Charter of Rights for People in Need of Long Term Care and Assistance

Warum wurde diese Initiative implementiert?

The need for the definition of ethical standards in long term care has long been vocalised through initiatives and associations who defend the interests of dependent older people, e.g. the Forum zur Verbesserung der Situation Pflegebedürftiger e.V. (Forum for the improvement of people in need of care) or the Bundesinteressenvertretung der Altenheimbewohner (Federal representation of residents in care homes). The example directly addresses gaps in the quality of LTC particularly addressing disrespect towards older people who are too vulnerable to defend their interests. Thus the Charter is designed as a guideline for people and institutions providing long term care, support and treatment. For them, the Charter formulates quality criteria and objectives for long term care and support. Indirectly, by the design of the Charter development process, also gaps in cross-sectoral cooperation are dealt with. Hence older people and formal carers/professionals are the main target groups of the example.

Beschreibung

The Charter was developed in one of the working groups of the “Round Table Care". In eight articles it describes the rights of dependent people and encourages them to defend their interests with respect to:

1. Self-determination and support for self-help 

2. Physical and mental integrity, freedom and security

3. Privacy

4. Care, support and treatment

5. Information, counselling, informed consent

6. Communication, esteem and participation in society

7. Religion, culture and beliefs

8. Palliative support, dying and death 

Since its completion in 2005 its wording has remained unchanged. In 2007, the Charter was sent out to 27,000 organisations, mostly inpatient and outpatient care providers, throughout Germany. Since then an agency is operating to further disseminate the Charter and to support its implementation. The agency provides support and advice to health professionals and the general public and organises public events for the exchange and discussion of improvements and new solutions within LTC. With regards to costs and resources, the expert organisations participated in the development of the Charter at their own expense. The service agency is funded by the German Ministry for Family, Seniors, Women and Youth and run by a staff of three people assisted by a student assistant. The Charter is also published in English. More information on the activities of the agency is available here.

Welche Effekte wurden erzielt?

The agency for the implementation of the Charter is based at the Deutsches Zentrum für Altersfragen (German Centre of Gerontology), a public research institute on socio-gerontological issues. The agency is also responsible for monitoring and reporting evidence on impact. Upon distribution of the Charter in 2007, there was a significant response which included follow-up questions, letters of agreement and criticism, and indications of intentions to implement the Charter. Until autumn 2010, approximately 300,000 copies of the Charter had been ordered, mostly by care providers, schools for nursing staff and private people. Approximately 370 organisations and 700 individuals have publicly declared their support and commitment to the rules of the Charter on the agency website. Further, seven new laws and legal regulations at national and regional level explicitly refer to the Charter as a basis for their development (November 2010; for more details click here). LTC insurance funds use it to inform and give advice to users. In organisations of services providers it is applied in quality circles and staff trainings and is sometimes part of contracts between service providers and users. In two pilot projects guidelines for the self-assessment of inpatient and outpatient service providers according to the Charter principles were developed. They are based on moderated benchmarking circles, self-evaluations, reports of participants and on-site observations. In addition to that, the German Charter was one of those used as a basis for the development of the European Charter of the Rights and Responsibilities of Older People in Need of Long Term Care and Assistance, which was finalised in May 2010. It goes beyond the approach of the German Charter by adding certain responsibilities. These include responsibilities concerning the rights and needs of other people working and living with the person in need of care; and an obligation to report any abuse or maltreatment experienced to the authorities in charge.

Worin bestehen die Stärken und Schwächen der Initiative?

The Charter is highly supported in the public discussion on ethical and quality aspects in LTC in Germany. Experts across all sectors and disciplines were involved in its development and other activities of the “Round Table Care”, so that a creative process could be initiated. The Charter statements have moved towards a shared reference framework and positive developments; they form the basis for a benchmarking system according to which organisations can perform self-assessments and identify strengths and potentials for improvements. Resources have been made available by the national government to sustain the implementation of the Charter through a special agency and thus are contributing towards ensuring that human rights and dignity are firmly placed within long term care. Critical comments refer mainly to the following aspects:

1. Despite the representation of all key areas in LTC, there was a lack of practitioners in the development phase of the Charter. This may have contributed to the fact that implementation issues were only brought up at a later date.
2. The statements of the Charter have no legal binding force at all. Since providers do not have to prove the implementation of the Charter, they can pay lip service about their commitment towards the demands. No investigations or evaluations have been carried out concerning the practical use of the Charter.
3. Focusing on the rights of people in need of care might render certain responsibilities less visible which could in itself be disrespectful. Studies on abuse in care settings show in particular that help is needed by both the victim and the perpetrator, and the boundaries can sometimes become blurred.

Impressum

Autor: Karin Stiehr, Institut für Soziale Infrastruktur
Reviewer 1: Thomas Emilsson
Reviewer 2: Francesca Cerruzzi
Verified by: Anna Hokema

Externe Links und Literatur

• Aichele, V./Schneider, J. (2006) Soziale Menschenrechte in der Pflege. Berlin: Deutsches Institut für Menschenrechte.
• Austrian Red Cross (ed.) Breaking the Taboo. Violence against Older Women in Families: recognizing and acting. Vienna et al: Austrian Red Cross.
• Buchinger, S. (2008) ‚Die Pflege-Charta aus Sicht der Pflegenden. Eine kritische Stellungnahme’ in: Heim + Pflege 39(7/8): 204-208.
• Bundesministerium für Familie, Senioren, Frauen und Jugend/Bundesministerium für Gesundheit (Hg.) (2007) Charter of Rights for People in Need of Long Term Care and Assistance. Berlin: BMFSFJ/BMG.
• Igl, G./Klie, T. (2007) ‘Charta der Rechte hilfe- und pflegebedürftiger Menschen’, S. 34-36 in: Igl, G./Klie, T. (Hg.), Das Recht der älteren Menschen. Baden-Baden: Nomos Verlagsgesellschaft.

For further information on the self-assessment of residential care facilities see:

• Konkret Consult Ruhr (2008) Leitfaden zur Selbstbewertung auf Grundlage der Charta der Rechte hilfe- und pflegebedürftiger Menschen – eine Handlungshilfe zur Umsetzung der Pflege-Charta in stationären Pflegeeinrichtungen.

For further information on the self-assessment of home care services see:

• Deutsches Zentrum für Altersfragen (2010) Umsetzung der Pflege-Charta in der ambulanten Altenpflege. Benchmarkingprojekt mit ambulanten Pflegediensten. Bericht zum Praxisprojekt.

See also:

• The European Charter of the Rights and Responsibilities of Older People in Need of Long-term Care and Assistance.

Bitte loggen Sie sich ein um einen Kommentar zu verfassen