As the Victorian aged care death toll from COVID-19 heads towards 600, the federal Royal Commission into the sector is going through submissions on impacts of the virus.
But advocates like Maria Berry know the pandemic has only exacerbated long-standing gaps in the provision of care.
"Not all people, not all organisations are like this, and I want to thank the good people out there and recognise their work," she said.
"Because the industry is struggling to retain staff, we've got to support those out there who are trying to do the best they can."
The Royal Commission's interim report left no room to hide, detailing the "neglect" occurring within the system.
"We have found that the aged care system fails to meet the needs of our older, often very vulnerable, citizens. It is unkind and uncaring towards them," the Commission stated.
"They become 'just a resident', just another body to be washed, fed and mobilised, their value defined by the amount of funding they bring with them."
On home care, the system designed to keep Australians in their homes for as long as possible, the Commission said people often waited a year or longer for a level four package.
"We have been alarmed to find that many people die while waiting for a home care package," they wrote.
"By any measure, this is a cruel and discriminatory system, which places great strain on older Australians and their relatives. It is unfair."
Pressures on staff
"Unfair" is how Mrs Berry describes the expectations put on her when she started work with one of the country's biggest home care providers, Australian Unity.
Her four months working at the Farrer branch in 2018 as a case manager of home care packages was a negative experience.
"I was given no indication when I walked in of the number of cases I was to manage ... it was weeks down the track before I was shown the numbers," she said.
"My first response was 'I can't do that'. It was too many.
"I was shut down, and the response was 'I've got a high workload too, and we are a business'."
Asked by the ABC's Anne Connolly if it was appropriate providers were operating more as a business than a healthcare service, Federal Aged Care Minister Richard Colbeck said, "Well it is a business, they're in the business of provision of care".
In that 7.30 report on Tuesday, Mrs Berry detailed some of her concerns.
Mrs Berry told The Border Mail she was only allowed to schedule client visits - which could take place as far away as Balldale - on two of her four working days.
This meant many clients that should have been seen in person - those with dementia, under palliative care or who were experiencing serious health decline - were often assessed over the phone.
"You could never get to your clients or on top of your workload," she said.
"Two days in the office were answering calls. At the end of every day, you were sent a group email with graphs of how many calls you've taken.
"The majority of phone calls were complaints; some hadn't seen a case manager for two years but had been charged case management fees, and they were concerned about deterioration with loved ones needing reviews.
"There was one case where a lady's daughter rang up, and she'd just had a belly-full.
"It was about her 16th call and my first time speaking to her; her mother was on a level-four package and had plenty of money that she was aware of, and the wheel on her walker had snapped off.
"She was a high-falls risk, and this lady had no walker for six months, when the money was sitting there. It was just appalling.
"I couldn't do it anymore ... I left."
According to Australian Unity, during the time Mrs Berry worked at the Farrer branch, at least 10 staff were available to answer around 90 calls from existing customers per day, and out of the 1946 customers in those fourth months, only 44 customer complaints were recorded.
"Australian Unity is always working to improve the products and services we offer to our members and customers, with a focus on delivering value-for-money," a spokesperson said.
"We take seriously concerns raised by our customers and employees and we value and listen to feedback so that we can improve their experience with our organisation.
"We are aware of a number of claims made by former employee Maria Berry, who was employed with Australian Unity for a period of four months and 17 days in early 2018.
"We have previously addressed these concerns directly with her during and following her period of employment.
"While we were unable to substantiate some of Ms Berry's claims due to lack of detail, we can demonstrate that many of the practices she questioned have substantively improved or changed since she left our organisation more than two years ago.
"This commitment to continuous improvement is demonstrated in our customer feedback, with compliments exceeding complaints since March 2020 at the Farrer branch."
Sixteen months ago, Australian Unity launched a resourcing and planning tool across all of its home care branches, which includes calculation of staff-to-customer ratios to support a quality service.
This year, the provider's home care business has started co-developing goal-oriented well-being plans with customers, to be revised at least annually.
Speaking up for all
In the years since she worked at Australian Unity, Mrs Berry has been involved in creating the Embolden Festival and now works at the Older Persons Advocacy Network as a consumer representative advocate.
Her role includes supporting people through the system, with applicants being place in a national prioritisation queue before a package of services is 'assigned' - they then often wait up to a year before receiving their approved level of funding.
At the end of March, there were 957 people in the Riverina-Murray who were waiting on a home care package at their approved level, who had yet to be offered a lower-level package.
In December, that figure was 2804, and in September last year, it was 943.
While the number of people in a home care package in the region has grown by 52 per cent, there has only been a 12 per cent increase in the number of approved home care providers.
Mrs Berry said there were not enough providers or staff in the region.
"We say older people have the right to choose which provider - but we've got limited providers," she said.
"If they're already saying they're at capacity, they don't take on any more new clients.
"My big concern is people falling through the cracks, who are not even in the system.
"One of the biggest things is the government needs to step up.
"There needs to be a regulatory body and there needs to be accountability.
"We should all know exactly where money is going - sometimes people are so grateful to get a package, they're not looking at what they're being charged, or they don't understand the breakdown of charges."
OPAN chief executive Craig Gear said Australia needed a "rights-based system".
"We need more of a focus on consumer support that helps you navigate the system, more access to advocacy services and more home care services to allow people to actually get care at home - which should be their right," he said.
"People are dying while waiting for a package, and that's not being dramatic, that's the truth.
"They are not being able to live a full life, because they're not able to access the levels of support in time and in the place of their choosing.
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"We have to do better ... particularly in rural areas - your postcode shouldn't mean you can't have equitable access."
Mr Gear said an 18-month wait for a package - which was featured in the 7.30 report - was not acceptable, and the wait should be no longer than three months.
He said it was only through people like Mrs Berry speaking up, that there could be systemic change.
"Yes, these provides have got to be viable, but they're in the care business; they've got to make sure people get the supports they need," he said.
"It's when we get down to the particulars of what it's like ... that you realise, there has to be a better way.
"Ageing should be seen as a joy, and not a burden."
The federal government announced a $537 million funding package in response to the Royal Commission interim report, including the creation of an additional 10,000 home care packages.