As the royal commission opened hearings into home care this week, it heard that COVID-19 would likely reposition home care in Australia’s aged care system.
“COVID is likely to reinforce people’s preference to age in place at home, and do all they can to avoid admission to residential care,” Counsel Assisting Peter Gray said in his opening statement.
Community Care Review surveyed providers about how they saw the pandemic affecting the home care sector now and into the future.
Confidence and demand
A national survey by Leading Age Services Australia in June found one in three home care providers experienced a drop in new enquiries and three quarters had clients cancelling services as a result to COVID-19.
Providers contacted by Community Care Review told a similar tale.
Benetas, which provides a range of aged care services to more than 8,800 Australians, experienced a decline in home care clients and a 28 per cent reduction in home care services in the early days of COVID, CEO Sandra Hills told CCR.
Those numbers are now being restored to normal levels – at more than 900 pre-COVID – thanks to proactive communication regarding infection prevention and control measures, Ms Hills said.
“In the early period of COVID-19 in particular we lost a number of our home care clients out of fear of contracting the virus and apprehension around the key changes being made,” she said.
‘It took a number of weeks before some 20 per cent of those clients then felt safe enough to reach out again.
Chief executive David Panter noticed a similar response at South Australian community care specialist ECH, saying initially about five per cent of its home care package clients declined services because of COVID concerns.
“Within a few weeks we were able to give them the confidence that it was safe for them to receive services at home and that it was probably more detrimental to their health and wellbeing to not have the services,” he said.
Despite the initial dampening effect of COVID-19 on home care, it’s yet to be seen whether the spread of the virus through many residential facilities, predominantly in Victoria, will drive ever more people towards home care in the future.
Mr Panter believes it will, saying COVID has given impetus to a pre-existing trend.
“Demand for residential age care has been slowly falling for some time given the preference of most older Australians to stay at home for as long as possible and potentially die at home,” he told CCR.
“The COVID experience has inevitably created another reason for people to want to stay living independently if at all possible.”
Villa Maria Catholic Homes CEO Sonya Smart says falling occupancy rates have contributed to more than $3 milion of losses at VMCH during COVID.
But she says the COVID equation isn’t that simple.
Ms Smart says the shift to increasing demand for home care has long been a direction of government and is not related to the current pandemic.
Fallout from the royal commission, as well as “sensationalised media reporting” have also contributed to what she believes is an “unjust” drop in confidence in residential care.
“I believe the reduced confidence in the residential system, based on COVID, is unjust and diminishes the amazing work and effort that has been implemented and funded by providers,” she says.
Turbo charging uptake of technology
Home care providers have had to adapt and innovate to be able to continue providing services in a COVID-safe way.
For many this has meant turbo charging their uptake of technology, ushering in a sea change that is likely to persist long after the pandemic is gone.
Geneneral Manager, Home & Community at Catholic Healthcare, Therese Adami, says the provider is using technology to facilitate contact between clients, coordinators and care advisors, and reviews and assessments are now conducted via phone or video messaging such as WhatsApp.
“We have a better utilisation of the MYCH (My Catholic Healthcare) tablet for clients which has video and email communications functionality,” Ms Adami told CCR.
“We have helped clients who have not used smart phones before to purchase, navigate and use and we have commenced trialing an App for clients that don’t have a MYCH tablet.
“We have also been promoting telehealth to our clients.”
ECH is no stranger to technology and has been one of aged care’s early adopters.
The provider recently acquired the tech start-up responsible for the Billy home monitoring system and has established an in-house tech development team which is looking at new products to support clients.
“We have always seen technology, in various forms, as being a useful tool for enabling people to continue to live independently at home,” Mr Panter says.
VMCH is also changing the way it remains connected and provides services to at-home clients, Ms Smart says.
But she adds it’s important that the human element isn’t overlooked in the rush to embrace technology.
“We are looking at how we can continue to provide services in this way, whether it is the use of telehealth appointments, the installation of (home monitoring) technology, or holding social events online.
“It is important that we can still build relationships with our clients, as we know that human contact continues to be the key for reduced isolation and improved psychological health.”
Reviewing infection control
COVID has also highlighted the need for rigorous infection control protocols for home care, possibly to a greater extent than ever before.
David Panter says ECH reviewed and tweaked its existing infection control protocols after the pandemic was declared.
The provider used in-house resources to develop training videos for staff around infection control and the use of PPE.
Communication with staff was important, Mr Panter said.
“As part of our initial response we had daily ‘huddles’ for key staff to track how we were going and to interpret SA Government regulations as they were issued,” he said.
Staff were also provided with additional paid leave to cover them if they were forced to self-isolate while waiting for test results or in the event that they became infected.
Catholic Healthcare introduced a new outbreak policy including a management plan for staff and clients, PPE protocols, feedback mechanisms and confidentiality protocols, and reviewed supplier compliance with Covid-19 protocols. It also introduced a media and communications strategy.
A new screening tool was introduced for staff entering a client’s home and visitor’s to Catholic Healthcare wellness centres are screened on entry.
Social distancing, temperature checks, registration and limits on attendees are also in force at wellness centres.
The organisation has also developed volunteer risk assessments which have allowed 50 per cent of community volunteers to return.
VMCH acted early to mandate face masks, shields and goggles.
Its infection control protocols are in line with Victorian health department guidelines, and are provided to all staff through the organisation’s online learning portal, Ms Smart says, and the VMCH critical incident management team has been central in ensuring all guidelines are met.
Ms Hills describes vigilance, control and communication as key to infection control during COVID and says Benetas continues to work hard to train teams in infection control as well as regularly checking with clients to ensure they are supported.
Benetas is also offering telehealth where possible for services like OT, dietetics and counselling.
“We’re working to offer this where possible to minimise transmission risks and ensure the important ongoing delivery of care,” she said.
Home care after COVID
Providers who spoke with Community Care Review said they believed the pandemic would bring lasting change to their services and the way they meet the needs of clients, often for the better.
“We have absolutely had to change how we provide our services,” Ms Smart says.
“In some cases, this has been quite positive, as there are numerous benefits of technology, no matter the age or ability of our clients.”
She VMCH responded to increasing isolation caused by implementing the Umps program, which uses power plugs learn a person’s routine alert an emergency contact of changes.
VMCH has also been providing activities and events for its carer support program online to enable carers and their loved ones to participate together in their home.
“This has been really well-received by our carers, especially as the carers support program is as much about social interaction as much as it is about taking a break from their caring responsibilities,” Ms Smart says.
The provider’s disability services have been adapted to be conducted online, including craft activities, exercises and cooking lessons.
Meanwhile, VMC has more than 500 employees currently working from home who remain connected via Microsoft Teams, and are supported through internal online activities, including “Mindfulness Monday” and “Wellness Wednesday”.
“Given the positive outcomes we have already seen, we are now looking at how we can permanently include these within our service offerings on an ongoing basis,” Ms Smart says.
“We hope that this will allow us to provide support to those not immediately within our office catchments.”
BallyCara CEO Marcus Riley told Community Care Review the longer term economic and social impacts of Covid19 will influence the provider’s future priorities.
“There’s been a huge demand on our focus and resources across our organisation both in terms of preventative and precautionary actions as well as preparation to respond if different scenarios eventuate,” he said.
The impact with reach to staff recruitment and retention strategies, PPE supplies and ensuring mental wellbeing for both clients and staff.
Mr Panter says ECH took action despite South Australia’s relatively low infection rates.
“During the height of restrictions we ceased our group activities supporting social connection and wellness but converted many to individualised service delivery in our centres using COVID Safe plans or in the home.”
The pandemic has also given ECH a chance to pilot new ways of working, such as telehealth for both individual and group activities, in ways that will ultimately bolster its home care capabilities.
“The overall effect has been to strengthen the organisation and reconfirm our focus on home care,” he says.