An independent consultancy company was asked to remove the word "systemic" from a report reviewing Bupa's South Hobart aged care facility after the home was sanctioned.
Wilson and Webster Consultancy Services founders Bethia Wilson and Dr Penny Webster told the Royal Commission into Aged Care Quality and Safety on Friday they were engaged to provide advice to Bupa about eight facilities from December 2018 to March 2019.
The commission heard Bupa asked the consultancy company to replace the term "systematic" on the front of their report with "emerging themes".
"There was a general comment that we considered most of the failures we were seeing were systematic," Dr Webster said.
"Bupa didn't really want people collectively to know how bad things were," Ms Wilson said.
"Our overarching view is that we would prefer euthanasia than to go and live in one of those places."
The consultancy firm was engaged to look into Bupa South Hobart after the facility was sanctioned in October 2018 when it failed to meet 32 of the 44 expected quality outcomes.
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Ms Wilson said she and Dr Webster visited Bupa South Hobart to hold meetings with residents of the home and their families to hear what they had to say about the service they were receiving.
"They were extremely upset, angry [and] overall they were really worried about the welfare of their relatives," she said.
Ms Wilson said Bupa missed a great opportunity to improve things for their residents and their families by not being open to complaints.
"I believe that a complaint is a wonderful thing in terms of quality improvement," she said.
Ms Wilson said she believed residents' families who complained thought that meant their relative would not get good care.
"There was an element of fear attached to it ... that people who complained were troublemakers," she said.
Ms Wilson said the consultancy service got little feedback from Bupa following their reports.
"We came to the conclusion that our recommendations hadn't been put in place when sanctions were replaced on some of the facilities," she said.
"We've been advised today by Bupa and we've heard in evidence they have now in fact implemented a complaint system."
Dr Webster said a lot of the recommendations made did not cost money but were just a change in attitude and simple improvements such as putting in a communication board at the front of the facility.
Bupa South Hobart was one of 10 Bupa-operated homes across Australia sanctioned between July 2018 and March 2019.
Bupa Villages and Aged Care New Zealand managing director Caroline Cooper said Bupa Australia found itself with an unsustainable financial model.
Earlier in the hearing, the commission heard evidence a strategy called 'save a shift' was implemented which saw staff on sick leave not replaced to cut costs.
"It's not a policy that I would endorse," Ms Cooper said.
"It actually would be absolutely ideal if we could have more staff in the aged care sector. It's not just registered nurses, it's more carers as well."
Two daughters of a resident at Bupa South Hobart told the commission on Friday they were put under pressure by care staff to medicate their father who suffered from dementia with a drug they described as a "chemical restraint".
The siblings, appearing anonymously before the commission under the pseudonyms UQ and US, said starting in 2017 they were repeatedly asked by care staff at Bupa if they wished to prescribe their father risperidone.
The commission heard after the death of their mother, UQ and US' father became a fulltime resident at Bupa South Hobart in 2013 and his behaviour at times was challenging as he suffered from dementia.
The pair consulted their brother, a psychogeriatrician, about the suggestion to prescribe risperidone who said the drug was inappropriate in their father's case and saw this as "behavioural euthanasia".
"He did tell us basically it would kill off his current behaviours, both the challenging behaviours and loving behaviours rendering our father semi-conscious and possibly immobile," said UQ.
"He would no longer enjoy the things he continued to enjoy."
UQ said she believed staff continued to ask if they could prescribe the drug after being told no because it would make their father easier to manage for the care staff.
"I was disappointed that they didn't relate to him as a person. It was more just to attend to the personal needs," said UQ.
"By in large, the majority of staff I felt it was just a job. They wanted to get into his room, do the job and get out as quick as possible because they had many other things to do."
US and UQ said over the years they have encountered many problems at Bupa including wait times after pressing the call bell, incontinence pads being left in their father's room, clothes missing or shrunk and other people's clothes including obviously women's clothing being put away in his room.
"It may seem insignificant but they were difficulties that we found," said UQ.
"Small indignities I'd say," said US.
Shining a light on care failings
In his closing remarks on Friday, senior counsel assisting Peter Rozen thanked the Tasmanians who shared their stories with the commission over the past week.
"Those account remind us of the important work in which we're engaged and focus our attention on what really matters in aged care," Mr Rozen said.
"These witnesses all gave personal accounts that raised the over-arching themes in the other evidence adduced during the past week: deficiencies in care caused by insufficient care time, deficient organisation culture, insufficient attention to quality and safe clinical care, poor communications from facilities and a lack of responsiveness to complaints. "
The hearing was adjourned with further hearings to begin in Canberra on December 9.
The commission will deliver its final report in November 2020.