Institutions in Macedonia - type, number and distribution

In Macedonia, there are twelve (12) public social institutions of which the largest is Demir Kapija (221 residents), for the people with intellectual disabilities. There are two facilities that are nominally designated as rehabilitation facilities – one for physical disabilities in Banja Bansko and one for intellectual in Topansko Pole – Skopje. Both of these two institutions were primarily, and are still nominally meant for children and youth. However, the majority of residents is over age, so we have treated them in the analysis below as adult institutions. Further two institutions are for children without parental care – one in Bitola (for infants) and one in Skopje and two institutions for more troublesome children (one for children with educational and social difficulties and one for children in conflict with the law, practically merged into one) in Skopje.  Five public institutions are intended for old age. There are 19 private old age institutions mostly concentrated in Skopje with smaller capacities. There are also three large psychiatric hospitals: Bardovci near Skopje and Demir Hisar in Southern Macedonia, and a smaller one in Negorci near Gevgelija. These hospitals, besides providing for temporary residents, also house a substantial number of long-stay residents, which may be estimated at about 700 long-stay residents.

There are altogether 34 institutions of which 19 (small) private and 15 public. They accommodate about 2400 (our count 2328) long-stay residents. Of those in social institutions 1628 residents, most of them in old age homes (1146), much less (319) in adult institutions and comparably small number in children institutions (163).

Most of the institutions are located in the towns, there is a concentration of private old age homes in Skopje (17), where there is another public old age home and four institutions primarily designated for children. In Skopje, there is also a large psychiatric hospital. Seven are located in regional centres (2 in Bitola, Prilep, Kumanovo, Negotino, Radoviš, Berovo) and four are located in the countryside, two of them for people with disabilities and two psychiatric hospitals. Three of the latter are relatively big and they host about a quarter of all residents. Institutions for children and old age tend to be nearer the urban centres, some right in the centre of the city. These institutions are typically smaller in size.

Excluding the psychiatric hospitals, the only institution over 200 residents is Demir Kapija. Three public old age homes host between 100 and 200 residents. All the other institutions have less than hundred residents.  Four of public institutions and two private are with around 60 beds, two public and six private around 40 beds, 17 private below 31 beds, of which 5 with 16 or less beds. One public old age home (Berovo) is in this range too.

In social institutions, there are 840 employees. Little more than half are employed in old age homes, more than a quarter in adult institutions and a fifth in children institutions. Demir Kapija with 134 staff is the biggest employer in social institutional care (16 % of total number).

Table 1: Institutions and their distribution

Institution	type	geographical location	micro location	n. [1][2] res.	n.[3] staff	res/ staff[4]
Adult institutions				319	237	1,35
Demir Kapija	intellectual disabilities	Vardar region	on the edge of small town	221	134	1,73
Banja Bansko	physical disabilities	Strumica	near Spa; not far from Strumica (14 km)	63	40	1,70
Topansko Pole	intellectual disabilities	Skopje	part of Skopje city, few km from the centre, in residential area	35	63	0,74
Children institutions				163	161	1,01
Bitola	infants without parental care	Bitola	residential area 2 km from city centre	72	59	1,26
11.oktomvri	children without parental care	Skopje	near city centre in Skopje	45	44	1,02
25 Maj	social difficulties	Skopje	near city centre in Skopje	27	28	0,96
Ranka Milanović	CIL	Skopje	near city centre in Skopje	19	30	0,63
Old age homes				1146	442	2,54
Majka Tereza Zlokućani	old age	Skopje, Karpoš	outskirts of Skopje	67	14	4,79
dr. Ivan Vlaški	old age	Berovo	small town centre	15	7	2,14
Kiro Krstevski Platnik	old age	Prilep	near centre of Prilep	112	37	2,67
Zafir Sajto	old age	Kumanovo	near town centre	149	41	3,39
Sju Rajder	old age	Bitola	on the edge of the town – 3 km from the city centre	201	38	5,15
25 private old age homes	old age	23 in Skopje, Negotino, Radoviš	usually in the residential, suburban part of the city	602	305	1,97
psychiatric hospitals
Bardovci	psychiatric hospital	near Skopje	residential area near Skopje – 8km from city centre	300	NA
Demir Hisar	psychiatric hospital	Southern Macedonia	on the edge of small town (2.500 inhabitants) – 29 km from Bitola	300	NA
Negorci	psychiatric hospital	South-East	outside small town, 8 km from Gevgelija	100	NA
Social institutions				1628	840	1,94
TOTAL				2328

The ratio of residents per staff member varies greatly between the institutions (from low of 0,63 – which means that there are almost 1,5 staff per a child in Ranka Milanović to the max. 5,15 in Sju Rajder home in Bitola. The highest ratio is in old age homes at 2,54 for all the residents and staff, with the median value of 3,39 for the home in Kumanovo. The public homes have considerably higher ratio of 3,97 residents per one staff member compared to the ratio for private old age homes with is almost exactly half of the value for public old age homes. The ratio of private old age homes is comparable to ratios of the Banja Bansko and Demir Kapija special institution. Children institutions have much more favourable ratios – one staff on one resident is the average ratio. Of them home for infants has unexpectedly high ratio compared to other children institutions. The special institutions are somewhere in between the two groups with Topansko Pole having astonishingly favourable ratio (four employed per three residents).[5]

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 and Andreja Rafaelič are considered to be co-authors.

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[1] Topansko Pole institution has 69 users, some of them are day centre visitors. For psychiatric hospitals the number of residents is a crude estimate of long-stay patients.

[2] For private old age home are the data of Statistical Office for 2016. The capacities according to data of MoLSP were in 2017 794 beds.

[3] Merged for Ranka Milanović and 11. Oktomvri. Topansko pole has in fact 79 employees, however it is employer of the staff of the Allowance for Third Person Care Commission. In this facility they employ 16 people. Those we subtracted from the total staff, since our interest lies in the number of staff working in the providing institution.

[4] Calculated value for Topansko Pole would be 0,56. However, this figure is still misleading since the institution provides also day care for 34 visitors, which is almost as much as they have residents. Under assumption that a quarter of staff is needed on average for this work, the ratio has been calculated on the corrected value of staff – 47,25,

[5] Resident/ staff ratios should be understood as a statistical measure. In fact, in many institutions at a given moment the ratio is that one staff is working with 20 residents with intense needs. Even if we take into account that residents are there 24/7 and staff 8/5 it also a question of division and organisation of work. To put it very graphically – if in children institutions, in which the ratio is one to one, every member of staff would take a child to live with him, the institution could close. If they took two, half of the staff could be supporting the other half. This is mainly hypothetical argument, but similar things happened in some transformation of the children institutions in some instances.