An Illawarra aged care worker is terrified about what a COVID-19 outbreak would mean at her facility - or any other in the region.
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Sarah, who did not want to use her real name, said understaffing combined with a lack of resources and inadequate training had left facilities ill-equipped to deal with the pandemic.
"We're frightened for our own health and safety, and that of our families," she said. "And we're extremely frightened for our residents - many of whom would not survive COVID-19."
There's been almost 2000 confirmed COVID-19 cases among residents in aged care homes in Australia according to the latest available federal government figures on Friday - and 481 have died. That represents 70 per cent of the total 678 deaths in this country.
University of Wollongong aged care expert Professor Kathy Eagar said the nation's aged care system in 2020 was simply not prepared to tackle the coronavirus pandemic.
The director of the Australian Health Services Research Institute said the COVID-19 threat had only served to highlight the deficiencies inherent in the system.
"Aged care was a disaster waiting to happen," Professor Eagar said. "It has been really badly resourced and was not equipped to deal with a pandemic."
Aged and Community Services regional chair Mark Sewell - the CEO of Warrigal - said the sector was already underfunded, and the extra staffing and equipment needed to prevent COVID had "blown the budgets" of most providers.
Staff, understandably, were also on edge.
"Some frontline staff in aged care have told me that it's like having a bomb in our midst and waiting for it to go off," Mr Sewell said.
Some frontline staff in aged care have told me that it's like having a bomb in our midst and waiting for it to go off.
- Mark Sewell, Warrigal CEO
"It's a tense and frightening time for aged care as this global pandemic has affected every country and region in the world and is a huge risk to the health and safety of older people in particular."
The COVID-19 outbreak at Sydney's Newmarch House between April and June - which led to the deaths of 19 residents - underlined the impact the virus could have on an aged care facility. So far 29 aged care residents have died in NSW as a result of the pandemic.
Meantime the tragedy in aged care in Victoria is still unfolding. To date, 450 aged care residents in that state have died as a result of COVID-19.
"We have learnt a lot since the virus began late last year," Mr Sewell said. "Even though our plans are thorough and we have prepared as best we can within the stretched resources of the aged care and hospital systems, there is a shared relief that we have had no outbreaks in this region so far."
All three welcomed the additional funding for the sector announced this week by Federal Health Minister Greg Hunt - but said it didn't go far enough.
Mr Hunt announced the federal government would invest an additional $563.3 million to extend support for the aged care sector's response to COVID-19. This would include $245 million for providers to improve areas including staffing.
A study led by Professor Eagar found that more than half of Australia's aged care residents lived in facilities with a one or two star rating for staffing levels.
The study, which she presented at the Royal Commission into Aged Care late last year, modified the US five-star rating system of staffing to suit Australian conditions.
"We found that 58 per cent of residents were in homes with unacceptable levels of staffing - one or two stars," Professor Eagar said.
"Twenty-seven per cent were in homes with acceptable staffing, or three stars. Fourteen per cent were in four-star facilities and just one per cent in five-star homes."
Illawarra worker Sarah said the chronic understaffing in many homes meant that one worker often had to do the work of three or four. And that meant residents were often left unattended.
"One staff member can be responsible for 10 or more residents - so if you're with one resident for 45 minutes due to their high care needs, then there's nine others unattended," she said.
"You hear buzzers going off and you just can't get to them. It may be someone who's a high fall risk who's trying to get up; or another whose been buzzing for 20 minutes for help to go to the toilet.
"We're just run ragged by the end of our shift, and it's getting to the point that there's no safe environment for staff, or for residents. And now, on top of that, we have to deal with the COVID threat."
Sarah said as well as too few staff, there was not the right mix of staff.
"You used to need a certificate three in aged care to get a job, now they're hiring people off the street with no qualifications, no experience," she said.
"They get little training - a few 10-minute computer courses and a computer check list. They're not prepared for the role - and they're certainly not prepared for COVID-19."
Professor Eagar said today's staffing issues stemmed from the decision by the federal government in 1997 to separate aged care from health care.
"Aged care was changed to a social model of care and subsequently handed over to private providers to run on a competitive basis," she said.
"The workforce was deregulated - homes were only required to have 'adequate' staffing, and there was no requirement for registered nurses to be in homes.
"That's why they stopped calling them nursing homes and they became aged care homes ... some people argue that it's time to put the nursing back into nursing homes.
"During this pandemic the international evidence is overwhelming that the number of registered nurses a home has, directly impacts its ability to undertake infection control and manage an outbreak."
Sarah said even highly qualified, experience staff were not prepared for the pandemic - with little training, and a lack of protocols in place.
"Only two weeks ago we were given a checklist on how to correctly don, and take off, PPE (personal protective equipment)," she said. "And it's only in recent weeks that we've had to wear masks - and this pandemic started in Australia in March."
The low pay meant that staff often had to work two or more jobs - which could lead to cross-contamination at different sites if they fell ill - and poor access to paid pandemic leave increased the risk of staff coming to work sick.
Meanwhile lack of access to PPE and other resources was hindering staffs' efforts to adhere to strict hygiene measures.
"We get accused of stealing PPE if we use too much," Sarah said.
Professor Eagar said the key to ongoing management of the pandemic came down to the "four P's".
"Firstly it's about prevention - the homes should have enough PPE, adequate training, and the right amount - and right mix - of permanent staff who have access to paid pandemic leave," she said.
"Secondly there needs to be the right preparation. Every home should have an on-site assessment by the local public health service to ensure there's a plan in place.
"Then there's the primary response - the evidence is overwhelming that the first positive case needs to be managed quickly and assertively.
"The fourth P is pandemic management - if there is an outbreak how will the positive cases be separated from the negative cases."
Mr Sewell said while the federal government was responsible for the aged care sector, in the Illawarra providers had formed a collaborative with the local health district to fight the COVID threat.
"The Illawarra Shoalhaven Local Health District has been very helpful and has offered to co-operate fully with aged care homes as they prepare for an outbreak," he said.
"Their infection control teams have visited every home in the region and got a better understanding of how each home will manage any positive cases if they have them.
"... It's really good planning assistance but aged care homes will also need NSW Health to provide PPE, some additional highly skilled nurses and an offer to transfer infected residents to hospital."
This was vital, Mr Sewell said, as aged care facilities were "homes not hospitals".
"Aged care staff are very good at coping with occasional infection outbreaks such as influenza and gastro," he said.
"As we observed the early impact that COVID was having overseas, it was apparent that this virus is a rampant contagion and needed to be managed by immediate isolation.
"The challenge for aged care providers is that the treatment is much more than an influenza outbreak, and requires ventilation in an intensive care unit where deemed necessary in a very high number of COVID cases in older vulnerable people."
There was also a huge difference in funding between aged care and health care. Mr Sewell said: "A person gets funded more than $1200 a day of care in a hospital but only about $170 a day when they move to an aged care home."
At Warrigal, Mr Sewell said a range of measures had been undertaken including the recruitment of more than 200 additional part-time staff.
Existing staff who have another job had also been offered extra hours to prevent transmission of the virus from one workplace to another.
"We have stockpiled a lot of PPE, especially facemasks, gloves and gowns and asked all staff to wear masks at all times whilst at work," he said. "Over 300 staff have been routinely tested with no positive results for the virus."
Safe visiting areas with perspex screens have been installed at all Warrigal homes, and detailed screening of all managers and staff, contractors and visitors takes place daily.
"Whilst a coronavirus outbreak would start with community transmission cases and then enter our hospitals and care homes from the community, there is a very strong commitment by everyone to work together tirelessly to protect the lives of every older person if we can," he said.
"It's what we do."
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