Apology over aged care, but little hope problems have been addressed

It was clear before the pandemic hit that Australia's aged care sector was beset by problems - under-qualified, casualised staff; funding models that put profits before people; and a lack of accountability over horrific stories of neglect. This was not the best army you would bring to fight a highly-infectious disease.

And even though these problems were known, the aged care royal commission heard this week they weren't properly mitigated or planned for as governments prepared for the likelihood that coronavirus would sweep through aged care homes.

And even once the virus had killed 19 people at Newmarch House in Sydney, the lessons learned there weren't used or passed on to the wider sector, leaving Victorian aged care homes on the back foot when community transmission took over in that state.

Professor Joseph Ibrahim, an expert in aged care from Monash University, told the commission he didn't think things could get worse after last year's findings from the royal commission, but the virus had proven otherwise.

"Hundreds of residents are, and will, die prematurely because people have failed to act," he said.

"There's a level of apathy, a lack of urgency. There's an attitude of futility which leads to an absence of action."

Professor Ibrahim pointed to a lack of accountability, an inappropriate reliance on advanced care plans and treating aged care residents with the virus in the homes instead of hospitals as part of the problems and mistakes that have so far cost 205 lives of aged care residents, and of a further seven who were being cared for in their homes have also died.

More than half of Australia's deaths recorded so far are residents in aged care. Across the sector there has been more than 1400 cases in residents, and at least a thousand more among staff.

"In so many cases, these are unforeseen consequences and unforeseen issues and people do the best they can in the circumstances they find themselves," Prime Minister Scott Morrison said on Friday.

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But as the royal commission heard, many of the issues experienced in Victoria were foreseen, and could be foreseen.

Centres in Victoria had to replace their entire workforces, something they were not warned about in federal guidelines, despite the exact same issue already occurring at Newmarch House in Sydney.

In evidence that made commissioner Lynelle Briggs exclaim "oh god", Health Workers Union secretary Diana Asmar explained how staff in aged care homes were limited to just two masks per shift, and continued to face limits in the amount of personal protective equipment they used, and lacked training in how to properly use it.

Two major systemic issues emerged through the royal commission this week, and despite an apology from the prime minister, there doesn't seem to be acknowledgement at the highest of levels that they must be addressed in future responses to coronavirus in aged care homes.

The first is whether or not the federal government had a proper plan for the aged care sector and the pandemic, a point of great contention. Counsel assisting the commission, Peter Rozen QC, said the federal government did not have a plan for the sector and showed "a degree of self-congratulation and even hubris" after early outbreaks in Sydney.

Despite Mr Morrison's apology, he has maintained, along with health secretary Brendan Murphy and acting chief medical officer Paul Kelly, that the federal government did have a plan for the sector. That plan is actually titled "national guidelines", and only in its third iteration did it outline a role for the federal government. The three men have all rejected Mr Rozen's characterisation of the federal government's preparedness and attitudes.

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Decisions around transferring patients who were diagnosed with coronavirus to hospital were also still to be resolved. The sector has called for it to become mandatory for any aged care resident who tested positive to automatically be transferred, both for their care and to help prevent the spread to other residents. They reported resistance from hospitals and public health units to transferring residents away from facilities.

According to evidence to the royal commission, NSW authorities resisted efforts to transfer residents from Newmarch House to hospital, due to the "precedent" it would set. There are reports of similar issues in Victoria.

On Friday, Victorian Premier Daniel Andrews assured reporters decisions on hospital transfers were made individually.

"The clinical needs, the healthcare needs of your loved one, will drive - exclusively - any decisions that are made about whether they stay in place in their home, or whether they come to a hospital," he said.

But advocates are calling for all states to make hospital transfers for residents automatic, as they are in South Australia and Queensland, a fight that still has a long way to go.