disability service organisations ! An
alternative model ! Community
research ! Community
Any business, service or organisation that provides a service to a
group of people is organised around a set of cultures,
values, roles, hierarchies, behaviours and expectations. Whether the
service is a day care for
toddlers, a video hire, a school or hospital, nursing home or prison,
they all have the same characteristics. Institutional care is about a
specialised service that is provided within a community, where the
community does not have the skills and resources to provide for the
needs of it's members. While the characteristicts of the institutions
of the community,
business, service or organisation are the same, the outcomes of the
community, business, service or organisation are different.
Shows the relationship between
the skills and resources of the community,
and the amount of support that can be provided within the
care Vs Institutional care)
Institutional care can be
thought of within
two main groups:
1) Institutional care (formal) :
mechanisms for providing support for a group in society.
... Short term care
... Long term care
2) Social institutions (informal) :
provides the mechanisms for social
Are defined by the agenda, mission statement, objectives,
values and behaviours of the business, service or organisation. These
are generally set out
by a code of ethics and behaviours that can be used to measure the
outcomes of the institution. These can be voluntary, where the service,
organisation or busness sets its own standards, or mandatory, where
they are built into government regulations that allows the service to
... provides the role of the business,
service or organisation within society - what is its role?
... defines the way the business, service or organisation functions
within society - how does it do it?
... sets the scope and boundaries of the business, service or
organisation - when does it do it
... defines the roles of the members of the business, service or
organisation - who does what?
Any service that happens in an acceptable period of time, and does
much impact on our lives. I may get a plumber to fix the tap or go to
doctor for a checkup. I can get on with my normal lives without to
much irritation. If for some reason the plumber has to replace all the
pipes in the house, or I have to go the hospital for a few days,
my normal routine is disrupted for an appreciable amount of time, and
may create some stress for me and the others around me. I may enroll
in a course at school or uni and have to change my whole lifestyle to
accomodiate the different patterns and routines. I have books to buy,
lectures to attend, exams to pass, and various other social functions
associated with the school or uni. There are behavoiurs and
expectations required of me and this can be a very stressful period.
However I know that I am working toward a goal, and am prepared to
adjust my normal way of living for the period required. Even changing
a job or moving house can involve a stressful period until I adjust to
the new situation. What ever happens, I know that I still have some
control over my life and still have the choice to opt out of the
system if I choose to.
also makes the distinction between long term and short term stay. When
the stay is short time and the outcomes are positively
valued, the person may be able to adjust to their normal living
patterns quickly. Short term stay can also result in negative valued
outcomes that last a persons lifetime.
It could be argued that the process of institutionalisation starts
within our family, in
the day care centre or kindergarten or with friends
and peer groups. We learn the values and cultures from significant
others in our lives.
Whatever happens, there is a sense of control over our life. We can
and work toward a future, and those institutions are a part of the
backround, just as a canvas is the background that a picture is painted
on. Its only when these institutions become more promonent in our life,
that problems occur.
The longer the time in istitutional care, the more disruption occures
in a person's life.
There is a period of adjustment, and maybe rebellion, to the new
There is a learning curve involved in finding out how things work
(learning the ropes).
The amount of loss of independence depends on
the reason for the long term care
the amount of skill and resources the person has
the amount of skills and resources the service has
the amount of control the person has over his/her own life
A person may have to give up a significant amount of his/her previous
may be realocated to another setting
that is more able to provide for his/her needs.
Shows the relationship between
the length of care and the amount of institutionalised care provided.
A person may spend a few years in a hospital or in a university. The
amount of restrictions in the person's life depends on the
as well as the skills and resources of the service. The longer the
person spends in institutional care, the more institutionalised the
person becomes. For some, this can be a gradual process, and others,
this process can be sudden and abrupt. For others, it is the only way
of life that they have known. Goffman
acknowledges that the concept of a "Total institution" is a
concept only, that institutions can never be total, but can be
positioned on a continuum from open to closed (Total
Institutions: K. Joans & A.J. Fowles - In Understanding health and
social care By Margaret Allott, Martin Robb, 1998, Open University P.70
Goffman uses the term "institution" to describe the building and the
institution of the building (the social construction). An interesting
observation about the
concept of a "Total institution" is that there is an assumption is that
staff of the institution are just as institutionalised as the
residents, This may be the case where the staff treat others outside
the institution the same as the residents of the institution, however,
the term "institutionalised"
refers to the residents of the institution and not the staff, visitors
or any outside contact that staff may have with the outside world,
Therefore, any institution, where the residents have no
others, (staff, family, friends etc.) or the outside world, can be
as a total
institution in the truest sense of the word. Institutionalisation has
been used to describe the negative experiences and outcomes associated
with long term care. It is also
that a person is
not considered institutionalised, where, the experiences and outcomes
are positevely valued.
Institutional care, then, is an ordered
that requires an appropriate setting, skills and resources that are not
available within the wider community. The way the care is provided and
the outomes of this care are directly related to the service that
provides the support. A prision, for example, has the same institutions
as a hospital, however it is immediately obvious that the outcomes of
the prision and the hospital are different. Even within different
prisions and hospitals we see different outcomes.
From the above, it can be seen that the
institutions of the buildings and communities that disadvantaged people
were placed in,
are the same as the institutions of the different buildings and
communities that we
all participate in,
but have different outcomes. At he bank, we have to suffer all sorts of
indignities to get a loan or see a teller. There is no compensation
when something happens to our money because it is not their fault. Even
when it is there fault, there is no one that takes responsibility.
Informal institutions allow the members or groups to function within
organisation or busness. These institutions may vary according to what
the members do within the business, service or organisation. Different
members or groups have different functions or roles that allow these
groups to coordinate their activities within the organisation. These
institutions are informal because they are more about the way these
members and groups interact with each other, rather any formal
policies, rules or
regulations of the servise, organisation or busness. There can be any
number of layers in the business,
service or organisation, The bigger the business,
service or organisation, the more layers there may be.
... provides the role of the group
within business, service or organisation - what is its role?
... defines the way the members or groups functions within business,
service or organisation - how does it do it?
... sets the scope and boundaries of the members or groups within
business, service or organisation - when does it do it?
... defines the roles of the members of the members or groups within
business, service or organisation - who does what?
The relationship between the
formal and informal institutions
within the business, service.
organisation or community.
These Informal insitiutions
could also be described as the social systems
of a business, service,
organisation or community.
- Peer groups
Are all ways that the members of a business, service, organisation or
community organise themselves.
When providing the most appropriate
care for people with high support
1) The community is not where the
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.