The quality of care for older people in residential care, the lack of clear rules about access to health-board facilities and the absence of a complaints procedure have been raised by the Human Rights Commission in a recent report.
The report on older people in long-stay care was written by barrister Ms Ita Mangan for the commission, and focuses on the human rights of older people.
It has gone to the Department of Health, health boards and other relevant bodies and, following feedback, will form the basis for recommendations.
The report found that community care was the preferred option for older people, but it is not adequate and is not being delivered as envisaged.
Commitments given in official documents were not delivered.
Entitlement to community care is unclear, according to the report, and the provision of supports, like a home-help, varies in different parts of the country.
Long-stay residential care is a necessary part of a continuum of care, but the report finds that in practice what is favoured is the private provision of such care.
There is a shortage of long-stay beds, and both law and practice on entitlement to this care are unclear.
This means there is "an unacceptable risk of arbitrariness in decision-making".
The report also expresses concern about the quality of care. The health boards are the inspector of private-sector providers, but there is no external assessment of their own facilities.
The report found that there was virtually no up-to-date information available on the quality of care being provided.
While the reports of inspections of private nursing homes give considerable information, there has been no systematic analysis of these reports.
There is no independent complaints and appeals procedure within the health service.
There is also no organised advocacy service for vulnerable, older people in care, and no provision for third-party complaints to be heard.
Government commitments in these areas date back to 1988.
The report details the human rights issues which arise from the treatment of older people in long-term care.
These include the adequacy of measures to ensure equality of treatment in various forms of care; the lack of clarity of entitlement; the inadequate provision of public care; the inadequacy of measures to ensure equity in the allocation of places, and in the application of the means test; the incidence of inhuman or degrading treatment; the right to an effective remedy; and the right to participate in decision-making.
The deadline for responses to the report is June 6th.