Frequently, numbers of care staff in care homes were insufficient, in particular at
night, which directly affects the quality of service provided. On several occasions,
the Chancellor’s advisers formed the impression that even though the staff of the
institutions were dedicated to their work and cared about the clients, clearly not
enough specialists were available to deal directly with clients. More than the
statutory minimum number of staff are required if clients are in need of special
care and the building has a specific character. In that case, an institution should
be able to deploy more competent and motivated staff to deal with the clients.
In several care homes, the Chancellor’s advisers found unlawful restriction of
freedom of movement of clients – the practice of locking doors of departments as
well as rooms, thus impeding residents from freely moving around. The general
care home service is provided on a voluntary basis, i.e. at a person’s own request
(i.e. these are not closed institutions where individuals may be kept against their
will). It is inadmissible to restrain persons either physically (locking or using means
of binding) or by using medication. Freedom of movement was restricted mostly
for clients with dementia and serious memory problems whose behaviour could
be problematic and unpredictable and who are difficult to handle. In view of this,
the Chancellor sent a memorandum to the Ministry of Social Affairs in autumn
2016 and requested that development of a care service aimed at persons suffering
from dementia and having reached the retirement age should be initiated. In the
reply, the Ministry of Social Affairs agreed with the Chancellor’s proposal and
considered it necessary to create a suitable legal framework for providing a service
for elderly people with dementia and to develop the respective service. The
Ministry in its reply also pointed out that the principles of funding social services
should be reviewed in the course of the administrative reform to ensure the
capacity of local authorities.
In July 2017, the Chancellor wrote about the problems of general care services and
the funding of the social sphere in a circular concerning the quality of the general
care service. The aim was to draw the attention of all general care service providers
to the shortcomings found during the inspections, so as to contribute to improving
the quality of the service and prevent possible violations.
The Chancellor’s advisers also discussed the issue of the rights of the elderly at the
autumn conference “Elderly patients in healthcare institutions” organised by Tartu
University Clinic and Ida-Viru County Central Hospital in autumn 2016. The
Chancellor’s advisers discussed the challenges facing healthcare institutions and
medical professionals at the bioethics seminar “Right to freedom versus the right
to protection of health – an inevitable and unmanageable moral conflict?”
organised in cooperation between the Estonian Bioethics Council and the Ministry
of Social Affairs on 16 December 2016. In a special edition of the law journal
9