1. Monitoring quality of long term care
EU SIDE EVENT
5th Open Ended Working Group on Ageing
31 July 2014
Kasia Jurczak
Policy Analyst
Social Protection Unit
European Commission DG Employment, Social Affairs and Inclusion

2. 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

3. 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?"

4. 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 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" 3) governments have the responsibility to protect older people from potential abuse;
1) effectiveness and safety 2) person-centeredness and responsiveness 3) care-coordination

5. What measures are collected?
Responsiveness and care-coordination
- user experience in LTC
- waiting times for LTC
- avoidable admissions for chronic conditions among the elderly patients
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
Indicators of LTC quality are useful for government regulatory oversight, hep providers identify problems and point to adverse events in the provision of care, and can help users make informed choices.
However, few countries systematically measure whether LTC is safe, effective and centred around the needs of care recipients.
Quality of life:
- Patient and user experience:
- consumer choice,
autonomy,
dignity,
comfort,
security,
relationships and social activity;

6. 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;
minimum standards are often key elements of evaluation criteria for accreditation or authorisation to practice; these have evolved: initially focus on inputs (workers/users); processes (management of medication, record keeping, infection control);
more recently outcomes: quality of life, choice, dignity (Human Rights link)

7. 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?

8. Side event 5th OEWG-A 31 July 2014 Claudia Mahler GIHR
Older Persons Project
Side event 5th OEWG-A
31 July 2014
Claudia Mahler GIHR

9. 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

10. Member Survey – April / May 2014
Members’ recent work
Members’ planned work
Ideas for the Project
Objectives, content, methodology, output, outcomes, resources, stakeholders

11. 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

12. 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

13. Activities Desk based research Monitoring activities Awareness raising
Recommendations
Evaluation
Follow up

14. 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

15. Monitoring Care of Older Persons from a Human Rights Perspective
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

16. APF Conference on Rights of Older Persons in Sydney from 13-15 May 2014

17. 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
The provision of basic necessities of life, including food, clothing, shelter, education and medical care;
The right to work, that is the right to guaranteed employment at a reasonable wage having regard to the quantity and quality of work;
The right to reasonable rest, recreation and leisure; and
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.

18. Two instruments to ensure care and human rights in Bangladesh
1. National Ageing Policy 2013
2. Parents Maintenance Act 2013

19. 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

20. 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

21. 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

22. 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)

23. 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

24. HelpAge International
Project launching of HelpAge International Dhaka 2014

25. Some organizations working for old age care
Sir William Beveridge foundation
Dr. Atique delivering speech at Dementia Conference organized by SWBF

26. Bangladesh Gerontological Association

27. Ageing Support Forum
Warm Cloth Distribution Program of Ageing Support Forum for OPs January 2014

28. NHRC Monitoring to the care system
Prof. Mizanur Rahman, Chairman of NHRC visiting Older Persons after the communal incident of Ramu, Bangladesh

29. the Founder of BOSPUK, shelter home of nearly 500 Ops near Dhaka city
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

30. 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

31. Examples of care for Older Persons in bangladesh
Institutional (Old Home)
Sir Willium Beveridge Foundation
2. BAAIGM
3. Ageing Support Forum
4. Elderly and Child Rehabilitation
Centre
Private Care
Nursing home,
physiotherapist
Traditional Family Care
A caregiver providing residential service in Dhanmondi, Dhaka

32. Bangladesh strength and challenges
Old Age Allowance Scheme of Government
National Ageing Policy 2013
Parents Maintenance Act 2013
Govt. Support to the different NGOs and philanthropic organizations
Uphold the religious ,family and social Values . Therefore protection for older persons in care is built in.
Very rich Values of Ethnic community in regards to respect to older persons
Involvement of the older persons in decision making in regards to ESCR as well as Civil and Political arena.
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.

33. Bangladesh strength and challenges
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

34. 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.

35. 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.