Is this the future of services that support people with high support
(aged, severe disability etc.) ????
While asyulms were origionally a place of safety or retreat from
became places of hardship, deprivation and depravation. What started as
small hospital facilities soon became large buildings that supported
hundreds of people. Built around a medical model of care, a culture
evolved that enabled a small number of people to support a large number
of people. Social policy
was to hide these groups behind walls, where society was protected from
the activities that happened within those walls. There has been a great
deal written about the values, behaviours and attitudes of the system
that supported the residents of these buildings within society. Because
they were in long term institutional care, the term "Institution"
referred to the building, the culture and the outcomes of the building
and the culture. While the charasteristicts of this institutional care
was similar to other institutions, the outcomes were different. Today,
we see small services evolve into organisations that
support different groups within society. Organisations are getting
larger to cope with increased demand for
services. As an organisation gets larger, more resources are needed to
support the organisation. Things wear out and need replacing. New
equipment and technology
replaces old and outdated equipment and technology. Direct care staff
need to be increased to meet the needs of its clients, which means more
support staff are needed to meet the needs of the direct care staff.
organisation also has its own needs in fulfilling its
role in providing for the needs of people with disability.
service provider can not provide for its own needs or the needs
of its clients, the culture and institutions of the service provider
change, so that the basic needs of its clients can be met, and other
needs that are considered as not important are not met.
For example the normal staff ratio may be 1 staff to 4 clients. As the
service grows, and the service can not get the extra staff because of a
lack of funding, skills or available workforce, then the service has to
prioritise needs as well as ration resources. Because the service
provides direct intervention in supporting its clients there may be no
other service that can provide support. The result is that the service
may become the Asylum that Goffman, Wolfensberger
and others wrote about in the past.
This is most noticeable in nursing homes where costs increase and
suitable staff are scarce. The nursing home tries to cut costs and
ration resources and as a result the clients are not getting all their
needs met. Hospitals are also suffering from a lack of skills and
resources. People are not getting the proper care, patients are left in
corridors because of a lack of space, etc. etc. This also happens
within disability service organisations
where the needs of the organisation become more important than the
needs of the clients. Administration, OHS, payroll, maintain, staff
training, policy development, volunteer coordination, area
medical staff, transport, recreational, employment, direct support
staff, relief management, relief staff - just to name a few roles
may have - may mean that there are 200+ people supporting 100 clients.
(CLP) - SA
for example has approx 40 staff employed to
than 20 and up to 30 clients, of which approx 20% need 24 hr support.
Suppose this group was supporting 100 clients. It is not unreasonable
to suppose that the group would need a minimum of 80 to 150 staff to
provide the same quality of service. Imagine what the service would
look like if it was supporting 200 or more clients. What would the
service look like if it was supporting 600 clients, which could easily
happen in the future.
Activ employs more than
(management, staff support and direct support).
Provides direct support:
homes to 250 people,
assist another 82
their own homes and deliver respite care to 268.
jobs to 1045 people with disability
= 1645 who receive direct support (source:
= 1/1.83 staff/clients ratio
Would the service become the Asylum that Goffman, Wolfensberger
and others wrote about in the past (both literally and figuratively) if
the community did not have the skills and resources to look after their
etc.) are not
the same as there were 20 or 30 years ago. The
telephone, radio, TV, motorcar, and now the
Internet has changed our world forever. Advances in
health and knowledge in various conditions has meant that people with
high support needs are living longer and healthier today. This group is
becoming larger each year.
Of course these groups should have the same opportunities and rights as
anyone else in the community. I am not advocating that we should lock
them up or anything like that, however, we should provide the most
appropriate care for the person as well as each community that the
person is a part of, where the community has the knowledge, skills
resources to look after their needs. Whether a person is a part of the
community of a service, or a number of communities, the person should
have the same opportunities as others within society.
Australian population will increase by about 22 per cent to more than
between 2008 and 2023 with most increase in the over 65 age group.
total number of
person's who identify themselves as having a disability will increase
about 38 per cent
to around 632,600 by 2023." (DSC
: Disability Future Directions, 03/2010 : P.37)
We talk about the
generation and what they may do with their inherence.
... What will
families be like in the future?
... How will they
the needs of
you and me in 30 or 40 years time?
... Will communities
knowledge, skills and resources to look after
... What will be the
role of a
community in supporting people
with high support needs?
... What will be the
policy and practice in supporting people
with high support needs?
... What will the
(ACTIV, TCCP etc.) be like in 30 or 40 years time?
... Will we depend on
these organisations in the future?
Families have lost their knowledge, skills and resources in providing
for the elderly. The socially accepted thing these days is to place
them in a nursing home while we carry on with more important things.
Other communities also have lost
knowledge, skills and resources to look
after the needs of disadvantaged people and rely on organisations
instead. Today we see a rising population, which is getting older,
being stretched, pressure in existing services is increasing etc. etc.
would not be surprised to see these current service organisations
(ACTIV, TCCP etc.) become the institutions that Wolfensberger and
about in the past (full circle). In fact I really think that it is
already happening today and it's to late.
Maybe it's the society that we live in, that we need to
deinstitutionalise, rather that the disadvantaged people that we are
trying to deinstitutionalise. We need to provide valued roles to
families and communities in looking
after the elderly, people with disability and other disadvantaged (poor
and destitute, and other medical conditions) so they have a future.
When providing the most
care for people with high support
1) The community is not
person is living, but where the
person participates, shares experiences and has valued relationships
2) People with high support needs (severe disability, aged etc.)
will always need support structures as a part of their lives.
3) The amount of participation in a community (living, education,
employment or recreation) is directly related to the skills and
resources of the person, and, the skills and resources of the
community that the person wishes to participate in.
4) Institutions are going to be around in one form or another
whether we like it or not, It is the way that they are used that is the
5) The institutions of a society towards a particular group
determine the way the group participates in society.
6) The institutions of a particular government department,
profession or service define the way the person is supported within
7) Facilities that support people with high support needs do not
need to be the nursing homes or prisons in the
that they are today, but can become warm inviting community places that
offer a range of services to the community, as well as be a part of the
wider community within that society.
8) People with high support needs are a minority group in our
society, and will have the same problems as other minority groups in
being a part of society.