Vera Crebert was 87 when her family reluctantly decided to place her into an aged care facility.
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She was the much loved matriach of an enormous family - with nine children and nearly fifty grandchildren - but even with many willing pairs of hands, the toll of providing around-the-clock care at home was proving too much.
Within a few months of moving into SummitCare's nursing home at Wallsend in late 2012, she was dead.
Now Vera's granddaughter, Cassie Crebert, is suing the owners of the facility - Stelcom Pty Ltd - for alleged negligence, after a wound on her grandmother's foot was allegedly allowed to fester until an infection took hold that left her incoherent and barely conscious.
Cassie claims family members argued with the facility's staff over whether her grandmother should be taken to hospital. By the time Vera was eventually admitted, doctors at the Calvary Mater Hospital gave her a two per cent chance of survival.
Cassie is speaking out about her ordeal in the hope that it might save another family from being robbed of precious time with a loved one in their twilight years.
"One of the biggest struggles with me from the beginning, is that I just keep thinking if there was a way that we could of taken Nan home, could we have done something to keep her going a lot longer?" she said.
She argues the alleged failings of SummitCare paint a broader picture of a sector strapped for cash, with stretched and inexperienced staff struggling to meet the demands of an ageing population.
"I've always heard about the deficits in the aged care sector, but until you've got someone in one of those facilities and you see it first hand, you don't really realise how big those gaps are and how much they're damaging an individual's life, which then has a domino effect on the rest of the family."
Vera Crebert was devoted to her clan and would host lively dinner parties from her home in Windale.
Cassie also remembers her as being private, dignified - she would conscientiously apply makeup and perfume each morning - and for her razor sharp mind.
"She was fighting fit in the mind. You couldn't get anything past her," she said.
Upon entering the facility, Vera was diabetic and had osteoporosis but had "strong organs" and was otherwise in good health.
But she soon started to develop diabetic blisters on her legs.
One on the top of her foot is believed to have burst. It became infected and rapidly went downhill.
On visits family members would allegedly find dried-up pus from burst blisters and medical tape plastered to her foot.
One of the biggest struggles with me from the beginning, is that I just keep thinking if there was a way that we could of taken Nan home, could we have done something to keep her going a lot longer?"
- Cassie Crebert
"Nan had a similar wound when we were looking after her at home but with early intervention she got over it really well," Cassie said.
"I got her GP in really quickly to swab it and to give her antibiotics."
But when they tried to arrange for her grandmother to see a GP while she was a resident at the SummitCare facility, things were different.
"We tried organising appointments to see the GP but...families aren't always able to make an appointment.
"We got told to make an appointment at the GP's rooms but when we got there we were told Nan's records weren't there and he couldn't see us anyway and they sent us back to the nursing home.
"I just wanted to know what the heck was going on."
She said even though she was listed as her grandmother's medical care decision-maker on paper, she felt "powerless".
"I daresay it's not just SummitCare, it's across the board, you've got these systems which make it really difficult for families to try and advocate medically on behalf of residents.
"It was hard to be in that position after looking after her at home, where I had been there for Nan every day and made sure that whenever something was wrong it was fixed right away."
On her final day at the nursing home, Vera's breathing was laboured and she kept nodding off.
But the family still had to "push and push" to have an ambulance called, Cassie claimed At the hospital, Vera had "pretty much faded out" and was given a two per cent chance of survival. The family had to weigh up whether the doctors should try and keep her alive or allow her to pass peacefully.
"It was a decision no family should ever have to make," Cassie said. "Those are the decisions people would be making when someone's been in a car accident or some sort of emergency, not when someone's been in a facility to be cared for and nurtured."
Her solicitor, Catherine Henry of Catherine Henry Partners said that the negligent management of pressure sores was rife within the sector.
"Clinicians will tell you that all pressure sores are avoidable," she said.
She declined to comment on the specifics of Cassie's case but has been a long-term advocate for reform within the aged-care sector. She said stricter regulation of the industry was sorely needed, but the government had shown little appetite to go down that path over the last two to three decades. It had instead focused "nearly exclusively" on funding, meaning it was often left up to the court system to improve standards of patient care and provide a "deterrent" effect to rogue operators.
"I think it's perhaps - as John Howard was fond of saying - aged care isn't a barbecue stopper," she said. "The aged care resident is largely invisible and doesn't have a voice."
She argued most of the problems arose as a result of inadequately qualified staff and inappropriate levels of staff, and said the industry should have the same mandatory staff-to-patient ratios as childcare facilities.
"What's the difference?" she said. "Nursing and caring for children and the aged is intense. You've got low numbers of AINs, the most lowly qualified nurses, managing large numbers of patients. They're probably run off their feet or may not know what to do."
Cassie urged families to be more discriminating about where their loved ones were placed and said they should trust their gut if they felt something was wrong. She now wonders if she should have acted sooner on early warning signs, including seeing a cockroach on a placemat being used to serve her grandmother lunch.
"Leaving home and entering a facility is the biggest fear for a lot elderly people," she said. "And you know what? It should be. This is not something that you would want to put anybody that you love through."
She doesn't believe her grandmother's case is unique and hopes it will help the case for better regulation of the sector.
"All I've every really wanted from this was just the acknowledgement that things could of been different and may not have ended the way they did if things were dealt with properly.
"Nan left an amazing legacy in the family that she's got but if change can be part of her legacy that would be even better."
SummitCare did not respond to the Herald's request for comment.
Do you know more? carrie.fellner@fairfaxmedia.com