A man with Down's Syndrome had the worst pressure sores some medical staff had ever seen when he was admitted to hospital, an inquest has heard.
Alun Rees died from multiple organ failure due to an overwhelming sepsis infection a month after being taken to Wrexham Maelor Hospital in August 2011.
The 54-year-old had been cared for by his sister at their home in Brymbo since 1993.
But the hearing in Ruthin was told the house was "not fit to live in".
On admission to hospital, more than a dozen pressure sores - many of the worst grade - were discovered on his heel, hip, buttock and other areas.
Home Office pathologist Dr Brian Rodgers said it was his view that the sores had been present on Mr Rees's body for a period of time.
"They could have been there for weeks" he said, adding that some medical staff had documented that they were "some of the worst they'd ever seen".
Ambulance technician Douglas Green, who attended the home of Mr Rees and his sister, Brenda Griffiths, on the day he was admitted to hospital, told the hearing it was "not fit to live in".
He described it as cluttered with an "overwhelming smell" which he agreed was probably because of a "lack of hygiene and ventilation".
He told the hearing Mr Rees's sister had called the ambulance because her brother's breathing had changed, he was pale, weak and lethargic.
In a written statement, hospital accident and emergency staff nurse Paul Richards said Mr Rees was in dirty clothes, "emaciated and dehydrated".
He discovered serious pressure sores and photographed them.
He said that when he pointed them out to Mr Rees's sister she was "shocked" as she had not thought they were serious.
The nurse claimed she said that Mr Rees had been fit and well up to two weeks previously but that his health had been declining.
Mr Rees's older brother, John, told the hearing he saw his sibling for the first time in 18 years when he was admitted to hospital.
On seeing him, he said: "It was very distressing. I wouldn't have recognised him. He was alien to me... the weight loss was extreme."
He said there had been a disagreement between himself and his sister after she took over the care of their brother following the death of their mother in 1993.
He would call regularly at the house but the door was never answered and telephone calls were not answered, he added.
The inquest was told that he made phone calls to social services to raise his concerns over his brother's care and his lack of access to him, but said he was ignored and he stopped calling in 2008.
Questioned by Angus Piper, counsel for Wrexham council, he was asked why he had not written to the social services department about his concerns.
"I didn't feel it was a necessity... they had totally ignored me," he said.
Mr Rees denied claims from Ms Griffiths's counsel, Brett Williamson, that it was untrue that he had made such efforts to see his brother.
The inquest continues.