Presentation on theme: "Monitoring quality of long term care"— Presentation transcript:
1Monitoring quality of long term care EU SIDE EVENT5th Open Ended Working Group on Ageing31 July 2014Kasia JurczakPolicy AnalystSocial Protection UnitEuropean Commission DG Employment, Social Affairs and Inclusion
2Approach to long-term care in the EU Long-term care as well as health care are EU Member States' responsibilityEU's role is to coordinate – Social Protection CommitteeFocus on quality, access and affordability
3What have we done so far in this field? Quality of care and prevention of elder abuse and neglectFunding 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?"
4Why 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
5What measures are collected? Responsiveness and care-coordination- user experience in LTC- waiting times for LTC- avoidable admissions for chronic conditions among the elderly patientsClinical quality:- elderly falls and fractures- bed sores- medication use- weight loss- mental health outcomes (minority of countries): depression;- use of physical restraints in nursing homesIndicators 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;
6Main 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 practiceMarket incentives: accreditation or certification of care facilitiesAccreditation 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 requiredMore 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)
7Enforcement Enforcement is not strong enough Expensive to monitor compliance; expensive to adhere to norms and protocols;Strict regulation has limitsstifle 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?
8Side event 5th OEWG-A 31 July 2014 Claudia Mahler GIHR Older Persons ProjectSide event 5th OEWG-A31 July 2014Claudia Mahler GIHR
9Mapping Report - Sept 2013Many NHRIs in Europe work to promote and protect older persons’ human rightsMultifaceted approach:Working with rights holdersRaising awareness of human rights standardsAddressing structural issuesSome uncertainty on future work, due to limited resources
10Member Survey – April / May 2014 Members’ recent workMembers’ planned workIdeas for the ProjectObjectives, content, methodology, output, outcomes, resources, stakeholders
11Project Objectives and Scope Embed human rights standards and approach in care of older personsIncrease human rights protection for older personsClarify which international hr standards apply on older persons in careRaise awarenessDevelopment of practical toolsRecommendations to various actorsSpread best practice for supporting and monitoring hr for older persons
12Take into account Relationship with home care Rights of care staff Impact of the economic crisisDiversity of older personsRelationship with OPCAT and CRPDDevelopments at the OEWG on ageing
13Activities Desk based research Monitoring activities Awareness raising RecommendationsEvaluationFollow up
14Human rights approach requires increased: EmpowermentAwareness-raising for rights holders and advocatesAdvocacy that involves rights holdersAccountabilityEmbedded in inspection regimes and indicators (NHRI)Embedded in public procurement and policy development (state and EU bodies)AbilityStaff training and qualificationsHuman rights impact assessments
15Monitoring Care of Older Persons from a Human Rights Perspective Open-Ended Working Group (OEWG) on Ageing UN HQ New York31st July 2014Monitoring Care of Older Persons from a Human Rights PerspectivePresented by:Kazi Reazul HoqueFull Time MemberNational Human Rights CommissionBangladeshAnd APF Speaker
16APF Conference on Rights of Older Persons in Sydney from 13-15 May 2014
17Rights 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 ProvisionsThe 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; andThe 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.
18Two instruments to ensure care and human rights in Bangladesh 1. National Ageing Policy 20132. Parents Maintenance Act 2013
19Old Age Care and Human Rights Getting care at old age is a fundamental necessityOld age is related to vulnerability and disability, therefore care and support mechanism is the responsibility of the state.Commissioner Hoque is visiting BAAIGM tosee the care situation of the older persons
20Care system of Older Persons in Bangladesh A. Institutional CareCare from the Government (There exist many initiatives to support and care the older persons like old age allowance)Old Age Support from the GovernmentOld Age Allowance 400 taka (USD 6 approx) per person per monthDisable allowance: 500 taka (USD 7 approx) per person per monthFreedom Fighters Allowance (All are Ops) : 5000 Tk. ( USD 65) per monthInclusion in the academic curriculum regarding care giving of the older persons by the a. Family level b. School level b. Community level
21Institutional care (Contd…) A. Institutional CareBangladesh Association of Ageing and Institution of Geriatrics Medicine-BAAIGMBayoska o Shishu Punorbason Kendra (Boshikpur)Sir William Beveridge Foundation
22Care 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 familyE. Private Care (Nursing Home, Physiotherapist)
23Some 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
24HelpAge International Project launching of HelpAge International Dhaka 2014
25Some organizations working for old age care Sir William Beveridge foundationDr. Atique delivering speech at Dementia Conference organized by SWBF
27Ageing Support ForumWarm Cloth Distribution Program of Ageing Support Forum for OPs January 2014
28NHRC Monitoring to the care system Prof. Mizanur Rahman, Chairman of NHRC visiting Older Persons after the communal incident of Ramu, Bangladesh
29the 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
30Role of nhrcMaintaining liaison with the GO and NGOs working with older personsAwareness creation to the community to uplift the rights of the older personsSupport 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 coverageProposing for the insurance policy for the older persons to the government
31Examples of care for Older Persons in bangladesh Institutional (Old Home)Sir Willium Beveridge Foundation2. BAAIGM3. Ageing Support Forum4. Elderly and Child RehabilitationCentrePrivate CareNursing home,physiotherapistTraditional Family CareA caregiver providing residential service in Dhanmondi, Dhaka
32Bangladesh strength and challenges Old Age Allowance Scheme of GovernmentNational Ageing Policy 2013Parents Maintenance Act 2013Govt. Support to the different NGOs and philanthropic organizationsUphold 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 personsInvolvement 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.
33Bangladesh strength and challenges CHALLANGESImplementing National Ageing Policy 2013Implementing Parents Maintenances Act 2013Rate of increase in the number of Older PersonsResearch ConstraintsAttitude of general people not being aware of old ageProper Distribution of Old Age AllowanceAwareness and training of rural and urban Older Persons to cope with the changing situationIsolation of the organizations working with old age issues. Coordination among the GO NGO initiatives
34Comment 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.
35Comment 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.