39/32 Intersessional seminar on the protection of the family: role of the family in supporting the protection and promotion of the human rights of older persons - Report of the United Nations High Commissioner for Human Rights

GE.18-12895(E)



Human Rights Council Thirty-ninth session

10–28 September 2018

Agenda items 2 and 3

Annual report of the United Nations High Commissioner

for Human Rights and reports of the Office of the

High Commissioner and the Secretary-General

Promotion and protection of all human rights, civil,

political, economic, social and cultural rights,

including the right to development

Intersessional seminar on the protection of the family: role of the family in supporting the protection and promotion of the human rights of older persons

Report of the United Nations High Commissioner for Human Rights

Summary

The present report, mandated by the Human Rights Council in its resolution 35/13,

summarizes the presentations made and debates held during the one-day intersessional

seminar on the impact of the implementation by States of their obligations under relevant

provisions of international human rights law with regard to the protection of the family on

the role of the family in supporting the protection and promotion of the human rights of

older persons.

In the report, the United Nations High Commissioner for Human Rights reflects the

contributions made by experts, States, national human rights institutions and civil society

organizations during the intersessional seminar held on 11 June 2018, including challenges

and best practices examined as well as the conclusions and recommendations identified.

United Nations A/HRC/39/32

Contents

Page

I. Introduction ................................................................................................................................... 3

II. Opening of the intersessional seminar ........................................................................................... 3

III. Summary of proceedings .............................................................................................................. 4

A. International framework for the protection of the family and human rights

of older persons..................................................................................................................... 4

B. The role of the family in providing long-term care and support to older persons ................. 7

C. The role of the family in promoting age-friendly environments ........................................... 10

IV. Conclusions and recommendations ............................................................................................... 13

I. Introduction

1. In its resolution 35/13, the Human Rights Council decided to convene, with the

support of the Office of the United Nations High Commissioner for Human Rights

(OHCHR), a one-day intersessional seminar on the impact of the implementation by States

of their obligations under relevant provisions of international human rights law with regard

to the protection of the family, on the role of the family in supporting the protection and

promotion of the human rights of older persons, and to discuss challenges and best practices

in that regard, with the participation of Member States and other relevant stakeholders,

including national human rights institutions, academic experts and civil society

organizations.

2. The intersessional seminar took place in Geneva on 11 June 2018 and was attended

by representatives of Member States, national human rights institutions, United Nations

entities, civil society and academia. The present report contains a summary of the

proceedings, and the conclusions and recommendations emerging from the seminar. The

agenda for the seminar and the list of participants are available on the OHCHR website.1

The seminar was webcast on UN Web TV.2

II. Opening of the intersessional seminar

3. Speaking on behalf of a cross-regional core group of main sponsors of Human

Rights Council resolution 35/13, the Permanent Representative of Egypt to the United

Nations Office and other international organizations in Geneva, Alaa Youssef, said that the

family was an undisputable social, cultural, moral and religious value. In accordance with

international human rights law, States had to provide the widest possible support and

protection to families, so as to allow them to fully assume their role in the community and

to provide a conducive environment for the growth and well-being of their members. In

addition, families played a key role in fostering social development, cohesion and

integration, and in the effective empowerment of women. Families had a primary

responsibility for the nurturing, guidance and protection of children, for the full and

harmonious development of their personality. Older persons could make important

contributions to economic and social development, with their experience, skills and

knowledge. Older persons, particularly older women, also played a vital role within

families as caregivers for spouses, grandchildren and other relatives, which often remained

unrecognized and undervalued. In addition, older persons contributed to strengthening

social capital by actively participating in community and civic life.

4. The Chief of the Human Rights and Economic and Social Issues Section of

OHCHR, Lene Wendland, delivered the opening statement on behalf of the United Nations

Deputy High Commissioner for Human Rights, in which she recalled that the Universal

Declaration of Human Rights recognized the family as the natural and fundamental group

unit of society. Society and the State should protect the family, as a strong force for social

cohesion and integration, intergenerational solidarity and social development. With rapidly

ageing populations in countries all around the world, families provided most of the care of

older persons, especially women. Changing living arrangements and lifestyles were making

1 See www.ohchr.org/EN/HRBodies/HRC/Pages/IntersessionalSeminarProtectionFamilyHROlder

Persons.aspx.

2 Opening and session 1: http://webtv.un.org/meetings-events/treaty-bodies/watch/opening-session-1-

intersessional-seminar-on-family-older-persons-human-rights-council/5796144743001/?

term=&lan=original;

session 2: http://webtv.un.org/meetings-events/treaty-bodies/watch/session-2-intersessional-seminar-

on-family-older-persons-human-rights-council/5796150471001/?term=&lan=original;

session 3: http://webtv.un.org/meetings-events/treaty-bodies/watch/session-3-intersessional-seminar-

on-family-and-older-persons-human-rights-council/5796499906001/?term=&lan=original;

session 4: http://webtv.un.org/meetings-events/treaty-bodies/watch/session-4-closing-intersessional-

seminar-on-family-and-older-persons-human-rights-council/5796504080001/?term=&lan=original.

it harder for family members to provide care for their older family members. Stress, and

being overburdened, combined with a lack of awareness about rights, could sometimes lead

to abuse of older persons. Therefore, there was a need for new ways to support family

caregivers, and to provide alternatives to family care. Furthermore, there were significant

normative gaps in existing international human rights frameworks regarding the protection

of older persons. National standards were weak in regard to age discrimination, an adequate

standard of living, support for autonomy, participation in decision-making, and freedom

from violence, abuse and neglect. Notwithstanding, Ms. Wendland noted that there had

been encouraging developments, with older persons increasingly integrated in the human

rights agenda as well as in the 2030 Agenda for Sustainable Development, and recognition

of the potential of older persons to make significant contributions to families, communities

and development.

III. Summary of proceedings

A. International framework for the protection of the family and human

rights of older persons

5. The team leader for economic, social and cultural rights at the Human Rights and

Economic and Social Issues Section of OHCHR, Rio Hada, moderated the first session,

which was focused on the legal and policy framework at the international, regional and

national levels for the protection of the family and the human rights of older persons. He

asked panellists to reflect on the obligations and other key commitments that States had,

under international and regional human rights instruments as well as under national laws, to

protect the human rights of older persons and to support the role of the family towards that

end.

6. The Independent Expert on the enjoyment of all human rights by older persons,

Rosa Kornfeld-Matte, described the steady increase of the older population worldwide, and

the fact that that population cohort itself was ageing. She warned of the profound effects of

such a demographic transition on societies, at all levels, which was a growing concern for

human rights. It was essential to analyse those phenomena in a comprehensive way, taking

into account the whole range of human rights. Older persons were not a homogeneous

group or a single category, and every person had different needs and interests. In addition,

old age represented a social construction based on the custom and perception of the role

that particular individuals played in their communities.

7. Often it was families who provided the front-line support for their older members,

and who contributed to the realization of their right to an adequate standard of living,

including the right to adequate food, clothing, housing, water and sanitation. Nevertheless,

older persons were at risk of neglect within their families, as well as of physical,

psychological, emotional, sexual or financial abuse. From a family perspective, an

important concern was cash transfer and monetary assistance programmes, where the

concept of household units did not take into account intra-household dynamics and did not

recognize potential discrimination in distribution within the home.

8. Although family care was the preferred option for many older persons, there was a

need for effective support systems for informal caregivers. Such systems should include

respite, needs assessments, information and counselling services, self-help groups, hands-

on training in caregiving, and the dissemination of information on health protection

measures. They should also take into consideration the physical and mental health of

caregivers, the need for weekend breaks, and integrated care planning for seniors and

families. It was particularly important that social security schemes cover caregivers, since

they were often women who did not receive any income or training, as the assistance

provided by informal caregivers did not replace the obligation of States. National policies

should help older persons to continue living in their homes for as long as possible through

improvements to the housing and by adapting housing for access and use by older persons.

9. She noted that currently there was no universal human rights instrument specifically

devoted to older persons, apart from implicit references and rare explicit references in some

human rights treaties. At the regional level, the Inter-American Convention on Protecting

the Human Rights of Older Persons obligated the States parties to prevent all forms of

violence within the family or household and to ensure treatment with dignity for older

persons. The United Nations Principles for Older Persons, of 1991, contained a section

specifically devoted to care, in which it was stated that older persons should benefit from

family care in accordance with the cultural values in each society. Nevertheless, the

absence of a comprehensive and integrated international instrument had made it difficult to

specify the obligations of States towards older persons. In addition, existing mechanisms

and procedures for monitoring human rights instruments generally neglected older persons.

10. The Deputy Chair of the Council of the Federation Committee for Agricultural and

Food Policy and Environmental Management, of the Russian Federation, Irina Gekht,

described the constitutional mandates of her country to support the family and older

persons, including State obligations to develop a system of social services, benefits and

other social guarantees. Although there was no specific international agreement for older

persons, the general international human rights treaties were applicable. For older persons,

the family was one of the most important spheres in which to realize their needs.

Nevertheless, physical, psychological and economic abuse sometimes occurred within the

family. The failure of family members to fulfil their responsibilities with respect to

nutrition was punishable by the criminal law. Identifying human rights violations in the

family was difficult, since the family was a closed cell within society, where there were

legislative limits on State intervention. In addition, the narrowing of social contacts, and

older persons’ lack of knowledge about their rights, reduced opportunities to receive

outside assistance.

11. With the transition to a new economy, the intellectual resources, knowledge and

experience of older persons had acquired special value, and the views on the role of older

persons in the socioeconomic system were changing. Policies were aimed not only at

preserving the quality of life and dignity of older persons, but also at creating the conditions

for leading an active social and economic life. For example, the Russian Federation had

adopted a strategy of action for older citizens aimed at increasing their life expectancy and

quality of life and supporting active ageing. The strategy addressed the need to overcome

negative stereotypes and manifestations of violence and discrimination against older

persons, and to create a favourable environment and economic conditions that were

conducive to active longevity and integration in society. It also included the establishment

of geriatric services, and needs assessment systems for care, as well as training of older

persons in physical exercise and sports.

12. Measures at the federal and regional levels aimed at protecting the rights of older

persons in the family included generating awareness about the rights of older persons,

counselling families caring for older relatives on social, medical, psychological and legal

issues, setting up telephone hotlines for older persons subjected to domestic violence,

establishing shelters for temporary stays, training lawyers to specialize in law relating to

older persons, and supporting non-governmental organizations (NGOs) assisting older

persons. Other initiatives were aimed at including older persons in the development process

and promoting active ageing, for example through continuing education.

13. Despite the results achieved, differences remained in the quality of life of the older

population, both between regions and between urban and rural areas. It would be necessary

to continue working on realizing the rights of older persons in line with obligations arising

from international instruments, and taking into account the best international experiences.

Family policies should prioritize the preservation of traditional family values and family

life, the revival and preservation of spiritual and moral traditions in family relations and

family education, and the creation of conditions for ensuring family well-being and

responsible parenthood.

14. The Special Envoy of the Global Alliance of National Human Rights Institutions,

Florence Simbiri-Jaoko, described the expected demographic changes in Africa, which

included population growth, accelerated urbanization, decrease in fertility and mortality

rates, increase in life expectancy, and ageing of the population. In that context, the African

Charter on Human and Peoples’ Rights recognized the rights of older persons to special

measures of protection. The same Charter recognized the duty of individuals to preserve the

harmonious development of the family and work for the cohesion of and respect for the

family, to respect their parents at all times, and to maintain them in case of need.

15. The region had made further progress following the adoption, in 2016, of the

Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Older

Persons in Africa, by the Assembly of the African Union. The Protocol called upon

Governments to institute urgent measures aimed at guaranteeing the rights of older persons.

The rights identified included access to regular income, equitable distribution of resources,

employment opportunities, access to appropriate health services, access to basic social

services, access to good care and support, recognition of the contribution by older persons

to the care of persons with HIV/AIDS and orphans, respect and recognition for older

persons’ role and contribution in society, and recognition of older persons’ needs in

emergency situations.

16. Notwithstanding the progress made, the Protocol had so far been signed by four

countries and had not entered into force. And yet, it was an opportunity for African States

to engage in a more robust discussion at the United Nations level on the need for an

international legal framework. It offered the opportunity to highlight how States could

nurture families as critical links to protection and respect of the rights of older persons.

National human rights institutions could advocate for States to sign and ratify the Protocol,

and could use it as a framework for measuring compliance by States that had adopted the

Protocol. Legislation should allow national human rights institutions to monitor family

care, since limited access to justice for those cared for by families meant that, many times,

abuses went unreported. There was a need to move from a narrative of care to a rights-

based approach, guided by human rights standards.

17. In the interactive dialogue, representatives of Brazil, China, Côte d’Ivoire, Ecuador,

Mexico, Nigeria, the Russian Federation, Saudi Arabia, Uruguay, the European Union,

AGE Platform Europe, Alliance Defending Freedom International, HelpAge International

and Human Rights Watch made interventions. In the interventions, it was stressed that the

family was the primary cell and fundamental basis of society, covering all its dimensions,

and that it was a guarantor of all rights, cultural heritage, social cohesion and identity.

Speakers also emphasized the primary responsibility of States to ensure the enjoyment of

all human rights of individual family members, and to ensure there was no discrimination

within the family, including multiple discrimination and gender inequality. In increasingly

ageing societies, States must promote the independence and autonomy of older persons and

protect them from all forms of violence and abuse.

18. Some speakers affirmed that the family was the natural place for older persons to

live, and stressed the responsibility of the family in providing the conditions to allow older

persons the enjoyment of their rights, including autonomy and independence. Others

emphasized that, although family members played a fundamental role in caring for older

persons, family support was not the only form of care, and there was a need to recognize

the different forms of family in different cultural, social and political contexts. Some States

said that the international community should pay greater attention to the family in its role in

development as well as in protecting its members. In many interventions, speakers noted

the normative gaps in the current international human rights framework concerning the

protection of older persons, which required a dedicated binding instrument to be developed.

Finally, some States described their national legal, institutional and policy frameworks,

including systems of community-based care and support services.

19. In response, Ms. Simbiri-Jaoko said that many States in Africa were making

progress in the area of the rights of older persons, and African States should seize the

moment and ratify their protocol. Meanwhile, in the absence of a binding international

instrument, national human rights institutions were already receiving complaints and

reports of violations of human rights of older persons, and were providing remedies for

them and acting as a link to the authorities, within their existing mandates. They also

included the rights of older persons in their periodic reports to different national, regional

and international mechanisms.

20. Ms. Gekht said that States needed to promote and support the participation of older

persons in various social activities and movements, including through State provision of

grants, volunteer programmes and infrastructure. It was important for the State, in

addressing the problems of unemployment and isolation, to promote the participation of

older persons in social life, since having the feeling of involvement was very important for

older persons’ well-being.

21. Ms. Kornfeld-Matte emphasized that the only binding instrument in force was the

Inter-American Convention on Protecting the Human Rights of Older Persons, which had

been ratified by several countries. She said that States could do more to support formal

caregivers to complement informal family caregivers, who were often in situations of stress

and provided care without respite. In addition, States could train informal caregivers, and

create day centres for older persons to attend at certain times, as a way to avoid

institutionalization in long-stay facilities. Finally, States should take advantage of the

possibility of involving older persons in university networks for older persons, which

would greatly help their socialization.

B. The role of the family in providing long-term care and support to older

persons

22. In his introduction, the moderator, John Beard, Director of the Ageing and Life

Course Department of the World Health Organization, said that the lack of support for

family caregivers resulted in unnecessary burdens and in inadequate care for older persons

and violations of their rights. Girls and women were often in charge of family care, which

sometimes limited their possibilities for study or of having equal access to employment.

Furthermore, in some countries, older women with dementia suffered accusations of

witchery, and forced institutionalization. He noted several innovative developments, such

as community-based self-help groups, and the creation of care economies that produced

jobs for younger people while they cared for older persons. However, stewardship by

governments was necessary for the success of any such initiatives. The moderator asked the

panellists to explore the challenges faced by older persons in accessing long-term care and

by the families supporting them, and to describe what responsibilities States and other

stakeholders had in order to address those challenges while reinforcing the centrality of

family.

23. Mona Ibrahem Isa Ahmed, of the Ministry of Administrative Development, Labour

and Social Affairs of Qatar, underscored the importance of the family in caring for its

members as an integrated unit. A cohesive family could make significant contributions in

providing support and care to the elderly. The Constitution of Qatar recognized that family

was the basis of the society and was founded on religion, ethics and patriotism. In addition,

the Constitution mandated the law to prescribe adequate means to protect the family,

support its structure, strengthen its ties, and protect maternity, childhood and old age.

Governments needed to support and encourage programmes and initiatives to support older

persons, including for formal care for the elderly, to complement the support provided by

members of the family.

24. Among the types of families in Qatar, extended families consisted of grandparents,

mothers, fathers, children and grandchildren. Such a family structure gave older persons the

opportunity for natural interaction with children and other relatives, and prevented them

from suffering from isolation. A study had shown that over one half of older women, and

one third of older men, lived in extended families. In addition, one poll on the social and

environmental challenges faced by beneficiaries of the social security system had shown

that less than 3 per cent of the population regarded caring for older persons in the family as

troublesome.

25. Ms. Ahmed described policies aimed at supporting families and older persons,

within government agencies such as the Ministry of Administrative Development, Labour

and Social Affairs. The policies included a service that provided access for older persons to

public offices, and hotlines for communication and coordination with social researchers,

who were able to conduct case research or provide assistance through any of the services

provided by the Ministry. Another project facilitated home care by means of specialized

nursing teams with rehabilitation staff, which conducted round-the-clock home visits to

older patients.

26. The experience and research had proved that the best option for older persons was to

live with family members and not in isolation, especially for older persons with disabilities.

Home care reduced the feeling of isolation and psychological depression. Still, social

changes, and the reduction of social links, posed challenges for older persons. As older

persons’ interactions became increasingly limited to closer relatives, it was the role of

family to help them link with the wider society, for example by visiting heritage sites and

participating in neighborhoods councils for older persons established by the State. Families

should participate in those initiatives by the State aimed at promoting the involvement of

older persons in society, and encourage older persons to participate, taking into account the

valuable experience they had accumulated over the years. Finally, older persons should

have access to social and legal services.

27. Xenia Scheil-Adlung, a health and long-term care policy adviser, described the

global deficits regarding coverage and access to long-term care for older persons. Studies

had shown that almost half of the world population that was aged over 65 lived in countries

without any right to long-term care. Over 46 per cent of the world population lived in

countries where policies demanded poverty as an eligibility requirement to receive long-

term care. Just over 5 per cent of the world population aged over 65 lived in countries with

universal long-term care systems. The population aged over 65 suffered exclusion from

long-term care due to deficits in public expenditure. The unaffordability of those services

implied the potential for impoverishment for many older persons in countries without

universal coverage. In addition, significant workforce shortages in long-term care excluded

people from accessing quality services. She noted that there was a gap of over 13 million

long-term care workers globally.

28. There was therefore a need to define the role of family carers, while analysing who

was filling the workforce gap to make services available and affordable. Studies had

concluded that only 20 per cent of the long-term care workforce was composed of paid

formal workers. The rest were unpaid informal workers; mostly female family carers aged

over 40, caring for one or two persons. In high-income countries, family members provided

up to 90 per cent of care, exceeding by far the number of formal care workers. In low- and

middle-income countries the number of family carers was even higher, due to the lack of

formal long-term care workers and infrastructure.

29. The high levels of reliance on family care had implications. For family carers,

caregiving was highly demanding physically and mentally, sometimes resulting in burnout

and ill-health due to lack of training and decent working conditions. It could result in loss

of income or social protection, when it necessitated ending or reducing paid employment

and no compensation was available. Work-family conflicts and risk of job loss could

happen when providing care in addition to carrying out paid employment. For long-term

care recipients, it implied an increased level of dependence due to physical and mental

deterioration in the absence of quality services, high costs and potential impoverishment

due to lack of income from family carers, and increased risks of abuse and violence due to

family carers being overburdened as well as to lack of training. There were socioeconomic

implications too, such as foregone economic growth and higher unemployment, higher

public expenditure, increased income and gender inequities, and failure to comply with

labour regulations.

30. Policy considerations to address those issues included public investment in creating

jobs for formal long-term care workers, which would have multiplier effects in productive

sectors, reduce unemployment and create economic growth and development. Similarly,

investing in support for informal carers would avoid negative socioeconomic impacts.

While the policy priority should be for home-based care, there was a need to ensure the

rights of older persons by providing adequate access to long-term care, including universal

coverage through fair financing mechanisms; and making quality services available by

increasing the formal long-term care workforce. Moreover, it was necessary to establish

support measures, such as funding for the delivery of long-term care services, cash benefits

or income replacement, and social protection coverage, including leave time from care

duties, training, and being replaced during vacations.

31. Nena Georgantzi, a human rights officer from AGE Platform Europe, focused on the

challenges faced by older persons with regard to the right to self-determination and the

right to the exercise of their legal capacity, in the context of care, and the link between

those challenges and the role of the family. She affirmed that, due to ageist attitudes, there

was a perception of older persons as being unable to make decisions, or else disregard for

their will and preferences in all aspects of their lives. Families played a pivotal role in the

care and support of many older persons, although not all older persons had families, or

lived close to them. Therefore, it was crucial to consider the wide variety of experiences

and living circumstances of older persons that did not necessarily take place in the context

of the family.

32. Many situations illustrated the importance of increasing awareness of older persons

as rights holders. For example, there were repeated cases of lack of informed consent

within nursing homes and institutions. A report that monitored care homes in Europe had

concluded that forcing older persons into institutions without their consent was a common

practice. In some countries, families were encouraged to put older persons under legal

guardianship in order to have access to care homes. Regarding control of their finances,

even though older persons were entitled to pensions, many were not able to collect them

themselves and depended on a relative to do so, which sometimes led to financial abuse.

33. In countries with high rates of unemployment, some families lived on the pensions

of older persons, and many older persons had been put in informal care at home because

their families could no longer afford the expenses of formal care. Such situations exposed

them to risks, such as inadequate care, abuse and limited autonomy. In some cases, there

was a potential conflict between what was best for the family and the wishes of the older

person. For example, for the sake of safety, families sometimes limited older persons from

participating in an active social life. Families were under pressure, especially as States

shifted responsibility for caring for older persons to families and individuals and cut down

on benefits and services. In most situations, families considered that they were doing what

was best for older persons, which in fact could amount to a violation of their right to self-

determination.

34. She noted the absence of adequate normative standards to prevent such situations.

Ageism was a pervasive form of discrimination, with age stereotypes prevailing and going

unchallenged, and injustices being overlooked or considered as normal. It entailed a risk of

applying human rights in divergent, unfair ways in old age, instead of on an equal basis

with others. The Open-ended Working Group on Ageing had warned that, although all

human beings were born free and equal, the enjoyment of all human rights diminished with

age, owing to negative prejudices and stereotypes. States had a duty to support families that

provided informal care, and older persons. It would be important to recognize that older

persons were rights holders on an equal basis with others, and to establish clear State

obligations through a binding international convention.

35. In the interactive dialogue that followed, representatives of Lebanon, Qatar and the

Russian Federation, of the Holy See, and of La manif pour tous, HelpAge International and

Human Rights Watch, took the floor. Interventions by States reaffirmed the family as the

basic core of a person’s life and of society. Speakers emphasized that a strong family must

enjoy support from the State to protect the rights of older persons, including through

economic incentives and specific fiscal and job policies. One delegation stressed the need

to create an enabling support environment where older persons would become agents of

development. One State warned about the need to take into account the social and historical

background of each State when designing policies such as long-term support systems.

Another delegation pointed out that the migration of young people from some developing

countries weakened the role of the traditional family as a support for older persons, putting

their rights at risk. Some speakers described their national normative frameworks around

the family and its members.

36. NGOs noted that the wishes and choices of older persons did not necessarily align

with those of their family members, and that the absence of clear standards on the right to

live independently and be included in the community caused risks of violations.

Governments had an obligation to protect the rights of older persons on an equal basis with

the rights of others in those contexts. Not every older person lived with, or chose to live

with, family members. Despite this, States often transferred their human rights obligations

towards older persons onto family members in relation to care and support, including

through maintenance or filial piety laws, which increased the dependency of older persons

and denied their autonomy. It was necessary to move away from an approach that excluded

older persons from their communities and denied them their autonomy and independence,

and instead move towards establishing and strengthening care and support services where

older persons had the right, and access, to individualized support that enabled them to

control their lives.

37. In response, Ms. Ahmed recalled that the Universal Declaration of Human Rights

recognized that the family was the natural and fundamental group unit of society and was

entitled to protection by society and the State. In addition, many associations sought to

preserve the unity of the family nucleus and to protect older persons from certain practices

that may lead to breakdown of the family by isolating the older person. Society had to leave

behind some negative practices and promote positive values. The State must intervene to

assist families caring for older persons, including by creating institutional structures.

38. Ms. Scheil-Adlung said that as long as there was a link between family care and ill-

health, loss of income, impoverishment or burnout, there would not be such a thing as free

choice for family carers. It was necessary to support family carers and establish certain

limits. Family carers could not replace formal skilled workers, especially when it came to

Alzheimer’s disease or other diseases that made family care difficult. A formal care force

should support family carers, as without it, no family would be able to give proper care to

older persons.

39. Ms. Georgantzi stressed that most human rights treaties did not provide an explicit

prohibition of discrimination on the ground of age, and that there were many gaps in the

application of the existing instruments. For example, it was still possible under international

law to force an older person to retire after reaching a certain age, and in some countries

there were different systems of treatment for younger persons with disabilities and older

persons with disabilities. Family was not necessarily the context where all older persons

lived; nevertheless, families shared the obligation with States to provide care and support

for the elderly. A convention on the rights of older persons would protect their human

rights and support families as a whole, as the instruments for other groups had done. Such a

convention should guarantee the right to autonomy and independence, and establish

explicitly that age was not an admissible ground on which to limit their legal capacity.

C. The role of the family in promoting age-friendly environments

40. The Chief of the Population Unit at the Economic Commission for Europe, Vitalija

Gaucaite Wittich, moderated the third session, which was focused on the role of the family

in promoting age-friendly environments. She noted that family settings were becoming

increasingly diverse, and that social contexts mattered when designing policies. Critical

interdependencies between generations and between men and women within families would

develop in daily interactions. Those interactions could be positive, but could also become a

breeding ground for abuse and neglect of older persons. Ageism was one of the most

socially normalized prejudices, which occurred in the family and also within the individuals

themselves. Violence, abuse and neglect were extreme outcomes of ageism, which in most

cases happened within the family. In that context, the moderator asked panellists to analyse

those challenges, as well as the roles of the State and the family in promoting age-friendly

environments and protecting and rights of older persons.

41. The Director of the Gerontology Programme at Brigham Young University, United

States of America, Jeremy B. Yorgason, affirmed that, although many older adults faced

discrimination in society in general, older persons who were isolated, dependent on others

for their care, or had mental health, cognitive or emotional challenges, were at risk for

mistreatment in some way. Those with poor or strained family relationships were at greater

risk. Statistics showed that nearly half of the older adults in the United States experienced

some limitation in activities of daily living. Individuals facing limitations who did not

reside in long-term care facilities were likely to receive care from family members, most

often women. Although care services for older adults were growing, family caregivers

provided the bulk of the care needed for older persons. It was also relevant to consider the

expected amount of time that older persons might live without disability, since family often

provided the care during those years of living with disability.

42. Research had found that family was one of the few institutions that did not segregate

by age, and that young adults viewed older family members with less negative bias than

they viewed older strangers. In addition, studies had indicated that when older spouses were

in need of health care, both patients and their partners reported improved marital

relationships. Still, although closeness may be one result of caring for an ill spouse or

family member, caregiving was generally regarded as a stressful situation that placed great

strain on family members. In consequence, overly strained family caregivers were more

likely to violate the human rights of older recipients of care. Moreover, when abuse or

violence had occurred in families in earlier years, it may be more likely to reoccur in later

years.

43. The avenues for promoting age-friendly environments included addressing ageism

within families through education. Quality of care improved when family caregivers were

educated about the expected behaviours associated with dementia, and about how to

communicate with and care for someone with diminished cognitive capacities in a kindly

way. Beyond education, family caregivers benefited from emotional support from

community support groups and other community resources. In addition, one of the greatest

risk factors for mistreatment of older adults was social isolation. When a primary caregiver

was the only person that a dependent older adult had contact with, the risk of mistreatment

increased because of the increased strain and decreased outside surveillance. Involving

secondary family caregivers and helping to coordinate their efforts could increase the safety

of older adults and lessen burdens carried by primary caregivers. When there were multiple

family caregivers, a natural check and balance occurred.

44. Although many community resources were available to caregivers, these did not

focus on family relationships. Teaching families to communicate, resolve conflict, forgive

past hurts and plan for the future could facilitate better care and lower the risk of abuse.

Families could encourage a network of care providers for older family members, especially

during times of care transition, such as when receiving a new diagnosis, during and after

hospitalizations and during end-of-life care. Family members could support primary

caregivers by facilitating their receipt of education, support and respite. Ultimately, families

shared the responsibility to ensure quality care and thus protect the human rights of their

ageing family members.

45. Marie Beaulieu, the Research Chair on Mistreatment of Older Adults at the Research

Centre on Ageing, at Sherbrooke University, Canada, affirmed that age-friendly

communities should have a positive approach in promoting the social inclusion of older

adults, establish policies, programmes and actions to improve physical and social

environments, and adopt a community-based strategy with an impact on individual well-

being. She described the evolution of the definition of elder abuse and neglect, which was a

social, public health and human rights problem. The World Health Organization had

defined it as a single or a repeated act, or an absence of appropriate action, occurring within

any relationship where there was an expectation of trust, which caused harm or distress to

an older person.

46. The definition of elder abuse and neglect included violence. Mistreatment could be

intentional, although many times it occurred unintentionally. The categories of abuse

included physical, sexual, psychological, material and financial abuse, violation of rights,

ageism and institutional mistreatment. Ageism consisted of negative or positive stereotypes,

prejudice or discrimination against (or to the advantage of) older persons on the basis of

their chronological age or their perceived age. It could be self-directed or other-directed,

implicit or explicit, and expressed on different levels. It influenced everyone to varying

degrees, by negative stereotypes and discourses. Those misguided assumptions led people

to misinterpret various situations, which could ultimately lead to mistreatment.

47. The violation of rights occurred in all types of mistreatment, and implied the

infringement of rights and freedoms. It included acts of violence, such as forced medical

treatment, as well as denial of the rights to choose, to vote, to privacy, to take risks, to

receive phone calls or visitors, to practise religion and to express sexual identity. The

concept of violation of rights also encompassed situations of neglect, including lack of

information or misinformation regarding the rights of the older person, failure to assist the

person in exercising their rights, and failure to recognize their capacities. The signs of

violation of rights included preventing the older person from participating in making

choices and decisions that affected his or her life, failure to respect his or her decisions, a

family member answering on behalf of him or her, restricting visits or access to

information, isolation, and complaints, among others.

48. A wellness approach to preventing mistreatment needed to focus on early detection

and appropriate intervention, bringing together practitioners from various sectors to achieve

a common goal. In addition, it was necessary to encourage and facilitate the reporting of

cases, develop knowledge and improve knowledge transfer, and provide support for

caregivers, including informal caregivers who were often family members. Several good

practices at the national level were aimed at moving from countering abuse and neglect, to

promoting well-being, respect for older persons’ dignity, self-esteem, fulfilment, inclusion

and security of the person. Governments should establish public policies and programmes

that were proactive, that had a specific focus on mistreatment of older persons, and that

were gender-specific, with participation from older adults’ associations, practitioners and

researchers, and with proper evaluation of their implementation.

49. In the ensuing dialogue, representatives of Bangladesh, Egypt, Maldives and the

Russian Federation, and of AGE Platform Europe, Global Helping to Advance Women and

Children, HelpAge International and Human Rights Watch, took the floor. One delegation

said that respect for traditional family values could contribute to the promotion of and

respect for human rights, and to the creation of a healthy family environment. States had an

obligation to provide effective protection and support to the family. Another speaker

stressed that older persons could make invaluable contributions to economic and social

development, thanks to their knowledge, skills and experience. One delegation noted the

importance of taking into account intergenerational relationships, which had been missing

in the public debate. Some States described their national experience, including specialized

services, social security systems, training to develop skills, legal protection, and the

establishment of institutional bodies.

50. A representative from an NGO said that ageism was the only form of discrimination

that was still widely accepted, and that it was the root cause of many human rights

violations. Another speaker underlined the need to recognize that sexual violence and rape

occurred within families — especially against widows, who faced social exclusion,

segregation and social isolation. A youth representative recalled that the Human Rights

Council had called upon States to promote opportunities for voluntary, constructive and

regular interaction between generations in the family, in the workplace and in society.

Young people and older persons alike benefited from intergenerational dialogue and

interaction. Many speakers stressed the State responsibility in assuring older persons’

enjoyment of their rights to privacy and a family life, non-discrimination, and freedom from

violence, abuse and neglect in all settings. A dedicated international set of standards that

articulated State obligations was necessary in order to promote an age-friendly

environment.

51. In response, Mr. Yorgason warned that legislation that imposed compulsory care of

older persons by families could lead to unpleasant situations and would be difficult to

enforce. Regarding intergenerational relationships, research had shown that they were

generally very positive for both grandparents and grandchildren. They should be

encouraged and promoted, though people should be cautious that forcing such relationships

could lead to negative outcomes. Sometimes parents and children did not get along, and

grandchildren could become a healing connection between the other generations. Finally,

he reflected on the difficulties of putting an actual value on elder care.

52. Ms. Beaulieu made a link between compulsory care and intergenerational solidarity.

It was important to remind generations that they should have solidarity together, through

education, values and shared points of view, however the imposition of family care could

lead to elder abuse in some situations. When designing any policy, it was necessary to

consider the natural process of ageing in all its stages. In conclusion, carers of older persons

had a demanding job, and often lacked proper training and proper pay. In high-income

countries, immigrants often carried out that job, as nationals would not want to do it, which

was another manifestation of age discrimination.

IV. Conclusions and recommendations

53. For the closing session, the Chair invited four panellists from previous sessions

to make concluding remarks and recommendations on the way forward to achieve

greater protection of the family and the human rights of older persons. They were

asked to share their views from the perspective of States, national human rights

institutions, United Nations human rights mechanisms, civil society and academia.

54. Ms. Gekht said that ageism was characteristic of countries where a

deterioration of traditional family values was occurring. This had an impact on the

respect for older generations. With regard to the situation of older persons who rights

were violated, the State needed to make extra efforts, alongside social organizations.

The State needed to create a network of institutions in the long term, but also social

institutions that protected older persons. Social organizations and associations had an

important role in providing legal aid and information to citizens when necessary, as

well as in promoting the active involvement of older persons in society, including

through physical activities and sport. The State should intervene to ensure proper

qualifications for older persons so that they were competitive in the labour market.

This should be a joint effort with social organizations and international forums. It

would be key to change the balance of the relationships between younger and older

generations nationally, but also to examine complementary measures to protect the

rights of older persons.

55. Ms. Simbiri-Jaoko affirmed that many of the issues raised concerned the lack

of normative frameworks at the international and regional levels, which had an

impact at the national level. For national human rights institutions, the main

contributions would be, within existing normative frameworks, to employ creative

processes to monitor the rights of older persons, by making specific use of norms,

whether soft or hard law. National human rights institutions should advocate for

comprehensive and holistic approaches by State parties at the national, regional and

international levels, in order to ensure that existing frameworks protected the rights

of older persons.

56. Additionally, national human rights institutions with investigative and

complaints handling capacity should develop tools that took into account the

circumstances of older persons. They needed to go beyond looking at the appearances

and instead look at the practicalities of how older persons experienced their

independence, autonomy and freedom. National human rights institutions, together

with State and non-State actors, should work towards facilitating intergenerational

dialogue aimed at increasing knowledge and awareness by family members about

their critical role in promoting and protecting the rights of older persons. Even in

regions with a long history of care institutions, a human rights-based approach was

missing. Older persons everywhere felt a lack of respect for their dignity. National

human rights institutions had the challenge, and the opportunity, of working harder

to strengthen and apply normative principles that clearly established the parameters

for upholding the rights of older persons at the national, regional and international

levels.

57. Ms. Kornfeld-Matte said that older persons as a group remained invisible and

often voiceless. Radical changes, including to family patterns and lifestyles, but also

the gradual erosion of the traditional multigenerational family environment,

increasingly left older persons without families and without support. The mandate of

the Independent Expert on the enjoyment of all human rights by older persons took

into account the difficulties that older persons faced, and the fact that those difficulties

required in-depth analysis and action in the light of the protection gaps. The

identification of best practices for implementing existing law had remained one of the

priorities for her mandate.

58. Families were likely to contribute to the realization of the right to an adequate

standard of living for their members. Older persons should have their preferences and

best interests considered in all aspects of their lives. States should guarantee free and

informed consent, and regulate conflicts of interest and undue influence. Legislation

and policies should be aimed at preventing and detecting elder abuse, and should

typify it as a criminal offence, and at protecting victims against reprisals. States

should develop a strategy to raise awareness of the problem and inform older persons

of their rights. It was important to assist families and other informal caregivers,

including through training on human rights, health and human resources, through

counselling, and by providing financial, social and psychological help, paying special

attention to the role of older women as informal carers. There was a need for national

home care and community-based care programmes as well as for social protection and

poverty reduction programmes for older persons, especially in rural and remote

areas.

59. The Sustainable Development Goals could help promote inclusive policies for

older persons. However, references to older persons were rare in the Goals and the

targets. Ensuring that no older person would be left behind would require recognizing

the equal dignity of older persons, and recognizing and facilitating their contribution

to society through the application of a rights-based approach. That lack of attention to

older persons was a consequence of the absence of an international instrument on the

rights of older persons, which could have formed a basis for integrating those issues

into the 2030 Agenda for Sustainable Development. There was unanimous support for

the need to strengthen the protection of the fundamental rights of older persons;

nevertheless, continued divergences existed among stakeholders on the way to address

the issue. Several proposals for new instruments and measures existed, including the

elaboration of a new convention.

60. Mr. Yorgason said that governments could provide support for local

ombudsman services, where government agents met on a regular basis with older

adults living in facilities to ensure that their rights were being met and protected.

Furthermore, when allegations of mistreatment were made, adult protection services

could investigate the allegations and refer them to the police when necessary. In

situations of neglect, ombudsman services could connect families with appropriate

community resources. Ombudsman and adult protection services could expand efforts

to target high-risk populations, for example through additional oversight where

violence in the family had taken place, in cases of care recipients with mental health

concerns or in cases of extreme poverty.

61. Human rights violations often occurred where older persons were isolated or

when the care receiver and a single caregiver were isolated. In situations where an

older adult needed help with finances, the involvement of multiple family members

would strengthen accountability and prevent abuse. New technologies could also help

connect primary family caregivers with secondary family caregivers, and bring

together family members, in order to prevent isolation. In addition, family-centred

care could target relationship processes. For example, where elder abuse had

occurred, an intervention could take place by the State and other actors, similarly to

when child abuse or neglect had occurred. There should be accountability and

rehabilitation of family relations. Family-centred care also implied that treatments

and interventions were personalized, and they were culture- and gender-sensitive.

62. Representatives of Belarus, of the Holy See, and of Global Helping to Advance

Women and Children, HelpAge International, Human Rights Watch and Vie

Montante International intervened from the floor. One State representative

reaffirmed the traditional role played by the family, which was the fundamental

element supporting and protecting the rights of older persons in society. Yet,

governments played a fundamental role, guaranteeing support to families that

supported older persons, and should uphold guarantees protecting the rights of older

persons, including social integration. Another delegation stressed the need to

strengthen solidarity among generations and encourage mutually responsible

relationships between younger and older persons. As the natural and fundamental

unit of society, where the principle of solidarity was lived out on a daily basis, the

family was entitled to protection by society and the State.

63. A joint statement by non-governmental organizations called upon States to

support intergenerational connections as a key part of social cohesion and of the fight

against isolation, and also as a means of transmitting social and cultural values. States

should ensure that persons ageing with disabilities had the best possible conditions of

housing and support. One speaker said that the family relationship between older

parents and adult children was absent in legislation on family reunification for

refugees, and that narrow definitions of family and onerous conditions and waiting

periods led to discrimination against older persons. Another speaker stressed that

ageism was a universal prejudice and a discriminatory social norm that demanded a

universal response, and that a clearly articulated prohibition of ageism and age

discrimination in a new convention was essential.

64. Finally, one speaker stated that it was crucial to involve older persons in

discussions regarding their rights, and to address their capabilities to contribute to

society and their responsibilities in society. In response, all panellists agreed that the

participation and involvement of older persons was crucial.