Workers' rights and issues: what does navigating tensions between rights of workers and older people mean?
People have rights regardless of whether they are providing aged care services or receiving them. Aged care workers have the right to a safe, healthy, respectful, and inclusive work environment and quality working life. [1] Safe and healthy environments help support workers do their job well and are supportive when incidents occur. Respectful and inclusive environments value and recognise the work being done and support a culture of respect for everyone. Quality working life includes right to fair pay and other entitlements such as allowances and right to feel valued and fulfilled. [2, 3]
Older people’s rights are described in the Aged Care Act 2024 and includes a Statement of Rights for older people accessing aged care services. [4, 5] These rights are about having:
- Independence, choice and control in making decisions for oneself
- Fair access to aged care assessment and services
- Safe and quality aged care services
- Respect for privacy and information
- Communication that meets the needs
- Support to raise issues quickly and fairly, and
- Support and connection with people and community.
Tension arises when these rights pull in different directions. For example:
| Workers’ rights | Older people’s rights | Where tension occurs |
| Right to deliver safe and quality care | Right to safety and privacy (e.g., receiving intimate care) | Delivering safe and quality care but compromising older people’s privacy [6] |
| Right to deliver safe and quality care | Right to family-centred care | Vague visitation policies at the time of COVID-19 including for people at the end of life [7] |
| Right to personal beliefs and moral integrity | Right to non-discriminatory, equitable care | Workers’ religious beliefs conflict with residents’ rights (e.g., LGBTIQ+ care) [8] |
| Right to personal and religious beliefs | Right to make own decisions (e.g., voluntary assisted dying) | Workers’ beliefs are not aligned with voluntary assisted dying [9] |
Both aged care workers and older people have important rights, but they may not always align. Navigating tensions means recognising these rights and involves making fair, transparent decisions that respect the dignity, safety and wellbeing of older people while also protecting the rights, safety and ethical responsibilities of workers. [7-10]
Why does this matter for rights-based care?
Navigating tensions between the rights of workers and the rights of older people is essential because the quality of care depends on both groups being supported. A rights-based approach in aged care aims to protect the dignity, autonomy, and safety of older people and uphold the rights of the aged care worker.
Organisations should emphasise shared beliefs and values that put the wellbeing of older people first. A clear focus on these values helps improve service quality and gives workers the support they need to provide consistent, respectful care. [2] Workplaces with positive organisational cultures are able to provide a good experience for both workers and aged care service recipients. [11]
Care practices that respect older people’s rights increasingly rely on negotiation between workers, older people, and organisations. [6] The next section provides examples from the literature on how to navigate tensions seen in practice between the rights of workers and older people.
Safety and privacy
Older people receiving aged care are entitled to privacy and dignity as fundamental human rights. [5] Protecting an older person’s right to privacy is vital to preserving dignity. Aged care workers must deliver safe and quality care to older people and need to be supported in doing their job well. This includes receiving support when delivering complex care and when unusual incidents happen. [1]
Tension may arise when urgent, complex or intimate care that exposes body parts needs to be provided. Some residents may also need nighttime monitoring, requiring staff to enter residents’ rooms frequently. These types of care can be disruptive, especially in shared rooms, and can breach the privacy rights of older people. [6,12]
Workers need to prioritise safety in providing complex or intimate care, while ensuring ethical care behaviours, such as:
- explaining and asking permission before doing a sensitive or intimate assessment or care service,
- keeping personal information confidential, and
- knocking on doors before entering. [6, 12]
Visitation policies during infectious outbreaks
Visitation policies in hospitals and aged care facilities during infectious outbreaks, such as the COVID-19 pandemic, aim to reduce infection risk. [7, 13] Tension occurs when strict but ambiguous visitation policies are implemented in hospitals and aged care facilities. A vague, case‑by‑case policy may give managers flexibility, but it can pressure families and leave managers making tough decisions without clear guidance. [7]
Keeping people apart can cause harm, including distress, poorer mental health and reduced quality of care. At the time, many rejected the idea that protecting the community meant that older people must face serious illness or death without family support. [7]
Older people have the right to be supported and connected to the people important to them, including their family and loved ones, especially at the end of life. [4, 5] Aged care workers must deliver safe and quality care and have rights to be supported in doing their job well, including times when infectious outbreaks happen. Workers have the right to a safe workplace and clear policies that do not force them to make distressing decisions alone. [7]
Clear and consistent visitation policies and communication plans are required to uphold the rights of older people and the workforce during infectious disease outbreaks, rather than relying on case‑by‑case arrangements. Workers who are uncomfortable with the policies should be supported through clear communication, and proper consultation. [14]
Aged care providers can think of innovative ways to support the ongoing health, safety and wellbeing of the people they care for, including helping them stay connected with loved ones and take part in meaningful activities. [14] Face-to-face visits may be conducted safely where appropriate risk mitigation measures are in place. These include protocols around visitor screening, good hygiene practices such as hand hygiene and cough etiquette, and the use of personal protective equipment where required. Phone and video conversations can be used to stay connected. [15]
LGBTIQ+ care
The Statement of Rights and the Aged Care Quality and Safety Commission protect the rights of older people and workers to access and provide aged care that is safe, fair, respectful and inclusive of diversity. [1, 4, 5] This includes respecting LGBTIQ+ residents’ care needs. [8, 10]
Tensions can arise when some workers’ religious or moral objections conflict with LGBTIQ+ residents’ rights to safe, respectful, non-discriminatory care. This reflects a broader pattern of bias and discrimination experienced by LGBTIQ+ residents in aged care settings. [8, 10]
Managers and aged care workers can address these situations by talking about the impact of denying care and by using the same fairness and safety arguments that support refusing religious exemptions. They can also remind workers of their legal and policy obligations not to deny care to any resident, including LGBTIQ+ residents. [8, 10]
*LGBTIQ+ is one of several inclusive acronyms used to describe people with diverse sexual orientations, gender identities and sex characteristics. The language is fluid, and terms are often used interchangeably depending on context, preference and community use. It commonly refers to lesbian, gay, bisexual, transgender, queer or questioning, intersex and asexual people, with the plus sign recognising other identities not explicitly listed.
Voluntary assisted dying
Physician‑assisted death or voluntary assisted dying (VAD) in the Australian context is when a doctor or health practitioner provides medication to a person with terminal illness to end their life. [9, 16] There are specific laws governing VAD in different Australian states/territories.
Older people receiving care have defined rights to make their own decisions, to be treated with dignity and respect, to have their privacy protected, and to access lawful services, such as VAD. [4, 16] However, aged care workers, especially health practitioners, may have personal or religious objections to VAD.
Aged care workers come from diverse backgrounds, with their own set of values and culture, such as personal beliefs in VAD, that should also be respected. [1] They have the right to refuse to participate in the process, but cannot prevent a person from seeking information or pursuing VAD. [9]
Aged care workers/health practitioners must still ensure older people can access VAD by referring them to an alternative practitioner. They also have responsibilities to handle VAD requests appropriately, maintain confidentiality, and work collaboratively across disciplines to provide coordinated end‑of‑life care. [9]
Refer to the End of Life Law in Australia for a comprehensive guide to VAD.
Want to learn more?
Explore these resources for a comprehensive understanding of the rights of all people, older people and workers:
To learn about the principles of rights-based care, read the Background and Context section.
What can be done?
Understand and embed rights in everyday practice
Care teams:
- Know and acknowledge the rights of older people in care settings.
- Know your own rights as an aged care worker.
Organisations:
- Embed the Statement of Rights for older people in everyday practice.
- Embed workers’ rights in everyday practice.
- Ensure and support a safe and respectful workplace.
- Establish a shared framework in the organisation that helps everyone understand and uphold the rights of both older people and workers.
The evidence:
- Rights-based approaches provide a framework for aged care providers to protect and promote the rights of residents in aged care facilities, strengthening their freedom of choice and ultimately enhancing their quality of life. [2]
- These approaches emphasise residents’ rights — first and foremost the right to be an active participant in decisions which affect them. It involves service providers working in collaboration with residents to determine care and services based on their rights, values and preferences as well as their needs. [2]
- Aged care workers are also recognised as having rights, even though rights‑based approaches have usually focused on older people. Having rights to a quality working life, where quality is described not only in extrinsic terms of physical conditions of pay, safety and welfare, but also in terms of intrinsic, psychological states such as value and fulfilment. [2]
Safety and privacy
Care teams:
- Respect personal space and privacy of older people. Knock before entering the room.
- Explain to the older person and/or family members if some care services may expose some body parts. Focus on achieving safe and quality care for the wellbeing of the older person.
- Reassure and support the older person especially when managing complex care or a serious event.
- Avoid sharing older people’s personal information.
Organisations:
- Implement privacy policies and protocols in the organisation.
- Provide staff training on respecting rights, privacy and dignity, and decision-making related to safety and privacy.
- Remind the whole organisation about shared values and priorities for safety and privacy.
Organisations and policymakers:
- Design spaces that respect personal space and privacy, such as modular designs or use of sliding doors or curtains to enable personal space in shared rooms. Read about personalised lifestyles and environment.
The evidence:
- The most common manner of upholding respect was by providing reassurance and support to residents in the management of an adverse event, both verbally and physically. [12]
- Staff training on dignity-preserving care helps balance safety protocols with resident preferences. [6]
- Addressing privacy and personal space requires the use of environmental design, ongoing training and education for caregivers, to support residents’ independence, privacy and wellbeing. [6]
Visitation policies in times of infectious outbreaks
Care teams:
- Recognise rights of older people to be connected with their families and loved ones especially at the end of life during infectious outbreaks.
Managers/leaders and organisations:
- Develop and implement clear visitation policies that respect the rights of older people and the workers in time of infectious outbreaks.
- Assist older people and families and workers manage end of life rights to be with the family and minimising risk of infection.
- Learn more about infection control and COVID-19 in aged care in the following ARIIA pages: Infection prevention & control and COVID-19
- Read about the Australian Government policies on:
- Managing COVID-19 in aged care
- Visitor restrictions for COVID-19
- National Outbreak Management Guideline for Acute Respiratory Infection (including COVID-19, influenza and RSV) in Residential Aged Care Homes
The evidence:
- Special considerations can be made for residents receiving palliative care or approaching end of life. [14]
- Visitation risks could be managed through appropriate precautions and prioritisation.[7]
- Establish a comprehensive communication plan to support regular and transparent communication with staff, residents, families, and visitors during an outbreak. Incorporate strategies that enable residents to remain socially connected with family and friends and reduce feelings of isolation. [14]
LGBTIQ+ care
Care teams:
- Recognise rights of older people and ensure equal treatment of older people regardless of identity.
- Speak to supervisors if there are concerns about care being provided for LGBTIQ+ residents.
Managers/leaders:
- Remind care teams about policies of inclusion, and non-discrimination that applies to both workers and older people.
- Remind workers that denying care is not fair and that it can have negative impacts.
Organisations:
- Remind the whole organisation about shared values and priorities as well as the importance of respecting individual differences and beliefs.
The evidence:
- Responding to concerns regarding the denial of care to LGBTIQ+ residents requires consideration of fairness, resident safety and comfort, professional and employment responsibilities, religious considerations, and alignment with relevant legislative and policy frameworks. [8, 10]
- Managers generally relied on laws and policies to guide decision-making. Even where specific policies were not explicitly referenced, their use provided clarity, reduced uncertainty and minimised the potential for conflict. [8]
Voluntary assisted dying
Care teams and health practitioners:
- Recognise rights and preferences of older people including VAD.
- Speak to supervisors if there are concerns raised about VAD by older people.
Managers/leaders and organisations:
- Refer the older person to another practitioner or facility if VAD conflicts with personal and organisational principles.
- Refer to the End of Life Law in Australia for a comprehensive guide to VAD.
The evidence:
- The end-of-life experience is deeply personal and varies from person to person; therefore, it is essential for lawmakers and healthcare providers to recognise it as a unique and subjective process for each individual. [9]
- VAD laws in Australia differ by state. Providers must be familiar with and comply with the legislation in their jurisdiction.[16]