06:41pm Tuesday 26 September 2017

Let aged stay in only home they've known

I have worked for and in residential institutions since I was a medical student in the 1960s and have seen the very worst of institutional practice and the very best.

I have also been attempting to understand and treat challenging behaviour in those with intellectual disability for 25 years and am very familiar with the emergence of concepts such as individual, person-centred care, inclusion and participation.

When the Richmond devolution to community occurred in the 1980s, a cohort of people with severe to profound disabilities were deemed too difficult to place in the community and remained in large, residential complexes, which then, for the most part, closed their doors to new admissions. These institutions underwent change to render them similar in style to the group homes that superseded them.

Large wards were modernised, broken up into small units with individual rooms, but residents retained access to in-house medical care, psychology, physiotherapy, occupational and speech therapy, and activities programs and easy access to community programs outside.

A new wave of administrators employed new policies, procedures and good governance imperatives.

Old attitudes do die hard, but in the years between my first clinics at Stockton in 1991 and now, there have been great evolutionary changes and I can safely contend that the residents enjoy the best of opportunity and care possible.

I contrast this with many of the group homes I regularly visit. Cramped suburban houses, little respite from each other, minimal access to services, poor medical supervision, and little or no behavioural support.

This does not describe all group homes, but the fact remains that, to get the same level of care, access to services and community participation in group homes requires an expenditure many times that of the large residential facilities.

It is a common fallacy that the non-government organisations running group homes are not-for-profit. They have to make money for their owners and do so very well. The state will no longer be able to provide even the token governance that it is now mandated to do.

Stockton residents enjoy very good opportunities for individualised participation, and engagement with the community, and inclusion in community activities but with the safety and access to services that they would find difficult to achieve in suburbia.

As the residents are now aged and infirm with complex medical needs, surely they should be allowed to live out their lives in the only home they have known, with 24-hour medical supervision and nursing care.

In fact, the newer model of cluster group homes mirror quite closely what is already in place at Stockton.

I am a long-time advocate for those with intellectual disability, and a strong supporter of the UN Convention on the Rights of Persons with Disability.

The decision to close Stockton has not been made on humanitarian grounds, nor on the basis of civil rights remediation.

Dr Bruce Chenoweth is a Senior Developmental Psychiatrist and Senior Conjoint Clinical Lecturer in the School of Psychiatry, UNSW. 

This opinion piece was first published in the Newcastle Herald.


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