The institutionalisation of deinstitutionalisation


Contents



"Institutionalised care for people with disability is alive and well in Western Australia"

Various disability groups and organisations promote themselves as promoting "community participation" or "community living", but what do they actually mean?
The goal of the current paradigm in the disability services is to include people with disability within a community.
This strategy is effective in providing local community supports for people with low to medium support needs.

People with low to medium support needs       ------> living community

What generally happens is that if the person does not have the skills and resources, or each community does not have the skills and resources ...

People with high support needs   <------ living community
                                                  <------ education community
                                                  <------ employment community
                                                  <------ recreation/social community

A person or group may also be disadvantaged in that there is no service (skills or resources) that supports their needs.
In remote areas where there are no services,
they have to rely on their own networks and support mechanisms or others in the community for support.

If the person or group does not have any support:

A lack of skills and resources in the community also means that the person may be seen as:

If fact some members of these groups are often placed in the same settings today (both literally and figuratively) that Goffman, Wolfensberger and others wrote about in the past.

Sometimes people are separated for their own good and in the best interests of their community ...
The above can happen in any place at any time where a community does not have the skills and resources to look after the needs of its members.


Institutional (or social) care
Institutional (or social) care is inportant in, and integral to, the way a community functions. These institutions (Organisations and services) complement communities in allowing communities to better manage their own needs, Hospitals, schools and universities, nursing homes, churches etc all provide valued roles in society, However these institutions are used is determined by the values, cultures etc (institutions) of the society in which they are used.



Full circle
Is this the future of services that support people with high support needs (aged, severe disability etc.) ????


While asyulms were origionally a place of safety or retreat from society, they 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.


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 coordination, medical staff, transport, recreational, employment, direct support staff, relief management, relief staff - just to name a few roles that the organisation may have - may mean that there are 200+ people supporting 100 clients.

When providing the most appropriate care for people with high support needs ...



Peter Anderson
http://www.psawa.com