The Covid-19 pandemic may have slipped from the forefront of most Australians’ minds.
But in aged care, another grim milestone has just been recorded.
This week, Australia marked its 4,000th death in residential aged care since the pandemic began. Data released Friday shows the aged care death toll now sits at 4,012, after another 32 Covid-related deaths were recorded last week.
Aged care has been the pandemic’s epicentre in Australia and 2022 has been the most deadly year by far. Nine months into the year, and the death toll in 2022 is already well above 3,000. The toll was greater than the first two years (231 in 2021 and 686 in 2020) of the pandemic combined.
So, is there any cause for optimism? What does the data tell us about the status of Covid in aged care? And what restrictions still remain in place?
Cases, deaths and outbreaks in decline after late winter spike
The data is unequivocal. This year has been the most deadly of the pandemic in aged care.
That is a function of Australia greatly easing its Covid restrictions – both in the general community and, to a lesser extent, in aged care. Doing so has allowed the virus to circulate freely in the community, making it much harder to keep out of residential aged care facilities.
The number of weekly deaths in aged care spiked to 176 in late July and the total number of deaths in 2022 surpassed 3,000.
So far this year, Covid was recorded as the cause in 6.8% of all deaths in residential aged care.
But despite that grim trend, there is cause for recent optimism.
Vaccines are working. About 84.5% of eligible residents have received their fourth dose and cases are less likely to cause death now than in the early stages of the pandemic.
In 2020, more than 33% of Covid cases in residential aged care caused death. That has dropped to 3.5% in 2022.
The sector has also clearly emerged from its recent winter Covid spike, which in early August left the sector grappling with more than 1,000 active outbreaks and weekly death figures of more than 100.
Some 219 aged care homes had active Covid outbreaks as of 21 September, a figure that is reducing rapidly.
The number of active resident and staff cases was 960 and 314 respectively at last count, also a dramatic reduction from the numbers in early August (upwards of 5,200 resident and 2,500 staff were reported as active cases, as of 5 August).
The sector is still concerned about the prospect of a spike in summer, which would mirror the experience of early 2022.
The end of lockdowns and remaining restrictions
There is little appetite within the sector to return to the kinds of aged care lockdowns used in the first year of the pandemic.
But restrictions do remain, particularly where a provider is experiencing an active outbreak.
The rules vary across states and territories, and even across individual providers.
Most have embedded rules requiring visitors, staff and residents to be vaccinated but have significantly relaxed visitation rules in recognition of the physical, social and emotional needs of their residents.
The bulk of Australia’s major aged care providers, peak groups and aged care advocacy groups have signed an industry code on visitation, dictating that:
Restrictions on visiting should be as least restrictive as possible, proportionate and in place for as short a time as possible.
Signatories to the industry code have accepted the need to require vaccines for visitors, with defined exceptions, regardless of the requirements of different states and territories.
The code requires providers adopt an “essential visitor” policy, which ensures residents always have at least one visitor, regardless of whether the facility is battling an outbreak.
Restrictions are gradually increased according to the extent of transmission in the community and whether an active outbreak is occurring within the facility itself, according to the code.
Providers who signed up to the code are told that when there is a high level of transmission in the community, they may need to reduce visitor hours and the number of visitors, or require any visitor to produce a negative Covid test regardless of vaccination status.
The health department is conducting routine audits, including on-site audits, to ensure providers are maintaining proper infection control and that staff and visitors are wearing proper personal protective equipment, though the number of audits dropped off in the last financial year, falling from 11,842 in 2020-21 to 8,364 in 2021-22.
Staffing pressures and the surge workforce
One enduring challenge for aged care is staffing.
Staffing shortages in aged care existed well before the pandemic.
But the spread of Covid-19 has exacerbated existing shortages. The pool of workers is greatly reduced at times of Covid spikes, due to active cases among the workforce, while those who remain are put under increased pressure to implement restrictions and help manage cases among residents.
The government has relied greatly on a surge workforce – made up primarily of private contractors – to plug the gaps.
Since the start of the pandemic, the surge workforce has filled 138,658 shifts in aged care facilities. The surge workforce is currently filling about 1,400 shifts a week, well down from the more than 2,700 shifts being covered during the late winter Covid spike.
The use of the Australian defence force has been more limited. On average, about 30 ADF personnel were deployed in aged care facilities during the winter spike.
