Actual resettlements in Macedonia so far

Metonymies for resettlements in Macedonia are foster care and group home, and resettlement to ‘biological’ families is mentioned. There are, however, many other possibilities at hand. Many of those are practiced in informal sector, some also in formal social care, but not systematically developed. In the tables below we list all the possibilities, even if we do not have hard data on those which are not practiced systematically, just to put them on the map and at least catch a glimpse. We refer to the number only in the resettlements observed in organised resettlements during the ‘official’ deinstitutionalisation processes and give definitions and clues for the rest. We split the different types of resettlements into few tables for economy of space reasons. First, we list possible resettlement in to one’s own families, then in other families, and at the end into intermediate structures and independent living.

Resettlement usually and linguistically means returning to one’s original environment. This, for children means returning to their parents, for adults this would mean returning to their spouses, and for some in late middle and old age it could mean that they would live with their children, if they are single maybe to leave alone or with a flat-mate of some sort. These kind of relocations are not extraordinary in everyday life, people often move from one arrangement to another and use sometimes unorthodox family choice especially in extraordinary or crisis situation, dramatic life events like divorce, eviction, loss of the job, illness. These solutions are used also quite often in the social work practice and in discharge from institution. However, in the organised resettlement from institutions they are used seldom. In general, there is a very small number of people that has been resettled in their own families. This sometimes happened spontaneously, only because of emotional reasons or because the families were completely unsatisfied with the conditions in institutions.

Table 3: Resettlements to own family by type, number and frequency

Type of resettlement	description	N	frequency
with parents	If the parents are known, they are contacted, encouraged and provided some assistance. Or, in case of spontaneous resettlement, the parents take their children back home.		Most typical resettlement in own families. In fact, this is the meaning of ‘biological’ family.
UNICEF SIDK project 2001–2004	Parents were contacted by the team and had been given some initial support.	4	less than 1/6 of cohort
Topansko Pole	With increase of extra institutional provision (day centres) some parents took their children out of institution.	NA	not frequent but regular
Poraka Negotino	One of the residents resettled from DK moved after a while to his own family.	1	one off
MIHB standard practice	when matters improve children return to their homes	NAp	1/8 of infants discharged in 2016
with one's own family (spouse and children)	This destination of resettlement is quite usual with MH service users. There are however often unresolved issues that require a lot of effort and patience, esp. with long-stay residents.	NA	Frequent in mental health, otherwise not.
With descendants	People return to the families of their children who are prepared to care for them. Old people who move in with their children or grandchildren spontaneously.	NA	Often with old age, less in MH. Not used in organised resettlement.
With more distant relatives	Uncles or aunts caring for children. Nephews or nieces for old people or people in late middle age with MH issues. Very often as a respite or other temporary solution.	NA	Occasionally used in children services. Often in informal care.

For children there is little other option than to resettle to a family.[1] If the family is not parental, it can be of some relatives or a family that is provided to children by childcare. These are adoptive and foster families. Adoption is the main resettlement (or more precisely discharge from an institution)[2] for the infants in Bitola, probably much less frequent in other children homes. While foster care is solution that is more frequent for older children and resettlements in general.

Adults have more types of families to choose, in principle, and the option of single independent living is open to them. On other hand, they cannot be adopted and fostering is not an adult option. However for some, care in a family or placement in a caring family could be a good solution. Although foster and care families share the same term in Macedonian, there has to be made a distinction in applying this form of care to children and adults. Fostering children implies that foster parents have, even if they are not legal guardians of the child, some parental responsibilities in everyday decisions. With adults, this is not the case. With adults, the distinction has to be made whether the situation is one where the accommodation is primary or that of care is more prominent. An adult can live with a family because this is the way of securing a place to be, or he (she) would live with another family in order to be cared for. In first case it is a lodging family in the second it is caring or supporting family. In the first instance the lodger may have also some care or support provided, but this may be either marginal or provided (also) by some other agency than the family where he or she resides. First is a care in the family and second care by the family. Care ‘in’ and ‘by’ a family can be provided by recruited and supported families like in child foster care, but in process of deinstitutionalisation it is natural to consider also that the staff in transforming institutions takes some residents and their work to their homes. Elsewhere this has happened in some institutions on a mass basis, in resettlement from Demir Kapija it has also happened, but not to a great extent.

Table 4: Resettlements to another family by type, number and frequency

Type of resettlement	description	N	frequency
Friends and neighbours	People in crisis (eviction, illness, etc.) or returning from institution stay for short or medium periods with friends or neighbours.	NA	Happens sometimes with children and old people, especially for short periods.
Adoption			most frequent in MIHB less in other children homes
MIHB	When adoptive parents are found children move to their homes.	NAp	most frequent solution, 2/3 of discharges
Foster (caring) family	Foster families provide accommodation and family care. Primarily for children but used also for adults.		Amply used service in resettlement, especially for the children and in the first wave of DI.
CSW Kriva Palanka resettlement	Foster families were found for SIDK residents from Kriva Palanka who had housing issues. They were given houses in order (or exchange) to foster care.	7	all in this resettlement action;
UNICEF SIDK project 2001–2004	existing or new foster parents were contacted and contracted with the help of CSW, after long preparation in the institution children were moved to the foster family	25	most frequent in this project
MIHB	children who cannot be placed in their families or in adoption are placed in foster care	Nap	1/8 of infants discharged in 2016
Board and lodging	Someone (usually a single person) stays with a family or a housekeeper (landlady) who provides also meals and does some housework. In private arrangements pays out of pocket, if arranged by social services by them.	Nap	once a frequent arrangement for single people, can be used for ex-residents;
living with ex-staff	Staff of transforming institution take some residents to live with them. They are still employed by the organisation, but work at home. An option for the staff in early retirement.		used in some projects (e.g. Kulina in Serbia[3]) not often in MK;
MHI & Poraka Negotino 2008–	One of the SIDK staff took within the project some residents to live with her	2&	unusual

Most of the resettlements have happened through the intermediate structures, i.e. group home but also day centres. Latter are helpful support facility also for resettlement to foster care, since they provide a place for the day activities and relieve the living space.

Table 5: Resettlements to intermediate structures by type, number and frequency

Type of resettlement	description	N	frequency
group homes
short term	Crisis centres, respite stay and sanctuaries. In resettlement from in institution, such stay (few weeks, half a year) can be productive for people to organise new start in life (MH, prisons).		Do not exist in MK, otherwise frequent in MH, as a respite care also in intellectual disabilities and old age.
medium	Resettlement into group home can be for medium term (1–3 years) with a purpose that residents get necessary skills and find their ways of living in the community. Children usually move on from such a structure when they grow up.
children from 11 O into a group home	Children resettled from institution to their home environment in Berovo.	5	only this incidence
long-term	residents are resettled to a group home where they live with not much prospect of moving on;
MHI & Poraka Negotino 2008–		93	most frequent in this project
from Demir Kapija	After training of staff, preparation of residents, housing facilities were acquired in Skopje and Negotino. The selected residents moved there	67	most of the users were resettled from DK in the initial stage
from other institutions	after the initial resettlements from DK the group homes admitted people from other institutions (TP 4, psychiatric hospitals 3, home for old people Prilep 3, 11. Oktomvri 1, Čičino selo 1)	12	quite frequent
Admissions from original families	admissions of the people who would in principle be otherwise institutionalised;	13	quite frequent
from foster family		1	one of
day centres	Residents do not resettle into DCs, but they are important support factor in some types of resettlement.		one of the most developed services in the country
housing communities	People for economic or social reasons chose to live together, share some costs and some space (kitchen, living room, bathroom). Spontaneously happens often with students.		not performed
(core) & cluster	people are resettled in single units dispersed in a neighbourhood with a centre for care		not existing

If the intermediate structures are to be intended for transition to the community and to be temporal, they should provide resettlement to various forms of independent living. These are either spontaneous or organised. Spontaneous events do happen occasionally but there is a lack of organised resettlements to independent living either by use of home help, personal assistance or personal care packages.

Table 6: Table 2: Resettlements to independent living by type, number and frequency

Type of resettlement	description	N	frequency
Independent living	People move to their own flat and have support they need there. Applicable for all groups.		not recorded and non-existent in formal provision
spontaneous	people or their relatives decide to leave a RI and arrange it themselves		happens rarely but regularly
resettlement during study period BB	Some residents leave the institution for the time of their study. They do not receive support from the institution and have to rely on the peer support of their colleagues and other informal resources. They get a special study allowance and grant.	2–4	rare
supported
home help	People move from RI and get home help. At this moment the amount of home help is so small that it is helpful to some old people but whether it is a preventive measure against institutionalisation it is questionable	/	in nascent form
personal assistance	an ex-residents moves out of RI and is supported by personal assistance	/	So far the recipients are not ex-residents
personal care package	residents articulate personal resettlement plan and move out with support of various care providers; applicable powerful tool for all groups of residents;	/	non existent

Table 7: Number and proportion of residents resettled in the process of deinstitutionalisation up until now

Type of resettlement	Projects	N	%
Own families (parents)		5	4
	UNICEF SIDK 2001–2004	4	3,2
	Poraka Negotino	1	0,8
Foster (caring) family		32	26
	CSW Kriva Palanka resettlement	7	6
	UNICEF SIDK 2001–2004	25	20
living with ex-staff		2&	2
	MHI & Poraka Negotino 2008
group homes	from institutions	84	68
	from 11 O into a group home	5	4
	MHI & Poraka Negotino 2008–	79	64
	from Demir Kapija	67	54
	from other institutions	12	10
All		123	100

There were 123 residents resettled in the process of the deinstitutionalisation. This represents 12 % of all the present residents in social care or 24 % of the respective (adult and children institutions). Most frequent were resettlements to group homes which represent more than two thirds (68 %) of all resettlements, while resettlements to foster families represent a little less than on third (28 %); the number of resettlement to original families is relatively small (4 %). The foster care was the main and exclusive destination of resettlement in the first wave of deinstitutionalisation, while group homes were a dominant mode in the second. This can be explained on one hand by the shift of target populations since foster families are more suitable for children and group homes for adults. However, it seems also that there was a shift in preference or model, since in the second wave there were also children involved (from 11. Oktomvri) and ‘foster’ care could be used also for some adults.

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.

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[1] Alternatively, children can live on the street or on their own. Both options are not seen as appropriate. Although we know from everyday experience that some adolescents live a good life on their own (e.g. parents have moved to work abroad and the child stays in the home country to finish schooling) with an arm-length supervision of adults (relatives, social services). For an adolescent, in comparison with a child, going to another family can be inappropriate or at least less crucial. The attachment issue is not as important as, for instance, for babies and younger children, and there may be adaptation and authority issues.

[2] Discharge and resettlement may seem as synonyms. There is a difference though. Discharge denotes the termination of responsibility of an institution (after treatment or the reasons for caring are over), while 'resettlement' does not necessary have this meaning. Furthermore, the term resettlement implies a wholesome process of many residents being relocated into the community, returning to their homes, settlements or forming new ones.

[3] These carers ceased to be employed by the institution and were treated as foster carers. Same applies for the solitary experience in Demir Kapija below.