Aged care clusters introduced by staff or visitors - review

6:33 pm on 11 June 2020

An independent review of Covid-19 clusters in aged care facilities confirms that the infections were introduced to the facilities by staff or visitors.

Chch Rosewood aged care facility with COVID-19 cases

The Rosewood Rest Home in Christchurch was a site of a significant cluster that proved to be New Zealand's deadliest. Photo: RNZ / Nate McKinnon

Sixteen of the 22 deaths attributed to Covid in New Zealand were linked to rest homes.

The Ministry of Health review, released today, examines five clusters, as well as a similar number of facilities which were largely unaffected.

According to the report, people at the facilities were exposed to the virus by infected staff or visitors. However, it noted no blame was being attributed to any staff involved.

Data from the Institute of Environmental Science and Research showed that at three of the facilities, it was staff who were first infected with the virus.

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The report said aged care facilities were not familiar with concepts such as outbreaks, clusters, probable versus proven cases, and other epidemiological terminology.

"Few facilities had fully comprehended the impact a probable case would have on their facility, or the impact of one member of staff becoming symptomatic with Covid-19 (and test positive)," the report said.

It detailed how the most notable adverse impact of a staff member's positive test was the stand-down of a high proportion of the facility's staff.

Communications and resources provided to aged care providers and management were at times confusing and not always clear or consistent, the report stated.

"Some noted a lack of available PPE leading into the pandemic contributed to an inability to practice wearing PPE in some facilities. Relationships with the local DHB infection prevention and control staff were variable."

The report was commissioned by the Director-General of Health in April, with the aim of being better placed to manage any further clusters of Covid-19 in aged care settings.

The ministry will be seeking feedback from aged care representatives, DHBs and Public Health Units on the review's recommendations over the next three weeks for a response and action plan for improvement.

The independent reviewers and ministry acknowledged the work of staff in preventing and managing clusters, and their willingness to participate in the review.

According to the report, few rest homes had fully comprehended the impact even one probable case of Covid-19 would have on their facility with large numbers of staff stood down - for clusters, up to 40 percent within two days.

It said most staff were stressed at the beginning of the outbreak, some described an "atmosphere of fear", and many felt the health authorities were unsure what to do.

Union reactions to report mixed

E Tū union represents thousands of aged care workers and its director Sam Jones was disappointed the report's recommendations did not suggest seeking input from those working in aged care.

"If you really want to make these environments safe for everyone and provide the respect and support that our elderly deserve when they retire, you need all the stakeholders involved," he said.

"There needs to be a strong input and voice from workers and their unions and the residents and their advocates as well."

The review made recommendations on what could be improved to avoid or better manage any similar future events, including developing more national-level pandemic management planning for aged care between the public health authorities and providers.

Nurse union New Zealand Nurses Organisation kaiwhakahaere Kerri Nuku said although some nurses took part in the review, she was disappointed the organisation was excluded from participating.

"Staff that work in these aged care facilities are largely on low wages and many need to hold down second jobs. None of those issues seem to be addressed," she said.

Nuku said more aged care staff would be needed to cope with any future outbreaks of Covid-19.

The aged care association represents 650 rest homes and its chief executive Simon Wallace said the report acknowledged the work rest homes had done to improve health and safety in recent months.

"There is certainly mention of national level guidance, that's something the association has been calling for right from the very outset."

"There are things there that we will take up and all of us will be better prepared it we have another outbreak."

Wallace said out of more than 36,000 residents, 39 were affected by Covid-19 and overall, the aged care sector did its best given the unprecedented nature of the pandemic.

The Ministry of Health review is one of three separate reviews of aged care facilities in process in response to the pandemic.