Graphic images showing horrific pressure injuries suffered by an elderly woman allegedly neglected while in residential care in Wollongong have been shown at the Royal Commission into Aged Care.
Shirley Fowler, 92, developed pressure ulcers on both her feet in 2017 that were initially missed by inadequately trained staff and became infected.
One foot was so seriously injured it exposed bone and developed harmful necrotic tissue shown to the commission in photographs.
Mrs Fowler then developed contractures in her legs, which resulted in the freezing of a limb in a foetal position due to the atrophy of muscles.
She is now immobile and can only move her eyes, which may have been avoided if she had received physiotherapy and massaging, Mrs Fowler's daughter Lyndall told the commission in Darwin on Tuesday.
Ms Fowler said "there have to be system problems" if a well-regarded facility that met quality standards did not notice the seriousness of the ulcers.
She was still physically mobile but had dementia when she moved into residential care at the IRT William Beach Gardens in Wollongong in 2013.
But her physical health declined after a series of falls and dramatic weight loss.
One incident contributed to the sacking of a male nurse, who had left Mrs Fowler in her bed without a blanket or proper dressing for her feet wounds with a bloody towel and rubbish left next to her.
Ms Fowler, a former nurse, intervened and was able to identify neglect, including the pressure wounds, contracture, poor oral health and poor diet.
Most patients did not have that advantage, putting them at more risk, special counsel assisting the commission Peter Gray QC said.
Ms Fowler met with the facility's medical and hospitality staff, saying her mother wasn't fed properly with soft or pureed meals she could swallow and had spilled food left all over her clothes by staff.
"It's very stressful, to not only have to witness her deterioration and loss of independence and dignity but to have to time and again bring things up that shouldn't have been my role," she told the commission.
In a letter to owners IRT, she questioned if the aged care home was "meeting the basic standards of preserving her (mother's) dignity".
She said she did not blame the staff, who were often paid less than McDonald's workers and had little incentives to train in gerontology or palliative care.
IRT William Beach Gardens care manager Kristy Taylor said Mrs Fowler had not received the care she should have, and blamed a lack of training for staff missing the pressure area injuries earlier.
She also admitted Shirley had received inappropriate attention for her needs after it took four months to see a physiotherapist.
Retirement villages owner IRT's business manager Nia Briguglio said the firm was currently working to improve its quality and audit and IT systems to meet national mandatory standards and ensure such signs were not missed.