Risky restrictions of freedom in retirement and nursing homes

On 12 and 13 March, an international conference on the topic “Monitoring in Retirement and Nursing homes” took place in Trier, Germany. The focus of the conference, which was organized by the Council of Europe, the National Agency for the Prevention of Torture of Germany and the Austrian Ombudsman Board, was on the topic of restrictions of freedom.

Which possibilities do National Preventive Mechanisms have to reduce measures that restrict freedom in retirement and nursing homes? Experts from 25 European countries devoted themselves to this question at the international conference in Trier. On the basis of the OPCAT agreement of the United Nations, National Preventive Mechanisms were established in these countries, which monitor places of detention, among them, retirement and nursing homes.

In Austria, the Austrian Ombudsman Board has been acting as a National Preventive Mechanism, together with its six interdisciplinary commissions, since 2012. So far, the Austrian commissions have visited more than 2.300 places of detention (Art. 4 OPCAT). 569 examinations were of nursing homes, of which 90 were follow-up visits. In the last five years, the commissions of the Austrian Ombudsman Board have therefore monitored around half of all authorized nursing homes in Austria. The detected shortcomings throughout Austria affect so many people and such considerable areas of care that it can assumed that they are caused structurally.

At the conference, Univ. Prof. Dr. Reinhard Klaushofer reported on the observations of his commission, as well as on the legal situation in Austria. Univ. Prof. Andrea Berzlanovich used short films and striking pictures to present which considerable impairments can result from restraints. Immobilization through the regular and constant use of measures that restrict freedom causes stress and also advances mental degradation. Improper use of such measures can lead to death in the worst-case scenario and, in rare cases; even correctly fixated mechanical restraints can have deadly consequences.

Studies that clearly verify that residents could not be prevented from falling with mechanical and medicinal restrictions of freedom were discussed. Due to forced sedation, the body loses muscular strength and balance, which can even increase the danger of falling in the end.

Regarding the question what an effective prevention of falling should look like; relevant evidence-based guidelines provide a relatively uniform picture in many points: An effective prevention of falling requires that the risk of falling of a person is extensively and structurally detected and that in doing so, the personal risk factors, as well as external or surrounding-based factors are taken into consideration. Since the risk of falling can change, it must be regularly checked, in any case, when there have been changes in the state of health or medication. Furthermore, cognitive restrictions and challenging behavior count as risk factors for measures that restrict freedom. The surrounding persons often experience displays of behavioral problems, such as the need for movement, physically and verbally aggressive behavior as well as restlessness, as trying. Trainings on how to deal with displays of behavioral problems as well as specific care concepts for dementia patients are essential approaches for the prevention of measures that restrict freedom. Moreover, the stance of the home directors and personnel on the right to self-determination and freedom plays a central role.

The participants very much enjoyed the training offered by two actors as simulation patients, who were schooled by the Medical University of Vienna, and played the biographies of persons with different symptoms in a convincing manner. Their professional feedback shows what needs to be paid attention to when it comes to starting a conversation and the content of a conversation with persons with cognitive disabilities and dementia patients. The learning effect is amplified via the analysis of decisive passages of conversations in the group. The Austrian Ombudsman Board has already successfully tested this practically oriented communication training with its commissions and will continue to use it.