Evidence review summary

Operationalising rights-based care: Evidence review summary

Overview

The Knowledge and Implementation Hub (KIH) conducted an evidence review to synthesise how rights‑based care (RBC) is defined, described, and operationalised in the aged care literature. The review was initiated because, while RBC is widely referenced across policy and advocacy, it remains conceptually under‑defined and unevenly implemented in practice.

This summary reflects an inductive, exploratory, and practice‑led review, designed to support practical application of RBC in aged care rather than prescribe a single model of care. 

What we did

The aim of the review was to synthesise evidence on how RBC is defined, described, and operationalised in aged care literature.

The review followed an iterative, inductive, and reflexive design. Given the under development of RBC in peer reviewed literature, the team deliberately prioritised grey literature to capture current thought leadership, practice based language, and implementation insights. Peer reviewed studies were then screened, analysed, extracted, and mapped onto emergent themes identified in the grey literature.

Scope and sources

• Grey literature: 79 documents, including policy documents, guidance, reports, and toolkits, with priority given to Australian government, government affiliated, and university sources.
• Peer reviewed literature: 582 papers identified through database searching; 209 studies included for full text screening following title and abstract review and 130 studies included in the analyses.

To be included, grey and peer-reviewed literature needed to address RBC or related human rights principles and publication in the last 10 years. Australian aged care settings were prioritised, with selected international sources included where concepts or practices were relevant and transferable.

Analytical approach

• Inductive thematic analysis of grey literature using NVivo, allowing concepts and themes to emerge organically. [1] 
• Iterative calibration and refinement of coding through team discussion and documented decision making.
• Extraction of peer reviewed studies, mapped to themes established in the grey literature phase.
• Identification of additional themes from the peer reviewed studies that were not present in the grey literature.
• Narrative synthesis designed to support sector use and website translation.

Use of AI and digital tools

AI tools like Microsoft 365 Copilot supported research tasks such as drafting, summarising, refining text, ensuring consistency with protocols, and organising material already collected. The research team made all decisions regarding study inclusion, interpretation, synthesis, and wording; AI did not independently screen literature, extract data, interpret evidence, or generate findings. Researchers reviewed, edited, and validated all AI-supported outputs for accuracy and adherence to methodological standards. [2]

What we found

The Australian aged care reform environment strongly shapes the way RBC is framed and applied. Grey literature situates RBC alongside increasing care complexity, workforce constraints, demographic change, and heightened community expectations. The evidence  underscores that local context matters, and that RBC must be implemented in ways that are responsive to setting, workforce, and population needs.

Definitions and frameworks for RBC

The literature  rarely presents a single, agreed definition of rights based care. Instead, RBC is described as an approach to care grounded in human rights principles, drawing on international human rights instruments and, in the Australian context, the Statement of Rights under the Aged Care Act. [3, 4]

Rather than functioning as a technical framework, rights based care is framed as:

• A strengthening of person centred care through explicit recognition of older people as rights holders. [5, 6]
• A shift in power towards older people through voice, choice, participation, and supported decision making. [5, 7-10]
• A corrective to historically paternalistic, task driven, or institutional models of care. [8, 9, 11, 12]

Principles underpinning RBC

Across grey and peer reviewed literature, a consistent set of inter-related principles underpin rights based care:

• Dignity and respect: Recognising inherent worth and treating older people with respect in all interactions. [7, 13, 14]
• Autonomy and empowerment: Supporting choice and decision making, including when decision making capacity is variable. [7, 8, 10]
• Equity and justice: Delivering inclusive, culturally safe care that responds to diversity and addresses structural disadvantage. [5, 15]
• Safety and privacy: Protecting physical and psychological safety while respecting privacy and confidentiality. [13, 15-20]
• Connection and participation: Supporting relationships, belonging, and meaningful engagement with community and others. [5, 9, 10, 12, 15]
• Accountability: Acknowledging responsibility when rights are at risk or breached, including transparency, learning, and repair. [11, 13, 15, 21, 22]

The evidence emphasises that these principles are not independent; they are enacted together and must be balanced in practice.

RBC strategies, interventions, and models

Across the literature, rights based care is operationalised through actions at multiple levels:

• System and policy level: International human rights instruments, national legislation and standards, guardianship and oversight reform, and workforce education policies provide the formal scaffolding for rights based care and signal that rights should be enforced, not just aspirational. [3-5, 23-25]
• Organisational level: Leadership commitment, workforce training, multidisciplinary and person centred care pathways, and embedded tools (such as care planning, risk assessment, incident response, and complaints systems) shape whether rights are realised in everyday practice. [9, 26-36]
• Individual level: Person centred, psychosocial, and non pharmacological approaches; supported and shared decision making; and education and empowerment of older people and families enable autonomy, participation, and choice. [14, 15, 27, 29, 33, 37-39]

The evidence consistently shows that RBC is strengthened when these levels are aligned, rather than relying on individual workers to carry responsibility alone. [15, 40-42] Support for implementation is crucial to ensure that organisational cultures are transformed to support: 

• Embedding rights aware language and actions into care planning and everyday conversations. [28, 43-45]
• Shifting from routine driven care to relational, personalised, and choice based practices. [28, 32, 41, 46, 47]
• Actively supporting shared and supported decision making. [29, 35, 36, 39, 48]
• Moving away from blanket risk avoidance towards approaches that enable dignity of risk. [12, 34, 47, 49]

Responding to adverse events and harm in ways that prioritise honesty, learning, and reparation. [13, 21, 50, 51]

Across sources, authors caution that adopting rights language without altering systems, resources, and expectations could result in superficial or symbolic implementation only. [43, 52, 53]

Practice specific considerations

The literature highlights several practice areas where rights based care is particularly tested, requiring deliberate attention and adaptation:

• Safety, restrictive practices, abuse and neglect: Tensions between protection and autonomy are common, with rights based care requiring proportionate, least restrictive responses, transparency when harm occurs, and mechanisms for learning and repair. [47, 54-56]
• Decision making and consent: Presumption of capacity and supported decision making are central, particularly for people living with dementia and cognitive impairment, where rights affirming practice depends on time, skill, and appropriate supports. [16, 18, 20, 49]
• Sexuality and sexual expression: The evidence identifies sexuality, intimacy, and sexual expression as frequently overlooked rights in aged care, often constrained by risk averse practices, organisational discomfort, or lack of guidance. [18, 20, 49, 57]
• Palliative care: RBC in palliative and end of life contexts emphasises dignity, comfort, choice, cultural safety, and respect for preferences, while navigating complex ethical and clinical decisions. [58-60]
• Psychosocial needs: Emotional wellbeing, trauma informed care, mental health, social connection, and meaning making are integral to rights based care, but are inconsistently addressed alongside physical care. [19, 50, 61-63]
• Diversity, equity, and access: RBC must respond to cultural, linguistic, sexual, and gender diversity, as well as the specific rights of First Nations older people, recognising how intersectional disadvantage shapes care experiences. [11, 19, 64, 65]
• Workers’ rights and relational care: The rights of older people and workers are interdependent; navigating tensions between safety, workload, professional obligations, beliefs and preferences, and residents’ rights is essential for sustainable and ethical care. [66-69]
• Organisational considerations: Duty of care, dignity of risk, safeguarding, open disclosure, and complaints processes shape how rights are interpreted and enacted, particularly where rights may appear to conflict or involve managed risk. [8, 13, 21, 34, 55, 70]
• Environment and living: The built and social environment play a critical role in realising rights, including access to appropriate food, nutrition, and dining experiences; personalised lifestyles and living arrangements; and the right to privacy in shared or institutional  settings. [9, 14, 20, 46, 62, 71-74]

Across these practice areas, the evidence shows that rights are most at risk where organisational systems, priorities, processes, or resources are misaligned with rights based intent. [36]

Barriers to RBC

The evidence consistently indicates that rights based care cannot rely on individual effort alone. Common barriers to operationalising RBC include:

• Risk averse organisational cultures that prioritise protection or compliance over autonomy. [34, 47, 75-77]
• Workforce pressures, including time constraints, staffing shortages, and limited access to training. [27, 42, 60, 78, 79]
• Variable understanding of rights based concepts among staff. [53, 60, 77]
• Systemic inequities affecting particular groups, including First Nations people, culturally and linguistically diverse communities, and LGBTIQ+ older people. [11, 30, 64, 78, 80, 81]
• Limited mechanisms for feedback, learning, and follow up when rights are compromised. [47, 54, 80]

Enablers to RBC

The evidence consistently shows that rights based care is strengthened when systems and organisational factors are aligned, rather than relying on individual workers to carry responsibility alone. [43, 85]  

Enablers to RBC identified across the literature include:

• Workforce education that explicitly links human rights concepts to routine care practice. [47, 52, 82, 83]
• Reflective practice, supervision, and team discussion to support ethical decision making. [27, 52]
• Practical tools, prompts, and frameworks that help staff translate abstract rights into observable actions. [34, 82] 
• Organisational cultures that encourage speaking up, learning from mistakes, and continuous improvement. [75, 84]

Gaps in research and practice

At the same time, the literature identifies several persistent gaps that limit effective implementation. These include:

• Limited evaluation of implementation or effectiveness: There is little empirical evidence assessing how rights based care approaches are implemented in practice or their impact on outcomes for older people, workers, or organisations. [29, 37, 81, 86]
• Inconsistent outcome measures: Few studies specify how rights based care is measured, with no agreed indicators for assessing whether rights are being realised in everyday care. [45, 72, 82]
• Variable translation into routine practice: While policy and guidance articulate rights clearly, there is limited evidence on how these are embedded consistently into care planning, documentation, supervision, and daily decision making. [29, 34, 45, 53]
• Workforce capability gaps: The literature highlights uneven access to education and support that links human rights principles to practical care situations, particularly in complex or high risk contexts. [60, 77, 81, 83]
• Under representation of lived experience: Older people’s and workers’ perspectives on what supports or constrains rights based care are inconsistently captured. [37, 54, 79, 87]

These gaps indicate that further work is needed to move beyond articulation of rights towards clearer evaluation, practical guidance, and evidence of what supports sustained RBC in different aged care settings.

Summary

This review shows that RBC in aged care is best understood as a practice oriented and principle driven approach, rather than a fixed model. While there is growing clarity about the principles underpinning rights based care, consistent implementation in everyday practice remains challenging. Translating rights into meaningful practice requires coordinated attention to system conditions, organisational support, workforce capability, and everyday behaviours and actions that enable rights to be realised in aged care settings.