The Royal Commission into Aged Care Quality and Safety begins hearings on residential aged care facilities, or nursing homes, in Sydney this week.

The standards of nursing homes in Australia have been in the public eye since the Oakden Aged Mental Health Care Service in Adelaide became embroiled in an elder abuse and neglect scandal, sparking reviews, inquiries and investigations across the sector.

This was the most prominent of a series of incidents of abuse and negligence that eventually led to the establishment of a royal commission.

So what are the challenges facing nursing homes and why are they under so much strain?