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.
