07 Dec 2017

Monitoring in LTC Settings

As ENNHRI’s project on The Human Rights of Older Persons & Long-term Care comes to an end, we’re reflecting on the benefits of human rights monitoring in long-term care settings.

Over the course of nine months in 2015-2016, a “Pilot Group” made up of six ENNHRI members (in Belgium, Croatia, Germany, Hungary, Lithuania and Romania) monitored the human rights situation in care homes in their jurisdictions. This monitoring work helped to identify common human rights concerns and the causes of these, as well as to start a conversation with care providers and policy-makers about how to reduce and prevent further concerns arising. This in turn helps to make the rights of older persons in and seeking care more visible and so improve rights protection in care settings.

The monitoring work carried out by these six NHRIs complements similar work carried out by 11 other ENNHRI members in previous years, either in residential long-term care settings or of formal care services provided in older persons’ own home. As this extensive work suggests, NHRIs have considerable expertise in monitoring and investigating the human rights situation on the ground and are a key actor in the field. However, they are not the only human rights actors that can monitor long-term care settings. Civil society organisations, national quality inspectorates and UN and Council of Europe human rights mechanisms responsible for monitoring compliance with human rights legislation can also consider carrying out this work. ENNHRI encourages all organisations with a capacity to monitor to engage in this work and help to improve rights protection in the long-term care sector.

Even if NHRIs are leaders in the field of human rights monitoring, particularly in long-term care for older persons, not all have a mandate to monitor human rights protection in institutions were people may be deprived of their liberty. This means that they have been instrumental in developing methods for accessing care homes and carrying out monitoring work that relies on the co-operation of providers rather than relying on unrestricted access, as is the case for other NHRIs. As part of ENNHRI’s project, three NHRIs had no automatic powers to access all places of detention, including long-term care settings, without restriction, to carry out human rights monitoring work.

In order to help these NHRIs, ENNHRI provided guidance on human rights monitoring methodologies collated from previous NHRI work on the best methods for gaining access to care homes, including the provision of sample letters to care homes that highlights the benefits of engaging in the monitoring process. ENNHRI also researched innovated practices for collecting information from all stakeholders, including older persons with communication problems and/or cognitive impairments in order to ensure that their voice was central to the process. This includes using visual aids, such as photographs or flashcards to stimulate conversation or interests and opinions in a particular issue, as well as the method of conducting “case studies” of 2-3 residents with communication problems and/or cognitive impairments that monitoring teams can carry out in order to understand how the care home takes the needs and rights of such individuals into account throughout the course of their care.

If you are interested in learning more about human rights monitoring in the long-term care sector, click here to access ENNHRI’s Handbook on Monitoring the Human Rights of Older Persons and Long-Term Care and here to access ENNHRI’s analysis of the human rights standards relevant to long-term care.