Newmarch House: confusion over who was in charge during Covid-19 outbreak worsened outcome
Confusion about which state or federal government health authority had decision-making power plus a lack of staff worsened the deadly Covid-19 outbreak at the Newmarch House aged care home in Sydney’s west, an independent review has found.
In a blistering final report on the outbreak – 19 residents died and there were 71 cases among staff and residents between early April and mid June – the facility’s hospital-in-thehome approach was found to have been “compromised by inadequate staffing”.
The review, conducted by infectious diseases physician Prof Lyn Gilbert
and health and aged care consultant Alan Lilly, also blasted the leadership of Anglicare, Newmarch’s operator, as being “generally invisible to external parties interacting with them”, which ultimately justified the intervention of the regulator, the Aged Care Quality and Safety Commission.
It found the situation inside Newmarch was “disorganised and chaotic” during the first three weeks of the outbreak. By 21 April, 10 days into the outbreak, “confusion, lack of clarity about the hierarchy of authority, unstable internal leadership and inadequate human and physical resources had taken an enormous toll on Newmarch House residents, their families, staff and managers”.
“Open and frank disagreements … added to rising tensions” between health authorities and Anglicare about how to contain the outbreak and whether to transfer infected residents to hospital, and “onerous” daily teleconference meetings diverted staff away from their duties and gathering updates for residents’ families.
“Anglicare managers who participated in these teleconferences reported frustration about conflicting advice from different agencies and the lack of clarity about the hierarchy of authority. Teleconference participants failed to identify themselves or the agency they represented and no minutes or action items were distributed to confirm or clarify the information or actions required.”
There were failings in communication to residents’ families – who were made to feel “disempowered, helpless and let down” – which led to aheightened sense ofisolation among residents who were already suffering from “severely depleted” staff shortages.
Shortcomings in infection prevention and control “identified in the early, crucial phases” of Newmarch’s outbreak were also found, and exacerbated by the facility’s architectural and interior design.
The review recommended a specific infection control expert be assigned to aged care facilities.
One medical professional who worked at Newmarch as part of the surge workforce provided by Aspen Medical told the review: “I couldn’t believe this was happening in my country.”
The review also found Anglicare could source only four “suitable” staff from the 64 expressions of interest made via the federal government-provided Mable staffing platform.
It highlighted how significant the effect of Newmarch’s staffing shortages was on the success of hospital-in-thehome approach, infection control and resident isolation. Staffing shortages were at their worst nine days into Newmarch’s outbreak, when 87% were fur
loughed because of isolation or quarantine.
Staff shortages reached their heights because full personal protective equipment was used only by staff interacting with confirmed Covid cases, so if a resident returned a positive test all carers who had interacted with them were immediately considered close contacts and forced into isolation.
The review also found that support staff sourced from outside agencies probably spread Covid among themselves by sharing taxis and buses to travel to Newmarch, and standing less than 1.5 metres apart when lining up to be tested for coronavirus at the beginning of a shift.
“There was crowding and frequent neglect of physical distancing in communal areas,” the report said.
“The skills and experience of staff provided by different agencies were highly variable and the numbers available unpredictable from day to day.
“Some staff were not aware that there was Covid-19 at Newmarch House and left soon after arriving for duty.
“Whilst most remaining staff continued to provide care, it was reported consistently that many were fearful of entering a Covid-19 outbreak workplace. This led to increased absenteeism.”
The aged care minister, Richard Colbeck, who made headlines last week when he was unable to tell the Senate select committee on Covid-19 how many aged care deaths had occurred as a result of coronavirus in Australia, said on Monday: “We continue to integrate the learnings from Newmarch and infections in Victoria into the national response as outbreaks occur.”
Labor’s aged care spokeswoman, Julie Collins, said the report “confirms the Morrison government learnt nothing from tragic outbreaks of Covid-19 in New South Wales before the disease tragically tore through Victorian aged care homes”.
“It is heartbreaking and completely unforgivable that history has repeated itself across multiple Victorian aged care homes,” she said. “It is time the prime minister took full responsibility for this failure.
“Issue after issue identified in the report … was not fixed by the Morrison government in the critical weeks before Covid-19 hit Victorian aged care homes.”
The review also recommended other aged care homes prepare for “a minimum of 50% of its staff” to be furloughed in case of an outbreak, and urged the health department to consider expanding its surge workforce.
Although the report noted the hospital-in-the-home approach “has many advantages for elderly residents and the health system”, it found it will be effective only “if the outbreak is limited to a small number of cases in residents and staff ”.
It said staff were diverted away from the routine care of uninfected residents, andcalled for an expert panel to be convened and make decisions about transferring individual residents to hospital when an outbreak occurs.
“Emergency response and interagency operations were characterised by a lack of clarity in the relationships and hierarchy among government health agencies, including Nepean-Blue Mountains local health district, NSW Health, the commonwealth Department of Health and the Aged Care Quality and Safety Commission,” the review found.
“This created confusion for Anglicare board and managers who were unfamiliar with the state agencies and the hierarchy of decision-making in the context of a Covid-19 outbreak.
“Leadership and management at Newmarch House and in the broader Anglicare organisation was generally invisible to external parties interacting with them.”
Pat Sparrow, chief executive of Aged and Community Services Australia, said the review highlighted “critical lessons” about the importance of transferring infected residents to hospital in future outbreaks.
“We urgently need all states to follow the lead of Queensland and South Australia where the first covid positive cases in aged care facilities are transferred to hospital. Aged care homes are not hospitals. They aren’t staffed like hospitals. They are not funded like hospitals. They are homes,” Sparrow said.
Food services were threatened and meal quality was affected as contractors who supplied food required Covid-19 workplace compliance documents to allow labour hire chefs to fill roster gaps.
The review also noted a “temporary loss of the electronic resident record system” impeded the containment effort at Newmarch, as surge staff struggled to understand the needs of residents that regular staff knew.