Yaraandoo Hostel in spotlight at aged care royal commission hearing

"When neglected like that I feel like I've been dehumanised, left as a carcass in an aged care abattoir ready to be processed like a slab of meat in a sausage processing factory at some future time," Yaraandoo Hostel resident Brian Harvey said in his submission to the commission.

Brian's submission was read at the opening of the week-long hearing in Hobart as he could not deliver it himself, having died at Yaraandoo on August 6, 2019.

The aged care facility was sanctioned by the Australian Aged Care Quality Agency in November 2018 after it did not meet 18 of 44 expected quality outcomes.

Brian's wife Ellie Valier was the first witness to give evidence in the case study of Yaraandoo and its operator Southern Cross Care Tasmania.

Ms Valier said her husband, aged 84, died an "avoidable, inexcusable and unforgivable death."

"If I can simply say that he had an agonising death," she said.

"Brian was a very tactile, caring, loving individual who was a big huggy kind of person [but] he couldn't bear to be touched, so I couldn't hold him in my arms.

"I couldn't comfort him. I just had to watch."

Ms Valier told the commission she first raised concerns about Brian's level of care at Yaraandoo six months after he arrived, in March 2018.

"People did not seem to have a clue what he needed outside of his regular carers," she said.

"[His treatment] was variable. They have some absolutely wonderful staff. It depended on the time of day, who was on duty and a lot of it had to do with big problems with communications."

Ms Valier said a first meeting with staff on March 27 was proactive with a clear list of Brian's needs posted on a list on the bathroom door, however this did not improve the level of care.

"At the end of June I took it down because what was the point?" Ms Valier said.

When again raising concerns in August about rumours of staff cuts and the management of Brian's medication, Ms Valier was told of the facility's financial issues.

"We were told that for the financial year ending 30 June 2018 that Yaraandoo had lost half a million dollars and that losses were continuing in the order of $30,000 to $70,000 per month," she said.

Ms Valier said Brian hated that he was not independent and would often put himself at risk to avoid bothering staff.

In October 2018, after waiting 80 minutes or more after pressing the call bell to go to the toilet Brian attempted to go on his own.

"He had got to the stage where he couldn't hold on any longer," Ms Valier said.

"He didn't want to soil his bed and Brian being Brian ... he managed to pull himself up and ... well, monkey grip backwards onto a mobile loo.

"Unfortunately something he didn't see was that the lid of the WC was down and I don't think I need to explain."

Ms Valier said Brian was very upset about how staff were treated at Yaraandoo.

"He did that time and time again, getting himself up, at considerable risk to himself," she said.

"He did it because he knew how stressed the staff were, particularly the care staff and the nurses."

When again raising concerns following this incident, Ms Valier said she felt intimated and talked over by facility staff.

In August 2018, carer hours at Yaraandoo were reduced by eight hours in the morning and six hours in the evening, an overall cut of 13 per cent.

Former facility manager at Yaraandoo Patrick Anderson said the decisions to cut staff were made on a purely financial basis.

"I was told these cuts were a matter of financial sustainability," Mr Anderson said.

"I don't believe there is such as thing as excess staffing in a care environment."

Mr Anderson said an analysis on what impact these cuts would have on the floor was not undertaken.

"That was an oversight on my part," he said.

Mr Anderson agreed the cuts did affect care, safety and quality at Yaraandoo.

"The main impact was waiting times for staff," he said.

Yaraandoo clinical care coordinator Tammy Marshall said the reduced hours caused a great deal of stress for the workers involved and created waiting periods for the residents.

When asked what the facility's vision was as an aged care provider, Ms Marshall said there was certainly a vision to save on costs.

Ms Marshall said although the senior staff at Yaraandoo were highly skilled, some of the direct care workers coming into caring roles are less skilled, often coming straight out of the course.

"Due to our roles being so significant with the workload, there was little time to be spent training other staff members," she said.

Ms Marshall said new residents were arriving in more frail conditions.

"For instance currently we have 54 residents and 50 of those are high care so some need two people to assist with transfers and care needs," she said.

Former nurse and administrator at Yaraandoo Jo-Anne Cressey Hardy began working at the facility in November 2018 after it was sanctioned.

Speaking generally about the aged care industry, Ms Hardy said there was a thing called churn where people are constantly moving from one organisation to another, trying to achieve the best outcomes they can in very difficult circumstances.

"Across the nation, the funding needs to be addressed," Ms Hardy said.

"If we're talking about Yaraandoo ... it's in a rural and remote area. It's extremely difficult to attract quality staff. It's extremely difficult to attract enough staff.

"So we're talking about quality and quantity."

Ms Hardy said as an organisation Yaraandoo was not working.

"One of the major defects was the inexperience of the facility manager," Ms Hardy said.

"It was his first facility manager role. He had very little supervision or support.

Mr Anderson said in retrospect he should not have taken on the role of facility manager with his level of experience.

"When I was interviewed I was assured that this was an appropriate role for a first time manager, that I would be receiving a lot of support and that the site was very, very stable," Mr Anderson said.

"On my last day I said it felt it was a site much more appropriate for a veteran manager."

The commission hearings this week will would focus on the activities of two approved providers of aged care in Tasmania, Southern Cross Care Tasmania and Bupa Aged Care Tasmania which constitute 15 per cent of the residential aged care market in the state.

Senior counsel assisting Peter Rozen said with a number of towns and regions served by small aged care service providers, Tasmania was particularly sensitive to the failure of aged care services.

"Some 37 per cent of older Tasmanians live in a rural or remote location," Mr Rozen said.

"This means Tasmania's aged care workforce is under pressure."

A second care facility operated by Southern Cross Care, Glenara Lakes at Youngtown also came under scrutiny on Monday.

An audit of Glenara Lakes in December 2018 found the facility was not meeting seven of the expected quality outcomes.

Mary Sexton told the commission her mother-in-law Lois Parravicini was admitted as a permanent resident at Glenara Lakes in January 2017.

The hearing heard Lois had between 20 and 23 falls in 2017.

"Bed and chair alarms [were effective] but there was too much time between when she stood up and when the alarm went up and people came to help her," Ms Sexton said.

"Quite often the alarms weren't plugged in ... or they weren't answered, or they were actually faulty."

After Lois had another fall in May 2018 and, following hip surgery, became completely dependent on nursing staff, Ms Sexton rang staff to speak about her mother-in-law's care needs.

"While she was in hospital they were keen on discharging her back to Glenara Lakes but we didn't feel it was safe because we had seen no evidence of there being enough staff to care for her and to keep on top of pain and her care needs," Ms Sexton said.

Lois' heath deteriorated and she passed away at Glenara Lakes.

When asked how her Lois' experience could have been improved Ms Sexton said it came down to staffing.

"The carers work really hard and all credit to them but they can't possibly do the amount of work that needs to be done safely and properly," she said.

The hearing continues.