1.4 Obiski v domovih za starejše 1.4 Visits to retirement homes V obiskanih domovih smo vpogledali v dokumentacijo nekaj naključno izbranih primerov oziroma postopkov sprejema in ugotovili več nepravilnosti ali pomanjkljivosti. Najpogostejša praksa domov je, da najprej izpeljejo sprejem s privolitvijo, pri čemer privolitev ponudijo v podpis stanovalcu, čeprav je očitno, da ta ni sposoben razumeti svojega položaja in izraziti svobodne volje (npr. Dom starejših Idila, Center starejših Notranje Gorice). V nekaterih domovih privolitev podpiše kar skrbnik za poseben primer, kar je prav tako v nasprotju z določbami ZDZdr. V sprejem na VO namreč lahko privoli le oseba, ki bo vanj sprejeta (pri čemer mora biti privolitev izraz svobodne volje, ki temelji na razumevanju položaja in je izoblikovana na podlagi primernega pojasnila o naravi in namenu obravnave) oziroma v primeru, da je osebi odvzeta poslovna sposobnost, da privolitev njen zakoniti zastopnik. Domovi nato, ko je oseba že sprejeta, (praviloma) podajo na sodišče predlog za sprejem osebe na VO na podlagi sklepa sodišča. Tako postopanje domov ni v skladu z ZDZdr, ki določa, da je – če oseba, pri kateri so izpolnjeni pogoji za sprejem na VO, ki jih določa zakon, v sprejem ne privoli – sprejem na VO dopusten na podlagi sklepa sodišča. Menimo, da bi bilo sicer smiselno, da bi ZDZdr urejal tudi (nujne) sprejeme na VO, torej še pred izdajo sklepa sodišča. Na to problematiko je Varuh že opozoril pristojno ministrstvo, vendar pa je vsakršno drugačno postopanje doma, kot ga določa ZDZdr do njegove morebitne spremembe, napačno. Pogosto ugotovljena nepravilnost je tudi zamujanje pri podajanju predloga za podaljšanje zadržanja stanovalca na VO. ZDZdr določa, da mora biti tak predlog podan najmanj 14 dni pred potekom roka iz sklepa sodišča. V Centru starejših Notranje Gorice smo npr. ugotovili, da je bil v enem primeru predlog podan le štiri dni pred potekom roka, v drugem pa 14 dni po preteku roka. V Centru starejših Zimzelen je bila situacija glede tega še bolj skrb zbujajoča. V enem primeru nepravilnosti sicer nismo ugotovili, v preostalih dveh izbranih primerih pa je dom stanovalki sprejel na VO leta 2010 oziroma 2011 in jima pri tem dal v podpis privolitev za sprejem na VO. Po petih oziroma devetih mesecih je podal na sodišče predlog za njun sprejem na VO. Iz spisovne dokumentacije ni razvidno, zakaj se je za to odločil. Sodišče je v obeh primerih dovolilo zadržanje za eno leto. Dom po preteku enega leta, čeprav sta osebi ostali na VO, ni predlagal podaljšanja njunega zadržanja v roku, ki ga določa zakon, temveč je to storil šele po šestih mesecih, oziroma v drugem primeru več kot leto dni kasneje. Sodišče je v obeh primerih znova dovolilo zadržanje na VO za eno leto, po preteku enega leta (julija 2014) pa je dom obema stanovalkama ponudil v podpis znova kar Izjavo o privolitvi za namestitev na varovani oddelek, ki sta jo tudi podpisali, in sodišču zato ni podal novega predloga za podaljšanje zadržanja. Socialna delavka doma nam je glede tako različne prakse obravnave iste osebe pojasnila, da so poskušali ravnati v skladu z veljavnimi predpisi, upoštevaje tudi Usmeritve za delo z osebami z demenco na področju institucionalnega varstva, ki jih je izdalo Ministrstvo za delo, družino, socialne zadeve in enake možnosti. Slednje pa so se spreminjale, tudi v delu, v katerih primerih mora o sprejemu odločati sodišče. Že v vprašalniku, ki smo ga poslali domu pred samim obiskom, je dom pojasnil, da je za stanovalce sam sodni postopek (narok) stresen dogodek. Glede na to, da so na VO nameščene osebe v poznejših stadijih demence, ko ni pričakovati izboljšanja, je bil mnenja, da ni smiselno, da se mora sklep »obnavljati«. Tudi zato, če smo prav razumeli pojasnila socialne delavke, se je center odločil, da je osebam, katerih zadržanje na VO je vsaj enkrat že dovolilo sodišče, po preteku sklepa sodišča v podpis ponudil Izjavo o privolitvi za namestitev na varovani oddelek, ki so jo vse tudi podpisale. Dom starejših Idila je za podaljšanje sklepa o pridržanju zaprosil sodišče v ustreznem roku. When visiting retirement homes, we reviewed the documentation of several randomly selected cases or admission procedures and established several irregularities or deficiencies. The most frequent practice at retirement homes was that admission by consent was implemented first, whereby the resident signed the consent, although it was obvious that they were unable to understand their situation and express their free will (e.g. Retirement Home Idila and Notranje Gorice Residential Centre for the Elderly). In certain homes, the consent was signed by a guardian in a special case, which was also contrary to the provisions of the ZDZdr. The consent to the admission to a secure ward may only be given by the person who is to be admitted (whereby the consent must be an expression of free will based on the understanding of the situation and formed on the basis of a suitable explanation of the nature and purpose of the treatment) or their legal representative if the person’s legal capacity has been revoked. Once the person has been admitted, the retirement homes then (as a rule) file a request to admit a person to a secure ward on the basis of a court order. Such conduct is not compliant with the ZDZdr, which stipulates that – if the person who meets the conditions for being admitted to the secure ward as provided by the act fails to provide their consent – the admission to a secure ward is permitted only on the basis of a court order. We believe that it would be sensible for the ZDZdr to also determine (urgent) admissions to secure wards, i.e. before a court order is issued. The Ombudsman had already notified the relevant ministry of this. Nevertheless, any conduct by the retirement homes other than stipulated by the ZDZdr before it is amended is unlawful. Another frequently established irregularity was delays in submitting requests to extend residents’ detention in secure wards. The ZDZdr stipulates that requests must be submitted at least 14 days before the expiry of the court order. It was established in Notranje Gorice Residential Centre for the Elderly that in one case a request was submitted only four days before the expiry and in another case 14 days after the expiry. The situation was even more alarming in Zimzelen Retirement Home. In one case, no irregularities were established. In another two random cases, the retirement home had admitted the residents in the secure ward in 2010 and 2011. Prior to admission, they had both signed their consent forms for admission to the secure ward. The retirement home submitted the requests for their admission to the secure ward by court order after five and nine months, respectively. It was not clear from the file documentation why the home had decided to do this. In both cases, the court extended the detention for one year. Although both persons remained in the secure ward, the retirement home did not request an extension of their detention within the deadline as stipulated by the act, but only submitted these requests after six months in one case and more than a year later in the other case. In both cases, the court extended the detention in the secure ward for another year, after which (in July 2014) the home submitted the statement on consent to accommodation in the secure ward, which both residents signed, so the home did not submit new requests to extend their detention to the court. With regard to such different treatment of the same person, the social worker at the retirement home explained that they tried to act according to the applicable regulations while also observing the Guidelines on working with persons with dementia in the field of institutional care for the elderly issued by the Ministry of Labour, Family, Social Affairs and Equal Opportunities. The latter, however, were being amended also in the section determining cases subject to court orders. In the questionnaire submitted to the retirement home before the visit, the retirement home explained that court proceedings (hearing) are a stressful situation for residents. Regarding the fact that persons accommodated in secure wards were in the latter stages of dementia, in which improvement could no longer be expected, they thought that it was not sensible to “renew” the order. And that was also one of the reasons, if we correctly understood the clarifications of the social worker, the home decided that persons whose detention in secure wards had at least once already been ordered by the court were offered the opportunity to sign the statement on consent to accommodation in the secure ward after the expiry of the court order, which they all signed. Retirement Home Idila asked for an extension of a court order in due time. 100 poročilo o izvajanju nalog DPM v letu 2014 DržavnI preventivnI mehanizEm po Opcijskem protokolu h Konvenciji OZN proti mučenju in drugim krutim, nečloveškim ali poniževalnim kaznim ali ravnanju IMPLEMENTATION OF THE DUTIES AND POWERS OF THE NPM IN 2014 National Preventive Mechanism under the Optional Protocol to the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment 101