Human rights fundamental to aged care reform

Above:  Age Discrimination Commissioner, Susan Ryan

By Keryn Curtis

Age Discrimination Commissioner, Susan Ryan, has released an Australian Human Rights Commission position paper this week entitled, Respect and choice: A human rights approach for ageing and health, which outlines a human rights approach for the implementation the federal government’s aged care reform package, Living Longer Living Better.

While welcoming the recent package of reforms, Commissioner Ryan said it was important that these new arrangements were built on a fundamental human rights approach.

“By adopting a human rights approach, we will be able to expect services that are available, accessible, appropriate and of good quality,” Commissioner Ryan said. “We also want to see effective monitoring mechanisms and ensure accountability.”

The report says that, while the aged care sector has long been concerned with equitable access to services and participation, sector policy “tends to speak in terms of priorities and goals rather than in terms of rights.”

“Outcomes and objectives are important of course,” said Commissioner Ryan, “but we want to make sure that the fundamental way in which people receiving care services are treated is respectful of their human rights.  

“It’s all about numbers of beds and packages and services and workforce, which are all important.  But underlying it all is every person’s right to choice, dignity, privacy etcetera; and those rights don’t decrease because you are 84 and getting services delivered to your home; or 92 and in an aged care facility,” she said.

 “It is the sort of focus that, while it is underpins everything, it needs refreshing from time to time. It can sometimes get lost, even with the best intentions.

Commissioner Ryan said the paper was deliberately timely, as the first elements of the reform package were beginning to be introduced.

“Because we have embarked on a new phase with these reforms, this was the right time to reiterate the message that a person remains a human and entitled to all the rights of every human, for their entire life.”

The paper says the application of a human rights approach will assure a strengthened focus on a people-centred approach to aged care and the requirement for meaningful participation by older Australians. This approach, the report says, will assist with ensuring that older recipients of home and residential care can help to set their own agenda and have their decisions respected.

The paper addresses the four interrelated elements of availability, accessibility, acceptability and quality, as they apply to the delivery of home and residential aged care services under the Living Longer, Living Better Reform package.  It specifically looks at how they apply to selected components of the reform package including consumer directed care, advance care planning, special needs groups, accessible services and human rights training for health workers.

The paper recommends monitoring and review of the ten year implementation process of the reforms using a ‘human rights lens’, a function that will be helped by the recent appointment of Commissioner Ryan to the Aged Care Reform Implementation Council, headed by Professor Peter Shergold, the membership of which was announced last week.

“Put simply, we are talking about ensuring that older people have choices in care, are provided with information about what is happening to them and have their privacy protected,” Commissioner Ryan said. “Whether care is being provided at home or in residential facilities, providers need training that creates respect for the religious choices, sexual orientation and cultural backgrounds of the older people in their care.”

Making it work

According to the paper, immediate obligations include the development of a national aged care strategy. 

“The reforms make reference to the need for the aged care sector to be incorporated or better linked with the general health sector. This aim would be assisted by the development of a national ageing-well framework or strategy that incorporates aged care within the framework. 

“The opportunity to develop a single national ageing-well framework has been provided by the national health reform agenda and the aged care reforms. It is also a recommendation of the Advisory Panel on the Economic Potential of Seniors,” the paper says.

The paper highlights certain human rights challenges in the delivery of person centred care, including the development of indicators that can monitor the accessibility and quality of consumer directed care as well as the area of ‘respect for the decisions of older Australians’.

The report says that the requirement for accountability is not new to the health sector. Financial accountability (tracking and reporting on allocation, disbursement and utilisation of funds) and performance accountability (demonstrating and accounting for performance in the light of agreed indicators) are well known. 

“Although human rights accountability is also concerned with these two categories, its focus is the degree to which the government is complying with human rights obligations,” says the report.

Human rights focus welcomed by consumer group

Ian Yates, Chief Executive of COTA Australia, says a human rights approach to ageing is critical to ensure the best opportunities for older Australians. In welcoming the Human Rights Commission’s paper, Mr Yates said that the Federal Government’s  aged care reform package Living Longer Living Better didn’t go far enough in giving people a right to quality aged care. 

“Older people have a right to quality care, choice and respect as they age,” Mr Yates said. 

“What many people don’t know is if you need aged care services today you may not get them. It’s not like Medicare where if you get sick you can be guaranteed health care.  

“Aged care services are based on an arbitrary rationing system. Currently the first 113 of every 1000 people over the age of 70 get the care and services they need. 

“While the Federal Government’s reform package will increase this to 125 over ten years that still means that many older people will miss out on appropriate support and care. 

“This is one key element of the Productivity Commission’s recommendations which was not adopted in the Living Longer Living Better package. 

“An end to rationing will ensure older people, regardless of where they live, have a right to access the care they need delivered by a provider of their choice when they need it. 

Mr Yates said a second key recommendation from the Productivity Commission’s report was that older people should be directly given an allocation of funds for support and care, which they can use with whichever provider they prefer, when and where best suits them. 

“The reforms went part of the way with aged care packages to be converted entirely to “Consumer Directed Care” or CDC, but current guidelines for CDC are far too weak.

“The government must strengthen CDC rules in line with the rights-based approach to aged care, so that the people who need the care can control it,” Mr Yates said.

* You can download a pdf or word version here of the Respect and Choice report.