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Deputy-Ombudsman concerned by the lack of guidelines for and supervision of elderly care

According to an investigation conducted by Deputy-Ombudsman Sakslin at her own initiative, there continue to be severe shortcomings in the operating practices for elderly care and treatment in municipalities.
 
The purpose was to identify how municipalities could proactively ensure that no individual elderly people suffering from dementia could be mistreated. A further purpose of the investigation was to highlight the action that municipalities could take if severe shortcomings have already arisen.
 
The supervision conducted by municipalities has been inadequate, and municipalities have not fulfilled their legal obligations to ensure that elderly people who are housed in an institution or assisted living unit and who suffer from dementia have been assigned a designated professional holding a municipal office (4944/2019).
 
The Deputy-Ombudsman states that the operations of municipalities are particularly important during states of emergency when it is more difficult than usual for relatives and family members to observe the care and treatment received by elderly people suffering from dementia.
 
A new initiative by the Deputy-Ombudsman in relation to the coronavirus epidemic (2688/2020) seeks to identify how municipalities have adjusted their practices during the state of emergency. Municipalities have been asked to respond to the following questions, among others:
 
1) How has the epidemic affected the services that are provided to clients who are judged to require services 24 hours per day?
2) How have municipalities arranged the supervision of services during the epidemic?
3) What steps have municipalities taken to ensure that the services for each customer with dementia can be provided in a humane and dignified manner if coronavirus infections are identified in the institution or assisted living unit?
4) What is the procedure if a resident at such a care unit is diagnosed with or is exhibiting the symptoms of the coronavirus?
 
Other ongoing activity in the oversight of legality in relation to the coronavirus epidemic
 
Deputy-Ombudsman Maija Sakslin has requested information on the instructions provided to the City of Helsinki’s home care personnel in response to a complaint (2648/2020).
 
Deputy-Ombudsman Sakslin took the initiative to investigate how the state of emergency and coronavirus pandemic have affected the guidance for home care and residential services. The purpose was to identify the types of instructions that cities have issued to employees working in home care and residential services during the pandemic (2679/2020).
 
Deputy-Ombudsman Sakslin took the initiative to investigate the duty of notification applying to personnel in social welfare units in order to identify the units’ procedures when an employee reports an incident of malpractice observed in the unit (2487/2020). The duty of notification is particularly important during the epidemic. It will also be ascertained in the same juncture exactly which measures the local authorities have taken to guarantee the sufficient availability of personal protective equipment.
 
Following an inspection of home care in Jyväskylä, Deputy-Ombudsman Sakslin decided to take the initiative to investigate the arrangement of dental care for home care clients (2534/2020). Oral and dental health are of great importance to the general health and functional capacity of elderly people. Shortcomings in basic health care and treatment can give rise to problems, particularly during a state of emergency.
 
Deputy-Ombudsman Sakslin also took the initiative to investigate reports by the police to social welfare offices concerning disappearances of old people and the actions taken by social welfare offices in response to the notifications during the state of emergency.
 
Inspections concerning elderly people
 
Inspections by the Office of the Parliamentary Ombudsman led to assessments of the arrangement of home services, assisted living, institutional services and health care, particularly from the standpoint of clients and patients. The effectiveness of self-monitoring was assessed on each inspected site, as well as the monitoring conducted by municipalities, Regional State Administrative Agencies and Valvira. Attention was paid to the quality, availability and sufficiency of service, as well as the use of restrictive measures. Special attention was paid to the use of operating models that prevent restrictions in units.
 
Locking doors
 
On the subject of locking doors, Deputy-Ombudsman Sakslin has stated the following. With insufficient staffing, locking the door of a resident's room may be dangerous, even if the resident has asked for their door to be locked. Locking a person in their room, especially if the unit does not have staff on-site at all times who can rapidly evacuate the residents, poses a serious fire safety risk. If a person wants the door to their room to be open and the door can be kept open by inserting an object into the doorway which hinders access to the room, this does not amount to a prohibited restriction of fundamental rights unless the object is harmful to the resident in the room.
 
Actions during the coronavirus epidemic
 
During the coronavirus epidemic, inspections will pay special attention to the treatment of elderly people whose mobility is limited on the basis of the Communicable Diseases Act.
 
According to section 68, paragraph 2 of the Communicable Diseases Act, the quarantine is carried out in the person's apartment or other location approved of or designated by the person ordering the quarantine. According to paragraph 1 of the same section, quarantine and isolation must be carried out in a way that does not needlessly restrict the person's rights. According to section 67 of the Communicable Diseases Act, the door of a quarantine or isolation room may be kept locked from the outside, when it is necessary to prevent the spread of a communicable disease that spreads via air or as droplet and contact transmission and meets the prerequisites for a generally hazardous communicable disease or a disease that is justifiably suspected of being generally hazardous. The decision on locking the door from the outside is made by the physician in charge of communicable diseases in a public service employment relationship either with the municipality or joint municipal authority for a hospital district. A person participating in the care of the patient must monitor the patient so that he or she can be in immediate contact with the patient. The patient must also be able to be in immediate contact with the personnel.
 
Deputy-Ombudsman Sakslin notes that when considering locking the door of a person with dementia, the symptoms of the disease must be taken into account. Compliance with the law requires that the person with dementia has the actual and effective possibility to contact the personnel. If a person is not independently capable of contacting the personnel, the personnel must be continuously present in order for this right to be respected. The deliberation must also take into account the other means of carrying out isolation, and the selected method must be the one that most effectively ensures the dignified treatment of the elderly person.
 
The inspection protocols listed below for sites inspected before the coronavirus epidemic have been published on the Parliamentary Ombudsman’s website 
 
Social welfare inspections concerning elderly people
 
- Mariahemmet, 19 March 2019, institutional care, 29 places, City of Raasepori (1764/2019)
- Villa Rosa, 19 March 2019, enhanced service housing, 21 places, Folkhälsan, Karjaa (1765/2019)
- Pihlajakoti, 28 March 2019, enhanced service housing, 20–30 places, Päijät-Häme Joint Authority for Health and Wellbeing (PHHYKY), Padasjoki (1842/2019)
- Lizeliuskoti, 10 April 2019, enhanced service housing 15 places and institutional care 33 places, Akseli joint authority for social services (Ptky Akseli), Mynämäki (2009/2019)
- Moisiokoti, 10 April 2019, enhanced service housing and institutional care, 50 places in total, Nousiainen, Ptky Akseli (2010/2019)
- Pakilakoti, 4 July 2019, short-term and long-term institutional care, 210 places in total, Helsingin Seniorisäätiö, Helsinki (3763/2019)
- Palvelukoti Onnela, 3 September 2019, enhanced service housing 24 places, Municipality of Pelkosenniemi (5023/2019)
- Saukoti, 3 September 2019, enhanced service housing 25 places and additional serviced apartments 10 places with access to round-the-clock support, Savukoski (4922/2019)
- Himminkoto, 17 October 2019, enhanced service housing unit, Lempäälä (5595/2019)
- Palvelukeskus Lehtiniemi, 5 November 2019, enhanced service housing 41 places, Keuruu (6033/2019)
 
Health care inspections concerning elderly people
 
- Espoo Hospital, 26 March and 3 April 2019, numbers of patient beds on the inspected wards: 45, 60, 45 and 15 (1706/2019)
- Katriina Hospital, Vantaa, 8–9 May 2019, 163 patient beds (2458/2019)
- Keski-Satakunta joint authority for health care, Harjavalta Health Centre Hospital, 11 June 2019, 30 patient beds (3264/2019)
- Pori City Hospital, 13 June 2019, 120 patient beds (3007/2019)
- Pelkosenniemi-Savukoski joint authority for public health work, in-patient ward, 3 September 2019, 12 patient beds, of which 3 are reserved for Pelkosenniemi’s social welfare. The beds were used for short-term treatments, Pelkosenniemi (5022/2019)
- Pitkäniemi Hospital, geriatric psychiatry, 14 October 2019, 17 patient beds, Nokia (5592/2019)
- Hatanpää Park Hospital, geriatric psychiatry ward, 16 October 2019, 28 patient beds, Tampere (5593/2019*)
 
Home care inspections concerning elderly people
 
- Pelkosenniemi home care, 3 September 2019 (4738/2019)
- Salla home care, 4 September 2019 (4739/2019)
- Lempäälä home care,17 October 2019 (5596/2019)
- Jyväskylä home care, 6 November 2019 (5789/2019)
 
Deputy-Ombudsman Sakslin emphasised the importance of handling any matters observed during inspections with the personnel. Many units have made substantial improvements since the inspections.
 
For more information, please contact Senior Legal Adviser Lotta Hämeen-Anttila on +358 9 432 3353.