Institutions

In my previous post, I spoke about deinstitutionalization and the development of care homes in the community. How did the decision come about to close the institutions and integrate into the community? The question can best be answered by describing life in the institutions. Most of the information I have about this subject came through conversations with people who have worked in the field many years more than I or from family members of those for whom I care.

A majority of those who live in care homes who are now middle aged or older, lived in an institution from early childhood well into adulthood. Generally, they were placed there based on a doctor’s recommendation to the family. Physicians would tell parents that their retarded or mongoloid child (both acceptable terms of the day) would never walk, talk, or be able to provide basic care for himself. They would drive the point home with the idea that the parents were not skilled enough to care for their child and it would be almost abusive not to turn them over to the care of professionals in the institutions. Shocked and horrified, parents often complied.

Those placed when they were too young to remember life on the “outside” were probably most fortunate. Those who were “remanded” at an older age often had difficulty with the transition and were therefore labeled as “highly behavioral,” resulting in less than friendly treatment. The behaviors were treated through physician prescribed physical management in the form of a “take down;” basically one or two aids would physically force the person to the ground and hold him there until he complied. This was just one part of the reward and punishment system that was institutional living.

Privacy was almost nonexistent in the larger institutions as the ratio of staff to patients was generally two staff to every twenty or twenty-five patients. These two staff would be responsible to provide meals, medications, and personal hygiene to their assigned patients during their eight hour shift effectively turning all of these into group activities. Therefore, shower-time was line them all up in the shower room and work your way down the row.

Physical management and lack of privacy are just scratching the surface of life in the institutions. Add to it physical and sexual abuse from other patients as well as staff, medical and dental procedures performed without anesthetic, and little positive social interaction and you are getting a clearer picture of what it was like for much of our developmentally disabled population. Care homes were and are designed to remedy this situation as physical management has almost become a thing of the past and we make certain people are treated with dignity and respect. Care homes are not mini institutions; they are homes.