This post deals with the argument that Aged Care Facilities should be able to prevent visitors when they want to. The argument is that if Covid gets into an Aged Care Facility, it will have a drastic effect on all of the residents in the facility.
Aged Care Facilities in Australia since early 2020 have been banning family visitors from their facilities without any statutory authority. Many people have been so scared of Covid that they think this is “reasonable”, “justified”, and an “appropriate balancing of risk”.
In these website pages I explain why these restrictions by Facilities are unlawful, cruel or unjust. In this post, I answer some of the arguments that have been used to justify these visitor restrictions.
Facilities assert that visitors are not carers, and that only the staff are carers.
The argument that “family visitors” should not be allowed to visit residents assumes that family are not carers.
The State and Territory government directions for Aged Care Facilities have by and large allowed visitors for the purposes of “care”.
There has been an assumption made by Facilities and some members of the public that the only carers of the aged are those who are being employed by the Facilities. (They make this assumption to justify banning family members from visiting the elderly.)
This is wrong.
But it is a fallacy that the Facilities like to maintain.
I can think of some reasons for this. But for now, it is enough to state clearly that family visitors are carers of residents. They don’t visit just to entertain themselves for the afternoon. Believe me, watching a movie is not as stressful as visiting someone in an aged care facility.
We can say with certainty that it is clear that there is widespread abuse and neglect at the hands of Aged Care Facilities nationally. Many investigations have concluded this. The Royal Commission into Aged Care Quality and Safety confirmed this.
The Providers blame funding issues, but this is no excuse for Providers who are making large profits, or funnelling profits back into property investment (which happens with non-profit Providers, including church-associated bodies). Others blame a lack of trained staff, ignorance or lack of interest.
Will the Government fix the system? I doubt it. We can live in hope that they will. But whatever you blame, and however long the Government takes to fix it, we have to admit that people living in these Aged Care facilities continue to suffer all sorts of terrible and sad things.
It is therefore crucial that the visitors to residents have full and free access to visit when they are able to do so.
Family and friends who visit people in Aged Care provide physical, mental and emotional care that the Facility cannot, or will not, provide.
Visitors are actually carers, and they are essential to provide physical, mental, and emotional care to the people who have been forced to spend their last days in an institution. More about this below.
Family who visit people in Aged Care will pick up substandard care and can ask the Facility to lift their game. Being an auditor is providing care.
Visitors are essential to check that the Facility is doing their job. They are essential because they can often do something about it when the Facility fails.
You see, if you live in a Facility, and you are 80 years old, and frail, and you depend on that facility to feed you, wash you, clothe you and put you to bed; you won’t feel able to stand up to them and complain about their substandard service day after day. You will be scared of making waves. And you will try to cooperate with them and keep quiet as much as possible.
The place is your “home”, like it or not. It’s where you live, and you have nowhere else to go.
And if you have dementia, or something impeding your brain’s function or your ability to speak; you will certainly not be able to advocate for yourself.
You need someone to speak for you. Someone who is not employed by the Facility. Someone who can advocate on your behalf to the Facility.
For example, when I visited Mum and Dad, I would be asking the Facility nearly every day to please do one or more of the following:
- clean the room
- empty the bin
- provide a cup of tea at morning tea
- provide milk to go with the tea
- provide a spoon with the breakfast cereal
- answer the call bell
- provide pain relief
- fix the dangerous leaky bathroom floor (which went on for months, and was only sorted when I mentioned Mum might fall and break a bone)
- don’t yell at my Dad
- wash the clothes
- don’t lose the clothes
- don’t wreck the clothes
- provide hand towels
- provide towels
- clean the floor
- mop up spills on the floor
- clean Dad’s big toe every day like the doctor said, otherwise he will lose the toe (turn your back for a moment and they will cut corners and clean every other day, causing the toe to bleed and risk needing to be chopped off – fortunately I picked this up, insisted they follow the gp’s orders, and after daily cleaning the wound cleared up, just like the doctor said it would)
- don’t say you are coming back to talk to my Mum and then forget. She was sitting waiting for you for ages and you never came back…
As well as keeping the Facility to account, a family visitor cares directly for people in the facility.
I had to complain regularly to the non-profit provider who couldn’t be bothered properly managing their facility. Their substandard care ranged across issues from health to hygiene to diet to exercise to medical treatment.
Of course none of this covered the following things that my family did for Mum and Dad – direct care, if you like:
- got a great radio/speaker
- played jazz and music that Mum and Dad loved
- watched tv with them and talked about the news
- told them of family and friend updates
- gave them things they liked
- connected with them emotionally
- brought my little dog, who Mum called “her boyfriend”
- took them for walks
- brought different food (after a battle, but that’s another story)
- organised stuff
- reminisced about the past
- stayed for a while and talked
- took them on outings
- organised birthday lunches
- said goodnight.
No staff member can do all of these things. They are not family. They don’t have the time. It’s not all part of their job.
Representing someone to a doctor or hospital is a form of care, too.
I was also a medical treatment decision maker for Mum and Dad. I often met with doctors, went to medical appointments, spoke to doctors on the phone, and helped with navigating the complex medical issues that can attend old age.
This was also a form of care.
Staff of Aged Care Facilities are not generally medical treatment decision makers, and do not generally do this type of assistance with medical care.
The Royal Commission found that family visitors are critical carers.
Here are some key points from the Royal Commission:
- “Informal carers are a critical element of the care system for older people… They supplement the care provided by… services, and maintain critical social and community connections” (Royal Commission Final Report pg 64);
- “It should be easy for older people to access the care they need” (RCFR pg 65);
- “Substandard care and abuse pervades the Australian aged care system” (RCFR pg 68);
- Abuse is not uncommon;
- Providers do not care adequately for people with dementia;
- People’s mental health needs are not being met, and depression is common;
- The routine care of older people “often does not meet” expectations in areas such as diet, oral health, skin care, medication management, continence, infection control, and social and emotional needs;
- Maintenance and improvement of mobility is too often ignored… (RCFR pgs 68-72).
Visitors to Facilities can make sure that care needs are met, and complain when they are not met. They hold the Facilities to account, and do their best to stop or prevent substandard care and abuse. They are ESSENTIAL CARERS for sure.
If a Facility denies that you are a carer, what motivates them, I wonder, to do this?
So far, I have established that family visitors can be true carers, in a way in which staff can never be.
But there’s another important point to make about all of this. Who gets to decide whether you, as a family member, are a carer of your loved one?
A Facility doesn’t get to decide who is a carer.
Sadly, Aged Care Facilities seem to think that they can decide who is a carer and who is not. A manager of a Facility might read all the comments above and say: “I don’t care what the law says, or what the evidence shows, I am going to ‘decide’ that Mary and Bill are not carers of their Mum. I am going to decide that they are just non-essential visitors.”
That’s the way the system has been working since the beginning of 2020.
Well, the Facilities don’t have the right to decide who is a carer and who is not. It’s outrageous for them to “declare” that dedicated family members are not carers. Unfortunately, many family members find themselves having to mount an argument to a stranger who runs an Aged Care Facility; a stranger who, by the way, is probably unaware of all that the family member does to care for their loved one. The family members find that they have to collect evidence and make points and confront a complete stranger, to justify that they are caring for their Mum of 60 or more years. It’s utterly outrageous!
The Facilities should stop overreaching their powers, and just be rational about this. If a family member visits to have a chat to Mum or Dad, then they are a carer. Plain and simple. You don’t need any more evidence than this.
But if that family member complains to you about your substandard care, then their status as a carer is elevated to another level. And you have no right to call them irrelevant to the resident’s care: they are calling you to account, and their presence is needed even more.
So if you, an Approved Provider of Aged Care, or a manager of an Approved Facility, want to insist that family members are generally not carers, then you are wrong.
And if you, an Approved Provider of Aged Care, want to treat family members differently from staff, in terms of covid risk, consider the comments below.
Staff vs family visitors – balancing risk?
The argument put by Aged Care Facilities is that family visitors should be prohibited because they might bring Covid into the Facility.
In most cases, Covid-19 has been brought into Aged Care Facilities by staff of the Facility (including agency staff).
In most cases, visitors to residents have not brought Covid-19 into the facilities.
Therefore, experience tells us that allowing in family visitors does not bring a higher risk of Covid-19.
And there are some very important practical reasons for this, which I set out below.
But first, I want to make the point that Aged Care Facilities have no right or power to assert that they are gatekeepers in terms of public health risk.
An Aged Care Facility doesn’t get to “balance risk”, unless they have the power or authority to balance that risk.
Sure, a Facility might be able to temporarily lock down a facility if there is a crazy gunman wielding a gun in the foyer. They can make decisions in emergencies when there is imminent risk of harm.
But guessing about a potential covid risk from an unknown person is another matter altogether. And locking down a facility due to fear of that unknown and unspecified risk is not something a manager is qualified or empowered to do.
It’s the government who is properly qualified and authorised under legislation to assess public health risk, not the facilities. And the State and Territory governments, around Australia, have already balanced risk and made proper medical and public health assessments when they have issued public health directions.
So it’s clear from the above that Facilities are not in a position to close their doors by guessing at risk analyses. But even if they were, they are getting it wrong.
Facilities argue that there is an unacceptable risk that family members will bring in covid.
Argument no 1 – Staff are more risky than family visitors, because staff are touching many many residents per week, across different facilities. Visitors typically don’t touch any residents, or at most, one.
Think about it. When my Mum and Dad were in Aged Care, they had easily 10 people a day come into their room and deal with them. That’s 70 people a week. Each of those 70 people dealt with all the other residents in that facility. That’s 60 residents. What’s more, some of those 70 people worked across different facilities. Let’s assume 3 different facilities with 60 residents each. That’s 180 residents from different facilities, plus the 60 at Mum and Dad’s facility. That’s 240 residents each staff member might be touching or getting close to over the course of a week.
Let’s analyse what touching or getting close to means in an Aged Care Facility. It means wiping your bum, showering and drying you, feeding you, wiping your face, applying creams to your body, getting you into a mobility machine to take you to the toilet, putting you in a wheelchair, putting you to bed, dressing you, putting a food tray in front of you, touching the tv remote, standing in your very small room for 20 minutes (if you are lucky) to talk to you.
Contrast that staff member with me.
I was working from home. I lived with one other person. I went shopping once a week. I went for walks with my dog. I talked to other dog walkers from 2-3 metres away in the open air. I drove places in my car and went out of the car and didn’t touch anyone. I bought a take away coffee once a week.
I got close to one person over the course of the week – the one person I lived with – and only saw a few people at close quarters – like over a counter in a shop. I didn’t touch any of those people, just the one I lived with.
So there’s me, who is in close contact with one person per week; and the staff or agency staff member, who is in close contact with 240 people per week across different facilities.
Which person is at more risk of contracting Covid-19 and transmitting it to the Aged Care resident?
Argument no 2 – Agency staff are more risky than visitors, because the Facility doesn’t know anything about them
If the Facility wants to claim that they are managing risk, they are not being real.
My parents’ facility knew me. They knew who I was. They knew where I lived. They could vet me and see if I could understand social distancing rules. They could ask me questions about my life. They could work out whether I was trustworthy in terms of Covid-19 risk.
But agency staff are often provided at short notice. The Facility does not know who they are. I doubt that they even have their names before they arrive, let alone addresses. They don’t ask them questions about their lives. They don’t form a view about their trustworthiness.
I don’t think they even have a “staff list” that covers agency staff. They just call the agency and ask them to send someone urgently.
In fact, a nurse told me that when she was administering Covid tests at an Aged Care Facility in Victoria, she asked them for their staff list, and they said they didn’t have one!
No staff list at all!
And what’s more, if the agency staffer does something wrong (which happened with my Dad, when the agency staffer yelled at him cruelly), the Facility just says to the agency, don’t send that person back. There’s no accountability for their conduct, and no misconduct allegation that gets made, because the Facility doesn’t even directly employ them.
Please don’t misunderstand me. I am not complaining about agency staff. I honour every single person who provides proper care in an Aged Care Facility. It is under acknowledged work. We need everyone to help as much as possible.
But I am talking about the Facilities and Aged Care Providers who are misleading the public when it comes to risk. It is misleading to make the family visitor the evil one who might bring in Covid-19, when you are ignoring the risk that you, the Facility, are bringing in yourselves with your employees and agency staff.
Argument no 3 – Family visitors might be more likely to be vaccinated than staff
Family visitors seem to be happy to get vaccinated, and will produce certificates of proof to the Aged Care Facility if requested.
Staff are not necessarily vaccinated, for a range of reasons.
Now I don’t want to get into the debate about vaccination, except to say this. If you are pretending that you are scared of Covid-19 getting into your Facility, then wouldn’t you see a vaccinated family visitor as less risk than a staff member or agency staff member who may not even be vaccinated?
Argument no 4 – residents of facilities who are afraid of Covid from family visitors can choose to self isolate
Sometimes Facilities will say that some of the residents want them to ban visitors for everyone. However, residents don’t have the right to impose their fears on all others in the facility.
If a resident is scared of covid from family visitors, (knowing that they are likely to interact with 70 staff members or more per week), they do have the right to refuse family visitors, and they also have the right to stay in their rooms.
They have the right to stay in their room – or self isolate. They don’t have to associate with other residents or even see visitors to those residents in the corridors if they don’t want to.
I don’t suggest that this right be removed from them.
But that doesn’t mean they can impose restrictions on everyone else.
Don’t forget about the real risks of banning visitors and restricting movement
The real risks of banning visitors are much greater nationally than the risks of Covid.
350,000 people are in Aged Care Facilities across Australia. Since Covid, there have been 685 deaths associated with Covid in Aged Care Facilities. (This is the figure as at 7 August 2021.)
I use the phrase “associated with Covid”, because a person might die with several conditions, one of which is Covid. Whether or not Covid caused their death, or whether the other conditions caused their death, is not considered in these figures.
This figure is quite low. It represents .19 per cent. Or 1.9 in a thousand.
On the other hand, how many tens of thousands of people have suffered from illegal lockdowns imposed by facilities, even unto death? Onset or worsening of dementia, depression, anxiety, loneliness, malnutrition, wound infection, loss of mobility, severe weight loss, and complete loss of awareness, so that when visitors are actually allowed in, they cannot recognise them any more?
Facilities are not qualified to “balance risk”, but nor are they even beginning to be rational about this. If you care for someone, you care about the whole person. You don’t act out of fear of one vaguely possible outcome and ignore all the very real outcomes that your very lockdown creates.
Everyone I speak to about this reports that their loved one has suddenly declined due to banning of visitors. People with dementia have declined permanently. People have lost mobility. People have become lonely and depressed. People’s physical needs are not being met. They can’t communicate with their loved ones. The Facilities are providing substandard care and there is nobody to pick this up.
In some cases, people have died alone, because of the Facility’s unlawful banning of visitors. This is possibly the worst tragedy of all.
And it’s completely avoidable.