JOURNAL ISSUE 11
SOCIAL CARE HOME HRASTOVEC –TRATE:
DISLOCATED RESIDENTAL UNITS
Dr. Vito Flaker, Professional Director
Magdalena Zakelj, Social Worker
The history of the care for people with mental distress in Slovenia has been more or less the same as in the rest of Europe. The institutionalisation of the insane was not truly on a large scale until World War II, for at the time Slovenia was a predominantly agricultural country. The rapid post war industrialisation has produced many institutions, amongst them also Hrastovec in 1947.
There are two types of institutions for people with mental distress in Slovenia. On one hand are the psychiatric hospitals—there are 6 hospitals, with approximately 1,300 beds, a part of the health sector. On the other hand we have social care homes—there are 6 special care homes, 4 special units in retirement homes, and 2500 residents, a part of the social care sector. While the former provide short term psychiatric treatment (the average stay is approximately 50 days) the latter provide long-term residential care (the average stay is approximately 10 years). During the past 15 years a voluntary sector providing community services has also evolved, with approximately 25 group homes for approximately 130 residents, with 5 day centres and 5 “information offices”.
Hrastovec is the largest of these institutions, giving residence to 626 people. It is not only the largest, it is also known as “the last stop”; i.e., it provides service to all people who were dismissed by other services, not being able to manage coping with them.
Hrastovec also has a long history of innovations, for they have started introducing important socio-therapeutic innovations and approaches (group work with residents, group excursions, placement into foster families, holidays, etc.) already by the end of the 1970s. In the 80s it became known for its international youth camps and the various forms of voluntary work and the first thoughts on de-institutionalisation in our region. It is also the first public institution that introduced community care in the field of mental health, after a long struggle for a group home in Maribor in 1999.
Great changes started with the new management in 2001 and grew bigger during the next years.
Dislocated residential units are the most obvious feature and achievement of the changes in Hrastovec. They are based on the concept of group homes, and are located in larger (offering housing for up to 12 persons) normal houses, generally with rooms for one or two persons. They are located in urban areas with access to all general services (bank, shop, post-office, church, nature, etc.), offering residents a life as close to ordinary as possible.
The staff help the residents at their daily chores according to their needs. Mainly, the residents prepare their own meals, and apart from this they also perform certain activities with which they can earn some money or they spend their time in leisure activities. The residents are free to move around their surroundings; they participate in special and everyday events; they go shopping, take walks, visit, go to events, and perform their daily routines. Contacts with relatives are more intensive.
The needs for staff are organised according the actual needs of the dislocated unit for staff (24-hour presence or only a part of the day). The staff is recruited from the Hrastovec employees, public works, relatives, and volunteers. The actual workers in these units are mainly staff with secondary nursing education. Professional services are ensured by the mobile service from Hrastovec and the existing services in the local community (centres for social work, health centres).
One of the forms of dislocated units is farms. There, life can be organised in an intensive connection with nature (environment, animals). They offer accommodation, contact with nature, production and earnings, recreational possibilities (farm visits, an opportunity to work, relaxation, learning—also for other residents of the institution), and they can also be a learning base for the residents within the frame of the resettlement programme.
Hrastovec is also known for its tradition (that spans over decades) of placing residents into so-called “foster families”. Such a form was predominantly chosen by partial farm families, who found the greatest motive for accepting a resident in the additional help on the farm and less commonly in the financial funds that they received for the resident. Regardless of the motive, the residents (with rare exceptions) were treated as second class family members. The task of the mobile service is to offer support and ensure professional help at the homes. The form and duration of the help depends on the needs of the relocated person. However, it is also oriented towards other family members (it offers them counselling, education, strengthens the bonds between the family and the institution, supervises the fosterers if necessary, etc.), other relatives, and the environment. In the event of mutual acceptation the integration can take place very fast.
Some residents from Hrastovec have moved into residential homes that are led by non-government organisations. They enter them on the basis of an individual plan, finances and service package for the certain resident and a written agreement. The problems are that the non-government organisations seek very independent residents, they do not have enough space, and they have insufficient financing.
The first impressions offered by the evaluation reports show that the residents are extremely satisfied with their living arrangements in these units and favour them greatly in comparison to living in the institution (they state that they would never return). The residents of these units have revived or gained anew the skills necessary for everyday life; some of them have even re-established their contacts with their relatives, who prefer to come to the dislocated units (geographic, as well as social closeness) for they are of the opinion that the residents are more approachable when they live in a normal environment, a normal house, a normal neighbourhood. It is easier to visit someone in an informal environment, where you are offered a cup of coffee and you can talk in a relaxed manner, and then pay a visit in an institution, where the visitor feels tense and strange.
In all of the enumerated units the work is based on the principles of normalisation and entering the broader social community. The residents actively participate in sport and cultural activities that are prepared by the local communities. The residents use the services of the public medical network (for instance personal physician, dentist). The workers from the professional services manage the administrative matters (for instance registering the temporary accommodation) at the local administration, they inform the members about the novelties in Hrastovec, enable them to visit other units (apartments or farms), accompany them at their visits of relatives, and if necessary help at managing the contacts with the relatives.
In some units residents engage in different kinds of work—for instance, growing mushrooms, various co-operative works, manufacturing recycled paper for greeting cards or manufacturing various decorative objects from wood, wool, or cloth. The members perform various paid work for Hrastovec: they iron cotton serviettes, sow, and they are also paid to work in other units. They are free to spend the money they earn as they see fit. The members of a unit in Slovenska Bistrica I. paid special attention to the appearance of their unit, for which they received the “Golden Rose” award by the local authorities at the competition for the best kept garden.
On the farms and in village communities the residents have a plenitude of choice: they can decide what they are going to grow, how they will organise their working rhythm (work, leisure time), for what price will they sell their produce and how will they spend their money. They participate in the planning of the production. They participate and are informed about everything that is happening on the farm and the village community. Their participation and decision-making is equal to the staff’s. They decide about the everyday rhythm of life, their relationships with other residents (they can withdraw to their room) and neighbours. They have much more choice as to what they are going to eat and when. They can choose between various village ambiences (inn, shop, neighbours, field, forest, etc.); they can decide to go to town, the post-office, medical centre, cinema, etc. Once again they take over the responsibility for their actions and accept the decisions as regards the risks, which is a prime mover for any personal development and learning.
While the residents in the institution are mainly in contact with paid staff and relatives (if they preserved the contacts), the contacts on the outside are much more vast and of higher quality. They do not feel depersonalised in a smaller group. The living conditions in which individuality, respect, and solidarity come into the foreground cause much less stress and discomfort; thus they can build warmer and closer contacts and relations. At the same time they have a greater chance of avoiding more serious conflicts, and physical violence has not been registered. They have a relatively guaranteed privacy, for they can withdraw to their bedrooms or other quiet rooms, where they can be alone if they please. It is easier for them to avoid conflicts also due to the division of labour, for they choose their responsibilities, which are thus not enforced upon them.
Their contacts with the staff are close and honest. There is a certain solidarity developing amongst them. They are no longer second-grade people; instead they participate in all activities as equals to the staff. The greatest improvement is noticeable in their contacts with the neighbours. They never had this experience in the institution, where all of their contacts were almost exclusively linked to paid staff. Here, the rural lifestyle enables them easier establishment of contacts through neighbourly help with tools, participation at village feasts, etc. We also noticed an increased interest shown by the relatives. We explain this by the idea that the stigma of the institution was a barrier at maintaining quality and intensive contacts (my mother no longer lives in an asylum, but in a nice private house).
Life in an institution additionally traumatises individuals who are taken from their natural environment. Their return into the natural social environment leads them to quickly forget their lives within the institution. The only important source of stress that remains for them is that they are low on cash, regardless of the money they earn and their allowance. Life in a natural social environment offers considerably greater opportunities for satisfying the needs and desires; however, when these are linked to money, there is never enough of it.
Life in external units makes most of the residents to be more engaged, to get more involved and thus develop new and revive old and forgotten skills and knowledge. In this process the residents rediscover their potentials, for life forces them to do this. Because we have a programme of working for earning in all external units, they are able to improve their situation. They are forced to think of ways to improve their situation. Thus, for instance, in Ziberci they discovered that they do not get enough money if they plant one line of each vegetable. They decided to focus on a single type of vegetable, which will yield them greater earnings, for the input into work, seeds, etc. will be much smaller then the expected profit. Open structures offer a great deal of opportunities to obtain new skills and knowledge.
Amongst others, the advantage of dislocated units is that in the town (location) it is possible to go out, to make excursions. The location and the way of life support simplicity, which is undoubtedly an advantage from life in an institution. In dislocated units the residents trust the staff. The efforts of the staff are noticeable. A typical characteristic is that the residents have more peace and privacy, while at the same time they also have greater choice and possibilities to participate in the events surrounding them.
We can still notice some remnants of the institutional organisation (e.g. timetable, smoking, decision-making) and group houses are a collective solution, for a number of people live within such units. In some examples this is also noticeable in the layout of rooms (in the unit where an adult training centre used to be). It is also noticeable that the residents need more activity and associating with other people. They also lack money in order for them to feel more included into the environment.
Most of the Hrastovec staff have a positive opinion as regards to the way of life and work in the dislocated residential units of Hrastovec. They are of the opinion that the life is of higher quality, for there are greater opportunities for an individual approach, it is more homely, it is more similar to life within a family. The greater the independence, the more opportunities residents have to be included into the environment and have greater contacts with the outside world in general. The more they are able to reach decisions for themselves, the greater privacy they have. They can revive the previously obtained but forgotten skills that are necessary for performing tasks they could not perform within the institution (laundry, cooking). They have greater freedom to develop the already forgotten and new skills; they have greater influence over their lives. They also have better living conditions because they are in a closer contact with nature.
A great number of staff would immediately opt for working in a dislocated residential unit if they had the chance, for they are of the opinion that it is easier to establish a close contact with an individual in a smaller group; it is easier to feel his needs, to listen to him. They consider the work in dislocated residential units to be diverse, demanding and responsible, but they also think that it is full of new challenges and opportunities for their own creativity. They can see the future of the residents’ lives and their work in opening and working in such units.
The most visible and obvious change in Hrastovec as an institution is the resettlement of more than hundred people from Hrastovec during the past two years. This is most obvious in the abandoned castle of Trate. At the same time the evaluations show that the residents as well as the staff are satisfied with the resettlement. Even more, the lives of the residents are much richer; they have greater control; they find it easier to use their skills and learn new ones; they have greater opportunities for an intimate life and the development of their interests. Their networks are also expanding and becoming stronger. At this it should be emphasised that there have been no incidents so far, that the safety of the residents is taken care of as it is by the support, when necessary.
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