A/HRC/42/43/Add.1 60. Under the new care system, which was launched in 2016, all older persons and persons with disabilities have the right to access care services. The Care Act recognizes the right of caregivers to perform their work in decent working conditions and aims to change the prevalent gendered division of labour. 61. Older persons’ care and care for persons with disabilities are some of the key services provided by the National Care System. A needs-based system, it offers personal assistants, tele-assistance and long-term institutional care. 62. Currently, 3 per cent of persons aged 65 and over receive institutional care. Uruguay has different types of institutional settings dedicated to older persons: nursing homes for older persons, private residences, and day-care centres and night shelters.23 63. Act No. 19149 and Decree No. 265/014 establish the obligations of providers of long-term care in institutions to guarantee respect for older persons’ rights to participation, privacy, decision-making, freedom of movement, promotion of autonomy, respect for private property and confidentiality. However, the implementation of the regulatory framework remains weak and fails to fully guarantee the fundamental rights and freedoms of older persons, leading to recurrent complaints about violations of the guaranteed rights of residents. 64. Cooperativa Caminos is the largest auxiliary care and therapeutic assistance organization in the country. It provides personal assistance in the home, in clinics and in hospitals and employs a multidisciplinary team of health professionals, including licensed nurses, medical practitioners and psychologists. Older persons and their families work together with the caregivers to create an individual care plan, stressing autonomy and family collaboration wherever possible.24 65. On 24 August 2017, Uruguay passed Act No. 19529 on Mental Health. Despite the efforts of and the dialogue facilitated by the National Commission for a Mental Health Law, a group of civil society organizations, the new law fails to incorporate a human rightsbased approach. While it provides for the establishment of a national mental health-care oversight commission, the Commission for the Control of Mental Health Care, it does not provide for that commission to have a sufficiently independent status. This hinders the commission’s ability to monitor the level of respect of patients’ human rights at all levels and to impartially review involuntary admissions, and thus contradicts the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. The persistence of the isolation model through prolonged hospitalization is another matter of concern. 66. There are no reliable data about older persons suffering from dementia. It is estimated that more than 10 per cent of older persons aged over 65, more than 40,000 persons, suffer from some form of dementia. In addition, it is estimated that 10 per cent of older persons in the community have depressive disorders. Figures are higher among older persons who are institutionalized (15–35 per cent) and those who are hospitalized (10–20 per cent). 67. The health system in Uruguay provides a very limited response to older persons with dementia, including in terms of treatment, which is exclusively pharmacological, and does not comply with internationally defined standards of quality and good practice. 25 Under the current National Integrated Care System, older persons with dementia are neither informed about the diagnosis nor included in decisions on treatment in the early stages of the disease. As a result, older persons become gradually objectified. 68. The National Palliative Care Programme was created in 2013 and provides guidelines for the operation of palliative care units. 23 24 25 Observatorio Iberoamericano de Protección a la Vejez: Capítulo Colombia, “Estudio comparado de los países seleccionados y Colombia: valoración de Uruguay”, 2017, p. 17. See https://cooperativacaminos.coop. Robert Pérez Fernández, “El tratamiento de las demencias en el sistema de salud de Uruguay”, Psicología, Conocimiento y Sociedad, vol. 8, No. 2 (November 2018–April 2019). 11