Hospitalisation call not so simple

While it is emotionally understandable that people would expect their loved ones to be moved from aged care to hospital when they contracted Covid-19, it can be argued that this would have made no difference to their outcome, but would have placed hospital staff at great risk (Rick Morton, “Exclusive: The government phone call that denied elderly coronavirus patients access to hospital”, August 15-21). Journalists tend to treat all aged-care residents as a common group, but they are anything but, and should not be considered as a common entity in discussion. Briefly they comprise people with slow or non-progressive physical illness such as multiple sclerosis, Parkinson’s disease, stroke or profound quadriplegia, or people with slowly progressive cancer, frail elderly with multiple comorbidities but no specific fatal illness, and a large number with dementia. This diverse group can be triaged into three cohorts – first, those who have a completed life who are waiting to die and do not want to go to hospital; second, those whose state of health is such that no hospital treatment will make any difference to their outcome (i.e., treatment is futile); and third, a group for whom aggressive hospital treatment might result in survival, and they want that. The first two groups should have been provided with effective palliative care in quarantine in situ, while the third group should have been transferred to hospital for assessment. The federal government says it had a plan, but clearly it was an ineffective plan. The current plaint to move all Covid-19-positive aged-care people to hospital is also an ineffective response that will alter little except expose important skilled hospital personnel to infection. Unfortunately, the time to implement an effective plan (prevention) is long gone, and we are reaping the consequence.

– Rodney Syme, Yandoit Hills, Vic