Some aged care facilities are facing last-minute cancellations or only getting “very short” notice of the Covid-19 vaccine’s impending arrival, putting pressure on them to obtain informed consent from their residents in time.
Australia’s vaccine rollout across the aged care system began this week, and was soon marred by a serious error and slower-than-anticipated distribution in some states. The federal government says 71 aged care facilities and 4,715 residents had received the vaccination by Wednesday, with another 20 facilities and 1,600 residents due to receive the jab on Thursday.
The government has hired four private contractors to assist with the rollout: Aspen, Healthcare Australia, International SOS and Sonic Clinical Service.
Aspen is on track to roll out the vaccine in six of the states and territories it is working in.
But HCA has begun missing deadlines and failing to supply vaccines to some aged care facilities in New South Wales and Queensland. The company has blamed the delays on closer government scrutiny after one of its doctors erroneously gave an 88-year-old man and 94-year-old woman four times the recommended dose of the Pfizer vaccine at the Holy Spirit Nursing Home in Brisbane.
HCA has now had to cancel at facilities including Peninsula Villages at Umina Beach on the Central Coast, which was expecting a delivery on Tuesday, the ABC reported. Moran Aged Care at Engadine, BaptistCare home in Caloola and the Forrest Centre Aged Care in Wagga Wagga have also reported delays.
HCA’s overdose error not only prompted fury from the health minister Greg Hunt, who described the error as “callous”, but forced its chief executive officer, Jason Cartwright, to be stood aside on Thursday.
HCA initially told the department the doctor responsible had undergone the mandatory training, before admitting he had not. The company has now been placed “on notice of termination” and any further error will see the company’s vaccine rollout contract torn up, Hunt said.
“It is a company with a long history of medical provision across Australia, and a long history through Covid of medical provision, but frankly we have thrown the book at them,” the health minister said.
Both the Council on the Ageing and the Older Persons Advocacy Network, which has had advocates present in facilities receiving the vaccinations, have told the Guardian the rollout is going remarkably well, given the complexity of the exercise.
But both have described some “teething problems”.
One problem was ensuring that aged care providers were given enough advance warning before receiving the vaccine.
Advance warning is needed to prepare residents for the jab and obtain informed consent from all residents prior to the vaccinations arriving. That can be particularly difficult when a relative is needed to provide consent on behalf of a resident.
Council on the Ageing chief executive Ian Yates said some providers were getting only “very short notice” prior to receiving the vaccine. He said that notice was, in some cases, only several days.
Others had been told to expect the vaccine on a certain day, only for nothing to happen.
Yates expressed confidence that the processes behind the vaccine rollout were sound, and expected the teething problems to be resolved in coming weeks.
“Certainly some providers had very short notice because of the desire to roll it out fast, and there have been some hiccups in people being told they’d be on tomorrow, but they weren’t, because there were logistical issues,” Yates said. “I think the processes are in place such that should settle down. I think those kinds of bumps in the road are inevitable in the first week, if we continue seeing them in later weeks, that would be a concern.”
Yates said the problems had been identified and that the government was trying to conduct better forward planning to give more notice to facilities.
Older Persons Advocacy Network (OPAN) chief executive Craig Gear said it was critical that residents be given enough time to give proper informed consent to accepting the vaccine.
“There’s naturally going to be teething problems about having everyone ready, having residents been given the information they needed,” he said. “That’s something that we’ve been very concerned about, to make sure that older people are getting the information that they need to make that decision and are supported in that decision.”
“I think we’ll see some of the teething problems this week around getting information in time and that sort of thing to be smoothed out as we go through.”
OPAN has been given assurances that older Australians will be given more time to consent if they need it.
“It’s really important that the older person is brought into the consent process,” he said.
He said the process took more time when a substitute decision maker was involved.
“But you still need to have all the information so that you can make an informed decision and provide informed consent, so that does put pressure on aged care providers, it puts pressure on GPs, and pressure on doctors.”
A spokesperson for the health minister told the Guardian the government recognised the importance of consent and “appropriate engagement with all residents”.
“Vaccine recipients and/or their carers will be provided with information on Covid-19 vaccination and providers will be given guidance on specific aspects of Covid-19 vaccination that should be discussed to obtain informed consent, as well as additional information to assist with answering specific concerns raised by patients,” she said.
“There has been information packages provided to aged care facilities to assist in working with families and obtaining consent. There have also been regular updates to the peak organisations to also support them in working with their members.”
The spokesperson described the rollout as “one of the biggest health logistical challenges undertaken”. She said the government was working closely with facilities to manage rollout scheduling and ensure information was being effectively communicated with as much notice as possible.
“The rollout is a highly complex logistical operation, both for the storage and handling of the temperature-sensitive vaccines and sensitive management of the needs of aged care residents and workers,” she said. “We are continually reviewing processes to ensure efficient and safe practices are upheld, particularly for our most vulnerable.”
