Organisational considerations
Factors to consider when operationalising RBC
Aged care provider organisations have several responsibilities related to rights-based care:
- They must practice duty of care, which is a legal and moral obligation to take reasonable steps to prevent harm, and dignity of risk, which is defined as supporting an individual’s right to make choices that involve risk in order to live a dignified life. [1]
- They must practice safeguarding, which includes the ways that aged care providers keep older people safe, and open disclosure, which requires providers to report and repair after an adverse incident occurs.
- They must demonstrate accountability through effective complaints pathways and advocacy for older people in their care.
Why does this matter for rights-based care?
Organisational duties can uphold or undermine older people’s rights.
Duty of care, dignity of risk, and clinical governance
Aged care providers are required to take reasonable steps to prevent harm. This concept is called duty of care, and it represents the minimum standard that providers must take to keep older people safe.
Risk is commonly framed as prioritising physical safety and risk avoidance. Organisations sometimes interpret duty of care to mean that all risk should be avoided, it can shift the focus away from supporting the older person’s rights. Overly risk-averse practices in residential aged care can limit dignity, autonomy, and quality of life. Dignity of risk requires reframing risk as having both potential harms and benefits. [1]
Sometimes duty of care and dignity of risk can compete with other organisational pressures such as convenience (‘it would take too much effort to change policy’), efficiency (‘it would take too long to ensure the older person can take a risk safely’), or financial impact (‘it would cost too much to put safeguards in place’). When this happens, it can also suppress older people’s rights. [2]
While individual aged care workers are responsible when providing care directly to the older person, organisations are responsible for providing appropriate training , implementing policies that support duty of care and dignity of risk, and learning from and implementing feedback to improve services beyond harm minimisation. [1-3]
Flexible policies and risk management frameworks that reflect dignity of risk principles can enable staff to support residents to take reasonable risks. [1] Decision-making processes should prioritise courses of action that produce the least number of restrictions on resident rights. [4] Participatory risk assessment includes the older person in making decisions about how taking risks will impact their quality of life, rights, and choice. [5]
Clinical governance provides a framework for leading, monitoring or improving the safety and quality of care. It supports harm prevention alongside better clinical outcomes by continuous improvement through leadership, policies, procedures, and processes related to oversight. The Aged Care Act (2024) and Aged Care Quality Standards hold organisational boards accountable for ensuring effective clinical governance. [6, 7]
Duty of care and dignity of risk can be reflected in clinical governance frameworks to outline how care is delivered. Through the lens of RBC, clinical governance can support dignity of risk by enabling workers to make rights-based decisions, implementing safeguarding policies that encourage complaints and feedback, and learning from errors and improving care. [2, 8, 9]
Safeguarding
Safeguarding focuses on the prevention and protection of older people at risk of harm, and includes the actions required to keep them safe. Safeguarding is a core organisational responsibility that must be preventative and responsive. It is dependent on rights-focused policies and procedures, staff training, complaints pathways, whisteblower protection, and monitoring and oversight processes. [2, 10, 11]
Providers must ensure that rights-based values are embedded in policies, escalation pathways, and training so that rights violations can be identified, prevented and addressed. It requires advocacy, mediation and education to prevent and address rights violations. [12]
Open disclosure
The Aged Care Act requires providers to practice open disclosure when something goes wrong. Open disclosure requires apologising, explaining what happened, and discussing steps to prevent it from happening again. This mandatory process is reflected in the Aged Care Quality Standards 6 (Feedback and Complaints) and Standard 8 (Organisational Governance). [7]
Good open disclosure policies are important because organisational responses to harmful events can be perceived as insufficient, dismissive, or lacking post-incident support. [13] Helpful responses after a harmful incident include advocacy, mediation, and education to protect rights and encourage reflection and learning. [12] Clear organisational policies are needed to support appropriate responses and learning after harm occurs. [14] These policies should be reflected in organisations’ clinical governance frameworks.
Complaints and advocacy
Aged care providers are required to have robust feedback and complaints mechanisms to uphold older people’s rights. [7] The research suggests that organisations should understand complaints as a key tool to uphold rights and take them seriously - not just to think of them as a way to provide feedback on the service. [11]
The research shows that organisations should ensure a transparent and supportive environment where older people feel safe to make a complaint. Fear of retaliation can cause complaints to go unaddressed, which means rights may be violated. [5, 15]
Advocacy means giving older people opportunities to speak up about their needs and preferences, and raise concerns when they feel their rights are at risk. [16, 17]
Organisations should enable older people in their care to have meaningful input into organisational policies that affect them. These can be formal or informal opportunities for them to participate, such as service design. [12, 16]
Advocacy and complaints pathways work hand in hand to uphold older people’s rights. Advocacy provides opportunities for older people to express their needs and preferences early, while complaints pathways provide opportunities for correction if a person’s rights are not upheld.
Want to learn more?
The resources below support aged care providers to fulfil their obligations under RBC.
This Risk Enablement Framework provides guidance for balancing duty of care with autonomy, dignity, and choice.
This presentation outlines effective strategies for balancing dignity of risk and duty of care.
The Clinical Governance priority topic provides evidence summaries and resources to support organisations to implement effective clinical governance frameworks.
This guidance from the Aged Care Quality and Safety Commission provides a framework for implementing open disclosure in aged care organisations.
These resources outline rights-based complaints processes:
- Asking for a review of a complaint decision
- Better practice guide to complaints handling in aged care service
- Making a complaint
- Dealing with complaints
- Rights-based complaints and feedback handling checklist
- What to do if you have a complaint
- Checklist for practitioners handling feedback and complaints
This Self-Advocacy Toolkit helps older people understand their rights and speak up about their concerns.
What can be done?
Embed rights in policies and procedures
Organisational leaders:
- Review and revise organisational policies to explicitly prioritise residents’ rights.
- Ensure policies make rights operational, not just aspirational.
The evidence:
- Studies show that rights must be embedded in formal organisational rules to guide everyday decision making, especially where rights conflict with efficiency or convenience. [2, 17]
Provide workforce training in RBC
Organisational leaders:
- Deliver regular training on human rights, dignity, autonomy, and participation.
- Include rights-based decision making in induction and ongoing education.
- Support staff to understand how rights apply in complex situations, such as with dementia or intimate relationships.
The evidence:
- The literature consistently shows that rights based practice requires skill and confidence, which can be improved through effective training. [18, 19]
- Training in rights-based care, especially as it applies to complex situations, should be coupled with ongoing organisational support. [20]
Establish and strengthen safeguarding, open disclosure, complaints, and feedback systems
Organisational leaders:
- Ensure clear, accessible complaints processes for residents and families.
- Actively protect older people who make complaints from retaliation.
- Communicate with staff and older people that complaints are a right, not an inconvenience.
- Integrate safeguarding into everyday practice, not only incident response.
- Practice open disclosure to repair after harmful incidents and prevent reoccurrence.
The evidence:
- Safe complaints systems are central to rights enforcement. [11]
- Services should create a supportive and transparent environment where people feel safe to make a complaint without fear of retaliation. [5, 15]
- Organisations may lack adequate post incident support, leading to insufficient remediation. [13]
Support advocacy by staff, residents, and families
Organisational leaders:
- Encourage staff to act as advocates for residents’ rights.
- Support residents’ participation in decisions and governance.
- Value advocacy as part of professional and organisational responsibility.
The evidence:
- Advocacy supports the upholding of rights and should not be seen as a challenge to organisational authority. [12, 16]
- Implementing rights-based frameworks in organisations enhances older people’s ability to meaningfully participate in the creation of policies that directly impact them. [16]