Even though older people in New Zealand are not highly over-represented among actual Covid 19 cases to date, all the people who have died of the virus have been more than 60 years old, and more than half lived in aged residential care. Six rest homes had Covid-19 cases, two of which accounted for 16 of the 22 Covid-linked deaths. Once the virus invades these homes, it spreads rapidly, not only to other residents but also to caregivers and nurses. Worldwide, Covid-19 death statistics for older people in residential care are alarming. In Europe, official counts indicate people living in care homes account for 54% of all Covid-19 deaths and it is estimated that the real toll may be much higher. In the UK, an estimated 22,000 people have died in aged care homes – double the official figure. These figures have highlighted shortcomings in aged residential care and how these facilities relate to general healthcare services.
Ageism and Human Rights in residential care
Recent submissions by the EveryAGE Counts campaign to the 2020 Royal Commission into Aged Care Quality and Safety in Australia highlight the issue of human rights and ageism in aged care, especially in relation to the COVID-19 pandemic.[1] Here are the main points made in the submissions, which are worth thinking about in the New Zealand context.
- The absence of personal agency and voice of older people in residential age care decision-making during the pandemic
EveryAGE Counts maintains that the voices of older people in residential aged care have largely been absent from public debates on key issues, such as visitor policies, resident movements and the location of medical treatment for COVID-positive residents, while acknowledging that this engagement is not always easy with residents who are frail. Families of residents had only a limited voice in the media – largely associated with the failure of information flows.
The absence of older people’s voices in debates about how to balance safety and wellbeing is seen by the campaign as a clear violation of the sovereignty of older people in the context of care. The submission calls this symptomatic of “infantilising stereotypes” of vulnerability and dependency in which older people become the object of care and not agents of individual or collective decision- making. The result is to entrench public views that it is appropriate to make decisions for and about older people in the residential care setting without their active engagement.
- How COVID-19 outbreaks are managed in residential aged care.
The submission criticises the acceptance of a segregated system of care for older people, constructed as a one-way journey, with tighter segregation as the only containment strategy available. They argue that this means that COVID-19 infected residents were not moved from residential care to a hospital. “Residential aged care facilities are homes, not acute medical facilities”. They do not have the medical resources required to deliver acute care, specialised medical equipment, or sufficient levels of personal protective equipment to cope with a significant outbreak. Nor are they funded to enable clinical care to be delivered. The campaign suggests that this illustrates a view that residential care is somehow able to transform itself into an extension of the critical care infrastructure in the tertiary health system, resulting in a denial of the right to proper medical treatment and protection against infection to an entire community of older people.
AGE Platform Europe, a European network of non-profit organisations of and for people aged 50+, has also highlighted this concern. Its Secretary-General argues that aged care lockdown measures in Europe did not aim to save older persons’ lives. Instead, the purpose of those measures was to enable the health systems to cope with the pandemic.
“When we look at the number of people who lost their lives because of COVID-19, half of them were older persons who were never brought to hospital”.
The question then is whether individual residents actively choose to remain in residential care – on the basis of advance care directives and/or discussion with them and their families – and whether the option of hospitalisation is freely available to them. Further, did keeping Covid-19 patients in residential care exacerbate the spread of the virus among a congregated, highly susceptible group of people?
The conclusion reached in the submission is that ageist assumptions are influencing who should receive critical hospital care in a pandemic, treating aged care residents on a collective rather than individual basis and deeming them not suitable for medical treatment in hospital – an option available to older people in the community.
- The impact of physical isolation on residents
The issue of visitors in residential aged care during the pandemic presents difficult dilemmas for all involved. People dying in residential aged care have largely been unable to have family with them because of fears of contagion. But blanket bans on visitors have a significant effect on mental health and wellbeing.
EveryAGE Counts calls for a much broader and deeper conversation about balancing mental wellbeing, social connectedness, quality of life and the rights of older people when public health responses rely on isolation as the key protective measure. In other words, individual rights and wishes have to be balanced against a collective approach. There needs to be an investigation of innovative ways of enabling safe personal contact between residents and visitors and also identifying the impacts of isolation policies and practices.
The submission continues by asking “…how could we build a residential facility that lets people live the way they want to.” To “design out” as much infection risk as possible, “without resorting to strict and prolonged physical and social isolation.”
- Reform of the aged care workforce
The pandemic shone a light on the low social value placed on aged care, older lives and working with older people. Hence the need to address significant issues regarding the aged care workforce, and the reforms required for its sustainability, such as remuneration, skill levels and work stress.
Media reports around the world portray older adults as frail, helpless and unable to contribute to society. There are headlines depicting older people as a threat, needing to be isolated. Age UK, in a recent article, has said that prolonged shielding of older people could lead to victimisation.[2] How much more is this likely in the residential aged care environment?
I also invite anyone to register for the Vision for Ageing In Aotearoa Conference to hear more about the views of Aged Residential Care as part of our panel discussion ‘Taking a Breath: Reflects on Covid-19’, Simon Wallace, CEO of the Age Residential Care Association is a panelist. This conference is a collaboration between Age Concern New Zealand and New Zealand Association of Gerontology.
[1] The impact of COVID-19 on the Australian aged care system. EveryAGE Counts Campaign Coalition submission, 29 June 2020.
[2] https://www.theguardian.com/society/2020/apr/28/longer-lockdown-for-over-70s-could-create-sense-of-victimisation
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