As the number of cases of coronavirus in aged care residents and staff members increases, calls are growing within the industry for residents who are diagnosed with the disease to be automatically transferred to hospital.
Earlier this week, all infected residents at Menarock Life aged care home in Essendon in Victoria were transferred to hospital, but that state is battling against outbreaks in multiple aged care facilities.
Voices across the sector want state government protocols changed to ensure residents who are diagnosed with the virus are moved to hospital straight away, both to assist in treatment and to help facilities manage outbreaks.
Chief executive of Aged and Community Services Australia Pat Sparrow said it was important for the first case of coronavirus found in an aged care facility's residents to be hospitalised, both for the patient and the facility.
"Older people are more vulnerable, they have comorbidities. It also means it gives us the best chance in a facility to stop the spread," she said.
Ms Sparrow says the South Australian government's protocol, that allows for automatic transfers of residents to hospitals, should be adopted by other states. No states prevent residents from going to hospital but say residents should be transferred in.
Even before the current Victorian outbreak, some of Australia's most concerning coronavirus clusters have been in aged care facilities, including the notorious Newmarch House cluster in Sydney, where 19 residents died from the disease. Some families who are suing Anglicare over the handling of the outbreak believe there were delays in transferring their loved ones to hospital that could have cost them their lives.
The aged-care sector is covered by a handful of peak bodies, all of whom are in agreement about the need for automatic hospital transfers for infected residents and suspected cases.
Sean Rooney, chief executive of Leading Age Services Australia, said transferring residents to hospital gave facilities the best chance to stop the spread.
Health authorities haven't moved to automatic transfers of infected aged-care residents and chief executive of the Council on The Ageing Ian Yates believes decisions on hospital transfers should be made on the individual clinical assessment.
"Would this person, whatever their age, would a doctor say 'I have to get them into hospital?' then if the answer is yes, it doesn't matter what age they are, that's where they should go," Mr Yates said.
He is wary of instituting automatic transfer procedures in an industry that has been shown through the aged care royal commission to transfer aged care residents to hospital when there isn't a clinical need to do, sometimes causing distress to residents, especially those with dementia.
"We've got to be cautious of anything that sounds like a simple answer," Mr Yates said.
"The resident's interests are obviously paramount and if the clinical view is, without any ageism, that the resident is comfortable where they are and can be cared for where they are, and are safe where they are, then fine."
Acting chief executive of the Aged Care Guild Nick Brown said residential aged care facilities needed appropriate support from public health units in the case of an outbreak.
"In responding to COVID-19 outbreaks, senior Australians must have the same right to access hospital care as any other person in the community, particularly given they are a higher-risk due to their age and underlying health concerns," he said.
Leaders in the aged care sector say their call for the protocol isn't an admission that they are shirking their responsibility or not up to the task of caring for residents with coronavirus.
"Residential aged care homes are 'homes'. They're not hospitals," said Tracey Burton, chief executive of Uniting NSW.ACT, the largest provider of aged care across the state.
"'Hospital in the Home' has a higher risk of failure, especially if 80 per cent to 100 per cent of staff are sent home to isolate. It is complex. It takes time to set up. It is a compromise in care. And many aged care homes are not suitable as they have practical challenges including shared rooms."
Ms Burton said aged care facilities should be given the best chance possible to stop the spread of the disease to other vulnerable residents.
"In order to break that chain of infection, that's what we're trying to do, is get the outbreak under control with as few people impacted as possible and as short an outbreak as possible," she said.
"Once you have a resident who is tested positive, them or anyone else who is suspected transferred to hospital I think is the safest way."
Aged care expert Joseph Ibrahim, head of the Health Law and Ageing Research Unit at Monash University, is in favour of the automatic transfers because it takes away the possibility that the lives of older Australians will be devalued when compared to younger people who also need access to hospitals during an outbreak.
"If you asked me before COVID, 'are you keen on older people going to hospital?' I would have said no, it needs to be measured, but this is different," Professor Ibrahim said.
"With COVID you drop off a cliff quickly."
Most people who spoke to The Canberra Times said it would also be acceptable for isolation locations to be used other than hospitals.
"It's a challenging situation with aged care. Sometimes those residents are looked after in place. If the isolation, single rooms, en suite bathrooms are available and those patients, residents, can be managed onsite, that's done," Victorian Chief Health Officer Brett Sutton said on Tuesday.
"In other facilities, because there's a shared bathroom or difficulties in managing the movement of residents around the facility, they will be transferred, as has been the case with Menarock aged care."