Human rights and the care of older people: a UK perspective

1. Human rights and the care of older people: a UK perspective UN Open-Ended Working Group on Ageing: fifth session 30th July to 1st August 2014 Ruthe Isden, Health Influencing Programme Director, Age UK

2. Plenty of reports….

3. And headlines….

4. UK Parliamentary Joint Committee on Human Rights 2006/7 Inquiry into hospitals and care homes • Malnutrition and dehydration (Articles 2, 3 and 8) • Abuse and rough treatment (Articles 3 and 8) • Lack of privacy in mixed sex wards (Article 8) • Lack of dignity especially for personal care needs (Article 8) • Insufficient attention paid to confidentiality (Article 8) • Neglect, carelessness and poor hygiene (Articles 3 and 8) • Inappropriate medication and use of physical restraint (Article 8) • Inadequate assessment of a person’s needs (Articles 2, 3 and 8) • Too hasty discharge from hospital (Article 8) • Bullying, patronising, and infantilising attitudes towards older people (Articles 3 and 8) • Discriminatory treatment of patients and care home residents on grounds of age, disability and race (Article 14) • Communication difficulties, particularly for people with dementia or people who cannot speak English (Articles 8 and 14) • Fear among older people of making complaints (Article 8) • Eviction from care homes (Article 8)

5. Dignity and respect in hospitals

6. Dignity and respect in care homes

7. Dignity and respect • Weak regulation – inadequate information, ‘tick box’ inspections and inadequate expertise • Process and target driven management and policy making • Deeply embedded professional and institutional cultures that mitigate against dignity or a rights based approach • Lack of emphasis on care of older people or a rights based approach to care within professional training • Chronic lack of training for health and care assistant workforce • Low awareness of rights amongst service users and front line staff – e.g. NHS Constitution

8. Poor access and inadequate processes • Denying people rightful access to health and care services – e.g • Low referral rates to specialist services • Limited access to primary care services within care homes • Failure to offer best practice treatments – i.e. talking therapies • Inappropriate processes or failure to apply processes appropriately – e.g. • Deprivation of liberty orders • Do Not Resuscitate orders • Discriminatory decisions making – e.g. • Clinical decision making based on assumptions about age and frailty • Inappropriate medicating of dementia patients

9. Poor access and processes

10. National policy frameworks • Care Act will introduce significant new legislation but challenges remain • High bar for eligibility • Insufficient care provided • Failure to afford protection to private care users • Failure to tackle embedded age discrimination • Explicit age ‘cut-offs’ embedded in national outcomes frameworks