Characteristics of residents of Macedonian social care institutions

Table 2: Residents' demographic characteristics

Institution	n. residents	M	F	mean age[1]	age span[2]
Institutions adults	319
Demir Kapija	221	124	97	45	5–85
Banja Bansko	63	29	34	41	7–69
Topansko Pole	35	25	10	23	8–38
Children institutions	163
Bitola	72	40	32		Nap
11.oktomvri	45	30	15	13	5–19
25 Maj	27	21	6	14.2	10–18
Ranka Milanović	19	14	5	17	11–20
Old age homes	1146
Majka Tereza Zlokućani	67	25	42	80	51–91
dr. Ivan Vlaški	15	6	9	80	70–95
Kiro Krstevski Platnik	112	46	66	69	26–96
Zafir Sajto	149	43	106	75.6	48–97
Sju Rajder Bitola	201	50	151	77	41–96
Private old age homes	602[3]	213	389	over 80	41––
∑		668	916

Sources: Annual reports, questionnaire and Statistical Office data

The distribution of residence according to gender is uneven. In children’s homes (except for infants home) and institutions for adults under 65 years of age, there is a strong disproportionate number of men. In old age homes one third of residents is male. The disproportions it the former can be explained by the tendency of male users being seen as more disturbing, and are generally more frequently subject of institutionalisation , while prevalence of women in old age is a consequence of women’s longer life span (or maybe also a lower subsidiarity threshold).

Table 3: Admissions dynamics

Institution	average length of stay	number of admissions 2016	discharged	Deceased
adult institutions
Demir Kapija	24,5 [4]	16	2	11
Banja Bansko	30*	6	3	2
Topansko Pole	12	6	6	2
children institutions
Bitola	NAp	52	64	2
11.oktomvri	10*	7	8/19*
25 Maj[5]	2,7	7	10
Ranka Milanović	1	9	11
Old age homes
Majka Tereza Zlokućani	15	20	5	2
dr. Ivan Vlaški	0,5		5	2
Kiro Krstevski Platnik	7	112	29	33
Zafir Sajto	11	102	15	81
Sju Rajder Bitola	1.5	91	22	66

Sources: Annual reports, questionnaire and Statistical Office data

The time spent in the institutions for an adult is very long. If the data for Banja Bansko are right, this means that people more or less spend their life in this institution. Topansko Pole has still a substantial proportion of children, which lowers the average stay in the institution. Two old age homes have a very low average stay. In Berovo, because it was just opened, in Bitola because the facility is used partially as a hospice. The number of discharged residents in adult institutions is quite low, even in comparison with old age homes. There are almost no possibilities for people to leave the institutions for adults, in Demir Kapija the possibilities are les then 1 in a hundred. Mortality rates are at an expected level in adult institutions and very disproportioned between old age homes.[6]

Regarding social characteristics of residents, we had problems getting data, even when we asked the responsible staff to make an estimate. From the available data we can deduce that mostly the residents in adult institutions are quite poor (little less than half of the residents in Banja Bansko are estimated to be ‘absolutely poor’ – with no income and property). They do not have property (one in BB and seven in Demir Kapija do) and have no or few visitors (estimate in BB is that six (6) have frequent visitors and in Demir Kapija 21). In children homes profile is not much better. The rate of visitors is surprisingly low (only three have been recorded in Ranka Milanović to have frequent visits).

Table 5: Social status and rate of visitors in old age home (estimates)

Institution	n. residents	socio-economic status			Visitors
		Absolutely Poor[7]	Relatively poor	Middle class	None	Rare	Frequent
Majka Tereza Zlokućani	67	12	12	43	7	15	45
dr. Ivan Vlaški	15	0	0	15			15
Kiro Krstevski Platnik	112	7	45	60	35	46	31
Zafir Sajto	149	24	27	98	29	41	79
Sju Rajder	201	25	42	84	19	64	68
total	544	68	126	300	90	166	238
%		13,77	25,51	60,73	18,22	33,60	48,18

Source: questionnaire

In old age homes, the profile of residents is more balanced. In all the public old age homes majority (61 %) is estimated to be middle class and a substantial number of residents owns some property. In public homes there are however more poor residents than in the private ones (see modes of payment in Makstat report). Also the number of residents who do not have visitors is relatively small in old age homes (18 % in comparison with BB 38 % and 25. Maj 27 %) and almost half have frequent visits (as opposed to BB where every tenth resident has frequent visits).

It seems that socio-economic status is more prominent determinant of institutionalisation in adult and children institutions than in old age homes.

It seem that residents in institution are abandoned and forgotten.

Apart from those few who have visitors, there are two typical reasons for lack of social contacts outside the institution. One is that the residents never had anybody and in fact, some residents came to Demir Kapija from orphanage, or their parents died. It often happens that after parents, who had been regularly visiting, die, that other siblings do not continue the visits. The other reason is that their relatives have written them off. Reason for writing off may not be necessary because of indifference, sometimes it is the way to deal with guilt feelings. Those arise from not caring for their relative. This may be combined with the distance to travel and misunderstanding of the attitude of the staff to them (which in institutions is usually unwelcoming). In cessation of visits of siblings we can observe that the family moral imperatives are smaller, but because not practicing family solidarity the guilt feelings stronger.

Regarding mobility the most of the residents in BB have mobility issues, which is expected since it is an institution for people with physical disability (however, a quarter of residents are mobile without use of aids). But also more than a quarter of residents in Demir Kapija have such difficulties. In old age home the picture is somewhere in between the two adult institutions – half of the residents is mobile without aids, a third is immobile and a sixth is mobile with aids, of them a third of residents are with wheelchairs.

Table 6: Mobility of old age homes residents (Zlokućani exempted)

		Immobile	wheel chair	Mobile with aids	Mobile without aids
dr. Ivan Vlaški	15			5	10
Kiro Krstevski Platnik	112	45	12	15	40
Zafir Sajto	149	57	4	12	76
Sju Rajder	201	54	9	15	123
Total	477	156	25	47	249
%		32,70	5,24	9,85	52,20

Source: questionnaire

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, Andreja Rafaelič and Kalia Popovska are considered to be co-authors.

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[1] Data for Topansko Pole are for all users, including the daily visitors.

[2] Data for Topansko Pole are for all users, including the daily visitors.

[3] Data of Statistical Office for 2016. The capacities according to data of MoLSP were in 2017 794 beds.

[4] the longest is 59 years

* Diminished validity of data.

[5] These two have been merged onto one location.

[6] Low mortality rate in Zlokućani care home can be explained by the fact that this institution is a part of Gerontological centre of Skopje, which has a palliative unit, and the dying residents are transferred there, while high incidence of deaths in care home in Bitola can be attributed to quite the opposite arrangement of institution having such a unit incorporated in its system.

[7] no income, no property