This blog is part of a series relating to the economic impacts of the COVID-19, novel coronavirus outbreak of 2020.
In a statement released on the 25th of March, Prince Charles, heir to the British throne, was confirmed to have tested positive for Coronavirus after displaying mild symptoms. He was said to be self-isolating and working from home as usual. On the 30th of March, the same release was updated to indicate that Prince Charles was now out of self-isolation. In his capacity as patron of Age UK, a not-for-profit organisation that supports older people to “love later life”, the Prince shared a video message about the experience. He shared that he was “on the other side of the illness but still in no less a state of social and general isolation.” Despite continuing his duties via video link, he shared that it was a “frustrating and often distressing experience” in which “the presence of friends and family is no longer possible and the normal structures of life are suddenly removed”. Someone like Prince Charles is highly connected, supported and catered to in his life and yet the realities of COVID-19 are not able to be escaped. Spending time in isolation looks different for every person but when even the most supported among us struggle we must consider what the impacts will be on the most vulnerable.
For many older people, especially those in aged care facilities, feelings of isolation and loneliness are already a common experience. According to Beyond Blue, between 10-15% of older people experience depression and about 10% experience anxiety. However, for those in residential aged-care facilities rates of depression are believed to be much higher, closer to 35%. For this group, there are also additional barriers to care. For example, among those over 65 the attitudinal stigma is still a factor, with many people considering mental health conditions as a flaw or a weakness. This can mean that there can be more hesitation when it comes to sharing their experiences and symptoms as well as difficulty seeking help. Many older adults are exposed to more of the risk factors for developing a mental health condition such as experiencing physical illness or personal loss. As well as this, there can be a reduction in feelings of self-efficacy, with moves into a facility not always being out of personal choice, as well as a loss of social connection, with moves often taking older people away from their broader support networks or significant others. Another factor is the reduction of access to ordinary pleasurable activities, such as going outside and socialising with visitors and fellow residents.
As at 30 June 2019, there were 242,612 Australian in residing permanently in residential aged care – or about 1% of the Australian population. After a sixth resident of a Sydney nursing home died today, Professor Brendan Murphy, the Chief Medical Officer, reiterated at today’s media conference that “this virus wreaks havoc in aged care”. This same facility has seen sixteen residents and five staff members test positive for coronavirus, even with the Government’s restrictions on visitation and increased hygiene measures. In general, life in a residential aged care facility involves a high degree of structure with relatively rigid parameters for where and when activities can take place.
While necessary, many are understandably concerned about the impacts of these measures on the wellbeing of residents. The introduction of further restrictions to daily life, along with the reduced level of physical contact necessitated by social distancing rules, is a potentially devastating experience for many older people, with the amount of staff-resident, resident-resident and resident-visitor contact drastically reduced. The official government mandate is that residents are allowed to receive just one visit per day of no more than two people which is recommended to be limited to just 15 minutes. The reality is that for many older people in residential aged care facilities, life has gotten even smaller and it is harder than ever to experience meaningful connections with other people, something so vital to supporting emotional and physical wellbeing. With all of us feeling additional anxiety and confusion about what is going to happen, for older Australians, this is compounded by the fact that many already experience higher rates of physical illness and compromised immunity, putting them at higher risk of contracting and experiencing severe side effects of the disease.
In terms of managing the impacts of coronavirus on social relationships, older Australians are also less able to access some of the additional supports available. Connecting to one another online to receive social and medical support relies on a degree of digital literacy and access to technology that is not necessarily as available to older Australians, especially those in residential facilities. In addition, the support to set up these options may ordinarily come from visiting family and friends who are less able to access the facilities. With existing staff-to-patient ratios having been criticised as insufficient for a long time now, which can limit the amount of personal attention and time being spent with individual residents, staff will likely not have scope for providing this support within their existing duties. Furthermore, with the industry being subject to a Royal Commission so recently, there are concerns about what a lack of visitors and unannounced inspections might do to oversight of these facilities during the pandemic. Some facilities have made the decision to ban all visitors, without providing warning to residents or their families. In one instance, this was a decision made by a facility used as a case-study in the Royal Commission after evidence that the company failed to replace sick staff as a cost-saving measure. Vital activities such as feeding and toileting are often undertaken by family or additional carers who are no longer allowed access, a situation that can be further devastating to the health of residents, half of whom are already malnourished, according to an interim report from the Royal Commission.
“If we had trust in the system, people would not be as angry or upset about the lockdown,” said Professor Joseph Ibrahim, a geriatric medicine expert from Monash University. “If it’s a lockdown in an intensive care unit or at a hospital, people come to terms with that quickly and are very supportive because they have faith and belief in what’s happening behind closed doors. “We don’t have that same level of confidence in aged care.”
While the “strange, frustrating and often distressing experience” of isolation is something we are all managing right now, for those older Australians in residential facilities there are layers of further distress that are likely to be experienced throughout this crisis. We have implemented these measures to protect our most vulnerable to this virus at the cost lowering their quality of life in residential aged care. The question is, how are we responding as a community to meet the needs of this group?
Contact the Coronavirus Mental Health Wellbeing Support Service 1800 512 348 or access the online forum here.