Elderly stuck in wards with mentally ill and dangerous

Photo: Andres Haabu

Due to lapses in Estonian law, demented elderly and alcoholics find themselves sharing wards with aggressive and dangerous schizophrenics and the like. 

AS Hoolekandeteenused chief Maarjo Mändmaa sued Pärnu city into Supreme Court to protest a demented woman appointed for his institution. On February 10th, Supreme Court satisfied Mr Mändmaa’s complaint and sent the decision back to circuit court. The case is complicated by the law not allowing Mr Mändmaa to decide whether the individual in question is supposed to be in a closed institution after all.

-Rubbish heaped, and paranoia

The individual, let’s call her X to honour privacy of relatives, into the social welfare institution as the relatives deemed her a threat to themselves and fellow men.

Police data says since 2014 they have received two applications by X regarding apartment theft. During these past three years, the woman has heaped the apartment full of trash and will not allow it to be cleaned out. Rescue Board says she once needed help to switch off electric stove. Meanwhile, there is extreme fire-risk in the apartment. The woman has always turned down help offered.  

«Dementia means people go into mental regression, as evidenced by things like loss of memory, possibly behavioural disorders and paranoia,» explained AS Hoolekandeteenused quality manager Aster Tooma. Dementia is incurable, thus the best way to take care of X is to place her in a supportive environment.

According to Ms Tooma, the individual has been placed in a totally wrong place. «For instance, if a violent and mentally ill individual be placed in the same department with an elderly woman whose danger consists in collecting trash, it is not safe for the latter,» she explained.

Ms Tooma said it is difficult to find a place to care for the demented and many institutions of overall care are unable to provide sufficient oversight. «So they’ll not go roaming, get lost, or get in other kinds of danger,» specified Ms Tooma. Also, restriction of movement may make a demented client angry.

As noted by the quality manager, Estonia has institutions like SA Viljandi Hospital where nursing services feature an oval corridor where a demented individual walks round and around, without encountering closed doors.

-A forced situation for all

Though the dispute reached Supreme Court, Pärnu city government quite agrees with AS Hoolekandeteenused. Chief specialist for care of the elderly Iris Ruut said court rulings have individuals placed in closed institutions who are in highly differing conditions while the place is the same. Essentially, the city is forced to pour the mentally ill into the same pot. «Not placing them [in institutions] will endanger themselves or others and no other help is available,» admitted Ms Ruut.

The specialist thinks the state is unwilling to create a system more flexible and the attitude is let local governments solve their situations.

Money may also be the problem. Ms Tooma says the costs multiple times exceed the pension of those in need for help. And the social care institutions are short of places.

«All we can do at the moment is placing the individual in a ward with clients more quiet and peaceable,» admitted Ms Tooma. Even there, conflicts arise with the others. «Like when somebody switches a lamp on at night, the other switches it off, the first one gets angry and hits the other,» said Ms Tooma.

She said they have such a broad variety to service: the mentally ill, the alcoholics, those with autism, the demented.  

All of these would actually need differing approaches and support. «For instance, our staff has no training whatsoever to treat alcoholics. We just keep them from getting hold of alcohol,» said Ms Tooma.

The Estonian Patient Advocacy Association head Pille Ilves says the problems arise from ignorance. «For people with psychic disorders, the state appoints representatives without any knowledge,» said Ms Ilves.

She explained that the right for liberty may only be restricted by placement in closed institution when the following conditions are met simultaneously: the individual has a severe psychic disorder, he is dangerous to himself or fellow citizens, and other measures to remove the danger have not been sufficient. «Often, they only see the first of these,» she noted.