Blanket policies in aged-care facilities, including complete lockdowns and two-week quarantines for residents who seek external medical treatment, have been a major barrier for patients seeking anti-VEGF treatments, the Macular Disease Foundation Australia (MDFA) has revealed.
The organisation told Insight it has made several individual representations on behalf of residents and their families to federal ministers, aged care peak bodies and several aged care providers.
This is due to the varied federal and state health guidelines, as well as individualised aged care provider COVID-19 management policies.
It comes after some ophthalmologists reported an initial 30% drop in scheduled intravitreal injection visits early in the health crisis in March. This, according to the MDFA, was due to a disconnect between Australian Government guidelines and the community’s understanding of what constituted ‘essential care’, leading many to cancel their appointments.
Although numbers have begun to improve as restrictions were lifted, MDFA CEO Ms Dee Hopkins said some patients living in aged care facilities remained dependent on the individual policies of providers.
“In the early stages, several families and ophthalmologists approached MDFA outlining concerns about aged care residents who were unable or unwilling to attend scheduled sight saving treatment due to confusion about their provider’s policies,” she said.
“While aged care providers understandably were concerned about safeguarding residents’ health and wellbeing, blanket policies were often unnecessary where there were no cases of the virus. As providers are responsible for setting their own policies, policies varied from provider to provider and each state and territory had different COVID-19 containment stages.”
Hopkins said that some policies included complete lockdown, which meant no resident could go outside the facility, while others who attended external medical treatment were asked to quarantine in their room for two weeks.
“The 14-day quarantine became a major barrier for aged care residents to attend their treatment despite knowing that missed appointments could compromise their vision,” Hopkins said.
“In one case a 92-year old aged care resident insisted on attending this scheduled appointment but on each occasion, he had to quarantine in his room with his wife for 14 days. He felt this was totally unnecessary and unfair as there had been no cases of the virus in the facility.”
As a result, MDFA advocated on behalf of individuals and approached federal ministers, aged care peak bodies and providers with the request that – where no COVID- 19 cases are present – residents be allowed to attend treatment without fear of quarantine.
“In early June, we received a response from a large national aged care provider who have now relaxed their restrictions. We think it will take some time for all providers to follow accordingly,” Hopkins said.
Victorian lockdown poses fresh challenge
Meanwhile, at the beginning of the health crisis, MDFA’s national research advisor Professor Paul Mitchell reported an initial drop of 30% of scheduled injection appointments while others reported varying reductions of between 5-10%.
MDFA initiated a public campaign to ensure people kept attending their appointments.
“Since the campaigns have run, Professor Mitchell and other ophthalmologists, have reported an improvement in attendance. While we are seeing tightening of restrictions in Victoria once more with a second wave of the virus, it is important that we maintain our voice about the importance of essential eye treatments and support the more vulnerable Australians throughout this pandemic,” Hopkins said.
Reports from ophthalmologists since the campaigns suggest that attendance at scheduled appointments has improved significantly and in line with lifting of restrictions in most states. MDFA recently launched the inaugural longitudinal Macular Disease Social Impact study while Australia was in the initial stages of the pandemic restrictions.
Prior to print, it added an open-ended question directly relating to COVID-19 and the impact this was having on the macular disease community.
“We are currently collating this data and will be able to share patient insights in the not too distant future,” Hopkins said.