Australia was approximately fourteen months into its Royal Commission into Aged Care Quality and Safety when the coronavirus 2019 (COVID-19) pandemic took hold.
For a sector already beset with staffing, skilling and budgetary constraints, the pandemic has had a profound impact, prompting some to describe it as an “aged care crisis”.
Whilst much of the aged care rhetoric has zeroed in on the medical impact of COVID-19 – including numbers of confirmed cases, infection rates and fatalities – psychological researcher Dr. Monica Cations claims that the crisis has equally been one of mental health.
“The pandemic will have important psychological effects for people accessing aged care, as well as the staff working there,” said Dr. Cations ahead of the Aged Care Reform Conference.
“And these challenging times may be particularly difficult for people who have experienced a psychologically traumatic event earlier in their lives – which we know is true of more than 70% of aged care users.
“The impact of traumatic experiences can be compounded by the aged care experience. Many of those living in residential care report a loss of a sense of security in their new living environment.
“For many people, their home is cultivated as a safe place. When that environment changes and a person is moved into a hospital or residential aged care facility, that sense of security can be lost, often with profound mental health consequences,” she said.
This underlying mental health epidemic in aged care opens up some challenging ethical and political debates in the context of COVID-19.
With immediate physical safety needs getting first priority, mental health needs have often been viewed as “ancillary” in the aged and wider health care sector, Dr. Cations argued.
“Staff resources in aged care settings are limited as it is. If you have, for example, just a few hours to shower forty residents, then there is unlikely to be much time left over to meet people’s psychosocial needs,” she said.
Additionally, many aged care operator budgets have been under increased strain throughout the pandemic.
In the UK for example, falling occupancy rates due to high numbers of aged care fatalities – and rising PPE costs – have threatened the solvency of operators.
This has forced many into contractual arrangements with hospitals, whereby patient overspills are absorbed into the aged care facility, in a bid to retain viable occupancy rates.
Whilst this has helped some operators remain solvent, it has raised serious ethical, safety and mental health concerns for existing residents.
“With budgets and resources eaten up – and the higher risk of COVID-19 exposure – the mental health of aged care residents has been impacted three fold,” Dr. Cations said.
“Not only are residents in a high risk situation, which can be traumatic in and of itself, but they are often confined to solitude given the risk of COVID-19 contamination. Combined with the shortfall of adequate mental health support and it’s a high risk situation in terms of depression, anxiety and other related conditions.”
Dr. Cations applauds what she describes as a “positive development for aged care mental health”, seen in the 2018 Federal budget. It included dedicated funding for mental health services for people living in residential aged care facilities. More recently, there have been further measures at the Federal level, including the launch of a dedicated support line for older citizens.
However, she argues that this belies a “general undervaluing of older people and their quality of life,” with robust mental health services still not readily available for older people living in residential aged care.
Although Dr. Cations is sympathetic to the constraints of the sector, she believes there are still reasonable measures at hand to improve the mental health of aged care residents.
“Training staff on some of the early warning signs of serious mental health conditions is vital,” she said.
“Early intervention and appropriate treatment can make a big difference to the trajectory of a mental illness.”
Monica Cations is a provisional psychologist and epidemiologist who has worked in the ageing and dementia field for over a decade. Her research is translational with a focus on psychological wellbeing in aged care environments and young people using aged care.
She is due to speak more on this topic at the Aged Care Reform Conference 2020 – held as a virtual event on 9-10 November – where she will cover topics such as the Royal Commission, COVID-19 and her latest research findings.