Background and context

RBC does not have a single formal definition. It comes from the concept of human rights more broadly, which are often defined in international human rights laws and charters.

These rights are put into practice through common frameworks that legislators, service designers, and researchers can use to design, implement, and evaluate policies and programs.

Individual professionals such as doctors and nurses refer to ethical codes that go beyond the law and require them to uphold the rights of the people they serve through adherence to a set of values.

Reforms and legislation have shaped how RBC was introduced to the aged care sector in Australia; the new Aged Care Act and associated supports describe what rights older people have when receiving care, and how aged care providers must implement it. [2]

What are human rights?

Human rights are fundamental entitlements and freedoms inherent to all people. These rights are commonly understood as universal and undeniable, meaning they apply to everyone and cannot be taken away. Human rights apply to everyone, regardless of citizenship, social status, or ability. All rights matter together - one right cannot replace another. [3]

Australia has endorsed a number international laws, charters and declarations on human right that apply universally - most notably the Universal Declaration of Human Rights (UDHR). [3] 

The UDHR articulates a comprehensive range of rights relating to:

• human dignity and non-discrimination, 
• civil and political rights that protect individual freedoms, 
• economic, social and cultural rights that support an adequate standard of living, and 
• solidarity rights that promote international cooperation on global issues such as peace and development. 

While some international human rights documents are legally binding, others such as the UDHR, are morally upheld by many governments but are not legally enforceable. In Australia, there is no comprehensive national Human Rights Act that directly incorporates these rights into domestic law. As a result, human rights are largely reflected through a patchwork of legislation, policy commitments, and moral obligations rather than a single enforceable legal framework. [4] 

Older people have historically received limited explicit protection within binding international human rights law. The United Nations Principles for Older Persons (1991, [5]) were adopted by the UN General Assembly and Australia, as a UN member state, recognises them as part of the international human rights framework and routinely references them in policy, advocacy, and program design. [4]

The Principles for Older Persons identified five priority areas:

• independence,
• participation,
• care,
• self fulfilment, and 
• dignity. [5]

These principles align older persons’ rights with broader human rights principles and provide guidance for states and service systems, even though they are not legally binding. In practice, Australia draws on these Principles alongside domestic legislation (e.g., Age Discrimination Act [6]), and sector specific legislation (such as the Aged Care Act [2]), while also supporting current UN processes to strengthen international protection of older persons’ rights. [4] 

How are human rights put into practice?

Human rights-based operational frameworks 

Human rights based operational frameworks help turn human rights principles into everyday practice. These frameworks are often used to design systems, policies, or programs that strengthen human rights, as well as in research to measure human rights initiatives. [7]

One widely used approach is the PANEL framework, which is built on five core human rights principles: 

• Participation means that people are meaningfully involved in decisions that affect their lives and their rights.
• Accountability requires organisations and governments to monitor how rights are being respected and to act when things go wrong.
• Non-discrimination and equality mean that unfair treatment must be prevented and eliminated in all forms. 
• Empowerment focuses on helping people understand their rights and supporting them to have a voice in policies and practices that affect them.
• Legality ensures that actions are grounded in domestic and international human rights law. [7, 8]

Another commonly used framework is FREDA, which highlights values that guide respectful and fair decision making. FREDA stands for: 

• Fairness means that a person’s views are listened to and taken seriously.
• Respect involves acting in an unbiased way and recognising people’s beliefs, values, and property. 
• Equality focuses on preventing discrimination and supporting equal participation, including for people with disability, different genders, and cultural backgrounds.
• Dignity recognises every person’s worth, regardless of their situation.
• Autonomy supports people to make their own choices and to be involved in decisions about their lives. [7]

Together, frameworks such as PANEL and FREDA provide practical guidance for systems and organisations to move beyond viewing care and support as optional and instead treat them as obligations based on people’s rights. By doing so, these frameworks promote fairer, more inclusive, and more respectful systems that better protect individuals from harm and exclusion. For example, both the PANEL and FREDA frameworks informed the development of a rights-based approach in Australia’s National Disability Insurance Scheme. [9]

The PANEL and FREDA frameworks can also serve to evaluate how well RBC is implemented and are often used this way in the scientific literature. Unlike needs-based approaches, which measure success by whether services meet identified needs or targets, a rights-based approach measures success by whether human rights are realised. [10, 11]

Discipline-specific ethical frameworks

Some professionals may look to discipline-specific ethical frameworks when operationalising RBC. In health and nursing care for example, professional ethics frameworks contain rules about what is right and fair behaviour. While laws set minimum standards and are enforced by authorities, ethical responsibilities require that practitioners in a specific discipline often go further. In practice, law and ethics work together to protect patients’ rights, support dignity, build trust, and guide safe and compassionate care. These ethical frameworks can be used as guidance for aged care workers who implement RBC.

Medical and nursing ethics are commonly explained through four key principles: [12]

• Respecting a person’s right to make their own decisions (autonomy). [13]
• Treating people fairly and equitably (justice). [13]
• Acting to benefit the person (beneficence), and
• Preventing or providing the least possible harm (non-maleficence). [13, 14]

These principles are reflected in professional nursing codes of ethics, such as those developed by the International Council of Nurses, which also recognise human rights as central to nursing practice. [15, 16]

RBC principles

Several principles describe how RBC can be put into practice in aged care:

Respect and dignity

RBC recognises older people as equal partners in care, whose voices matter and whose life experiences and contributions deserve respect. [17] Older people have the right to live with dignity, and to speak up about concerns without fear of punishment or discrimination. [18]

Dignity includes valuing a person’s unique identity, beliefs, and relationships, and supporting personal preferences. [19] Dignity is affected by how people are spoken to, listened to, and supported to make choices. Dignity is also related to respecting a person’s privacy, such as limiting unnecessary exposure of the body during medical procedures. [19]

When dignity is not protected, older people may experience stigma, neglect, abuse, or loss of wellbeing. [17]
Creating a culture of dignity means rejecting all forms of abuse, avoiding restraints, and ensuring that everyone involved in care understands that respect and human worth must guide all actions. [19]

Empowerment and autonomy

Rights-based approaches support empowerment, recognising that older people are entitled to exercise their rights and freedoms. Empowerment means that older people:

• understand their rights, [17]
• can make informed choices about their care [17] and
• participate in the development of policy and practices affecting them. [8] [17]

Autonomy is described as feeling supported to make choices, feeling heard, respected, and empowered, participating in personally motivating activities, competence, and relatedness. [20]

Self-determination and autonomy are reduced when people felt controlled or undermined, identified as a risk in aged care settings. [20]

Equity and justice

Equity refers to fair and non discriminatory access to care that all older people deserve by virtue of their personhood, regardless of their location, background, or productivity level. [21] [22]  It requires making equitable choices to meet the diverse care requirements of all older people, adjusting care to individual differences. [1] [21]

Justice requires systems to actively address barriers faced by marginalised groups.  [21] It requires recognition of unequal starting points and targeted, responsive action rather than identical treatment. [21]

While societal-level factors contribute to injustice, justice in the context of RBC is relational and practice-based, not abstract. [1]

Access and quality

Access to services does not just mean availability of aged care services. Older people should be offered meaningful choices, so that they can make confident decisions about their care [13]. Older people require access to information, time, and support to make these decisions [23].

RBC also includes safe access to complaint pathways. Access to meaningful remediation of problems is essential to maintaining standards of care. [18]

Access failures are framed as systemic injustice. [1] Poor access is described as a human rights failure, not a service gap. [22]

Access to meaningful choices is a pre-requisite for quality services. [13] [21] Quality includes not only clinical competence, but services that preserve dignity, safety and are culturally responsive. [21] Quality cannot exist where services are culturally unsafe. [21]

The evidence review identified fear, discrimination, and silence as indicators of poor quality. Quality is dependent on effective accountability pathways, and it is undermined when residents cannot safely voice concerns. [18, 22] 

Safety and privacy

Safety and privacy should be embedded in everyday interactions, across the spectrum of services an older person may receive. [21]

Rights-based safety focuses on preventing harm, supporting quality of life, and building relationships. [21] Safety balances protection with respect for personhood. [23]

Safety includes freedom from:

• Abuse and neglect. Older people must be protected from elder abuse, inhuman or degrading treatment, and exploitation. [8, 24-26]
• Discrimination. A rights-based approach means that all forms of discrimination must be prohibited, [8, 24-26] and the safety of those who are most marginalised or historically prevented from realising their rights should be prioritised. [8]
• Restraint. While physical restraint is sometimes justified as ’safe’, it can cause harm and impact autonomy, freedom, dignity, and personhood. [27] A study suggested that Australian legislation should enshrine freedom from restraint to fully realise RBC. [26]
• Fear of mistreatment. Freedom from fear of mistreatment was also identified as key to rights-based safety, ensuring older people are confident that they will not face retaliation for speaking up about their needs. [7]
• Retaliation. Fear of damaging relationships is a common reason an older person may be reluctant to pursue a complaint. [18]

Safety also includes protection of bodily integrity and consent. [27]

Privacy is another core human right. Institutional routines in residential aged care can unintentionally erode privacy, with staff able to ’knock and walk in’ to residents' private spaces. [28, 29] Surveillance and monitoring, often instituted to support safety, can undermine privacy and discourage autonomy. [30]

Privacy violations frequently signal deeper rights failures; loss of privacy and dignity often accompany unsafe care environments. [18]

Connection and participation

Connection and participation should be treated as core human rights, not as lifestyle extras. RBC recognises older people as relational beings whose wellbeing depends on sustaining meaningful relationships. [31]

Connection includes social relationships, belonging, and trust, and is foundational to wellbeing. [21] Connection is reinforced when people feel listened to and are taken seriously. [32]

Connection depends on structural support, advocacy from care staff, and accessible opportunities, not just individual initiative. [1] That is, older people should not have to create their own opportunities for connection and participation—the provider should enable them. Collective decision making, such as voting on activities, builds trust, social connection, and community identity. [20, 32]

Participation includes meaningful involvement in everyday decisions as well as input into ongoing bigger-picture issues. Meaningful participation extends beyond individual care into policy, program, and system design when older people are meaningfully involved. [22] Participation must not be tokenistic; when older people are only involved at the surface-level, it undermines dignity and trust and limits feelings of belonging. [32]

Participation strengthens wellbeing, autonomy, and social inclusion, which contribute to the older person’s mental health and quality of life. [21] Participation strengthens both individual agency and group belonging [32] and improves relationships between aged care residents and staff. [20]

Isolation is not an inevitable outcome of ageing, though older people may experience it when faced with limitations such as loss of sight and hearing, or memory changes. [21] When connection and participation are not intentionally prioritised, older people may become isolated through no choice of their own. Isolation indicates a failure of rights, which should be addressed through removing environmental and structural barriers that keep people from participating. [21] Fear of damaging relationships can silence participation [33], also leading to isolation.

Rights based care must actively protect social connection and actively foster belonging and inclusion [21] through meaningful, ongoing opportunities for participation. [1, 22] 

Accountability

Accountability is the mechanism that moves rights from symbolic to real.  Enforcement mechanisms are essential to protect the rights of older people receiving care. [18] The literature shows that accountability in principle only, without enforcement, makes it weak and optional. [22]

Robust complaint pathways are key, both within and beyond one organisation. Accountability requires external oversight in addition to self regulation. [18]  

Studies framed accountability as proactive rather than responsive, describing systems that anticipate and prevent harm rather than reacting to it. [1, 33, 34] Accountability requires advocacy, mediation, and education to address violations. [1]

Accountability was also described as relational. Studies described how co-design should be embedded in the development and implementation of regulatory processes at multiple levels. [33, 34]

Studies talked about how unexamined power imbalances can thwart the effectiveness of accountability systems. Power imbalances can suppress the older person’s willingness to speak up, and lead to undermining justice. [33] Accountability requires shifting responsibility away from those who have less power-older people receiving care - and onto those with increasingly more power - providers, institutions, and the state. [18, 21]

Accountability is not measured by absence of complaints; silence can be a possible signal of systemic problems rather than resident satisfaction. [18] Fear of retaliation or mistreatment can lead to a reluctance to engage with complaint processes, which means significant problems can hide behind low rates of complaints.
 

In Australia, domestic policy, regulatory, and Aged Care Quality and Safety Commission activities have shaped how RBC has been introduced in aged care.

Rights-based aged care in Australia

Following on from decades of reform, legislation, and the Royal Commission, the Australian government enacted the Aged Care Act 2024, which protects the rights of older people in the care they receive by law. [2]

The Act is underlined by a Statement of Principles, which set out the core values for how the Aged Care system must operate. 

The Principles include:

• Person-centred care,
• Empowering workers and carers, 
• Transparent and sustainable aged care, and
• Continuous improvement. [2]

Each of these Principles must be integrated into the work of providers who provide services for older people, and the Principles should guide interpretation, decision-making and behaviour across the aged care system. [2]

The Act also includes a Statement of Rights, new Strengthened Quality Standards, and a Code of Conduct to provide guidance for older people and those who provide services to them.

The Statement of Rights outlines the rights that older people have when seeking services:

• Independence, choice, and control
• Equitable access
• Safety and quality
• Privacy
• Communication and feedback
• Support, advocacy and connection. [2]

Providers are required to act in line with the Statement of Rights when delivering services.

The Strengthened Quality Standards describe what good care looks like. There are seven standards that aged care providers must uphold when providing services: [2]

The Code of Conduct outlines how aged care providers, responsible persons such as board members and CEOs, and aged care workers are expected to behave when providing services. [2]

The Aged Care Rules, which contain details about how the Act is put into practice, were enacted in 2025. The Rules provide instructions for providers, regulators, and government to put the Principles into practice. [35]
 

A human rights-based approach to care starts from the position that older people are rights-holders, not passive recipients of services. This means that rights are not optional or dependent on goodwill, but are entitlements that must be respected, protected, and fulfilled. [22, 36]

Similarly, governments and public authorities are often described as duty-holders or duty-bearers, with responsibility for creating laws, policies, and systems that uphold the rights of older people. These responsibilities are shared across layers of practice. In care settings, managers and frontline workers are often the duty bearers closest to residents and have a direct role in fulfilling their rights in everyday interactions. These duty holders must be supported by organisations and systems to meet their obligations. [37, 38]

The literature shows that the responsibility for RBC duty-holders exist at all levels. At the system level, governments and regulators are responsible for laws, policies, funding, enforcement, and accountability. At the organisational level, aged care providers, boards, and leaders are responsible for organisational culture, policies, staffing, safeguards, and oversight. Individuals – aged care staff and professionals – practice rights-based care through daily practice, advocacy, decision-making, relationships, and respect. 

System level responsibilities

System-level entities include governments, legislators, regulators, ministries, commissioners, and oversight bodies. They are the primary duty-holders responsible for RBC. [22, 37, 38]

These system-level entities are responsible for enacting human rights-aligned legislation, and setting standards and expectations for how it is delivered. [27]

They are responsible for funding services adequately to realise rights. [22, 28]

System-level entities are also responsible for accountability including monitoring, enforcement, and redress. When no system actor is clearly responsible, there is a risk that responsibility is shifted downward onto organisations and individuals. [21, 22, 34, 39]

Organisation-level responsibilities

Organisational-level actors include aged care providers, boards, executives, managers, and service leadership. Their responsibilities include embedding rights in policies and procedures, providing workforce training in human rights, safeguarding, complaints and feedback systems, monitoring and responding to violations, and resisting commercial or efficiency pressures that undermine rights.

Organisations are responsible for creating the conditions in which rights can be realised, through embedding RBC in policies and processes, which should be reflected in culture, staffing, and leadership. [21, 28]

Organisations must build the capability of their workforce to ensure that they are confident, informed, and prepared to navigate situations when an older person’s rights may be at risk, such as when cognitive impairment, sexuality, or restrictive practices complicate ethical decision-making. [27, 28, 40]

Safeguarding and complaint handling are organisational responsibilities, rather than placing the burden on the older person or their family. Safeguarding focuses on the prevention of harm, reflecting a supportive and transparent environment where an individual feels confident and supported to make a complaint. [25, 41] Policies and procedures that proactively support residents’ and staff’s rights-based safety are key. [33]

Organisations must also actively identify and remedy rights failures, using monitoring and response processes and systems to prevent harm. To be truly accountable, organisations should regularly assess for and learn from incidents to ensure that they are proactively preventing harm. [8, 21, 39]

Individual-level responsibilities

At the individual level, direct care staff, professionals (nurses, care workers, allied health professionals) hold responsibility for the day-to-day upholding of older people’s rights.

Individuals who provide rights-based care are front-line duty-bearers, who must treat the older people in their care as rights-holders. [1, 32] 

They are responsible for upholding dignity in everyday interactions, supporting autonomy and decision-making, and respecting individual preferences. [1, 32]

These front-line workers must also be empowered to act as advocates and challenge unsafe or rights-violating practices. [14]
 

Learn more about the evidence: View summaries of relevant evidence in the RBC Priority Topic

Strategies, interventions and models for delivering RBC: This theme illustrates the strategies, interventions and models evident from the literature that can support the operationalisation of rights-based care within aged care. They can be categorised as actions that can be implemented at individual, organisational, system or policy levels.

Practice-specific considerations: This theme details practice-specific considerations that are relevant to rights-based care within the aged care sector. The categories span: 

• issues such as restraint, and neglect and abuse 
• RBC considerations via a cultural lens for CALD communities; and equity, access, and discrimination relevant to aged care for LGBTIQ+ older persons
• workers’ rights and issues, and
• organisational considerations.

Barriers to RBC*: This theme describes factors that get in the way of adopting, implementing, or evaluating RBC at the system, organisation, or individual levels.

Enablers to RBC*: This theme describes factors that can help systems, organisations, or individuals deliver RBC effectively.

Tools to implement and evaluate RBC*: This theme describes tools and frameworks that can be used to adopt, implement, or evaluate RBC at the system, organisation, or individual levels.

*Themes available May 2026

Want to see how other organisations have developed resources to support operationalising RBC in Australia’s aged care sector? Take a look at our curated resource collection on rights-based care.

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