A response from My Emergency Doctor to ACEM's State of Emergency 2026: Australia's Ageing Population

This week, the Australasian College for Emergency Medicine (ACEM) released State of Emergency 2026, it’s clearest account yet of what is happening to older Australians in our emergency departments (EDs). Its central finding should concern all health ministers, premiers, chief ministers, and every member of the incoming Commonwealth and state budget committees. The health system is not ready for the ageing of the population. This has been building for decades, and the impact is now arriving at the ED door.

My Emergency Doctor welcomes the report and supports its recommendations. We also want to make a case directly to decision makers. Of all the levers in this report, one can be scaled across every jurisdiction in months, not years: emergency specialist-led virtual care that diverts avoidable presentations away from the ED, before they happen. ACEM has named this in its recommendations. Governments now need to fund it as a core infrastructure, rather than a series of pilots.

What the report tells us

The numbers are stark, and they are national.

Demand is growing fastest where workforce is thinnest: since 2018–19, older-person presentations rose 25 per cent in regional EDs, 27 per cent in rural EDs and 33 per cent in remote EDs, versus 11 per cent in metropolitan EDs. In 2025, 35 per cent of ACEM-accredited EDs had unfilled specialist roles, fewer than one in five met minimum staffing guidelines, and only about one-third of hospitals providing emergency care had emergency physicians.

The consequences are immediate: extended ED stays increase delirium, falls, pressure injuries, infection and functional decline, often leading to longer admissions and earlier entry into residential aged care.

The political reality: a shared problem needs a shared fix

The response followed a familiar pattern: the Commonwealth pointed to state responsibility for hospitals, while the states pointed to Commonwealth responsibility for aged care, with 3,274 older Australians stranded in public hospital beds awaiting residential care.

Both are partly right—and that is why progress stalls. Older patients cross funding boundaries, often reaching the ED because aged care, home support or rural services cannot access senior clinical advice, leaving an ambulance as the only safe option.

The 2026-2031 National Health Reform Agreement Addendum, which began on 1 July, commits all governments to "stronger shared stewardship of the whole health system". It also adds $25 billion in Commonwealth hospital funding over five years. 

Virtual emergency care is one of the clearest tests of whether shared stewardship means anything in practice. It sits between the jurisdictions. It reduces costs for state hospitals and ambulance services, and it makes the Commonwealth's aged care and primary care settings safer and more capable.

Rapid Virtual Expertise: Ending the Default Emergency Transfer 

Much of the report focuses, rightly, on access block and exit block. These have no virtual solution. Australia needs more inpatient beds, more aged care capacity and better transition pathways, and ACEM is right to say alternative pathways must complement investment in ED and inpatient capacity, not replace it. We agree completely.

But every bed freed downstream fills again quickly if demand at the hospital front door keeps growing at four times the rate for younger patients. Half of older presentations arrive by ambulance, and that is where the decision point sits. Some of those transfers are essential. Many are made because the nurse in an aged care home, the paramedic at the bedside or the remote area nurse has no rapid access to senior emergency judgement. Without it, the default is transfer.

Virtual emergency care changes that default. 

An emergency specialist, connected by video, can assess the patient with the clinician who is physically present. They can review records and decide together whether the person needs the ED or whether they can be safely treated where they are. If they can stay, the plan is set on the spot: treatment, prescribing, pathology, follow-up and a clear plan for escalation if the patient gets worse.

The evidence is already here

This is not a speculative model. ACEM's own report endorses it, recommending that the Federal Government "jointly invest with State and Territory Governments in additional emergency medicine telehealth support for residential aged care staff and community care services". It also calls for expanded Virtual Emergency Department services backed by investment in research, infrastructure, and training.

The published evidence supports that position:

1. Metro North, Queensland. An evaluation of 2,080 referred patients found that the Virtual ED prevented 70 per cent of community-triaged patients from presenting the physical ED.
2. Southeast Melbourne, residential aged care. 79 per cent of virtual consultations (188 of 238) avoided hospital transfer.
3. Aged Care Emergency service. Cited in the ACEM report, a 2023 trial found ED presentations from aged care fell by 29 per cent when telephone support was strengthened with video consultation.
4. Specialist Telehealth Aotearoa. This emergency specialist-led service took mainly ambulance referrals for patients with a median age of 72. It avoided hospital transfer for 58 per cent of patients, and their seven-day re-presentation rate (10.2 per cent) was comparable to the hospital's overall rate (9.5 per cent).

That last finding goes to the heart of safety. Diversion that only delays a presentation is no saving. The evidence shows that well-designed, specialist-led virtual care keeps people out of hospital without pushing the risk downstream.

What My Emergency Doctor does

My Emergency Doctor was established in 2016 by Australian emergency physicians and has completed more than 350,000 consultations. We operate 24 hours a day, 365 days a year, and our clinicians are Fellows of the Australasian College for Emergency Medicine (FACEMs), supported by GPs with RACGP or ACRRM fellowship.

This matters to the debate ACEM have opened. The College stresses that the safe care of complex older patients depends on senior emergency medicine leadership. It warns against workforce substitution that leaves junior or non-medical clinicians without senior support. Virtual emergency care is how that senior leadership can reach every aged care home, ambulance crew and small rural hospital, including places that will never be able to recruit an emergency specialist.

Our partners already include ambulance services, Primary Health Networks, residential aged care facilities, hospitals, urgent care centres and multi-purpose services. The models we run line up with the report's recommendations:

Across Australia, more than 400 health services use our FACEM On-Demand and Virtual Admission Services. These services provide overnight care without a doctor on site, admit patients locally, and reduce transfers to larger regional hospitals, while protecting its local GPs from burnout. 

Older Australians make up a large share of the patients seen by My Emergency Doctor’s virtual emergency physicians. Between September 2025 and September 2026, 57% of consultations were for patients aged over 50. 

Seven in ten of those consultations (71%) ended with the patient being managed in situ. That means they received appropriate care where they already were, whether in a local hospital, an aged care home or at home, without needing a transfer. Saving the health service significant investment in both unsustainable locum fees and the cost and flow on impact of transfer on the wider service.

Within aged care, more than 90% of consults completed for patients over 50 were managed in situ. 

When a higher level of care is needed, virtual emergency specialists help make sure the right patients are escalated at the right time, with a clinical plan already in place.

 "The ACEM report describes what our emergency physicians hear every night from aged care nurses and paramedics. The decision to transfer a frail older person is often made because no one senior can be reached in time. 

Objectively, an emergency physician is an excellent choice to assess a frail elderly person prior to hospital transfer. We are senior clinical decision makers, and we are also the doctors who end up assessing the patients in the ED, often transferred in direct opposition to their own stated advanced care directives.  

The fault of the transfer does not lie with the nursing home staff or the ambulance staff or the next of kin: it lies in a lack of senior decision making, a lack of holistic perspective, a lack of knowledge of published evidence. Emergency physicians are trained in these exact skills, all of which can be deployed virtually. We can change that transfer decision safely, at scale and right now."

Dr. Tatiana Lowe, FACEM, Medical Director - My Emergency Doctor

What we are asking governments to do

Better coordination alone will not fix the crisis ACEM describes. It needs funded, measurable reform at the points where patients enter hospital. We ask Commonwealth, state and territory governments to commit to five actions.

1. Fund virtual emergency care as permanent infrastructure, not pilots. Use the implementation of the 2026-31 National Health Reform Agreement and the National Health Reform Strategy to establish recurrent, jointly funded virtual emergency care. Time-limited grants create services that clinicians hesitate to rely on and that vanish just as they prove their value.
2. Make specialist virtual triage the first call before any non-critical transfer from residential aged care. The 24/7 registered nurse requirement in residential aged care is only as useful as the support behind the nurse. Every aged care home should have guaranteed 24/7 access to emergency specialist video assessment, as ACEM recommends, jointly funded by the Commonwealth and the states.
3. Embed virtual emergency care in ambulance secondary triage nationally. Half of older presentations arrive by ambulance. Every ambulance service should be able to connect paramedics with an emergency specialist at the bedside, with clear pathways to treat in place, refer directly or transport.
4. Prioritise regional, rural and remote Australia. The fastest growth in presentations is in the places least able to staff an ED. Virtual FACEM support for small hospitals and multi-purpose services should be a standard part of rural health planning. It should sit alongside workforce and training programs such as EMET, not compete with them.
5. Measure what matters, openly. Fund the age-disaggregated data and independent evaluation that ACEM calls for. Virtual services should report transfer avoidance, re-presentation, safety and patient experience against common national measures. Then governments can expand what works with confidence.

The choice in front of decision makers

Australia cannot build its way out of this crisis quickly. New wards and aged care beds take years to plan, staff and open. In the meantime, the number of older Australians reaching their eighties is rising every year.

Virtual emergency care is not a substitute for that investment. It bridges the gap and protects patients while those long-term commitments are realised. It brings senior emergency medicine expertise to the bedside of an older person in an aged care home, a living room, or a country hospital at the exact moment a transfer decision is made. Every avoided transfer spares a frail person a long ambulance trip and hours in a corridor waiting for investigations that rarely change their medical management. It restores their choice and dignity. Ultimately, it frees an ambulance, clears a cubicle, and reclaims critical hours for the ED teams ACEM represents.

The evidence exists, the workforce exists, and the national agreement to act jointly has been signed. What is missing is the decision to fund it, at scale. My Emergency Doctor stands ready to work with every government in Australia to make that happen.

Media Contact: 

Lucille Webster, Head of Marketing

My Emergency Doctor

Lwebster@myemergencydr.com 

Sources

1. ACEM, State of Emergency 2026: Australia's Ageing Population
2. ABC News, 13 October 2026: ministers' responses
3. Department of Health, 2026-2031 NHRA Addendum
4. Prime Minister's statement on the $25 billion hospital funding
5. Metro North Virtual ED evaluation
6. Southeast Melbourne VED, aged care transfers
7. Specialist Telehealth Aotearoa evaluation
8. My Emergency Doctor: Solutions