There are signs posted all around Robert Bach’s house in north-west Sydney, reminding him not to “go walkabout” and that there is no need for him to take food from the freezer and hide it around the house.
The 80-year-old has Alzheimer's disease, a progressive brain disorder that impacts the ability to think and remember. It’s also the most common cause of dementia, which is one of the main reasons Australians enter aged care facilities.
Earlier this year, Mr Bach was placed in respite at an aged care facility after he “went for a wander” and got lost, his daughter Fiona Hutchinson told SBS News.
“I came to the conclusion that I would try him in respite, but I really wanted him to stay there permanently,” she said.
“But I thought ‘OK, I could put him in permanent and sell his house, but what happens if he has to go into lockdown?’”
As coronavirus cases continued to grow, Ms Hutchinson said she made the “hard decision” to pull him out of the facility. “The next day I got a letter to say that they were restricting people going in there,” she said.
A resident is removed from St Basil's Homes for the Aged in Fawkner, Melbourne. Source: AAP
Earlier this year, SBS News revealed the number of occupied aged care beds in Australia was expected to drop by more than two per cent in the 2019-20 financial year, .
New figures, provided to SBS News ahead of release in September, show bed occupancy dropped by 1.7 per cent between April and June, with the total decrease for the 2019-20 financial year hitting 2.6 per cent.
Grant Corderoy, a senior partner at Stuart Brown, which conducted the survey, said a three-month drop of that scale was "extraordinary".
While residential aged care occupancy has been in gradual decline due to an increase in at-home care packages, the recent figures are almost certainly a result of COVID-19, he added.
There were 1,748 active COVID-19 cases linked to 122 aged care facilities on Thursday, including ten locations with more than 70 cases. Approximately 60 per cent of the state's 210 coronavirus deaths are the result of aged care outbreaks.
Facilities with one or more confirmed cases represent more than 15 per cent of the industry in Victoria. It’s the second major hit to the sector, which saw major outbreaks in Sydney facilities, including the fatal Newmarch House outbreak, earlier this year.
The response to COVID-19 in aged care will be examined by the Royal Commission into Aged Care Quality and Care in a three-day hearing in Sydney from Monday.
For Melbourne resident Linda Donaldson, the growing COVID-19 death toll in aged care loomed large in her decision to delay moving her 79-year-old mother with Alzheimer's disease into a permanent facility.
“Do you put her in a home and if they get cases, she’ll be gone? She’s had a lung transplant, there’s no way she’d survive it,” Ms Donaldson said. “That’s the decision I have to make, it’s got to be OK and viable that most of the virus is gone and it’s not likely to happen.”
But living at home poses other dangers for people with Alzheimer's. Ms Huchinson said she’s had to buy her father a watch that notifies her of his location if he leaves the property. She also has a carer visit him every morning and evening to ensure he gets the correct dose of his medication, which has now been locked away to prevent accidental overdoses.
“It’s hard when they’re sick and dying and they can’t even stand up … you’ve got no choice, they have to go there [aged care],” Ms Huchinson said. “But when they’ve got Alzheimer's, you can put other things in place, and obviously everybody's case is different.”
As the COVID-19 cases continue to impact aged care, Ms Huchinson is not the only person being forced to make difficult decisions over the best way to keep her loved one safe.
In a Facebook support group for carers of older Australians, people have been asking for advice as they attempt to navigate the best way forward. Some members recommend removing a relative from a facility before a case is detected because, they say, once it is, it’ll be too late.
Others are concerned about COVID-19 but say they simply don’t have the capacity to care for them at home.
Many are particularly worried about the fact that once a case is detected, infection control measures mean there’s a good chance they will no longer be able to choose to move their family member out of the facility.
This drop-in occupied aged care beds will mean additional financial stress on a sector that is already struggling.
Cleaners are seen at Epping Gardens aged care facility in Melbourne. Source: AAP
"We're underfunded as a sector and what COVID is doing is laying bare some of the faultlines that are in the system," said Patricia Sparrow, chief executive of Aged and Community Services Australia (ACSA), the national peak body for not-for-profit aged care providers.
But Ian Yates, the chief executive of Council on the Aging Australia, said it was "no surprise" that occupancy was dropping. “That is a trend that will continue until we significantly transform the residential aged care sector in Australia so that it more consistently reflects high quality," he said.
But in many cases, aged care was still the safest place for older Australians to be, he added, urging families to ask any prospective facilities about their COVID-19 planning.
“There are a few families, not many, for whom caring for the loved one at home is now possible because a couple, for example, might be working from home,” Mr Yates said.
“But there are many people in residential aged care who are there because they have some very significant health issues, frailty, and dementia issues as well. Taking that task on at home is a real challenge and involves risk.”
Ms Sparrow said providers were working hard to stop the virus entering facilities and had developed a number of screening measures, including temperature checks for staff. "But, I think what we've seen is that coronavirus is a difficult virus and we are all struggling to make sure that we manage it well," she said.
"Given what's happening, families shouldn't feel concerned to talk specifically to providers about how they're managing coronavirus, their policies and principles."
Ms Donaldson said she still hopes to be able to find a suitable residential aged care facility for her mother once the worst of coronavirus has passed, but the crisis has changed her mind on one thing.
“I was going to put her into a private home … but after looking at what’s gone on, the homes that have had infections are private,” she said. “I’m seriously going to consider a different home to what I was actually considering because of this.”
People in Australia must stay at least 1.5 metres away from others. Check your state’s restrictions on gathering limits.
If you are experiencing cold or flu symptoms, stay home and arrange a test by calling your doctor or contact the Coronavirus Health Information Hotline on 1800 020 080.
