Increasingly desperate calls for more staff to work at Melbourne’s Epping Gardens Aged Care home during the height of the COVID-19 outbreak went unanswered, Four Corners can reveal.
- Documents reveal repeated urgent calls for more staff to work at Epping Gardens as COVID-19 spread
- There was a six-day delay in getting COVID-19 test results back after the first case was detected
- Staffing levels became so desperate that members of the executive team filled shifts themselves
The home in Melbourne’s northern suburbs is the site of the Australia’s largest aged care outbreak, with 162 residents and staff infected.
Four Corners can reveal key failures that led to the deadly outbreak, including extensive delays in obtaining test results.
After the first case, it took six days to confirm the extent of the coronavirus spread.
The investigation has seen documents that show management’s urgent attempts to get more staff on site as the pandemic spread through the facility.
Greg Reeve, CEO of Heritage Care, the company that runs Epping Gardens, said: “We found ourselves running on empty, in terms of staff.”
“We tried every agency. We accessed the Government, we informed the Department of Human Services, we informed the public health unit, we informed the [Aged Care] Quality and Safety Commission.”
Records reveal staff shortages, residents at risk
The home’s management met frequently with government agencies including the Aged Care Quality and Safety Commission (ACQSC), which regulates the sector, the Commonwealth Department of Health and its state counterpart, the Department of Health and Human Services (DHHS).
On Friday, July 24, when COVID-19 had already taken hold in the home, management reported that staff numbers were dropping to levels that put residents at risk.
Contemporaneous notes seen by Four Corners record executives telling bureaucrats: “Staff is a key issue. We have exhausted all avenues accessing agency and our own people.”
Staff levels, normally set at 110 people, were “serious” and “50 down now”, notes show.
Residents’ families were also desperate. They had been locked out since mid-July, and the lack of staff inside meant many anxious phone calls went unanswered.
Suzanne Agnello became increasingly worried about her 92-year-old mother-in-law Carmela.
“We’re not getting answers on the phone. We’re not getting answers on email,” she said.
Mr Reeve conceded it was chaotic inside the home.
“We were getting hundreds and hundreds of calls from families.”
Six-day delay in COVID-19 test results
One of the key failings that led to the virus spreading out of control at the home was that it took six days from when the first case was identified to getting all the residents tested and the results returned.
Victoria’s DHHS wrote to Epping Gardens saying it would assist in facilitating widespread testing of staff and residents.
However, swabs were not actually taken until three days after the first case was detected at the home.
The test results were expected the following day — a Friday — but did not arrive.
When Epping Gardens chased up the lab on Saturday, Melbourne Pathology replied they had been delayed because “we have received 3,200 nursing home tests over the past 36 hours”.
It was not until Sunday, July 26, that the test results were delivered: 60 residents and 22 staff were positive.
It is not clear which government agency is responsible for arranging testing. National COVID-19 guidelines say state health departments are responsible. However, DHHS told Four Corners that it was a Commonwealth responsibility.
The six-day turnaround in receiving test results meant for nearly a week the centre could not separate all COVID-19 positive residents from those who were not infected, and some residents failed to follow instructions to stay in their own rooms.
“The impact is that you’ve got a whole group of people that are in there together and we don’t know who’s positive and who’s negative, for … seemingly an unreasonable length of time,” Mr Reeve said.
The ACQSC criticised the onsite team at Epping Gardens for keeping residents in their individual rooms, rather than separating positive and negative cases into different areas.
The ACQSC told Four Corners: “The commission had concerns about the quality of care being provided at Epping Gardens.”
Just six staff showed up for work as COVID-19 took hold
A week after the first case was recorded, just six rostered staff showed up to care for 115 residents.
Two much-needed replacement care workers had to be sent away as they had been working at St Basil’s — the site of Victoria’s second-biggest outbreak.
Staffing levels became so dire that members of Heritage Care’s executive team went into the home to fill the gaps.
Mr Reeve, who is also a registered nurse, was one of them.
“We were completely devoid of staff from [head office] because we were all in there assisting,” he said.
By this time, COVID-19 outbreaks at a number of other aged care homes in Melbourne meant there was a shortage of surge staff from commercial agencies.
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Epping Gardens told not to send residents to hospital
Four Corners can reveal that Epping Gardens repeatedly made it clear that it wished to send positive or symptomatic residents to hospital.
But according to contemporaneous notes, ACQSC told the home: “[the] Commonwealth expects Heritage Care to be able to deal with COVID residents where possible.”
In spite of the regulator’s instruction, Mr Reeve said he directed staff to begin hospital transfers “in full knowledge we don’t have the numbers and skill mix of staff to support the care and services of the number of residents”.
Staff were to “identify all high-risk residents, in terms of their clinical need and … they are to be transferred to Northern Health by COB today.”
A day after test results showed how widespread the virus was in the home, documents seen by Four Corners show that health authorities continued to insist Epping Gardens make all efforts to keep the residents in the home.
“As advised multiple times, transfers to hospital will not be the default position,” a senior government official instructed.
“With the right workforce [Epping Gardens] should be able to care for residents onsite unless they are clinically unwell.”
However, there was recognition from the official that the “right workforce” was not in place, and that Commonwealth and state agencies were “urgently” attempting to source the staff Epping Gardens residents so badly needed.
ACQSC told Four Corners it was “aware that staffing issues were raised by Epping Gardens during daily operational management meetings”.
The federal Department of Health said that state health departments are responsible for the health response to an outbreak.
“This includes supporting the aged care provider to execute its role in an outbreak and the decision to transfer residents to hospital.”
Daughter called ambulance herself for sick mother
Unaware of the tussle behind the scenes between Heritage Care and the regulator and state and federal health departments, many families believed Epping Gardens was failing to act quickly enough.
Donna O’Brien was called on Sunday, July 26, by a geriatrician at Epping Gardens and told her mother was one of the residents whose positive results had come back that day.
“He thought she wasn’t looking too good. ‘But if you want, we can give her some tablets and leave her here for a while?'” he said.
“I put the phone down. I made one call back, as usual, nobody answered, and then I called the ambulance myself.”
Donna’s mother Maureen became gravely ill and has been in hospital since, including extensive periods on oxygen.
The Aged Care Royal Commission has been told that transferring elderly patients to hospital can be traumatic, and it is preferable to bring clinical care to them in the home.
James Branley, the head of the Department of Microbiology and Infectious Diseases at Nepean Hospital, gave evidence that the “wholesale evacuation of elderly residents of care homes is detrimental to their health”.
“Hospitalisation can result in deterioration in the condition of an elderly person due to altered sensory environment and changed conditions,” Dr Branley said.
Resident tests positive after being admitted to hospital for fall
Resident Carmela Agnello was transferred to hospital on Saturday, July 25, not because of COVID-19, but because she had had a fall.
On admission, her family were called by a doctor, saying there were signs Carmela was infected with COVID-19.
“To get a phone call to say she’s dehydrated, fluid in her lungs, heart not functioning properly, with a cough and came in with a temperature,” Suzanne Agnello said.
“[Did] that all happen in an ambulance, did it, in five minutes? I don’t think so.”
Once admitted to hospital, Carmela tested positive for COVID-19 and passed away three days later.
The family are furious with Epping Gardens and say they had concerns about the home being understaffed long before the pandemic began.
“I don’t want apologies. I don’t want anyone to talk to me about procedures and whatnot, how good they run the show … I want someone to take care of these people,” said Carmela’s granddaughter Anna Maria Mattia.
“I know there’s going to be people out there who say, ‘She’s 92, she was going to die anyway. She was old.’ But not like that. Not when it could’ve been prevented.”
The ACQSC commissioner, Janet Anderson, has since told families that she issued Heritage Care with a formal notice in relation to a number of concerns, including clinical care for residents, and organisational governance.
According to Epping Gardens, 97 residents had caught the virus, and 28 of those had passed away and 60 staff have been infected. Just 11 uninfected residents remain on site.
Sam Agnello told Four Corners: “To this day, my sister and I have not had a call from the management of Epping Gardens to say, ‘Condolences for your mum’ And I think that’s utterly disgusting and appalling.”
Epping Gardens confirmed it had failed to contact the Agnello family after Carmela’s sudden death.
Mr Reeve told Four Corners: “I’m exceedingly sorry. I feel for every one of them. Families, staff, the residents.”
“If I could’ve done it any different, I would’ve. If we as an organisation could’ve done it any different, we would have.”