Monitoring quality of long term care
5th
EU SIDE EVENT
Open Ended Working Group on Ageing
31 July 2014
Kasia Jurczak
Policy Analyst
Social Protection Unit
European Commission
DG Employment, Social Affairs and Inclusion
Social Europe
Approach to long-term care in the EU
• Long-term care as well as health care are EU
Member States' responsibility
• EU's role is to coordinate – Social Protection
Committee
• Focus on quality, access and affordability
Social Europe
What have we done so far in this field?
• Quality of care and prevention of elder abuse and
neglect
• Funding of "pilot projects" on preventing elder
abuse: data collection, standards development;
• Awareness raising:
•
conference with OHCHR (2013);
•
seminar with AGE Platform Europe and CoE (2014)
• Report with OECD "A good life in old age?"
Social Europe
Why is quality of LTC
important?
Aspects of quality of
LTC
1) Recognise that users/older
persons need more voice and
control over their lives
1) effectiveness and safety
2) the costs of care services
keeps on growing from 1,6% of
GDP across the OECD to at least
double this figure by 2050; ->
cannot afford to get it "wrong"
2) person-centeredness and
responsiveness
3) care-coordination
3) governments have the
responsibility to protect older
people from potential abuse;
Social Europe
What measures are collected?
Clinical quality:
- elderly falls and
fractures
- bed sores
- medication use
- weight loss
- mental health
outcomes (minority of
countries): depression;
- use of physical
restraints in nursing
homes
Responsiveness and carecoordination
- user experience in LTC
- waiting times for LTC
- avoidable admissions for chronic
conditions among the elderly patients
Quality of life:
- Patient and user experience:
- consumer choice,
- autonomy,
- dignity,
- comfort,
- security,
- relationships and social activity;
Social Europe
Main regulatory approaches
• Regulatory standards:
• setting minimum standards on inputs (labour, infrastructure)
• processes (management of medication, record keeping, infection
control);
• necessary for accreditation or authorization to practice
• Market incentives: accreditation or certification of care
facilities
• Accreditation and standards for home care and community
care services are less common, but can be found in FR, JP,
PT, ES, US;
• Staff training/continuous learning – very rarely required
• More recently focus on outcomes: quality of life, choice,
dignity – mainstreaming a rights-based approach to care;
Social Europe
Enforcement
• Enforcement is not strong enough
• Expensive to monitor compliance; expensive to adhere to
norms and protocols;
• Strict regulation has limits
• stifle innovation, limit autonomy of persons using the services
(risk aversion);
• focus on what is regulated rather than broader quality issues;
• Better standardisation for higher quality?
• How to bring in the rights based approach to care monitoring?
Social Europe
Older Persons Project
Side event 5th OEWG-A
31 July 2014
Claudia Mahler GIHR
Mapping Report - Sept 2013
• Many NHRIs in Europe work to promote and
protect older persons’ human rights
• Multifaceted approach:
– Working with rights holders
– Raising awareness of human rights standards
– Addressing structural issues
• Some uncertainty on future work, due to limited
resources
Member Survey – April / May 2014
• Members’ recent work
• Members’ planned work
• Ideas for the Project
– Objectives, content, methodology, output,
outcomes, resources, stakeholders
Project Objectives and Scope
• Embed human rights standards and approach in care of
older persons
– Increase human rights protection for older persons
– Clarify which international hr standards apply on older persons
in care
– Raise awareness
– Development of practical tools
– Recommendations to various actors
– Spread best practice for supporting and monitoring hr for older
persons
Take into account
• Relationship with home care
• Rights of care staff
• Impact of the economic crisis
• Diversity of older persons
• Relationship with OPCAT and CRPD
• Developments at the OEWG on ageing
Activities
•
•
•
•
•
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Desk based research
Monitoring activities
Awareness raising
Recommendations
Evaluation
Follow up
Human rights approach requires increased:
– Empowerment
• Awareness-raising for rights holders and advocates
• Advocacy that involves rights holders
– Accountability
• Embedded in inspection regimes and indicators (NHRI)
• Embedded in public procurement and policy
development (state and EU bodies)
– Ability
• Staff training and qualifications
• Human rights impact assessments
Open-Ended Working Group (OEWG)
on Ageing
UN HQ New York
31st July 2014
MONITORING CARE OF OLDER PERSONS FROM A HUMAN
RIGHTS PERSPECTIVE
Presented by:
Kazi Reazul Hoque
Full Time Member
National Human Rights Commission
Bangladesh
And APF Speaker
APF CONFERENCE ON RIGHTS OF OLDER PERSONS IN SYDNEY
FROM 13-15 MAY 2014
RIGHTS OF THE ELDERLY: BANGLADESH PERSPECTIVE
The article 15 of the Constitution is directly concerned with the
elderly rights of the People’s Republic of Bangladesh.
Constitutional Provisions
a) The provision of basic necessities of life, including food,
clothing, shelter, education and medical care;
b) The right to work, that is the right to guaranteed
employment at a reasonable wage having regard to the
quantity and quality of work;
c) The right to reasonable rest, recreation and leisure; and
d) The right to social security, that is to say, public assistance
in case of undeserved want arising from unemployment,
illness or disablement or suffered by widows or orphans or
in old age, or in other such cases.
TWO INSTRUMENTS TO ENSURE CARE AND
HUMAN RIGHTS IN BANGLADESH
1. National Ageing Policy 2013
2. Parents Maintenance Act 2013
OLD AGE CARE AND HUMAN RIGHTS
•Getting care at old age is a
fundamental necessity
•Old age is related to vulnerability
and disability, therefore care and
support mechanism is the
responsibility of the state.
Commissioner Hoque is visiting BAAIGM to
see the care situation of the older persons
CARE SYSTEM OF OLDER PERSONS IN BANGLADESH
A. Institutional Care
•Care from the Government (There exist many initiatives to
support and care the older persons like old age allowance)
Old Age Support from the Government
Old Age Allowance 400 taka (USD 6 approx) per person per month
Disable allowance: 500 taka (USD 7 approx) per person per month
Freedom Fighters Allowance (All are Ops) : 5000 Tk. ( USD 65) per month
Inclusion in the academic curriculum regarding care giving of the older
persons by the a. Family level b. School level b. Community level
INSTITUTIONAL CARE (CONTD…)
A. Institutional Care
Bangladesh Association of
Ageing and Institution of
Geriatrics Medicine-BAAIGM
 Bayoska o Shishu
Punorbason Kendra
(Boshikpur)
 Sir William Beveridge
Foundation

CARE SYSTEM OF OLDER PERSONS IN BANGLADESH
B. Traditional Care
(There is very good traditional
support system in Bangladesh)
C. Care from the community (organizations like
Ageing Support Forum takes various programs on Old Age
Care)
D. Care from the family
E. Private Care (Nursing Home, Physiotherapist)
SOME ORGANIZATIONS WORKING FOR OLD AGE CARE

Bangladesh
Association for the
Aged and Institute of
Geriatric Medicine
(BAAIGM)
Commissioner Hoque talking to the older women of BAAIGM
HELPAGE INTERNATIONAL
Project launching of HelpAge International Dhaka 2014
SOME ORGANIZATIONS WORKING FOR OLD AGE CARE
Sir William Beveridge foundation
Dr. Atique delivering speech at Dementia Conference organized by SWBF
BANGLADESH GERONTOLOGICAL ASSOCIATION
AGEING SUPPORT FORUM
Warm Cloth Distribution Program of Ageing Support Forum for OPs January 2014
NHRC MONITORING TO THE CARE SYSTEM
Prof. Mizanur Rahman, Chairman of NHRC visiting Older Persons after the communal incident of Ramu,
Bangladesh
NHRC commissioner Hoque along with NHRC Officials in a meeting with Mr. Zahid Mukul,
the Founder of BOSPUK, shelter home of nearly 500 Ops near Dhaka city
ROLE OF NHRC






Maintaining liaison with the GO and NGOs working with older
persons
Awareness creation to the community to uplift the rights of
the older persons
Support and assist older care initiatives (Ageing support
forum)
Monitoring whether proper food, medicare and other
standard facilities are given (jails, hospitals, and shelter homes.)
Advocating to the government to increase Old Age Allowance,
number of beneficiaries and area of coverage
Proposing for the insurance policy for the older persons to
the government
EXAMPLES OF CARE FOR OLDER PERSONS IN
BANGLADESH
Institutional (Old Home)
1. Sir Willium Beveridge Foundation
2. BAAIGM
3. Ageing Support Forum
4. Elderly and Child Rehabilitation
Centre
Private Care
1. Nursing home,
2. physiotherapist
Traditional Family Care
A caregiver providing residential service in Dhanmondi, Dhaka
BANGLADESH STRENGTH AND CHALLENGES
STRENGTH
1. Old Age Allowance Scheme of Government
2. National Ageing Policy 2013
3. Parents Maintenance Act 2013
4. Govt. Support to the different NGOs and philanthropic organizations
5. Uphold the religious ,family and social Values . Therefore protection
for older persons in care is built in.
6. Very rich Values of Ethnic community in regards to respect to older
persons
7. Involvement of the older persons in decision making in regards to
ESCR as well as Civil and Political arena.
8. Disregard, ignorance, violence against OPs are highly criticized in the
society.
9. In resolving any religious, social and familiar dispute, opinion of OPs
are highly honored and accepted.
10. Bondage of Extended family and community is very strong in care
giving.
BANGLADESH STRENGTH AND CHALLENGES
1.
2.
3.
4.
5.
6.
7.
8.
CHALLANGES
Implementing National Ageing Policy 2013
Implementing Parents Maintenances Act 2013
Rate of increase in the number of Older Persons
Research Constraints
Attitude of general people not being aware of old age
Proper Distribution of Old Age Allowance
Awareness and training of rural and urban Older
Persons to cope with the changing situation
Isolation of the organizations working with old age
issues. Coordination among the GO NGO initiatives
COMMENT ON EU PROJECT OF HR ON CARE
1. As institutional care and residential care have been
increasing in Bangladesh, Human Rights issues in CARE will
be of great importance. Monitoring of caregivers and setting
up new standards in providing care to older persons is a
necessity.
2. Traditionally, the family norms and values of Asian countries
are different than the norms and values of Europe.
Therefore, the Human Rights approach to care-giving in
these two regions should be different.
3. There are more than 12 million older persons in Bangladesh.
Therefore, awareness raising and structural issues of
implementing care standards and monitoring will be vital.
4. Study from Bangladesh shows that a significant number of
neglect and abuse exists in our society. Therefore, HR issues
should be properly monitored in residential and home Care.
COMMENT ON EU PROJECT OF HR ON CARE
5. As, in some country, poverty exists in a large scale, the
impact of economic crisis should be properly
investigated before implementing any such project.
6.Regarding the monitoring and care standards,
intervention with policy makers as well as the
organizations that work with Ageing issue is necessary.
7. Awareness, monitoring, follow up and other activities
should be administrated from a different and
independent office in the country.
8. Experts from ageing sector (academicians, researchers)
should be included in the Pilot group.
9. Mandatory retirement is a gross violation of human
rights. Therefore, unemployment issues of older persons
will have relation with receiving Care.