B. Frequently Asked Questions

Q16. How can decision makers benefit from this guide?

A16. Guided by the basic conceptual, technical and procedural information and examples of best practice presented in this document, decision makers can develop a roadmap for launching a process of wide-ranging legislative and procedural reforms aimed at abandoning institutionalization and replacing it with inclusive community-based services that enable persons with disabilities to live independently. Therefore, the following series of key steps needs to be taken in close partnership with persons with disabilities and their organizations:

1. Reviewing the system of national policies and legislation (strategies, constitution, laws, statutes/regulations, directives and ministerial decisions) to determine the legal position on institutionalization and whether any amendments are needed to begin the process of deinstitutionalization and the transition to inclusion and independent living;
2. Conducting a comprehensive and accurate assessment of persons with disabilities enrolled in residential institutions, which covers:
   • Age groups and gender.
   • The type, nature and degree of disability, and any development or change to the disability that has occurred between their admission to the residential institution and the date of the assessment.
   • The overall health of the individuals, any illnesses they may have, the types and doses of medications they take, the identity of the supervising doctor, the treatment plan being followed, and the process for and timing of its review and evaluation.
   • The date of admission to the residential institution.
   • Where and with whom the person resided immediately prior to their admission to the residential institution.
   • An assessment of what basic day-to-day life skills the individuals have in terms of how well they can eat, drink, use the toilet, shower, change clothes, and move around independently.
   • The type and nature of the assistance each individual needs to carry out some or all day-to-day activities, and how that assistance is provided.
3. Conducting a survey of each individual's biological or extended family. This should cover:
   • The family's circumstances, including the number of family members, their ages, their level of education and the average income.
   • The reason why the family decided to place the person with a disability in the residential institution.
   • The means and nature of any communication between the family, or members of the family, and the person placed in the residential institution.
   • The family's place of residence; the size of the family home; whether it is a standalone building or an apartment in a building; the floor it is located on; whether the entrance to the building has been adapted; whether it has an elevator if the apartment is on the upper floors; whether there is room to make modifications to the bathroom, kitchen or another room if needed; and whether the house is owned or rented.
   • If the person has no biological family (parents) or siblings, the extended family (relatives who are neither the person's parents nor his or her siblings) should be examined in terms of the aforementioned aspects.
   • The extent to which the biological or extended family of the person is aware of the rights of persons with disabilities, the harmful effects of institutionalization and the importance of inclusion.
   • The extent to which the family understands how to communicate with persons with disabilities and how to offer and provide assistance to them.
4. Conducting a specialized survey targeting residential institutions and those working in them. This should cover:
   • The location of each institution's building, whether it has branches, and where each branch is located.
   • The sector to which the residential institution belongs (governmental, private, or voluntary).
   • The date that the institution was established and licensed.
   • The capacity stated on the license and the actual number of enrolees.
   • The extent to which the building and its facilities are adapted.
   • Whether the building is owned or rented by the entity managing the institution.
   • The institution's record with the Ministry responsible for with supervising it in terms of any administrative or criminal offences committed and the details of these incidents, if any.
   • The number of male and female workers in the residential institution, and each one's qualifications and experience, the date they joined the institution, their working hours and days, their monthly salary and their criminal record.
   • The challenges faced by male and female workers, from their perspective, and the solutions they propose.
   • The extent to which male and female workers in the residential institution are aware of the rights of persons with disabilities, the Convention and national law, their attitudes towards inclusion and independent living, and the challenges they face in their work.
5. Conducting a comprehensive quantitative and qualitative assessment of the basic services and support services available in communities and the extent to which they meet the accessibility requirements of persons with disabilities;
6. Assessing the competence and professional needs, whether knowledge-related or technical, of those providing basic services and support services, where such services exist, to ensure effective communication with persons with disabilities;
7. Assessing prevalent attitudes in the local community towards disability and the extent to which there is a culture of acceptance and respect for differences;
8. Developing individual transition plans for those enrolled in residential institutions based on the results of the assessment to ensure a smooth transition from the institutional environment to the family and community environment;
9. Developing a human resources plan to make effective use of workers in residential institutions during the transition to inclusive community services, taking into account the experience and qualifications of each individual based on the results of the aforementioned assessment, while ensuring that none of them have a leadership role in the deinstitutionalization process in order to avoid conflicts of interest or their previous professional and attitudinal background from working in residential institutions having an unintended negative influence on the process;
10. Developing a comprehensive plan to strengthen basic services and support services in local communities and bolster the personnel responsible for providing them based on the results of the aforementioned specialized survey;
11. Developing a clear future plan to utilize the buildings and facilities of residential institutions for purposes that are completely unrelated to any alternatives or solutions to institutionalization. These institutions should not be converted, for example, into homes for those removed from residential services, nor should they be converted into inclusive day service centres. Given their isolating environments and painful history, premises used as residential institutions must not be a part of the reform process aimed at promoting inclusion and independent living. These buildings and facilities can be utilized by turning them into public hospitals, cultural centres or anything else needed by the local community;
12. Developing a monitoring and evaluation plan with clear qualitative and quantitative indicators, publishing periodic reports on its results, and working to immediately correct any error or deviation from the path, on the basis of observed results.