Aged-care staff on the coronavirus front line are battling grief and personal protective equipment shortages while residents are treated as second-class citizens, a royal commission has heard.

Australian Nursing and Midwifery Federation secretary Annie Butler said workers had detailed “incredible breaches” of infection control.

“We had members tell us they could only use one glove rather than two,” Ms Butler said on Wednesday during aged care royal commission hearings.

“Members (have been) told they had to reuse equipment, put it in collective plastic bags.”

Australian Nursing and Midwifery Federation secretary Annie Butler, pictured in April, said workers had detailed “incredible breaches” of infection control. Photo: AAP

Health Workers Union Victorian secretary Diana Asmar estimates 1000 of their members in the state had caught the virus.

Poor staffing ratios, a lack of PPE and the growing death toll had left workers feeling like they were “at the bottom of the Titanic”, she said.

More than 160 of Victoria’s 267 deaths have been from aged-care homes, with the national tally reaching 352 on Wednesday.

“There (are workers) grieving because the aged-care residents are their families,” Ms Asmar said.

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Leading aged-care expert Professor Joseph Ibrahim said residents were being treated as second-class citizens and hundreds more would die prematurely during the pandemic.

He said aged home residents made up more than 68 per cent of the nation’s virus deaths, putting Australia among the worst few nations globally.

“There’s a lack of urgency. There’s an attitude of futility which leads to an absence of action,” he said.

Brendan Murphy provided evidence on Wednesday. Photo: AAP

Former chief medical officer Brendan Murphy said the sector had received adequate PPE, support and advice from the government and the 68 per cent figure was a “meaningless statistic”.

“I would like to strongly reject the assertion that somehow the proportion of an extraordinary low death rate has any pejorative meaning,” he said.

He said 0.1 per cent of Australia’s aged-care residents had died from the virus, compared to five per cent in the UK, some 20,000 people.

Professor Ibrahim said the virus response had been hampered by a long-standing divide between federal and state governments and confusion about who was in charge.

Ms Butler said the union on March 4 told Aged Care Minister Richard Colbeck of the need for more staff and training but didn’t get a meeting for a month.

An ANMF staff survey in April showed just 29 per cent of members thought they were getting adequate PPE, the commission heard.

Professor Ibrahim also lashed regulator, the Aged Care Quality and Safety Commission, for using a self-assessment survey to determine the preparedness of some 2300 aged care homes.

An aerial view of Newmarch House, where more than 70 people were infected with the virus and 19 died. Photo: Getty

More than 40 per cent of facilities rated their preparedness as “best practice”, including Sydney’s Newmarch House where 17 residents died.

“Anyone with a child at school would know that if you ask someone to self-assess themselves they’re either super confident … or don’t know enough about their own problems to say that they’ve got gaps,” he said.

Aged Care Quality and Safety Commissioner Janet Anderson said greater regulatory measures had since been implemented.

“We have become more questioning. We have deployed additional regulatory activities in order to both prompt activity or action by providers,” she said.

-AAP