Maggots were found on elderly people in care in Western Australia's north, a royal commission has heard.
Rejane Le Grange, acting business manager of Germanus Kent House and Bran Nue Dae Day Community Centre in Broome, was questioned about the incidents at an aged care royal commission hearing in the Kimberley town on Tuesday.
In one case, family members of a respite client found maggots in their wound, in the other, maggots were discovered in the mouth of a palliative care client.
"The resident had poor ability to chew so there was food pooling and moisture pooling in her mouth, which would have created an ideal environment," Ms Le Grange, who was working in Perth at the time of the incidents, told the hearing.
She said palliative care residents who want to lay in a bed outside are now enclosed by netting, while adjustable screens are being used to ensure patients are kept fly-free during wound dressing.
Earlier on Tuesday, Royal Flying Doctor Service chief executive Martin Laverty said the primary health care system was failing older Australians in remote areas where services were deficient.
Dr Laverty said people in remote areas used Medicare at one-fifth of the rate of metropolitan residents and had much higher rates of avoidable hospital admissions, reflecting poor access to health professionals.
"The longer you are able to maintain your health through access to adequate primary care, the longer you are likely to avoid the necessity of access to the formal aged care setting," he said.
"We are letting older Australians down by a failure of the primary medical care system in remote Australia.
"The commission has an opportunity to articulate a reasonable standard. It then requires resourcing."
He said the usually emergency-focused RFDS was now responding to requests from aged care service providers for help with dental care - and there appeared to be little awareness among staff about the importance of oral health.
"Anecdotally we're being told there isn't the time within the workload of some care staff to be able to brush teeth, to support brushing teeth."
Providing health services in remote communities is not easy, the commission heard, with challenges including travelling vast distances and the northern wet season causing extreme flooding.
Two years ago, when Noonkanbah was cut off for more than three months, "you couldn't even land a helicopter to evacuate somebody medically," Kimberley Aged and Community Services manager Ruth Crawford said.
"The aged care services couldn't run, so we were doing a lot of support on the phone to individual families when they had phones. Not everybody does."
Recruiting staff due to funding-related tenure uncertainty is also an issue and, in some areas, staff turnover is high.
Navigating Aboriginal cultural complexities is also challenging, she said.
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