Contingencies of resettlements (Macedonia) - methods and reception

Little is known of methods used in the first resettlement action (Kriva Palanka). In the first wave of resettlements for Demir Kapija, the methods of assessment and training of the residents that would eventually leave were extensively used. The other part of work was to create day centres, recruit the fosterers and instruct them. In the second wave, the process was planned as by the book and there was more accent on getting the institution as whole involved, more assessment was done on the institution and its resources (staff, amenities). The future carers had a brief but intensive and up to date training. However, it seems something went wrong in the relationships and not everything went the way it was planned and created a schism between the institution, its staff and the external actors who were instrumental in the resettlement process. It looks like the crew responsible for the project got focus on the outcomes and did not let the process stop the resettlements.

Personal plans were used in that period, but not as a basic instrument of resettlement (as a resettlement plan), since the residents were moving collectively into group homes. They were used more to foster users’ perspective, to get the idea of likes and dislikes of the residents exiting the institution. Although the staff of new services has this knowledge, they do not use it as the main tool of the service delivery. We can assume that this is partly the case also because there is not a perspective of move from the group homes on.

That something was lost in terms of the methods during the process is also the impression received in Demir Kapija. Through the years, they have been exposed through various projects, to many methods and some have been developed on their own (cf.: teamwork in the annexe). However, the context of their work and the depressive attitude of resisting change has made staff less motivated to use those trainings and new methods of working. Nevertheless, the methods of ‘intensive interaction’ and personal planning introduced to Demir Kapija staff in recent months have been seen as important contribution to their work, tools of value in the future resettlements and were welcome. These two ways of working seem to be of great importance, since they provide tools of understanding and breaching the gap between the residents who are not able to express themselves in conventional manner and give the staff the vision of what they want, like and wish in their lives. Coupled with training in teamwork, organising new community services, risk taking and assessment methods and change management they would form a necessary pack that the staff of transforming institution should possess.

The reception of the community of the resettled residents was mainly good and welcoming. The interviews with various community members confirm this. They know that conditions in the institutions are bad, but often do not see the alternative since (as noted above) they believe that institutions are as a place where people are treated, cared for – “they have a doctor there (which in fact they have not) and can be given medicaments; they are better off in there than staying home”. Some more informed members of community have heard of the deinstitutionalisation or when they hear what it is about, they approve it and see its merit. A special educator in one of the day centres supports the process, but warns about the conditions that need to be fulfilled, i.e. that it is done completely and that all the residents have a chance for better life.

It looks like ex-residents were as a rule well received and that there was not much of the resistance against the new comers. The NIMBY (not in my back yard) effect was recorded, paradoxically, only in an attempt of the infants’ home to establish a group home for the children that out-grew the requirements of the institution (surpassed the age of three). The group home was planned to be in a ‘well-to-do’ suburban community and parents in the area petitioned against it – not wanting that their children would be in the same kindergarten with Gipsies. The discrimination and racism presented was, in this case, not against the disability but against Roma (children).

The protagonist of the second wave resettlement emphasise that it was more difficult for the users to be accepted by the neighbours and to access other services in Skopje rather than in Volkovo, which is a small community (settlement or village) close to Skopje, the people are friendlier and are accepting the users much easily. Here, the development of the users is much easier because after the day activities and according to personal wishes they go to the city for leisure and entertainment, visiting cultural and sports events etc. In Negotino, which is also a smaller local community, people are more tolerant and willing to provide help; the users have more opportunities to use local services and resources.  This opinion is partly true, but partly can be seen as a rationalisation of the fact that they had to move out of Skopje for economic reasons and we should be careful not to have over idyllic expectations regarding future resettlements. There are good and bad sides of different environments. While there is more of a community spirit and less anomia in smaller towns and communities, the city folks are more tolerant and there are more opportunities (e.g. for service support) in the cities.

The strong value and the norm of hospitality, generousness and compassion in Macedonian culture definitely helps the reception of people who return from the institutions. The part of the culture that is an obstacle to inclusion is the feeling of uneasiness and shame of such people to belong to one’s family. 

Claimer: This blog is intended as a part of Situation Analysis and Assessment/ Evaluation Report of Implementation of National Strategy on Deinstitutionalisation 2008–2018, which will be soon presented to the public within the EU framework project Technical assistance support for the deinstitutionalization process in social sector. For this blog, Vlado Krstovski is considered to be co-author.

 

Appraising the success of performed resettlements in Macedonia

If we look how particular types of resettlement were successful and contributed to the deinstitutionalisation, we can conclude that the group homes in the second wave of deinstitutionalisation contributed far most in terms of numbers of resettled residents. Foster care, which was used in the first wave, had a smaller contribution, while resettlements into original families were small in numbers, and there was no resettlements into independent living. In terms of the quality of life the first two forms of resettlement provide are comparable results; both, group homes and foster families provide much better quality of life than institutions but are inferior to supposed independent living, which was not practiced so far. In theory, return to own families would be for children a comparable solution to adults’ independent living. However, it was not that successful. The problem seems to be in the fact that these families have in general low quality of life (which has been one of the reasons for institutionalisation in first place) and they were not adequately supported to improve it. The second reason could be that their recruitment was too hasty and did not allow a process of ‘reconciliation’ or ‘renewal of family ties to take place.

In the deinstitutionalisation so far, clearly the optimal options for resettlement that would approximate ordinary living, i.e. community based and independent living for adults and return to original families for children were not used enough and omitted. Returning to original families was not neglected and it stands as a first choice in today social work practice. However, it takes time and patient, filigree work and additional resources to make it happen. In fact, original families have less financial reward and professional support than foster families.

Independent living as a means of resettlement was not used for a few reasons. Although a notion known to the actors in the field it was up to now totally undeveloped in practice – the methods of its implementation are not widely known, even less practiced, funding of such practice is anybody’s guess, in addition there is also a misconception that independent living means living without support. For the future, we can assume that its advantages, i.e. providing individual and personal solution and possibility to resettle, potential to create non-standard response, need for resettlement plan, and the fact that the user will get what he really wants and needs, will be the factors that will promote this kind of resettlement. Obviously there is a need of inventive new organisation of services in order to support this kind of activity.

Group homes were in the past most effective tool of resettlement. They provide possibility for fast action and are not difficult to organise. In the responsibility and organisation patterns, it is not all that different to institutional care. The provider is if not solely than mainly responsible for the wellbeing (and safety) of residents, the structure of costs is similar. They, in a way, represent a move of the same operation institution performs into the community, nicer environment and more home-like atmosphere with more personalisation and choice. If the management of such facilities is good, way of working result in empowerment of residents and resources are sufficient it can be a good solution for transition to the community. In Macedonian experience methods of work and management were in comparison with similar facilities in other countries good, however the resources were not sufficient to resettle people with intensive needs (raising threshold) and in order to keep providing services, in spite of the arrest of the deinstitutionalisation process as a whole, the services had ‘shrink’ (become concentrated).

Foster families were the cornerstone of the first wave of resettlements and also of intended Macedonian model of deinstitutionalisation. Even if their use for adults is questionable, rephrased form of such care could be used (care or support in another family) also for some adult residents exiting the institutions, since it seems to be in line with Macedonian mentality and way of life. The advantage of this form of resettlement are that can be ready available (if there is a wide pool of such families), that is an individualised solution and there are no complication with organising it for a group of people. However, it need more dispersed organisation and collaboration of at least resettling institution, local social services, family and user, which in the present mode of functioning of social services is hard to achieve.

Table 8: Factors promoting and impeding resettlements

factors of success / type of resettlement	promote resettlement	impede resettlements
original families	good process of renewing contacts, support in overcoming grievances caused in the process of admission, material support and reward,	hasty recruitment, bad conditions in the family, lack of support from the services,
foster families	tradition of fostering, in line with Macedonian mentality, availability, adequate reward, good recruitment and support,	retirement of fosterers and lack of replacement, inadequate number of foster families, inadequate support of the services,
group homes	fast and solid solution for resettlement, clear responsibility for care (one provider), good management, availability of premises, financing according to the residents’ needs,	inadequate financing (causes skimming), tends to be long-term solution – preventing resettlement from a GH, housing is not easily available,
independent living	best solution: enables to achieve residents priorities, can generate new services needed, cost benefit efficiency, new organisation of service delivery,	so far an abstract notion, misconception, lack of experience, absence of knowledge, skills and legal requirements, need for new funding system.

We can conclude that group homes were most used and are most efficient means of resettlement. However, their effect is an intermediate one and they function as solution that is difficult to overcome. Foster care was also used with success, unfortunately it is less practiced nowadays. Return to one’s family, even if it is a prime solution, especially for children, has been tried out but has not developed as a prominent way of working. Independent living as an optimal destination of resettlement, both from institutions and group homes, has yet to be developed.

Claimer: This blog is intended as a part of Situation Analysis and Assessment/ Evaluation Report of Implementation of National Strategy on Deinstitutionalisation 2008–2018, which will be soon presented to the public within the EU framework project Technical assistance support for the deinstitutionalization process in social sector. For this blog, Vlado Krstovski is considered to be co-author.