An elderly mum was left to die by her own sons on a urine-soaked mattress, a court heard.

Shirley Thompson died of blood poisoning on September 2, 2017, suffering from infected bedsores down to the bone and a serious wound the size of a fist.

The 72-year-old's two sons, Phillip Thompson, 43, and his brother David Thompson, 40, are on trial for her manslaughter.

Photos shown at New South Wales Supreme Court in Australia show the stained mattress where Ms Thompson lay for months.

On August 23, 2017 paramedics found her naked on the bed when David finally called an ambulance.

He told the control room his bedridden mother couldn't eat and had a wound on her backside, the court heard on Monday.

She was rushed to Blacktown Hospital where she died little more than a week later.

Both brothers have pleaded not guilty and are being tried by a judge alone.

Prosecutor Jeff Tunks said Ms Thompson became extremely isolated after her husband's death in 2012.

He said she was totally dependent on her sons for her nutrition, mobility, and personal hygiene.

He told the court the brothers were aware in the weeks before her death that their mum's condition was deteriorating.

Paramedic Megan Kuhner, who attended the Greystanes house after the triple-zero call, said Ms Thompson's room had a stench and smelt 'really poorly'.

Everything was filthy and when Ms Kuhner first looked at the floor she thought it was just dirt and not actually carpet.

The patient, whose pallor was almost greyish, was lying in bed on a towel smelling of urine.

"It was quite disgusting," Ms Kuhner said. "It was just soaked in urine and faecal matter."

Ms Thompson had bruises, pressure sores and a large open wound on her bottom, a wound which contained faecal matter.

When asked about medical treatment, David Thompson told her: "She doesn't like to see doctors. She is very stubborn."

Ms Kuhner noticed both sons were quite clean despite the house being filthy.

At one stage, Ms Thompson told her: "I am so thankful to have my sons."

Triage nurse Lauren Cole said Ms Thompson was pale and generally unkempt and smelt of urine.

She had a deep, red inflamed wound on her bottom which was 'the size of my fist and I could put my fist in it'.

But defence lawyers told Justice Des Fagan the case was about choices made by the mother, who had previously refused any medical care.

"We say Shirley Thompson died because of choices she herself made," Tony Evers, acting for the younger brother, said.

He claimed she made choices about when, if and what to eat, about using the bathroom and about not seeking medical help.

"It is true the house could have been cleaner, but of course he was not a professional. He was her son," he said.

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