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The horrific conditions at coronavirus-ravaged nursing home Newmarch House Caddens, western Sydney

Residents of a coronavirus-ravaged aged care home were fed frozen sandwiches, banned from showering and suffered weight loss, dehydration and pressure sores, a damning report has found.

Newmarch House in Caddens, western Sydney, suffered a huge outbreak of COVID-19 which killed 17 and infected 71 residents and workers in April and May. 

By mid-April, one just week into the outbreak, 87 per cent of frontline care and nursing staff – including most of the home’s 50 back-up staff – were forced into isolation, leaving a skeleton crew to look after the residents.

This meant that their care was ‘compromised’ and ‘delayed’, a report into the outbreak has found. 

In the early stages of the outbreak, the care home banned showering for fear that it would spread COVID-19.

Family members reported their loved ones were suffering from poor hygiene and were unable to wash their hair. 

Some residents suffered from ‘weight loss, dehydration, pressures sores, increases in urinary tract and skin infections and general deconditioning’, the report said.

Family members were also concerned about the food quality, with reports of residents being given ‘frozen sandwiches, cold or inedible meals and delays in meal service delivery.’

The report also said that residents were emotionally distressed by being moved into rooms formerly occupied by friends who had died.  

Furthermore, some families were left unable to contact their relatives because of delays in installing landlines into bedrooms.

The review found the care home suffered a ‘vicious cycle’ of staff and protective equipment shortages, as well as sub-optimal infection control practices.

The outbreak at the Anglicare-run nursing home started on April 11 and was declared over on June 15. In that time 19 residents died, with 17 of the deaths directly attributed to COVID-19.

Professor Lyn Gilbert and Adjunct Professor Alan Lilly were in June asked to undertake the review by the federal government and on Monday released their final report highlighting a lack of consistent expert guidance on infection prevention and control at the nursing home.

The report found the lack of this advice at the start of the outbreak led to inconsistent use of personal protective equipment.

A lack of physical distancing between staff during meal breaks, at meetings, and when sharing transport to and from work also led to the rapid depletion in staff numbers.

Some 10 different agencies were called to help boost staff numbers but their skills and experience were found to be variable and their availability unpredictable.

The professors also found some employees were not aware COVID-19 was present at Newmarch House and left soon after arriving for duty.

There was a lack of clarity between the different agencies, which the review found created confusion for the Anglicare board and managers.

Medical care at the nursing home was delivered as a hospital-in-the-home program, which the review found has advantages for elderly residents but its implementation was compromised by inadequate staffing and support.

But the report said Anglicare ‘spared no effort or expense’ in responding to one of the ‘most significant crises’ to occur in residential aged care in Australia.

NSW Health responded to the review saying its outbreak response was ‘prompt’ and delivered in the absence of firm action from Newmarch House or Anglicare.

The department said the lack of preparedness at residential aged care facilities – seen in Newmarch House and in Victoria – prompted NSW Health to step in and ensure aged care facilities can demonstrate they have comprehensive outbreak plans.

NSW Health Minister Brad Hazzard said the department has since developed a protocol to make sure there is clarity around leadership at aged care facilities if an outbreak was to happen again.

‘Clearly there were some major concerns at the time that the structure at Newmarch House and Anglicare was not sufficient to be able to respond in a way that was necessary,’ he told reporters on Monday.

Premier Gladys Berejiklian said authorities have to learn from what’s happened to help stop it from happening again.

‘All of us still feel for the relatives and obviously the patients of Newmarch who experienced such trauma and of course, our hearts continue to go out to them,’ she told reporters.

Federal Aged Care Minister Richard Colbeck also responded to the report.

‘We continue to integrate the learnings from Newmarch and infections in Victoria into the national response as outbreaks occur,’ he said in a statement.

Daily Mail Australia has contacted Anglicare for comment. 

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