A/HRC/30/43 80. Care work is often characterized by a heavy workload, long working hours and emotional exhaustion; and care workers tend to be undervalued, underpaid and undertrained. There is evidence that the satisfaction of persons receiving care correlates with the well-being of their care workers. 4. Elder abuse and violence against older persons 81. Abuse of and violence against older persons in home and institutional care settings, by both formal and informal caregivers, is still a taboo subject in many countries and an underreported problem. These older persons may be subjected to intimidation, aggression, inappropriate behaviour-control methods, negligence, or a failure to provide the appropriate or necessary care, among other forms of ill-treatment. 82. Risk factors for abuse and violence in care settings may relate to institutional aspects, such as poorly trained staff, also as a result of a lack of career prospects and high turnover, as well as a culture of tolerance of aggression towards patients. 83. Regular inspection and monitoring of home visits by certified care workers is necessary to ensure adequate quality of care and the protection of older persons, including against physical and mental violence, and from degrading treatment and neglect. 84. Certain countries have implemented technical services provided by public prosecutors to help older persons who are involuntarily hospitalized or involuntarily receiving medical treatment. Offices of an ombudsperson have also been created to support older persons in expressing their needs and decisions, and to seek remedy.18 In care facilities, committees composed of older persons have been put in place to supervise and evaluate the quality of the services, especially regarding food, hygiene and interaction with staff. 5. Geriatric services and palliative care 85. Older persons have different patterns of disease presentation than younger adults, they respond to treatments and therapies in different ways, and they frequently have complex social needs that are related to their chronic medical conditions. It is therefore important to ensure that sufficient doctors, staff and others qualified in geriatric health are available to ensure that these older persons can fully enjoy their right to health. 86. Particular attention needs to be given to palliative care. In certain countries, this is not officially recognized as a medical speciality and the medicine used in such care is limited, for several reasons, including restrictive drug regulations, failure to implement a properly functioning supply and distribution system, and inadequate health-care system capacity. 87. The Independent Expert stresses that the Special Rapporteur on the right to health and the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment qualified the failure to ensure access to controlled medicines for the relief of pain and suffering as a threat to the fundamental right to health and the right to be free from cruel, inhuman and degrading treatment. 19 6. Groups in focus 88. Particular attention should be given to specific groups of older persons when designing and implementing care policies, goods and services, in particular older women, 18 19 Economic Commission for Latin America and the Caribbean. Autonomía y dignidad en la vejez: Teoría y práctica en políticas de derechos de las personas mayores, pp. 82-83. Available from http://repositorio.cepal.org/bitstream/handle/11362/37523/S1421014_es.pdf?sequence=1 A/HRC/22/53. 15