Rest home reviews will save lives

Suzanne Snively
Chair Transparency International New Zealand

There are currently two reviews underway that have the potential to address the spread of COVID-19 to those who are genuinely vulnerable. The Office of the Ombudsman has been asked to carry out a review of the conditions at rest homes. The Auditor General has been asked to review the distribution of personal protection equipment (PPE).

Vulnerability is related more to clusters than age

Regrettably, the approach to protecting people 70 years and over in New Zealand started on the wrong track, when it comes to preventing deaths.

The initial data from Wuhan showed that fatalities were much higher for those aged over 70. Experience has since shown that age alone is a poor indicator of genuine vulnerability.

It has turned out that the truly vulnerable are a much narrower group. The virus thrives in places where people are living, travelling or working closely together.

A significant sub-set of this 70+ group is rest home residents who both live closely with others, as well as having health vulnerabilities. Most of New Zealand’s COVID-19 deaths have occured in rest homes. The few New Zealand deaths outside of rest homes have been to individuals with health vulnerabilities.

In Vietnam, the tradition has been to look after their older family members at home. This may be a reason why Vietnam has had no COVID-19 deaths to date. Our more common reliance on rest homes has led to a worse outcome. Protection against the spread of the virus in rest home facilities was addressed too late to prevent deaths here.

Like cruise ships, rest homes are places that can spread the virus. More dangerous than cruise ships, it is often impossible to isolate rest home residents, most of whom are there because they require direct, daily contact with their caregivers.

Rest home residents, whether infected or not, have endured more repercussions from the virus than the rest of the population.

Testing positive means being isolated, away from their rest home colleagues, their friends and family. In many cases, too, they will have different caregivers from the ones they are familiar with. If they die, they do so away from loved ones.

Those without COVID-19 but with different ailments that require hospitalisation, have been moved away from their usual living arrangements. They are unable to return to familiar and comfortable environments.

Two reviews need to be comprehensive and quick

To offset the impact of COVID-19 on society and the economy, Parliament has given the Government a rare and considerable degree of flexibility to fund its response to the COVID-19 crisis. But public transparency still remains paramount. 

If we want to tame the virus, the defensiveness so common to the kiwi-psyche must be overcome when scoping and carrying out these reviews.

Government agencies will need to overcome the impulse to spin the findings so that they look good. Often when a government agency commissions reviews on themselves, they “manage” to avoid potential criticism by keeping the scope narrow, the time short and the resources limited.

Recall the limited scope of the early Pike River reviews!

The virus has no interest in whether government agencies look good. To tame COVID-19, government agencies must BE good, they must do the right thing. The two reviews are essential to ensure New Zealand can continue to eliminate COVID-19. They need to seek the truth and set out the steps required to implement changes as soon as possible.

Early results from the two reviews will save lives

As well as using Parliament’s funding for the health services, it is important to adequately fund these two reviews to ensure that they can provide comprehensive feedback. And to deal with the remorseless virus, this feedback needs to be published as quickly as humanly possible.

The request for the Ombudsman to review rest homes has come too late to prevent rest home deaths from the coronavirus, even when the virus is contained in other parts of the community. But it does provide a chance to learn how to improve conditions of care now in ways that can be more effective if there is another wave of COVID-19 or future pandemics.

Overseas experience has shown the vulnerability of caregivers without proper PPE. Many deaths have been reported overseas of previously healthy doctors, nurses and caregivers. One significant factor in preventing deaths is the availability of PPE for caregivers.

As the Auditor General says:

“Personal Protective Equipment (PPE) is being produced, procured, managed, and distributed to critical services. It is important that the public has confidence that those working as part of the response to COVID-19 have the equipment they need to be able to work safely.”

The Auditor General has agreed with the Ministry of Health that it will examine the systems for acquiring and maintaining stocks of PPE, and its systems for distribution. It is important that this includes the distribution of PPE to rest homes.

Both reviews say that they are being done urgently, with plans to report back before the end of May. This timing is not urgent enough to prevent more deaths. A focus on rest homes with early findings published is imperative.

It is a matter of life and death that the reviews by the Ombudsman’s Office and Auditor General be done comprehensively, openly and truthfully, without the constraints so often built into past reviews of government activities. The findings need to be accompanied with constructive recommendations for improvement.

This is a time for facts and truth. The quality of the lives of caregivers as well as those of our vulnerable New Zealanders in rest home care, depend on it.

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