents knew about the staffing crisis in aged care long before the pandemic. The government also knew. It gave $2 million to an Aged Care Workforce Strategy Taskforce. Once you waded through the report’s managerial speak – ‘the creation of a research translation ecosystem’; ‘touchpoints for consumers in their ageing journey’; and ‘a well-supported research translation pipeline’; you reached its conclusion: staff ratios were not needed. Staffing ratios will not ‘necessarily result in better quality of care outcomes.’
“As a result, some aged care homes continue to operate without a registered nurse who is on site 24 hours a day.”
One piece of the highly-corporatised puzzle
The public-private divide is obviously just one of the many workforce issues exposed by the outbreak, and should be acknowledged within the various systemic complaints of regulation, funding, design and design identified in last year’s royal commission report ‘Neglect‘.
As Crikey’s Bernard Keane argued yesterday, the spread of COVID-19 via staff increasingly working across more than one facility — currently 20-30%, according to peak body Leading Age Services Australia, a spike from just 10% according to a 2012 Department of Health study — can be tied to systemic casualisation, skills issues, and workplace retention:
“This isn’t a problem so much of funding, or even of non-profit versus private providers: it’s a complex policy problem about effective linking of the vocational training system, service provision, consumer empowerment and aged care funding mechanisms so that the sector can attract and retain people with the right competencies.
It’s a national scandal that we have known about the challenge for so long but have failed to respond to it, and it’s one we all share the blame for, not just one government or one provider.”
Further, as The Australian ($) reveals today, just one in five workers across the nation had completed the federal government’s personal protection training module on the eve of Victoria’s spike at June 4.
Still, regulation of staffing levels and ratios is invariably tied to job security and workplace sustainability, which are in turn directly linked to how the federal-state governments handles the highly-privatised sector throughout the outbreak; even after the federal government’s $205 million COVID-19 investment, Russell claims that a “recent letter” to her acknowledged “that the government outsources responsibility for a coronavirus ‘outbreak management plan’ to private providers”.
While there are significant reforms happening in real-time — Aged Care Minister Richard Colbeck’s funding package designed to retain staff at single sites is a de-facto recognition of workplace insecurity, as is the Fair Work Commission’s ruling on two weeks’ paid pandemic leave for workers on three awards required to self-isolate — sector representatives remain visibly furious over the historic lack of regulation.
Notably, Australian Nursing Midwifery Federation Secretary Annie Butler has hit out at federal inaction on the 29 ANMF submissions to aged care inquiries between 2009-18 calling for staffing ratios to better pay and conditions.
And on the skills issue, Russell has balked at the Leading Aged Services Australia early-pandemic plan to bring in a large numbers of unemployed people into private facilities, The National COVID-19 redeployment program, through a 10-hour online course:
“Considering the complexities of working in an aged-care home during a pandemic, it is inconceivable that someone with 10 hours of training is qualified to provide competent care,” Russel writes. “You simply can’t learn how to use PPE safely in an online video.”
“The pandemic has once and for all highlighted the systemic issues in aged care that were hiding in plain sight. What more will it take before the federal government finally admits that the care of vulnerable older people is too important to be left to the whims of the free market?
“It is time the government ditched the Aged Care Sector Committee’s Aged Care Roadmap that has driven aged care down the neoliberal road and over the cliff.”
State wrap: Victoria’s updated homelessness policy
Amidst the state’s horrific second wave, the Victorian government has announced a $150 million ‘From Homelessness to a Home’ package designed to both:
- extend COVID-19 crisis accomodation for 2,000 rough sleepers currently supported in hotels and motels until April; and then
- help transition them into long-term housing with
- 1,100 guaranteed leases for private rental properties;
- tailored assistance to new tenants i.e. mental health, drug and alcohol and family violence support services;
- additional funding to the Private Rental Assistance Program to “encourage more people leaving emergency hotel accommodation to set up their own private tenancy, helping with the bond and initial rent”; and
- funding to metropolitan and regional homelessness agencies.
For more on what other states and territories have done in this space, see Premium’s ‘The Briefing: will COVID-19 eliminate rough sleeping homelessness?’.
In other state and territory news:
- From today, South Australians will be banned from returning home from Victoria, and the government will tighten exemptions for essential workers.
- Although no official bans have yet been implemented, ongoing reports of community transmission in Sydney prompted Premier Annastacia Palaszczuk to warn Queenslanders against travelling to NSW.
When bans collide
Has there ever been a place on Earth in recorded history where both Anti-Mask and Mandatory Face Mask Laws co-exist? pic.twitter.com/1mOES4SrUD
— Simon Shen (@simonshen_glos) July 28, 2020