Appraising the success of performed resettlements in Macedonia

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.