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Provision of care and rights

2017: Standards for Residential Care Facilities


Admission

In the majority of the countries, at the time of admission, prospective residents (and/or their representatives) should be informed in writing about the key aspects of the service provision. This information has to be given before or on the day of admission. In Belgium (Wallonia), the Czech Republic, Ireland, France and Slovenia, prospective residents should also be informed about their rights and obligations. In Ireland, according to the National Standards, information on rights should be provided in an accessible format and residents should be supported in understanding their rights. In addition, often the resident is required to sign a contract (or agreement) which should describe, among other aspects, the services that will be provided and often, their cost. The National Standards for nursing homes in Northern Ireland refer specifically to the importance of this pre-admission stage for people with dementia:

“It is vital that at the pre-admission stage prospective residents, their relatives and representatives have all the information they need to make an informed choice about moving into the home. This is particularly important for those residents whose capacity to make informed choices might be limited due to learning disability, mental health issues or cognitive impairment such as dementia”.

In the Czech Republic, Ireland, Malta and the UK (Northern Ireland, Wales and Scotland) it is stated that the information has to be written in a language and format suited to the prospective resident. In Malta, the information has to be available in English and Maltese. In Turkey, information about the residential care facility should be available in an accessible format.

The National Standards in Malta, Ireland and the UK (Northern Ireland and Wales) specifically state that admissions into a residential care facility should be planned. In Ireland and Northern Ireland, the residents’ needs should be assessed prior to admission to a residential care facility to ensure that their needs can be met by the facility. In Northern Ireland, the residents’ medical history (e.g. medication and treatments), referral forms and any necessary aids and equipment should be in place prior to admission.

In Bulgaria, Croatia, the Czech Republic, Ireland, Lithuania, Malta, Romania, Slovenia, Turkey and the UK (Northern Ireland, Wales and Scotland), it is stated that there should be opportunities for the prospective resident (and his/her next of kin, representative or friends) to visit the residential care facility, spend some time in it and meet the staff as well as other residents before making a decision about moving in. In some countries (e.g. Netherlands), visiting the care facility prior to admission is encouraged but it is not stated in the regulation.

Specific provisions exist in Ireland and in the UK (Northern Ireland and Wales) regarding the support that a resident should receive from staff members around the time of admission. In Ireland, residents should be consulted with, supported and involved in the planning for their transition into the residential care facility. The prospective resident should be offered the opportunity to meet with a member of staff prior to admission, to discuss what the transition into the residential service will mean and the application for admission. In Wales, prospective residents are given the opportunity for staff to meet them in their own home and also can benefit from a place on a “trial basis”. In Northern Ireland, the manager or a senior member of staff should visit the resident prior to admission and a named member of staff should be identified to provide support for the resident for the first few days and a key worker from the staff team subsequently. In Hungary, before admission, some health care professionals (e.g. GP, social workers, etc.) have to assess if the prospective resident is entitled to admission.

A common provision related to consent at the time of admission, is the need for the resident to sign a contract or admission agreement that sets outs the terms and conditions of accommodation and residence. The relevant national legislation on decision making, legal capacity[57] and involuntary internment should also be taken into account for residents who may lack capacity to consent or may need support to consent at the time of admission or at any other time. Often, this legislation was developed for internment in hospital settings or is related to people with mental health problems. Some countries, however, have provisions which apply specifically to residential care settings. These provi- sions for moving into or out of the residential care facility, follow in some cases a relatively flexible approach which allow a relative or the appointed guardian to make these decisions (e.g. Croatia, Norway, Slovakia, Slovenia, Turkey), whereas in other countries, these decisions have to be approved by Court (e.g. Czech Republic, Netherlands). In countries where this legislation has shifted to assisted or supported decision-making (e.g. Ireland, UK), the resident should be supported for as long as possible in making these decisions. Some examples are provided below:

  • In Norway, according to the Regulations for nursing homes and special dementia units (article 4), if a resident with dementia (or if for some any other reason the person cannot safeguard his/her own interests) wants to move out of the residential care facility, or go to a different care home, this has be decided in consultation with their relatives.
  • In Croatia, Slovakia, Slovenia and Turkey, if the person has an appointed legal guardian, the legal guardian can make this decision and sign the contract/ agreement on behalf of the person.
  • In the Czech Republic, if the resident has an appointed legal guardian, additional approval from the Court (or guardianship council) is required for admission. If a resident living in a residential care facility has a serious disagreement with the service provided to him/her but is no longer able to terminate the contract him/herself, the service provider should inform the Court of this disagreement within 24 hours. The Court has then to decide within 45 days whether the person should or should not stay in the residential care facility. Similarly, in the Netherlands, residents admitted under BOPZ law (The Psychiatric Hospitals (Compulsory Admissions) Act – Wet bijzondere opnemingen in psychiatrische ziekenhuizen, BOPZ), cannot leave the facility without approval from the Court.
  • —In Ireland, each resident, where appropriate, should be supported to make informed decisions and have access to an advocate. Residents with a cognitive impairment should receive the support they require to uphold their right to exercise their legal capacity. Effective arrangements that protect the will and preferences of each resident who lacks capacity to give informed consent are in place. Each resident’s consent to treatment and care is obtained in accordance with legislation and current evidence-based guidelines. Where residents express a wish to leave care and return home, they are involved in planning and discussing the best way to prepare for their move on.
  • In the UK, in keeping with the different mental capacity legislation that exists across the nations, a person should be presumed to have mental capacity to consent or refuse care or treatment unless proven otherwise. Residents should be involve in decision making in line with relevant guidance on consent, treatment and care. In the Standards for nursing homes in Northern Ireland, the resident (or their representative) and the Registered Person should sign the agreement prior to, or within five days of, admission. Where the resident or their representative is unable or chooses not to sign, this is recorded. Neither the Registered Person nor any staff member acting as an appointee or agent on behalf of a resident may sign the written agreement on the resident’s behalf. The agreement should be made available in a format and language suitable for the resident.

Footnotes:

57  For further information on this topic, please see Dementia in Europe Yearbook 2010 and 2016.


Table 13: Requirements in relation to the admission of residents

 

Residents being informed in writing about internal regulations (information about the residential care facility, services provided, charges etc.) and signing a contract/agreement.

Belgium (Wallonia and Flanders), Bulgaria, Croatia, Czech Republic, Hungary, Finland, France, Netherlands, Germany, Ireland, Lithuania, Luxembourg, Malta, Portugal, Romania, Slovenia, Slovakia, Turkey, UK (Northern Ireland, Wales and Scotland).

Residents being informed in writing about their rights and obligations.

Belgium (Wallonia), Czech Republic, Ireland, France, Slovenia.

Prospective residents being able to visit the facility before admission.

Bulgaria, Croatia, Czech Republic, Ireland, Lithuania, Luxembourg, Malta, Romania, Slovenia, Turkey and the UK (Northern Ireland, Wales and Scotland).

Specific support from staff around the time of admission.

Croatia, Ireland, Luxembourg, Poland, Slovenia, UK (Northern Ireland and Wales).

 

 

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Last Updated: Friday 31 January 2020

 

 
  • Acknowledgements

    This Dementia in Europe Yearbook received funding under an operating grant from the European Union’s Health Programme (2014-2020). The content of the Yearbook represents the views of the author only and is his/her sole responsibility; it cannot be considered to reflect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive Agency or any other body of the European Union. The European Commission and the Agency do not accept any responsibility for use that may be made of the information it contains.
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