More than 20 Hunter, Central Coast and Taree aged care homes on the non-compliance register

Some are missing out on basic care - regular showers, access to dentists and optometrists, and specialised bedding to prevent pressure wounds, as well as medical attention and prescribed treatments.

Instances of neglect include residents being given the "silent treatment", and having their buzzer's placed out of reach or ignored.

Requests for pain relief are sometimes ignored along with scheduled medication, people miss out on meals or are provided with food they cannot eat, and many are not monitored or assessed after falls, sometimes multiple falls, with no attempt to investigate the cause.

Affected family members say they feel duty-bound to attend their loved ones on a daily basis to ensure their basic needs are met.

Relatives of people who have been named in audit reports due to the sub-standard care they have received say must make repeated requests and insist on basic scans and tests be done, must ensure observations are done following falls, and that other medical procedures required are completed, and recommended treatments provided.

More than 20 aged care facilities across the Hunter, Central Coast and north to Taree feature on the Aged Care Quality and Safety Commission's non-compliance register for the period between July 1, 2022, and February 28, 2023.

The region is home to between 20 and 13 per cent of non-compliance notices issued across NSW for some quality measures. It is also home to the only nursing home in the state sanctioned during that period - Taree's Anglican Care Storm Village.

The region's nursing homes are also in some cases failing to meet standards according to another separate measure, published on the federal government's My Aged Care website.

For example, at Anglican Care McIntosh Court in Booragul, residents experienced physical restraint at 78 per cent above the national average, while at Taree's Alkira Lodge, 49 per cent of residents were physically restrained, 27 per cent above average.

According to My Aged Care, high use of physical restraint is an indicator of poor quality care that can lead to physical and mental harm, and should "only be used as a last resort to protect a person's safety".

It is one of five quality measures introduced off the back of the Royal Commission into Aged Care Quality and Safety.

The other four are the number of residents who have one or more falls, the rate of pressure injuries and unplanned weight loss, and medication management, which monitors the incidence of polypharmacy and the use of antipsychotic medication.

The new rating system also tracks and publicly reports on staffing levels, residents' experience and compliance.

There were at least three homes in the region with rates above the national average rate for every quality measure.

Residents at three homes - Fig Tree Point Aged Care Facility in Toronto, Abernethy Nursing Home in Cessnock, and Arcare Kanwal experienced falls at a rate more than 15 per cent above the national average, at 27 per cent, 21 per cent, and 18 per cent above the national average respectively.

At Calvary St Francis Retirement Community in Eleebana, 55 per cent of residents were prescribed nine or more medications, 17 per cent above the national average.

Staffing levels were listed as a significant issue at many homes, some receiving a one out of five star rating meaning "significant improvement needed", and some with a two-star rating, "improvement needed".

Details about areas of non-compliance, and deficiencies identified during site audits published on the watchdog commission's website, paint a vivid picture of what those failures mean for individuals.

Feedback from residents included that staff intentionally put call bells out of their reach. For one person that meant they were rarely assisted with toileting, forcing them to use incontinence aids.

Another resident at the same facility, Arcare Kanwal on the Central Coast, said staff purposefully "refrained from speaking to them" while providing assistance for several months. When they were provided with a meal they couldn't eat, it was not replaced.

Another resident said they were only showered once a fortnight, with bed washes on other days, despite requests for a daily shower.

In another case at Kanwal, a resident said they were forced to remain in bed because there were too few staff to help them get up, and that staff responding to a call bell request enter the room, turn off the buzzer and leave.

At Calvary St Joseph's Retirement Community in Sandgate, the inadequacy of some residents' pressure wounds and "skin integrity" care led to the development of pressure injuries, and for some who had lost weight, the service failed to monitor their food intake and/or address any underlying issues.

"Most consumers and representatives interviewed said consumers often have long wait times when using their call bell,'' the home's site audit report said. "One consumer said this is usually more than 15 minutes."

One resident and two other people said consumers experienced incontinence due to staff response times, with one family member saying staff were so rushed they missed basic care needs such as providing additional fluids.

Staff agreed, telling assessors they sometimes have to miss breaks, work short staffed or work overtime to try and deliver quality care.

At Hakea Grove Aged Care in Hamlyn Terrace, investigations revealed two residents' falls were likely caused by a lack of help to use the toilet.

In the case of another resident, who had three falls over three days, no neurological observations were done and staff did not try to identify the cause.

"One consumer with an unstageable pressure injury did not have a risk assessment or risk mitigation strategies identified," the audit report says.

"The service did not identify and respond to the deterioration in a consumer's health after multiple falls despite exhibiting changes in mobility and pain level.

"The consumer was eventually reviewed at the hospital where they underwent surgery for a fracture that was suspected to have occurred three weeks prior to the surgery."

In another case, it took three months for a resident to be formally reviewed by a specialist.

In Shoal Bay, at the Port Stephens Veterans and Citizens Aged Care facility, one resident had to contact their family to get help to go to the toilet, "especially in the mornings".

Another reported a lack of personal hygiene support. and said they regularly received no support to transfer out of bed.

"Safe and effective clinical care is not consistently provided by the service in relation to wound care, diabetes management, pain management, enteral nutrition, neurological observations and clinical observations ...

"Review of care documentation for one consumer who recently passed away demonstrated there was no record that comfort care was regularly monitored to effectively manage discomfort and there was no end of life care plan, or advanced care directive."

Elermore Vale's Uniting Koombahla nursing home was found to have failed one resident who reported frequently waiting long periods of time for assistance with personal care, as well as access to equipment to assist with chronic airways disease.

Staff were aware, the report says, confirming that at times they were unable to attend to residents in "a timely manner".

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