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sobota, 3. marec 2018

Staff profile in Macedonian social care institutions
























In most of the institution staff is in a greater degree female (ratios from 1: 2 to 1: 5). There are however few institutions for youth in conflict with law and Topansko Pole with a gender balance in staff. The staff in most institutions is relatively old, exception is the old age home in Berovo, which was established only recently. Demir Kapija and Ranka Milanović seem to have a slightly younger composition of staff. This is shown also in the next table in the average employment, where employment in these institutions is on average shorter. Long employment and age may, but not as a rule, imply certain degree of conservatism, but also means that it is staff with a lot of experience.


Mostly the fluctuation of workforce in institutions is (moderate) around 15 %, with equal numbers of staff leaving and entering the job.[1] However, there are some extreme occurrences in Demir Kapija, Zlokućani and 25. Maj institutions. In the 25. Maj institution half of the staff changed. In this institution, there was an even exit and entrance. This was not the case in Zlokućani and Demir Kapija where 50 % of present staff has left the job, which was not compensated by new employment. In Zlokućani institution, which has small number of staff anyway, this may be attributed to the regulation on ‘no new employment’ in the period of elections – as it is the case in infants home of Bitola, where they had been waiting to fill missing employment after the election. Even if this may be partially the case also in Demir Kapija, the difference in number cannot be explained only this factor. There the downsizing of the staff is probably consequence of notion that it is appropriate not to have new employment since the institution is in the process of deinstitutionalisation.[2]

In some institutions, there is an extreme rate of absenteeism. Absenteeism is a rule in children institutions (which are small but have good resident staff ratios). In institution for adult this rate is considerably smaller, which to participants of the camp in Demir Kapija is a surprise, since there was a lot of talking about difficulties in organising work because of supposedly endemic absenteeism. Maybe this the impression is based on few extreme cases (that are recorded and had a lot of attention) or the absenteeism is endemic to all of the institutions (this has to be checked with some comparable data in the country).

Mostly staff live in vicinity of institution and the daily mobility is very low. Exception are Banja Bansko and Zafir Sajto (Kumanovo) where most of staff commutes daily from neighbouring settlements. We assume that among commuters there are more professionals (e.g. in Demir Kapija). In Demir Kapija, part of the staff would not mind to change their location of work or some would even be happy to do so since some of their family works elsewhere, but in general, the staff is against such arrangement.[3]

Average salaries range from 19.450 MKD to 14.524 depending on the profile of staff, which in some institutions consist of greater numbers of professional staff with higher salaries and in some with a great portion of staff of low professional profile (care workers). There is quite a variance in average and highest salaries across the institutions. Skopje institutions have average salaries over 18.000 while other have around 15.000 (with exception of Kumanovo). The lowest salaries seem to be around either 12.000 or 10.500 MKD regardless geographic position.

A half of staff in institutions are of caring and nursing profile. Other half, split into two equal quarters are professional and auxiliary staff (administrative and technical). Among professionals, dominant professions are teachers and educators (46 % of all professional staff), special educators (15 %) and social workers (20 %). However, the number of social workers in individual institutions is usually one or two, but they are present in all institutions, also in private homes. Special educators are however, concentrated in the institutions that accommodate residents with (intellectual) disabilities. Teachers and educators are concentrated in the children institutions.

Health and care staff are concentrated in old age homes (geronto housekeepers[4]) and in institutions for people with disabilities. There is little of this profile of staff in the children institutions, except a substantial number of nurses in the infants’ home.

There is a relatively big number of auxiliary staff (administrative and maintenance[5]). While administrative staff does not have much contact with residents, the maintenance staff does so on the daily basis, and they can be sometimes considered as important support workers (there is thin line between a cleaner and ‘geronto housekeeper’).

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.


[1] This is shown in the median measures, the mean measures show different picture. However there is the contribution of extreme occurrences – the difference between intake and outflow of staff can be attributed to dig downsizing in Demir Kapija and loss of staff in Zlokućani and Bitola. On the other size the impact of downsizing is accommodated by new employments in the new institution in Berovo and small rise of employment in some other institutions.

[2] This would be appropriate policy if the deinstitutionalisation process in Demir Kapija would be seen as substitution, if the model of transformation would be conversion such thinking would be wrong. In any case, even if such downsizing is not motivated by the idea of deinstitutionalisation, for the staff this is an alarming omen and causes the resistance to deinstitutionalisation.

[3] Not only because traveling would be time consuming but also because general trend seems to be that employers do not pay travel to work expenses.

[4] Auxiliary staff employed in old age care providing care combined with housework.


[5] Although many managers complain that, the number of cleaners is not sufficient.

četrtek, 1. marec 2018

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.

[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