Carers: Interfacing family and community
Since the 1960s there has been a restructuring of care services that involved the closing down or downscaling of large institutions and their replacement by a variety of community-based care networks (Milligan 2001). Neoliberal governments in Europe and North America in fact used deinstitutionalization as the excuse for reducing welfare provision (Dear and Wolch 1987; Walker 1993). According to Gleeson and Kearns (2001), the speed with which reform occurred obscured popular understanding of the nature of human services, simplifying caregiving into notions of ‘right’ and ‘wrong’ care viz. community care in a humane environment is better than the ‘dehumanizing’ nature of institutional care (Philo 1997, cited in Gleeson and Kearns 2001: 62). Three broad ethical issues raised around deinstitutionalization accounted for this shift: a rejection of ‘clinical treatments in asocial facilities which were ineffective and therefore unethical in its therapeutic regime’ (likened to hospital-like care); an understanding that custodial care infringes basic human rights because it removes privacy and freedom amongst a long list of other inhumane conditions purportedly found in institutions; and last, the removal of care recipients from family and community that can aid in recovery to ‘remote, often desperately under-resourced, congregate care facilities’ (Gleeson and Kearns 2001: 64) is detrimental. In turn, deinstitutionalization aims to create an ideal ‘caring community’ that will be helpful to both carers and care recipients but is an ideology which does not materialize in an instant (Gleeson 1999).