Idom_Report_CRD

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REPORT on monitoring of the human rights situation in psycho-neurological institutions in the Republic of Moldova

2013

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Contents

ACKNOWLEDGMENTS ................................................................................................................................................ 3

SUMMARY ....................................................................................................................................................................... 4

GLOSSARY. Notions and terms for the care of people with mental deficiencies ............................................................ 5

INTRODUCTION ............................................................................................................................................................ 6

DESCRIPTION OF THE PSYCHO-NEUROLOGICAL INSTITUTIONS UNDER THE JURISDICTION OF

THE MINISTRY OF LABOR, SOCIAL PROTECTION AND FAMILY OF THE R M ......................................... 9

The Brinzeni psycho-neurological boarding house ............................................................................................................ 9

The Badiceni psycho-neurological boarding house ......................................................................................................... 11

The Coceiri psycho-neurological boarding house ........................................................................................................... 11

The Balti psycho-neurological boarding house ................................................................................................................ 11

The Orhei boarding school for children with mental deficiencies (boys) ......................................................................... 12

The Hincesti boarding school for children with mental deficiencies (girls) ..................................................................... 12

MEDICAL CARE AND SUPERVISION (Admission to the facility) ........................................................................ 16

The Brinzeni psycho-neurological boarding house .......................................................................................................... 16

The Badiceni psycho-neurological boarding house ......................................................................................................... 21

The Cocieri psycho-neurological boarding house ........................................................................................................... 30

The Balti psycho-neurological boarding house ................................................................................................................ 45

The Orhei boarding school ............................................................................................................................................... 56

The Hincesti boarding school ........................................................................................................................................... 65

CONCERNS AND RECOMMENDATIONS .............................................................................................................. 73

Concerns regarding the respect of the right to hosting conditions of persons with mental deficiencies in psycho-

neurological institutions ................................................................................................................................................... 73

Recommendations regarding the respect of the right to mental health of persons with mental deficiencies in boarding

schools .............................................................................................................................................................................. 78

Recommendations regarding the respect of the right to mental health of persons with mental deficiencies in psycho-

neurological institutions ................................................................................................................................................... 80

REFERENCES. National and international legal regulations regarding mental health ............................................... 81

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ACKNOWLEDGMENTS

This report benefited from the generous support and valuable contributions of many people and

organizations, by giving feedback on discussions, making available basic documents or carrying out

researches.

We are extremely grateful to Civil Rights Defenders for the professional and financial support for

Advocacy for institutional changes and human rights of the

persons within psycho-neurological institutions in the Republic of Moldova

Finally, we thank the Ministry of Labor, Social Protection and Family of the Republic of Moldova

for the provided general information and for permeation to access the psychiatric institutions, as

well as to accompany the working group by the Center for Human Rights of Moldova

representatives on monitoring visits.
http://www.ombudsman.md/en

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SUMMARY

This Report is the result of activities carried out within the Project: Advocacy for institutional

changes and human rights of the persons within psycho-neurological institutions in the Republic

of Moldova implemented by Moldovan Institute for Human Rights.

About Moldovan Institute for Human Rights

The Moldovan Institute for Human Rights (IDOM) is an independent, non-profit organization,

founded in 2007 by a group of jurists and human rights defenders, which aims to protect the

fundamental human rights and freedoms. The members of IDOM are experienced in monitoring

respect for human rights and adherence to the obligations that the Republic of Moldova accepted

before the OSCE, the United Nations, the Council of Europe and other international organizations.

IDOM conducts advocacy and litigation, informs specific groups, as well as the entire society on

the most severe violations of human rights, caused by the ignorance of superior values of individual

freedoms, social justice, equity and non-discrimination.

The members of IDOM have contributed to writing reports on various human rights violations,

followed by the analysis of the situation, analysis of cases, comparative analysis of national and

international human rights legislation, recommendations for improving the situation addressed to

authorities, etc.

Main purpose of the visits

This Report presents the results of monitoring the human rights situation in the psycho-neurological

institutions in the Republic of Moldova under the jurisdiction of the Ministry of Labor, Social

Protection and Family.

Information gathered from the examination of institutions, legality of admission and maintenance

conditions, from the analysis of personal files of the patients with mental deficiencies, as well as

from the discussions with the medical staff, included in this Report, reflect the unique position of

the Moldovan Institute for Human Rights towards these institutions, towards the existing normative

acts, towards the practice used and methods of admission and also a unique position towards the

maintenance conditions of people, including their treatment during their stay in psycho-neurological

institutions.

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GLOSSARY. Notions and terms for the care of people with mental

deficiencies

Deficiency lack or insufficiency of certain mental, intellectual capacities.

Its main symptoms are the following: a) cease or slowing of the rhythm of evolution, especially of

organic functions; and b) reduction of social competence.

Causes of mental deficiency may be: a) individual etiological cases; and) mental deficiency is the

effect of several causes, which acted simultaneously or successively during the development.

If according to the old paradigm (medical model) disability was a disease (illness), a pathological

state of a person, which, actually, represented the root of all the problems faced by him/her, now,

according to the new paradigm, disability is a situation resulting from the interaction between

persons with impairments and attitudinal and environmental barriers (social model).

mental retardation, mental disability, mental debility. The term of mental disability tends to replace

the other terms.

According to the UN Convention on the Rights of Persons with Disabilities, persons with

disabilities must be provided with support in exercising their legal capacity [Art. 12 par.(3)],

including in controlling their own financial affairs [Art. 12 par. (5)]. This means that the vicious and

discriminatory practice of depriving persons of their legal capacity (an universal and fundamental

human right) by establishment of guardianship, must be abolished and the decision making

support system for persons in need, must be introduced without depriving them of legal capacity,

irrespective of the severity of their disability.

According to UN Convention on the Rights of Persons with Disabilities, persons with disabilities

-term physical, mental, intellectual or sensory impairments which in

interaction with various barriers may hinder their full and effective participation in society on an

equal basis with others

Social assistance element of the social protection system, represents the group of facilities and

measures by which the state, local public administration authorities and civil society ensure the

prevention, limitation or removal of temporary or permanent effects of situations that might cause

marginalization or social exclusion of a person.

Community services (protection of persons with disability) Services that allow to take care of the

patient in his/her natural life.

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INTRODUCTION

Admission

The psycho-neurological boarding house is actually a specialized psychiatric institution for persons

with chronic mental disorders. Therefore, the admission procedure must not differ from the

procedure used by the Psychiatric Hospital. Considering their profound and severe mental disorders

and that they are declared by courts incapable, the admission of beneficiaries in psycho-

neurological institutions is actually involuntary.

Within the current procedure of involuntary admission, patients must undergo compulsory

examination within 48 hours of their admission by a commission of psychiatrists of the facility. If

the admission is founded, the commission of psychiatrists shall send, within 24 hours, appropriate

notice to the court. The psychiatric inpatient admission request sent by the representative of the

facility shall be examined by the judge within 3 days of its receiving.

According to the Framework regulation for the functioning of boarding schools, approved by the

Ministry of Labor, Social Protection and Family of the Republic of Moldova (2008), the boarding

house is an institution for temporary or permanent placement, provider of social and medical

services, for adults with mental disabilities.

Beneficiaries of social services are persons who at one point may find themselves in a difficult

situation generating marginalization or social exclusion when they have no support from their

family or community and depend on third persons.

The purpose of the boarding house

The objectives of the boarding house are: to provide social and medical care to beneficiaries

according to their special needs and characteristics of individual development; to help socialization

and (re)socialization of beneficiaries in their extended biological family or in community.

At the same time, according to the Instructions on accommodation of the patronized in social

institutions under the jurisdiction of the Ministry of Labor, Social Protection and Family of the

Republic of Moldova, approved by the same Ministry (No 61/227 of 16.02.2000) and Ministry of

Health (No 06-34/188 of 16.03.2000), people with chronic mental disorders, people with disabilities

and third age people who cannot take care of their own may be hosted temporarily or permanently

in these social institutions.

Case referral to highly specialized social services Case referral to highly specialized residential social services developed at a national level according

to the Law on social services, Case referral mechanism in the social services system approved by

the Order of the Ministry of Social Protection, Family and Child No 55 of 12.06.2009 (currently the

Ministry of Labor, Social Protection and Family of the Republic of Moldova), is an activity carried

out for a relatively low number of people with no legal tutor, residents of the Republic of Moldova

under the law and it is usually accomplished by local structures at the suggestion of the community

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social assistant only if there are valid reasons to believe that the medical and social services

developed at the national level cannot satisfy the needs of the appliers. The case referred is

accompanied by a set of documents according to the law which confirms the social status, health

state and opportunity of intervention. The procedure of registration and record of persons referred is

carried out in the ministry and in the local social assistance office. The accommodation letter of

referral is issued depending

moment of service request.

The scriptical evidence of beneficiaries is made by keeping records in the Registry of applicants for

residential services, in the order of arrival of personal files and depending on the type of unit

recommended by the Consulting Medical Commission under the Public Medical-Sanitary Facility.

Documents serving as legal basis for admission in the psycho-neurological boarding house:

Minutes of the meeting of the Medico-pedagogical commission which recommends the

admission in a specialized Institution for children with mental deficiencies, under the jurisdiction of

the Ministry of Labor, Social Protection and Family of the Republic of Moldova.

Medical observation sheet of the patronized.

Welfare report of the person referred to admission, Court Decision which declares the

incapacity of exercise of the patronized.

Approval of the Ministry of Labor, Social Protection and Family of the Republic of

Moldova.

According to court decisions, people hosted in boarding houses have restrained capacity of exercise.

But the direct admission to the boarding house and the term of admission does not depend on the

court decision.

Range of services that should be provided by the psycho-neurological boarding house:

accomodations, medical care, meals;

services for the development of cognitive, communication and behavioral skills;

recovery and rehabilitation services;

support for educational inclusion;

counseling of family members; and

leisure activities.

Range of psychological, psycho-pedagogical and social interventions

undertaken by psycho-neurological institutions

Adaptation to social needs and development of social habits are the quintessence of psycho-social

interventions necessary for the institutionalized persons with severe mental deficiencies.

Currently, the psycho-pedagogical specialists are using the following fields of psycho-social

interventions to children with severe mental deficiency:

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a) motor (general motility, fine motility and ocular-motor coordination, psychomotility).

b) communication and language.

c) cognitive (reading-writing-communication, mathematics, working with the concept of

number).

d) social-affective (personal and social autonomy, socio-affective maturity). Because of the

lack of psycho-pedagogical specialists and crowding of the Hincesti boarding school with adults,

the range of psycho-pedagogical interventions to children with severe mental disabilities are very

limited. Also, they actually are reduced only to those elementary.

It urges the Ministry of Labor, Social Protection and Family of the Republic of Moldova,

responsible for the activity of the boarding school and psycho-neurological institutions, to develop

national standards on Specialized medical assistance and Range of psycho-pedagogical,

psychological and social interventions for the patronized with different stages of mental deficiency.

Unfortunately, the range of interventions used for adaptation to social needs and development of

social habits in the case of persons with severe deficiencies is very limited. This is caused by the

health state itself, the mental deficiency and the lack of certain appropriate forms models of

specialized interventions in such situations.

Of the 315 persons hosted in the Hincesti boarding school for children with severe mental

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staff, medical assistants, educators and nurses are practically limited, according to the staff, only to:

how to hold the spoon;

how to use the toilet;

how to wipe their mouths;

how to stay at the table;

how to listen to the staff.

The staff trained directly in medical assistance consists of: 7 doctors, paid by sponsors and 18

medical assistants paid from the budget; and in psycho-pedagogical interventions 19 persons,

educators, paid from the budget.

Considering the very low number of employees and the fect that the staff is trained in psycho-

pedagogical interventions in two shifts, day-night, we can state -

specialized support provided to those 315 persons hosted in the Hincesti boarding school is limited

only to the supervision of beneficiaries and their physical care and nutrition.

A part of the specialized equipment donated to the boarding house cannot be used for persons with

severe deficiencies.

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Legal rights to admission, medical care and release from psycho-

neurological institutions

Psycho-neurological institutions do not have an independent jurist to promote and protect the

category of beneficiaries unable to exercise their capacity to act and defend their rights to admission

to the boarding house, compulsory medical care in this facility, maintenance conditions; their rights

to be involved in different educational psycho-social interventions and to be released from the

boarding house. It is inconceivable that the facility does not have a jurist independent from its

administration.

Accreditation of psycho-neurological institutions, public medico-social

facilities

Psycho-neurological institutions are not subject to the accreditation applied to public medical-

sanitary facilities under the jurisdiction of the Ministry of Health, which aims to establish their

capacity to provide the population with appropriate medical assistance. Therewith, the institutions

do not have clinical standards to provide medical services.

Descriptions of the psycho-neurological institutions under the

jurisdiction of the Ministry of Labor, Social Protection and Family of the

Republic of Moldova

The Brinzeni psycho-neurological boarding house is located in Brinzeni village, Edinet

region, approximately 225 km from Chisinau. The boarding house is accessible by bus from

Chisinau, Edinet, and some other neighboring localities. The road conditions to Brinzeni are poor

and the traffic is slow.

The institution has a kitchen with dining room, food storage, an animal farm, a greenhouse for

vegetables as well as agricultural land and other unused auxiliary rooms.

The majority of beneficiaries are former residents of orphanages for children with mental

disabilities from the left bank of the river Nistru, who have been transferred to this institution after

the start of the military conflict in 1992. Since 2004, the Brinzeni psycho-neurological boarding

house hosts also chronic patients from psychiatric hospitals and the Orhei and Hincesti boarding

schools .

The official capacity of the Brinzeni psycho-neurological boarding house is 301, of whom, 79 had

schizophrenia, 175 had mental disabilities and 47 had epilepsy.

According to the doctors, 12 persons from the boarding house were placed in other facilities after

being diagnosed with pulmonary tuberculosis.

From 9 August 2013, the boarding house experienced a 12 -month tuberculosis outbreak.

According to the statistical information presented by the administration of the Brinzeni psycho-

neurological boarding house, since 2 January.2013 there are 311 patients, of whom 183 are men and

128 are women.

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Men :

Age : No of persons :

20 - 30 years 22

31 - 40 years 36

41 50 years 51

51 - 60 years 52

61 - 70 years 4

over 70 years 4

Women :

Age : No of persons :

20 - 30 years 16

31 - 40 years 34

41 50 years 24

51 - 60 years 34

61 - 70 years 12

over 70 years 8

From the total number-311 patients on 2 January 2013 No

Disabled people, I degree 104

Disabled people, II degree 205

Disabled people, III degree 2

Bed-ridden 32


First-degree relatives 71

Second-degree relatives 66

Third-degree relatives 50


First-degree relatives 71

Second-degree relatives 66

Third-degree relatives 50

Orphans (have no relatives) 124


Schizophrenia 81

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Profound and severe mental retardation (total), 177

Mild mental retardation 20

Severe mental retardation 157

Consequences of organic cerebral affections with dementia 20

63 of 311 patients do not have a Court decision.

248 of 311 patients do not have a legal representative.

During 2012, from the total number of patients, 22 have been placed in the Psychiatric

Hospital from Balti and 3 in the Phthisiology Hospital from Pavlovca, Briceni region.

The Badiceni psycho-neurological boarding house is located 5 km from Badiceni village, in

the Soroca region, covering12 hectares.

The road to the institution is damaged and during winter, access is limited.

The boarding house has an administrative building with a surface of 350 m2, built in 1957 and

repaired in 2006; apartment building with two levels with a surface of 2100 m2, built in 1986 and

partially repaired in 2005 (by changing the roof) and in 2010 (by changing the doors and windows);

laundry room built in 1986; food storage built in 1985; boiler house built in 1986 and repaired in

2011.

The electricity is delivered according to the agreement concluded with S.A. Red-Nord-Vest. The

boarding house has an artesian well that provides drinking water and a coal boiler house. The sewer

system is working, but it is old and needs to be reconstructed.

The capacity of the Badiceni psycho-neurological boarding house is 460.

On the visit day, in the Badiceni psycho-neurological boarding house there were 455 beneficiaries,

of whom 241 men and 214 women. All the beneficiaries have identity cards, which are kept in

personal files and have been paid from the budget of the institution.

Depending on the nosological form, the beneficiaries are distributed:

No

Schizophrenia 117

Mental retardation 277

Epilepsy with dementia 25

Organic disorder with dementia 36

The Coceiri psycho-neurological boarding house is located in Cocieri village, Dubasari

region, 46 km from Chisinau.

On the visit day, in the Cocieri psycho-neurological boarding house there were 346 beneficiaries, of

whom 200 men and 146 women. The patients of the institution are from the age of 4 years and

above and benefit from complete maintenance.

The Balti psycho-neurological boarding house is located 3 km from the center of Balti,

covering 45282,6 m2 , of which 8922,6 m2 are the total surface of the building and 36360 m2 the

pertaining land. The patients of the institution are men and women of different ages who benefit

from complete maintenance.

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The Balti psycho-neurological boarding house began operating in August 1984. It has 4 apartment

buildings for the hosted beneficiaries, outpatient department equipped with consulting rooms,

treatment rooms, physical therapy, vaccination, massage rooms, clinical laboratory, dental

departments, gynecological departments. The institution has a kitchen with dining room, food

storage, events room, library, laundry room, autonomous heating system, houses for transportation

units and other auxiliary rooms.

The Orhei boarding school for children with mental deficiencies (boys) is a public

institution of social assistance which provides placement services to children with mental

disabilities towards their recovery, social and family rehabilitation and (re)integration. The Orhei

boarding school is meant to be for children with mental disabilities from the age of 4 to 18 years.

The capacity of the institution is 350.

The boarding school is located in close proximity to Orhei and consists of a building with 4 levels

and a building f

The Hincesti boarding school for children with mental deficiencies (girls) operates

according to the Framework regulation for the functioning of boarding schools, approved by the

Order of the Ministry of Labor, Social Protection and Family No 45 of 13.06.2008.

The boarding school for children with mental deficiencies is a public institution of social assistance

which provides placement services to children with mental disabilities towards their recovery,

social and family rehabilitation and (re)integration. The Hincesti boarding school is meant for

children with mental disabilities from the age of 4 to 18 years. From the total number of

beneficiaries, 174 persons are over 18 years, respectively, 141 are underage. The youngest

beneficiary is 4 years old and the oldest 52 years.

On the visit day (11 January 2013) to the boarding school for children with mental deficiencies

(girls) we found out that according to documents there were 315 patients, of whom only 141 were

children (46 being bed-ridden) and 174 were adults (48 being bed-ridden). From the 94 bed-ridden

persons, 68 were suffering from convulsions.

Depending on the nosological form, from the total number of 221

children and adults, persons not bed-ridden are distributed:

No

Mild mental retardation 2

Profound mental retardation 3

Severe mental retardation 216

Statistical dynamics from the last 3 years of

the visit day is the following:

2011 2012 2013

Hosted primarily 13 9 7

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Financing of psycho-neurological institutions

The Brinzeni psycho-neurological boarding house:

Total budget for facility 14834,8 thousand lei, of which 14834,8 thousand lei : 365 days =40,6

thousand lei.

One day per person hosted in the boarding house: 311 beneficiaries = 1300 thousand lei (somatic-

1305,0).

The Badiceni psycho-neurological boarding house:

On 30 September 2013, the execution of the State budget was: according to the plan mentioned for

the management period - 11697.8 thousand lei, financed 11532.8 thousand lei, effective costs -

11707.1 thousand lei.

The Hincesti boarding school:

Plan mentioned for the year 2013:

lei

From the Budget 15268,6 thousand

Executed for 9 months, 2013 10631,5 thousand

Effective costs for 9 months, 2013 10770,7 thousand

From home 5 6 1

From other facilities 8 3 6

Released 8 26 13

To relatives 3 2 1

In other facilities 5 22 12

Deceased 3 2 0

Plan mentioned for the year 2013:

lei

Special means

Executed for 9 months, 2013 923,4 thousand

Effective costs for 9 months, 2013 613,3 thousand

Humanitarian aid:

Received for 9 months, 2013 471,7 thousand

Including:

Food 55,9 thousand

Medicines 20,3 thousand

soft inventory 231,3 thousand

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From the discussions held with the management, the institution has received financing according to

the established terms, the main source being the state budget and donors. No delays in salary

payments have been noticed. Currently, the staff of this institution is worried about low salaries and

insufficient staff members. There is no periodical independent monitoring on the expenditure of

money and material resources (from the budget and donors) received by the boarding school.

Therefore, it is impossible to monitor the expenditure of money and material resources for each

beneficiary.

Staff of psycho-neurological institutions

household materials and objects 164,2 thousand

Spent 319,1 thousand

Including:

Food 84,0 thousand

Medicines 26,1 thousand

soft inventory 67,9 thousand

household materials and objects 141,1 thousand

Maintenance costs of patients:

lei

Food

according to the budget 32,10

de facto 32,70

Medicines


de facto 6,96

Total per person/day: 10770,7 thousand


de facto 142,00

Comparative characteristics.

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Insurance of boarding schools with health care staff

Orhei Hincesti

No Unity According

to staff

scheme

Occupied

with

natural

persons

According

to staff

scheme

Occupied with

natural persons

Professional doctors

1. Head doctor 1.0 1 0.25 0.25

2. Therapist 1.0 0.5 - -

3. Psychiatrist 1.0 0.25 1.0 1

4. Neurologist 1.0 - 0.5 0.5 external part-

time employment

5. Dentist - - 1.0 0.5 external part-

time employment

6. Pediatrician - - 1.0 9 (8 sponsorships)

7. Gyneacologist - - 0.5 0.5 external part-

time employment

TOTAL 4.0 1.75 4.25 11.75 (8

sponsors)

Medium medical staff

1. Chief medical

assistant

1.0 1 1.0

2. Medical assistant 17.0 11 18.0 20+2

(sponsorships)

3. Procedure

medical assistant

1.0 1 1.0 1

4. Medical assistant

- masseur

3.0 3 1.0 1

TOTAL 22.0 15 21.0 24

Low medical staff

1. Medical assistant 2.0 2 -

2. Nurse 113.0 96.5 108.0 186 (+78, part-

time employment)

TOTAL 115.0 98.5 108.0 186

Other employees involved directly in the health care of beneficiaries

1. Speech therapist 1.0 1 - -

2. Educators 8.0 9 19.0 19

3. Social assistants 3.0 2 1.0 1

TOTAL 12.0 12 20.0 20

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MEDICAL CARE AND SUPERVISION

(Admission to the facility)

The Brinzeni psycho-neurological boarding house

Living conditions: The boarding house has 3 apartment buildings with 2 levels. On each level there

are a number of rooms/bedrooms, 1 rest room, 1 sanitary unit and 1 storage place for clothes and

shoes, some of them have been donated and others have been bought by the institution.

During the day and night, patients in each group are supervised by one nurse.

The source of artificial light in each room is provided by bulbs, mounted on the ceiling, the light

quality being satisfactory. Also, the windows are large enough to let the natural light come in during

the day (in picture).

The boarding house is completely connected to an autonomous heating system, which has been

broken for at least half of a year. They patients suffer from the cold and sleep two to a bed in order

to stay warm. The electric heaters are also broken and beneficiaries have to wash themselves with

cold water. According to what we have been told, the renovation of the heating system may take

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Currently, the boarding house is in quarantine because of the tuberculosis outbreak. The institution

does not have sufficient electric heaters to warm the rooms and the use of several electrical heaters

overloads the electrical system.

During the discussions with the staff, we found out that in certain groups there are no:

Additional quilts;

Bedside tables for personal belongings;

The halls of the institution are moldy and there is a strong smell of cigarette smoke

everywhere, because patients (especially men) smoke in halls and rooms (in picture).

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Personal hygiene: The sanitary conditions in each unit were satisfactory (in picture).

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The bathroom and sanitary unit are divided in two rooms. In one of the rooms there are two or three

toilets (many of them broken) and one sink. In the other room there are one or two showers, which,

according to certain nurses have not been used by patients for quite a long time, because the heating

system does not work and there is no hot water.

Many sanitary units of the institutions are broken and are not connected to the centralized sewer

system. The floor is wet or there are large surfaces of water. The working group saw how a patient

with locomotor disability had to go to the toilet through these surfaces of water and her clothes got

wet eventually. According to the staff, all the beneficiaries have a face towel, soap and toothbrush.

Dietary: Patients have meals four times a day, at preset hours (in picture-menu).

We have to mention that, according to the chef, patients with special dietary needs have a separate

menu, depending on their health state.

The institution has a dining room for all the beneficiaries from the 3 buildings and to avoid

overcrowding, they eat in groups, i.e., according to the building they are placed in (in picture).

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From the discussions held with certain patients, we found out that the food and drinks (tea) are

practically always cold, especially for the last group. The kitchen staff ensured us that the diabetics

have a separate menu. According to certain beneficiaries, we found out that often the food is not

enough or has no salt or sugar.

Other occupational activities: The beneficiaries of the institution have the possibility to be involved

only in the household activity (almost 10% of the patients).

The Badiceni psycho-neurological boarding house

Living conditions: The boarding house has 3 buildings with 2 levels. Two of them are apartment

Each group has a bedroom, sanitary unit and restroom equipped with a TV set, chairs and a table.

The beneficiaries are eating here, because there is no dining room (in pictures).

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During the day and night, patients in each group are supervised by one nurse and one medical

assistant for six groups.


quality is being satisfactory, but unfortunately, in most of the groups, only 4 of the 8 bulbs are on,

the others are pulled out or broken. Also, the windows are large enough to let the natural light come

in during the day, but also to air the room, so there is no odor.

During the cold time of the year, the facility is completely heated, having for that purpose a boiler

house (in picture) tively good and varies between 21-23

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Clothes, shoes and bed linens are kept in wardrobes (in pictures). Some of the beneficiaries have

personal bedside tables, which can be fastened with a lock in order to protect their personal

belongings.

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Most of the groups are clean. There are carpets on the walls and the floors are covered (in pictures).

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Personal hygiene: The sanitary conditions in each unit were satisfactory. The humidity is high and

varies between 71-76%. The walls and ceilings of certain rooms are moldy (in pictures).

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The bathroom is separated from the sanitary unit by a concrete wall. In these rooms there are two

toilets, one bath and two sinks. Each sanitary unit has hot water.

Patients have the possibility to use the bathroom everyday for personal hygiene.

Here were found large quantities of sodium chloride, which stood at hand patients (in pictures).

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Dietary: Patients have meals three times a day, at preset hours. The facility has also special food

storage: for meat, dairy products, berries, tins, fruits and vegetables.

Other occupational activities: The beneficiaries of the institution have the possibility to be involved

in tailoring and auxiliary household activities.

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The Cocieri psycho-neurological boarding house

Apartment building: During the night, patients in each unit are supervised by 2 nurses and during

the day by 1 nurse.


quality is being satisfactory during the night. Also, each room has windows which let the natural

light come in during the day.

There is no ventilation system, so the rooms are aired by opening the windows.

The institution is completely connected to autonomous heating system.

Bed linens were clean. They are changed once in 10 days.

Most of the rooms on the 3rd

floor are equipped only with beds, thus there are no individual bedside

tables and wardrobes for clothes or other personal belongings (in pictures).

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Whereas on the 1st and 2

nd floor, we have noticed at least one bedside table or wardrobe in each

room, where there between two and four beneficiaries (in pictures).

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Each unit has a restroom for the patients. This is equipped with chairs or couches and a TV set (in

pictures).

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The institution has also a library, which is on the 2nd

floor. It has Romanian and Russian literature:

books, newspapers and magazines. Recently, the Adevarul Holding made a donation: several

collections of universal literature, novels and fiction. According to the librarian, beneficiaries come

often to the library.

Dietary: Regarding the dining room, patients have meals three times a day and according to the

director of this facilit

We have to mention that, according to the chef, patients with special dietary needs (50 persons)

have a separate menu, depending on their health state.

The institution has also food storage. Storage and preparation of food is poor (in pictures).

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According to the beneficiaries, some of them are satisfied with the food offered here, but some do

not like it and say that it is not enough and they are often hungry. Others told us that they are

periodically visited by their relatives who bring them food supplies.

Personal hygiene: According to the nurse, patients take a bath twice a week: on Tuesdays and

Fridays.

The sanitary conditions were unsatisfactory on the 2nd

and 3rd floor (in picture). Thus, these places

need major repair and endowment with all the necessary.

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The sanitary conditions were satisfactory on the 1st floor.

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The sanitary unit has:

3rd

floor, Group 3V and 3G: 2 toilets, 1 sink and 1 shower.

3rd

floor, Group 3B: 2 toilets, 1 sink and 1 bath.

2nd

floor, Group 2V: 2 toilets, 2 sinks and 2 showers.

2nd

1st

Patients receive shoes and clothes from their relatives or periodically from donations. The dirty

clothes are collected in a room, where there is also the laundry. The clothes are washed, dried here

and put in separate rooms, on separate shelves. According to the responsible person, in the morning

some of them are dressed with clothes chosen at random, by size and others recognize and wear

only their clothes (in pictures).

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Here was found the existence of a detention place. The low qualified staff decides who is detained

and for how long (in pictures).

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The Balti psycho-neurological boarding house

Apartment building No 2

On the 4th floor there is the Unit for women.

On the 3rd floor there is the Unit for men.

On the 2nd floor there is the Unit for men and women.

The most difficult unit regarding the provision of care services and medical assistance is the one

which has almost 200 persons with severe mental disabilities: mental retardation, senile dementia

etc., who are under a closer supervision in the Building No 2 (so-called secure care unit).

Beneficiaries from this category are hosted in a separate building, with 4 levels and are under

continuous supervision.

There are 50-70 beneficiaries on each floor, supervised by 3 nurses: 1 man and 2 women. The

beneficiaries are distributed depending on the severity of disability: on the 1st floor there are hosted

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persons with locomotor disabilities, on the 3rd

and 4th floor persons in severe conditions and

persons transferred from other units due to the deterioration of their mental health.

The access doors to the units located on the 3rd and 4

th floor are locked 24 hours a day. The majority

of doors are open and the handles are removed. But certain doors have hanging locks, fastened on

the visit day (in picture).

Some rooms had no bulbs (in picture).

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The windows are grated. On average, there are 5-7 beneficiaries hosted in each room bulbs (in

picture).

We have measured four rooms chosen at random on each floor:

3rd floor room with 9 beds measured 31,34 m2 (although there were 11 persons in this

room);

4th floor room with 7 beds measured 30,76 m2 and room with 6 beds measured 17,42 m2;

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2nd floor room with 4 beds measured 18,84 m2

According to the staff, enhanced security measures are necessary because the beneficiaries are very

aggressive.

On the 4th and 3

rd floor the hosting conditions are unsatisfactory: there is a strong smell of urine,

cigarette smoke, beds are old, some beds do not have mattresses or linens and the hall is dirty, the

minimal necessary furniture is missing (bedside tables, chairs, wardrobes), in certain rooms

switches are not running, the bulbs are missing and the concrete floor is full of holes and poses a

threat to life and that is why it must be repaired as soon as possible (in pictures).

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During the night, the clothes of beneficiaries are kept in separate rooms. In the morning they are

dressed with clothes chosen at random, by size (in pictures).


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On the 2nd

floor the hosting conditions are better comparing to the other floors, because linens are

clean, there are wardrobes and bedside tables, the floor is in good condition and in some rooms the

floors are covered with carpets in good condition (in pictures).

The source of artificial light in each room is provided by a bulb, mounted on the ceiling, the light

quality being satisfactory during the night (in pictures).

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The institution is completely connected to autonomous heating system. It is cold in the halls, since

there are no heaters. Are not well warmed up either.

During the visit, we have noticed that in the so-

transferred not only persons with disturbances or deteriorated mental health, but also persons who

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tried to escape from the facility.

Apartment building No 3

On the 1st floor there are hosted persons with locomotor disabilities, but the elevators do not work

and patients have difficulty in moving without help. On a whole, the hosting conditions are

satisfactory.

The windows are not grated. There are 1-2 beneficiaries hosted in a room, 4 at most. They are

allowed to decorate their sace at their own will. They are allowed to put a telephone line in their

room at their expense, to decorate the room with personal belongings (additional furniture, TV set,

Microsystems etc.), lock their rooms. Beneficiaries from this building are allowed to choose their

roommates and form couples.

During the day, beneficiaries are not involved in recovery/resocialization and maintenance of

capacities activities; their only occupation is to take care of the living spaces and to nurse bed-

ridden beneficiaries. They go for a walk, play cards, watch television, talk.

Dietary: Patients have meals three times a day, at preset hours.

The 2nd

, 3rd

and 4th floor from Building No 2 (Secure care unit) has its own dining rooms, located on

the same floor, but the conditions are unsatisfactory (in pictures).

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The facility has also a dining room for patients from the open care unit, who have meals in two

od being of 30,40 lei.

We have to mention that, according to the chef, patients with special dietary needs have a separate

menu, depending on their health state. Bed-ridden patients have meals directly in their rooms.

The facility has also a storage place for food supplies, food samples and for food preparation.

Personal hygiene: The sanitary conditions in each unit were satisfactory (in pictures).

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The bathroom and sanitary unit are divided in three rooms. In one of the rooms there are 4 hands

and foot wash sinks. In another room there are 4 shower units, isolated from each other by a special

wooden wall. In the 3rd

room there are 4 toilets. According to certain patients, they have a bath only

once a week.

According to beneficiaries: During the visit, we have discussed with more patients, who expressed

their opinion regarding the life in the facility and the attitude of the staff towards them. Some of

them are happy that they have a place to sleep and eat. Others want to go home, but their relatives

do not have possibilities to take care of them.

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The Orhei boarding school

Apartment building: During the day and night, patients are supervised by a nurse, educator and

medical assistant.

The source of artificial light in each room is provided by a bulb, mounted on the ceiling, the light

quality being satisfactory during the night. Also, each room has windows which let the natural light

come in during the day.


The institution is completely connected to autonomous heating system.

It is clean here, thus the conditions are satisfactory.

Each group from the 2nd

floor has:

rest room with a TV set, chairs and tables (in pictures 1, 2, 3, 4, 5, 6, 7);

wardrobe for clothes and shoes (in pictures 8, 9, 10);

bathroom equipped with 3 baths (in pictures 11, 12, 13);

activity room (in pictures 14, 15);

bedroom (in pictures 16, 17, 18);

sanitary unit equipped with 4 toilets and 4 sinks, small compartments for towels, soaps and

tooth paste (in pictures 19, 20, 21, 22).

1.

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2.

3.

4.

5.

58

6.

7.

8.

59

9.

10.

11.

60

12.

13.

14.

61

15.

16.

17.