Older people and poor care: a human rights issue

In this blog Helen Wildbore, Policy and Programmes Manager at the British Institute of Human Rights, shares some key points from her speech to the All-Party Parliamentary Group on Ageing and Older People’s inquiry on human rights on 24th April. Helen shared the platform with Dr Eileen Burns, President of the British Geriatrics Society.

Why is poor care a human rights issue? At the British Institute of Human Rights (BIHR), we work with people at the sharp end of public services and people placed in vulnerable situations, including older people. When things go ‘wrong’ and people receive poor care, their first thought isn’t necessarily their rights.

But human rights can be a powerful tool as:

  • An empowering language – using human rights moves the conversation away from ‘needs’ and ‘charity’ to the more empowering language of universal rights, for everyone
  • Redressing power – helping address the power imbalances that can sometimes be felt by people using services
  • Getting things moving – as they are legal rights, with a legal duty on public officials, using human rights can help ensure services take notice and act
  • Creating a level playing field – taking the heat out of conversations between public officials, focusing on the person at the heart of a decision
  • Assisting practitioners – using the framework of the human rights law can help practitioners to make (often) difficult decisions on the frontline of service delivery

Poor care is about human rights. The Human Rights Act (HRA), our law here in the UK, contains key rights to protect people from poor care:

  • If an older person is abused or neglected in care, this is about their dignity, protected by the right to be free from inhuman or degrading treatment (Article 3 in the HRA)
  • If an older person is not involved in decisions about their care or are ignored, this is about their autonomy, protected by the right to respect for private life (Article 8 in the HRA)
  • If an older person is patronised or spoken down to, this is about stigma related to age, protected by the right to be free from discrimination (Article 14 of the HRA)
  • If an older person is not offered health treatment or their physical health is neglected, this could be about their right to life (Article 2 in the HRA)

The HRA is the lever health and care practitioners can use to avoid poor care, and it’s the law we can all use to hold services to account. The HRA places a direct legal duty on public officials to respect and protect people’s rights. This means public officials need to design and deliver rights-respecting services. Where they don’t, we can use the law to talk to public officials directly about our care or treatment. This makes the HRA useful and practical, allowing us to take action at a local level, outside of courtrooms.

For Erin, in her late 70s, affected by dementia and living in care, her relationship with her partner, Patrick, was at risk after he was seen touching Erin in a sexual way. Staff at the care home raised a safeguarding alert with the council. But Erin’s advocate spoke to the council about Erin’s right to family life, and the positive impact the relationship was having. Taking this into account, Erin was assessed as having capacity to decide about contact and the safeguarding inquiry concluded Patrick could continue to visit.

What does ‘good’ care look like? BIHR’s work with services shows that using human rights can lead to better decision-making. There is a tendency for services for older people to focus on protecting from risk. Whilst safety is an important human right, older people also have the right to autonomy and to liberty. Lisa, a senior dementia practitioner, told us:

“I was able to challenge poor practice around planning the care pathway of a client using a human rights approach. The client’s own wishes to live in her own home were not given appropriate weight and thinking about the range of human rights involved meant she was given a much more dignified, respectful way to be supported to live in her own home.”

Our work also shows that using human rights empowers staff and reconnects them to their values. As a social worker involved in our project told an independent evaluator, human rights “help, in difficult times, to give us back our values in a meaningful way”. Embedding human rights across services can also lead to culture change. As practitioners increase their knowledge and confidence about human rights, this has the potential to transform the organisation from the inside. As one practitioner put it:

 “[Using a human rights approach] has improved the culture of our organisation. I started off sceptical about what difference it would make, but there has been a big turn around and the service is better as a result.”

What are the barriers? This is a big question, but I’ll briefly address two factors. First, the culture and context services are working in. As austerity and cuts have kicked in, services have become more stretched and practitioners are being asked to deliver more with less money. As a result staff are struggling to keep up with the basics and provide a minimum level of care. Human rights are not an ‘added extra’, or about ‘luxuries’; they are about minimum standards. But this leads us to the second factor: lack of awareness of human rights. Awareness of the duty on public officials, to deliver rights-respecting services, remains low. Training for health and care staff on human rights is patchy and very few practitioners are trained on how the HRA underpins the other laws they work to. From BIHR’s work, I’ve seen how training and supporting staff to use the HRA can lead to increased knowledge and confidence, improving practice and outcomes for people using the service.

Taking action. This year BIHR is celebrating 70 years of universal human rights, and their protection in the UK via the HRA. You can add your voice to help us mark this landmark anniversary by signing our birthday card to the Universal Declaration of Human Rights. We will deliver the card to the United Nations and to the UK Parliament on Human Rights Day (10th December). Add your voice to ensure our leaders hear loud and clear that universal human rights are vital, for older people, for everyone.

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