The acting Ombudsman of Spain, Francisco Fernández Marugán, has sent recommendations to all Autonomous Communities to improve health care for residents in retirement homes, the information provided to their families and the protection of their rights.
The Institution has received a considerable number of complaints in which the relatives of the residents have highlighted shortcomings in their health care and a lack of information and transparency from the centres. They also express their hopelessness for not being able to say goodbye in the event of death and the insecurity regarding their rights at this time.
The Ombudsman, after analysing the complaints received and given the dramatic data of those affected and those who have died in retirement homes, believes that it is necessary to reinforce the health care measures in the centers and the attention to other rights of those who are confined in residential centers, postponed in the face of the urgent need to protect life.
Recommendations
In a document addressed to all the regional social policy departments, the Institution recommends that due health care be reinforced in residential centres for covid-19 patients with no indication of hospitalisation.
To this end, it points out that coordination with the departments responsible for health care must be improved and urges that the retirement homes obtain adequate medical and nursing support, at least through the on-site and provisional assignment of backup health care personnel, the delivery of the health care equipment required for the care function, the supply of individual protection equipment for the staff and the performance of diagnostic tests on all residents and staff of the centre.
The Institution also considers it urgent that workers in nursing homes be replaced by service providers (or, in their absence, by the corresponding authority) in order to guarantee adequate care (hygiene, food, mobilization, etc.) for the elderly.
The Ombudsman considers it necessary to improve the information that families receive. Along these lines, he has requested that the necessary measures be adopted to guarantee continuous and complete information, at least on a daily basis, to the person designated by the family of the resident regarding his health situation, activities, meals and other aspects of interest, without prejudice to providing direct or telematic communication tools.
The Ombudsman also requires that families be notified of transfers of residents within the facility or referrals to another residential facility or hospital.
In addition, he recommends that the family representative be kept regularly informed of the general situation of the retirement home in terms of users affected by covid-19 (deceased, confirmed and with compatible symptoms), available resources and personnel incidents.
Regarding the rights of residents, the Institution has urged the Autonomous Regions to allow non-infected elderly people to voluntarily and temporarily return to their families during this coronavirus crisis, without loss of place, and whenever possible in accordance with the requirements for the protection of public health that are established.
Lastly, the Ombudsman has demanded that, in cases of a terminal clinical state, protocols be adopted to facilitate the farewell of at least one family member. In the Institution’s opinion, the death process should be as humane and dignified as possible, while also meeting public health needs to guarantee the safety of other users, workers and the family member himself. Likewise, if requested by the patient, spiritual care must be provided to the resident according to his or her beliefs.
Ex officio action
These recommendations have been addressed to all the Autonomous Regions, since they retain the powers conferred to them by current legislation in the day-to-day management of their services to take such measures as they deem necessary within the framework of direct orders from the competent authority for the purposes of the state of alarm, pursuant to article 6 of Royal Decree 463/2020 of 14 March.
The resolutions of the Institution join the general actions already undertaken with the Ministry of Health and the ex officio action opened with all the health and social policy departments of the autonomous communities, to learn about the response in each territory to this health emergency in a more structured manner, and to determine aspects of improvement that will allow for the strengthening of coordinated measures in the face of new epidemic threats.
In a context in which the absolute priority is to defend the right to life and to stop the spread of the Covid-19 pandemic in order to save as many lives as possible, the Institution is aware of the effort being made, to the maximum of its forces and capacities and on the front line, by all health and emergency service personnel and workers who attend the most vulnerable people in retirement centres.
In-depth review of the model
The Ombudsman has been examining for a long time the care provided in retirement homes throughout the country and warning of the lack of means and personnel in many of them.
In the 2018 report (See the PDF in spanish version) some general conclusions were drawn after collecting and analysing information from the competent councils on the situation of residential care in all the Autonomous Communities.
This analysis continued throughout 2019 and is reflected in the report for that year which will be delivered to the Spanish Parliament shortly.
The lack of resources and personnel in many of the retirement centres are structural problems that have been revealed in all their severity in the current crisis.
With the current pandemic, the dramatic situation lived in many centres reflects the model’s difficulties in adopting sufficient measures of prevention and reaction, as it is a purely welfare model, with scarce means and which is supported for all health care in the National Health System.
Therefore, in the Ombudsman’s opinion, the model as a whole requires a thorough review.
