People in nursing homes left at the mercy of private individuals

Although almost all nursing homes boast on their websites that they provide top-notch care and quality treatment to those in their later years, some of them do not meet the conditions for caring for the infirm and sick. They do not have enough staff, do not keep records of medications and health problems of patients, can not call an ambulance… At the same time, patients’ health is taken care of by part-time doctors who, when patients die, work as coroners, which is in direct conflict with law which prevents the same doctor from treating the patient immediately before and determining the cause of death.

This is roughly the situation in the Home for the Elderly “Milena” in Prijedor, where, according to Bosiljka Božić, her father VR passed away a little over a year ago, in agony and due to negligence of nursing home owner Milena Jauz and her staff, but also ambulance workers who did not want to pick him up even after four calls. She says that her father did not receive even the minimum care and medical assistance in this nursing home, which they were obliged to provide him with, and that he died in great agony.

She tells eTrafika that her father spent several winters at the “Milena” nursing home in Prijedor and everything was fine as long as his health served him to some extent and until he needed specific care. With the deterioration of his health condition, she says, various problems have surfaced, among the first being the denial of the necessary medical care and the necessary general care that they paid well for in this nursing home. She claims that her father died in terrible torment due to neglect of the nursing home owner’s obligations and failure to provide adequate medical care and that everything was later covered up and marked as a natural death, because an old man was in question.

“My dad died of dehydration because they didn’t let him eat and drink and because they tied him up in bed, and when he started bleeding and moaning, they left him in agony all night and morning before they somehow took him to hospital, from where he was returned to the nursing home to die. I am aware that he was 86 years old and that he was both ill and old, but he did not deserve such treatment and to die in such agony”, says Bosiljka.

A series of irregularities

She says she believes her father suffered and that it was torture for him. He says that he had mucus in his throat that was drying and he could not spit it out, which is why he had to get up at night to drink water. In order not to get up and wake others, he forcibly wore a diaper and was tied up in bed during the night. He choked trying to clear his throat so he could breathe at all.

“The doctor who worked in the nursing home at the time described it as ‘deliberate madness’, which wakes up others in the nursing home. When he started bleeding from the colon and had blood in his urine, it took days before he was taken to the hospital from where he was just brought back to the nursing home. He died soon after, and the documents said it was a natural death, which is not true. He was old, but I don’t believe that he died of old age, it is impossible for that to happen on the same day when he had such bleeding”, says Bosiljka.

Božić says that she did not expect that he would have Western living conditions in this nursing home, but he did say that he would be provided with minimum care for which they paid 1,000 KM every month, with an additional 200 KM for necessities and 50 KM for pocket money.

“He was usually in the nursing home during winter, because it was difficult for my mother to be alone with him in a remote village, far from the doctor. And she is already quite old and sick and did not want to leave the house. Dad had early dementia, he fell in the tub a couple of times, and she couldn’t lift him. He was first in a nursing home owned by Milena’s husband, and then we were suggested to move him to the city, because it’s easier. Dad was quite patient, he didn’t complain about the conditions, he knew why he was there,” our interlocutor points out.

For a while, she says, they talked, but then he stopped answering, allegedly because he dropped his phone and it got wet.

“A few times I asked him if he got extra food for which I left money, he said he didn’t get it“, she explains and adds that the situation with the pandemic made everything even more difficult, because then she couldn’t even come and visit her father, nor to get a clear idea of how bad his condition is.

At that time, she says, they started avoiding their obligations at the nursing home and denying him necessary care, there was no physical therapy or adequate medical care. Because of all this, she says that she planned to move him to another nursing home at the first opportunity.

“I was told all the time that he was fine up until his last days, but it seems that he was not. I tried to hear from him several times, but they didn’t want to give him the phone, so I was suspicious. I called Milena on September 30, 2020, and told her that I would cancel my dad’s place and move him to another nursing home. Then she attacked and insulted me just like that, there wasn’t anything she didn’t say to me, she threatened to throw him out on the street immediately. As I am in Sweden, I was afraid that she would do it, that the man would stay on the street, so I begged her to calm down. She continued to threaten me, while I told her to wait a few days and that I would pay as much as she wanted “, says Bosiljka. She says that she tried to come immediately, but that due to the pandemic, it was almost impossible to travel.

She begged the owner of “Milena” not to throw him out on the street, to drive him to the hospital if he is sick, even though it is expensive, that everything will be paid for.

“She shouted at me and said that he got sick because of me and that’s why he’s not doing good. At one point she said Dad was bleeding. When I asked when it started, it turned out to be ongoing. She said that they called the ambulance all morning, but no one would come, so they would call a private ambulance from Banja Luka. After that, I couldn’t get her anymore because she turned off the phones. A day later she called me and when I asked how Dad was, she just told me he had died. I was shocked and unprepared, and she just shoved it in my face”, says Bosiljka.

She says that even today she is shocked by the inhuman treatment of her father by those people who were well paid to make sure that his last days pass in minimal torment. They said that everything was fine while money was being paid and there was not a lot of work around the old man. When his condition worsened and they had to do their jobs, it turned out that they did not take care of old people and that they were only interested in earnings, she claims.

“My sister wanted us to go public while my dad was still alive. I was not for that, I wanted to dedicate ourselves to his health, and when it ended like this, I then insisted that we investigate everything, report to the institutions. We corresponded with all of them for a long time, we corresponded with each other, it all lasted for months and no one was held accountable. No one seems to be to blame. In the end, they told us to go to court and sue them. Now all I want is for people to know what is happening in nursing homes and to whom they are leaving their parents, to be aware that it is not nearly as idyllic there as it is presented on the websites of those institutions,” she says.

Bosiljka’s words are confirmed, almost up to the last detail, by the extensive commission transcript formed by the Ministry of Health and Social Welfare of Republika Srpska after her report. In the control they carried out on June 8 last year, dozens of irregularities were listed on 15 pages, some of them with several shouts of disbelief from the members, after which they were ordered to be corrected.

From the transcript of this commission, which you can review, we point out that VR passed away on October 6, 2020, in the Home for the Elderly “Milena” in Prijedor, and that he stayed here several times, the last time from October 1 to 2019. On November 13, 2020, the Ministry requested that expert supervision be conducted over the work of this nursing home, following the report of his daughter, and that the commission declare itself regarding the objections she submitted. At the beginning of March last year, documentation on the work of this nursing home was requested, including a written statement from the caregiver about the health needs of this ward, treatment and provision of medical care.

Surveillance showed a series of irregularities, and perhaps the most frightening of them is that the same doctor, Dr Dušica Kecman, worked in this nursing home under a contract of additional work and treated all wards to whom she prescribed therapy, regardless of who was their family doctor, although she herself is employed at the Health Center in Prijedor. At the same time, she worked as a coroner when one of the wards passed away, which is a direct violation of the law which forbids the same doctor to treat the patient immediately before and determine the cause of death.

According to the transcript, the same doctor issued death certificates on an invalid form and wrote on his that a natural death was in question, although the day before he was in an agonal state and was bleeding in his colon and had blood in his urine. It was also determined that no written records were kept on the medicines given to the wards of the nursing home and that the therapies were arranged by the nurse as prescribed. According to the transcript of the commission, the ward felt bad on September 26, had a fever and vomited, and the doctor prescribed therapy without an examination nor blood work, based on the information she received from the employees. Likewise, she commented on his advanced dementia, which was followed by aggression and, as stated, “madness”, but she never referred the patient to a psychiatric specialist who would be the only one able to make that diagnosis.

“On August 5, 2020, she ordered his “fixation” (binding) according to a rulebook that is not known and is not allowed in these institutions, under the description that the patient snores and spits and asks for water to rinse his mouth, and that he fell from his bed. However, it remains unclear why the help of a psychiatrist was not sought even then. The commission did not receive the requested report on the patient’s condition from the day he fell ill until October 5, when he moaned all night, bled on his colon and developed a fever. Only then was an ambulance called, which did not come because “it has to be paid for, and the patient already needs to go to the hospital” (800-900 meters away from the nursing home), so it took more than six hours for a private ambulance to arrive from Banja Luka so that he could be taken for an examination and returned to “intensive care at home”, as said in the transcript, but it was not explained whether that ambulance was called at all or not and whether it came or not.

However, no one in the Health Center in Prijedor remembers the calls from the nursing home that day, nor were they recorded, although the listing of calls showed that they received four calls from “Milena” to their number. The patient was eventually taken for an examination in the director’s son’s private car, referred to in this document as “luxury”, with the seats being folded down so that he could be carried on a stretcher. The doctor told the commission that she suspected that the medicines that his daughter sent him in February were the cause of the bleeding in October, which he used without supervision. The documentation states that his daughter sent it to him once and that it was taken away from him.

There is no evidence that he bled because of this or that she sent them several times, although the director of the nursing home claims that shd did, but she did not record it anywhere. Medical technicians said that they noticed blood in his urine as early as October 3, but nowhere in the medical documentation is that stated until he went to the hospital. He was examined there, but it was determined that the operation was not possible because he would not be able to withstand the anaesthesia. He passed away the next day. The director of the nursing home first said that he was not examined that day, and then that he was, and from the statement of the technician who was on duty and the doctor, it was not possible to conclude what exactly happened. The director of the nursing home then claimed that he was not in such a bad condition and that he got down to the car on his feet. She later said he was in an agonal state.

The owner rejected the accusations

Milena Jauz, the owner of the Home for the Elderly in Prijedor, rejected all the accusations made against her by Božić. She says she has struggled with her and her family for the past year. Jauz says that the relations with the family were good while the grandfather was well, but when his condition worsened, they were no longer satisfied with her work.

“It came over the years, that he crashes mentally and physically. They took him to various homes, and as he had dementia, they were expelled from every nursing home because of his behaviour. It happened that he couldn’t control himself, he said everything, and then many people understood that as a reason to remove him from the nursing home. I accepted him, I worked for a long time in psychiatry and oncology as a nurse and I have a lot of experience with these patients. Grandpa was good and he loved me and my staff”, says our interlocutor.

She adds that everything was good in the first year, that they corrected him, that he improved and gained weight.

“The psychiatric ward is close and we could often consult them about his condition. Grandpa was seriously ill, he had problems with his heart and stomach, and the dementia was getting worse. You know how it goes with old age, worse. However, the daughter did not allow it to be said that he has dementia. I told her ten times that the priority was to go to a psychiatrist. Understand me, I am a medical worker, it is not easy with such a man, you have to know how, you do not help him if you deny him a psychiatrist and adequate therapy”, she says.

Jauz explains that in the fall of 2019, the ward was brought to the home in poor condition, that he could barely walk and was untidy.

“We fixed it and civilized it, but the Corona was starting. At that time, he had already begun to decline beyond recognition. He started to lose weight, vomit and get other health problems. The daughter called only once or twice to get information. Suddenly we are no longer good enough, although I told her that he is weak and that he is already old, that not much can be done there. One morning around three o’clock, he started to get worse, he started vomiting and got a fever, his blood pressure was dropping”, she points out.

She says she called an ambulance afterwards.

“I called three times and told them that the man was ill and that if something went wrong, who would explain to the family that they did not want to go out. I can’t drive him in my private car there in that state, and he’s getting worse by the hour. We took him to the hospital later, examined him, but he was not to be kept in the hospital. He died a few days later”, Jauz said, adding that she told his daughter that he had passed away, and that she then “started to get hysterical” and made accusations.

Jauz says that she told her that she had a clear conscience and that everything was fine up until now, and that grandfather was old and sick, and that he took his own laxatives, on his own, that he did not need, and which his daughter sent in packets.

“After grandfather was buried, she started reporting me to whomever she could, from the Ministry of Health to the crime police. They questioned me for a year, about what we did, whether or not we did everything we could, a three-member commission came and they checked the complete nursing home, not only related to him, but everything. They found that there were no grounds to report. Her father told me that he loved me more than his daughter. This torture lasted for a year. I called her sister and hoped that we would come to an agreement more easily, that she would be more reasonable. However, we could not find common ground. They told me they would slander me wherever they went”, she said.

She adds that she hired a lawyer to defend herself from the mentioned attacks.

“She accused me of killing him with my ignorance and reluctance to work, but even the Ministry said that I did not kill him. She has been welcomed in my home for years for coffee and lunches, as if she were part of the family. Is that any way to give it back to us? I told them that I was in favour of paying all the costs of the autopsy and to see if anything wrong had been done. They didn’t let anyone touch their dead dad”, says Jauz.

When asked about the transcript of the Ministry of Health and the work of Dr Kecman, she said that she did not know that she cannot be a doctor in the nursing home and a coroner when her patient dies.

“I didn’t know she couldn’t, how do I know she can’t be a doctor and a coroner. I used to call the Health Center, and the doctor who would answer would say they couldn’t and to contact her, that she would solve it. She doesn’t work with us anymore, the commission banned it and stopped. And I don’t need to be paying her anymore, I paid her heavily. We were ordered, we have a family doctor and to call the ambulance. It suits me, it is far cleaner. If the family doctor can’t send referrals, I call the ambulance, the call is verified and I’m clean. It was a great learning opportunity for me”, she says.

Jauz especially underlined that there was no tying of patients in her home, but that there are special wheelchairs with belts over the chest and abdomen that prevent the patient from falling while receiving therapy, if they cannot sit or control themselves.

On the other hand, Bosiljka Božić says that the owner of the home never mentioned that she noticed changes in her father and that she was below every level to comment on the accusations that the family did not allow him to be taken to a psychiatrist.

“It is underneath every humiliation to comment on her statements because they are false. We had too much tolerance for her even though her behaviour was beyond condemnation and it took us a while to figure out what kind of person she was. She did not tell us anything about his condition, and she isolated him from other patients, we even learned some of the details indirectly. When we realized that this place was dangerous for him, it became too late. I don’t know how she has no shame, after all the lies and illegalities she committed, which the ministry confirmed, that she is still doing the same. Is there any written record that she asked for him to be taken to a psychiatrist or for any examination? That we refused? Why would we refuse an examination by a psychiatrist, he had an examination when he extended his driver’s license a year before going to the nursing home? Did she mention to the commission that we refused the psychiatrist’s examination? No, because she lied”, says Božić.

Dr Kecman without comment
Dr Dušica Kecman was not willing to talk about the situation in the home “Milena”. She said that she did not want to comment on the events we are writing about, nor to comment on what was happening there.

“I can’t comment on that, I have a patient with a very demanding subject. In that regard, you have everything where you were and that went to a higher level. So I have nothing to say and that is my answer to you. Because over there is a great primitivism of everyone there and madness, not to mention exactly who, but it’s about psychotic people,” she said.

When asked who she meant, the owners, staff or patients, the doctor did not want to explain.

“I have not named anyone and I will not be decisive,” said Dr Kecman.

The Ministry and the Inspectorate are familiar with the case
The Ministry of Health and Social Welfare of Republika Srpska says that the control of the commission ordered that all shortcomings in the work of this nursing home be eliminated.

“In the process of supervision, certain shortcomings in the work of the nursing home were identified, for the elimination of which recommendations were given. Timely and in accordance with the Law on Health Care, ensure the provision of primary health care services to nursing home users, which means that it is provided by health institutions, as well as examinations by medical specialists in accordance with their health status, as well as regular monitoring of health status and regular recording the same and the keeping of daily written records of taken therapy of each user, and keep the personal list of the user on the prescribed form”, said the Ministry.

Also, the recommendations state that in case of death of the nursing home user, it is necessary to inform the Health Center Prijedor in order to determine the cause of death of the person in accordance with the Rulebook on determining the death.

“The Commission stated that it is necessary to improve the procedure of the handover of shifts so that data on the current condition of users are recorded in writing, and the provisions of the contract on accommodation of users are harmonized with the Law on Social Protection and rules of the profession. The provisions of the contract on accommodation of users should be corrected so that the signatories of the contract are not obliged to pay the costs for the coroner’s trip, considering that the funds for these costs are provided in the budget of the City of Prijedor”, the Ministry states.

In its recommendations, the Commission stated that the measures of physical restriction of movement (fixation) of users in nursing homes can be applied only in accordance with the Law on the Protection of Mental Health.

“It is also necessary to improve the exchange of information on the condition of the beneficiary with the family members of the beneficiary and to enable the relatives of the deceased beneficiary, in the case you cite, as a family member of the deceased, access to medical and other documentation, which was created during their stay at the nursing home”, said the Ministry.

The Inspectorate of Republika Srpska says that on October 29, 2019, their health inspection regularly inspected the “Milena” home at the address where the “San” home used to be, and that irregularities were found regarding the statute, keeping records, and the required number of staff and space for the said institution.

“Based on the identified irregularities, the acting inspector issued an inspection decision. The control inspection eliminated the shortcomings and the supervision process was thus completed. The same home was subject to control in March 2020. On that occasion, all activities of inspectors were aimed at controlling the implementation of anti-epidemic measures, when, given the specifics of homes for the elderly (collective accommodation for vulnerable groups and the existence of an explicit ban on visits), supervision of their work was suspended until further notice, they said in the RS Inspectorate.

In the period from 2020 to 2022 (period of a state of emergency), in the field of social protection, regular inspections of social work centres were carried out, in accordance with the plan, and a couple of extraordinary inspections of homes for the elderly performed on applications. In the mentioned period, there were no complaints about the work of the home “Milena” Prijedor”.

Tying up an old woman
Searching the internet to find information about this nursing home, we learned that seven years ago it was called “San” and was owned by the Jauz family and that it was then reported that one old woman was tied up in a chair and that she was not allowed to go to the toilet. After the reaction of her family and media reports, the owner of “San” Rade Jauz, the ex-husband of Milena Jauz, kicked the old woman out of the home, and told the media that patients must be tied up so that they would not accidentally fall or develop an infection because of the catheters they put in them”. In this case, Milena Jauz says that she was not the director of the home and that her ex-husband worked there at the time.

The lucrative business of caring for the elderly and sick whose children are often abroad or in other cities for work and family life, for many of them turns into agony when the door closes and they are left without the protection of their loved ones. Some texts on other portals mention the poor conditions of accommodation and food, as well as the fact that the user is arranged in rooms so that the mobile elderly person is with the immobile to help her, although it is not her job. Also, it was especially pointed out that insufficient attention is paid to the immobile and people with dementia, and that there are a considerable number of users who tolerate such carelessness of nursing home staff, because they have no other choice.