A little over a week after entering his Port Augusta aged care home in August 2021, Eric Wise was found unresponsive.
Warning: This story contains images and descriptions that may be upsetting for some readers.
The retired labourer, who lives for his wife and family, was diagnosed with a rare neurological condition before he entered the home and requires around-the-clock care.
"He was deteriorating rapidly, he was just wheezing and he could barely speak," his daughter Trish Wise said.
Ms Wise said it was only after his family demanded an ambulance that Mr Wise was taken to the emergency room at the Port Augusta hospital.
She said the family was told he was "severely dehydrated" and had a urinary tract infection.
After a period of treatment, he returned to the provider, which was the only care option available within an hour of their home.
"Mum and I were incredibly anxious about him re-entering the facility, knowing that that had occurred," Ms Wise said.
At the time, Eric had a patch of delicate skin on his bottom that was healing.
"Every two hours, it's required that he needs to be rotated from one side to the other, to alleviate the pressure," Ms Wise said.
"But it was clear that they didn't have enough staff to fulfil that need.
"[Mum] would ask how the wound was going, and was always told it was getting better."
Over the next seven-and-a-half weeks, the bedsore developed into a gaping hole, where dead flesh had been eaten away.
"[It] was inexcusable," Ms Wise said.
"Mum even said it [had] a terrible smell. In seven-and-a-half weeks, how could his body get that bad?"
The cavity went so deep that his spine was showing through the wound.
"It almost killed him," Ms Wise said.
Home fails every aged care standard
The Port Augusta facility is operated by Edenfield Family Care, a for-profit provider which runs two nursing homes, known as Ramsay and Nerrilda, in the regional South Australian city.
Aside from a dedicated Aboriginal nursing home, they are the only aged care options for the town's residents.
Both facilities failed the majority of aged care standards after unannounced site visits from the Aged Care Quality and Safety Commission in 2021.
The Ramsay facility, where Mr Wise lived, failed on all eight measures.
"The service does not have [a] framework to prevent abuse and neglect," the audit report found.
"Clinical staff did not have sufficient skills and knowledge" to "manage pressure injuries", to "identify, monitor and manage clinical deterioration", or "to effectively perform their roles".
The audit found residents with dementia had been locked in and out of their rooms to prevent wandering, and that "clinical and care staff did not identify this action as a form of abuse".
Others had been chemically restrained without identified reasons as to why psychotropic medication was used.
Staff told the commission there were not enough workers to carry out basic care, including serving meals or taking residents to the toilet.
Pads 'a terrible cost to the home'
Cheryl Dawson's mother Jean entered the facility several years ago after a fall at home.
Ms Dawson said her mother quickly became dependent on the staff.
"When you ring your bell and you have to wait 10 to 15 minutes before it's even answered to be taken to the toilet," Ms Dawson said, "over time, you become incontinent yourself."
"And you're just told, you've got pads on, you just have to go to the toilet in those pads."
She says her family started buying incontinence pads for their mother, after a comment from staff.
"The staff member just said, 'You're using a lot of incontinence pads here, you might have to start buying them yourself because it's a terrible cost to the home,'" Ms Dawson said.
"My mother, the next day, she was shaking all over and quite distraught and depressed and crying and that's when she told me she'd rather be out with my dad out at the cemetery."
Edenfield Ramsay staff have told the ABC residents are given a limit of three incontinence pads per day, and workers have to write an "explanatory note" if more are used.
Families call for transparency over $30 million in government funding
The Port Augusta Council owned and operated the two nursing homes before they were sold in 2017 to Edenfield Family Care.
At the time of the sale, the council held $3.5 million in cash bonds — the fee residents pay to enter the home, and which can be used to improve facilities.
Instead of transferring the cash to the new operator, the council struck a deal — Edenfield Family Care took on the liability for the bonds and the council kept the residents' money to pay down its own debts.
In a statement, a spokesman for the Port Augusta Council said it "sought external support for the aged care sale process" and "undertook due diligence in relation to offers made".
"The Department of Social Services approved the transfer of the bed places to the Approved Provider and were provided with a copy of the sale agreements," the council spokesman said.
Since then, families allege no significant work has been done to improve the homes.
Together, the for-profit facilities have received almost $30 million in federal government funding since then, but there is no public reporting around how it has been spent.
Grace Stokes is an Adelaide IT worker whose 96-year-old grandmother Amelia lives in the Ramsay facility.
"I don't have any visibility about how those taxes are being spent to support someone that I love," she said.
Ms Stokes drew up an online petition in February calling for administrators to take over the Port Augusta home, in the wake of the quality and safety failures.
She said it had prompted hundreds of emails from families across the country.
"When you become old in Australia, at the moment, you're disposable."
Ms Stokes said the provider did not agree to her family's request for a copy of the home's general financial statement, which a resident's next of kin is entitled to.
"We were told we would need to sign a non-disclosure agreement or confidentiality deed, essentially limiting how we could share or use that information that we would receive," Ms Stokes said.
"It shouldn't be hard for us to find out how subsidies from the government are being spent.
"I hold the federal government accountable for the failings in the home.
"The federal government funds this home, the federal government manages the structure which allows providers to exploit vulnerable people and vulnerable employees."
In a statement, Federal Aged Care Minister Richard Colbeck said he had been "regularly updated on the actions taken to address the deeply concerning reports in Port Augusta," and that the government had "strengthened" the regulator's "oversight capacity allowing greater transparency across the sector".
Labor calls for more staff, PM says they can't make 'nurses fall out of the sky'
The ABC can reveal $123.5 million in taxpayer funds has been paid out to cover accommodation bonds for aged care providers who have gone broke in the last five years.
The majority has been spent bailing out for-profit providers and the federal government has confirmed it has recovered none of those debts.
Labor has committed to reforms that would require providers to report "in public and in detail what they are spending their money on".
The men vying to become the next prime minister were asked about the aged care workforce at Wednesday night's leaders' debate.
Labor has promised to put nurses in aged care homes 24/7 — a recommendation from the royal commission.
"I think most people would be surprised that there aren't nurses in nursing homes now," Anthony Albanese told the crowd on Wednesday night.
"It seems so fundamental,."
Scott Morrison told the audience that was unrealistic.
"If you make that the standard in aged care facilities … then you will be closing aged care facilities in rural and regional areas across the country," Mr Morrison said.
"We can't just make nurses all of a sudden fall out of the sky."
Senator Colbeck was unavailable for interview, but said in a statement that the government had "already acted to implement important measures to increase transparency of spending by providers as part of its comprehensive response to the royal commission."
"A new funding model, the Australian National Aged Care Classification (AN-ACC) will be a game changer when it comes to keeping providers accountable," the statement said.
"Facility management are already required to report spending on food under a requirement for the $10 basic daily fee supplement, a mechanism that will be expanded with the introduction of AN-ACC to include spending against a number of areas including assessed care need and allied health."
The Liberal member for Gray, Rowan Ramsey, said he was horrified by the alleged treatment at the home and physically winced when the ABC showed him an image of Mr Wise's wound.
"That's horrific. And it just can't be allowed. I mean, it's clearly in breach of the rules of care," he said.
Mr Ramsey said he had written to Senator Colbeck raising concerns about the home, and had faith in the Aged Care Quality and Safety Commission's processes.
He acknowledged there were still problems with neglect in aged care, but said it was not possible for him as a local member to be across every home in his electorate.
"There have been some terrible, terrible circumstances ... across the board," he said.
"You cannot ... oversee every nook and cranny of every organisation.
"I'm a farmer, and we work very hard to look after our livestock.
"But can I guarantee that every sheep that goes through my shearing shed, or every sheep that goes through a handling system, and that everybody that deals with that handling system, is dealing with that livestock, that animal, in the way that I would deal with it?
"Well, of course I can't. And I guess it's the same with any organisation."
Safety commission monitoring compliance at Edenfield
Edenfield Family Care rejected many of the concerns reported in the commission's audit into the Ramsay facility.
The provider told the commission it was "inconceivable" that staffing levels were inadequate, and said those claims came from "a small number of residents, who, in the large, have diagnosed cognitive impairments".
The provider also denied the home had no framework for preventing abuse and neglect.
"The organisation has a well-defined governance structure with regular meetings to analyse data," the response to the commission stated.
Edenfield Family Care was unavailable for an interview.
In a statement, it said the home was "working closely with the quality agency, residents, families, and staff to rectify any shortcomings."
"This has included engaging an external advisor," the statement said.
Edenfield Family Care declined to provide the ABC with copies of the home's financial statements and would not reveal its annual profit.
The Aged Care Quality and Safety Commission told the ABC it was monitoring compliance at Edenfield's Ramsay site.
"The Commission shortened the service's accreditation, which now expires on 24 January 2023," a spokesman for the commission said in a statement.
"This is shorter than the three years typically available to residential services with a strong track record of compliance and means that, in addition to other quality and assessment monitoring activities, the Commission will return to the service unannounced sooner, to conduct a comprehensive site audit."
After Eric Wise was transferred to hospital for his wound, he did not return to the Ramsay facility.
Trish Wise said the family was told the treatment was expensive, and that the home could not cater to his needs.
"They were not willing or trained to do that wound care," she said.
After six months of hospital treatment, he has now moved to another provider in regional South Australia.
He is permanently disfigured as a result of his treatment.
Cheryl Dawson said she wanted to see more training for staff before they even entered the home, and more compassion for the needs of the residents.
"They have given up everything to go in there, and expect to be looked after at least half decently," she said.
Watch this 7.30 story on ABC iview.
