Call for replacement of large impersonal care establishments with a network of community-based services
The European Committee of the Regions expressed its firm support for the transition from institutional to community-based care for independent living. The opinion on Deinstitutionalisation in care systems at local and regional level adopted unanimously on 30 November during the plenary session provides specific guidelines for the transitional period, reflecting a growing perception that institutional care is outdated.
"My opinion," explained Xamuel Gonzalez Westling(SE/PES), member of Hofors municipal council, "calls for a paradigm shift towards more individualised care. Deinstitutionalisation is a step forward on the path of considering everyone as equals. In the past, we though that only large institutions can achieve economies of scale and good outcomes for people; today we know that services in the community offer better quality and enable users to stay connected with their family and neighbourhoods."
An estimated 1.2 million Europeans currently live behind closed doors in institutions and suffer the lifelong impact of institutionalisation. One in six people in the European Union – around 80 million people – have a moderate to severe disability. Over one third of people over the age of 75 have a disability that restricts them to some extent. These numbers are set to rise as the EU population ages. Most of these people are all too often prevented from fully participating in society and the economy because of physical or other barriers, as well as due to discrimination.
"I believe that diversity is something that enriches our culture and makes us better at understanding the important things in life," said the rapporteur. "Everyone in our society is contributing to its progress in one way or another. It is our differences that make us stronger as a whole. When we embrace those differences and try to learn from them, we will make better choices and decisions, but we will also get to know ourselves. Deinstitutionalisation is a means to an end, rather than just a goal in itself," he stressed.
The CoR's unanimously adopted opinion points out that given society's changing attitudes towards people with disabilities and mental health problems, institutional care will increasingly be called into question. There is consensus on the negative effects of long-term institutional care and that more open forms of care in the community are preferable, with high-quality local services not necessarily costing more. Research in the field of health economics demonstrates that community-based mental health services generally cost the same as hospital-based services. However, as they consistently deliver better outcomes for the individual, they are more effective from a societal perspective.
The transition from institutional care to a system of family- and community-based care requires not only logistical changes – including the development of quality services in the community, the planned closure of long-stay residential institutions and the transfer of resources from the institutional system to the new services – but also steps to combat stigma, tackle prejudice, challenge stereotypes and change attitudes.
The CoR also places special emphasis on promoting and protecting the rights of the child, recognising that, whenever possible, families (biological or foster) and the wider community provide better care outcomes than institutional alternatives.
The Council of the European Union is expected to adopt the conclusions on "Enhancing community-based support and care for independent living" on 7 December 2017 .
Note to editors
The opinion on Deinstitutionalisation in care systems at local and regional level was requested by the Estonian government, currently engaged in a reform process to modernise its care provision.
The Charter of Fundamental Rights of the European Union states that "the Union recognises and respects the right of persons with disabilities to benefit from measures designed to ensure their independence, social and occupational integration and participation in the life of the community." Furthermore, the EU and its 27 Member States have already committed to creating a barrier-free Europe by signing the United Nations Convention on the Rights of Persons with Disabilities.
The European Disability Strategy specifies measures that the EU should take as part of the Europe 2020 strategy ( IP/10/225 ) as well as measures proposed in the 2010 EU Citizenship Report ( IP/10/1390 ).
Guidelines on the transition from institutional to community-based care can be found in a 2012 report drafted – with the support of the European Commission – by the European Expert Group on the Transition from Institutional to Community-based Care, a coalition of stakeholders representing people with care or support needs and their families.
Photos are available on the CoR photo library page of the European Committee of the Regions.
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