Older people imprisoned

More than half of residents who have been prevented from leaving nursing homes and similar institutions have capacity to decide where they should live, according to Dr Shaun O’Keeffe, of the Department of Geriatric Medicine, at Galway’s Merlin Park Regional Hospital.
He has slammed ‘de facto imprisonment in nursing homes,’ adding that there is no legal basis for older people with dementia to be pushed into a nursing home, if they say they do not want to be there. ’Older people are being imprisoned,’ he said.

Dr O’Keeffe called this ‘criminal’ and said he believed the number of people in this situation, is ‘much larger than people realise’. “If someone goes into a nursing home, de facto that is a life sentence. The difficult home circumstance they came from has now been dismantled. There is no going back after a short period of time. If you are detained under the mental health legislation by contrast, it is not forever,” said Dr O’Keeffe.
Legal change is needed, he said. Dr O’Keefe described what he calls ‘the Gotcha syndrome’. “Once the patients are in hospital, people with dementia face a bleak ‘Kafkaesque’ world. Risk assessment has taken over from the assessment of need: litigation is increasingly common. Also, there have been the horrors of restraint injuries, resulting in three deaths in the last two years,” he said.
In younger people, even where the person is a bit slow, capacity legislation is unlikely to be invoked. “By placing a threshold on capacity, it is older people with dementia who are ‘trapped’ in this way,” Dr O’Keeffe said. Assessing autonomy requires a functional approach. This has been endorsed by the Law Reform Commission in three reports in recent years. It recommended that the Minister should set up the working group on standards for capacity.
The Irish Council for Bioethics has supported the introduction of advance directives. The commonest advance directive of all is ‘don’t put me in a nursing home’ or ‘I want to stay at home’. It has been found that nursing home placement accelerated short-term cognitive decline in Alzheimer’s patients. Increased feelings of loneliness, marginalization, worsening psychiatric symptoms and poorer quality of life are typical.