Regional communities are in the spotlight as the aged care royal commission holds three days of hearings in Mudgee in the NSW central west.

The inquiry on Monday examined a case study from a local residential aged care facility, Pioneer House, which was sanctioned in February for failing to meet expected outcomes under the standards.

Allan Codrington, Pioneer House's chairman of the board, told the commission it was difficult in country areas to find competent aged care nurses.

"We just had a lot of difficulty getting registered nurses, enrolled nurses with particular experience in aged care with clinical knowledge," he said.

"Any incentive to bring people to the country areas might be an advantage.

"We obviously pay to the standard but aged care nursing is a lot more demanding - incontinent people, people with dementia, vulnerable people."

While advertising for the role of deputy director of nursing, the aged care provider only received one applicant, he told the commission.

In a submission provided to the commission, Mr Codrington said small regional aged care providers would be better supported to provide safe and quality services by having more qualified and better-paid workers.

"If we could offer (nurses) more money, more incentive to move from somewhere else to Mudgee, make them feel more secure that they'll be well-paid - and we think the government could do that," he said.

"We've got to try and attract enrolled nurses from probably an easier or higher elevated position back to aged care, we need people that want to dedicate themselves to looking after the aged."

While the organisation has partnered with the federal government to bring in "visa nurses" who have been trained overseas, the organisation has had to implement a "buddy system" to pre-train them to the standard needed, an arrangement which relies on other nurses to upskill them.

He suggested a system to train specific aged care nurses.

The senior counsel assisting team is considering putting forward to the commissioners proposals to fund bonded scholarships through which people can be trained locally on the condition they work in that region, and establishing registered training organisations within or linked to rural aged care providers.

In his opening address to the hearing on Monday morning, Mr Gray said there is "no doubt that rural and remote settings pose special challenges for the delivery of aged care".

Many of the challenges are due to structural aspects of remote living, such as wide population distribution, transportation issues, geographic isolation from large centres of economic activity and potentially having populations which are too small to support services, Mr Gray said.

However, equal access to aged care for people living in these regions "is a matter of simple fairness".

"Rural and remote Australians make a huge contribution to the nation and deserve a first-class aged care system," he said.

"Regrettably, the evidence suggests they are not getting that first-class system."

Special measures designed to cater for people in the regions and set out under the federal Aged Care Act are "not achieving their intended purpose," Mr Gray added.

The royal commission's interim report was released last week ahead of the final report due in November next year.

Australian Associated Press