New Zealand Rehabilitation Association, Inc.

‘A rose by any other name would smell as sweet.' -Shakespeare's Romeo and Juliet, 1594

What about an institution by any other name?

I mentioned in a column last year how the closure of Levin's Kimberly Centre (a residential facility for people with physical and intellectual disabilities) had been presented by the Ministry of Disability Issues as ‘the end of institutionalisation in New Zealand'. I was somewhat surprised then to see in the recent Budget 2007, the government had allocated $44 million over the next four years to residential services for disable people under 65.  This is separate from the $32 million over the next four years that is ear-marked for home-based disability support services.  So what are these ‘residential services' exactly and why are they not considered to harbour ‘institutionalisation'?

I've also been wondering why this semantic quibbling makes me so hot under the collar. Well, I think it is because I believe that the issue of institutionalisation is still a reality for many people with disabilities in NZ today, and that it should be a contemporary issue for rehabilitation providers to consider. Sure disabled people are no longer put into institutional care as children for the rest of their lives, but there are still plenty of institutions for people with disabilities around: for people with mental health impairments, with intellectual impairments, with severe physical disabilities or simply age-related disabilities. I would argue that any inpatient or residential rehabilitation service is an institution capable of ‘institutionalising' its inhabitants. Yes, health professionals are much more aware of patient's rights these days and yes, we focus far more on community integration than perhaps we once used to - but any rehabilitation or residential service still has to have processes to get everyone fed, washed, and dressed each day. This means that meals have to come at set times and personal cares need to occur when staff are available to assist. Rehabilitation services need to have policies (for safety and security) to manage all of the people who come through the doors: the friends, the family members, the general public etc, so there are rules about who is able to visit and when. Yes, residential services have perhaps greater awareness of the need to offer more community-based activities nowadays - but even these have to be structured as much to fit the available staffing and resources as to match the preferences of the residents. And so on.

In other words, I would argue that any institution which makes decisions on behalf of its inhabitants about any aspect of their lives is promoting institutionalisation. Don't get me wrong: I'm not saying we should do away with such institutions (or ‘residential facilities' or ‘group homes' or whatever you want to call them) - I suspect that there will always be a need for such facilities - just that we are fooling ourselves if we think that living in a residential facility equates to ‘living in the community'. I would also assert that institutionalisation is an inevitable risk associated with residential living or even any hospital admission of a reasonable duration. The longer the duration of admission or residential placement, the less confident and more anxious a person may become regarding their ability to cope in the ‘real world'. Regardless of how good an inpatient rehabilitation service is, a person is not going to know how they are going to manage in the community until they get there.

So, should we strive towards practices that minimise the impact of institutionalisation? Yes. Should we fund, research and develop rehabilitative approaches to promote deinstitutionalisation? Yes. Should we disguise institutionalisation with euphemisms and neologism? No. Will there ever be such a thing as ‘the end of institutionalisation in New Zealand'? I suspect not.