Prevention is the best course of action for dealing with coronavirus in Australian residential aged care, and facilities should lockdown and lockdown hard, says a leading aged care expert.

The situation overseas shows the importance of this, says Professor Joseph Ibrahim, a practising senior specialist in geriatric medicine and head of Monash University’s Health Law and Ageing Research Unit.

“Once the virus is in, as we have seen in America and Europe, it is devastating,” Professor Ibrahim told Australian Ageing Agenda.

“We want to do everything we can to stop it from getting in because once it is in, what we are able to do is quite limited,” he said.

Professor Joseph Ibrahim

Professor Ibrahim sees three groups.

There are older people with multiple chronic diseases and a serious COVID infection who will die regardless of what anyone does, and another group with a mild case of COVID who survive.

“It is the middle group I am worried about. It’s the ones who have a mild to moderate infection with COVID that tips the balance of their other diseases.

“With attention to detail and early support we would be able to rescue a lot of those people,” Professor Ibrahim said.

“We need to reinforce as much as possible and work towards prevention and get everyone to focus on hand washing, social distancing and paying attention to the small things that we think don’t matter.

“They are the things that are critical,” said Professor Ibrahim, who is part of a new COVID-19 podcast series and closed Facebook group targeting aged care staff and management.

“If we manage the infection control absolutely meticulously in residential aged care, we save the lives of residents, we save the lives of staff and we reduce the need for additional health services, which will be stressed,” Professor Ibrahim told.

Pandemic takes away usual support

A pandemic affects all levels of society and the resources and people facilities usually rely or draw on are busy doing other equally important things, he said.

During a gastro outbreak in one, two or five facilities in Victoria, there are 700 other places in the state that could send staff and acute hospitals are not overstretched with cases coming out of the door, Professor Ibrahim offered as an example.

“In a pandemic you need to be far more innovative. You need to be able to make decisions on evidence that is in front of you.

“We have to be making decisions in a considered way that is open and shared with other people who understand the dilemmas and [we have to be] making choices in the best possible way,” Professor Ibrahim said.  

Resource fills gap in media

This is where the Prof Joe Covid 19 Aged Care Podcast launched last week comes in.

It aims to fill a gap in aged care specific media coverage, information and resources.

There have been nine episodes published to date with Professor Ibrahim discussing COVID-19 and how it affects aged care residents and the people who care for them.

Since going live the podcast has listened to more than 1,600 times and received more than 1,200 unique users.

It is hosted by Prateek Bandopadhayay and features subject-matter experts, industry and health professionals and consumer advocates.

Among them are Napier Street Aged Care Services CEO Marie Crossland, aged care occupational therapist Sally Eastewood, COTA Australia chief executive Ian Yates and infection control nurse Noleen Bennet.

Call for strict but humane restrictions

In the most popular episode to date, Professor Ibrahim calls for aged care facilities to go further than government advised visitor restrictions and immediately implement a hard lockdown.

“We don’t believe the government recommendations are strict enough or sufficiently standardised. They allow for a wide range of interpretation, which creates confusion and loopholes in it. 

“We think you need a very strict lockdown. You need to restrict the total number of people coming in and out of any place,” he said.

However, Professor Ibrahim said the restrictions must be humane and make way for exceptional circumstances, which is covered in a subsequent podcast.

The exemptions would be around end-of-life care, for families who provide daily hands on personal care and the family of residents with dementia who may become more confused, alienated and frightened or fail to respond to calming techniques from staff, he said.

“They’re three exceptions. Clear direction on that strictly applying to every home in the country is needed. Otherwise we end up with these experiences where some facilities say we have been letting lots of people in and nothing has happened.”

But just because nothing has happened doesn’t mean it’s not going to, he said.

The challenge with understanding prevention is that when it works, you never see it, like how seatbelts prevent people dying in car accidents, Professor Ibrahim said.

“For prevention to work every single person no matter who they are has to play that role because that’s what helps everyone, helps the country and keeps everyone going.”

Stories of no problems arising from breaching or relaxing the rules gives people a false sense of security, he said.

The latest episode is on infection control and future planned episodes will look at surveillance, mental health and operating during a coronavirus outbreak among several other topics.

FB group connects workers

The Prof Joe COVID 19 Aged Care Facebook Group is restricted to aged care workers so they can speak freely, ask questions and share ideas.

A closed Facebook group aims to connect workers to share COVID experiences

It has gained more than 90 members in its first week.

“That closed Facebook page could potentially have the greatest impact of anything our team does because it connects people to share their successes and their worries. 

“The other thing is it gives you a greater sense of community and gives you more people to think through what the problems might be,” Professor Ibrahim said.

The infection control and infectious diseases specialists will help the aged care sector on the technical side, but only the people in aged care can help colleagues with working together, following instructions, being innovative, and caring for others.

“It is up to us to work as a team and find ways to make their instructions come to life, and help us,” Professor Ibrahim said.

“Those ideas come from everyone, not just technical experts.”

The other members of the Prof Joe Covid 19 Aged Care Podcast team are Jeremy Ley, Mia Gvozdic and Bernard Thomson.

Access the podcast and Facebook group at profjoe.com.au

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6 Comments

  1. I think your headline is misleading, and is unfortunate for those of us who are fighting to be able to continue to care for our family member(s). My family fits into 2 of the 3 categories Joe Ibrahim suggests should be given exemptions. We also fit into the category of providing “care and support” which our state govt. has listed as an exemption under its recently passed Direction to the Emergency Management Act: Residential Aged care Facilities and Covid-19. However our provider is intransigent, and totally inflexible. Your headline seems to endorse their position. I also think your survey could have been a little more nuanced. I think the govt’s recommendations as they are are too wide open, but I also think they are too strict. I think they need to be more flexible, but there wasn’t an option for that.

  2. It is evident by reading posts on social media that a large number of care facilities have ignored the Government recommendations and gone directly to full lock down . This is inhumane. Many are understaffed and without care givers who come daily to tend to their loved ones overworked staff will not cope and the standard of care will falter. My experience indicates some will not receive appropriately nourishment , falls, toileting and disruptive behaviours will increase. In the case of palliative and end of life care it is simply cruel to prevent loved ones from being with their loved ones at this time…I t would not be unreasonable to suggest that many aged care facilities are actually operating on reduced staff numbers. Have we not learned anything from the results of the Royal Commission? It is not difficult to put infection controls in place for visitors. Reduce visitor numbers is viable a blanket ban is cruel and unnecessary

  3. Thank you for your feedback Anne. It is tricky choosing the few options for the poll and I understand your frustration and will consider it for future polls.
    Professor Ibrahim and the podcast do call for very strict restrictions (with only three humane exemptions) whereas the government advice stipulates restrictions that provide for much more access from a much larger range of visitors.

  4. I agree with and support Prof Ibrahim completely
    The current debate on the need to allow partial controlled access by families and loved ones into aged care homes has many views put forward on social media platforms. Doing so will see Australia follow the lead of the US where a single facility with one hundred residents had 35 COVID-19 deaths, with many more staff and residents infected and became the epicentre for the infection.
    In the United Kingdom, there have been over 600 deaths in aged care facilities where restrictions have not been imposed and enforced.
    In Australia there are 44 aged care residents in 19 aged care facilities infected with the deadly COVID-19. At the time of writing at one home in NSW six residents have died and 9 staff have been infected.
    The number is going to grow unless we close each and every facility to the outside world.
    This is a time for pragmatic decisive action and not a time for the heart to rule. Sadly, we cannot always rely on the community to do the right thing if visitation is permitted.

  5. I wonder how we measure the amount of care and support? Once this is allowed it opens the floodgates for everyone to argue that they provide this. No one would argue that the current restrictions are meeting the spiritual and emotional wellbeing of elderly residents. Has anyone thought however about what happens if less strict controls allows the virus in? This will affect staff as well as residents, and while this may not be fatal for staff, the same cannot be said for this very vulnerable cohort. The Royal Commission findings cannot be used as a reason to let all the lessons learnt from other countries and advice from all the health experts around the world. There is not one person who works in aged care who doesn’t appreciate the assistance from those who do come on a regular basis and who are very sorely missed. Please help us get through this together (remotely at the moment). We are anxious, stressed and very tired, however we continue to go to work to provide the care that is so vital. It should be remembered that aged care staff also have families including elderly parents who themselves are required to isolate with little or no contact. We hear you because we are you.

  6. Athena, I’m wondering if this would meet your criteria for “care and support”. In the nearly 6 years Dad has been in the home, we (family members and privately paid carers) have contributed 18 – 32 hours/week to his care. Almost every day we have fed, hydrated and read to Dad, put away his clothes and arranged his flowers, and from time to time shaved him, applied lotion to his head and lips, cut his nails, helped him blow his nose, etc. In doing this, we have been able to check that the correct food and cutlery has been delivered, the soup has been strained (no bits to cause choking), the ice-cream not melted, and that the temperature is right. We have put on music and/or the TV, using the wireless headset we bought for him a year or so ago. (We haven’t had much success with asking staff to use the headset.) We have also checked on his seating position, the position of the footrests, his clothing, the supply of Steradent, etc.
    Our contribution has been necessary because of inadequacies in staffing levels and supervision, as has been acknowledged by the CEO of his provider, in writing. Some aspects of caring for Dad are very time-consuming, particularly assisting with meals and drinks. He is a very slow eater, taking about 80-90 minutes to eat his meal, his one bit of chocolate and a drink. The home simply does not have the staff to meet this need. Our doubts as to the capacity of the home to adequately feed and hydrate Dad arise from our experience over the years, including severe dehydration and weight loss – the latter at a time when I had a hip replacement, and we weren’t able to put in as many hours.
    I don’t think that recognising some exceptions means “opening the floodgates”. Health care has a concept called triage, which it is very experienced at applying.

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