Inadequate Commonwealth funding for residential aged care has left half of all metropolitan facilities and almost three-quarters of regional facilities in financial stress. The expense of preparing for COVID-19 has added to this stress and some facilities may not survive.

The fundamental problem is that residential aged care is being expected to provide quality care for older people with problems that it was never designed to handle.

Thirty years ago, there were government institutions that cared for older people with chronic mental health problems, with intellectual disability and with severe behavioural disorders associated with dementia.

The states were provided with Commonwealth money to build homes for younger people with acquired brain and spinal cord injuries but these homes were often not built.

The result is that aged care facilities are now expected to care for older people with severe medical and nursing problems; with dementia, including a full range of behavioural issues; with chronic mental health problems; with intellectual disability; while also housing young people with severe disabilities. This is all expected in one environment with one poorly funded staffing mix.

The system was already broken, partly for the reasons given above, partly by inadequate funding and partly by the entry into the industry of new operators, some of whose loyalties to resident care are stretched by competing interests. The Royal Commission graphically described the current situation in part of the industry.

COVID-19 presents a challenge for which no one could have been adequately prepared. Aged care facilities are not hospitals but government guidelines to the industry would suggest that they are expected to provide equivalent care with little significant additional funding or staffing.

Supplies of PPE (personal protective equipment) promised by the Commonwealth government have not materialised forcing some facilities to source from overseas or purchase at local retailers. The experience of Newmarch has demonstrated that aged care facilities are the most vulnerable of all our institutions in the face of COVID-19. Many people in this age group with multiple chronic medical problems will not survive COVID-19 disease and will not wish to go to hospital and intensive care.

There are many facilities of high quality which have prepared thoroughly and will cope with an outbreak with appropriate support. Others, however, are not in that position and could experience the same catastrophe as experienced at Newmarch.

To their great credit, the Local Health District and the Primary Healthcare Network have worked closely with aged care providers to prepare for a COVID-19 outbreak.

The Local Health District has established a team of public health and infectious diseases clinicians which can go immediately to any facility that has a positive case. This team will assess the facilities preparedness and work with the senior staff to devise a strategy of management and required support.

Availability of PPE for aged care facilities is still a major issue and the Commonwealth government needs to have a stockpile of PPE in each state to be provided immediately to any facility with a positive case. It also needs to guarantee adequate funding or staffing to cover staff who need to isolate or quarantine.

The experience of Newmarch as described in the Sydney Morning Herald on May 16, suggests that special units should be prepared to take cases if facilities are needing a safety net. This would help to prevent further spread and assist facilities to cope. Most importantly, these special units would ideally be staffed by nurses trained in respiratory and palliative care and equipped with sufficient PPE to allow families to be present at the bedside.

We are by no means out of the woods with regard to COVID-19, although we are in a better position than most countries. Countries that had early results equivalent to Australia have experienced second waves as lockdown restrictions were lifted. We may have another 12 months to go before a vaccine or cure is available and we must not let our aged care system be a casualty of COVID-19.

After COVID-19, we need to start to redesign the aged care system so that older people can confidently expect a dignified and safe older age. This will mean adequately funding and staffing existing facilities but also developing new models, some smaller in size and some targeted to specific groups of older people. Community controlled and cooperative housing models should be considered.

Fortunately, the Hunter is the ideal environment in which to design an innovative system that will be acceptable to coming generations.