Delays in realising Covid-19 was spreading within some rest homes meant more people were infected, an official review has found.
An independent review of how the aged care sector coped with Covid-19 found "in some cases, recognition of an outbreak was relatively delayed which accelerated internal facility transmission".
"For three of the outbreaks, notification to the PHU (primary health unit) was late in the outbreak," the review noted. "It appears more than half of the people had developed symptoms of illness before the outbreak was notified." That made contact tracing difficult.
The Ministry of Health-commissioned report was released yesterday and also found personal protective equipment (PPE) wasn't available in some facilities, and advice from health authorities was sometimes confusing and inconsistent.
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Six rest homes had Covid-19 cases, two of which - Rosewood Rest Home in Christchurch and CHT St Margaret's in Auckland's Te Atatu - account for 16 of NZ's 22 Covid-linked deaths.
Director general of health Dr Ashley Bloomfield noted the differing results when ordering the review, which didn't name individual facilities and also included other rest homes without Covid cases.
An unprecedented crisis
The review found all facilities had compliant infection control policies, but none were prepared for the impact of a positive case "let alone an outbreak/cluster".
"Clear continuity planning for staff backfilling was limited to reduction in 20 per cent, 40 per cent or 50 per cent of staff, but did not require continuity planning for up to 100 per cent staff reduction of staff and was not stress tested."
Facilities with Covid-19 were "broadly critical" of their interactions with services such as public health units (PHUs) and DHB incident management teams.
PHUs sometimes told staff they were suspected or close contacts and not to work, in the middle of a shift and without telling the facility.
"The sudden loss of staff caused the ARC [aged residential care] provider to turn to casual and agency staff, which also resulted in increasing the risk of infection. This period was described as 'complete chaos' and was highly stressful for all concerned."
Most facilities kept visitors away before this was officially required, but one was hesitant to go against advice by their DHB. "This was something that they regretted later," the review noted.
DHB staff helping at Covid-hit homes weren't properly briefed. One told reviewers of arriving to chaos: "Everyone was new. We had no idea of the work routine, nothing got documented, we couldn't work the hoist, and all we could do was feed, keep people clean, toilet, and ready at bedtime."
Media reports created anxiety for staff and residents' families. One facility was given 10 minutes warning before being named as a cluster.
'Atmosphere of fear'
Staff and management described an "atmosphere of fear", and an initial perception that the Ministry, DHBs and PHUs were unsure of what to do.
There was confusion around testing, with "lag times and provision of results variable and not well communicated through to the ARC facility", which made rostering difficult. All staff felt they should have had access to testing sooner.
Some staff worked in other facilities, in some cases without an employer's knowledge and against their guidance. That complicated contact tracing.
Others were threatened with eviction by landlords or housemates if they kept working for a facility, and reported feeling like "lepers".
Preparing for another wave
The review's recommendations include developing a national infection prevention and control (IPC) strategy for the aged care sector, and to clarify "case recognition to identify infections early".
The Herald has previously reported on how residents at St Margaret's rest home in west Auckland were only swabbed 11 days after a staffer tested positive - turning up undetected cases, two of whom later died.
Aged Care Association chief executive Simon Wallace has said those testing gaps were despite the efforts of rest homes and his industry association to have more residents swabbed. The Ministry had "held on to their case definition and would not test".
He welcomed today's report, saying many recommendations picked up on what the association had called for, including better access to PPE and testing.
"As the review points out, the MOH's initial focus with the pandemic was on hospitals rather than aged residential care. In the absence of that early support we had to take a strong leadership role and believe it is important that the MOH continues to work closely with us."
The ministry said it would seek feedback with the sector of the report's recommendations.
"The key focus of both the reviewers and the Ministry is to improve systems to prevent similar occurrences," a spokeswoman said. "No blame is being attributed to any staff involved."
The review's release came after documents obtained by the Herald revealed Canterbury DHB took over Rosewood Rest Home after concerns about its response to what became NZ's deadliest cluster, with 12 lives lost.
A lack of available staff meant the facility breached its contract obligations in multiple areas including cleaning, food and laundry services and emergency provision of supplies.
The Herald has previously revealed concerns about PPE use at St Margaret's rest home, including a lack of bins for safe disposal.