Harold L. Doherty of Facing Autism in New Brunswick raises an important question: What do we do with severely disabled people when the institutions close? Harold advocates the reforming of the institutional system, so that those with the most severe disabilities can get quality residential care. He claims this opinion is based on a realistic approach to the care needs of the most severely disabled, and I have to agree in part, in that often the wrong motives are used to deinstitutionalize those with severe intellectual and developmental disabilities, namely, cost-effectivness and the presumption that these people are truly more independent than we think they are. Now what if they aren’t?
I have always advocated individualized care programming, and I continue to do so. This means that some people will find a sheltered environment more appropriate. Others may prefer a community-based setting with as much or as little care as they need. They key here is individualization. Most institutions, even modern ones, don’t employ that concept, and often do not really provide the sophisticated care some patients need. In fact, neglect happens at almost every long-term care facility I’m aware of. That should change. Residential settings for those who want them as well as appropriate community services should be built, but most of all, the care in these facilities should be catered towards the residents’ needs. That may not be cost-effective. So be it. Humane care is not a luxury.