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Institutions and institutional care

Social Role Valorisation (SRV)g
Deinstitutionalisation
Disability services
Disability and community

The role of institutions in society
Characteristics of an institution
Community care Vs Institutional (social) care
The institutionalisation of community care
Institutionalisation, deinstitutionalisation what's the difference
How does the community care? The reality in supporting people with high support needs





Institutions and institutional care
Formal institutions
Short term care
Long term care
Informal institutions


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 (See Characteristics of an institution) 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 community.
(See Community care Vs Institutional care)

Institutional care can be thought of within two main groups:
1) Institutional care (formal) : provides the mechanisms for providing support for a group in society.
... Short term care
... Long term care
2) Social institutions (informal) : provides the mechanisms for social interaction and participation.


Formal institutions:
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 function.

These institutions...
... 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?

Short term care:
Any service that happens in an acceptable period of time, and does not have much impact on our lives. I may get a plumber to fix the tap or go to the 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.

Goffman 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.

Long term care:
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 plan 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 situation.
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 life
belongings
friends
lifestyle
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 institution, 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 the 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 contact with others, (staff, family, friends etc.) or the outside world, can be considered 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 interesting that a person is not considered institutionalised, where, the experiences and outcomes are positevely valued.

Institutional care, then, is an ordered and specalised intervention 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:
Informal institutions allow the members or groups to function within the servise, 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.

These institutions...
... 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.
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 needs ...
1) The community is not where the person is living, but where the person participates, shares experiences and has valued relationships with others.
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 problem.
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, organisation, profession or service define the way the person is supported within that society.
7) Facilities that support people with high support needs do not need to be the nursing homes or prisons in the sense 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.




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