Federal government coronavirus preparations for aged care were "in some respects insufficient", says a royal commission which has called for urgent changes to the sector.
Immediate Commonwealth funding must be provided to ensure friends and family can visit elderly residents, and infection control experts should be deployed in all homes, the report said.
It found the federal government made efforts early on in the pandemic to implement advice from the Australian Health Protection Principal Committee.
However, the measures were "in some respects insufficient to ensure preparedness".
"Confused and inconsistent messaging from providers, the Australian government, and state and territory governments emerged as themes in the submissions we have received," the report, released on Thursday, said.
"All too often, providers, care recipients and their families, and health workers did not have an answer to the critical question: who is in charge?
"At a time of crisis, such as this pandemic, clear leadership, direction and lines of communication are essential."
The commission said the understandable restriction of visitation at aged homes had tragic, irreparable and lasting effects.
"Visits from family and friends are critical to the physical, mental and emotional health and wellbeing of people living in residential aged care and also their friends and families," the report said.
"The benefit of such visits cannot be wholly replaced by technology."
In all but extreme cases, blanket bans on visitation are unacceptable and should be both explained and justified, it added.
Visitation must be proportionate to risk, even during times of community transmission.
"(Residents) should certainly not find themselves in their more vulnerable days facing their fears of the pandemic without the comfort and support of their friends and families," the report said.
The commission wants the federal government to set up a system where providers can apply for staff funding needed to facilitate visits.
The commission has also called on Canberra to increase the availability of allied health and mental health services, and set up a national aged care advisory body.
It wants infection experts in all homes as a condition of accreditation.
Aged Care Minister Richard Colbeck said the government has accepted all recommendations and work was underway on four of them.
He pledged an immediate $40.6 million in extra funding for the sector, including $10.8 million for leadership training of senior nurses.
More than 665 aged care residents have died from COVID-19 in Australia, with outbreaks affecting some 220 facilities.
The report said levels of depression, anxiety, confusion, loneliness and suicide risk in residents had increased since March.
"Some of this can be attributed to missing family, changed routines, concern about catching the virus or fear of being isolated in their rooms," it said.
The report said there was no one-size-fits-all answer to whether residents who contract the virus should be transferred to hospital or cared for in their home.
Australian Associated Press