Aged care homes led by a CEO with a clinical background were less likely to experience a COVID-19 outbreak while homes that are large, in metropolitan areas or owned by a large chain were more likely during Victoria’s second wave, a Monash University study has found.

Aged care homes with a history of regulatory non-compliance or located close to a high-risk industry, such as abattoirs, were also more likely to have a COVID-19 outbreak, according to the study published this month in the Australasian Journal of Ageing.

The research explored what aged care home characteristics, such as size, location and operating model, had on the likelihood of a COVID-19 outbreak, outbreak size and mortality through a population-based cross-sectional study of all aged care homes in Victoria between 7 July and 13 November 2020.

Lead researcher Professor Joseph Ibrahim said it included looking at the clinical experience of CEOs to see whether those with it were more capable at preventing or managing outbreaks.

And while it is not statistically significant, he said they found homes that didn’t have COVID-19 outbreaks were more likely to be led by a CEO with clinical experience.

“This is a classic example of if you’re running a business, then you want an accountant in charge. But if you’re running a public health emergency, then you don’t run to your accountant for that,” Professor Ibrahim told Australian Ageing Agenda.

Joseph Ibrahim

A CEO with clinical experience is going to be more helpful in managing a public health crisis, saidProfessor Ibrahim, head of the Health Law and Ageing Research Unit at Monash University.

“Having either more CEOs with clinical experience or having a clinical person designated to run the emergency is important.”

He said it was not surprising that metropolitan facilities were more likely to have an outbreak.

“In a sense, it’s a no brainer because that’s where the largest population is and you’re more likely to be at risk of COVID,” Professor Ibrahim said.

“Part of our thinking is that those that were part of a large chain were more likely to have staff moving between [facilities], and then the homes that were in an area close to a high-risk industry goes to the idea of community transmission.

“And a home that was non-compliant with regulations would obviously be at an increased risk,” he said.

The larger outbreaks were associated with homes in metropolitan areas, accommodating 91 or more residents, with shared rooms, or owned by private providers operating 11 or more facilities, the study also found.

However, location seems to be the key indicator here rather than ownership type, Professor Ibrahim said.

“Our thinking with the size of the outbreak is that – and we weren’t able to do the statistics on this –is the majority of metropolitan homes are owned by private providers.

“The fact that it’s in a metropolitan area and a private provider, doesn’t necessarily mean it was the private provider aspect. It’s just that it was located in a metropolitan area,” he said.

The study also found that the highest fatality rates were in homes not-for-profit run homes operating many facilities, and located close to a high-risk industry.

A possible explanation is that homes in close proximity to a high risk industry might mean that health services in that area were already busy, however this is speculative, Professor Ibrahim said.

Professor Ibrahim the findings are more explorative than definitive because case numbers were not as high as in other countries where more rigorous comparisons could be done.

However, the findings can inform risk management, prioritise emergency responses and optimise future operations, he said.

“What we could have done better last year was to apply some of these ideas to stratifying risk and to allocating resources to the groups that needed them the most,” Professor Ibrahim said

“If we had identified all of those homes early… we might have been able to address them very early on in the pandemic and put our effort there.”

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