Apply enough pressure to even the most robust systems and cracks will begin to appear. That is what emergencies and natural disasters do - stretch systems and people beyond breaking point, exposing hidden flaws and exacerbating existing weaknesses.
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Our natural tendency is to wait for a crisis to abate before holding the inquest. The logic being that there is simply no time to find a better way, no time for recrimination or forensic investigation as the fire still rages. That instead, one should wait for the dust - or in the case of last season's bushfires - the embers, to settle.
The same cannot be said for COVID-19. The concerning and continuing record spike in cases in Victoria, and the surge in case numbers globally in recent weeks, is an unwelcome reminder that Australia must do more than simply shelter in place and leave the lessons learnt to a future season.
COVID-19 has completely disrupted our way of life, taken lives and loved ones, and disproportionally impacted those in our communities who are most vulnerable and disadvantaged.
But as much as we are in uncharted waters, the reality is that we are also learning more about our new normal with each passing day.
It is fortuitous then that the Royal Commission into Aged Care Quality and Safety, established in October 2018, is examining the impact of COVID-19 on the aged care sector ahead of its final report due in February next year.
Fortuitous and much needed, providing us the opportunity to address the cracks that have appeared and the deficiencies that have been identified.
Palliative care should be core business in aged care, and its importance has been emphasised during this time.
And not in preparation of a hypothetical future pandemic, but rather to urgently address - as the situation in Victoria makes clear each day - what remains an ongoing and constantly evolving crisis.
Palliative Care Australia, the peak body which I chair, has been engaging with the royal commission via a range of submissions, which have provided eight key recommendations in relation to palliative care in aged care. PCA has now provided a further submission that includes 11 key recommendations.
Our submission is informed by the clinical, research and academic expertise of the Australian Coronavirus Disease 2019 (COVID-19) Palliative Care Working Group, which we established in March in response to the pandemic. The submission also draws on the work of our member organisations (representing all state and territory palliative care peak bodies) and professional affiliate members.
Chief among our recommendations is a call for greater funding and resourcing of residential aged care facilities, together with an increased investment in palliative care in aged care to ensure residents are provided high-quality palliative care, when and where it is needed.
COVID-19 has highlighted the lack of adequate telehealth capability in the aged care sector, at a time when video and telehealth consultations would have assisted greatly in optimising clinical care while at the same time minimising risk for vulnerable residents.
The pandemic has also exposed weaknesses in the state and territory regulations governing the storing of medications (imprest stock) in residential aged care facilities. Access to medication for aged care residents is critical. Already an issue in normal times, it is further exacerbated because of COVID-19, and more must be done to ensure that adequate and appropriate palliative care medications can be stored safely, securely and in suitable quantities.
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Notwithstanding the need to take active measures to protect residents, their families and staff during COVID-19, there are also concerns and ample evidence that we haven't quite got the balance right. What is needed, beyond a more standardised approach across facilities, is a compassionate response to the visiting arrangements for dying patients and those receiving palliative care.
Communication about a resident's health status and preparing for future clinical problems with residents and their families through the provision of information around their specific conditions and treatment options are the backbones for excellent care in residential aged care. Such communication is essential whether it is in facilities with suspected or confirmed COVID-19 infections or those that are COVID-free. In truth, the need for clear and regular communication protocols to engage with families has never been so important.
And, of course, residents in facilities with COVID-19 cases should still be provided with the daily care, services and medication they require. A pandemic places extraordinary stress on a sector for which there were already concerns about access to sufficient and adequately trained staff, critical in delivering care.
Palliative care should be core business in aged care, and its importance has been emphasised during this time. COVID-19 has also brought many deficiencies in aged care into sharper relief.
We now have the opportunity and impetus for the aged care and broader healthcare sectors to continue to work collaboratively with governments in order to urgently address these gaps and failings laid bare by COVID-19.
That opportunity must not be missed.
- Professor Meera Agar is a palliative medicine physician and the chairwoman of Palliative Care Australia.
