1.4 Obiski v domovih za starejše 1.4 Visits to retirement homes DPM meni, da so določbe ZDZdr glede sprejema osebe na VO jasne. Kar zadeva Izjavo o privolitvi za namestitev na varovani oddelek, ki sta jo podpisali stanovalki, pa je bila ta pravzaprav formulirana kot izjava vnaprejšnje volje, ki je – kot je bilo navedeno že v sami izjavi – dana po svobodni volji osebe, njeni izbiri in odločitvi in temelji na razumevanju vsebine izjave in odločitve. Ne more se je torej, kakor je storil dom, ponuditi v podpis osebam, ki so že na VO (ali bodo vanj sprejete) in niso več sposobne razumeti svojega položaja in izraziti svobodne volje (ne nazadnje je o zadržanju obeh stanovalk na VO že dvakrat odločalo sodišče). Izvedenec DPM se je pogovoril z eno od zgoraj navedenih stanovalk in glede na ugotovljeno psihično stanje in podatke v medicinski dokumentaciji zaključil, da je mogoče podvomiti o sposobnosti stanovalke, da poda soglasje za bivanje na VO. DPM je zato dom opozoril, da mora v takih primerih (če osebi ni odvzeta poslovna sposobnost oziroma za osebo z odvzeto poslovno sposobnostjo, če v sprejem ne privoli njen zakoniti zastopnik) podati sodišču predlog za sprejem osebe na VO, pri čemer je v skladu z veljavno zakonodajo sprejem dopusten šele na podlagi sklepa sodišča. Z namenom boljše informiranosti stanovalcev smo temu domu predlagali tudi, da se obrazci Izjave o privolitvi za sprejem na varovani oddelek dopolni z informacijo, da lahko stanovalec privolitev kadar koli prekliče. V enem od domov smo posebej opozorili še na to, da je preklic soglasja lahko tudi usten in ne le pisen. Dopolnitev obrazca: »Soglasje za bivanje na oddelku za osebe z demenco – varovani oddelek« smo predlagali tudi Domu starejših Idila, in sicer z dodatno rubriko o preklicu privolitve z navedbo datuma preklica privolitve. Ocenili smo tudi, da bi bilo smiselno poenostaviti postopek za preklic soglasja, saj stanovalec z okrnjenimi spoznavnimi sposobnostmi ne more biti sposoben podati pisni preklic soglasja za bivanje na varovanem oddelku (npr. ko je bil varovanec sposoben podati soglasje in je upad spoznavnih sposobnosti med bivanjem na VO napredoval in bi želel kasneje preklicati soglasje). V primeru ugotovljenih nepravilnosti smo domovom predlagali, da pri sprejemu oseb na VO in pri podaljšanju zadržanj na VO dosledno ravnajo v skladu z določbami ZDZdr. Kljub določenim pomislekom, ki so jih glede sprejema na VO po ZDZdr sicer imeli določeni domovi, se na to naše priporočilo nobeden od obiskanih domov ni odzval odklonilno. Predlagali smo tudi, da pri vseh tistih stanovalcih, ki zaradi napredovanja upada spoznavnih sposobnosti (ocena psihiatra) niso sposobni razumeti podaje soglasja za bivanje na VO, sprožijo postopke o morebitni potrebi po delnem ali popolnem odvzemu opravilne sposobnosti (obvestilo zdravnika psihiatra domu in obvestilo doma pristojnemu CSD-ju). Uporaba posebnih varovalnih ukrepov (PVU) V vseh obiskanih domovih, razen v Domu starejših Idila, so pojasnili, da PVU ne uporabljajo. V Centru starejših Pristan v primeru nemirnega stanovalca zaradi potrebe po bolnišničnem zdravljenju pokličejo dežurnega zdravnika. Podobno v Centru starejših Notranje Gorice vsakemu stanovalcu poskušajo ambulantno urediti medikamentozno terapijo tako, da bi bila obdobja nemira čim bolje nadzorovana. Če ne uspejo, ga začasno premestijo na psihiatrični oddelek. Dom starejših Idila za izvajanje PVU uporablja trebušni pas. Povedali so nam, da PVU uporabljajo predvsem zvečer za doseganje umiritve in z namenom preprečevanja poškodb. Izvedenec je domu ugotovil zmanjšanje uporabe PVU, vendar pa je bila uporaba PVU pri nekaterih stanovalcih v letu 2013 zelo pogosta. Glede na pridobljena pojasnila o namenu pogoste uporabe PVU za umirjanje smo Domu starejših Idila sporočili, da je po naši oceni bolj smiselno odpravljati vzrok psihomotornega nemira in v primeru neučinkovitosti nefarmakoloških metod uporabiti dopustne odmerke psihofarmakoterapije, npr. za odpravljanje nespečnosti, saj je PVU skrajen ukrep in ne more biti namenjen pogostemu, praktično vsakodnevnemu umirjanju oseb z demenco. 102 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 The NPM believes that the provisions of the ZDZdr are clear on admission of a person to a secure ward. Relating to the statement on consent to accommodation in the secure ward signed by the residents, the statement was actually formulated as a statement of a prior will which, as stated in the statement, was given freely by the person, was their choice and decision and was based on understanding of the content and decision. The statement could not be submitted for signing, as this was done by the retirement home, to persons who were already in the secure ward (or would be admitted) and were no longer capable of understanding their position or expressing their free will (after all, the detention of both residents had already been decided twice by the court). The NPM’s expert spoke to one of the aforementioned residents and concluded on the basis of the established mental condition and data in the medical documentation that it was possible to doubt the resident’s ability to consent to staying in the secure ward. The NPM thus warned the retirement home that in such cases (if a person’s legal capacity was revoked or if a legal representative fails to give consent to admitting such a person), a request for admission to the secure ward must be submitted to the court, whereby the admission is only permissible on the basis of a court order issued in compliance with the applicable legislation. In order to improve communication with the residents in this retirement home, we proposed that forms for the statement on consent to accommodation in the secure ward be amended with the information that residents may revoke their consent at any time. In one retirement home, we particularly stressed that the revocation of consent may also be oral, not only written. To amend the form, “Consent to accommodation in the ward for persons with dementia – secure ward”, we also suggested to Retirement Home Idila to add a section on the revocation of consent with the provision of the date of revocation. We also evaluated that it would be sensible to simplify the procedure for revoking the consent, since residents with limited cognitive abilities would not be able to give a written revocation to their consent for accommodation in secure wards (e.g. when a resident was able to give consent and the worsening of their cognitive abilities during their stay in the secure ward has progressed and they would like to revoke their consent later). In the case of established irregularities, we suggested that the retirement homes consistently comply with the provisions of the ZDZdr when admitting persons to secure wards and when extending detention in secure wards. Despite certain concerns expressed by certain retirement homes about admissions to secure wards as per the ZDZdr, none of the visited homes responded adversely to our recommendation. We also suggested that procedures for the partial or complete revocation of legal capacity be instigated for residents who, due to the progressive worsening of their cognitive abilities (assessment of a psychiatrist) were no longer able to understand the notion of consenting to admission to secure wards (notification of the psychiatrist to the retirement home and the notification of the retirement home to the competent social work centre). Application of special protection measures All visited retirement homes except Retirement Home Idila explained that they did not use special protection measures. If a restless resident in Pristan Retirement Home is in need of hospital treatment, an on-duty physician is called. Similarly, Notranje Gorice Residential Centre for the Elderly is also trying to provide medications in order to control restless periods. If this is not possible, a resident is relocated to the psychiatric ward. Retirement Home Idila uses an abdominal belt for the implementation of special protection measures. They stated that special protection measures were used particularly in the evening to calm residents and prevent injuries. The expert noted a reduction in the use of special protection measures in the home; however, the application of special protection measures was very frequent in 2013. Relating to clarifications obtained about the frequency of using special protection measures for calming purposes, we informed Retirement Home Idila that the elimination of reasons for psychomotor restlessness was more sensible, and if non-pharmacological methods are ineffective, permissible doses of psychopharmacotherapy should be applied, e.g. for the treatment of insomnia, because special protection measures are the last resort and should not be used for frequent or daily calming of persons with dementia. 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 103