Background
There are thousands of people living in Israel today with various disabilities and limitations - physical, mental and emotional - who require residence in out-of-home frameworks. The majority of these individuals live in large institutional settings, isolated from the rest of society.
Of the 7,500 people with mental disabilities living in out-of-home settings, 6,100 live in institutions, and over 1,000 in hostels. Only a small number live in housing frameworks within the community. In contrast, there are no housing units in the community allocated for individuals with physical limitations. The only out-of-home living options available for this population are institutional or hostel frameworks. Thousands living with emotional disorders will often spend years in psychiatric hospitals for lack of appropriate rehabilitative housing frameworks in the community.
What is the theoretical basis for community residences?
The idea of housing frameworks in the community is based on two principles: that of equality, and the recognition that a community living arrangement is the best alternative for individuals living with disabilities. This has been shown to be true for all types and degrees of disabilities.
Choice of place of residence is a basic human right. It embodies an ultimate expression of equality and dignity. It expresses the individual's desire for integration into a given community according to the cultural norms dictated within that community. As a basic right, the right to choice of residence cannot be determined or mitigated by any other individual. Those with disabilities are entitled to all the support that will enable them to live within a given community and enjoy its services, their possibly limited ability to contribute to that community notwithstanding.
As early as the 1960s, experts recognized and established the benefits of housing individuals with special needs within housing frameworks in the community. It was concluded that the quality of life of these people was greatly improved when they lived in suitable housing within their familiar home community. It was found that residence in home-like accommodations allowed for the proper attention to individual needs required by each resident.
What is the nature of housing frameworks in the community and what makes them unique?
When we speak of housing frameworks in the community, we refer to small groups of individuals with special needs living together in apartment units or homes and conducting a lifestyle as similar as possible to that of their community neighbors. A staff of professional caregivers works closely with the residents, providing all necessary assistance along with general supervision. While residents enjoy a good degree of privacy, they are also supported by a backbone of authority and guidance when necessary. They are free to enjoy community services from subsidized health care, social services and the local postal system; to shop at groceries and use laundromats; to leisure time spent at community cultural centers, youth group activities, and local cafes. Thus their daily activities serve to integrate them into the surrounding community.
The staff assigned to a housing framework in the community is charged with providing the residents with round the clock direction and support based on their individual needs. Their job is to encourage the residents to engage in decision-making and to take control of their lives, thereby empowering them to live as independently as possible. Staff members work to foster confidence among residents by exhibiting respect for their opinions and thoughts, and encouraging residents to express themselves, even when this does not come easily. Treatment of residents is based on individualized consideration of each resident's specific needs, and encourages individuality and development of personal styles among residents. While allowing for as much freedom as possible, the staff is fully responsible for residents' physical and mental well-being and will intervene where there is any danger to them.
So why aren't they more widespread?
Although the ideal of normalization for individuals with disabilities has been accepted and applied throughout the western world for decades, this trend has not taken root in Israel. As a result of housing frameworks in the community in the United States and Scandinavia there is a trend toward closure of institutional living frameworks in favor of community residences subsidized by welfare budgets. Unfortunately, the opposite trend has been noted in Israel, with new institutions opening all the time to accommodate individuals not able to function in the outside world in a fully independent manner. Only a small minority of people with disabilities are considered for housing frameworks in the community. This phenomenon seems most blatant with regard to people with physical disabilities, for whom there are no appropriate assisted living arrangements available at all. People with physical disabilities are particularly appropriate candidates for integration into communities, yet those who turn to establishment resources for assistance are consistently referred to institutional settings.
This trend is fostered through the policies of the Ministry of Labor and Welfare, which allow for community living only for those with the most minor of disabilities, while all the rest are referred to institutional settings. These policies are based on antiquated perceptions that individuals with disabilities are not fit for life within the community, and furthermore, are not welcomed by the host communities. Individuals with disabilities are thought to be 'safer' in closed institutional environments, and more efficiently and easily cared for and looked after in such settings.
We believe that these establishment concerns can and must be resolved. They certainly do not justify housing people in segregated institutions when integrative community settings foster a high level of equality with the surrounding non-disabled community. The qualitative benefits of community living for individuals with disabilities are clear. Furthermore, there has been no proof that institutional frameworks are more cost-efficient overall; in actuality, significantly less resources have been allocated to housing frameworks in the community than to institutions.
Bizchut's involvement
It is our belief that living within a community is an ultimate expression of equality for people with disabilities, and therefore, promotion of housing frameworks in the community is extremely high on our priority list. We strive to support this objective through a combination of strategies, using the legal, communal and educational tools at our disposal.
Support for groups and individual requests
Bizchut provides support for groups of parents and families seeking housing frameworks in the community for family members, supplying them with information, guidance and legal assistance. Additionally we field individual requests for assistance in placement in housing frameworks in the community, guiding the applicants appropriately.
Bizchut encourages the establishment of new housing frameworks in the community and expansion of existing ones through applying pressure on relevant government ministries to allocate additional funding for this purpose, and by providing practical advice on how to establish new frameworks.
Developing new models
In parallel with these activities, Bizchut is developing a model of housing frameworks in the community for individuals with more severe mental impairment. We have developed this initiative in conjunction with Amichai, an organization of parents with children living with severe mental and functional disabilities. Amichai's appeals to the Ministry of Labor and Welfare to establish new housing frameworks in the community went unanswered by the relevant department in the ministry. In response to this tacit rejection, the group decided to independently raise the necessary funding for establishment of a housing framework in the community. Amichai turned to Bizchut for professional assistance in the actual establishment of the framework. Bizchut supported Amichai through the initial set-up of the framework, while also documenting the process. The framework opened in November 2001.
Our goal is to construct a model for establishment of housing frameworks int eh community for individuals with severe mental disabilities, and to make this crucial information available to other groups of interested parents and relevant organizations.
Promoting legislation
In addition to organizational assistance, Bizchut also promotes advancement of housing frameworks in the community through support and promotion of relevant legislation, such as the draft legislation of the Equal Rights Law for People with Disabilities and of the Law for the Rehabilitation in the Community of People with Mental Illness.
Relevant legislation
Draft legislation for the Equal Rights Law for People with Disabilities (Amendment - accessibility, housing frameworks in the community and individual aid, cultural leisure and sport activities, education and knowledge, legal system, special needs and information), of 2000.
Support Law (Care for the Mentally Retarded), of 1969
The Support Law (Care for the Mentally Retarded), of 1969 states that once a case is brought before the designated diagnostic committee and it determines that the individual in question indeed suffers from mental disabilities (the terminology used in the legal wording is 'retardation'), the committee is bound to designate a course of action for the case. Furthermore the law states that in deciding a course of action for the disabled individual, the committee must take into account the wishes of the individual and his/her caretaker (within reasonable limits).
The wording of the law defines possible treatment as including '…assignment of the disabled person to a residence or attendance at a day center.'
An amendment to the law, passed in 2000, states that out-of-home living arrangements and day care frameworks are also acceptable treatment options. It also states that the committee must give preference to housing frameworks in the community for an individual with a developmental disability.
Law of Supervision of Institutional Residences, 1965
This law determines the obligation of any private institutional residence housing more than two individuals with developmental disabilities to obtain a license from the Ministry of Labor and Welfare. Such a license will only be issued if the residence is run according to specified regulations.
The law furthermore states that the Minister of Labor and Welfare must appoint supervisors to oversee the law. These supervisors will be entitled to enter and check any licensed residence to ensure its proper administration.
According to the stipulations of this law, housing frameworks in the community must also obtain a license, achieve the standards determined by the ministry and be subject to occasional visits by ministry supervisors.
Law for Planning and Construction (Amendment #42), 1995
Amendment #42 to this law states that:
'Where the plans for a building state its purpose as a residential dwelling, this should be interpreted as inclusive of residential units designated to house charges of the Ministry of Employment and Welfare for which appropriate licenses have been obtained, and in which no more than six such charges will reside. In an unpopulated building this limitation does not apply;…'
The ramifications of this amendment are that building residents may not object to the establishment of a housing framework in the community unit for individuals with developmental disabilities in their building, as long as no more that six such individuals live in the designated residence. Where the residence is a freestanding house, the limit of six residents does not apply.
Law for the Rehabilitation in the Community of People with Mental Illness, 2000
This law establishes the rights of individuals with mental illness or emotional disability to rehabilitation and integration within the community. This type of rehabilitation affords these individuals the chance for maximal levels of independence and quality of life, while preserving their dignity enshrined in the Basic Law: Human Dignity and Liberty.
The law further states that, where an individual with mental illness or emotional disability is entitled by law to rehabilitation, the treatment plan will be determined by a regional rehabilitation committee. Such a treatment plan may include rent stipends (for a housing framework in the community or hostel), assistance in obtaining necessary equipment for the residence, and home visits as necessary.
Information sheet: Law for the Rehabilitation in the Community of People with Mental Illness, 2000
