A potential gap in the country’s defence against the coronavirus might soon be plugged by allowing regular screening at rest homes. David Williams reports

Ministers and officials are considering allowing in-house Covid-19 testing at rest homes.

The Aged Care Association has been calling for registered nurses at more than 650 facilities around the country to be given coronavirus testing kits, which would mean they could test asymptomatic workers. The association has been in talks with Associate Minister of Health Jenny Salesa and the Health Ministry, and it appears the idea is under genuine consideration.

Salesa tells Newsroom: “I support the further testing of this dedicated workforce to ensure both staff and residents in aged care facilities remain protected as best we can. I am working with the ministry and taking their advice on how best to achieve this.”

Staff at aged residential care facilities – which number about 20,000 – are already in a priority group of people eligible for asymptomatic testing.

Ministry of Health’s Clare Perry, the community health system improvement and innovation group manager, confirms increased surveillance testing of rest home staff is being discussed with ministers. “The practicalities about how best to do this are still being worked through.”

A recent survey of E tū union members across the health sector, including aged care workers, found 85 percent supported compulsory testing.

E tū national director Sam Jones says that’s a fairly strong mandate, but the move would need to be paired with job and income security. “They’re not going to be so keen to be tested if they’re going to be stood down without pay or on a subsidised wage that’s reduced.”

Public health professor Michael Baker, of the University of Otago, Wellington, says there might be an argument for systematically testing aged care workers in Auckland, given the community transmission of the virus in the city. “I’m not sure how strong the rationale would be for the rest of the country at the moment.”

Now, testing of asymptomatic people is focused on people recently arrived from overseas in managed isolation facilities, contacts of known cases, and frontline border staff.

“It’s really quite a moot point as to who you would test after that,” Baker says.

Risks to rest homes

It’s easy to see why protecting rest home residents is a good idea.

There’s this country’s own situation, in which 16 of 22 deaths were in rest homes, including 12 at the country’s deadliest cluster, Christchurch’s Rosewood rest home and hospital.

However, the industry would point out while every death is a tragedy, coronavirus has affected few rest homes in New Zealand, and a tiny number of residents.

The virus has been devastating in places like the United Kingdom, where, The Guardian reports, more than 17,000 people have died of Covid-19 in care homes, almost a third of all coronavirus-related deaths.

The recent surge of cases across the Tasman has been similarly sobering.

Up to yesterday, Australia had reported 678 Covid-related deaths, with 591 from Victoria. More than 450 of those deaths are in aged-care facilities, while almost 900 residents and 252 staff have tested positive. The under-pressure Australian Government has increased funding to the sector by $A563 million. On Tuesday, the opposition Labor Party tried, and failed, to censure the Minister for Aged Care, Richard Colbeck.

Amid a recent spike in cases in New Zealand, which sent Auckland into alert level three and the rest of the country into alert level two, many were surprised by the fact border staff weren’t being regularly tested, as had been announced, and a lull in testing.

At the first sign of trouble, rest homes were locked down in level-four-like conditions, barring visitors in all but the most desperate of situations, and banning workers from working across multiple facilities.

The Aged Care Association has, for months, been calling for new rest home residents to be tested, as well as regular testing for staff.

Chief executive Simon Wallace raised the prospect of in-house testing at rest homes on August 12. The idea’s been “heard positively” by Minister Salesa and the Health Ministry, he says.

“We think it will do a couple of things – it’ll free up pressure on the CBACs (community based assessment centres) and the GPs, and it will also mean that we can test our staff on-site.

“Across 650 facilities, if our registered nurses could have Covid-19 testing kits, or swabs, it would be hugely beneficial, but at the moment we’re being told the priority is around the border.”

The border should be a priority but, Wallace argues, so should aged-care facilities.

Test, test, test

The mantra from World Health Organisation (WHO) director general Dr Tedros Adhanom Ghebreyesus has been “test, test, test”, something repeated by Prime Minister Jacinda Ardern.

Last Sunday, Mary-Louise McLaws, a University of New South Wales professor and WHO expert advisor, told TVNZ’s Q+A programme: “It’s so cost-effective for testing frontline healthcare workers, frontline carers, and the very important people who look after those under quarantine who are returning from, often, countries with very high numbers of Covid.”

(McClaws said despite the recent spike in Covid-19 cases, New Zealand, like Taiwan, is still held up as a poster country in the world for our pandemic response.)

E tū union’s Jones says there’s been a high turnover of aged care staff since the country’s lockdown. Some of that might be down to the risks of age and medical vulnerabilities, but much of it’s about a lack of income security – a problem that might be exacerbated by regular testing.

“Lots of them have been forced to use leave and had reduced wages or leave without pay, and you’re just not going to get them fronting up to be tested if you’re not going to protect their income.”

The union represents about 15,000 workers in health, public hospitals, residential aged care, home support and disability care, and some community organisations. Many worked long hours during the lockdown. It’s tough work and, for the service workers doing the cleaning, laundry and kitchen work, not well-paid.

Yet they’re some of the most essential staff during a pandemic, Jones says. “Right now we need really high-quality, well-trained cleaners doing a great job.”

Not only are people leaving aged care work, he says many will, no doubt, be reluctant to join the sector. (In the UK, it was the larger facilities, with lower staff-to-resident ratios, that were hardest hit by the virus.)

Yet, despite the financial risks, rest home staff are overwhelmingly in favour of regular testing, because they live day-to-day with the worry they might bring the virus into a rest home, or home to their families. That’s why, Jones says, they deserve to have their incomes protected.

Otherwise the dwindling, “unsustainable workforce” at rest homes will continue, he says – “and we really need them at this time”.

David Williams is Newsroom's environment editor, South Island correspondent and investigative writer.

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