Managed facilities are well placed to assist their residents and staff during the coronavirus pandemic, write Christie Gardiner and Samantha Prime.

COVID-19 has forced governments around the world to take increasingly draconian measures to protect public health while shielding the economy from collapse. During this time, it can be difficult to interpret in entirety, how these evolving measures impact any one person.

However, what is clear is that COVID-19, like most acute respiratory infections, disproportionately impacts older members of the community whom are more likely to have a pre-existing chronic condition if not multiple, thus increasing morbidity and mortality amongst this demographic.

It is unsurprising then that government intervention is largely targeted towards safeguarding the older members of society. To date, interventions have included restrictions on open visitation to aged care facilities, with a total prohibition on entry by some, coupled with an emerging requirement that all people  visiting or working in aged care facilities be vaccinated for influenza.

As part of the Federal Government’s multi-million-dollar support package for residential aged care facilities, services are bolstered to mitigate the risk of infection but also to manage staff shortages and introduce additional services in support of resident’s physical and psycho-social wellbeing.

The same level of intervention, guidance and government-funded support is more underwhelming for most older people, who are simply being told to isolate in their own homes. This includes those living in managed retirement villages such as residential parks, land lease communities and lifestyle villages.

Everyone is now required to adhere to a range of general restrictions on movements and gatherings, unless certain exemptions are met. While Prime Minister Scott Morrison has specifically urged all people over 70 years (or over 50 for Indigenous Australians) regardless of health status to stay at home to the maximum extent, many states have a lower threshold and are urging people over 60 years to avoid leaving their homes.

Several organisations have been quick to criticise governments around the world for an over-reliance on chronological age in policy responses to COVID-19. Such an ageist approach mischaracterises the complexity of risk factors and frustrates intergenerational cohesion.

While, rapid policy responses to novel large-scale crises can often require aggregated characterisations of vulnerability based on what is known; it is important to continue to monitor the impacts of such generalist strategies to ensure those that are truly vulnerable to the pandemic and to pandemic responses are adequately protected.

For example, self-isolation directions come at a time when little guidance has been given federally or by the states concerning how people’s basic needs will be met while in isolation in the community. Many are significantly dependent on government funded, not-for-profit and volunteer-based community services, and those with more complex needs requiring higher levels of interaction with multiple support services and personnel on a daily basis are unsure of how to maintain the level of support needed while protecting themselves from infection.

The Department of Health’s recently released COVID-19 Fact Sheet: Advice for retirement villages highlights the government’s awareness of the need to better support residents and staff of these facilities.

However, the advice is limited in scope and contains conflicting and confusing messaging that is already partially obsolete – such as regarding communal gatherings. An over-reliance on this fact sheet should be approached with an abundance of caution. Particularly given much more can and should be done to mitigate the risk of COVID-19 and support those in isolation.

Managed facilities are well placed to assist residents and staff with regular education relating to social distancing, hygiene and symptom identification – as highlighted in the fact sheet. However, ensuring nominated family members are equally well-informed and included as part of a deliberate networked response by managed facilities is also critical.

Further risk reduction and response measures

In addition to education, managed facilities have a unique opportunity to bolster their risk reduction and response protocols. Engaging the services of suitably qualified clinicians to be based on-site, such as registered nurses supported by community workers, can facilitate:

  • symptom screening of those entering the site to reduce the risk of COVID-19 being introduced
  • the provision of health checks, symptom screening and counselling for all residents as a first point of contact to reduce the need for residents to travel within the community, therefore reducing their risk of exposure to COVID-19
  • assistance for residents with access to telehealth health consultations
  • the provision of holistic support for residents in isolation through ensuring essential community services remain in place, as well as the timely access to additional community support services should they be required
  • supporting the mental health and wellbeing of residents by being a consistent source of credible information and education.

The risk of isolation on the health and wellbeing of all people, including seniors is well documented. For those who experience acute and chronic illness, and for the 68 per cent of residents who live alone, their mental health vulnerabilities are likely to be further compounded during this time.

Social distancing does not mean social exclusion and it is therefore important that residents be safely supported by management to do what they have reason to value, including exercising and remaining connected to their social and support networks in perhaps new and innovative ways.

Enhanced participation and dignity

Through this crisis we are seeing a high degree of visibility of older people, but as acknowledged by the UN Independent expert on the enjoyment of all human rights by older persons, “their voices, opinions and concerns have not been heard. Instead, the deep-rooted ageism in our societies has become even more apparent. We have seen this in some cruel and dehumanising language on social media and in the exclusive emphasis on older persons’ vulnerability ignoring their autonomy.”

Participation is a central pillar of age-friendly environments, alongside health and security. Wherever policies, laws and practices impact older people, particularly in adverse ways, those impacted ought to be directly consulted.

Ensuring mechanisms are in place within managed communities to identify, review and respond to common concerns raised by residents in times of crisis as well as times of relative stability are vital to promoting age-friendly environments.

Ultimately, the scale of the crises facing Australia necessitates that the government alone cannot be responsible for protecting and supporting every individual in every way that is necessary and ideal. A high degree of leadership by managed communities has never been more necessary than it is today.

Christie Gardiner is Associate Lecturer of Law at the University of Newcastle and Samantha Prime is a registered nurse, a health researcher and final year PhD candidate at QUT.

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