The transformation of Mangere Hospital: A case study in deinstitutionalisation

Abstract

This thesis is an analysis and evaluation of a case study in deinstitutionalisation of people with intellectual disabilities. The process has been viewed as an example of organisational change and the focus is on the relationship between formal and informal caregivers and the notion of care. Three key groups were included in the study, families of residents, the residents and staff. A qualitative approach was taken. The theoretical perspective that was developed attempted to account for links between social movements, organisations and individual experience in the arena of intellectual disability. This was based on the approach of New Institutionalism in organisational theory. The focus was primarily on the process--of change, and in caregiving. Three models of intellectual disability, which have informed policy and the recent changes to a preference for community care, have been identified and the links between these and the elements of organisations developed for providing care explored. The experience of families and residents within the hospital setting and then the community care setting has been examined in relation to the nature of the organisation. Outcomes for the three groups have been examined in terms of their needs and the extent to which these needs were met by the arrangements over a given time. It is concluded that community care has the potential to better meet the needs of those involved, than has hospital based care. A number of factors in the process of change and in the delivery of care have been identified as impacting on outcomes for those involved. Consideration is given to the practical implications of these findings.