23. 7. 2024
At the Ljubljana Vič Rudnik Retirement Home - Bokalce Unit (DSO Bokalce), the social inspection, which is primarily responsible for oversight in homes, has concluded an inspection related to allegations of inadequate care and treatment of residents. And what is the summary of the eight-month investigation, for which we have been seeking answers weekly on our portal? In one word: dismal. Does anyone even care about the distress and suffering of the elderly? Is it acceptable to place the elderly in scalding water, change their medications, and choke them with a foreign denture in their mouths? Even the Medical Chamber did not find any errors. Are the responsible institutions covering for each other? However, the Police took the complaint more seriously and filed a criminal charge due to justified suspicions of a violent crime.
The Police confirmed that in the case of the incident at DSO Bokalce, "following the institution's initial report and after collecting information, they filed a criminal charge with the competent District State Prosecutor's Office in Ljubljana due to justified suspicions of the crime of violence under the second paragraph of Article 299 of the Penal Code (KZ-1). The charge was filed against two known suspects."
Eight months ago, we published the harrowing testimonies of the daughters of two residents of the Bokalce elderly home in Ljubljana, who shared stories of cruel treatment at DSO Bokalce towards their helpless mothers. Silvija Novak relived an incident with her now-deceased mother, who was placed in scalding water during a bath, resulting in hospitalization. Silvija Novak reported the incident to the police but did not pursue charges against the caregivers, knowing the weak social situation of employees in long-term care.
Brigita Kneževič's mother nearly received incorrect medication and food, which would have endangered her life due to severe illness. Luckily, Brigita Kneževič prevented the mix-up as she discovered that her mother was lying in a bed labelled with another resident's name. During one of her regular visits, Brigita Kneževič found her mother choking on a foreign denture and caught her half-naked in the middle of winter on her way to the hospital.
Both daughters, Silvija Novak and Brigita Kneževič, also informed the director of DSO Bokalce about other inappropriate practices: cold food, unsuitable food for immobile residents, such as salad on smooth plates, personal belongings of residents thrown into the waste bin for bodily fluids, etc. The DSO Bokalce acknowledged all mentioned incidents, but director Melita Zorec attributed them to unfortunate circumstances. She justified her employees' actions by saying: "We record deviations in the provision of health care and services, discuss them with all involved, and take appropriate action. If necessary, we also conduct extraordinary professional supervision or cooperate with competent institutions." The DSO Bokalce supposedly carried out extraordinary professional supervision in the reported cases.
The Director was Taken at Her Word
So, what did the oversight body find in the eight months since we notified the social inspection about the incidents? “In the field of social welfare, which is overseen by the Social Inspection (basic care, social care), it was found in all reviewed cases:
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that the employees were informed of the complaints from the residents’ relatives,
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that they responded to the complaints by verifying their validity,
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that they recognized the mistakes made and, where possible, immediately corrected them or took additional measures to reduce the likelihood of recurrence.
In cases of conduct that included elements of criminal offences, the home informed law enforcement authorities and cooperated with them and the complainant as required.”
The inspector found that errors had occurred but there was no need to impose corrective measures because the home had already taken action. This is the concise response from Chief Inspector Katja Čoh Kragolnik.
Due to the prolonged medical leave of the only inspector assigned to oversee retirement homes, the inspection, which had been stalled for several months, brought no insights or measures for improvement. As Director Melita Zorec told them, the mistakes were corrected. How is a promise made by the Bokalce retirement home management—that they will not place people in boiling water, change their medications, or put the wrong dentures in their mouths—sufficient for the social inspection? It sounds like listening to a child swearing to improve after being caught misbehaving. The inspector took the director’s word. This is the inspection paid by citizens, supposed to ensure safe, careful, and dignified living for the most vulnerable in institutions where families pay hefty fees. It’s like a police officer believing a murderer’s word that they recognized their mistake and will reform. Unbelievable. An insult and a degradation of the dignity of all those who, at any given moment, are in a position where someone lays hands on them and cruelly mistreats them. "The Social Inspection, when reviewing the complaints, found that the complaints largely pertain to the provision of healthcare, overseen by the Chamber of Nursing and Midwife Association, or treatment, overseen by the Medical Chamber," the Social Inspection wrote. The easiest thing to say is, "we're not responsible for anything." Did they wash their hands of the incidents? Have the inspectors ever peeked through the home's doors and randomly checked the state since then?
Monika Ažman, President of the Chamber of Nursing and Midwife Association, confirmed that they are in the middle of supervision in the Bokalce retirement home unit. Since not all individual interviews with those involved have been conducted, she cannot say more at this time. More alarming is the finding of the Medical Chamber under Bojana Beović’s leadership; as they stated, after reviewing the complaint about healthcare in the Bokalce retirement home from March this year, they found no elements of professional error.
Silvija Novak is not surprised by the inspection's conclusion: "Despite the expected inspection findings, I would still emphasize the necessity that the inspection should be unannounced, as a surprise. There have been several inspections at the Bokalce retirement home. However, inspections were announced in advance and none were conducted in favour of the complainant, even though criminal things were happening. Regarding my mother’s case (bathing in boiling water ...), they did apologize to me, but I demanded that the two individuals be removed from the department while my mother was there."
Brigita Kneževič is also disappointed by the response. "The home's management took no measures or sanctions when my mother had a foreign denture in her mouth and was choking on it, or when she was inadequately dressed for transport to the emergency room in minus ten degrees. The director's response was insulting. It happens! Without apology, a hint of shame. The professional director Barbara Purkart even offered to transfer my mother to another home because I was apparently dissatisfied with them. I did not expect such behavior and it hurt me. The home had some qualified nurses and technicians who wanted improvements for the benefit of the residents, but unfortunately, they didn’t succeed. Management didn’t give them the green light, and they left. The real culprits remained in positions, and the director carried on with her work.” What hurt her the most was that "the inspectors believe lies, do not come for unannounced inspections, and the truth remains hidden due to the inefficiency of the competent authorities."
Violence Against the Elderly is Invisible
Violence against the elderly and helpless reflects an extreme erosion of societal values. However, the Labor Inspectorate received only two complaints against the Bokalce retirement home unit in the past five years. The complaints were related to assistance with getting in and out of bed and sitting at the table, chair, or wheelchair, and in 2021, concerning visitation restrictions during the COVID-19 measures. Alarmingly, as explained by the Office of the Human Rights Ombudsman, many wrongful acts in homes are reported anonymously, and sometimes even relatives do not believe their elderly parents or relatives when they share their own experiences of poor treatment by staff.
Unfortunately, violence against the elderly is invisible and often occurs behind closed doors in family settings or institutional care. Society already treats the elderly as second-class citizens. They are often disadvantaged due to age, economic and health status. Due to illness and frailty, the elderly are even more vulnerable, knowing they depend on the help of others - family members, staff in healthcare or social institutions. Their voices are not heard, which is particularly concerning.
“Within closed walls, it is easier for violations of elderly rights to go unnoticed. The victims are powerless and often dependent on the perpetrators of violence, so they cannot or dare not report it. We must be vigilant about the occurrence of violence at all times and act if we detect it. Investment in the training and education of all professional groups working with the elderly is also necessary,” emphasized Human Rights Ombudsman Peter Svetina during the outbreak of violence at the Trebnje retirement home, where a student aggressively attacked a demented woman. Therefore, the state and politicians should speak on behalf of the elderly, who helped them gain power by contributing to the budget for their education. But it seems the elderly are not being heard. Maybe politicians don't want the elderly to be heard. Or are they turning a blind eye to violence in institutions?
One in Six Elderly are Victims of Abuse
When did our society become immune to violence and apathetic towards the abuse of the elderly? When did societal norms become so trivial that even those who are morally and legally obligated to act at the slightest suspicion of mistreatment of the elderly blindly follow bureaucratic procedures and do not listen to painful words? We understand that sometimes there are serious accusations, but why would people invent stories of violence, physical or psychological? Violence is the silent companion of ageing. Data, provided by the Slovenian Police, show that there were 320 cases of violence against people over 64 - 200 against women and 120 against men. And these are not just slaps and insults. These are serious abuses involving beatings, deprivation of physiological needs like changing diapers or hydration, and starvation. As a society, we are divided by a chasm where on one side the healthy, mobile, and young have access to all the world's abundance, and on the other side, it's hell for the helpless, weak, immobile, old, lonely, and abandoned.
The World Health Organization highlights the following facts:
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One in six people worldwide aged 60 and older experienced some form of abuse in their environment in the last year.
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Elder abuse is common and severe in institutions such as nursing homes and long-term care facilities. Two-thirds of staff report committing abuse in the past year.
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Elder abuse increased during the COVID-19 pandemic.
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Elder abuse can cause serious physical injuries and long-term psychological consequences.
What has the Ministry of Solidary-Based Future done since our first reports of violence against the elderly? At our media outlet, we committed to making the elderly our concern and responsibility, advocating for zero tolerance of violence, and insisting that everyone is entitled to proper care. Minister Simon Maljevac has not moved beyond agreeing on the scope of the problem and making empty promises. Otherwise, long-term care would be more than a haven for Left party employees, who, as we reported, are cashing in on long-term care benefits.
We have not yet seen a scenario where the minister calls on all state institutions and related ministries to jointly prepare a campaign to prevent elder abuse and especially to unite in efforts for fundamental changes in long-term care. This includes sectors like education, health, labour, and economy. But no, the minister continues to focus on buildings, cutting ribbons in front of new homes where there will be no staff to work. Caregivers, who earn barely enough for their own survival despite working hard, responsible jobs in multiple shifts and on three weekends a month, are offered better working and salary conditions by retailers. Retirement homes employ staff who, a few years ago, would not even have been considered. Staff without the necessary knowledge, empathy, or mindfulness.
"This is the Epilogue of Negligent and Criminal Work in the Service of the Most Vulnerable People"
The purpose of inspections is to ensure the lawful conduct of supervised activities. Inspectors must use their measures to guarantee that the activities they oversee comply with current regulations. However, neither the social nor health inspections conduct regular oversight in nursing homes. When they do visit following a complaint, the visit is usually announced in advance. Therefore, issues can be swept under the rug. As recently stated by director Peter Stefanoski, a significant obstacle in the inspection process arises if the resident has passed away: "We cannot question the deceased to verify the actual situation. We trust the relatives, but we cannot verify their claims."
This is how many cases typically conclude. Last year's inspection of neglect in the Danica Vogrinec retirement home in Maribor revealed no irregularities, despite media reports that residents were left in the same diaper for 15 hours and immobile residents had not been taken outside for fresh air for three years. The inspection of new irregularities that we highlighted at our media outlet is still ongoing. "And this is the epilogue of negligent and criminal work in the service of the most vulnerable people. No inspection will eliminate all the superficialities and blunders because no one fears them. When they announce their visits, everything is polished, unfavourable things are hidden, and the caravan moves on," said Silvija Novak, expressing her disappointment with state inspectors. Inspections are still ongoing in Preddvor, the Jutro Institute, and the Social Work Centre Kočevje, where we also highlighted irregularities.
Our long-lived society faces significant changes but is full of pitfalls. Preparedness for these challenges and awareness of their necessity is not yet part of the general consciousness nor the paradigm of the decision-makers. The elderly are our present and future. Oversight of 115 nursing homes and other social institutions across Slovenia is conducted by only five inspectors. Only one inspector is responsible for abuses in nursing homes. In the past five years, the Labor Inspectorate has received 109 complaints concerning work in nursing homes. More than half of these complaints involved allegations related to healthcare, which were forwarded to the appropriate authorities.
According to officially available data, 154 inspection surveillances have been conducted in nursing homes over the past five years. The risk of inappropriate conduct increased in about one-fifth of cases, and in less than 10 percent of cases, irregularities directly affecting residents were found.