Library Collections: Document: Full Text

Another innovative service worthy of experimental government support is vacation homes. Under NARC or other sponsorship, a series of camps and homes could be set up at strategic locations. These facilities would specialize on providing vacation resources. One would think that even if the full cost of such a service had to be borne by the parents, there would be enough of them to support several such facilities if they only existed or were well known. The utility and success of such vacation homes has been amply demonstrated in other countries such as England, Germany, and Scandinavia.

Tizard (1968) and Klaber in this volume have found that it is the social organization of our present residential institutions for the retarded which is the main factor responsible for the poor quality of care which many of them provide. This highlights the need to direct our attention to the extent which the traditional hierarchical staff organization at institutions for the mentally retarded has brought on a situation deleterious not only for the resident but also for the basic care staff. Adequate human management requires that priority be assigned to the upgrading of this basic staff with whom rests the greatest share of day-to-day contact with the residents. Upgrading must occur in terms of salaries, qualifications, and last but by no means least in terms of status both in relation to the rest of the staff and in relation to parents and to persons outside the immediate realm of the residential facility.

As an example of needed change, reference can be made here to the regulation, still in existence in many institutions, that the basic care staff is not to discuss the residents' functioning, that this may be done only by the physician or another designated member of the administrative staff. It is encouraging that from within the ranks of the basic care personnel has come recognition of the anomaly of their situation (Carter, 1968).

The normalization principle also provides helpful orientation as to which type of staff should render human management services in residential centers. Obviously, mentally retarded residents with acute medical and nursing problems should be cared for by a highly qualified nursing staff. Similarly, special psychiatric services must be available to children and adults with severe behavior disturbances. However, as has been brought out innumerable times in recent years, a very considerable percentage of children in these institutions do not have such problems, and therefore the obvious answer for them is to have staff acquainted with good common child care as long practiced in good children's homes. Tizard (1968) and his colleagues in England have likewise stressed a need for a child care orientation in institutions serving mentally retarded children, and have put into question the suitability of a nursing background.

Unfortunately, discussion of this very crucial subject matter in terms of planned change meets two critical obstacles. One that will be dealt with in a later section of this chapter pertains to job security and union rights. The other is a more subtle point: a hesitancy on the part of administrators to put into question a nurse's qualifications to care for children on the one hand, and, on the other land, to face the nurses' displeasure for having questioned their suitability for the task when their devotion to sick children has been so amply demonstrated.

The point, of course, lies in the very word normalization: mentally retarded children need a normal environment and not the formal environment of nursing which has been developed in our hospitals. A good example of this formalism was encountered in the planning for a new residential facility in an eastern state. The plans centered on small units serving eight individuals with two of such self-contained units within each building. Even though these buildings were designed for an ambulatory group, the supervisory nursing staff insisted not only that in each of the self-contained units of eight there be a nursing station, but in addition that in each building there be a separate nursing office, even though in each of the units of eight there was provided a staff sitting room with adjoining toilet. The formal trappings and prerogatives of the nursing profession had to be preserved at all costs.

Normalization in human management services runs counter to an expedient employed with increasing frequency, namely, the all-purpose center designed to meet in one building-complex and often under one roof all the needs of the mentally retarded. Normalization implies the kind of separation of functions usually encountered in normal living. Children leave home to walk to school. Adults leave home to go to work. As Norris points out, this separation of function also implies that the child should not encounter the houseparent in the class room in the role of a teacher. Implications of the principle of normalization in terms of the child's physical surroundings in residential care are discussed in a separate section devoted to architectural considerations.