Czechia

Reflections on how 4 countries in Europe work to end institutionalisation of people with intellectual disabilities

Inclusion Europe

02 Oct 2024 — 4 min read

Organisations from Czechia, Lithuania, Romania, and Slovakia work together to support transition from institutionalisation to community-based support.

They created analysis of their countries when it comes to deinstitutionalisation. What follows are extracts from these analysis and reflections created by the organisations:

Czechia

In Czechia, deinstitutionalisation aims to enable people with disabilities to live in a mainstream environment in conditions comparable to other citizens of the same age.

The transformation of institutional services to community-based services is necessary to enable people with disabilities to make decisions about their lives, exercise their rights and be supported to live independently.

Despite a wide variety of social services, there are still many people living in institutions. Over time, the capacity of residential institutional services has reduced and the number of places in community social services for people with disabilities has increased. Transformation processes and the promotion of other support networks have influenced these changes.

Community-based support services are becoming more available, as does greater support for family carers.
One of the main problems with the implementation of deinstitutionalisation is that it is not a priority for the government. The state continues to provide financial support for institutional services.

People’s needs are not addressed, and they are not routinely involved in decision making. Healthcare professionals are not always in favour of change and many public guardians do not always act in the best interests of the person when intervening or making decisions. There is very little direct involvement and participation of people with disabilities in the process of transformation of services. People with disabilities who live in institutional services are not part of the decision-making.

Lithuania

Deinstitutionalisation is defined as a transition from institutional care to family and community- based services. There has been a strong focus on the development of "Group Living Homes" in Lithuania, and deinstitutionalisation has been understood as the transformation of large residential facilities into smaller buildings in the community.

Lithuania focuses on the danger of trans-institutionalisation. If deinstitutionalisation is not correctly implemented, people with disabilities are in risk of being relocated to a different residential infrastructure with no components of community-inclusion. Group living homes are the most common practice in, they receive varying levels of support from NGOs that advocate the rights of people with disabilities. Lithuania needs support regarding the development of independent living and inclusion in the community.

Freedom of choice is still an important issue. Much more needs to be done to ensure complete freedom of choice, and to work along with community/social integration to truly achieve deinstitutionalisation.

Romania

Institutionalisation is perceived as a good solution for adults with disabilities and therefore, alternative community-based services do not really exist.

The decision leading to a person living in an institution in Romania is mostly made by public system employees, family members or legal representatives (legal guardianships).

National public funds (250 million euros per year) are invested into a segregated system. This money needs to be redirected and reinvested in community support services urgently.

Romania adopted a so-called ‘disability tax’, an employment quota requiring employers with over 50 staff to ensure 4% are persons with disabilities. Otherwise, a tax must be paid. 450 million euros per year is collected with this tax. It has not been disclosed how this money was spent, and potentially reinvested into institutions instead of being used to invest in community-based services and accessibility.

Most issues regarding institutionalisation are not known to the public or people outside the closed care system, awareness and recognition of these human rights abuses is desperately needed in Romania.

A recent assessment of Romanian centres for adults with disabilities highlighted how institutional practices violate the human rights of residents. Examples include:

limited autonomy,
inaccessible buildings,
no outside communication,
lack of medical care,
a controlling and regimental environment with punishments used to induce residents' compliance.

A restructuring process of residential centres started in 2018, but this cannot be seen as deinstitutionalisation. It is merely downsizing of institutions instead of supporting people to move into the community.

Slovakia

Deinstitutionalisation became national social policy in 2010 when the EU stopped funding for institutional services in Slovakia. Following a long struggle by NGOs, families and people with disabilities, the ministry started to draft a Strategy of Deinstitutionalisation in 2011. There is still a lot of opposition to deinstitutionalisation. The CRPD and human rights approach is affecting the EU funds and national policies, but on regional and municipal level and in social care provision there are many people and organisations actively against it.

Lack of education and support of inclusion in daily life of people with intellectual disabilities along with the lack of knowledge about fundamentals rights remain strong barriers. All data and information indicate an urgent need for transition from institutional to community- based care.

An example of good practice in Slovakia is a support services agency, Zilina, who focus on providing people with disabilities support that benefits their development, independence and enhances their quality of life. They also aim to provide support in mainstream environments in the community in social environments along with adopting a person-centred approach.

What's next

These reflections come from a bigger analysis of the situation in each country. These documents serve as a starting point to create training for people who implement deinstitutionalisation.