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Governing Risk and Older Age During COVID-19: Contextualizing Ageism and COVID-19 Outbreaks in Australian Aged Care Facilities During 2020

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Handbook on COVID-19 Pandemic and Older Persons

Abstract

The infectious spread of the novel coronavirus (COVID-19) has generated numerous media and political responses that bring together health, risk, and age. Within these responses, older people have been cast as “the vulnerable elderly” who are less socially worthy and valuable than younger people, in poor health, and considered to be automatically at risk of COVID-19 due to their age. This simplistic connection between older age, frailty, and ill-health reduces older age to a medical and health problem, which perpetuates and deepens ageism. The implied connection has been particularly evident during the coronavirus pandemic through the imposition on older people, who are living in aged and long-term care facilities, of severe lockdown restrictions enforced through the processes of risk governmentality and authoritative control. These socio-political and institutional regulations have heightened the isolation from society that older people living in such environments already face, ironically further threatening their health and wellbeing. Drawing on Australian media reports and specific institutional responses imposed on or emerging from residential aged care that occurred during 2020, our theoretical examination reveals how ageism, risk discourses, and risk governance during the coronavirus pandemic jeopardized older Australian’s health, wellbeing, and dignity of risk, while also reinforcing barriers to social inclusion. We conclude with suggestions for dealing with ageism including challenging the medicalisation of older age, promoting and supporting older people’s dignity of risk, and radically changing our attitudes towards, and language regarding, ageing.

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Notes

  1. 1.

    The final report of the Royal Commission (2021) was released on 1 March 2021; it contains 148 recommendations for comprehensively reforming Australia’s aged care system.

  2. 2.

    The first wave of coronavirus reportedly occurred from March to April 2020. The second wave of coronavirus—from June to September 2020—was caused by community transmission and was primarily experienced in the state of Victoria, and heavily localized to its capital city, Melbourne (Australian Institute of Health & Welfare, 2021).

  3. 3.

    Australia has eight internal state and territories that form the Commonwealth of Australia (Queensland, New South Wales, the Australian Capital Territory, Victoria, Tasmania, South Australia, Northern Territory, and Western Australia). In this chapter, we collectively refer to these as “states”. Based on geographical size, Australia is the world’s smallest continent and largest island (Geoscience Australia, n.d.). It is also the world’s sixth largest country, with a land mass approximately 50 percent larger than Europe and 32 times greater than the United Kingdom (Australian Government, n.d.; Geoscience Australia, n.d.). It is the only nation to govern an entire continent.

  4. 4.

    Australian aged care policy focuses on ageing-in-place (in one’s own home or in the community). RACFs mostly provide care for older people who have higher and complex needs (Eagar et al., 2019; Ibrahim, 2020). The underfunding of and significant waitlists for home and community care, however, have led some older people to die while waiting for such services or to prematurely enter RACFs (Royal Commission into Aged Care Quality & Safety, 2019, p. 158).

  5. 5.

    During health emergencies, the Australian Health Protection Principal Committee (AHPPC) is Australia’s key decision-making committee.

  6. 6.

    Based on geographical size, Tasmania is Australia’s second smallest state/territory. Tasmania is an island state located 240 kms off the southern eastern end of Australia. The physical separation between Tasmania and the rest of Australia allowed Tasmania to implement a hard border rule during 2020 and for most of 2021.

  7. 7.

    Based on geographical size, Victoria is Australia’s third smallest state/territory. It is located north of Tasmania, from which it is separated by the Bass Strait. Based on population size, Victoria’s capital city, Melbourne, is the second largest city in Australia. Victoria is Australia’s second most densely populated state/territory in Australia (28 people per square kilometre) (Australian Bureau of Statistics, 2020).

  8. 8.

    As of 25 February 2022, Victoria has had a total of six lockdowns since March 2020. As of 22 October 2021, people who were living in Melbourne had experienced the longest length of lockdowns in the world at 262 days since the start of the coronavirus pandemic.

  9. 9.

    Minister Colbeck came under scrutiny in 2022 when he chose to attend three days of a cricket match between Australia and England in Tasmania rather than attend a Parliamentary Enquiry into COVID-19. Minister Colbeck, however, cited the reason for his absence was due to “The Covid-19 pandemic … [being] at a critical point with the onset of numerous Omicron outbreaks” (Colbeck, in Karp, 2022). Minister Colbeck has appeared at the inquiry twice: 4 August 2020 and 21 August 2020 (RMIT ABC Fact Check, 2022).

  10. 10.

    RACFs are precarious workplaces—care staff are often employed casually, work across multiple sites, and are undervalued and poorly-paid (Royal Commission into Aged Care Quality & Safety, 2019), factors which have created heightened risks (to themselves and others) during the COVID-19 pandemic (Wahlquist, 2020).

  11. 11.

    In Australian RACFs, some of these issues were already known problems including incidents of sexual and physical assault, poor pain management, and the overprescribing of antipsychotics and benzodiazepines (Ibrahim, 2019). There is chronic under-resourcing and under-staffing of RACFs, which includes a dearth of staff expertise on high and complex health needs (Eagar et al., 2019; Ibrahim, 2020). These are structural problems that compromise optimal care and quality of life for people who live in RACFs, and which have become more visible and profound during the coronavirus pandemic (Zhuang, 2021).

  12. 12.

    Australian RACFs are defined in the Australian Aged Care Act 1997 as people’s homes. This fostered “the development of a workforce that is less clinically skilled and oriented with greater reliance on lower skilled personal care workers” (Eagar et al., 2019: 4). Even though there is an obligation for RACFs to “provide safe, respectful and quality care and services” (Standard 7, Aged Care Accreditation Standards, in Eagar, 2019, p. 4), they are not medical facilities and do not have the associated material and human resources including highly trained medical specialists.

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Correspondence to Peta S. Cook .

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Cook, P.S. et al. (2023). Governing Risk and Older Age During COVID-19: Contextualizing Ageism and COVID-19 Outbreaks in Australian Aged Care Facilities During 2020. In: Shankardass, M.K. (eds) Handbook on COVID-19 Pandemic and Older Persons. Springer, Singapore. https://doi.org/10.1007/978-981-99-1467-8_18

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