The pandemic has affected the whole of society- our social relationships, economic activity and expenditure, our health and consequential effects on health and social care provision. Older people have been clearly identified as the social group most at risk of serious illness and death if they contract Covid-19. What effect has the pandemic had on the human rights of older people?
The United Nations Principles for Older Persons lists five key principles:
The UK is a signatory to the UN Declaration of Human Rights, The European Convention on Human Rights and has its own legislation, the Human Rights Act of 2010.
What have been the effects of the pandemic on older people?
In the community: isolation and loneliness; cessation of many of the social activities they normally engage in; problems in accessing health and social care services(delays in getting GP appointments; delays in diagnosis and treatment e.g. hip and knee replacements and cataract surgery); loss of contact with family members.
In hospitals: greater risk of serious complications and death; risk of contracting the virus even when admitted for other reasons; being discharged without knowing whether or not they are infected; being discharged to a care home which already has coronavirus infections; restrictions on contact with family.
In Care homes; during the first wave , risk of being infected with Covid -19; virtual isolation , the only social contact being with nursing/care staff; poor access to protective clothing for some staff; limited access to testing for staff and residents; no face to face contact with family.
Were the human rights of older people respected?
Independence: Like the general population older people had severe restrictions placed on their personal freedom . The overwhelming majority of older people, knowing the life-threatening risks of contracting the virus , have been the most consistent of all groups in observing lockdown rules , social distancing, wearing masks and avoiding large gatherings. This placed them at higher risk of isolation and loneliness, particularly those living alone. Many in care homes were confined to their rooms for long periods with virtually no independence. Even their relatives had to comply with such severe restrictions and in some cases were prevented from removing their relative from care. There were lacks of resources to establish Covid free areas for visiting, lack of testing and protective clothing , which pushed many care homes into such a protective and restrictive approach; most care homes are privately run with no indemnity if residents died as a result of their actions.
Participation: For older people both in the community and in care homes participation has been severely restricted, with very limited opportunities for activities or excercise. Confinement is a high risk factor for depression and a sense of frustration. Older people with a dementia could not understand the reasons for being confined, unable to meet family members and why staff wore protective equipment.. Younger people , who have had their own anxieties to cope with, have had recourse to social media and digital technology to keep in touch with friends and relatives an avenue often not available to older people lacking digital skills.
Care: Managers and care staff in care homes want to provide good quality care for residents. They were seriously hampered in their efforts by poor access to protective clothing and testing. The emphasis on “saving the NHS” ignored the interconnectedness of health and social care and only belatedly did supplies of protective clothing improve . Testing for care staff and residents was not seen as a priority as it was for NHS staff. Even now in England it is only announced that testing for all residents and staff will be achieved by Christmas. In Wales there is to be an investigation into the circumstances of the discharge of 58 hospital patients into care homes without being tested. A group of bereaved relatives is taking legal action about similar circumstances in England . It is significant that doctors organisations are seeking indemnity from actions they are instructed to take which could harm patients. At the height of the pandemic there is a need to investigate whether clinicians were instructed to discharge patients without testing or not to provide treatment because of shortages of beds or , for example , ventilators.
Self-fulfilment: Opportunities for self-fulfilment were reduced throughout the pandemic. At its simplest level every care home resident should have been able to take a short walk in the care home garden or locally. But this implies staffing levels which see this a a priority and we know that many homes had staff self-isolating and were relying on agency staff to fill the gaps. The lack of testing meant that relatives could not take on this task. One of the basic elements of self-fulfilment is to be known and recognised by someone else. The pictures of residents only able to see a relative through a window is a terrible commentary on our values.
Dignity : The cumulative effect of losing independence , participation in social life, losing any control over their own life, not able to have family contact is a loss of self-worth and dignity. It is reported that prisoners had more visits and contact with family than some residents in care homes. It is unsurprising that many relatives report a serious deterioration of their loved one’s condition during the course of the pandemic.
Older peoples’ human rights were not addressed sufficiently during the first wave of the pandemic. There many factors involved; the UK’s general unpreparedness for dealing with a pandemic(a weakened public health system and general underinvestment in health service; non-recognition of the relationship between health and social care; prioritising hospitals over social care rather than viewing both as essential; the failure to have a secure and fair system of funding for social care.) . Older people were seen as a problem for services to deal with (a variant of viewing old people as troublesome bed-blockers) rather than individuals with rights. The primary focus was protecting older peoples’ bodies rather than their spirit. . Given the resources it would have been possible for care homes to enable family contact and greater levels of physical and mental activity. It will remain for future inquiries to determine whether older people were deliberately exposed to harm or denied treatment.. Yet the message is clear that in responding to major health emergencies in the future governments , managers and all those working with older people should use the United Nations Principles to guide their actions.