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Moving from Residential Institutions to Community-Based Social Services in Central and Eastern Europe and the Former Soviet Union
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by David Tobis
July, 2000
 One of the most harmful, costly, and intractable legacies of the command economies of Eastern Europe and the former Soviet Union is the reliance on residential institutions for the care of children, the elderly, and people with disabilities. As a result, there are almost no community-based alternatives to care for large and growing numbers of vulnerable individuals.Poor, neglected, or disabled children live in institutions that stunt their physical, emotional, and intellectual development. Children with disabilities are segregated from society in grim facilities most of them will never leave. The elderly and disabled adults are cloistered in social care homes. Few, if any, of these individuals need to be confined to institutions. This legacy has created profound barriers that must be overcome if reliance on residential institutions is to be reduced.
The transition to market economies has caused economic and social conditions in the region to deteriorate rapidly. As many financial and social supports have been eliminated or cut back, more vulnerable individuals have been placed in residential facilities. Although the conditions have improved in some institutions and staff have received some training, the overall quality of care is worse today than it was 10 years ago. More children are cared for with fewer resources, and fewer options are available to them once they are too old to qualify for residential care. International donors, through their work to improve conditions in these institutions have reinforced, perhaps inadvertently, local reliance on residential care.
Other industrial nations have experienced similar periods of economic and social upheaval and also relied on residential institutions to care for vulnerable and marginalized groups. But most of these nations have switched from residential care for children, people with disabilities, and the elderly (except for the severely disabled) to community-based social services.
How can the countries of Eastern Europe and the former Soviet Union make the same transition? This study examines the use of residential institutions for vulnerable groups, past and present, and proposes strategies for the future. It focuses on five countries: Albania, Armenia, Latvia, Lithuania, and Romania, where the World Bank is helping develop community-based social services to reduce the reliance on residential institutions.
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