Eighty patients from a Quakers Hill nursing home have been taken to nine Sydney hospitals following Friday morning's fire.
Of those, eight patients were in a serious condition, NSW Ambulance Acting Commissioner Mick Willis told reporters.
A further 44 patients from the home have been taken to the Lottie Stewart private residential care centre.
Police have asked families of residents to not go to the scene, and call 1800 227 228.
A total of 79 patients are now being cared for in hospitals or care centres.
Seventeen patients who were being cared for in a makeshift triage centre set up inside a nearby Anglican church have been taken to a nursing home in Blacktown.
Melinda Champion, office manager of Quakers Hills Anglican Church, said the 16 unharmed elderly people at the church would be taken to other nursing homes.
"As we speak, they're loading patients onto a ambulance bus and transporting them over to Blacktown Nursing Home," Ms Champion told Macquarie radio.
She said there was a sombre mood at the church.
"Very quiet some of them, others are quiet chatty," she said.
"We've got a lot of their family members here as well so they're very comfortable.
"It's been quiet good that we've been able to match family members with patients.
"There's also a few that have turned up looking for their family and unfortunately their family hasn't been here, they've been moved to other nursing homes or to hospitals."
Emergency services were called out to the building in Hambledon Road, Quakers Hill, at 4.53am (AEDT) on Friday.
Dozens of the 100-odd residents were trapped inside the inferno when firefighters arrived at the scene.
Thick black smoke had engulfed the building, choking residents and compounding the problem for firefighters, who were forced to search the rooms by crawling on their hands and knees.
WORST NIGHTMARE
"This is a firefighter's worst nightmare," Superintendent Greg Mullins told reporters at the scene.
"(They) could not see their hands in front of their faces...
"Crews had to literally crawl on their hands and knees into every room in the complex, reach up under the beds, searching cupboards, anywhere where someone may have crawled away."
Many of the elderly people could not get "out of harms way" and the "roof was on fire above them", he added.
"It was a horrific scene," he said.
"This has been a very, very serious fire, a tragic scene - a lot of people injured. There have been some fatalities, there may be more."
Comm Mullins said it would have been a horrific experience for the elderly people, many of whom are in wheelchairs and beds, huddled outside the burnt out building.
"They are confused... they are not sure what is going on," he said.
"It is just horrific, absolutely horrific," one neighbour told AAP.
"Tremendously sad that this has happened to gentle elderly folk."
Comm Mullins said the cause of the fire was under investigation.
The state coroner and arson and homicide investigators will attend the scene.
Comm Mullins said the nursing home had been "searched from top to bottom".
The cause of the fire - one of the in Sydney worst in decades - is currently under investigation.
"No idea at this stage what caused the fire," he said.
"It's decades since we've seen a fire like this."
HOMICIDE DETECTIVES
Quakers Hill Superintendent Gary Merryweather said the investigation was being assisted by homicide detectives and it was too early to say if the blaze was suspicious.
"The investigation is going to be quite lengthy," he said.
"We do ask anyone who may have family members here not to come to the scene because all of the patients from the nursing home are being transported to a number of hospitals, including Mount Druitt and Blacktown."
Ambulance NSW said the residents had various degrees of injuries and most were suffering from smoke inhalation and minor burns.
"It has been a long, long time since I have seen something like this, something of this magnitude," a spokesman told reporters at the scene.
The Domain Principal Group, the company which runs the Quakers Hill Aged Care Facility, released a statement to advise they had been notified of the "serious fire".
People have described the incident as an "absolute tragedy".
"The cost to human life is going to be very high," Srin Najaken, a 56-year-old nurse whose home neighbours Quakers Hill Nursing Home, told AAP.
"Somebody banging on my door woke up me up shouting 'there's a fire, there's a fire, get out'.
"Luckily for us the fire didn't spread but it is an absolute tragedy."
Another neighbour, 60, who did not want to be named, said emergency services had told him up to seven people had died in the blaze.
"They told me it was up to seven dead," the man told AAP.
"I feel for everyone involved; those that've died, their relatives, the workers.
"It is a tragedy, there's no other word."
Sally Pearson, 30, lives in Quakers Hill and walked past the scene around 7.45am (AEDT).
"You just imagine elderly people unable to move or really immobile as the fire took hold," she told AAP.
"I think of my own grandmother... You never want anything like this to happen to anyone."
Rod Young, CEO of the Aged Care Association Australia, said arrangements were being made to accommodate around 80 displaced residents.
"We've got a number of people making contact with all the nursing homes in the neighbourhood trying to see what's available and arrange for transfers as soon as possible," he told ABC Radio.
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