Every day for more than two years, Mae has brought breakfast and dinner to her husband, Dean, 75, (not their real names) in his aged care facility in their town in Northern Queensland. Dean has dementia and Mae sits with him for hours, encouraging him to eat each bite. It’s a time-consuming process born of love, and something harried care workers cannot do, short-staffed as they are. Once, when visits were banned for two weeks during a scabies outbreak, Dean lost two kilos.
In response to the threat of COVID-19, Prime Minister Scott Morrison announced a limit on the number of visits to aged care facility residents to one per day, with a maximum of two visitors per visit. He also announced restrictions on the locations of visits within facilities. This would limit Mae’s visits to Dean to one meal per day. It will be difficult, but she’ll manage. But for residents of some facilities, the situation is much worse.
This is because many aged care facilities have gone beyond this guidance, banning visitors altogether. These restrictions have been given the euphemistic term “voluntary lockdowns,” with exceptions only for palliative care visits, but older people living in aged care facilities are not volunteering for this. For people like Mae and Dean, such a ban carries huge risks.
The prime minister’s announcement, along with various other controls, is in line with Australian Department of Health's public health guidance on COVID-19 in aged care facilities. Having limits on visitors is reasonable, given that older people are at high risk for severe disease and death, and the guidance properly reinforces the importance of proper infection control, protecting both residents and facility workers.
However, “voluntary lockdowns” by aged care providers can do more harm than good by cutting off older people from vitally important family and social connections. Older people who find themselves unexpectedly alone without control over their circumstances, are at particular risk for a variety of severe, even life-threatening physical and mental health conditions, including cognitive decline. Such underlying health conditions are harmful enough on their own, but with a disease that is particularly dangerous for people with them, voluntary lockdowns might not be the answer.
Older people should have the choice to receive a visit from a healthy partner, relative or friend. Losing one’s choice in old age is ageism’s hallmark, and stereotypes about older people needing protection rather than making their own choices persist. This is happening in many of Australia’s nursing homes already. When Human Rights Watch partnered with the Samuel Centre for Social Connectedness to address chemical restraint in aged care facilities, as best we could determine, staff in the aged care facilities where we conducted research did not seek or secure informed consent prior to giving people medications to control their behavior.
Beyond the possibility of health risks from social isolation, our research also noted that people who are on their own, without family or friends visiting or communicating with the facility staff, and who have language barriers or disabilities that make communication between them and others difficult, are some of the most at risk for poor treatment. More than half of the people living in aged care facilities in Australia have dementia.
Australia’s Department of Health’s own guidance for residents and families about COVID-19 in aged care facilities acknowledges that some facilities are cutting residents off, but has yet to criticize these moves. It even lists the phone numbers of advocacy organizations to call about these lockdowns. Instead of shifting the burden to residents and family members to challenge aged care facilities, it should put the burden on the facilities to explain why they cannot abide by the department’s guidelines and restrictions already in place. It should recognize the risk of social isolation by monitoring visitor bans, and require aged care facilities to eliminate them to balance the protection of older and at-risk residents with their needs for family and connection.
Bethany Brown researches older people’s rights at Human Rights Watch. Kim Samuel is founder of the Samuel Centre for Social Connectedness.