Home | COVID-19 | Why aged care residents with COVID-19 should be transferred to hospital: opinion
Residents were evacuated from St Basil's Home for the Aged at Fawkner in July. Photo: NCA NewsWire/Andrew Henshaw

Why aged care residents with COVID-19 should be transferred to hospital: opinion

More than a third of care residents who have contracted COVID-19 have died.[1] That’s more than 36 times higher than the rest of Australia’s population.

If COVID-19 was tearing through schools or workplaces in such numbers there would be uproar and a call for an urgent overhaul of how to treat this disease. So what can we do to stop more lives from being lost?

Most states prefer a ‘Hospital in the Home’ type policy which aims to contain the spread of COVID-19 by treating aged care residents with the disease within the facility, instead of transferring them to a hospital.

How the ‘Hospital in the Home’ system was developed was understandable. It was created partly to avoid swamping the hospital system and partly due to avoid disruption to aged care residents who might be unsettled by moving to an entirely new environment.

But months on, and 642 aged care deaths later, it’s clear that aged care homes are not designed or resourced to deal with an outbreak as infectious as COVID-19.

So Catholic Health Australia is calling on state and territory leaders to adopt a nationwide protocol that would see the first aged care residents infected with COVID-19 immediately transferred to a hospital.

It’s already standard policy in South Australia and Queensland, but these are states where the number of cases of COVID-19 remain thankfully low. We now need states like NSW and Victoria to urgently follow suit.

The women and men who work in our aged care sector are striving tirelessly to prevent COVID-19 from getting into their homes. But despite their best efforts we need to be realistic: the disease will continue to breach infection control for many months to come.

Aged care homes are designed and operated as home-like communal living environments with an emphasis on social engagement and interaction. The risk of cross infection in an aged care home is therefore significantly higher than in a hospital from both a staff and physical environment perspective.

For a virus like the flu, that risk is manageable and the aged care sector has decades of experience in how to keep residents safe. But COVID-19 has proven a much more deadly disease. It requires superior clinical skills and purpose built and equipped facilities which only a hospital can provide.

It’s also far more contagious, making it vitally important to identify, isolate, and move the first COVID-19 positive residents out of an aged care facility as quickly as possible. This will not only minimise the chance of the outbreak spreading, but also relieve the pressure on the overall healthcare sector.

Moving infected residents off site will also provide valuable time for the aged care home and other agencies such as the Public Health Units to activate their emergency plans and focus on providing a safe and comfortable home environment for remaining residents.

The last thing we want to do is lock people in their rooms and turn aged care facilities into sterile wards.

Despite optimism about the potential for a vaccine, the fact is this virus could be with us for years. We therefore need a robust and long-term protocol to manage it and keep older Australians safe.

Switching the ‘Hospital in the Home’ model for a smarter protocol will help our aged care homes keep the virus at bay and save lives.

Pat Garcia is chief executive of Catholic Health Australia.

[1] https://www.health.gov.au/resources/covid-19-cases-in-aged-care-services-residential-care based on the number of people who have died from COVID vs active and recovered cases.

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2 comments

  1. With all due respect, transferring residents to hospital certainly does come with it’s own issues.

    What happens if the resident has dementia with a propensity to wander and tests positive, but is not sick enough to stay in bed? The hospital would sedate them – we have seen this time and time again. Sedated old people usually do not have good health outcomes. Usually they die.

    Another concern. Delirium.
    People who have dementia can experience delirium when moved out of their familiar environment and this also can cause death.
    It is also mentioned in regard to best practice in managing dementia in the Aged Care Quality and Safety Standards, under standard 3 Personal Care and Clinical Care.

    Clearly Aged Care Facilities are, as you have stated in the article, “not designed or resourced to deal with an outbreak as infectious as COVID-19”. So why are we not addressing this issue?
    Why is our Government not investing in properly designed and resourced Aged Care?
    This is the crux of the issue, not “hospital in the home”. It’s the appropriate funding and resourcing of the Aged Care sector.
    The Royal Commission has identified it.
    Those of us who are working in the industry know that it has been the same way for decades and nothing has been done.
    Don’t dare victim-blame the Aged Care homes when it is the Government – dating back to Howard in fact, who has allowed this to happen through under-resourcing and privatisation of the industry.

  2. More importantly, what happens if a dementia resident with Covid isn’t transferred to hospital? Sedation or delerium is the least concern when a wandering covid resident is infecting vulnerable residents inside the home.
    Nursing homes are designed for community living, they were not equipped nor should anyone expect them to be prepared for a pandemic.
    Best practice has seen S.A and QLD keep homes there free. The NSW and VIC governments used residents “advanced care Directives” against residents and the facilities. These documents aren’t considered when a fire rips through the building and to essentially lock and guarantee cross infection is tantamount to murder while funded and staffed covid wards sit empty is a crime.
    The industry was privatised to enable growth and to provide a sustainable aged care option. The government could have kept it in house but the cost would be enormous. They certainly haven’t shown any expertise in clinical management because we all recall Oakden, in regard to financial management… government facilities receive the same federal funding as private but are additionally funded by the states and their outcomes don’t reflect the extra cost. They also have considerable tax and cost advantages than the private sector.
    You can’t expect a sector to have two billion dollars ripped away, CPI axed, ACFI butchered, payroll tax subsidies abolished etc etc to not make spending cuts. The government has failed its duty of care to provide adequate funding for the provision of appropriate services for the elderly residents.