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Chancellor of Justice: Many problems found in special care homes and hospitals

Last year, advisers to the Chancellor of Justice visited four psychiatric hospitals, six special care homes and 12 nursing care hospitals to see how the rights of residents are protected. In many institutions, problems were detected in the storage of medicines and their administration to residents. There are also doubts regarding residents’ dignity always being guaranteed in these places.

In 2014, the Chancellor of Justice gave special attention to the aspects of handling and administering medicines when inspecting psychiatric hospitals, special care homes and nursing care hospitals and thereby cooperated actively with the State Agency of Medicines. Deputy Chancellor of Justice Nele Parrest said that medicines were not stored in accordance with requirements in several institutions or that there were problems with their administration to residents.

Inspections of some special care homes gave rise to suspicions that medicines were being administered to residents outside of their treatment plans and against their will. The Deputy Chancellor of Justice said that care homes are not allowed to force anyone to take medicines: involuntary treatment is only permitted in psychiatric hospitals and hospitals for infectious diseases. “Involuntary treatment is forbidden in care homes, so it’s unacceptable if medicines are added to a resident’s drink without telling them about it,” Parrest explained. She also expressed concern about the fact that in some care homes the administration of medicines was decided by activity instructors who do not have the required competence.

There were also problems in the handling of medicines. For example, in some places medicines were stored in unlocked rooms that were not constantly guarded, which means that service users had access to them and potentially put their life or health in danger by taking them arbitrarily.

Parrest said that there were also problems in keeping account of medicines – for example, there was no overview of the quantities and administration of prescription drugs. “Some institutions kept medicines belonging to residents who had left, expired medicines or medicines that service users no longer had to take,” she said. “These medicines were collected for administration to other residents, often by employees without the relevant competence. This is a dangerous tendency, as it could be the case that the confluence of medicines is not assessed when the medicines of one resident are administered to another without a doctor’s prescription, which could place the resident’s life and health in danger.”

The Chancellor of Justice made recommendations about the handling and administration of medicines after the inspection visits of 2014 to Erastvere Home, Valkla Home, Hiiu Care Centre, Järva County Hospital, Jõhvi Hospital, Kuressaare Hospital, the Psychiatric Department and the Nursing Care Department of Narva Hospital, Narva-Jõesuu Care Home, Paunküla Care Centre and Wismar Hospital.

The inspection visits of the Chancellor of Justice to psychiatric hospitals, special care homes and nursing care hospitals last year give reason to suspect that treating residents in a dignified manner may be a problem in some institutions. “Institutions could turn more attention to offering leisure activities for residents, as boredom makes people passive in regard to their lives,” Parrest said. “Inactivity can also cause anxiety, which has an adverse effect on recovery.” The Deputy Chancellor of Justice also found that the privacy of residents was often not guaranteed. For example, service users often had to carry out hygiene procedures in full view of others – there was no option of being alone or in silence, and they could not use screens.

The Chancellor of Justice made recommendations about guaranteeing the dignity of service users to Erastvere Home, Valkla Home, Hiiu Care Centre, Järva County Hospital, Võnnu Hospital, Narva Hospital, North Estonia Medical Centre, the Psychiatry Clinic and Nursing Care Department of Tartu University Hospital and Wismar Hospital.

Parrest said that another important problem is that not enough activity instructors worked in special care homes, leading to the suspicion that the institutions are unable to guarantee appropriate services and a safe environment. For example, an employee had to be at work for 17 hours in a row in one care home, and during one evening visit it was found that the activity instructor, who was on duty alone, did not remain in the department at all times, meaning that the department was not constantly supervised. In psychiatric hospitals, there were problems in the documentation of the application of restraining measures. Similar to the observations made in 2013, the Chancellor of Justice had to admit when visiting nursing care hospitals that the required consent for providing services to persons with limited active legal capacity (e.g. people suffering from dementia) is often not obtained.

In order to draw attention to the most important issues noted during the visits to the psychiatric hospitals, special care homes and nursing care hospitals, the Chancellor of Justice sent memos to all services providers requesting that each of them review their practices and make any necessary changes.

Summaries of the inspection visits in English.