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Community care Vs Institutional (social) care

Social care in the community
Social Role Valorisation (SRV)
Deinstitutionalisation
Disability services
Disability and community

What Are Institutions
Institution - Wikipedia, the free encyclopedia
How does the community care?
Removing the barriers to community participation and inclusion
The role of social care in the community
The community of the building
The reality in supporting people with high support needs
The role of institutions in society
The institutionalisation of community care
The institutionalisation of deinstitutionalisation
Some Perspectives on Deinstitutionalization
Explanation of terms



Community care Vs Institutional (social) care
Community care
Community care is
Advantages
Disadvantages
Where is the line drawn between community care and institutional care?
Institutional (social) care
Institutional care is
Institutional care has
Advantages
Disadvantages
A question of values
Negative outcomes (devalued)
Positive outcomes (valued)
Deinstitutionalisation





The expression "care" is used to describe a concern or interest in, or, a set of behaviours or interventions that are used to support, aid, assist or help a person or a group of people in meeting their needs. This expression is used extensively in society to describe a multitude of activities, programs and settings that are designed to support people in society. Community groups and services provide this care in society. Social services and organisations also provide this care where it is unavailable in a community. The term institution has been used to describe these social services and organisations, however, this description is misleading in that an institution describes a means of cooperation and coordiation only, and not the settings that this cooperation and coordiation happens in. An institution is a part of any community. It provides the mechanisms for social order and stability (see Characteristicts on an institution). An Institution defines the way we interact with each other within a community. It is determined by the formal and informal cultures and values of that community, and provides order and stability within that community. When we refer to a hospital, school or asylum we are not talking about the building, but what happens within the building (the community of the building).

"Institutions are structures and mechanisms of social order and cooperation governing the behavior of a set of individuals. Institutions are identified with a social purpose and permanence, transcending individual human lives and intentions, and with the making and enforcing of rules governing cooperative human behavior. The term, institution, is commonly applied to customs and behavior patterns important to a society, as well as to particular formal organizations of government and public service. As structures and mechanisms of social order among humans, institutions are one of the principal objects of study in the social sciences, including sociology, political science and economics. Institutions are a central concern for law, the formal regime for political rule-making and enforcement. The creation and evolution of institutions is a primary topic for history." (Wikipedia: Institutions)

Without a form of order and stability ...
... the community can not fulfill its role,
... there are no boundaries that define the community,
... the members do not see themselves as a part of the community,
... communication brakes down, or is nonexistent
... the commnity looses its skills and reources,
... the community can not fulfill its needs,
... clubs, teams, groups etc are no longer are a part of the community,

While the care provided within the community, social service or organisation is based on the institution of the community, social service or organisation, a distinction can be made between the institution of the community and the institution of the social service or organisation.
I feel there are two basic types of care:
1) Community care (informal): where the community has the skills and resources,
2) Institutional care (formal): where the community does not have the skills and resources.



Shows the relationship between the the skills and resources of the community,
 and the amount of support that can be provided within the community.


Community care:


Community care
Community care is (see Characteristicts on a community):  (Top)
Is about how the community looks after its members
What skills and resources does a community have?

Community care is ...
Informal, where there are no rigid guidelines or principles that define the service. Is not bound by government policy or practice.
Spontaneous, where the service is temporary in fulfilling a specific need at a particular time and in a particular setting.
Relies on community members to provide the service.
About the members supporting each other.
A value in being a part of the community.
Having something to contribute to the community.
Advantages:  (Top)
The person keeps the existing communities (living, recreational, education or employment) that the person is a part of.
The person is supported by their community.
The person is treated as a valued member of their community.
The person keeps the existing institutions of the community.
Minimual disruption to the persons lifestyle.

Disadvantages:  (Top)
The amount of support provided is directly related to the existing skills and resources of the community.
Where a person has no existing communities (living, recreational, education or employment), that person will be disadvantaged in not being able to fulfill his/her needs.
Other community members may treat the person as an object of pity, sick, an idiot, a trouble maker, wasting resources that are needed elswhere in the community etc.

Where is the line drawn between community care and institutional care?:  (Top)
I feel that community care is about ordinary community members getting together as a group to provide for the needs of others in their community. Institutional care is more organised around a specialised service that provides specalised skills and resources that are not available in the wider community, to a group, whose needs can not be fulfilled within the wider community.
Personal Fulfillment, Values and The Role of Supportive Communities



Institutional (social) care:  (Top)
Institutional care can also be described as "Social care".

Institutional care

Where there is a specific need that can not be managed by the community, a service is created that specalises in that need. Hospitals, for example, are designed to fulfill a specific need in the community. The hospital has a specific set of values, behaviours and cultures (institutions) that are unique to the hospital and not used in the wider community. There is generally a set of criteria, process or rite of passage that allows entry into the service. There is also an induction where a person goes through some formal procedure before entry.

Institutional care is (see Characteristicts on an institution):  (Top)
Formal, where there are rigid guidelines or principles that define the service. Is bound by government policy or practice.
Has a set agenda, charter which determine the role, objectives and outcomes of the service or organisation.
Permanent, where the service fulfils a specific on going need.
Relies on its own skills and resources to provide the service.

Institutional care has (see Characteristicts on an institution):  (Top)
Formal institutions:
Short term care.
Long term care.
Informal institutions.
 
Groups or communities within the service that are seperated from the wider community
Social networks
Professional networks

Advantages:  (Top)
The person is treated as a valued member of the service.
A person gets the appropriate care.
The service is built around the persons needs.
The service provides the community of support for the person.
The institutions of the service provide valued outcomes for the person.
The person has the opportunity to participate in normal social activities that are available to others in society.

Disadvantages:  (Top)
A person may not be eledgible or fit the criteria of the service.
A service may not have room for the person.
A service that is specialised in the needs of the person may not exist.
The service may not have the skills and resources to provide for the persons needs.
A person may lose his/her existing communities (living, recreational, education or employment).
The person has to learn and adjust to the institutions of the service.
The institutions of the service may devalue the person.
A co-dependent relationship may exist between the community and the service.
Other community members may treat the person as an object of pity, sick, an idiot, a trouble maker, wasting resources that are needed elswhere in the community etc.

A question of values:  (Top)
Negative outcomes (devalued):  (Top)
Collins 1993 (from Mental health care for elderly people By Ian J. Norman, Sally J. Redfern, P 501) describes institutional characteristics that are negatively valued as:
"... denial of humanity and individuality
... no personal space
... no privacy
... little choice
... little comfort
... little personal safety
... few possessions
... no dignity
... pauperized
... dependent
... no control, participation or decision making
... cannot function as ordinary human beings"

Other negative outcomes:
... A small staff/client ratio
... Low value (Sick Person, Subhuman, Organism, Menace, Object of Pity, Burden of Charity, Holy Innocent, Deviant etc. The Origin and Nature of Our Institutional Models)
... Low expectations
... Are treated as objects (numbers, interns, defectives ect)
... Settings and activities are structured around staff --> residents
... Strict separation of staff and residents
... Separation of residents into groups
... All residents are all treated and dressed the same
... All residents follow the same daily patterns of communal living
... There is no variety in the routine
... Activities are confined to the facility and separated from the community
etc.

Positive outcomes (valued):  (Top)
Ramon, 1991 (from Mental health care for elderly people By Ian J. Norman, Sally J. Redfern, P 503) describes institutional characteristics that are positively valued as:
"... people first
... respect for the person's
... right to self-determination
... right to be independent
... empowerment"

Other positive outcomes:
... A large staff/client ratio
... High value
... High expectations
... Settings and activities are structured around residents --> staff
... Residents are treated as individuals
... Less structured daily patterns of communal living
... Variety of activities and different patterns in the routine to suite the residents
... Mixed activities where residents are included in the normal activities of the community (living, recreational, education and employment)
etc.

Goffman describes four main characteristics of institutional care as:
Batch living
Binary management
The inmate role
The institutional perspective

Rather than describing a characteristic of institutional (the building and the "social construction") life, Goffman is actually describing a set of outcomes that are characterised by the "social construction"of the institution. These outcomes are described as negatively valued outcomes. When used in the context of the corrective services or similar institutions, or in another culture, these outcomes may be seen as positive outcomes.

Batch living, for example, describes the conditions of living, the activities and the attitudes of the management and staff towards the residents.
"Batch living – where people are treated as a homogeneous group without the opportunity for personal choice. Activity is undertaken en masse. Rules and regulations dominate and residents are watched over by staff." (Lennox Castle Hospital: a twentieth century institution)

Batch living is used to describe negatively valued outcomes:
The members are separated into groups - authoritarian - subservient
The members of the subservient groups are all treated the same - as a group (group living, group activities etc.), rather than as individuals (no personal choice, no variety etc.) by the authoritarian group. "It is characterised by a bureaucratic form of management .... 24 hours a day without variety or respite." (Goffman, 1961 : 5-6, in, K. Joans & A.J. Fowles : P.71)

Within the wider community, we see these same outcomes, and although they may be less extreme, they are still there in all forms. Sometimes these outcomes, described as batch living, are a necessary part of the activity and the setting and are positively valued in providing positive outcomes for its members. A package tour, for example, the members are all living together and participating in the same activities. They are restricted in what they can and can't do, they have a set timetable that has to be followed, the service provider is responsible for their welfare etc. The value that is placed on the packaged tour is determined by the experiences of the members of the tour. I'm sure you have read or heard about a tour where the members were poorly treated, were placed in lousy accommodation, left on a ship or in a hotel for the whole time (these things have happened) etc. Boarding schools, the army, a prison are other examples of batch living.

We also see these outcomes (in varying degrees) in living, recreation, employment and education services that support disadvantaged people in the community. Does this mean that we need to remove all organisations, community groups or services that support disadvantaged people?

NO! There will always be a need for institutions and institutionalised care in the community.


Goffman states that no institution is all open or all closed. That they all share similar characteristics.
An institution is either positively or negatively valued, according to the values
of  the community or society that the institution is a part of.

It is the total value of the outcomes of the institution that determine whether the institution is
positively or negatively valued, rather than the characteristics of the institution.
The value of these outcomes are determined by the values of the community and it's members.

Institutions and institutionalisation can then be seen to have two definitions within society.

1) the community definition is concerned with normal community activities such as education, religion, the legal system, or any body of knowledge or behavior that is a part of the community and is organised within a set of formal and informal settings, beliefs, values, roles, expectations and behaviours. These are usually positevely valued outcomes.
2) within the human services, the terms institutions and institutionalisation have been used to describe the social conditions that people with an intellectual disability lived in, in society. These are usually negatively valued outcomes.




While the term Institutionalisation can be seen to have
two definitions, they are describing the same things.
Community definition: the model of care is positively valued.
Social definition: the model of care is negatively valued.


"The term institutionalisation is widely used in social theory to denote the process of making something (for example a concept, a social role, particular values and norms, or modes of behavior) become embedded within an organization, social system, or society as an established custom or norm within that system. See the entries on structure and agency and social construction  for theoretical perspectives on the process of institutionalisation and the associated construction of institutions.

The term 'institutionalisation' may also be used to refer to the committing by a society of an individual to a particular institution such as a mental institution. The term institutionalisation is therefore sometimes used as a term to describe both the treatment of, and damage caused to, vulnerable human beings by the oppressive or corrupt application of inflexible systems of social, medical, or legal controls by publicly owned, private or not-for-profit organisations or to describe the process of becoming accustomed to life in an institution so that it is difficult to resume normal life after leaving." (Wikipedia: Institutionalisation)

Deinstitutionalisation:  (Top)
Deinstitutionalisation is the process of changing the outcomes of a setting from a negative value (black) to a positive value (white).


Negatively valued outcomes  :  low expectations, conform, structured around the needs of the staff etc.
Positively valued outcomes  :   high expectations, individual, structured around the needs of the residents etc.



"The authors discuss what can be learned from our experience with deinstitutionalization. The deinstitutionalization of mentally ill persons has three components: the release of these individuals from hospitals into the community, their diversion from hospital admission, and the development of alternative community services. The greatest problems have been in creating adequate and accessible community resources. Where community services have been available and comprehensive, most persons with severe mental illness have significantly benefited. On the other hand, there have been unintended consequences of deinstitutionalization—a new generation of uninstitutionalized persons who have severe mental illness, who are homeless, or who have been criminalized and who present significant challenges to service systems. Among the lessons learned from deinstitutionalization are that successful deinstitutionalization involves more than simply changing the locus of care; that service planning must be tailored to the needs of each individual; that hospital care must be available for those who need it; that services must be culturally relevant; that severely mentally ill persons must be involved in their service planning; that service systems must not be restricted by preconceived ideology; and that continuity of care must be achieved."
Some Perspectives on Deinstitutionalization


When providing the most appropriate care for people with high support needs ...
1) The community is not where the person is living, but where the person participates, shares experiences and has valued relationships with others.
2) People with high support needs (severe disability, aged etc.) will always need support structures as a part of their lives.
3) The amount of participation in a community (living, education, employment or recreation) is directly related to the skills and resources of the person, and, the skills and resources of the community that the person wishes to participate in.
4) Institutions are going to be around in one form or another whether we like it or not, It is the way that they are used that is the problem.
5) The institutions of a society towards a particular group determine the way the group participates in society.
6) The institutions of a particular government department, organisation, profession or service define the way the person is supported within that society.
7) Facilities that support people with high support needs do not need to be the nursing homes or prisons in the sense that they are today, but can become warm inviting community places that offer a range of services to the community, as well as be a part of the wider community within that society.
8) People with high support needs are a minority group in our society, and will have the same problems as other minority groups in being a part of society.


01/10/2010
Peter Anderson
http://www.psawa.com