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Protection of Persons Restricted in their Freedom

Social Care Institutions

Visits and activities in 2008

Themed visits to 17 social service facilities for elderly people (hereinafter the “homes for the elderly”) were performed from April to October 2008. During the themed visits, the Defender concentrated primarily on the issues he had pointed out in his 2007 Annual Report. These include, in particular, the issue of factual inequality of parties concluding an agreement on the provision of a social service, the unsatisfactory position of persons formally capable of legal acts but in fact unable to make decisions on themselves or the non-uniform approach of founders to the division of services into basic and facultative services. The Defender also dealt with the financial aspect of clients’ stay in the facilities.

The Defender performed follow-up visits to four homes for the elderly where he wished to verify observance of the recommendations he had addressed to the management of the homes for the elderly after the visits in 2007. The Defender selected the Domažlice home for the elderly, the Kladno retirement home, the Podlesí home for the elderly, the Skalice home for the elderly, the Telč home for the elderly and the Krč home for the elderly for his follow-up visits.

The Defender ascertained that a part of the recommendations had been fully implemented by the facilities. These included, for example, the installation of bedside signalling, temperature controllers on heaters and increased specialisation with respect to elderly people suffering from dementia. There was also an improvement in the application of the standards of quality of social services and more intense work with the individual plans. The home rules of many facilities had also been reworked and the earlier practice of “permitting” or “approving” leave outside the home were no longer used. The homes had also accepted the recommendations directing the possibility of locking cabinets, rooms and toilets.  Almost all the homes increased the number of their personnel, in particular carers and social workers, and the homes were also establishing new jobs (a worker for leisure time activities, occupational therapist, etc.). Some homes had introduced external supervision to support their personnel.

On the other hand, some measures had not been implemented, for example the re-registration of permanent residence. Although the internal regulations grant the clients the right to a free decision as to whether to re-register their permanent residence, in fact the personnel still force them to re-register. The personnel also often do not provide the possibility of choosing the method of payment of pension (the only option in some facilities still being a “collective list”, where the pensions of all clients are remitted to the home’s joint account). In some cases the personnel of the facility (primarily social workers) perform the role of the clients’ guardians and the possibility of conflict of interest still persists.

As for the use of provisions restricting the freedom of movement, the personnel of the facilities pay increased attention to it (for example by documenting it more thoroughly or taking a more careful approach), but the Defender must reiterate that the use of provisions restricting the freedom of movement has accurate rules stipulated in Section 89 of the Social Services Act, which must be observed (e.g. the practice concerning the use of sideboards has not changed). A certain progress lies in the fact that clients with psychiatric diagnoses are no longer locked in their rooms.

The Defender deems the situation in the Podlesí home for the elderly as unsatisfactory. The facility has not yet adopted a revision of the home rules so as to correspond to the new legislation on social services (because the draft new text was sent one year ago to the operator (Vsetín Social Services) and the latter has not approved it to date)). A controlling approach to clients persists in the facility, the care plans concentrate only on satisfaction of basic needs (catering, housing, hygiene), and individualised planning of the provision of the service has not been introduced. Curtains for hygienic procedures are not used, the personnel is still not aware of how to use restrictive measures, sideboards for the prevention of falling are used in an entirely arbitrary manner and no records are kept of their use.

The elderly people are locked in the department for clients suffering from Alzheimer’s disease without permanent presence of the personnel. Haloperidol and other psychiatric drugs are used to sedate them only on the basis of a preliminary or general consultation (the doctor is not contacted after the application and the latter is not properly documented). It can be summarised in spite of the aforementioned shortcomings that the facilities have usually paid attention to the Defender’s recommendations and implemented a number of them in practice within the framework of their capabilities.

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