1.1 Visits to social care institutions (residential homes for the elderly)
Restriction of movement
Wards accommodating persons with progressive dementia are secured in different ways. Sometimes,
they are secured by locks on both sides of the door leading to the ward and can be opened either with
a key or a code. Such security measures can be found in Trebnje HE, Olmo Home, Bor HE, Trnovo CE
and Danijel Halas Home. In the latter establishment, the doors are only temporarily locked, i.e. upon
the admission of a new person to the ward who due to spatial and temporal disorientation, is confused
and must accommodate to life in the ward. As explained by the staff, permanent residents who have
adapted to live in the ward do, in fact, not leave the ward of their own will although it is not locked.
Departures of residents from this ward are otherwise restricted and must be announced to the ward’s
employees in advance.
Nursing homes with a HLSW prevent their residents from leaving the ward more indirectly. In Ptuj RH,
this is done by doors which are somewhat difficult to open, while for calling the elevator one must
type the numeric code which is written down next to the numeric keypad. In Hmelina Home there is a
rotating knob on the inner side of the door which is sometimes also open. However, in order to prevent
the residents from leaving the ward or the nursing home unaccompanied, the door is supervised by
employees. In the HLSW of Škofja Loka Centre, the door leading to the ward has a simple door handle.
On the inner side of the door there is a reflective glass (mirror) and in front of it, an opaque coloured
curtain is fixed in order to make it less obvious that this is the ward’s exit door. Some residents are
diverted by this measure, while others leave the ward all the same. The reception desk personnel of
nursing homes pay special attention to residents who are able to leave the ward, but should, for the sake
of their own safety, not leave the nursing home, and direct them back to the ward.
In Ptuj RH where security measures are also rather “lenient” and where there is a great possibility that
a resident of the HLSW will leave the home they also use wristbands bearing the inscription “home
resident” and the nursing home’s phone number that are worn by the residents on their wrists.
During its visits, the NPM has thus established that the nursing homes still define the protection of
the residents with progressive dementia in two ways. Some nursing homes have introduced secure
wards where they try to fulfil all conditions for the verification of such ward. For the sake of safety of
their residents, other nursing homes also ensure their protection and prevent them from leaving the
institution of their free will. This is done with the assistance of the staff and, in extreme cases, by the
receptionist at the nursing home’s exit. Nursing homes define such wards differently; some of them still
define them as high level supervision wards.
In several nursing homes visited, the NPM has thus established that they have no typical secure
wards; however, they have introduced one or more units for dementia sufferers that are designated
differently. In view of the concept of work and the method of protection, these are nevertheless
wards with high level supervision as defined by the Guidelines for Work with Persons Suffering from
Dementia in the Field of Institutional Care of the Elderly (hereinafter: the Guidelines) and prepared
by the Ministry of Labour, Family and Social Affairs.
The Guidelines have indeed introduced a kind of intermediate model and designated it High Level
Supervision Ward where, supposedly, no legal provisions regarding the conditions for admission to the
secure ward need to be complied with. However, in the NPM’s opinion, the definition of the high level
supervision ward used in the Guidelines is disputable, as in terms of the protection of residents, it does
not differ from the definition of a secure ward, as defined by the law. As a matter of fact, Article 2 (17) of
the Mental Health Act (hereinafter: ZDZdr) defines the secure ward as a ward in a social care institution
where due to their needs, persons are provided with the necessary protection and care on an on-going
basis and cannot leave the institution of their free will. The NPM drew attention of the aforementioned
Ministry to this disputable regulation. In its letter no. 070-18/2011/6 of 12 July 2012, the Ministry assured
the NPM that it would amend the Guidelines so as to delete high level supervision wards from the text.
At the same time, the Guidelines will present in detail the concept of work with dementia sufferers
outside secure wards where no restriction of freedom, either with technical or any other means, may
be applied. Although the Ministry subsequently informed the residential homes for the elderly about
the abolition of such wards, it failed to adopt amendments to the Guidelines or draft a new relevant
document even by the beginning of 2014.
IMPLEMENTATION OF THE DUTIES AND POWERS OF THE NPM IN 2013
NATIONAL PREVENTIVE MECHANISM UNDER THE OPTIONAL PROTOCOL TO THE UN CONVENTION AGAINST TORTURE AND OTHER CRUEL, INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT
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