Friday, November 23, 2018

A new book on European Elder Law: "Ageing, Ageism, and the Law"

Until not many years ago, the field of law and aging was relatively neglected within European jurisprudence. 
This has changed dramatically in recent years.
However, much was left to be studied, at least in the field of ageism and European law.
A new and recent book in the field, edited by Prof. Israel Issi Doron, and Nena Georgantzi, presents a collection of articles in the field. The book was published by EE - Edward Elgar.
Here is a synopsis of the book:

Europe is ageing. However, in many European countries, and in almost all fields of life, older persons experience discrimination, social exclusion, and negative stereotypes that portray them as different or a burden to society. This pivotal book is the first of its kind, providing a rich and diverse analysis of the inter-relationships between ageing, ageism and law within Europe.

Throughout the book – which builds on a European Cooperation in Science & Technology (COST) action – leading scholars offer theoretical and empirical analysis in order to discern the role European law plays in perpetuating and combating ageism. Including specific examples of how stereotypes and prejudices influence and shape the European legal system, the book contributes to the broader current global social movement towards advancing a new international human rights convention for older persons.

Timely and engaging, this book will appeal to students and scholars of law, sociology, public policy and a wide range of related fields including gerontology, human rights, and health studies. Practitioners, policy-makers, civil society organizations and senior citizens activists will also benefit from the insights into the socio-legal aspects of social policies and human rights of older persons.




Monday, November 12, 2018

WHO - World Health Organization and the Combat on Ageism

There is a clear link between the human rights of older persons (or lack / infringements of these rights) and ageism - the social construction of old age.
In recent years there has been a growing awareness for the need to combat ageism as part of the battle to promote the human rights of older persons and their social status across cultures and countries.
One of the key players on the global level in this field is WHO - the World Health Organization.
In its web-site one can find wealth of information, data, and empowering kits to work "on the ground" to address not only ageism, but also self-ageism, which is the internalization of negative attitudes by older persons as part of self adoption of social expectations.
See the WHO web-site and the wealth of its materials:

Friday, October 12, 2018

Ageing Equal: A global awareness raising campaign against ageism

Here is a new press release about a new and important global human rights campaign:

The Universal Declaration of Human Rights (UDHR) will celebrate its 70th anniversary this year. AGE Platform Europe, with partners active in the promotion of human rights, is seizing this momentum to launch a 70-day awareness campaign for “Ageing Equal”. Testimonies and research from around the world prove that ageism is the most widespread discrimination. As we are all getting older, ageism affects or will affect all of us. And yet: because it is often more socially accepted, ageism is one of the least known form of discrimination. Fighting ageism should be everyone’s concern: it is time to take action against it!

Stand up against ageism
Globally, the number of persons aged 80 years or over is projected to increase more than threefold between 2017 and 2050, rising from 137 million to 425 millioni. Ageist attitudes lead to the marginalisation, poverty and abuse of older persons and have negative impacts on their health and well-beingii. Research has shown that people with more negative age stereotypes live on average 7.5 years less than those with more positive attitudes to ageingiii.
Pervasive ageism is embedded in our cultures, institutions and policies. It prevents us from enjoying our human rights when we reach older age and from recognizing the harmful effects of discrimination in older age. For example, age limits that hamper the participation of older workers in trainings are still widespread today. For unemployed over 55, it is more likely that they will not be employed again. In some EU member states, older people above the age of 70 are denied the right to rent a car regardless of their driving abilities. If these discriminations were based on sex or race, we would find them unacceptable – why are they permitted on the ground of age?
70 days to learn and act
The momentum launched by the United Nations to celebrate the 70th anniversary of the UDHR is reminding us that human rights are rights that everyone enjoys,
AGE work is co-funded by the Rights, Equality and Citizenship Programme of the European Union. The contents of this document are the sole responsibility of AGE Platform Europe and can in no way be taken to reflect the views of the European Commission. regardless of age, gender, ethnicity or race, belief or religion, sexual orientation or property, etc. For 70 days, the “Ageing Equal” campaign will invite you to reflect on the prevalence and gravity of ageism and on the importance to stand
up for your rights no matter what age you are.

The campaign will kick-off on 1st October, the International Day of Older Persons,
and will culminate on 10th December, the International Human Rights Day. It will
be structured around 10 thematic weeks reflecting the diversity of experiences in
older age and the multiple discrimination experienced by different groups as
they grow older. The campaign will invite everyone to become vocal about this
unrecognised denial of human rights, and hopefully will draw a path to create a
society for all ages.

Useful resources
 Campaign blog: ageing-equal.org (live from 1st October 2018)
 Campaign communication toolkit: trello.com/b/q14dqegb
including a joint statement from Members of the European Parliament
Intergroup subgroup on Active Ageing and Solidarity between Generations
that will be updated regularly as we receive more signatures from MEPs
 Campaign page on AGE website: bit.ly/AGE-AgeingEqual

Press contact
For any query or to organise an interview with AGE members or partners,
please contact: Estelle Huchet, estelle.huchet@age-platform.eu

Tuesday, September 25, 2018

International Rights of Older Persons: Ageism, Justice, and Social Policy

International Rights of Older Persons: Ageism, Justice, and Social Policy

BIFOCAL, Vol. 35 Issue: 2

by
About the author: Prof. Israel (Issi) Doron is the Head of the Department of Gerontology, University of Haifa, Israel. He is also a former “International Commissioner” of the ABA Commission of Law and Aging.
(Note: The pdf for the issue in which this article appears is available for download: BIFOCAL Vol. 35, Issue 2.)
Introduction 
Much has been said on the fact that we are living in the era of a demographic revolution: the revolution of ageing. The data and the implications on the dramatic change in the demographic composition of the human race are well-known, and have been reviewed in recent decades in innumerable articles, studies, and books. I would go so far as to say that there exists today a fairly broad consensus that one of the most important social policy issues that will engage the entire world in the 21st century is the issue of the ageing of society.
There are those who say that at issue is no less than a “social revolution,” and even if we do not agree with this term, it is undoubtedly a change in the human experience of a type that has never before been experienced in human history: There has never before been a time when a person could rise in the morning, go out into the public space, and every fourth person he or she meets in the street is above the age of 65. Looking inward, the central challenges in the domestic political sphere will therefore be connected to the various aspects of the ageing of the societies, and for the broad implications that this phenomenon will have on economics, health, and society.
This social demographic revolution has also legal implications. Elder law and the issues of rights of older persons have become key elements in legal reforms all over the world. New and novel pieces of legislation along new precedents and court-based (common-law) developments can be found almost in any country around the world. This is true not only on the national-law level but on the international-law level as well. As of today, one of the most important discussions at the international level is whether there is a need for a new human rights convention regarding the rights of older persons. I have written in the past on this issue (Doron & Apter, 2010, 2010a; Doron & Spanier, 2010; Doron, Brown, & Somers, 2013).
In this short article, which is based on my presentation, August 13, 2013, in New York as part of the fourth meeting of the UN Open Ended Working Group on Ageing, I argue that the need for such a convention rests, amongst other things, on the need for social justice for older persons around the world.
On Professor Nancy Fraser’s Model for Social Justice
My argument is based on a theoretical model of social justice. This model was presented by Professor Nancy Fraser of the New School for Social Research, New York, NY, in her article entitled, “From Redistribution to Recognition? Dilemmas of Justice in a ‘Post-Socialist’ Age” (Fraser, 1995). It is a philosophical argument comprising four different parts, which I will briefly present below:
Injustice of Distribution vs. Injustice of Recognition 
In the first phase of the argument, Professor Fraser draws a distinction between two different kinds of social injustices: economic-distributive injustice and cognitive-cultural injustice. According to her, the distinction is based on the fact that:
The first is socioeconomic injustice, which is rooted in the political-economic structure of society. Examples include exploitation (having the fruits of one’s labour appropriated for the benefit of others); economic marginalization (being confined to undesirable or poorly paid work or being denied access to income-generating labour altogether); and deprivation (being denied an adequate material standard of living).
The second kind of injustice is cultural or symbolic. It is rooted in social patterns of representation, interpretation, and communication. Examples include cultural domination (being subjected to patterns of interpretation and communication that are associated with another culture and are alien and/or hostile to one’s own); nonrecognition (being rendered invisible via the authoritative representational, communicative, and interpretative practices of one’s culture); and disrespect (being routinely maligned or disparaged in stereotypic public cultural representations and/or in everyday life interactions).” (pp. 70-71).
Exploited Classes, Despised Classes and Bivalent Collectivities
After Professor Fraser presents both types of the different injustices, she then presents what is derived from them – in other words, a spectrum of various types of “collectives” or “classes.” On one end of this group spectrum are the exploited classes: “At this end let us posit an ideal-typical mode of collectivity whose existence is rooted wholly in the political economy. It will be differentiated as a collectivity, in other words, by virtue of the economic structure, as opposed to the cultural order, of society. Thus any structural injustices its members suffer will be traceable ultimately to the political economy.” (p. 75). In practice, the classic example of such an exploited “collective” is, of course, the “working class,” at least in its Marxist conceptualization.
On the other end of the collective spectrum, Professor Fraser describes the following group: “At this end we may posit an ideal-typical mode of collectivity that fits the recognition model of justice. A collectivity of this type is rooted wholly in culture, as opposed to in political economy. It only exists as a collectivity by virtue of the reigning social patterns of interpretation and evaluation, not by virtue of the division of labor. Thus, any structural injustices its members suffer will be traceable ultimately to the cultural-valuational structure.” (p. 76). In practice, a good example of such a decentralized collectivity is, for example, the group of homosexual people who, despite the fact that they are dispersed across all parts of the economic-standing class of capitalist society, still suffer from scorn and humiliation due to their sexual orientation.
Finally, in a range between the two edges of the spectrum, Professor Fraser presents the collectives that she calls “bivalent,” which suffer both from economic and cultural injustice. As she says: “When we consider collectivities located in the middle of the conceptual spectrum, we encounter hybrid modes that combine features of the exploited class with features of the despised sexuality. These collectivities are ‘bivalent.’ They are differentiated as collectivities by virtue of both the political-economic structure and the cultural-valuational structure of society.” (p. 78). According to Professor Fraser, belonging to a gender or racial group are examples of bivalent collectivities, in which both encompass dimensions of economic injustices alongside cultural and symbolic injustices.
Affirmative Remedy vs. Transformative Remedy
After presentations of the various types of injustices, and presenting the types of social collectives derived from them, Professor Fraser goes on to present the various types of “remedy,” which purport to provide a solution for the various social injustices. Similar to the previous phases, Professor Fraser draws a conceptual distinction between two different types of social policy whose purpose is to resolve or to remedy the injustice: affirmative remedy and transformative remedy. Or, in her words:
My aim is to distinguish two broad approaches to remedying injustice that cut across the redistribution–recognition divide. I shall call them ”affirmation” and ”transformation” respectively... By affirmative remedies for injustice, I mean remedies aimed at correcting inequitable outcomes of social arrangements without disturbing the underlying framework that generates them. By transformative remedies, in contrast, I mean remedies aimed at correcting inequitable outcomes precisely by restructuring the underlying generative framework. The nub of the contrast is end-state outcomes versus the processes that produce them. (p. 82).    
Integration: The Results of an Intersection between the Types of Injustices and the Types of Remedies
After presenting the various types of injustices, the various types of social collectivities that are derived from them, and the patterns of the “remedy” for the various types of injustices, Professor Fraser, in effect, moves on to the operative “result” of the integration of the matrix of these classifications. The result is the following table (p. 87):
[For the chart, please see page 54 of BIFOCAL Vol. 35, Issue 2.] 

As the table shows, each intersection of a type of injustice with a type of change leads to a different pattern of social policy. From a description of matters thus far, it is fairly clear that Professor Fraser, on the conceptual level, supports a policy that integrates a transformative remedy on both of the injustice fronts – the redistributive as well as the recognitive. Or, as she puts it: “For both gender and ‘race’, the scenario that best finesses the redistribution–recognition dilemma is socialism in the economy plus deconstruction in the culture.” (p. 91).
Status and Injustice for Older Persons
At this point, I would like to incorporate the knowledge about the ageing, along with Professor Fraser’s theory of social justice that was presented above, and to ask first: From what “injustice” do older people suffer? And what “type” of social group are they? I will risk stating that, generally speaking, older persons suffer from what Professor Fraser would call distributive injustice. The basis for this argument is supported by a wide range of well-known data relating to poverty rates of older persons around the world: a significant portion of the older population experiences poverty. In many countries around the world, many older persons suffer from moderate or severe nutritional insecurity, or experience economic distress. I believe that there is sufficient evidence to prove that there is truth to the argument that older persons across the globe indeed suffer from “distributive injustice.”
I now arrive at the central question: Do older persons suffer – in addition to the distributive injustice – from cultural and symbolic injustice as well? My answer to this question is: Yes. Older persons are not only an exploited class, but a disparaged class as well. They are a disparaged class due to the fact that they suffer – significantly and substantively – from what is known as ageism. Ageism is a complex term, which is not easy to define. One of the key figures in connection with developing the boundaries of the term ageism and defining it is the late Dr. Robert Butler. One of the first definitions, known as “Butler and Lewis’s definition” of 1973, defined ageism thus (Butler and Lewis, 1973):
Ageism can be seen as a process of systematic stereotyping of and discrimination against people because they are old, just as racism and sexism accomplish this for skin color and gender. Old people are categorized as senile, rigid in thought and manner, old-fashioned in morality and skills [. . .] Ageism allows the younger generations to see older people as different from themselves, thus they subtly cease to identify with their elders as human beings.
Do older persons suffer from ageism around the world? Once again, I believe that there is ample evidence to suggest that the answer is yes. Older persons are discriminated because of their age at the work force; they are presented in a humiliated way in various popular media platforms; they are invisible to many key cultural institutions; and they are marginalized in major social activities. In most parts of the world, no one wants to be named: “old person.”
So - What Kind of “Social Justice” Do Older Persons Really Need? 
At this stage, it is time to move to the socio-legal remedies. In my opinion, the socio-legal policies that have been adopted in many countries around the world in the sphere of social justice in old age have focused on the different aspects of affirmative remedy of the distributive injustice:
  • Creating a social security system that is based on old age and survivor allowances alongside old age assured income systems;
  • Adding long-term care (either in the community or in institutions) to social security schemes;
  • Allocating resources to financing institutional frameworks for nursing care; or
  • Creating a range of economic discounts and benefits for “senior citizens.”
These all focused on an attempt to redistribute revenues in a manner that would “correct” the injustice of the elderly poor.
On the other hand, thus far, in the vast majority of countries around the world, no effective and significant legal action has been taken as part of a coherent and clear social policy aimed to contend with the symbolic and cultural-recognition injustice of older persons. Reality in many cases is quite the opposite: Social policies increased and emphasized the aspects of weakness, illness, and disability of older persons, and in so doing, in effect, reflected and bolstered the disparagement and the humiliation from which older persons suffer.
My personal conclusion from the analysis presented above is clear: in the sphere of socio-legal justice for older persons, national and international focus should be shifted from the “well-known failure” of redistributive justice to the “unknown failure” of cultural and symbolic justice. More specifically, this conclusion is relevant to the current discussion at the international level regarding the need for a new and specific human rights convention for the rights of older persons.
Beyond all other arguments, the understanding that there is a real symbolic, cultural, and “recognitional” importance to a new international human rights convention exclusively dedicated to older persons – is of significance. It explains why even if legal rights of older persons can be currently indirectly addressed through existing human rights instruments – this is not enough: it will not resolve the existing socio-legal injustice older persons are experiencing. Only a new and exclusive human rights convention will symbolize and dignify our recognition of older persons as a fully equal group worthy of society’s respect.
References
Doron, I. & Apter, I. (2010). International rights of older persons: What difference would an international convention make on the lives of older persons? Marquette Elder’s Advisor Law Review, 11(2), 367-385.
Doron, I. & Apter, I. (2010a). The Debate Around the Need for an International Convention on the Rights of Older Persons. The Gerontologist, 50(5), 586-593.
Doron, I., & Spanier, B. (2012). International convention on rights of older persons: Where we were, where we are and where we are going? Global Ageing, 8(1), 7-16.
Doron, I., Brown, B., & Somers, S. (2013). International protection for the human rights of older people: History and future prospects. In P. Brownell and J. Kelly (Eds.) Ageism and Mistreatment of Older Workers: Current Reality, Future Solutions (pp. 165-180). NY, New York: Springer.
Fraser, N. (1995). From Redistribution to Recognition? Dilemmas of Justice in a ‘Post-Socialist’ Age. New Left Review, 212, 68–94. ■ 

Sunday, September 23, 2018

A new book on Australian Elder Law


A new book on Australian elder law. Yet another example of the growing need and interest in our field.



Tuesday, July 17, 2018

Time for AGEIVISM

If one wishes to promote the human rights of older persons, one need ideology.

"Ageivism" refers to an ideology which serves as the basis for calls for social action (echoing similar "isms", e.g. feminism, or socialism) on the protection and promotion of the rights of older persons based on the grounds of political, social and economic principles of identity, dignity and social justice.
Ageivism derives from two well-known bodies of knowledge: one – the politics of identity; the other – the concept of ideology. The politics of identity is not new to the field of social justice and social policy. Women, Afro-American, Persons with disabilities, the LGBTQ community, have all used this kind of discourse to utilize their social struggle for equality, dignity, human rights and social justice.[i] One very clear and forceful example of the importance of the politics of identity can be found in the feminist writings of Prof. Nancy Fraser.[ii] It is beyond the scope of this short article to fully discuss and implement Fraser's argument in the context of older persons as this has been already done.[iii] For the purposes of this article, it would be sufficient to argue that older persons experience both symbolic and cultural injustices, such as being portrayed in the public media as a burden on society or irrelevant and senile.
Along with the politics of identity, the concept of "ideology" is central to the term "ageivism". For the purposed of this article, "ideology" will mean "a system of ideas and ideals" as well as "the set of beliefs characteristic of a social group."[iv]  Ageivism therefore is an ideology which encompasses a set of ideas and ideals regarding older persons as a distinct social group. This isthe outcome of viewing old age a social construction rather than compartmentalizing old persons according to chronological age, biology or other categories. Ageivism calls for the liberation of older persons from existing oppression and discrimination which is embedded in ageism. It opposes any attempt to eliminate older persons as a distinct social group, or eradicate old age as a unique human experience. Ageivism, as an ideology, encourages older persons to self-identify as such, and to actively resist the attempts to ignore their unique subjective social experiences of being old in modern and post-modern societies.
Eventually, ageivism as an ideology calls for social change through social activism. Once again, these terms are not only historically and theoretically rich and complex, but entail diverse sociological, psychological and political contexts.

See new web-site: www.ageivism.org

Thursday, June 14, 2018

The Right of Older Persons to Freedom from Violence, Abuse and Neglect - Joint Submission to the OEWG



Joint submission by AGE Platform Europe, HelpAge International, The Law in the Service of the Elderly and the National Association of Community Legal Centres Australia
Open-Ended Working Group On Ageing, 9th Working Session, 23-26 July 2018

Normative content on the right of older persons to freedom from violence, abuse and neglect

Authors
This joint submission is authored by Robin Allen (Cloisters), Andrew Byrnes (Australian Human Rights Institute, Faculty of Law, University of New South Wales), Israel (Issi) Doron (University of Haifa), Nena Georgantzi (AGE Platform Europe / National University of Ireland Galway), Bill Mitchell (National Association of Community Legal Centres, Australia) and Bridget Sleap (HelpAge International). Our views do not necessarily reflect the broad and consensual positions of the organisations we represent, which will be submitted separately.

Affirmation of the right
1. Older persons have the right to freedom from violence, abuse and neglect.

Scope of the right
1.1 The right includes all forms of violence, abuse and neglect against older persons.

1.2 The right applies to violence, abuse and neglect in private and public settings.

1.3 States Parties are responsible for acts of violence against older persons and abuse and neglect of older persons committed by organs, officials and agents of the state at all levels, including private actors acting under the direction of or in accordance with the instructions of the state, or whose acts are otherwise attributable to the state.

1.4 States Parties are responsible in relation to the acts of non-state actors if the State Party fails to meet its obligation to take all reasonable measures to prevent, as well as to investigate, prosecute, punish and provide reparations for acts or omissions by non-state actors which acts of violence against older persons and abuse and neglect of older persons.

State obligations
2. States Parties shall take appropriate legislative and administrative and other appropriate measures to prevent violence, abuse and neglect of older persons in public and private settings by, inter alia:
·         Raising awareness of, and sensitising society to, the different forms of violence, abuse and neglect in older age and how to identify and prevent them.
·         Putting in place effective legislation and policies to ensure all forms of violence, abuse and neglect are identified, investigated and redressed
·         Ensuring that measures to prevent violence, abuse and neglect are proportionate and compatible with the right to autonomy and independence
·         Allocating sufficient resources for effective implementation
·         Providing information to and raising awareness of older persons of their rights
·         Providing training for all care and support providers, including family and other informal care and support providers, and other service providers, including law enforcement
·         Ensuring a system of appropriate needs assessment and monitoring in all situations of care and support
·         Ensuring that all facilities and programmes designed to serve older persons are effectively monitored by independent authorities
·         Ensuring a comprehensive violence protection policy in all care and support settings, regardless of whether care and support is provided by state or non-state bodies. This shall include training of providers, a complaints system, protection of those reporting violence, and interventions procedures
·         Paying specific attention to the intersectional and other determinants of violence, abuse and neglect.

3. States Parties shall ensure timely and effective access by older persons to a range of support services for victims, survivors and persons at risk of violence, abuse and neglect, including but not limited to:
·         A full range of medical, social, psychosocial, rehabilitative and legal services
·         Access to information about available support and services
·         Access to appropriate support services for victims, survivors and persons at risk.

4 States Parties shall ensure timely access by older persons to effective remedies and redress by taking appropriate measures which include but which are not limited to:
·         Investigating violations effectively, promptly, thoroughly and impartially and, where appropriate, taking action against those allegedly responsible in accordance with domestic and international law
·         Providing older persons who claim to be victims of violence, abuse and neglect with equal and effective access to justice, irrespective of who may ultimately be the bearer of responsibility for the violation
·         Ensuring timely access by older persons to support, where necessary, to make autonomous decisions about reporting acts of violence, abuse and neglect
·         Providing effective remedies to victims and survivors, including reparation. Criminal justice responses, criminal offences and sentencing practices shall reflect the aggravated nature of offences against older persons. Prosecutorial action and compensatory damages shall not be limited by older age.

5. States Parties shall undertake to collect, disaggregate, analyse, utilise and make public at regular intervals appropriate information and statistical data on all forms of violence, abuse and neglect for all age cohorts. This shall take intersectionality into account and include prevalence and trends, risk factors, perpetrators, access to support services and effective remedies and redress. The process of all information collection, and research and use of statistics shall comply with internationally accepted norms and ethical principles.


Wednesday, May 30, 2018

Long Term Care and Palliative Care - Joint Submission to the OEWG


Joint submission by AGE Platform Europe, HelpAge International, The Law in the Service of the Elderly and the National Association of Community Legal Centres Australia
Open-Ended Working Group On Ageing, 9th Working Session, 23-26 July 2018

Long-term care and palliative care

Authors
1.       This joint submission is authored by Robin Allen (Cloisters), Andrew Byrnes (Australian Human Rights Institute, Faculty of Law, University of New South Wales), Israel (Issi) Doron (University of Haifa), Nena Georgantzi (AGE Platform Europe / National University of Ireland Galway), Bill Mitchell (National Association of Community Legal Centres, Australia) and Bridget Sleap (HelpAge International). Our views do not necessarily reflect the broad and consensual positions of the organisations we represent, which will be submitted separately.

Context of Response
2.       This response addresses the guiding questions from a global perspective. It is an executive summary of a more comprehensive statement which will be provided to the 9th Working Session.

Guiding Question 1: Long-term care
3.       Living independently at any stage of life means the provision of all necessary support to enable one to make decisions, perform actions of daily living and participate in society in accordance with one’s will and preferences.

4.       Support is the act of providing help or assistance to someone who requires it to carry out daily activities and participate in society.  Knowledge about, access to and choice and control over the support necessary to be able to live according to one’s will and preferences is central to autonomy, dignity, and independence in older age.

5.       There is no specific right to support for independent living in older age in international human rights law. A wide range of general provisions in international human rights law are pertinent in long-term care settings but their specific application in this area has yet to be fully explored. Article 19 of the Convention on the Rights of Persons with Disabilities 2006, which explicitly guarantees the right to independent living for persons with disabilities and includes provision of support services to enable such independent living, applies only to older persons with disabilities.

6.       Some regional human rights standards recognise care and support for independent living in older age. However, these vary and are inconsistent across regions.

Guiding Question 2
7.       Older persons’ choice and control over the support they require is often limited or denied within current systems of long-term care. Support options available may serve the system rather than the individual user’s needs and preferences. Support is also often unavailable and may not be guaranteed under the law. Some types of support, for example, personal assistance schemes, may be subject to upper age limits and therefore not available to older persons. Support may also be unaffordable or tied to particular living arrangements.

8.       The use of restrictive practices to manage behaviour in long-term care and support settings, including within in-home care settings, is a particular concern. Common forms of restrictive practice in long term care include: detention (e.g. locking a person in a room or ward indefinitely); seclusion (e.g. locking a person in a room or ward for a limited period of time); physical restraint (e.g. clasping a person’s hands or feet or mis-use of equipment to stop them from moving); mechanical restraint (e.g. tying a person to a chair or bed); and chemical restraint (e.g. giving a person sedatives or other unnecessary medication to restrict or subdue behaviour). These practices amount to violations of human rights.

9.       Isolation, social exclusion, segregation and loneliness can affect older persons regardless of their particular living arrangements.

Guiding Question 3
10.    Explicit, legally binding international human rights standards are needed on older persons’ right to affordable, appropriate, integrated, quality, timely, holistic, care and support services which are adapted to their individual needs, promote and protect their well-being and maintain their autonomy, dignity, and independence, without discrimination of any kind.

11.    The right should extend to the provision of care and support services in all settings, public and private, including but not limited to in the home, in the community, and in residential settings.

12.    Older persons should have the right to the care and support services they require independent of and unrelated to the income of their family members.

13.    States should take steps to ensure, inter alia, older persons:
·         Enjoy autonomy and independence in the exercise of this right
·         Are able to participate fully in the community and society
·         Have access to effective complaints and redress mechanisms
·         Have access to information about their health status and care and support services

14. States should ensure that standards, professionalism, and quality of care and support services are in line with human rights principles.

15. States should ensure that older persons are not denied necessary and appropriate care and support services based on their and/or their family’s financial means. States should develop and implement policies to address public and private financing of care and support services.

16. States should ensure effective compliance mechanisms for complaints arising out of a range of issues including pricing, quality, and the protection of human rights in care and support.

Guiding Question 5: Palliative care
17. Palliative care is an approach that seeks to improve the quality of life of patients diagnosed with life-threatening illnesses through prevention and relief of suffering. It also addresses the psychosocial, legal and spiritual aspects associated with life-threatening illnesses and end-of-life care.

18. While existing international human rights treaties do not specify a right to palliative care, there is a growing body of authoritative interpretations and “soft law” that establishes this right. Access to palliative care is both a component of the right to the highest attainable standard of health and implicates the right to freedom from torture, cruel, inhuman and degrading treatment.

19. Some regional human rights standards recognise the right to palliative care. However, these vary and are inconsistent across regions.

20. International human rights standards are needed on older persons’ right to quality palliative care services that are available, accessible, and acceptable without discrimination of any kind.

21. The right should apply to holistic palliative care in all settings and should not be limited to pain relief or any particular treatment or setting.

22. States should take steps to ensure, inter alia:
·         Quality palliative care services are available, accessible and acceptable for older persons in a setting consistent with their needs, will and preferences, including at home and in long-term care settings
·         Availability and accessibility of essential medicines, including internationally controlled essential medicines, for the treatment of moderate to severe pain, and for palliative care of older persons
·         A range of supports to exercise legal capacity, including the appointment of one or more trusted persons to assist them to make decisions based on their instructions, will and preferences, and the opportunity to make advanced directives, living wills and other legally binding documents that set out their will and preferences around medical interventions, palliative care and other support and care at the end of life
·         Older persons are able to express their free, prior and informed consent to their palliative care treatment and any other health matters
·         Regulation and monitoring of compliance of all palliative care providers with professional obligations and standards.