A Sydney woman spent the final weeks of her father's life begging hospital staff not to send him back to his nursing home, the Royal Commission into Aged Care has been told.

Key points: Vincent Paranthoiene was often in pain while receiving palliative care in his nursing home

Vincent Paranthoiene was often in pain while receiving palliative care in his nursing home When he was admitted to hospital his daughter begged staff not to send him back to the home

When he was admitted to hospital his daughter begged staff not to send him back to the home The Alkira Gardens nursing home has now offered a personal apology to the family

In September 2017, Shannon Ruddock's father, Vincent Paranthoiene, was in often excruciating pain after being diagnosed with a malignant spindle cell tumour in the left side of his chest.

But she said his aged care facility, Alkira Gardens in Sydney's southern suburbs, was unable to adequately monitor and manage his palliative care, with her father telling her "you need to throw me under a bus", because his pain was so great.

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He had been discharged from hospital with prescriptions for three types of pain medication, but was often not given pain assessments or given the strongest painkiller unless his daughter requested it.

"I constantly felt that the staff at Alkira did not understand that they were caring for someone who was dying," she said.

On the fourth day of the Perth hearings, the commission turned its focus to palliative care, using Mr Paranthoiene's experience at the Alkira Gardens facility, which is run by The Sisters of Our Lady of China Health Care Pty Ltd as an example.

Commissioners Lynelle Briggs and Richard Tracey heard the facility sometimes ran out of his opioid medication, often failed to conduct regular pain assessments on Mr Paranthoiene and did not have a palliative care plan.

After a devastating fall which left his life in the balance — his fifth fall in a period of weeks — Mr Paranthoiene was transferred to hospital, where Ms Ruddock found his palliative care improved.

She begged the hospital to allow him to spend his final weeks there, feeling guilty for wishing he would develop a serious condition which would let him die there.

"During this time, I spent most of my time hoping my father's condition would deteriorate rapidly so that the hospital would be forced to keep him, and he would not have to go back to Alkira," she said.

Everyone deserves a peaceful death: daughter

Before he could be transferred back to Alkira Gardens, Mr Paranthoiene's condition declined, allowing him to spend his final days in hospital, surrounded by his family.

"It was just very peaceful, I felt he was being taken care of," Ms Ruddock said.

Shannon Ruddock says she is pleased to have received an apology from Alkira Gardens. ( ABC News: Rebecca Turner )

Outside the hearing, Ms Ruddock said she had received a personal apology from Alkira Gardens management after giving evidence this morning.

She said everyone deserved a peaceful death.

"I shared my story hoping I could contribute to a public discussion about how we can improve access to high quality palliative care for residents in aged care facilities," she said.

"Everyone deserves the right to die in a calm and loving atmosphere, free from pain and the risk of harm.

"That is what dying with dignity looks like."

Nursing home admits treatment shortfalls

Palliative care nurse practitioner Joshua Cohen said Mr Paranthoiene's care was inadequate, with staff failing to assess his pain needs as frequently as he needed.

"He was never going to be pain free but that's not to say [his treatment] couldn't have been better," he said.

The commission was told the care facility failed to conduct regular pain assessments on Mr Paranthoiene and did not have a palliative care plan. ( Supplied )

The Sisters of Our Lady of China Health Care Pty Ltd compliance manager John Leong acknowledged Mr Parantheoine's treatment was inadequate.

"Yes, I agree there were unfortunately some occasions where there were shortfalls in that," he said.

"And we have rectified the problem and all the staff have been trained to make sure they are assessing pain better and they will document that for each occasion."

Alkira Gardens was also sanctioned by the Department of Health in October 2017, which Mr Leong said led to a better procedures in pain management, assessment and care.