In the fall of 2020, the NPM visited elderly care homes for the first time as part of its mandate to prevent ill-treatment. Photo of Åsgårdstrand sykehjem: The Norwegian National Preventive Mechanism

Visit to elderly care homes by the Norwegian National Preventive Mechanism

By: Hanne Harlem, the Norwegian Parliamentary Ombudsman and the National Preventive Mechanism

This article was first published in Norwegian in Kommunal Rapport May 6th, 2021.

The mandate of the Norwegian Parliamentary Ombudsman (From 1th July 2021: The Parliamentary Ombud) acting as the National Preventive Mechanism (NPM) has at its core the duty to prevent inhumane and degrading treatment in places where people are, or may be, deprived of their liberty.

The NPM has previously visited police custody facilities, prisons, immigration detention centers, child welfare institutions and psychiatric hospital wards. The NPM’s first report from visits to elderly care homes was published in the spring of 2021.

In Norway, public elderly care homes are run by the municipalities. All public authorities, including municipalities, must abide by human rights law. This involves ensuring elderly residents in long-term care and nursing homes are treated with dignity and respect while delivering adequate services that secure the fundamental needs of each resident. For residents in long-term placements this is of particular importance because the care home will in practice be the place where they spend the final phase of their lives.

Deprivation of liberty in elderly care homes

Following a legal decision resident may be held back or detained against their will in long-term care and nursing homes. Furthermore, it is well known that residents in care homes can be subject to extensive restrictions, such as locked doors. In order for decisions restricting movement of a person to be valid, such as locking doors, the decision needs to fulfill certain legislative requirements. It is well known that these types of decisions often lack the necessary legal criteria. As such, persons residing in care homes may experience situations where they de facto are deprived of their liberties.

Furthermore, residents in long-term care homes will have a wide range of medical and physical needs that require nursing care and personal care and other support services. Residents will therefore have a significant dependency on staff, putting them in a vulnerable situation and at risk of ill-treatment.

The visits to elderly care homes

In the fall of 2020, the NPM visited elderly care homes for the first time as part of its mandate to prevent ill-treatment. We inspected the premises, conducted interviews, and reviewed various documentation relating to the internal procedures and regulatory framework.  We conducted  conversations with the residents, their relatives, management and staff members. Out visit complied with the applicable covid19 pandemic public health measures at the time of the visit.

The reports from two elderly care homes, from the municipalities of Nordre Follo and Horten respectively, will be published in early May 2021. These reports are the first in a series of several care homes that will be visited by the Norwegian NPM.

So far, we have focused on the following areas and made the following observations:

The use of coercion in healthcare

We have looked at whether or not, and if so, how, the care homes use coercion. We have checked whether the use of coercion has been documented in writing and  whether the decision to use force is in accordance with the legislative requirements. We have asked whether staff members and management are familiar with the conditions for using coercive measures. We have emphasized that there needs to be a clear understanding of role and responsibilities amongst staff when using coercive actions against senior residents. Sufficient knowledge of the process and criteria for making decisions to use force is imperative.

There is a legal requirement that the municipality have a supervisor who is notified of all decisions involving the use of coercive measures.  This allows elderly care homes to keep track, and have an overview of, how often residents are subjected to force and restrictions, compared to other elderly homes in the municipality.

Ensuring basic needs

The majority of long-term care residents require a wide range of health and personal care services in order to get their most basic medical and physical needs met. This may include access to 24-hour nursing care and physical support, in order to maintain their physical functions, reducing pain and preventing injuries – in addition to ensuring quality of life.

We investigated the following areas: whether residents were offered individually adapted activities; access to fresh air; whether residents were included in decisions that had a direct impact in their lives; whether residents were given adequate follow-up appointments to medical concerns, including questions concerning medication and nutrition.

Protection from violence and assault

We also investigated whether the care homes had procedures in place to protect the residents from violence, aggression and assault from other residents, and in some cases staff members (elder abuse). Recent research from Norway has shown that such incidents do occur in elderly care homes and that they can have serious consequences for vulnerable residents. It is important that elderly care homes acquire an awareness and knowledge about elder abuse, and that municipalities create mechanisms   to prevent abuse and to address this important issue.

Work environment

In order to provide elderly residents with responsible care over time, staff members must feel safe at work, get support and follow-up after difficult incidents and be given the tools necessary to handle challenging events. It is also crucial that they are given the necessary knowledge to take care of their own personal health and safety, as well as that of the residents.

The municipality must ensure that staff are capable of taking care of the residents’ rights and needs. This includes ensuring adequate staffing. The staff at Norwegian elderly care homes do an invaluable job every day, even with the increased risk to their own health during the pandemic.

The reports provided by the Norwegian NPM consists of findings and recommendations that can add value and be of relevance to all elderly care homes and municipalities in Norway. We hope that our reports will be read with interest, and that they may result in changes that can be beneficial for residents, relatives and staff.

This article was first published in Norwegian in Kommunal Rapport May 6th, 2021.