Addressing Abuse of Older Adults in Long Term Care Facilities: Through Data and Action.

 Long-term care (LTC) services were recognized by the United Nations Economic and Social Council as one of the emerging issues that the international community needs to act upon¹. Nursing homes, memory care units, and other institutional settings play a critical role in supporting older persons experiencing physical or cognitive decline, as well as those with care and support needs, yet they also present unique challenges. Meeting these challenges is critical when ensuring the protection of residents from abuse and neglect. Abuse of older persons in institutional settings, such as nursing homes and long-term care facilities, is often an unrecognized public health issue.

A World Health Organization (WHO)-led meta-study from 2017 reviewed published studies that conducted long-term care staff interviews to address the difficulty of gaining access to and obtaining informed consent from nursing home residents. Researchers found that 62.2 per cent of those interviewed believed that in the past year, either they or other staff perpetrated physical, sexual, or psychological abuse and neglect against residents. Unsupervised residents, particularly those living with dementia, can also pose risks to coresidents who may require additional support³. These data, collected in reports and studies, emphasize the pervasive nature of abuse in institutional settings and the need for continued data collection as well as evidence-based interventions that protect the human rights and dignity of residents. They also emphasize the need for training and support of staff working with and overseeing diverse resident populations. The United Nations Decade of Healthy Ageing (2021–2030) established action areas and enablers, with older persons at the centre, including combating ageism, collecting better global data on healthy ageing, developing cost-effective solutions, making an investment case, and raising funds. Recognizing that older persons in long-term care facilities are especially vulnerable to abuse and neglect, WHO recommends strengthening oversight and regulation of long-term care facilities, promoting a culture of respect and dignity, and providing residents and their families with access to support systems. These include information, advocacy, and legal support if they witness or experience abuse or neglect. Implementing these recommendations can be both impactful and cost-effective. For example, with trained volunteers as part of Ombudsman programmes, care homes can ensure the availability of cost-effective access points. Long-term care facility management can reduce staff-caring stress with training and stress-reduction interventions. Governments collaborating with universities can expand knowledge about the prevalence and incidence of abuse in residential care settings through jointly developed research studies. Mandating the reporting of incidents to Government health departments and law enforcement can also promote knowledge, particularly if researchers have access to Government reports for analysis. Integrating palliative care into residential long-term care programmes helps ensure attention to end of life and pain management, supporting residents with chronic and life-threatening illnesses in realizing their right to health and living with dignity. Training all staff on the human rights of long-term care residents, drawing on applicable human rights principles and standards where they exist, can strengthen awareness and promote more respectful, person centred care and support. The right to justice is another important human right that is not always observed in residential long-term care settings. Ensuring that residents and their families are made aware of complaint procedures, implementing resident-focused complaint handling, and providing access to an external advocate, such as a volunteer ombudsman, can lead to the realization of that right. Women live longer but tend to be more marginalized and disadvantaged than men, leading to higher rates of poverty in old age⁸. Women are also overrepresented in long-term care facilities both as residents and as workers. Lack of resources can limit access to needed care for care dependent older women and can also perpetuate poverty through the low wages of the long-term care workforce, which is largely female. Member States subsidizing the cost of care and support for residents at the poverty level and raising wages for long-term care workers could ensure the right to access for residents and fair wages for workers.

Alignment between staff levels and knowledge, and quality care is paramount. Supporting residents living with dementia in a way that upholds the right to safety requires specialized training for staff and a person-centred approach tailored to each individual. Because resident to-resident harm is a known issue in long-term care settings, particularly in memory care units, management and staff should implement both structural and behavioural measures to help ensure the safety and well-being of all residents¹¹. Challenges of a universal unified data system for human rights violations in long-term care facilities for Member States are highlighted in both the thematic and country reports by the Independent Expert on the enjoyment of all human rights by older persons, Ms. Claudia Mahler. Her reports highlight that long-term care facilities in both developed and developing countries face deficiencies that can result in human rights violations against residents; however, as noted in her findings, developed countries tend to have more resources allocated to protection mechanisms, surveillance, and data reporting. This disparity exists despite the fact that many developing countries are experiencing population ageing at a faster pace than developed ones. An important overarching recommendation for strengthening long-term care systems and standardizing data reporting globally is the elaboration of a legally binding instrument on the promotion and protection of the human rights of older persons. A significant step in this process was taken by the Human Rights Council in April 2025 by adopting a resolution to establish an intergovernmental working group to draft a new legally binding international Convention. This effort aims to create a comprehensive legal framework to combat age-based discrimination and ensure the full recognition and protection of human rights in older age across all settings. In parallel, the implementation of the Madrid International Plan of Action on Ageing (MIPAA) provides a policy framework for strengthening national and regional action. The findings of the upcoming fifth global review and appraisal of the implementation of the Madrid Plan of Action, commencing in 2026, will offer valuable insights into progress made and remaining gaps in the protection of older persons’ rights, including in long-term care. These findings can serve to inform the elaboration of a legally binding instrument, helping to ensure alignment between normative advances and practical implementation on the ground.

Read the full concept note