◎Photo: Pexels.com

Author: Pavel Doubek (Czech scholar and lawyer formerly working at Czech NPM)^[i]

In 2014, the Czech NPM made a plan to regularly and systematically visit private social-care homes for elderly people, since the living conditions and treatment with elderly people in these institutions were still not sufficiently inspected and it was thus necessary to find out whether they are protected against torture and other forms of ill-treatment. 

In Czech, there are basically two types of facilities providing care for elderly in need of intensive support: general Elderly homes (533) and Homes with special regime for elderly suffering from dementia or other mental disability (352). Some homes for people with disability can also accommodate elderly people (205). As for illegal facilities that are unregistered, the number are unknown. The Czech NPM had visited elderly homes in 2006, 2007, 2008 and 2013. 

This series of visits followed-up visits to elderly homes in previous years and focuses on facilities that provided social-care services illegally (without state registration), which was supposed to increase the risk of torture and ill-treatment. 

Unannounced visits help curb inhuman practices

A team composed of 4 lawyers and medical expert set out for a visit in afternoon hours. Our visit was unannounced, thus we had to first find a director of the social-care home and explain to her the purpose of the visit, our mandate and competencies. Soon after the initial talk, which took just a few minutes, we proceed to visit the elderly home’s premises (such as rooms, toilets, nurses’ room, etc.), ask the residents about their experience of living in a facility, talk to nurses and other staff and review medical records and other documents. Although the initial talk with the facility director and the first review of formal documents did not indicate any problems, consequent monitoring revealed a different picture of reality.

After entering the living premises, we immediately encounter various forms of poor quality care that often reached the level of ill-treatment. In most rooms, there were a smell of urine, number of diapers scattered around, freely accessible medicaments and open medical records containing sensitive health information about the elderly people. In one room we further saw a blood-stained carpet. It was clear very soon, that the residents were composed of severely disabled people, where some of them suffered from a mental disability, however, no appropriate psychiatric care was available to them. Further, since the house had several floors and lacked an elevator, immovable people and people requiring a zimmer frame could not freely leave the house and get to the fresh air. We revealed a number of records in nursery documents noting frequent falls and other injuries.

Documents further show assumption on a practice of locking some people in their rooms against their will overnight, since they contain notes that people are beating at the door and screaming to get out during the night shift. To confirm this allegation, we decided to conduct a night monitoring and visit the facility again the same day late in the evening hours. To our astonishment, we revealed 12 people locked in their rooms, including elderly suffering from a mental disability and requiring constant supervision. To make the things worse, besides the receptionist sitting in the lobby at the reception, there were neither doctors, not nurses or other caring staff in the entire facility overnight. Thus, the most vulnerable with several health problems remained locked the whole night in their rooms without any possibility to get help. Consequent monitoring revealed further cases of ill-treatment regarding poor alimentation, sanitary conditions, health-care and so forth.^[ii]

The NPM elaborated all these findings and recommendations in the visit report, which was sent to the director of the facility. The key recommendation was to obtain the licence for conducting the social-care services legally or to cease its operations. NPM further asked the facility to provide specific timing and steps taken to meet this recommendation. Since the facility´s director was reluctant to fulfill this recommendation and failed to enter into a constructive dialogue, the case was postponed to inspecting state authorities to launch relevant proceedings. Further, the visit report has been made public to warn elderly people and their families to choose social care homes carefully.

Thankfully, our visit helps to stop inhumane practices in a given facility and since we revealed both, a visit report from this facility and summarizing report of all visits to these facilities to the public, broad public discussion on human rights of elderly people in social-care homes was launched. In particular, the publication of summarizing report at the press conference produced key momentum. Besides sending the report to the government, the NPM also sent it to organizations working with elderly, hospitals that release elderly to social care facilities, etc. These have led to systematic changes in law and practice.

For example, At the suggestion of the NPM, the Czech Government ordered the Minister of Labor and Social Affairs to take steps to ensure the availability of social services for the elderly and the disabled people. The Government also accepted the NPM’s overall recommendation for a systematic solution to the problem of unregistered social services facilities, including the amendment of relevant legislation to foster the powers of inspecting bodies in illegal social-care homes, so that the state guarantees that seniors will not be subjected to ill-treatment. Thanks to the social momentum created by the NPM, this wave of reforms is now going on in Czech.

Note:

1. This article is one of the NPM TRAVELBOOK series written by Mr Pavel Doubek and invited by Covenants Watch (CW), Taiwan. The original text was written in English and was translated by Yi-Ching Tsai, CW’s researcher. For more information about the column, please read the preface to the column.
   
2. It is worth noting that the standards the Czech NPM uses to evaluate “poor” quality of care were not just based on Czech laws, but reflect more the CPT Standards or ECtHR case-law. The evaluation must be context-based, and the Ombudsman often discuss with the NPM team about the extent of “poor quality assessment”.