Ordinarily the powers-that-be resist anything that comes to them under the label of reform. Sometimes a deaf ear is given to mugwumpish proposals out of vested Selfishness, sometimes out of a cantankerous aversion to novelty, but one idea which swelled up out of the '60s has caught on among the the mossbacks who make the decisions around here. It is deinstitutionalization.
Hospitals, orphanages, insane asylums, old folks homes have been evacuated. The rationale for deinstitutionalization, half therapeutic, half civil libertarian, is that institutions are cruel, depersonalizing warehouses in which distressed humanity is stored, not cured or helped. Social critics long ago recognized the line between incarceration and help may be oblitereated in an orphanage, especially if it is run by civil servants.
The solution, it was argued, would be to place people in "the community." The word is in quotes because there is no locution in the language used with more frequency and less precision unless it might be the word leadership. Community, once an expression evocative of either high social ideals or a discernable and permanent set of relationships, is now a mere collective. We speak of the business community, the intelligence community, the handicapped community in much the same way we talk of a pride of lions, a mob of businessmen, a group of spies, or a tangle of congressmen.
Community means nothng more than a buncha . . . a buncha folks who don't know each other, who may not even know of each other's existence. There's no one there, so that when we talk of deinstitutionalization, taking clients or patients or wards, or however the inmates are to be denominated, and turning them back into people by returning them to the community, more often than not we're playing croquet with Alice and the White Rabbit.
Nevertheless deinstitutionalization, an idea first propounded by the left, has been popularized by the propaganda machinery of the right. It takes no detective work to discover the reason. Closing the institutions and putting people in the community is cheaper. It saves money and it works rather well if you flick your eyeballs away from the bag ladies, those deinstitutionalized souls with four slightly torn shopping bags and three overcoats who can be seen with increasing frequency plunked down over sidewalk gratings to capture warmth on cold winter nights.
The first wave of deinstitutionalization came with the realization that mental patients, permanently dosed with tranquilizers, don't have to be kept on a funny farm. They're harmless, save perhaps to themselves, and can exsist in rented slum rooms. Ideally, of course, they were supposed to be placed in halfway houses or given some other form of supervisory care. but there have been enough horror stories about what actually happens to the wretches to make it clear that for many, deinstitutionalization isn't a therapeutic measure but a cost-cutting one.
The same may turn out to be the case with patients being pushed out of hospitals and nursing homes. It costs government about $400 a month to place a long term, semi-invalid in a foster home as compared to $900 for a nursing home. Needless to say, letting them stay in hospitals is far, far more expensive. Medical World News reports that "backlog" patients, that is patients who are stuck in hospitals but don't need to be there, ran up an unnecessary $35-million annual bill in just one five-county area of New Jersey. Multiply that across the land and you can see that the cost cutters have some very large points on their side.
So we've reached an impasse. Institutionalization has failed for the most part. Our hospitals, which are horrendously expensive, are successful enough when it comes to high-tech procedures, but are notorious in their insensitivity to their patients' dignity. As for TLC, forget it.
Employes in other caring institutions are demoralized as they walk in the door. When was the last time you saw a TV program glamorizing or heroizing the people who work in nurshing homes? The work of caring, the most difficult, the most spiritually consuming, the never-ending work of succor, gets no status. Nor as a whole have we shown ourselves a people with a give for making a community. Many of the places we live in look like communities because we spend so much time on our lawns. If we devoted as much time to cultivating the network of stable, mutually supportives relations which defines community as we do cultivating the putting greens in front of our homes, there might be a community to sustain the least among us in their lameness, affliction and despair.