If the incontinence pads are half wet, they stay on. This is the instruction that aged care worker Esther Priol says she and her colleagues have been directed to follow - even when elderly nursing home residents ask to be changed.
"We have been told we have been spending too much money on pads," Ms Priol said. "Unless they are 75 per cent wet, then the rule is we don't change them.
"You divide the pad into fours and if three-fourths of the pad is wet, you change it."
Ms Priol, who works at an aged care facility in Sydney's west, is one of thousands of aged care workers nationally who complain about increased rationing of everything from incontinence pads to meals. They say they struggle to provide the most basic level of care and dignity for elderly people.
In Canberra, a memo from aged care provider Bupa outlines a protocol for sticking to the continence "pad quota" which is running "over budget".
Across NSW, 58 per cent of aged care workers surveyed said they have not been able to provide the level of care residents deserved because of budget cuts. Of those, 80 per cent said staff shortages were the main barrier to providing proper care.
The results of the survey of 300 members of the Health Services Union will be released when the union launches a national campaign in Canberra on Tuesday. They will urge the government to restore funding for the sector.
The Our Turn to Care campaign follows revelations in Fairfax Media about the horrific neglect of elderly people in nursing homes.
NSW HSU Secretary Gerard Hayes said the elderly deserved dignity, but $3 billion in federal budget cuts since 2013 had put their care in "serious jeopardy".
He said $1.2 billion in cuts in 2016 alone had left the average aged care facility half a million dollars worse off each year.
"As a society, we need to ask why we shower praise and reward on the CEOs of major corporations like banks, while we push aged care workers to their physical and emotional breaking point," he said.
"These cuts are hurting the very people who looked after us."
The amount spent on food per resident fell from $6.34 to $6.08 per day between July 2014 and June 2016, according to a study published in the Nutrition and Dietetics journal in July.
"When our members are told they have to ration out sanitary pads or keep food budgets under $6 a day, you know something is seriously crook," Mr Hayes said.
Sean Rooney the chief executive officer of industry group, Leading Age Services Australia, said cuts of $1.2 billion over four years a cut of $472.4 million from aged care support in the Mid-Year Economic and Fiscal Outlook had created "a challenge".
"Regardless of this, residential aged care providers are committed to providing high quality services and implementing improvements on a continuous basis. They are highly conscious of not allowing funding issues to reduce people's quality of care, while at the same time advocating to government for fair and sustainable funding outcomes," he said.
Aged Care Minister Ken Wyatt said the Commonwealth was constantly monitoring the safety and quality of care of aged care residents.
He said the government announced measures in the 2016-17 budget which "saved $2 billion" over four years.
"These measures were not funding cuts, but were instead intended to mitigate the higher than anticipated growth in residential care expenditure," he said.
"Federal funding for residential care will continue to grow at an average of 5.1 per cent per annum over the next four years, while overall Commonwealth aged care investment will rise at 6 per cent per annum."
'I wouldn't eat the food we serve'
Ms Priol said meals she served to residents have "shrunk" to save on costs.
The food is either pureed or is not what Ms Priol would eat herself.
"They get fish fingers and mash potatoes, always mash potatoes, and there's always a bean of some kind," she said. "Sometimes they are given food and they ask me 'what is it?', and I say 'I have no idea'."
Another respondent to the HSU survey said when staff numbers were short, "residents had to be fed cold meals because we couldn't feed them all fast enough".
Ms Priol said the aged care facility where she works was "constantly understaffed" and that supermarket staff were paid more to look after fruit and vegetables than some aged care workers.
Aged care workers earn an average of $21 to $24 per hour, not far above the national minimum wage of $18.29 per hour.
"We are underpaid, but I think a lot of the frustration and stress comes from being understaffed. We are just stretched so thin," Ms Priol said.
"Half the time we are working with 10 residents to one carer. They are not getting the proper care they need because we don't have the staff.
"It's just inhumane."
Among responses to the HSU survey was one which described the ratio of staff to residents as "dreadful". "You've normally got two staff to 35 people including those with chronic needs and palliative care. You're pushed with work, you can't fulfil all your duties in the 7.5 hours. It's not fair on the workers [or] the residents."
Staff also said they had been asked to turn out lights and cut back on recreational activities to save money. Run off their feet, they often had have no choice but to leave residents lingering in front of the TV or in bed.
"People had to be lying in wet beds for hours on end because there weren't enough staff to change them," one frustrated worker said.
Too busy to answer the buzzer
Aged care worker Marta Ordenes is frustrated and concerned about the dignity of aged care residents.
"Everything is done in a rush," Ms Ordenes said. "We are often too busy to answer the buzzer.
"They call and call and want help to go to the toilet and we can't get there in time. It's not a nice feeling for them or for us.
"We can not do a proper job because we don't have enough staff."
Ms Ordenes said there were five full-time carers and one registered nurse to care for almost 70 aged care residents at the facility where she works in western Sydney.
The staff levels had stayed virtually the same for two years despite residents' needs increasing as they have lost mobility.
"Most of them have nobody but us and we can't even take 10 to 15 minutes to take them for a walk and just talk to them.
"To spend time with them, you have to do it on your break, but sometimes we don't even have time to have a break. We need more staff to give them decent care and their dignity."
Ms Ordenes, 55, said she has been working in aged care since 1984 because she loves the residents.
"That is why I have been there for so many years. I like looking after elderly people," she said.
"That is why many of us work for $20 an hour."
Meryl Andrews, whose father Trevor Andrews is in a Bupa facility in Melbourne's eastern suburbs said a lack of staff had contributed to a decline in the care he received.
His mobility and health rapidly declined this year which means he now has to be fed and hoisted in and out of bed and chairs.
She complained to management about his development of bed sores and being left in bed for too long when staff were too busy to move him into a chair.
"Dad would miss out on showers because it took two carers to do it," she said.
Bupa Aged Care Australia Chief Nurse Maureen Berry said that while tightening of government funding was "a threat to the sustainability of the aged care sector, we reject any suggestion that we have allowed this to impact on the care and wellbeing of our residents".
She said Bupa training on continence pads was based on "best clinical practice for the assessed level of need across our resident population and means some residents will require more or less".
Ms Berry said Bupa was aware that Mr Andrews' daughter was informed by a staff member that an element of her father's care plan was not carried out due to lack of staff.
"The matter was immediately investigated and while we are unable to provide details due to privacy, we do not believe that staffing levels were the reason for this," she said.
Nurses unions in Victoria and NSW have been deadlocked in industrial disputes for weeks over staffing levels and pay for aged care workers working for Bupa aged care facilities.
Annie Butler assistant federal secretary for the Australian Nursing and Midwifery Federation said a national survey of 3000 nurses recently found the vast majority of nurses had complained about inadequate staffing levels.
"They know they are missing care," she said.
Mr Rooney said his organisation was opposed to mandated staff ratios. He said quality of care "is not as simple as the number of staff on duty or arbitrary staff to resident ratios".
Pat Sparrow, chief executive of industry body Aged & Community Services Australia said aged care providers strive to deliver the highest level of care they can with the funding they receive.
"It is also true that faced with a rapidly ageing population and an increasing number of higher needs residents, those resources are under pressure," she said.