Where's the death data for Aged Care Vaccinations?
I would have thought COVID data on deaths in Aged Care would be on hand for the Government, especially at Senate Estimates. Instead they've taken the questions on notice. I was also shocked to find that there had been no improvement in breaches of the Aged Care Quality Standards.
Senator ROBERTS: Thank you all for attending today. I have three sets of questions. The first is pretty straightforward: it’s only one question. How many aged-care residents died of COVID-19 by state per month since March 2020; and how many died in aged care within four weeks of receiving a COVID-19 injection?
Dr Murphy : I don’t think we could provide that information other than on notice.
Senator ROBERTS: I’m happy for that.
Dr Murphy : We can certainly provide that on notice. That sort of level of detail wouldn’t be available to officials today.
Senator ROBERTS: Can you provide data by state per month on the deaths due to COVID; and the deaths within four weeks of receiving a COVID-19 vaccination?
Mr Lye : Regarding the second part of that question about the relationship to vaccinations, I think that the work that Professor Kelly’s leading may shed some light on that question but it might be harder to get than the other. But I think that we can get the other data quite simply. The second one might take a bit longer.
Senator ROBERTS: I would have thought—
Senator HUGHES: Senator Roberts, can I ask a question maybe through you for the real COVID death rate. For example, what is the death rate for people who had cancer or were in palliative care but also had COVID; did they die of COVID or did they die of the cancer that they had? When you get those figures, can we actually have a look? I know a lot of COVID deaths were put down as the person dying of COVID—as opposed to with COVID—and that other factors were involved.
Dr Murphy : As we said at the last estimates, I think that the Victorian health department did some detailed analysis on their aged-care deaths and found that 44 per cent of people who died with COVID had died primarily from another cause such as cancer or severe dementia. We always report them as COVID deaths because we want to be absolutely inclusive; however, in many of these vaccinated people who’ve had another condition, the COVID is incidental to the cause of death.
Senator ROBERTS: Mr Lye, before I move to the next question, I would have thought it would be fairly simple, given the aged-care records, to know whether or not a person died within four weeks of getting a COVID injection.
Mr Lye : I’m outside of my area of competence but, to save other officials coming up, I think the complexity is working with states and territories around settled death data, which takes some time, and then the additional linkage to the system that covers immunisation.
Dr Murphy : Yes, we certainly can link to the immunisation record, and that data analysis can be done. As you know, Senator, the TGA also does get reports of deaths reasonably close to vaccination. Many of those are considered completely coincidental and not related to the vaccination. We can explore what we can do by data linkage to see if we can come up with an answer.
Senator ROBERTS: I’d be surprised if you couldn’t tell me if someone died within four weeks of getting their injection, but anyway we’ll see what happens.
Dr Murphy : With 1,000 people per week in aged care dying and a busy immunisation program, there will definitely be some who die within a month of their injection just as a matter of course.
Senator ROBERTS: I accept that, but we’ll see if there is any trend.
CHAIR : Senator Roberts, we have to break at 11 am, so you need to conclude by then. I am just giving you a heads-up.
Senator ROBERTS: Thank you, Chair. I move to the second set of questions. One in three nursing homes continue to spend less than $10 a day per resident on food, despite being given an extra $10 a day by the Morrison government. How are you checking whether the cash that the government gave providers is being used for its intended purposes?
Mr Lye : I might hand over to Ms Laffan and the Aged Care Quality and Safety Commissioner on this. The short answer is that we have required people to report to us on nutrition based on that uplift in funding. Those people who hadn’t given us assurance that they would report to us have had their additional funding stopped. Then we have a process by which people who haven’t met the standard are referred to the quality and safety commissioner. I’ll let Ms Laffan give you a complete answer and then the commissioner, who is here, can give you more detail again.
Ms Laffan : As Mr Lye said, first we require providers to provide an undertaking that they will use the money with a focus on food and nutrition and then we require quarterly reporting on matters of food and nutrition. We’ve recently released the data from the first two quarters. We found that 75 per cent of providers reported on-site only spending on food and ingredients, with an average spend of $12.25 in the July quarter and $12.44 per resident per day in the quarter starting in October. Those providers that spent less than $10 per day were referred to the Aged Care Quality and Safety Commission. Ms Anderson may be able to tell you what she has been doing with that information.
Ms Anderson : We received a list of 883 services—referred from the department—which had reported less than $10 expenditure per day on a calculated basis. We looked closely at that list and then we added some services to it on the basis of our analysis of risk. We added to it services who appeared to use only preprepared food and then added a further number who use a combination of fresh and preprepared food where they had relatively low expenditure on food and associated labour. We looked at a list of 955 services, so a larger list than came across from the department, and we made an assessment of their food and nutrition profiles.
We looked at that in the way that we assess risks generally, by looking at a number of different parameters. We looked at their relative ranking in relation to the quality indicator for unplanned weight loss and at the top percentile of concern there. We looked at the relative number of complaints that we had received about that service in relation to food and nutrition and rated those low, medium and high. We also looked at any findings of noncompliance that we had made about those services in relation to the standard in the Aged Care Quality Standards specifically relating to food, 4(3)(f), which says: ‘Where meals are provided, they are varied and of suitable quality and quantity.’
On the basis of that analysis of the 905, 4.5 per cent of those services were rated as high risk for noncompliance with the expectations in relation to food and nutrition, and another 41.3 per cent were rated at medium risk. The balance were rated at low risk, or they had not yet submitted their quality indicator data which meant that we weren’t able to do a full risk profile. We then looked at the high- and medium-rated risk services. Those services we rated as having a high-risk profile will be prioritised in our monitoring schedule in terms of their compliance specifically with that requirement in the quality standards. I won’t go into more detail about that because if we are to undertake a visit, our visits are unannounced. But I can say that there will be a greater intensity in the monitoring that we undertake of those services. Services which have been rated as high or medium risk will be required to participate in an education program that we’re currently putting together which will give them more information and be clearer about the expectations that the Australian community has of them in relation to food, nutrition and the dining experience. We’ll be expecting both staff and management to participate in those educational sessions.
Senator ROBERTS: Would it be fair to say that they know they’re being watched?
Ms Anderson : Yes, that would be accurate.
Senator ROBERTS: Thank you.
Senator WATT: Do the high-risk facilities—I’m not going to ask you to name them individually—tend to be major providers or smaller independent providers? Is it a mixture? Is there any sort of trend there?
Ms Anderson : I’m sorry, I really don’t have access to that detail. It is an interesting question, I agree with you, but I really can’t answer it today, I’m sorry. I’ll have to take it on notice.
Senator ROBERTS: I understand you measure quality and safety standards—has the rate of breaches of quality and safety standards improved specifically? Can you quantify it?
Ms Anderson : No, there’s been no material improvement in assessed compliance with the Aged Care Quality Standards. However, it’s a complicated question to answer succinctly, because we have been improving our capability as a risk based regulator, which means that we are more able to identify the higher risk services because we are more proficient and skilful in understanding bits of intelligence that come to us. We put them together as information in a risk profile for individual services, and we understand how that profile relates to other profiles for peer organisations. In that risk profiling exercise, we pay greater attention to those who are rated as higher risk. Our detection rate for noncompliance has actually improved because we know where to look. We are finding high levels of noncompliance, but we’re also looking in the right places for noncompliance. That is why I can’t say categorically that we are seeing overall improvements in quality and safety, because as a regulator we are becoming more efficient and effective in identifying noncompliance.
Senator ROBERTS: Minister, would it be possible for one of my staff to go and have a talk with the agency?
Senator Reynolds: I’m sure that would be fine.
Senator ROBERTS: Senior Australians have different needs and health issues to younger people, yet they’re treated as part of a larger community segment. Why do we not have purpose-built seniors focused healthcare facilities, including seniors’ hospitals? Wouldn’t that be a way of not only improving the service but saving money?
Dr Murphy : The average age of the in-patient in our major state and territory public hospitals is about 70, so effectively we do have hospitals that are looking after the elderly, because—as you obviously realise—chronic disease and the disease burden mostly increase as we get older. But I think your point is valid. There are some specialist services that are very much directed toward dealing with the elderly, and we have a very strong focus in the department to enhance working with the states and territories to get geriatric services into aged-care facilities. There are now some very good models of in-reach where those aged-care services get those specialist geriatric services and specialist mental health services. But, essentially, our hospitals are largely for the treatment of people of more advanced years, given that’s the nature of disease.
Senator ROBERTS: It’s a useful point you raise, because I and many people find hospitals daunting, so for an elderly person it’s even more daunting. Some doctors say it’s better to stay out of hospital; they’re not being derogatory, they’re just saying—
Dr Murphy : You don’t want to be in a hospital unless you really need to be in a hospital—
Senator ROBERTS: Right, that’s what I’m getting at.
Dr Murphy : That’s absolutely right.
Mr Lye : The multidisciplinary outreach measure in the budget is precisely about bringing gerontologists and some of those health experts into residential aged care to give that access in the home setting. When people have a more complex set of health circumstances, what we don’t want is the residential aged-care facility just quickly admitting them to hospital all the time, and them having that experience, when it could be delivered in the residential facility.
Senator ROBERTS: Thank you. Who do we contact, Secretary, for the previous question?
Dr Murphy : I think we can seek a briefing from Minister Colbeck’s office.
Senator ROBERTS: Thank you.
CHAIR: So, on that note, we’ll take our break and then continue with outcome 3.