Safeguarding Older People Across Care Settings in Viet Nam: Preventing and Responding to Abuse, Neglect and Loss of Dignity
LONG-TERM CARE QUALITYAGE-FRIENDLY CARE QUALITY
Safeguarding Older People Across Care Settings in Viet Nam: Preventing and Responding to Abuse, Neglect and Loss of Dignity
LONG-TERM CARE QUALITY, AGE-FRIENDLY CARE QUALITY
Last reviewed: October 2026
An older person may depend on other people for help with bathing, meals, medications, mobility, finances or communication. That support may come from family members at home, health professionals in hospital, community workers, paid caregivers or staff in a long-term-care setting. Most care is provided with good intentions, but dependence can also create situations in which harm occurs, remains hidden or is difficult for the older person to report.
Sometimes the harm is obvious: physical violence, threats, financial exploitation or deliberate withholding of care. Sometimes it is less visible. An older person may repeatedly be left hungry or in soiled clothing, spoken to in a humiliating way, isolated from people they want to see, handled roughly during personal care, ignored when in pain, or prevented from expressing preferences because doing so is inconvenient for those providing care.
These situations do not all have the same legal meaning, and not every failure in quality constitutes abuse. But they raise a fundamental question for health and care organizations: how do we make sure that people who depend on care remain safe, respected and able to live with dignity?
In this article, safeguarding is used as a quality, safety and governance concept: the arrangements that help prevent harm, recognize concerns, protect an older person when necessary, respond appropriately and learn from what happened. The national legal and policy instruments reviewed here do not create one unified statutory safeguarding framework spanning every older-person care setting in Viet Nam.
Abuse of older people is broader than physical violence
WHO defines abuse of older people as a single or repeated act, or a lack of appropriate action, occurring within a relationship where there is an expectation of trust and causing harm or distress to an older person. It includes physical, sexual, psychological and emotional abuse; financial and material abuse; abandonment; neglect; and serious loss of dignity and respect. WHO considers abuse of older people both a public-health problem and a violation of human rights.
This broad definition matters because abuse is often imagined only as visible physical violence. Psychological abuse, neglect and financial exploitation may be much harder to recognize. An older person may depend on the same individual who is causing harm, have difficulty communicating, fear losing care or housing, worry about family conflict, or simply believe that poor treatment is something they have to tolerate.
WHO continues to report that around 1 in 6 people aged 60 years and older experienced some form of abuse in community settings during the previous year, based on a systematic review of 52 studies from 28 countries. This is an international estimate and should not be interpreted as a prevalence figure for Viet Nam. Evidence from hospitals, nursing homes and other institutional settings remains more limited and methodologically challenging.
The consequences can be substantial. WHO links abuse of older people with physical injury, depression, cognitive decline, financial loss, increased use of emergency and hospital services, institutional placement and premature mortality. Functional dependence, disability, poor physical health and cognitive impairment are among the factors associated with greater vulnerability.
For healthcare and long-term-care organizations, this makes safeguarding part of quality rather than an issue that sits outside routine care. WHO’s emerging Global Standards for Quality Health Care Services for Older People are being developed to support person-centered, integrated and responsive care that promotes functional ability, autonomy, dignity and quality of life across diverse settings.
Viet Nam already has important protections across family and healthcare settings
Several existing Vietnamese laws provide important protections, even though they do not form one unified safeguarding regime across the whole care continuum.
The Law on the Elderly No. 39/2009/QH12 prohibits insulting, maltreating, humiliating, persecuting or discriminating against older people. It also prohibits interference with their property and other lawful rights, failure to fulfil support obligations, exploitation of caregiving for personal gain, and forcing older people to work or undertake activities contrary to law.
Where harm occurs within family relationships, the Law on Prevention and Combat against Domestic Violence No. 13/2022/QH15, effective from 1 July 2023, provides another important layer of protection. The Law covers intentional conduct by family members that causes or may cause physical, psychological, sexual or economic harm. Of particular relevance to older people, it includes abandonment, failure to pay attention to, nourish or care for an older family member, as well as isolation and economic control. Older people are specifically identified among groups whose lawful rights and interests should receive priority protection.
The Law also establishes reporting and response mechanisms. Where a domestic-violence report concerns an older person, the chairperson of the commune-level People’s Committee assigns the commune police to handle the case. Depending on the circumstances and applicable legal conditions, available measures include requiring violent conduct to stop, police intervention, no-contact measures, temporary shelter and essential support, healthcare, legal aid and psychological counseling.
Healthcare settings have their own relevant protections. Under the Law on Medical Examination and Treatment No. 15/2023/QH15, patients have the right to respect for their dignity, health and privacy. Article 10 states that patients must not be stigmatized, discriminated against, maltreated or subjected to physical or sexual abuse during medical examination and treatment.
These protections matter because safeguarding cannot be reduced to an organization’s internal incident procedure. Where suspected conduct may constitute domestic violence, a criminal offense, a violation of patients’ rights or another legal breach, organizational processes need to connect with the relevant Vietnamese legal and public-authority mechanisms.
Safeguarding becomes more important as Viet Nam’s care continuum expands
Viet Nam’s older-person care architecture is changing quickly. The Law on Population No. 113/2025/QH15, effective from 1 July 2026, provides a new legislative foundation for older-person care, while Decree No. 168/2026/NĐ-CP develops more detailed arrangements for care at home and in the community.
Decree 168 provides for community care clubs and community day-care points, as well as participation by volunteers, commune health personnel, population collaborators, village health workers and social workers. Community day-care points are established within the commune-level health structure and must be organized in a way that ensures safety and is appropriate to the characteristics of older people.
Ministry of Health Decision No. 1976/QĐ-BYT of 1 July 2026 then provides professional guidance for older-person care at home and in the community, covering daily care, health support, training and technical guidance for people involved in providing that care.
These developments are important, but expansion also creates a quality-governance challenge. More settings, workers, volunteers and caregivers mean more interfaces at which responsibilities, professional boundaries and safeguards need to remain clear.
The National Strategy for Older People to 2035, approved by Decision No. 383/QĐ-TTg in 2025, explicitly recognizes violence and abuse as national concerns. For 2025–2030, it sets a target that at least 80% of older people facing financial difficulty, violence or abuse should receive legal-aid services in accordance with legal-aid law when they need them.
The next challenge is therefore not merely to expand access to care. Protection from harm, neglect and loss of dignity needs to develop alongside that expansion.
Neglect and loss of dignity may be less obvious than abuse
Neglect is particularly difficult because poor care and abuse do not always have a clear dividing line. An occasional mistake or delay does not automatically establish neglect or abuse. What should attract attention is the broader pattern: essential needs repeatedly going unmet, foreseeable risks being ignored, significant deterioration not being acted upon, or care becoming systematically unsafe because no one takes responsibility for what the person needs.
For an older person with substantial dependency, missed care can have serious consequences. Inadequate support with drinking may contribute to dehydration. Poor repositioning can increase pressure-injury risk. Failure to provide toileting assistance can cause distress, skin problems and loss of dignity. Failure to recognize an acute change in cognition may delay assessment of delirium or illness, while prolonged inactivity can contribute to functional decline.
The cause also matters. Some situations may involve deliberate disregard, while others may emerge from caregiver exhaustion, inadequate training, understaffing, weak supervision or poorly designed systems. A quality response therefore needs to look beyond the question of whether there is a “bad caregiver” and ask what circumstances allowed unsafe care to develop or continue.
Dignity deserves similar attention. WHO explicitly includes serious loss of dignity and respect within its definition of abuse of older people. This does not mean that every disrespectful interaction automatically constitutes abuse under Vietnamese law, but recurring loss of dignity can be a warning that the culture of care is becoming unsafe.
Talking about an older person as if they were not present, unnecessarily exposing their body during personal care, using humiliating or infantilizing language, disregarding preferences purely for staff convenience, or assuming that cognitive impairment means a person has nothing meaningful to contribute can all undermine person-centered care.
Dignity therefore needs to be built into routine practice through privacy during intimate care, respectful communication, attention to personal and cultural preferences, involvement in decisions to the extent possible, and ways for people to raise concerns without fear.
Safeguarding needs prevention, recognition and a reliable response
Teaching staff a list of warning signs is not enough. A safeguarding system needs to connect prevention, recognition and response.
Prevention begins with the conditions under which care is delivered: clear roles, appropriate competency and supervision, realistic staffing, caregiver education, attention to workload, safe medication practices, respect for privacy, appropriate controls where staff handle money or property, and accessible ways for older people and families to raise concerns.
People also need to recognize possible warning signs. These may include unexplained or recurrent injuries, inconsistent explanations, sudden fear of a particular caregiver, unexplained poor hygiene, malnutrition or dehydration, untreated pain, unusual financial changes, social withdrawal or marked changes in behavior. None of these findings proves abuse on its own. They indicate that something may require further assessment.
When a concern arises, workers need to know who receives it, who has authority to assess the situation, when senior management or another designated responsible person should become involved, when urgent healthcare or immediate protection is required, and when the concern should be reported to a competent authority under applicable Vietnamese law.
The older person’s immediate safety should come first. Internal review should not delay urgent medical care, necessary protection or reporting to competent authorities where required by law.
Protection should not silence the older person
Safeguarding can become paternalistic if the desire to protect someone becomes a reason to stop listening to them.
An older person may choose to remain in a relationship that professionals find difficult to understand. They may value independence even when it involves some risk, decline a proposed intervention or hold priorities that differ from those of their family. Those choices cannot simply be dismissed because of age.
At the same time, cognitive impairment, communication difficulty, fear, dependence or coercion may limit a person’s ability to explain what is happening freely. Good safeguarding therefore requires careful communication rather than assumptions. Where appropriate, professionals should create opportunities to speak with the older person privately, use communication support when needed and distinguish as carefully as possible between an informed preference and a situation shaped by pressure or control.
In healthcare, Vietnamese law contains specific provisions governing the exercise of patient rights where a person cannot exercise those rights independently or has difficulties with cognition or behavioral control. Organizations should therefore follow applicable Vietnamese law and professional guidance rather than importing assumptions about capacity, representation or decision-making from other jurisdictions.
Family caregivers also need to be part of prevention. Most family caregivers are not perpetrators of abuse; they are often the people keeping an older relative safely at home. But severe dependency, dementia, behavioral symptoms, continuous caregiving and financial or emotional strain can make care extremely demanding.
WHO identifies caregiver interventions that reduce caregiving burden among the more promising approaches for preventing and responding to abuse of older people, while also noting that the overall evidence base for many interventions remains limited. Supporting caregivers therefore matters, not because caregiver stress excuses harmful behavior, but because reducing avoidable burden may reduce some of the conditions in which unsafe care develops.
Organizations need a culture in which concerns can be raised
Safeguarding becomes difficult when speaking up feels dangerous. An older person may fear worse treatment if they complain. A family member may worry that raising a concern will jeopardize access to care. A junior employee may hesitate to question a senior colleague. Repeatedly rough or disrespectful practices can gradually become normalized because they are described as “just how things are done here.”
Organizations therefore need more than a complaints box. Older people and families should know how to raise concerns and what will happen next. Staff should have clear internal channels for reporting genuine concerns in good faith, while management should create an environment in which people can speak up without inappropriate adverse treatment.
Managers also need to distinguish among different types of problems. Deliberate misconduct, a competency gap, caregiver overload, inadequate staffing and a poorly designed process may require different responses. Serious allegations still need appropriate assessment and escalation, but identifying the underlying cause is essential if the organization wants to prevent recurrence.
Where conduct may constitute domestic violence, a criminal offense, a violation of patients’ rights or another legal breach, internal governance processes should connect with the relevant Vietnamese legal and public-authority mechanisms. An internal incident report does not replace action required under applicable law.
A safe reporting culture is therefore not one in which an organization can simply point to a very low number of incidents. It is one in which concerns can be raised, examined, acted upon and learned from.
Measuring safeguarding requires more than counting confirmed abuse
Safeguarding is difficult to measure because confirmed cases represent only part of the picture. A low number of reports may mean little harm is occurring, but it may also mean that people do not know how to report concerns or do not feel safe doing so.
Organizations may therefore need a broader set of signals. Depending on the setting, these might include staff knowledge of safeguarding responsibilities, time from concern to review, completion of required escalation, recurring complaints about dignity or communication, unexplained injuries, missed essential care, caregiver concerns, repeated medication or financial discrepancies, workforce turnover, and whether incidents result in documented learning and improvement.
The experience of older people is equally important. Do they feel safe? Are they treated respectfully? Can they speak privately with someone if they are worried? Do they know how to raise a concern? Do they believe that a complaint will be taken seriously?
These are illustrative quality measures, not a proposed national safeguarding indicator set for Viet Nam. Their purpose is to demonstrate an important principle: safeguarding cannot be understood from a single incident count.
Viet Nam can build safeguarding into services as they develop
Creating an integrated safeguarding framework across healthcare, social care, domestic-violence services, justice, local government and long-term care would be a substantial undertaking. Organizations do not need to wait for such a framework before improving their own systems.
Hospitals could incorporate possible abuse and neglect into appropriate clinical assessment, discharge planning and staff education, particularly for older people with substantial dependency, frailty or cognitive impairment. Existing patient-rights provisions under the Law on Medical Examination and Treatment already provide an important foundation for dignity and protection within medical settings.
Home- and community-care programs could train workers to recognize concerns and define how these should be escalated to commune health services, organizational management and competent authorities where appropriate. Long-term-care providers could establish clear responsibilities for prevention, reporting, resident and family complaints, incident review and governance oversight.
Newer community models provide an opportunity to build protection in from the beginning. Decree 168 requires community day-care points to be organized safely and appropriately for older people. Dignity, privacy, safe assistance, supervision and escalation can therefore be designed into local operating procedures before poor practices become established.
Local pilots could answer questions that international frameworks cannot resolve for Viet Nam: Which warning signs are most useful in Vietnamese care settings? Who should receive the first concern? How should health, social and legal responses connect? What support helps family caregivers most? How can confidentiality be protected while necessary information reaches the right authority? Which measures genuinely tell us whether older people feel safer?
The answers should be developed for Viet Nam rather than copied uncritically from safeguarding systems designed for different legal and service environments.
Safeguarding is ultimately about whether care remains worthy of trust
Older people who need care may have to trust other people with some of the most personal parts of their lives: their body, medications, money, home, private information and everyday decisions. That trust creates responsibility.
Viet Nam already has important legal foundations. The Law on the Elderly prohibits maltreatment, humiliation, discrimination and exploitation. The Law on Prevention and Combat against Domestic Violence addresses harmful conduct within family relationships and provides mechanisms for reporting, protection and response. The Law on Medical Examination and Treatment protects dignity and prohibits maltreatment and physical or sexual abuse during healthcare. The National Strategy for Older People recognizes violence, abuse and access to legal assistance as national concerns, while the 2026 population and older-person-care framework is expanding the ways care can be provided at home and in the community.
As the care continuum develops, protection from harm needs to develop with it.
For healthcare and long-term-care organizations, the most useful question is therefore not simply, “Have we had any confirmed cases of abuse?” It is:
“Can older people, families and staff recognize when care is becoming unsafe, raise a concern without fear, and rely on a system that will protect the person, respond appropriately and learn from what happened?”
When the answer is yes, safeguarding becomes more than a response to abuse. It becomes part of the infrastructure for safe, dignified and person-centered older-person care.
References
World Health Organization. Abuse of older people. Fact sheet. 15 June 2024.
World Health Organization. Tackling abuse of older people: five priorities for the United Nations Decade of Healthy Ageing (2021–2030). Geneva: World Health Organization; 2022.
World Health Organization. WHO Global Standards for Quality Health Care Services for Older People — Technical Working Group Members. 23 August 2026.
National Assembly of Viet Nam. Law on the Elderly No. 39/2009/QH12. 23 November 2009.
National Assembly of Viet Nam. Law on Prevention and Combat against Domestic Violence No. 13/2022/QH15. 14 November 2022; effective 1 July 2023.
Government of Viet Nam. Decree No. 76/2023/NĐ-CP detailing selected provisions of the Law on Prevention and Combat against Domestic Violence. 1 November 2023; effective 25 December 2023.
National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. 9 January 2023; effective 1 January 2024.
Prime Minister of Viet Nam. Decision No. 383/QĐ-TTg approving the National Strategy for Older People to 2035, with a vision to 2045. 21 February 2025.
National Assembly of Viet Nam. Law on Population No. 113/2025/QH15. 10 December 2025; effective 1 July 2026.
Government of Viet Nam. Decree No. 168/2026/NĐ-CP detailing selected provisions and implementation measures of the Law on Population. 15 May 2026; effective 1 July 2026.
Ministry of Health of Viet Nam. Decision No. 1976/QĐ-BYT issuing professional guidance on care for older people at home and in the community. 1 July 2026.