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Italy: Violations of the human rights of older residents of care homes during COVID-19 pandemic

A report by Amnesty International Italia examines the impact of decisions taken and practices adopted by the authorities in responding to the pandemic in care homes in three Italian regions. Notably, these included failing to ensure the right to life, to health and to non-discrimination for older people in care homes.

Abandoned”, highlighting human rights violations in care homes in Italy during the COVID-19 pandemic looks at the impact of the Covid pandemic on the human rights of older people in care homes in the Italian regions of Lombardy, Emilia-Romagna and Veneto. It highlights the shortcomings of Italian institutions at the national, regional and local level in adopting timely measures to protect the life and dignity of older people in care homes during the COVID-19 health emergency. The delay or failure in adopting adequate measures often resulted in the violation of the right to life, to health and to non-discrimination of older care home residents and workers.

Decisions taken and practices adopted by authorities at all levels resulted in or contributed to violations of the human rights of older residents of care homes – notably their right to life

Donatella Rovera, Amnesty International

“Decisions taken and practices adopted by authorities at all levels resulted in or contributed to violations of the human rights of older residents of care homes – notably their right to life, their right to health, and their right to non-discrimination,” said Donatella Rovera, Amnesty International’s Senior Crisis Response Adviser.

“These approaches also negatively affected residents’ rights to private and family life, and may in certain cases have violated their right not to be subjected to inhuman or degrading treatment.”

In Italy, thousands of older care home residents have lost their lives since the beginning of the pandemic. The research presented today highlights the main failures related to the management of the pandemic in care homes for older people, which contributed to the spread of the COVID-19 infection.

Untimely restrictions to care home visits, nonexistent or delayed provision of personal protective equipment (PPE), and delays in testing older residents and staff are some of the shortcomings that contributed to the tragic outcome. These outcomes demonstrate the de-prioritization of care homes in favour of hospitals, despite the World Health Organisation (WHO) drawing attention to the fact that older people were among the most vulnerable to the virus since the beginning of the pandemic. To date, there are still no clear national policies or guidelines requiring regular and frequent testing in care homes.

The discharge of older patients from hospitals into care homes, including those infected or potentially infected with Covid-19, contributed to the spread of the virus in care homes. This was notably due to the failure to ensure that care homes had the necessary systems and human and material resources in place to ensure protection for residents and staff, as well as the lack of effective oversight in verifying that necessary protective measures were in place. Health workers’ testimonies, received by Amnesty International Italia, lament the failure to implement protocols for the isolation of infected residents.

Authorities must to take adequate and timely measures to ensure that the response to the pandemic protects the fundamental human rights of older residents in care homes,” said

Debora Del Pistoia, Amnesty International Italia’s campaigner

“The pandemic has shown the inadequacy of the oversight system in care homes,” said Martina Chichi, Amnesty International Italia’s campaigner.

“Our investigation shows that at a time when inspections should have been more frequent and more in-depth – given the lack of oversight by family members or others during the closure of care homes to the outside world – often inspections carried out by local health authorities were only administrative formalities.”

Amnesty International also received widespread complaints from care home staff and older people’s relatives concerning the serious obstacles or outright refusal to hospitalize care home residents with Covid-19 or with flu-like symptoms. In particular, in Lombardy, the regional authorities adopted a specific policy advising that older residents aged over 75 with frailty and with COVID-19 symptoms should be cared for within care homes, de facto limiting their access to hospital. In the absence of individualized clinical assessments aimed at identifying the best individual solution for specific patients, this resulted in a lack of protection of the rights to life, to health and to non-discrimination.

The health emergency also exacerbated systemic failures that already afflicted the care home sector. Among these, workforce shortages, worsened by the high number of health workers in sick leave and by additional recruitment by hospitals, led to a drop in the quality of assistance and care for residents and resulted in care home workers enduring horrific working conditions, subjecting them to severe physical and psychological stress and overexposing them to the risk of contagion.

A range of failures increased the risk of infection for care home workers, notably the scarcity of  PPE, the poor guidelines about its use – or even instructions requesting to recycle single-use PPE – together with inadequate training, and irregular and belated testing only starting at an advanced stage of the health emergency during the first wave, after the period of mass spread of the virus and after thousands of care home residents had died. The failure to implement appropriate infection prevention and control measures in care homes also contributed to this risk.

In an already challenging environment, during the pandemic disputes between staff and care home management increased. For example, five health workers in a care home in Milan were fired after filing a complaint against management for having hidden cases of workers infected by COVID-19 and having prevented the use of PPE so as not to scare residents.

The closure to family visits made it difficult for families to obtain information about the health and conditions of their loved ones. Many families have complained about the lack of transparency by care home managers regarding the spread of the virus in care homes and the measures taken to protect their relatives within care homes. The self-isolation of many doctors often made it  impossible for families to speak with care home doctors to obtain adequate information about their relatives’ health.

Finally, since the beginning of the health emergency, the government and regional and local authorities have failed to make public adequate data and information related to the spread of the virus in care homes. This data is crucial to gain a clear understanding of the phenomenon and to create the conditions, among other things, for responding to the systemic needs of the sector, avoiding the repetition of the failure to protect  the rights to life, to health and to non-discrimination of older care home residents.

“The report’s findings point to an urgent need for national, regional and local authorities to take adequate and timely measures to ensure that the response to the pandemic protects the fundamental human rights of older residents in care homes,” said Debora Del Pistoia, Amnesty International Italia’s campaigner.

“In particular, the authorities must guarantee the right to the highest attainable standard of care and non-discriminatory access to care for care home residents, as well as implement visiting policies that allow regular and meaningful contact with families.”

BACKGROUND

This report is part of a series of investigations conducted by Amnesty International in three European countries (United Kingdom, Belgium and Spain) on the impact of authorities’ decisions and practices in the response to the Covid-19 pandemic in care homes.