Brett Anthony Crawford, 34, allegedly broke into a NSW Central Coast aged-care facility shortly after midnight on November 15, 2023 and attacked the 90-year-old woman in her room.
She suffered serious injuries and was rushed to hospital after raising the alarm with staff. She died 13 days later.
Arrested five days after the alleged attack, Crawford was initially charged with aggravated breaking and entering to commit a serious indictable offence, inflicting actual bodily harm with intent to have sexual intercourse and two counts of aggravated sexual assault.
He remains in custody and on Friday his charges were upgraded to include murder and manslaughter.
Police allege he also stole some of the woman's property before leaving the aged-care home.
Sex Crimes Squad commander Jayne Doherty previously said the elderly woman had been left traumatised after the attack and suffered arm, leg and head injuries.
Officers believed the woman's cries for help had been muffled by bedding and that she had been pinned to the bed during the sexual assault.
Nationals MP Bronnie Taylor revealed under parliamentary privilege, after the woman died, that Crawford was recently released after serving 10 years in jail for a similar crime.
Crawford, then known as Brett Ralph, had been told to leave a house party before later breaking in and raping a woman at knifepoint, she said.
He stabbed the woman in the face after raping her, Ms Taylor said.
Crawford is due to return to court on February 21.
1800 RESPECT (1800 737 732)
Lifeline 13 11 14
National Sexual Abuse and Redress Support Service 1800 211 028
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