Community care Vs
Institutional (social) care
Contents
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).
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
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 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 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.
Institutional
Outcomes
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.
Peter Anderson
http://www.psawa.com
