Elder abuse also an act of omission: COVID lessons and the global abyss in access to palliative care for older adults

Written for Elder Abuse Awareness Day, June 15 2021 in honor of all those who died in care homes worldwide during the pandemic.

The Inter-American Convention on the Rights of Older Persons defines elder abuse as “a single or repeated act or omission to the detriment of an older person that harms their physical, mental, or moral integrity and infringes the enjoyment or exercise of their human rights and fundamental freedoms, regardless of whether or not it occurs in a relationship of trust.”

“Failure to integrate palliative care into health systems, including into long term care, constitutes elder abuse as an act of omission.”

The world has marked Elder Abuse Awareness Day on June 15 every year ever since the International Network for the Prevention of Elder Abuse (INPEA) began the tradition in 2006, persuading the UN General Assembly to adopt an official resolution of recognition in 2011. A decade later, in 2021, we must shout from the rooftops that what happened to older adults during the pandemic, particularly those living in care homes in high income countries, was elder abuse. Both a Deputy Director of the WHO and a highly placed Vatican official went further, calling it “the massacre of the elderly.”

In hindsight we know that, underlying the appalling death rates in care homes, particularly in Canada, Belgium, Spain, Sweden, and the US, is a tangle of causes and conditions, all nourished in the soil of toxic social ageism. Palliative care, along with prevention and treatment, would have mitigated, if not alleviated a great deal of the suffering of older persons and their loved ones during the pandemic.

Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness, and especially of those near the end of life. It
• Aims to improve the quality of life of patients, their families and their caregivers.
• Intends neither to hasten nor postpone death, affirms life, and recognizes dying as a natural process.
• Provides support to the family and the caregivers during the patient’s illness, and in their own bereavement.

Illustration by Cathy Gendron

Former UN Independent Expert on older persons Ms. Rosa Kornfeld-Matte said in 2015 that “States should ensure the availability and accessibility of palliative care for all older persons in need, particularly those who suffer from a life- threatening or life-limiting illness. Training, and adequate and affordable medication and therapeutic measures, should be provided in public and private care settings.” Never has this been more relevant than now, as UN member states prepare for a UN Special Assembly on COVID in November.

Obligations to Respect, Protect, and Fulfill

By becoming parties to international treaties, States assume obligations and duties under international law to respect, to protect and to fulfil human rights. The obligation to respect means that States must refrain from interfering with or curtailing the enjoyment of human rights. The obligation to protect requires States to protect individuals and groups against human rights abuses. The obligation to fulfill means that States must take positive action to facilitate the enjoyment of basic human rights. States clearly failed to meet their obligations to protect and fulfill the rights of older persons during the pandemic by neglecting to integrate palliative care into their health systems.

Moreover, as many of the aged care homes where multiple deaths occurred were businesses, UN Guiding Principle 1 is applicable “States must protect against human rights abuse within their territory and/or jurisdiction by third parties, including business enterprises. This requires taking appropriate steps to prevent, investigate, punish and redress such abuse through effective policies, legislation, regulations and adjudication.” (emphasis added) Care homes, whether public or private, must prevent elder abuse by omission by integrating palliative care into their operational plans.

Government failure to integrate palliative care is both an act of omission — failure to fulfill the right to health, and an officially actionable failure to protect — to prevent abuse — under the definitions cited above. Litigating this requires older persons to have access to justice. Integrating palliative care into primary health care as a component of the rights to health and to life, and making it available at all institutions that serve older persons is an appropriate action for pandemic preparedness planning going forward.

IAHPC advocates that a right to palliative care as a component of the right to the highest available standard of physical and mental health should be included in a binding convention on the rights of older persons. Suggested text: States Parties shall ensure palliative care services of good quality are available and accessible for patients and their families facing severe health related suffering.

For a tribute to older persons in the US who died in nursing homes, see the excellent Honoring Nursing Home Lives Lost to the Pandemic.

Author: Katherine Pettus

I am a political theorist and advocate for palliative care and palliative care medicines. I self-published the blog collection Global Palliative Care: Reports from the Peripheries to begin getting the word out about the global palliative care movement https://www.amazon.com/Global-Palliative-Care-Reports-Peripheries/dp/B089D3SC55

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