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Why Innovative Action?

From: Changing Patterns in Residential Services for the Mentally Retarded
Creator: Robert B. Kugel (author)
Date: January 10, 1969
Publisher: President's Committee on Mental Retardation, Washington, D.C.
Source: Available at selected libraries

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The underfinancing of most public institutions is a tremendous problem. The 1966-67 per diem costs over the country (excepting Alaska) range from about $3 to $14. (U.S. Department of Health, Education, and Welfare.) In contrast, five of the largest zoos even a few years back spent an average of over $7 for their large animals (see Blatt in this volume). While capital construction outlay and total operating budgets of institutions involve vast sums of money, budget increases, especially increases in per capita expenditures, have often been so token that very little help was given to the beleaguered institutional superintendent and his staff.

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The underfinancing pertains to all aspects of residential care; it contributes, of course, to the under staffing. Salaries have often been at shockingly low levels. In many states, professional salaries have been at levels so low as to attract no one of competence, and the nonprofessional salaries for attendant personnel in many places have been below the national poverty level! Physical therapists are frequently lacking altogether. Speech therapists may consist only of untrained individuals. Occupational therapists may be totally unknown. While the children and adults may be kept clean, they often have no programs for daily living other than the meaningless blare of a television set or the completely empty, fenced-in court. Can anyone doubt that such practices have interfered severely with effective programming?

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Many institutions have been so hard put to attract capable medical personnel that they have relied heavily on foreign-trained physicians, some of whom were unable to secure state licenses and hence were able to work only in a facility which could waive state requirements, such as is possible by a state facility. Unable to go elsewhere and being the only ones willing to accept the poor salaries, these men and women find themselves in virtual bondage, and the salary situation remains poor. Other institutions, even if large, have no full-time physician at all.

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On the basis of some rough calculations it is estimated that about 30 percent of all budgeted positions in public residential facilities are now vacant (Noone, 1967). This can be explained partially by the fact that the attendant positions of many of our institutions are at the level designated by our government as poverty wages. Three thousand dollars a year will not provide personnel of high caliber! Since the cottage life and ward personnel constitute the backbone of any residential program, it should not be surprising to find that many habilitative programs are frequently seriously inadequate or lacking altogether.

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The use of residents to perform work necessary to keep the institution running constitutes another problem which arises from under-financing and which is sometimes referred to as "institutional peonage." Although it is highly desirable that residents be productively employed, continued and inappropriate retention of residents in work situations has often been the only way the daily work could get done. Some important services in the ward, infirmary, maintenance, laundry, and kitchen areas would collapse if it were not for continued reliance on resident help. In addition, absence of adequate community resources (e.g., workshops, group living facilities, community supervision) has meant that even if residents were to be released, there is often no place for them to live and no job for them to have. To habilitate the retarded person who has lived the better part of his life in an institution is most difficult, since he is ill-prepared to cope with the social requirements of a normal community.

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The American Association on Mental Deficiency is currently evaluating our residential facilities. This is a voluntary process, and residential facilities are not obliged to submit. However, most of them do, and many are reporting that they are grossly overcrowded, being anywhere from 25 to 50 percent above their rated bed capacity (Blatt and Kaplan, 1967). Consequently, there are often large bleak wards where physically handicapped individuals are confined to bed, provided with minimal care, but given little in the way of stimulation to make their lives the least bit meaningful. Many will end their days in these drab surroundings. There is still an additional factor: increasingly, severely handicapped residents with multiple problems are being admitted because many such individuals, who would have died a generation ago, are now saved as a result of medical advances.

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Recently, Blatt and Kaplan (1967) published a book entitled Christmas in Purgatory. In this book they indicated pictorially the deplorable state of some residential facilities. Although the authors were criticized by some, I believe that Blatt and Kaplan have performed a great and important service by pointing up this shocking problem. We all know of places where residents sit naked, surrounded by their excreta. I have seen a man without legs condemned to walk on his stumps because he once ran away from the institution, got lost, froze his legs and had to have them amputated. Everyone was reluctant to provide him with rehabilitative services for fear that there might be a repetition of this behavior, and, furthermore, his condition was perceived as a deserved punishment!

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