• Background
• Institutions:  A non-normative lifestyle
• Bizchut's involvement
  

Background

In Israel today, thousands of people with disabilities live outside of their families' homes.  The majority of individuals with disabilities whose cases are processed by the Ministry of Labor and Welfare are referred to institutional frameworks.  Only a small minority lives in supervised community housing.  Of the approximately 7,500 people with developmental disabilities living outside their family homes, over 6,100 live in institutional frameworks, and only about 1,400 live in supervised community housing. Of these 1,400, the majority lives in hostel care facilities (really 'mini-institutions'), with only a few hundred actually living in apartments within the community.

Institutions:  A non-normative lifestyle

In the sixties, professional studies determined that the quality of life for individuals with disabilities was highest when they lived in regular housing within the community.  This was proven for individuals with all types of disabilities.  Crowded institutional settings, with a high caregiver to patient ratio, do not allow for much personal attention to each patient's individual needs.  In a setting where a limited staff is responsible for the care of many residents it is near impossible to implement programs advocating personal advancement for residents.  Another disastrous consequence of institutional care is the tendency to over-medicate patients with psychoactive drugs in order to minimize behavioral outbursts.  In a non-institutional setting, such issues can be resolved through implementation of specific behavior modification programs allowing for effective and individualized treatment plans.  (Note: this phenomenon was brought to our attention by directors of institutions during their visits to Bizchut offices).

Disconnection from society
People living in institutions are either completely cut off from, or at best live at the margins of society.  The institution provides all of their services, and residents have no access to those services available to the broader community.  Contact between institution residents and those outside is minimal, and there is no attempt to integrate them into any normative social activity within the community.  Most residents work and study within the secluded four walls of the institution. 

Negation of rights
Life in an institution is not conducive to the protection of basic human rights, such as the right to privacy, and the right to individual autonomy.  Residents of institutions have no control over their own lives.  They are kept from making even the most basic decisions, such as when to eat, what to wear, with whom to share a living space, in what activities to participate.  Institutional life disregards its residents' right to equality and dignity.  While this is certainly the case in poorly kept institutions that are overcrowded, dilapidated (broken doors, old peeling paint) and where residents clearly suffer neglect, this untenable reality holds true even for the most well appointed and well kept institutions.  It is the very framework of an institution that undermines the protection of its residents' rights.  

A sampling of statistics

• The Telalim Institution houses 283 residents with developmental disabilities.  
• At Telalim there are 150 residents who are not directed toward any sheltered employment programs.
• Many residents have only minor physical disabilities.
• Many residents' cases are not reassessed every three years as required by law.
• In the Bnei Zion pediatric residence, children are schooled within the facility with no effort at mainstreaming in the local community schools at all.
• In the Telalim and Bnei Zion facilities, some of the toilet and shower stalls have no doors.
• The chronic care unit at the Kfar Kana facility rooms up to 11 patients together in a room.
• The independent living wings feature a paltry ratio of one caregiver to every 15 residents.
• Chronic care patients have their position shifted only three times a day (during shift changes).
•  Of 179 residents at Kfar Kana, 80 are regularly medicated with psychiatric drugs.
• The Hevrat Ne'urim facility houses over 350 young residents.
• Chronic care patients are often kept in their rooms for months on end.
• Personalized programs for residents are often not implemented due to lack of personnel.
• Many people assessed as having developmental disabilities are hospitalized in psychiatric hospitals.
• Many patients remain in psychiatric hospitals unnecessarily for years, due to a lack of alternate community facilities available to serve them.

Bizchut's involvement

While Bizchut views the institutional lifestyle as devoid of equality and a distortion of social life, we feel an obligation to preserve and protect the rights of people living in such frameworks to the fullest extent possible.  One extremely problematic aspect of psychiatric institutions is that they function in a closed environment, out of reach of the critical public eye. The Ministry of Welfare is responsible for overseeing institutions and ensuring that residents are properly cared for and that their rights are preserved.  Unfortunately, the ministry's supervisory bodies do not do adequately address the neglectful conditions in many institutions, and the general public remains unaware of the situation due to institutions' isolation from society.  When information about harsh conditions in institutions does occasionally reach the public, a special department of the Ministry of Welfare steps in and forms internal committees to review the offending institutions.  However, these committees are a comprised of the same members of the supervisory bodies, and they rarely criticize themselves or recommend sweeping changes.  In order for residents of institutions to have a chance at a reasonable lifestyle, there must be more transparency on the part of institutions and heightened involvement on the part of community representatives.  In this vein, Bizchut organizes regular inspection visits to various institutions and publicizes details of their findings.  To date, Bizchut has conducted visits to the Telalim, Bnei Zion and Kfar Kana Institutions, as well as Kfar Shaul, Talbieh, Nes Ziona and Neve Yaakov Psychiatric Hospitals.  Following one of these visits, Bizchut went so far as to file a police complaint regarding gross disregard for residents' rights and neglect in their care.