Human Rights in Care Homes: From Rhetoric to Reality

Dr Caroline Emmer De Albuquerque Green, an Early Career Research Fellow at the Institute for Ethics in AI at the University of Oxford and Research Fellow at Reuben College, spoke to members of the Care Initiative at Green Templeton College on Thursday 2 November 2023.

Dr Green shared insights from her research on the application of human rights frameworks in English care homes, highlighting some limitations of the understanding of human rights that prevails and its interpretation in care homes. Her talk was based on her extensive research which includes a range of research projects and up to 150 qualitative interviews across England and Scotland. The talk and discussion proceeded in three parts.

Who are we talking about when we speak of care homes?

In the first part of her talk, Dr Green was at pains to point out the human side of care homes. Focusing on care homes for older people in England, she gave valuable insights on the people associated with care homes (mainly the 370,000 residents and nearly 380,000 workers but also the many people who visit and volunteer). Dr Green sought to challenge the prevalent view of care homes as building-based spaces of care in which residents live permanently and receive nursing and/or social care. She painted an alternative picture of care homes as ‘intimately relational spaces’  by which she meant settings packed with the rhythms and relationships of daily living but also facing various pressures like declining health and impairment, inequalities, prejudices, hyper-regulation and resource constraints. However, we know too little about care homes because there is little research done on them and the statistical and other data is inadequate.

Taking a critical approach to human rights in care homes

In the second part of her talk Dr Green offered us a framework to interpret the limitations of the existing approach. To do so, she contrasted two different approaches to understanding care homes. One sees them as institutions and it is this approach, which also treats individuals as autonomous rights holders, that has been widely influential on the human rights framework in England. It concentrates on putting in place regulatory and monitoring mechanisms to ensure that places like care homes are regulated according to strict rules whereby, among other things, management and staff treat residents in line with human rights. On the other hand, a relational approach is possible. This recognises the inherent equality and shared humanity of people living in care homes, those who work in them and those who visit them. In this view caring is the meeting of needs of another person in a way that respects them as people. This approach sees human rights as structuring relationships in a way that fosters particular values rather than searching for human rights violations. However, it is the former approach that is reflected in the law and regulatory bodies such as the Care Quality Commission.

But what does the regulatory institutional approach mean for human rights in care homes? Dr Green highlighted the main challenges associated with the application of human rights in care homes as follows. First, there are the negative connotations of ‘human rights’ language which tends to be a language of blame, control and negativity. It concentrates on violations rather than supporting positive change and education. A second issue is a lack of clarity and some confusion around how human rights can be and are applied in care homes. Such difficulties relate to inherent complexities in human rights themselves but also the particularity of care homes. How, for example, does one reconcile the duty of care with the person’s right to autonomy?  Other difficulties mentioned included the difficulty for people to claim their human rights in such a setting as a care home in which individual residents might feel powerless.

Bringing about Change

Dr Green’s work is helpful not just in critiquing the existing situation but also in identifying some possible solutions. In this she challenges us to think about how to change the existing human rights culture. For this, changing the way we view and think about care homes is crucial. Another possible remedy is to provide training in the application of human rights in care home settings. This could include training for residents as well as staff.

Dr Green’s work and thinking is exciting for those of us who are interested in care homes and the well-being of older people because of how she wants us to understand care homes as full of human life with all the complexities of trying to create a good life which managing often scarce resources and power imbalances. The contributors to the discussion generally agreed about the uniqueness of care homes but also that they are much in common with other homes. After all, ‘home’ is a keyword and so should have meaning. One participant suggested we should enable care homes to be places of love. Other points made in the discussion underlined the heterogeneity of care homes and especially the differences between residents who are self-funding (who may have a greater chance to have their wishes met) as compared with those funded by local authorities. The problems in the system were also pointed out in terms of strong uniform regulation and a one-size fits all approach.

Further information on Dr Green’s work

Professor Mary Daly
Governing Body Fellow
17 December, 2023