Young people are being forced into residential aged care and forgotten due to a "gaping hole" in health care checks and balances, the Royal Commission into Aged Care Safety and Quality has heard.

Key points: Neale Radley, 52, says has been living in an aged care home since he was left profoundly disabled after a diving accident

Neale Radley, 52, says has been living in an aged care home since he was left profoundly disabled after a diving accident Commissioner Lynelle Briggs says the system of placing younger people in aged care is "at best a national embarrassment and at worst a national disgrace".

Commissioner Lynelle Briggs says the system of placing younger people in aged care is "at best a national embarrassment and at worst a national disgrace". There are about 6,000 Australians under the age of 65 in residential aged care.

It comes as commissioner Lynelle Briggs, dubbed the current system a "national disgrace" in a fiery conclusion to evidence from the federal Health Department.

"The current system is at best a national embarrassment and at worst a national disgrace," Ms Briggs said.

The royal commission this week is investigating the treatment of people under the age of 65 who end up stuck in residential aged care.

A younger person with profound disabilities is only supposed to be sent to residential aged care when "there are no other care facilities or care services more appropriate to meet the person's needs," according the Aged Care Act.

Yet documents tendered by the Health Department showed there was no reference to this requirement when a younger person was approved for residential aged care.

"We don't seem to have a process to ensure that aged care is a last resort for younger people," counsel assisting Peter Rozen QC said.

The comments were made as a senior Health Department official, Nicholas Hartland, gave evidence to the royal commission.

In a case from 2018, a person was approved for residential aged care just two days after being referred.

"I can't even see a box that needs to be ticked in the forms you provided to us to say that there is no more appropriate service or facility," Mr Rozen said.

"Isn't that a gaping hole?"

Dr Hartland said authorities did consider alternatives to residential aged care during the assessment process but agreed the system needed to be improved.

"It's certainly the Department of Health's view that aged care is not appropriate and it's a provider of last resort," Dr Hartland said.

"We are looking at ways to improve the decision-making process in the system."

Resident says he feels trapped in his room

The royal commission has heard that many younger Australians feel lonely and isolated in residential aged care, and the facilities did not provide proper health care for younger Australians with profound disabilities.

Neale Radley, 52, was left an incomplete quadriplegic after a diving accident five years ago.

With his elderly parents unable to look after him, Mr Radley was sent to aged care.

Neale Radley says he feels like a prisoner in his room at an aged care facility. ( ABC News: James Oaten )

He told the royal commission the support in his facility was so poor that when his appendix burst, staff didn't notice until a day later.

"If something happens to me that requires medical attention then I am taken by ambulance to Bendigo," he said.

"I have nearly died three times."

Mr Radley no longer wants to make friends at the aged care centre, after a few residents he befriended died.

"Since moving in to the facility about 30 or 40 people have died," he said.

"The people I have liked, admired, and got close to while I've lived in here have all since died.

"I've had to start distancing myself from people so I didn't have to deal with their death.

"I feel like a prisoner.

"I have nicknamed my room cell 14 because I don't have the freedom to get out."

Commissioner calls for 'rapid movement'

The royal commission heard on Monday that many younger Australians felt lonely and isolated in residential aged care, and the facilities did not provide appropriate care for younger Australians with profound disabilities.

There are about 6,000 Australians under the age of 65 in residential aged care, a number that has remained steady for more than a decade.

Every week, 42 younger Australians are sent to aged care facilities.

The royal commission heard there had been no external audit of those younger Australians in residential aged care.

Ms Briggs said the intent of the Aged Care Act to use residential aged care as a "last resort" for younger Australians was commendable, but the lax enforcement of the rule was a problem.

She urged the Health Department to make some "rapid movement" to help younger Australians in aged care.

The royal commission continues.