Covid-19

Rest homes ‘rebuked’ for shutting doors early

The Health Ministry ticked off the aged care sector for restricting visitors to rest homes before the national lockdown. David Williams reports

On March 17, the coronavirus outbreak was seemingly in its infancy – yet it was closer to pushing politicians into drastic action than many thought.

Ministry of Health director-general Ashley Bloomfield announced three new Covid-19 cases that day, bringing the country’s confirmed cases to 11, with two probable. One of the new cases was a Dunedin man in his 40s, whose son, a pupil at Logan Park High School, was in self-isolation. (The next day, the pupil tested positive and the school went into a 48-hour lockdown, as 150 close contacts were traced.)

Tensions were high, and rumours swirled of a looming national lockdown.

Given what was happening at residential care homes overseas, and research suggesting the virus is more severe for older people, some rest home companies in this country decided not to take any chances.

Radius Care managing director Brien Cree sent a letter to families on March 17, a Tuesday, detailing restrictions on visitors to its 1700 residents at its facilities across the country.

“In response to the risks facing the people in our care, Radius Care will limit visits from anyone who is not a staff member or resident of its 22 facilities across New Zealand from today,” he wrote. “We humbly ask that you do not visit your loved ones except in the most urgent of situations.”

The restrictions went beyond Ministry of Health recommendations, Cree admitted. “I appreciate that this precaution may be distressing to you. Be assured we are taking this precaution to keep your loved ones safe and healthy.”

Not all families reacted well. One woman broke in to a Radius home, some tried to pass items through windows, and staff were abused for the restrictions.

Another party grumpy at the move was the Ministry of Health, which sent Radius an email on March 18 reminding the company of the official advice, and how important it was for families to stay in touch with their loved ones. Copies of the email were sent to the Aged Care Association and Care Association NZ.

Cree tells Newsroom he took it as a rebuke, but didn’t budge.

“I felt that that was the right thing to do so that's what I did. Yes, I did get criticised for it and, at the time, it was pretty annoying but it didn't encourage me to change my position. I still felt that I did the right thing.”

(In another bold move, Radius flew in a plane-load of PPE from China, so it didn’t have to rely on district health boards, or DHBs, creating stockpiles in the North and South Islands.)

The ministry’s email, released to Newsroom under the Official Information Act, was sent two days before Prime Minister Jacinda Ardern unveiled the alert level system, and five days before she announced the national lockdown. On that day, two cases of community transmission were confirmed and the health advice was clear – lock down the country or face an inundated health system and tens of thousands of deaths.

“I'm reluctant to be particularly critical,” Cree says of the ministry rebuke. “They were slow to respond and they did try and push us around a little bit, but common sense prevailed.”

(There’s a mismatch of language. The ministry email talks of a total lockdown, which would be against official advice. Cree’s letter to families said Radius would limit “visits from families and friends for non-urgent matters”.)

“Currently the ministry does not advise a total lockdown (ie. Prohibiting all visitors entering facilities). This is because there are no community outbreaks in New Zealand at the moment.” – Ruihua Gu

The ministry email was written by Ruihua Gu, a manager at the watchdog HealthCERT, on the afternoon of March 18, a Wednesday.

It was nuanced, of course, recognising the risk Covid-19 posed to older people and the importance of residential care facilities attempted to limit the spread through precautionary and strict screening measures.

Gu wrote the ministry acknowledged the work companies were doing to keep residents and staff safe.

“Should facilities have to totally prohibit visiting at any stage, this needs to be done based on clinical evidence and advice from the Ministry of Health. This is important to balance people’s rights and protect everyone’s health and safety.

“Currently the ministry does not advise a total lockdown (ie. Prohibiting all visitors entering facilities). This is because there are no community outbreaks in New Zealand at the moment. If that changes and/or stronger restrictions on visitors are required, the ministry will review and update its advice.”

Rest home auditing agencies, known as DAAs, were also copied the email, with the added note: “We don’t want to be punitive to providers at this time if their practice is against advice but also want to address issues appropriately.”

Coincidentally, on March 18, the Aged Care Association released a Covid question and answer sheet from its clinical adviser Rhonda Sherriff, which adopted the ministry’s line.

It told association members that visitors should be “diligently screened” and signage should be posted at entry points. “Should New Zealand move to widespread community transmission you will need to implement stronger restrictions on visitors, but this has not happened yet,” Sherriff wrote. “The MOH will provide recommendations should this occur.”

Simon Wallace, the association’s chief executive, says as private operators, it was their prerogative to take tougher measures if they felt it was necessary to protect the health and wellbeing of their residents and staff.

He interpreted the email as a ticking off “for doing what they genuinely believed at the time was the right thing to be doing”.

“I don’t think that it’s fair, given what we were seeing that was happening in care homes in overseas jurisdictions, particularly at that time, if I recall, in Spain and Italy,” Wallace says. “They were quite within their rights to be able to be doing that.”

Ministry of Health group manager of quality assurance and safety Emma Prestidge says in an emailed statement: “The ministry acted based on the clinical evidence and advice available and in accordance with the all of government response plan at that time.”

Radius was advised a full lockdown wasn’t required, Prestidge says, and was provided with the relevant official advice. Cree clarified in an email “that none of the facilities were locked down”.

A Radius Care facility in central Christchurch. Photo: David Williams

Sam Jones, a director of union E tū, says it was the country as a whole, rather than rest homes, that did a great job of locking down. While only six rest homes had confirmed cases, 16 of the country’s 22 Covid deaths were from aged care facilities. The biggest cluster was at Christchurch’s Rosewood rest home and hospital, which had 12 deaths.

(During the national lockdown, whānau were unable to be with loved ones when they died. Cree says: “It was terrible. I've been in the sector for probably 30 years and it was really, really difficult.”)

Aged care providers can be commended “a little bit” for imposing restrictions early, Jones says. “I would say that them locking down earlier than asked contributed to the lack of clusters,” he says. “And it is fair to say that the ministry and DHBs in general were a bit, I think, taken aback by that decision.”

However, he believes many of the companies took too long to connect residents to their families using online video chat. Health experts have warned it can be dangerous for older people to have an extended lockdown because of loneliness, social isolation and having less contact with their GP.

Jones says the Covid inquiries to date haven’t had wide input from residents and workers and don’t tackle the root causes of the problems at rest homes. The fragmented industry, contracts with for-profit companies, and worker stress and fatigue. The fact some care workers are still out-of-pocket for Covid stand-downs.

“I don't think they've learned anywhere near enough,” he says. “I don’t think they’ve even scratched the surface.”

Cree, managing director of Radius, says if Covid re-emerges it will act quickly. The company is far better educated now, he says – as is the ministry. “We all have learnt about something we didn't know about.

“From a Radius point of view, we've set our own, if you like, lockdown levels now, which have protocols around how we would act if certain things occur. And whilst we're not panicking on a day-to-day basis or anything, we are very aware that the Covid-19 that New Zealand is experiencing is very different to the Covid-19 that the rest of the world is experiencing.”

Planning for a pandemic is quite different to the reality, Cree says. “Everyone did their best. I know there were a lot of mistakes made but, yeah, it’s just the way it is.”

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