to the editor — Older people aged 65 and over who are residents of long-term care facilities (LTCH) in England endured a disproportionate amount of death and suffering during the COVID-19 pandemic. Lives could have been saved if, before the pandemic, a stronger framework was in place to protect their human rights, defined as the rights and freedoms of all human beings contained in international and national human rights law. could have avoided the level of hardship experienced by this marginalized population. group.
At least 43,256 LTCH residents died from COVID-19 in England and Wales between March 2020 and January 2022, according to the Office for National Statistics.1Mortality was particularly high during the first wave of the pandemic (until September 2020), with approximately 20,000 residents of LTCH related to COVID-19 and approximately 40% of all deaths due to COVID-19. accounted for %.Evidence suggests that many of these deaths were preventable2It is surprising that LTCH residents and their human rights were an afterthought to the UK government in the course of pandemic policymaking. The UK government has failed to take swift action to protect LTCH residents, especially in the early stages of the pandemic.vulnerability to viruses3For example, in March 2020, the government instructed the National Health Service to discharge patients from hospitals to LTCH without pre-testing for COVID-19 and without requiring them to be quarantined from other residents for 14 days. recommended. This policy he continued until mid-April 2020. The UK High Court recently found that the government had legally violated the right to life, privacy and family life with this policy, but found that the government acted unlawfully because it ignored the vulnerabilities of older people. confirmed. LTCH peopleFour.
The situation of LTCH residents during the COVID-19 pandemic has led to public acknowledgment of their precarious human rights situation. The media ran headlines referring to “human rights violations” and focused on visitation restrictions that were tougher and lasted longer than those affecting other parts of society. In October 2020, we published a report on the government’s human rights-related failures to protect LTCH residents from COVID-19, calling for a public inquiry into human rights in care settings.FiveGrassroots human rights groups led by families of LTCH residents have emerged demanding access to relatives who are dying without them.
However, as many in England live with relative deprioritization of COVID risks and heightened political and financial insecurity, the human rights situation of LTCH residents is on the minds of changemakers. There is a danger of moving to the background of the agenda… no meaningful improvement. To achieve such improvements, it is important to learn from residents’ experiences during the pandemic. This means analyzing and documenting the reasons for this particularly precarious human rights situation and addressing them.
LTCH residents started the pandemic from a weak human rights situation. Several human rights frameworks intended to protect the rights of LTCH residents or to remediate human rights violations introduced before the pandemic have clearly been deprioritized during the pandemic, effectively addressing human rights concerns. For example, the Care Quality Commission (CQC), the regulator and inspector of care services in the UK, announced in 2014 its responsibility to protect fundamental human rights such as dignity and equality. We have adopted a “human rights approach” to regulate and inspect LTCH, with the aim of burdening caregivers.of their inhabitants6The key mechanism here is the physical inspection of the LTCH. However, in March 2020, all LTCH inspections were suspended, as was CQC’s “human rights monitoring” in these environments. The CQC generally cannot investigate individual human rights complaints and therefore does not provide a viable alternative for raising concerns outside its inspection mandate. CQC’s reluctance to enter an LTCH for the elderly is understandable, especially in the early stages of the pandemic, but given the growing vulnerability of its residents, it is important to ensure that human rights are respected and protected. The role of CQC in providing care places stress on caregivers, which has never been more important.
There is also a lack of awareness and understanding among public authorities and care professionals of the various risk factors that lead to potential human rights violations and of robust frameworks to ensure that rights are upheld on an ongoing basis. And it seems. For example, in the UK there is evidence that groups such as LTCH residents have been subjected to “Do Not Attempt Cardiopulmonary Resuscitation” (DNACPR) notices without their consent. This is often based on blanket decisions based on age, infirmity or disability.7Early in the pandemic, there was no official guidance for care professionals on the use of DNACPR notifications in advanced care plans. During the pandemic, not only have individuals been denied resuscitation based on such blanket notices, but they have also been denied basic medical care, such as antibiotics and fluids, and have been deprived of life, health, and degrading treatment. It was reported that basic rights such as liberty may have been violated. Two years into the pandemic, the government finally issued guidance to medical and care providers to avoid future failures in applying DNACPR notices and other advanced care plans. Only such guidance existed pre-pandemic, and without proper training and awareness across care providers, it is doubtful that all instances of illegal DNACPR notification and its application could have been avoided. There should have been a framework for using and highlighting the human rights relevance of DNACPR notices to older adults in the pandemic.
Another problem is that in the face of competing legal obligations, clear-cut solutions to questions about how care providers protect and respect residents’ rights have been ignored and sometimes given no clear-cut solutions. lack of measures. This is outlined by considering human rights conflicts during the pandemic over residents’ rights to family life and social participation in the guise of protecting the right to health and life through infection control. The caregiver has a duty to protect the resident from her COVID-19 outbreak within the facility. Due to infection control, outside visits were not permitted or restricted during much of the pandemic. An update to her government’s official guidance for LTCH providers on visitation, issued in March 2021, states that every resident can appoint one of her “essential caregivers.” . However, the guidance was not legally binding and did not lift the provider’s legal obligation to protect her LTCH from the COVID-19 outbreak. This guidance has been updated more than 30 times between July 2020 and his March 2022, sometimes contradicting other similar guidance issued to providers. Providers therefore need to balance the competing rights of residents, as well as confusing and rapidly changing guidance, and potential legal and regulatory actions in the event of her COVID-19 outbreak. was also faced with8In the event of a domestic COVID-19 outbreak, a lockdown in LTCH remains a reality for many residents, with guidance to not allow visitors in all cases.
Another factor has been the lack of direct participation and voice of the population throughout the pandemic in terms of policy making and human rights advocacy. One example is the Joint Commission on Inquiry into Human Rights in Care Settings, which was launched in September 2021. This commission is a group of parliamentarians charged with investigating specific human rights issues and making recommendations to the government. The inquiry sought written and oral evidence from the public. While this is generally an important initiative to understand the precarious situation of LTCH residents, it is surprising how little of the evidence presented bears directly on the views of older LTCH residents. The voices of LTCH resident families and care professionals have been lifted during the pandemic, but the voices of residents are still quiet. Participation in is respect for the right to social and political participation, the right to freedom of expression, etc.
The human rights situation of older LTCH residents has also given rise to “good practices” or behaviors that may help address the points above. The charity Relatives & Residents Association has issued practical guidance to LTCH providers on how to navigate visitation and infection control and balance competing legal obligations. Advocacy continues to ensure the legal right of all her LTCH residents to nominate one or more of her individuals to visit in all circumstances.Academic study sheds light on LTCH human rights situation during pandemic9Other practical examples are shown in Table 1. Continued efforts of this kind could result in a stronger system of human rights protection. This could ensure that the human rights of her elderly LTCH resident are never again an afterthought, but instead placed at the center of policy-making and care delivery under all circumstances.
Declaration of Ethics
The authors declare no competing interests.
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Emmer De Albuquerque Green, C. Human Rights for People Living in Nursing Homes: Never Again.
nut aging (2022). https://doi.org/10.1038/s43587-022-00283-z