As Covid-19 cases mount in Victorian aged care facilities, experts have questioned the state’s policy of not sending all infected residents to hospital.
At least 40 aged care homes in Victoria now have at least one positive Covid-19 case, and there are more than 200 active cases connected to aged care facilities.
Last week, all Covid-19 positive residents of Melbourne’s Menarock Life aged care home were transferred to hospital, then all the remaining residents were evacuated.
But Victoria’s chief health officer, Brett Sutton, has said not all infected residents would be moved from aged care homes.
“Sometimes the safest place for them is to remain in that facility … it’s really done on a case-by-case basis,” he said.
Experts have cautioned that keeping positive cases where they are risks putting other residents in danger, and that infection control is much more difficult in an aged care home than in hospital.
Sydney’s Newmarch House, where up to 19 residents died from Covid-19 during the first wave of the pandemic, was criticised for its “hospital in the home” approach.
Only 16% of infected patients were sent to hospital from Newmarch House, whereas Dorothy Henderson Lodge, the site of another cluster, sent 80% of patients to hospital. Six residents died.
Prof Joseph Ibrahim, head of the health law and ageing research unit at the Department of Forensic Medicine at Monash University, said the fact there was still no official report about the Newmarch House outbreak made it harder to make good decisions.
“What you would normally expect is a full report from [both facilities],” he said “The question is why did Dorothy Henderson Lodge work so well, and why was there a difference between there and Newmarch? You’ve got a natural experiment which could have given us a hell of a lot of information about what to do next.
“We know that aged care homes are high risk and yet we haven’t had anything provided as far as I know to either the public, the residents or the aged care providers about what goes well and what’s a problem,” he said.
The aged care royal commission, the NSW coroner and the Covid-19 Senate committee are all looking at what went wrong at Newmarch, but none of these bodies has issued a report or findings yet.
Nigel Hart, a long-term resident at the Glendale aged care home in Werribee, told Guardian Australia he was generally happy with the care during lockdowns, but worried that some positive residents remained in the home.
“I think that’s wrong, but I understand from what I’ve been told by the managers here today that they are following guidelines and advice from the [health department],” he said.
“I think [moving positive people out] would improve everyone’s chances of not getting the virus. So far, touch wood, I’m still negative and I just hope to hell it stays that way.”
Although only 46, Hart has a number of serious medical conditions that require round-the-clock medical care. He has suffered 15 heart attacks and requires regular dialysis due to his kidneys no longer functioning. He is no longer able to walk and requires a tracheostomy tube to breath.
Hart said he was often learning of new Covid-19 cases in his home from the news rather than management.
“It does scare me ... who knows if [the new cases are] because of the people who are already positive, if it’s because of them or not. No one knows.”
There are now 28 cases connected with Glendale, but Hart said he did not want to be moved out.
“I think they have done a good job under the circumstances ... this is all new, no one in the world has ever seen this before. I think they have done a good job, except earlier since the outbreak I wasn’t being kept up to date every day, but the managers I talked to today said they will tell me things every day now. So besides the lack of communication in the past week on my side, I think they have done a good job.”
Prof Marylouise McLaws, an infection control expert at the University of NSW and adviser to the World Health Organization, said infection control was very difficult in aged care homes.
“Unless you have dedicated bathrooms – and not every aged care facility does – and unless you have highly trained staff in infection control, which you don’t have in aged care, then it is very difficult to ensure that any shared area is kept clean all the time,” she said.
Both McLaws and Ibrahim said Covid-19 patients should generally be moved to hospital to avoid infecting other residents. They said that aged care staff are not trained in infection control in the same way that doctors and nurses are.
Mclaws said aged care homes did not have the same measures as hospitals to prevent infection escaping, such as pressured rooms, Hepa filters, and designated areas to store protective equipment.
“It’s very difficult to all of a sudden turn really a shared home into a proxy hospital with cutting-edge infection control,” she said.
Ibrahim said the fact that facilities are meant to be like home for their residents made infection control harder.
“They’re not equipped in terms of laundry and all the rest of it to manage a high volume of waste because that’s not what they’re normally doing,” he said.
Ibrahim said infection control in homes was not “spot on” before the pandemic and aged care homes could not be expected to manage this extra challenge.
“It’s a bit like playing in the under 9s sport team and not being very good and then being promoted the following week to play in the adult competition and expected to perform at a high level,” he said. “It makes no sense.”
On Sunday, the federal and Victorian governments announced new measures to prevent infections reaching aged care, including support to prevent staff working across multiple facilities and to help them self-isolate when necessary.
Ibrahim said he was in favour of transferring people to hospital, but there were also sound arguments against it, including that residents might not be sick enough, they might not want to go, and moving people brought with it risk of infecting others.
“There are no good options,” he said. “But where those decisions are really hard ... the most important thing is to have information about what’s happened before and what’s worked and what hasn’t, so that we can make better decisions into the future.”
