Intermediary
structures are forms of care provision that lie between institutional care and
independent living in the community. Most known and common forms of
intermediate structures are group homes and day centres. Group homes or similar
residential care facilities are way of organising care, in which groups of
people, children or adults, live together in a house or a flat with support
from staff. Day centres or similar occupational facilities (clubs, drop-in
centres, sheltered workshops etc.) are ways of organising care, in which users
of this facilities spend part of the day occupied by activities of productive,
recreational or socialising nature.
Intermediary
structures are almost necessary first step in deinstitutionalisation since they
provide an immediate and relatively quick way of resettling residents into
community. They usually enable more ordinary, homelike and integrated environment.
These structures, do, however, have streaks of collective living that may lead
to practices akin to institutional ones. Therefore, they must be seen only as a
temporary provision leading to more independent, personalised and included
living arrangements.
Group homes
The Council of
Europe Commissioner for Human Rights has raised a number of criticisms of group
homes. He points out that group homes often do not differ much from
institutions as they restrict the control of the people over their lives and
isolate them from the community, despite being physically located within a residential
area. Clustering children or adults in the community draws attention to them as
a group rather than as individuals and sets them apart from the rest of the
neighbourhood. In addition, linking support services with housing in group
homes limits the choice of the people about where they can live. Systematic
placement of children with disabilities in group homes without ensuring equal
access to prevention, re-integration or family-based care should be avoided at
all costs. (CEG*)
At the same
time, small-scale residential care in the form of small group homes in
family-like environments can sometimes be used as temporary or last resort, if
it is in the best interest of the child (for example, in a case of continuous
placement breakdown), or if it is based on the child’s or young person’s own
informed decision. The use of such settings should always be limited to cases
where a properly conducted, professional assessment has deemed them
appropriate, necessary and constructive for the individual child concerned and
in their best interest. The objective of any residential care should be to
“provide temporary care and to contribute actively to the child’s family
reintegration or, if this is not possible, to secure their stable care in an
alternative family setting”.
For older
people, residential arrangements such as group homes are sometimes considered
preferred options. People live in their own flat with their own belongings
while benefiting from common services (such as a restaurant and other
facilities) and enjoy the company of peers. However, a range of alternative
community-based options needs to be provided in order to ensure that people
have real choice of where and how to live. It must also be noted that the
‘choice’ of an older person to move to a group facility and distance themselves
from the rest of society is likely to be influenced by society’s view of older
people as a ‘burden’. In summary, group homes could be developed as part of a
deinstitutionalisation strategy, but this should clearly be for a small
minority of users for whom an assessment shows this is a positive care/support
choice. They should not be seen as “the default solution that presumes to
embody the principles of the right to live in the community«. More efforts
should be invested in removing barriers in the environment, the provision of
accessible housing, the development of supported living arrangements and of
alternative family-based care options for children.
Day centres
Day-care centres
for adults and older people provide advice, support, meals and some aspects of
personal care, as well as social and cultural activities. For older and
especially frail people, they may be of considerable advantage as they can be
effective in combating loneliness and isolation. Factors which determine how
beneficial day-care centres can be include ease of accessibility,
affordability, the choice of services to be used and, of course, users’
involvement in the planning, implementation and evaluation of services to be
offered.
Separation of housing and support
The type and
level of support individuals receive should not be determined by where they
live, but by their needs and requirements. Support should follow the person
wherever they live; even high levels of support can be provided in ordinary
housing. Separating the provision of housing and support will ensure that
individuals will not lose their support should they decide to change their
living arrangements, for whatever reason.
Dispersed housing
should have priority over campus or cluster-style housing. ‘Dispersed housing’
refers to “apartments and houses of the same types and sizes as the majority of
the population live in, scattered throughout residential neighbourhoods among
the rest of the population”. Campus or cluster-style housing is used to
describe “provision of a complex of houses on a specialised campus, or homes
for people with disabilities (or older people) which are clustered in a
specific housing estate or street.” Between the two approaches, dispersed
housing has been shown to provide better quality outcomes for its inhabitants.
The disadvantages of campus/cluster housing identified include: the size of the
living unit, less home-like setting and furnishings, lower staffing ratios,
greater use of an-psychotic and an-depressant medication, less choice; and
smaller social networks. The exceptions to this are some situations where
people choose to live communally in village communities, where these then serve
a mixed population of disabled and able-bodied individuals.
Sources:
These definitions are drawn mainly from
Common European Guidelines on Transition from Institutional to Community-based
Care, on the UN Convention on Rights of People with Disabilities and the
General Comments of its article 19, and on our work done for the groundwork of
deinstitutionalisation in Slovenia including the manual on rapid assessment and
response to the needs related to deinstitutionalisation and long-term
care.
References:
- European Expert Group on the Transition from Institutional to Community-based Care (2012) Common European Guidelines on the Transition from Institutional to Community-based Care (Guidance on implementing and supporting a sustained transition from institutional care to family-based and community-based alternatives for children, persons with disabilities, persons with mental health problems and older persons in Europe), Brussels. [On line] Available at: deinstitutionalisationguide.eu/wp-content/uploads/2012/12/2012-12-07-Guidelines-11-123-2012-FINAL-WEB-VERSION.pdf
- United Nations Convention on the Rights of Persons with Disabilities (2007) [On line] Available at: http://www.un.org/disabilities/convention/conventionfull.shtml
- United Nations (2017) General comment on article 19: Living independently and being included in the community. Committee on the Rights of Persons with Disabilities Eighteenth session 14-31 August 2017 CRPD/C/18/1
- Flaker, V., Rafaelič, A., Bezjak, S., Ficko, K., Grebenc, V., Mali, J., Ošlaj, A., Ramovš, J., Ratajc, S., Suhadolnik, I., Urek, M., Žitek, N. v sodelovanju z Dimovski, V., Kastelic, A., Pfeiffer, j. (2015), Izhodišča dezinstitucionalizacije v Republiki Sloveniji (Končno poročilo, verzija 3.2). (študija po naročilu Ministrstva za delo, družino, socialne zadeve in enake možnosti, omogočila EU z uporabo Evropskega socialnega sklada), Ljubljana: Fakulteta za socialno delo.
- Flaker, V., Rafaelič, A., Ficko, K. & Meduza (2014) Hitra ocena potreb in storitev za dolgotrajno oskrbo in dezinstitucionalizacijo zavodov za dolgotrajno osrkbo na področju duševnega zdravja in intelektualnih ovir (DEZ-HOPS), interno poročilo, Verzija 1.0. december 2015, Fakulteta za socialno delo.
[1] 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 Andreja Rafaelič
is considered to be co-author.
