Deinstitutionalization and developing

Community Based services

International overview

Zsolt Bugarszki, PhD

Methodology

August-November 2015

Policy and document analysisInterviews

Focus groupsIn 7 countries and in 4 regions of Estonia

Methodology

• Czech Republic• Slovakia• Hungary• Romania• The Netherlands• United Kingdom• Sweden

Definitions and references

• United Nations Convention on the Rights of Persons with Disabilities

• Guidelines of the European Expert Group

UN Monitoring

• Committee on the Rights of Persons with Disabilities.

• The Committee is a body of 18 independent experts which monitors implementation of the Convention on the Rights of Persons with Disabilities.

Policy framework

Institution vs. community based care

The first wave of Deinstitutionalization

• Sweden 1993 – group of group homes, segregated disability blocks• The Netherlands – parallel system• Hungary – planning 150 beds new institutions in 2009• Romania – modernising and renovating existing large institutions• Slovakia – investing 200 million euros into large institutions

UN Monitoring committee’s Concluding Observations

“The Committee is concerned that across the European Union persons with disabilities, especially persons with intellectual and/or psychosocial disabilities still live in institutions rather than in local communities. It further notes that in spite of changes in regulations, in different Member States the ESI Funds continue being used for maintenance of residential institutions rather than for development of support services for persons with disabilities in local communities.”

The second wave of Deinstitutionalization

New attitude of the European Commission for the 2014-20 period:

• Structural Funds regulations include an explicit reference to the transition from institutional care to community living

• Only those actions that help to establish the conditions for independent living should be supported by the EU. Any measure contributing to further institutionalisation of disabled people or the elderly should not be supported by ESI Funds.

The second wave of Deinstitutionalization

• New strategy for Deinstitutionalization in Slovakia and Hungary• National Plan in Czech Republic for the period of 2015-20• Relevant reduce of hospital beds and institution beds in the Netherlands• Second turn of deinstitutionalization in Sweden

Developing community based services

Shared responsibilities• Centralization (Hungary) vs. decentralization (Czech Republic, Netherlands,

Sweden)• Local stakeholders vs. large service providers• Regulation, protocolization vs. flexible and responsive services• PR and communication of Deinstitutionalization

Developing community based services

Service provision• Strong evidences about the effectiveness of community based services

(UK, Sweden, Netherlands) • But community services are not cheaper alternatives to

hospital/institution based solutions• Community resources, community participation vs. traditional welfare

solutions• Local responsibility – local flexibility

Level of social expenditures

Developing community based services

Financial structure

• Sustainable local governments

• Co-finance system (health vs social services, centralized vs. local services)

• Tailored balance, instead of schematic solutions

• Well targeted direct payment and personal budgeting schemes

Developing community based services

Employment

• Strong tradition of sheltered workplaces (Hungary, Romania, Czech Republic)

• Promising tendencies to emphasise more integral solutions (supported employment, social enterprises, vocational rehabilitation, job coaching)

• Estonian employment policies belong to this second group but there are uncertainties around Work Ability reform and incentives, programs for companies are far from ideal.

Developing community based services

User involvement

• Sweden – co-determination. Users have strong influence on the support and services they receive

• UK – Recovery orientation, user led services, peer support workers• Netherlands – strong emphasis on community resources (eestvedaja)• Person centred vs. service centred solutions • Supported decisions making, personal budgeting, user involvement