A 74-year-old woman whose body was found at her NSW central west home alongside her 54-year-old son had left hospital months earlier without access to the services hospital staff thought she needed.
The two bodies were severely decomposed when they were discovered at their Dubbo home on March 9, 2015, making it impossible to tell a cause or exact date of death, an inquest into the pair's deaths heard on Monday.
The woman was cared for by her son, but there were signs he wasn't coping despite his dedication.
Paramedics found the mother in sheets stained with her own urine and faeces when they came to take her to Dubbo Base Hospital.
She was underweight, incontinent, and not capable of doing basic tasks to support herself.
She had two hospital stays in mid-2015 separated by just two days.
It was an "unusual, complex situation ... an extreme case of neglect from the community bouncing back into hospital," a registered nurse who worked at the hospital and assessed the woman's aged care needs told the court.
The nurse recommended the woman enter permanent residential care, instead of her request for home care.
Another hospital staffer said she believed the mother was not going to get adequate care when she was discharged, despite the son saying he could manage.
She was not eligible for home care because her needs were too severe.
The woman checked herself out of hospital against doctors' advice on July 8, 2015.
Despite concerns, the hospital decided she had capacity to decide to leave.
Counsel assisting the inquest, Elizabeth Raper SC, said in her opening submissions the proceeding would examine who, if anyone, is responsible for the care of older people where they are found to have capacity to make decisions, but there are still serious concerns for their safety.
When a nurse visited the house in September 2015, the son refused them entry.
"She'll be happy to see you tomorrow, there's too much going on, too much intervention and we want to be left alone," he told them, according to Ms Raper.
Other nurses failed to gain access to the woman around the same time.
The public guardian was then appointed the mother's custodian for three months, but never made contact with the family.
After the guardianship ended in January 2016, nobody from a nursing organisation that had previously had care of her, the public guardian, or the hospital contacted the mother.
The last phone calls made from the house were made on February 16, 2016 to a Chinese restaurant and a taxi company.
The nurse who assessed the mother, Toni Murie, told the court that while people may have capacity to make decisions, "they may lack insight and they may not be able to move forward with a decision that's in their best interest".
"Returning them to an environment of neglect or abuse is really inappropriate," Ms Murie added.
"We as a healthcare system are actually facilitating elder abuse."
There was no sign of trauma on either body, nor indication of suicide, pathologist Jane Vuletic, who conducted the post-mortem, said.
They had likely been dead for a week or more by the time they were found.
The bodies were equally decomposed, suggesting they died around the same time.
The pair had no close relatives. They cannot be named for legal reasons.
The inquest continues on Tuesday.