Current issues of assisted living. Pskov, organization of assisted living for persons with severe and multiple developmental disabilities

22.04.2019

MOSCOW, October 10. /Corr. TASS Inna Finochka/. The reform of boarding schools, where adults who cannot take care of themselves live, should involve the creation of alternative forms of residence, including accompanied ones. This opinion was expressed to TASS by the developers of the document.

In addition, on the eve of World Day mental health, which is celebrated annually on October 10, experts told TASS how the problems of people with mental disorders can affect any of us and why the system of psychoneurological boarding schools (PNI) needs reform of the system itself, and not just their disaggregation.

“We are now having a rapid discussion about what assisted living is reverse side PNI reforms, that is, the reform of the boarding school system for adults should take place in the direction of creating alternative forms of residence,” Elena Klochko, a member of the working group under the Ministry of Labor and a member of the Coordination Council for Disabled Children and Other Persons with Disabilities at the Public Chamber of the Russian Federation, told TASS.

According to her, attention was drawn to the problem after a meeting between President Vladimir Putin and representatives of NGOs. The President met in Karelia with representatives of civil society and discussed with them important social problems: helping the elderly, searching for the missing and lost, the life of adults with mental disorders in psychoneurological boarding schools (PNI) and many others. The meeting took place on July 26 in Petrozavodsk.

At the same time, an instruction was given to consolidate at the regulatory level various forms of “accompanied accommodation of disabled people, including such a form as accompanied cohabitation of small groups of disabled people in separate residential premises.” Klochko also noted that in general, PNI reform should be carried out in two main directions: medical and social.

Psychoneurological boarding schools are social protection institutions. Unlike dispensaries or hospitals, boarding schools have non-therapeutic purposes. According to the Ministry of Labor, in 2016 there were 504 boarding schools for adults operating in Russia. At the same time, about 246 thousand people were receiving inpatient care, and more than half of them lived in PNI. At the same time, according to the Ministry of Labor, there is a waiting list for accommodation at the boarding school.

Who lives in a boarding school for adults

The director of the Perspective charity organization, Maria Ostrovskaya, who spoke at the meeting with the president about the problems of people living in PNI, in a conversation with TASS noted that, in principle, every person can find themselves in a situation where they cannot take care of themselves. “Approximately 30-40% are children from orphanages and boarding schools, who, upon reaching 18 years of age, become adults, another large part are elderly people who suffer from mental and mental illness in connection with age characteristics(dementia, Alzheimer’s disease, Parkinson’s disease and others - TASS note),” Ostrovskaya said.

Another part of those living there are so-called family people with disabilities. Accordingly, these are those whom their parents cared for until they grew old and died.

“And another small part, less than 15%, have mental disorders, suffering from, for example, schizophrenia or bipolar disorders. That is, the majority of residents do not suffer specifically from mental illness, but have congenital and acquired mental disabilities,” she added.

Historically it happened this way

According to Ostrovskaya, these institutions, which appeared in Soviet time were originally buildings that protected inconvenient members from the rest of society. “That is, simply put, prison purposes mixed with supposedly therapeutic ones,” she clarified. Another paradigm that was laid down at the same time is that since a person is mentally unstable, then he is sick and needs to be treated.

“Although it is impossible to treat it, since it is not a condition that can be treated, it is a condition in which a person lives for a long time. But the old paradigm provides only one point of view - since a person is sick, then he needs to be surrounded by people in white coats, protected from everything around and placed in an appropriate room for permanent stay,” Ostrovskaya said.

The boarding schools themselves are built according to the corridor type. In addition, there are so-called “departments”, namely men’s and women’s. The limited number of nursing and junior medical personnel and social workers in the boarding school is often the reason that in a boarding school with a population of one thousand it is impossible to take an individual approach to the needs of the residents. At the same time, they often not only lack personal belongings, but also personal hygiene items. Often even the underwear in one “compartment” is shared.

In addition, according to human rights activists, the institutions themselves in the Russian Federation continue to function based on outdated documents. We are talking about the Regulations of 1981 and the Order of the Ministry of Health of 1978, on the basis of which these institutions now exist. According to expert analysis, these documents contradict the legislation in force in the Russian Federation, namely the Constitution of the Russian Federation, the Convention on the Rights of Persons with Disabilities and the Law on the Fundamentals of Social Services.

Boundaries and respect for people

Ostrovskaya believes that there is a certain stigma and many stereotypes regarding people with mental disabilities. So, according to her, for some reason it is believed that people with mental disorders do not need what they need to an ordinary person. “He is also considered to require ongoing supervision,” she added.

These problems are successfully solved by the corridor type of institution. “Showering takes place once a week, and all 150 people who live in the department must wash themselves in 2-3 hours. From 6 to 25 people live in a room, just like in an old hospital,” Ostrovskaya said. That is, if a person wants to wash at any other time, he will be refused, the same applies to lights out - the lights are turned off on the floor.

“It is clear that in these conditions, there can be no talk of any borders or any respect,” she noted.

In addition, boarding schools for adults have a so-called pass system. “In addition, only a few have a so-called pass for free exit from the department and boarding school for a walk on the street, contrary to all current laws and the Constitution,” Ostrovskaya continued.

These problems can be partially solved by the bill on distributed guardianship introduced into the State Duma. It provides that guardianship functions can be distributed among several people or organizations in order to avoid offenses.

Cause of offenses

At a meeting of representatives of NGOs with the president, Ostrovskaya said that many offenses are associated with the fact that in a psychoneurological boarding school, the director of the boarding school often turns out to be the guardian of people living there who are deprived of legal capacity. In fact, he is both a customer and a provider of social services.

“If a person who lives in a boarding school wants to complain about something, his guardian, that is, the director of the institution, can file a complaint on his behalf,” Ostrovskaya explained.

She also noted that there are regions in the country in which the legal capacity of everyone detained in such institutions is fundamentally deprived. “From 50 to 80% of people living in boarding schools are deprived of legal capacity. This fact is fraught with the fact that a person cannot independently spend a pension or disability benefits,” the expert clarified.

Three quarters social payments go to pay for the maintenance of a person in a penitentiary institution. The remaining quarter should, in theory, be transferred to the staff, who can buy what the ward wants. “But if there is only 1 medical worker per 200 people, one can imagine how the worker will make all the necessary purchases, that is, in fact, abuse on a huge scale,” Ostrovskaya said.

That is why a year ago they first started talking about the need to reform the system of psychoneurological boarding schools. At the same time, new boarding schools for adults are being built to replace the old ones, which have fallen into disrepair. In the summer of 2016, there were about 100 such institutions in the Russian Federation. At the same time, another 200 emergency boarding schools were rebuilt by 2016.

However, experts, representatives of NGOs and public organizations are convinced that it is necessary not only to build new boarding schools to replace old ones, but to develop alternative forms accommodation. People who are now lining up for psychoneurological boarding schools, according to the developers of the reform, should have a choice: receive the necessary social assistance at home in the form, for example, of assisted living or another alternative, or move to a boarding school.

The Ministry of Labor and Social Protection of the Russian Federation has developed and approved methodological recommendations for organizing accompanied accommodation for disabled people. , posted on the website of the Ministry of Labor, is advisory in nature, although previously it was assumed that regions would be required to use accompanied accommodation for disabled people as an alternative to psychoneurological boarding schools.

“Accompanied accommodation for disabled people is understood as a hospital-replacing technology of social services, which provides for the possibility of providing disabled people with social services, rehabilitation and habilitation services, educational services and carrying out activities for social support of disabled people in order to compensate (eliminate) circumstances that worsen or may worsen living conditions and preserve stay in a familiar, favorable environment for him,” the document says.

When organizing accompanied accommodation for disabled people, it is recommended to take measures to develop and maintain self-service skills, as well as the skills necessary for independent living - cooking, purchasing food and goods, using public transport, use of bank cards, use mobile phones, Internet, rehabilitation means, etc. It is also recommended to create conditions for education and employment of people with disabilities.

Depending on the person’s condition, the nature of his illness, needs and capabilities, three options for the provision of social services are provided: constant support, regular and periodic. The option of assisted living is determined by the degree of disability: the ability for self-care, independent movement, orientation, communication, learning and labor activity, ability to control one's behavior.

Constant support is recommended for people with severe disabilities who require constant supervision, assistance and care on a daily basis. Regular support is recommended for people who can partially take care of themselves, but need regular help, frequent reminders, and sometimes substitute work. But for people who only need a reminder several times a week and, in some cases, the help of an accompanying person, periodic support is recommended.

Accompanied accommodation for disabled people is recommended to be organized both in group and individual form. Individual accommodation recommended for those who need only periodic support, group – for those who need regular or constant support.

The possibility of accompanied accommodation for disabled people requires compliance with certain criteria: age over 18 years, absence, old age or illness of parents (guardians), decision of the guardian in the interests of the ward, absence of contagious diseases infectious diseases. In this case, the main criterion is the consent and willingness of the person with a disability to live together with other people.

“The result of organizing accompanied accommodation should be the residence (continued residence) of a recipient of social services with a disability at home with the provision of the social services he needs,” the document notes.

Earlier we said that a unique social project: the country’s first assisted living house for people with various forms of disabilities opened in the Novaya Okhta housing complex. It will house disabled people whose parents cannot take care of them and who had to go to social institutions

We also know that “Veronica’s House” has opened in Penza - an active boarding house for young people with disabilities. Young people with severe disabilities, deprived of parental care, will live, study and work there.

Currently in Pskov there is a network of organizations providing early help in the development of children at risk from 0 to 4 years old, raising and educating disabled children from 4 to 18 years old, employment after 18. It is important that children and adults live in families. The public organization of parents of children and adults with disabilities “I and You” together with the State Budgetary Educational Institution “Center for Curative Pedagogy and Differentiated Education” have developed the concept of assisted living.
This social practice is aimed at introducing a new model of providing social services to people with disabilities outside of inpatient institutions. The practice is carried out on the basis of social partnership of state, municipal structures and public organizations. The administration of Pskov and the Pskov region, the regional public organization of parents of children and adults with disabilities “I and You”, the State Budgetary Educational Institution “Center for Curative Pedagogy and Differentiated Education” (hereinafter referred to as the Center for Curative Pedagogy), and the public union “Pskov Initiative” are involved in its implementation. (Germany).
Each partner has undertaken to create conditions for assisted living. In 2012, the municipality of Pskov purchased four apartments in an ordinary residential building for assisted living for 10 people with severe disabilities. The administration of the Pskov region finances support services. The Center for Curative Pedagogy organizes staff training in assisted living technologies for disabled people. The public organization “I and You” takes responsibility for coordinating the practice, equipping the apartments with furniture and necessary equipment, and organizing the process of assisted living. In addition, “I and You” attracts volunteers to provide individual assistance to people in need. People with disabilities living in apartments themselves are not dependents; they pay all current expenses associated with their life in an apartment.
Funding for the practice comes from various sources. The municipality of Pskov made a large one-time contribution, allocating 10,000,000 rubles as part of the long-term target program “Housing”. for the purchase of four apartments for assisted living. The administration of the Pskov region finances the costs of paying accompanying personnel. The parent organization “I and You” seeks financial resources to equip apartments with furniture and everything necessary for people’s lives, organizes staff training and participates in remuneration of specialists. Residents themselves, using their pensions, cover the costs of food, utilities, consumables and soft equipment, as well as leisure activities.
From July 2013 to June 2015 the pilot stage is being implemented social practice. During this period it is planned to obtain the following results:
- to work out a model of assisted living based on two apartments in a regular residential building with the participation of 10 permanently residing people with disabilities;
- develop regulatory documents necessary for the introduction of assisted living in the Pskov region;
- involve volunteers and the public in solving socially significant problems related to social integration persons with disabilities.
The most important thing is that people who cannot independently realize their rights, as a result of common efforts, will be able to find a decent life in society even after the death of their parents.
Using a survey, families were identified who were ready to actively participate in assisted living. Criteria for selecting practice participants from among persons with disabilities and their families were developed, a coordinating council was created, which was entrusted with selecting participants based on the developed criteria. Plans for equipping apartments and various issues regarding the future life of young people were discussed at meetings with parents. All future residents completed a four-month course of training for independent living in the educational residence department of the Center for Curative Pedagogy.

Left by Administrator Mon, 01/10/2018 - 12:55

Description:

The article talks about a form of living arrangement that allows people with mental disabilities to live in a familiar social environment, and not in boarding schools. Theoretical and practical aspects organization of assisted living, lists its main characteristics, analyzes the necessary resources, as well as the problems of preparing people with disabilities for this form of living arrangement. The issues of providing necessary services during accompanied accommodation and the functions of accompanying persons are also touched upon.

Publication date:

01/10/18

Charitable Foundation “Downside Up”

18 years is a conventional milestone when we say to yesterday’s child: you are already an adult. But how can one determine whether a person has truly matured? Perhaps the most important thing is his ability to independently accept adequate solutions and be responsible for your actions. Parents and teachers of special children also dream of seeing them become adults and independent – to the extent possible. And nowhere is real independence fostered as well as in living conditions separate from parents. True, when we enter this area, many questions and doubts arise, but there is also the reality of life: parents leave, children grow up... How to provide them with a full life at any age and in any situation at home, and not within the walls of a boarding school?

Today in Russia there are successful examples of projects for independent living of people with developmental disabilities. Article by Andrey Tsarev, Director of the Center for Curative Pedagogy and Differentiated Training of the Pskov Region, First Deputy Chairman of the Commission for the Development of the Non-Profit Sector and Support of Socially Oriented NGOs of the Public Chamber of the Russian Federation, Chairman of the Board of the Interregional Public Organization in Support of People with Mental Disabilities and Psychophysical Impairments “Equal Opportunities”, - about how to organize such accommodation. Andrey Mikhailovich has been working in the field of helping people with mental disabilities for more than 25 years; through the efforts of his team, in collaboration with German partners and authorities, a system of assisted living has been created in the city. Theoretical provisions presented in the article, we, members of the editorial board of the journal “Down Syndrome. XXI century” N. Groznaya and M. Fursova, supplemented with their own “marginal notes”, as they visited Pskov and saw with their own eyes: accompanied accommodation is a chance for a decent future for today’s special children.

IN last years In Russia, significant efforts are being made to provide a legislative basis for improving the quality of life of people with disabilities. Thus, the ratification of the UN Convention on the Rights of Persons with Disabilities in 2012 and the adoption of a number of new federal laws indicate that the state and society intend to create conditions for the inclusion of people with disabilities in active life, including through the transition from stationary forms of service (when living in a boarding school) to the provision of services at the place of residence (when living at home), to providing employment (Articles 19 and 27 of the UN Convention).

People with mental disabilities are the least protected and most in need of help from the state and society. As a rule, in childhood they undergo continuous work on habilitation and social adaptation. However, when they become adults, many of the acquired skills are of little use and are quickly lost, and social isolation leads to deprivation and dependency. The situation is aggravated by the fact that in Russia many disabled people with mental and psychophysical disorders live in orphanages and boarding schools for children with disabilities. mental retardation and physical disorders and adult psychoneurological boarding schools (PNI). Young people with mental disabilities who grew up in families, as their parents age and die, also often end up in a mental health facility. Living in an isolated environment without any prospects or hope for change usually results in personality degradation.

Today in society there is an urgent task to develop such forms of living arrangements that will allow people with mental disabilities to live in a familiar social environment, and not in boarding schools. Otherwise, the meaning of all previous work on their development, education and socialization is lost and the efficiency of using public funds is called into question. Practice shows that people with mental disabilities can be active and productive, but for this it is necessary to create certain conditions. Fortunately, our country has already accumulated experience in training and adapting them to everyday life, preparing for independent life outside the walls of boarding schools and accompaniment during their stay, in social daytime employment. The corresponding terms have appeared: “accompanied accommodation”, “educational (training) accompanied accommodation”, “accompanied social daytime employment”.

Guided Living Basics

All these practices are developed mainly by socially oriented non-profit organizations(NGOs) and parent associations. The latter are most interested in creating decent living conditions and daytime employment for their adult children. In addition, in some regions, authorities are accommodating to public organizations and making positive decisions in this area, including within the framework of social partnership. Innovative experience of accompanied residence and accompanied social employment exists in the Vladimir, Irkutsk, Leningrad, Nizhny Novgorod, Penza, Pskov regions, in the cities of Moscow and St. Petersburg, as well as in other regions of Russia.

It is important to understand that support for persons with severe developmental disabilities is a complex, continuous process that is carried out at all stages of a person’s life. The characteristics of assisted living include the following main provisions:

Life at home, not in an institution. By “home” we mean, firstly, a homely atmosphere, way of life, the presence of personal space, etc.; secondly, housing documented to the citizen in the form of ownership. This may be the property of the person with a disability, his relatives or other citizens, or the property of non-profit organizations or municipalities. The use of residential premises located on the territory of boarding institutions is possible only at the stage of study residence;
Assisted living. Accompanying your stay is the provision of a range of services and activities that , firstly, they allow one to satisfy the basic life needs of a person (in organizing everyday life, communication and leisure); secondly, they support the maximum possible independence in solving various life problems. Supporting independence is about learning in the process Everyday life independently or with minimal assistance, make choices, make decisions, perform actions at an accessible level, i.e. take an active life position. Escort motto: “ As much help as needed, as much independence as possible».
Life in places where people usually live- V locality, in a separate residential building or in an apartment in a residential building in the vicinity of other people and in the presence of the necessary infrastructure (shop, public transport, clinic, post office, etc.).
Availability of supported daytime employment or employment. A person with a mental disability should not be at home 24 hours a day. Like most adults, he must go to work or an organization that provides social employment services in the morning, and return home in the evening.

Thus, assisted living is understood as a form of living arrangement for a person with a disability who is unable to lead a completely independent lifestyle, in which he lives at home (alone or in a group) and receives a range of social services and various forms of support aimed at supporting his maximum possible independence and independence in organizing everyday life, leisure, communication and social connections, taking into account his individual needs.

Today, the most pressing issues remain in the legislative implementation of the concepts of “accompanied residence”, “accompanied social daytime employment” and “accompanied work activity”. In this regard, public organizations make proposals to consolidate these concepts in two federal laws - Federal Law No. 181 “On Social Protection of Persons with Disabilities” and Federal Law No. 442 “On the Fundamentals of Social Services for Citizens” Russian Federation" In addition, there are still legal norms that do not allow capable people to voluntarily leave PNI. We are talking about Federal Law No. 3185 “On psychiatric care and guarantees of citizens’ rights during its provision,” which also needs to be amended.

How to organize accompanied accommodation: theory and practice

Living space and its arrangement

Residential premises for accompanied living of a group of people can be a house or part of it or an apartment in an apartment building, that is, any residential premises located in the city or in rural areas, meeting the necessary parameters. What housing parameters are we talking about? Firstly, its location in a populated area. It is important to ensure that within walking distance from such housing there are infrastructure facilities that are used by other local residents (shop, post office, clinic or first-aid post, public transport stop, etc.). Secondly, this is a set of internal premises and their sizes, which depend on the number of residents.

In 2012, the Pskov city administration purchased 4 apartments for assisted living for 10 people with severe disabilities. The apartments were located in a new area, so even at the stage of building houses, the public organization “I and You”, which was created by the parents, had the opportunity to participate in planning future housing and tailor it to the needs of special people. As a result, from four apartments they made two large five-room apartments, which are located in adjacent entrances. When you enter the apartments, you immediately understand that this is not ordinary housing. What makes it different? Spacious entrance hall, wide corridors - interroom passages, large living-dining room, several bathrooms (bathroom and toilet combined), technical room (laundry room). The children's rooms (they live alone or in groups of two) each have an individual design, because they themselves, together with their parents, thought through what their room would be like. The rooms have everything you need, but there is no feeling of clutter: nothing superfluous, order and cleanliness everywhere. The apartment has a room for accompanying persons and a small office where documents are stored. If the apartment is inhabited by people who need additional equipment, then it is installed. For example, for Sergei, who uses a wheelchair, a special ceiling rail system was installed, which helps social workers lift him and place him on the bed. Both apartments are located on the ground floor of the house, curbs have been removed in front of the entrance entrance, a ramp has been installed, and a folding ramp has also been installed on the stairs leading to the apartment.

A separate issue is relations with neighbors, with whom, as you know, it is useful to be friends, but harmful to quarrel. In order for the neighbors to treat special residents well, the guys try to maintain order and cleanliness. Having arrived at the houses, they organized a yard celebration on the playground for families with children who live in the neighborhood. At this holiday, through games and casual communication, they met their neighbors and answered all the questions that they were afraid to ask. Now special people are full participants in the life of the local community.

In addition to purely technical and everyday issues, it is important for people with mental disabilities to create conditions so that they understand the meaning and order of events in everyday life at home: why, when and what actions need to be performed, where they can find the necessary things, how and in what sequence perform any household activity (brew tea, set the table, wash clothes, etc.). But we cannot talk about the independence of people with developmental disabilities if they are constantly given verbal instructions. It is better to create a system of reference points in a living space that will allow a person with intellectual disabilities to independently (as a result of targeted training) solve accessible everyday problems. Such guidelines can be graphic images of objects and actions with them, and action algorithms compiled from them.

The system of pictograms and graphic algorithms is familiar to the children from their school apartment. On the stands there are diagrams of the daily routine, weekly duty, how to start a washing machine or iron clothes, in the bath - how to wash. For children with Down syndrome, such graphic prompts are very useful. Ilya loves to be on duty, relying on the cleaning or cooking scheme. As a rule, one of the guys prepares dinner together with a social worker. And Maxim loves to pet and does it exclusively according to a pattern from which he does not deviate under any circumstances. A separate point is the reward system. Guests see portraits of the best residents on the walls - once a week the results are summed up as to who was the best in terms of duty, maintaining cleanliness and other achievements. The winner receives a small prize in a solemn ceremony. This is very pleasant and important for the guys.

Type of ownership

The form of ownership of the residential premises in which assisted living takes place may vary. There are pros and cons to each option, so it is important that participants (people with disabilities and their legal representatives) and founders (NPOs, authorities) identify all risks and make decisions taking into account local conditions and opportunities. Housing may be owned by specific individuals, including shared ownership of participants in assisted living; may be the property of one person, including a benefactor; may be owned by an organization, bodies local government or government agencies. With all the variety of forms of ownership, it is important that the residential premises be documented in the name of the person living in it - the participant in the accompanied residence (or his guardian). If the residential premises are not owned by the resident, it can be provided to him on the basis of a rental agreement, lease, free use, etc.

In Pskov, assisted living apartments belong to the city, i.e. they are municipal property. The city rents them out to residents for a minimal fee (approximately 500 rubles per month per person). Lease agreements are concluded either with capable people with developmental disabilities or with legal representatives of incapacitated residents. The question arises: do families have guarantees that tomorrow the city will not change its mind and take away the apartments? According to Andrei Tsarev, this is purely theoretically possible, but since the assisted living system has existed in the city for many years and public organizations have a positive reputation, it is unlikely that the authorities will do something like that - it is politically unprofitable for them. On the contrary, in Pskov the regional administration even funds support services, which is very important. This is a serious guarantee of the stability of the entire assisted living system. The public organization “I and You” equipped the apartments with furniture and necessary equipment, organized training for accompanying persons and organizes the process of assisted living in general. In addition, it attracts volunteers to provide individual assistance to residents.

Assisted Living Resources

One of the most important questions is how the system of financing assisted living is formed. Experience suggests that its sources can be different:

the budget of a subject of the federation (for example, in the form of a subsidy from government bodies in the field of social protection of the population of a subject of the federation for the provision of social services);
charity (including targeted donations);
grants provided to service provider organizations;
own funds of service recipients (pensions, savings, living quarters, etc.).

As an example, we give an estimate of current expenses carried out by a service provider in Pskov (this is a socially oriented NGO “I and You”) in the conditions of two apartments of assisted living with eleven participants.

Expenditure	Sum (rub.)	Source of financing
Services (pay for accompanying persons)		Region budget
		Residents' pension
Utilities and communications		Residents' pension
Hygiene products; washing, cleaning and other consumables		Residents' pension
Rental of property		Residents' pension
Other expenses (leisure, transport, repairs, etc.)		Donations, grants
TOTAL

Table 1. Information on average monthly expenses for accompanied accommodation per person (for 2017)

The calculation does not include costs for capital investments - acquisition and major renovation housing, purchase of equipment.

In the example given, people with severe disabilities who need constant (from 8 to 24 hours a day) or regular (from 4 to 8 hours a day) support are provided with support. In the case of disabled people who are accompanied periodically (from 4 to 12 hours per week), the costs for this item are significantly reduced.

The total amount of financing is formed from parts of different volumes, but it is important that the costs of accompanying services are provided for at the expense of budget funds. People with disabilities living in apartments themselves are not dependents; they pay food costs, make utility bills and incur other expenses associated with their life in an apartment, as well as leisure activities. In Pskov, this “financial pie” looks something like this:

Forming a group of people with disabilities and training them participants

Forms of accompanied accommodation can be different:

1) individual, when a person lives alone in an apartment or house. This form is recommended for those who do not need daily support, but periodic (several hours a week) assistance to solve certain life problems (for example, when distributing money for purchases, etc.). Olga Chobur, a woman with Down syndrome, lives under this system in Pskov.

2) in small groups - usually from 3-4 to 7 people living in one apartment, house or in an autonomous part of the house (with separate bathrooms, kitchen, common room and utility room). Accompanied group accommodation is recommended for those who require regular (4 to 8 hours per day) and continuous (up to 24 hours per day) assistance.

When forming a group of residents, the rule “Measure twice, cut once” should apply. Experience shows how important it is to initially involve all interested participants in the process of creating a group: people with mental disabilities themselves, their parents, and accompanying people.

To form such groups in Pskov, a survey of parents of adults with mental disabilities was conducted in 2011. It was assessed what they knew about assisted living, whether they needed it and whether they were ready to actively participate in this project. The survey results showed that most parents are concerned about the future of their children, but in the near future the family is not ready to participate in assisted living. Among the reasons were the following:

The reluctance of the young man live apart from parents;

Fear of parents to let go of an adult child;

Uncertainty about the advisability of such accommodation;

Unwillingness to participate financially in the project (invest money in improving the place of residence, withdraw the young man’s pension from the general family budget);

Uncertainty about the young man’s ability to live separately from his parents, even with accompaniment;

Uncertainty about the quality of services provided.

Of the 140 families who filled out the questionnaires, only 13 expressed full willingness to participate in the assisted living project.

Based on the results of the survey, meetings of potential participants (children, their parents, as well as organizers and accompanying persons) were held, and the main desires and hopes of the families were expressed. In most cases, parents would like their adult children to remain living in the city, in familiar and comfortable conditions, and to continue working and studying throughout their lives. The young people themselves expressed a desire to “live independently.”

Thus, first condition group formation is the desire of the person himself with mental disabilities and their loved ones to participate in assisted living.

Unfortunately, not all children living in Pskov assisted living apartments have living parents. But it so happens that everyone has brothers and sisters. Nastya ended up in the apartment under an accelerated scheme: her mother died, and her sister, who became her guardian, lives in another city. The sister decided that the option of accompanied accommodation would be suitable for Nastya, and came to discuss all the details of the accommodation. Now several times a year she visits Nastya, her special, but completely independent sister.

Second condition - preparation for living together and completing the appropriate educational (training) course, which usually takes from a month to six months. It involves not only people with mental disabilities themselves, but also their parents and those who provide support. At this stage, accompanying people try to teach people with disabilities basic skills, primarily in the process of solving specific life problems (for example, in order to have dinner, you need to plan a menu, buy groceries in a store, prepare dishes from them, set the table, etc.). d.). It is important that accompanying persons provide assistance only to the extent necessary to enable a person with a mental disability to independently perform a particular action.

In addition to teaching the necessary skills for independent living, conversations, trainings, and master classes were held with future residents and their parents. They were organized in various forms: in small groups, in the form of trainings and general meetings with teachers, psychologist, lawyer (Table 2). At the meetings, young people with disabilities and their parents worked separately, but considered the same issues. There was not only discussion, but also modeling different situations cohabitation, collages were created on the arrangement of apartments, at the end of the meeting all participants tried to develop a common opinion on each issue.

It was very difficult for the children's parents to agree on the rules. Discussions, disputes, and misunderstandings arose between them. After all, every owner does even the simplest things in everyday life (like washing dishes, cooking dinner, cleaning) in his own way. But in order for the children to live peacefully and calmly in the future, the parents needed to come to an agreement. Which is what they eventually did.

It is worth noting that the guys live together, but at the same time everyone has their own personal space and time - as is the case in a family. In addition to the general schedule there is individual plan life for a day and a week. They spend their leisure time differently: it so happens that in the same apartment the guys prefer to watch TV together, play Board games, and in the other they prefer to study independently: sit at the computer, read, embroider.

Topics for discussion by people with disabilities	Topics for parents to discuss	Reached agreements
“Everything about me” (my favorite food, my clothes, I want to learn... etc.)	Catering (shared or separate, diet, menu, etc.). Organization of care (individual characteristics of the organization of sleep, eating, dressing, etc.). Organization of training (whether training is needed or quality care is sufficient)	Meals are shared (residents and accompanying persons eat together). Meals 4-5 times a day. A list of foods that are undesirable for consumption has been compiled. The need for continuous lifelong learning; highlighting priority areas and tasks for each
"My room"	Arrangement of the apartment. Search for additional sources of financing	Common premises will be equipped with the joint financial participation of all families. Directions for searching for sponsors have been determined. A set of necessary furniture for each room has been determined, taking into account the desires, tastes, individual characteristics of the residents, practicality and ease of use
"Neighbours. Who do I want to live with?	Problematic aspects of living together	The composition of the groups for each assisted living apartment has been determined. Rooms are distributed between residents taking into account wishes, psychological compatibility and the need for support
"My day". "I like to rest…"	Daily regime	An approximate daily routine for residents has been drawn up, taking into account the wishes of the applicants and their parents (five meals a day, daytime rest, mandatory walks on weekends). A list of options for spending free time has been prepared at the request of young people, taking into account recommendations from their parents. A list of games and leisure materials that need to be purchased has been compiled
“It is possible and it is not possible. Rules for cohabitation"	Rules for the participation of parents in the accompanied residence of their children	The basic rules of residence are written down (no one enters the residents’ room without knocking, after 10 p.m. there should be no loud sounds in the apartment, etc.); rules for interaction between parents and other residents and staff ( convenient time for calls and visits, transfer of information; joint general cleaning)
“Who will help me live independently? Do I need an assistant?	The role of the attendant	The idea of an accompanying person has been revealed: parents want to see a mentor, educator and “second mother”; residents - friend; specialists define themselves as assistants
"Money in my life"	Monthly contribution of residents; expenditure	The main expense items have been identified: general expenses (to pay utilities, rent of premises, food and household goods), personal expenses (for personal hygiene products, leisure, etc.), monthly contribution for unforeseen expenses (repair work, calling a housing and communal services specialist, other specialists, etc.). We agreed that large purchases (for example, seasonal clothes at , shoes) young people will still commit with their parents, legal representatives
"My Well-Being"	Organization of medical support	Applicants were trained on recognizing dangerous situations and behavior in such cases. With the participation of parents, instructions have been drawn up for actions in situations of fever, injuries and other cases of deterioration in the somatic condition of residents. The frequency of their medical examination has been determined
	Sex education for young people with disabilities.	Most parents/legal representatives considered this topic irrelevant, and some considered it taboo for discussion with their children.

Table 2. Preparation for assisted living. Topics of trainings and discussions

Third condition forming a group of residents - inclusion of people with disabilities of different genders and ages. This requirement is also based on the principle of normalization. Obviously, this raises the question: “What about sexuality and the possible desire of residents to start a family?” This question is undoubtedly very important. However, when partnerships arise and people want to start a family, different conditions are needed that are suitable for a family, and not for a group. In such situations, it is necessary to resolve the issue of finding housing for the family and opportunities to accompany it . We do not exclude the possibility of developments in this direction, but this is a separate topic.

Fourth condition – inclusion in the group of participants with a need for a different volume of services. If we include in the group only people with severe musculoskeletal disorders who require intensive care, then it will be physically difficult for the attendants to cope with their duties, a large number of personnel, a significant area of living quarters and massive lifting equipment will be required. Including only people with significant behavioral problems who require constant supervision will also require large quantity accompanying persons, and in addition, there will be a risk of turning the housing into a psychiatric medical ward. A group consisting entirely of people with intellectual disabilities, but who move independently and do not have behavioral problems - perfect option for assisted living, but why not give other, more “severe” disabled people a chance?

Perhaps the optimal solution was found in Pskov. In a group of 5 people there are people with different features: with a severe form of cerebral palsy, with severe behavioral disorders, as well as with intellectual development disorders, including Down syndrome. This arrangement allows us to provide necessary help everyone, while creating an individual approach and harmoniously distributing the load on the accompanying people.

Fifth condition organization of accompanied accommodation – availability of daytime labor or social employment separately from the place of residence. The need to separate place of residence and place of work (employment) is dictated by the principle of normalization of life.

Accompanied living services

The essence of assisted living is that people with mental disabilities are provided with necessary and sufficient social services at home. Unlike traditional social services, during assisted living, the social worker does not do for the client what his ward can and knows how to do independently, but provides as much help as is necessary to achieve a quality result.

That is why, at the initial stage of organizing assisted living, it is very important to conduct a detailed assessment of the needs of people with disabilities for certain services. This will allow, on the one hand, to identify their ability to independently perform this or that activity, on the other hand, to determine individual needs in help and care. Based on the assessment data, an individual residential support program (IPSP) is developed, the development of which also takes into account the individual program of the recipient of social services (IPSSU) and the individual program for rehabilitation and habilitation of a disabled person (IPRA).

Accompanied accommodation services are provided on the basis of Federal Law No. 442 “On the Fundamentals of Social Services for Citizens in the Russian Federation” and relevant by-laws, including regional lists social services and their standards. Unfortunately, today the current lists and standards largely diverge from the principles and requirements stated above for organizing accompanied accommodation. In particular, in standards and other regulations the required volume of services, educational orientation in the support process, and developmental care are not provided.

Functions of accompanying persons

Accommodation support is provided by an interdisciplinary team of specialists, including full-time workers: a social educator, psychologist, social workers, a manager, as well as specialists hired on an hourly basis: doctors (psychiatrist, neurologist) and lawyers. All specialists must undergo appropriate training.

The working hours of the accompanying persons can be organized in shifts: morning, afternoon and night shift– taking into account the fact that on weekdays residents will be at work or in organizations that provide daytime employment. On weekends, support occurs around the clock, taking into account the needs of residents.

A team of specialists implements an integrated approach to working with residents, which is based on respect for the dignity of each person. Specialists together plan and discuss work with clients, the content and scope of services, cooperation with relatives and specialists from other organizations, etc.

In addition, each specialist solves problems that fall within his professional competence and are included in job descriptions. Thus, a social teacher teaches residents skills in everyday life and social and communicative activities, deals with organizational and legal issues, communicates with organizations and specialists who provide services to his clients, maintains contacts with relatives, etc. Social workers directly provide support: help residents in everyday life , self-service and hygiene procedures ah, leisure. The manager organizes and coordinates the work of assisted living specialists, monitors the maintenance of documentation, resolves logistical and financial issues, and also participates in accompanying the residents.

Important role, especially in the initial stages of assisted living, a psychologist plays a role. As Pskov specialists admitted, for the first two years the psychologist worked almost all the time only with parents. They had a lot of anxiety - more than the guys. Many parents suffered because they let go of children with whom they were connected not only psychologically, but also physically - their lives were empty, they did not know what to do with free time. They were worried about everyday issues, doubted, worried... In addition, the psychologist helped create a suitable psychological climate in the apartments, establish friendly, constructive relationships between all participants in the supported accommodation: disabled people, their relatives, accompanying people, housemates. Of course, when apartment life is well established, the help of a psychologist is needed, although regularly, but not constantly - as needed.

Detailed information about the assisted living system created in Pskov can be found on the websites of the Pskov regional public charitable organization Society of Parents of Disabled Children with Autism “I and You” (http://me-and-you.ru) and the Center for Curative Pedagogy Pskov region (http://clp.pskov.ru/).

The topic of developing assisted living in Russia is being discussed at the federal level. Public organizations have achieved that in Pskov and Nizhny Novgorod, with the support of the Foundation for Children in Difficult Life Situations, pilot projects have been launched, the purpose of which is to create a description of models of accompanied accommodation, the regulatory framework of organizations that provide accompanied accommodation, and to prove to the state what to develop assisted living is more profitable than maintaining a boarding school system. It is important that the accompanied accommodation itself be varied and that the system be flexible. The main thing today is that the public and the state are working in this direction and, therefore, parents have a chance for a decent future for their children. At the same time, the activity of the families themselves is also important, their desire to become pioneers in this direction, to create their own projects of assisted living or to support the projects of other parents. And when such productive social activity is supported by the appropriate political will of the authorities, which can consolidate it at the legislative level, the assisted living system will really work.

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A study of domestic experience of supported living revealed that the predominant form is a social hotel (St. Petersburg, Porkhov), which provides a disabled person with the opportunity to live on a temporary basis. Permanent residence in apartments, in small groups, is difficult due to the undeveloped legislative framework for support. In addition, experts note a low level of readiness of young people with severe developmental disabilities for life outside the parental home, even in cases where they have the potential to lead a relatively independent life.

Taking into account the collected information, we identified the following tasks as priorities for the implementation of the project in Pskov:

develop and test a model for preparing young people with severe developmental disabilities for independent living, based on innovative European and Russian experience;
prepare young people with disabilities to live independently in a study apartment;
promote the development of a tolerant attitude of society towards people with disabilities;
develop a concept for an assisted living service for persons with disabilities severe violations development in Pskov.

As a basis for the implementation of the project, the Study Accommodation Department was created at the Fund. The staff of the department included three social educators and one psychologist. The work was carried out on the basis of a three-room apartment in an ordinary residential building, purchased with funds from the Evangelical Church Community “Wassenberg” (Germany). The apartment and the entrance to the house were adapted to the special needs of young people, especially those with various disorders musculoskeletal system. In particular, a ramp was built at the entrance of the house, a bathroom was combined in the apartment, the bathtub was replaced with a shower, and handrails were installed in the bathroom. The apartment is equipped with ordinary furniture and equipped with household appliances: microwave oven, food processor, electric kettle, etc.

Over the course of one and a half years, 14 young people (aged 18 to 36 years) with severe developmental disabilities were trained in an educational apartment. varying degrees gravity, which we designated as “students”. All of them attend Production and Integration Workshops for the Disabled in Pskov. Learning to live independently in an apartment took place in courses. The duration of the course was usually from three to five months. Two young people with more complex disabilities (a boy who cannot move and use his hands due to cerebral palsy, a girl with a complicated form of autism) studied for one month each.

In order to ensure continuity of education, preparation for independent living was not limited to the educational apartment, it continued in the conditions of the parental home and in the workshops where students worked, therefore two main areas of psychological and pedagogical work were identified: the actual teaching of students and advisory and methodological work with families.

The training was organized as follows. At the first stage students were selected, project staff were introduced to candidates and their families, and information about the goals and conditions of the project was carried out. Teachers conducted a survey of young disabled people and their parents in order to identify those willing to participate in the project. When starting our work, we were guided by the fact that those young people with severe and multiple violations development, which have the prerequisites for the formation of skills of self-service, life support and interaction with others.

Selection of project participants and recruitment study group was carried out taking into account the following criteria:

the desire of young people to participate in the project;
willingness of parents (guardians) to cooperate;
student age: not younger than 18 years;
heterogeneous composition of the group (2 young men and 2 girls were accepted into the group);
psychological compatibility of potential participants (identified during conversations with candidates, their parents and workshop staff);
level of independence and amount of expected assistance (groups are staffed in such a way that they include young people with different levels independence, various physical and mental abilities);
consent of students and their parents (guardians) to make a financial contribution to the project: using a disability pension to pay utility costs, food and the purchase of necessary supplies.

On second stage documentation was completed: the project’s pedagogical council made a decision on admission and entered into an agreement with parents (guardians) and with the students themselves. Parents filled out a questionnaire indicating their expectations from the project. During the first week of training, a psychological and pedagogical profile and an individual training program were compiled for each student. The individual program specified in detail the content of the student’s education in each area.

Third stage– the actual process of learning to live independently, which was carried out in three directions:

household activities,
leisure activities,
social and communicative activities.

Within household activities training took place in cleaning the apartment, caring for things, implementing hygiene procedures, and carrying out basic financial settlements and planning your budget, making utility and other payments, shopping, cooking.

Education socio-communicative activities included: development interpersonal relationships, orientation in social space, assimilation of generally accepted norms and rules, and their application in everyday life.

Direction "leisure activities" involved learning how to choose and organize activities for one’s free time, developing the need and ability to visit social and cultural places, go for a walk, travel out of town, etc.

When choosing a regime, we took as a basis the daily rhythm of life generally accepted for most adults: in the morning and afternoon on weekdays - work, in the evening - rest and household chores around the house, on weekends - relaxation at home and in other places. So, from Monday to Friday, after finishing work, students come to their study apartment by public or special transport, where they are met by teaching staff. From the moment of arrival until bedtime, as well as in the morning before leaving for work, students participate in various educational activities aimed at developing their independent household, leisure and other activities. Students spend every fourth Saturday in the PMO in order to learn how to organize their free time on weekends. On all other days and in case of illness, students live with their parents.

This regime is close to the ordinary life of adults, so the training was natural and was harmoniously connected with solving everyday life problems, which made it possible to form a more stable and long-term motivation for independent activity in the apartment. The duration of the training course played an important role. In our opinion, it is long-term living in a study apartment that allows you to adjust and consolidate independent living skills.

At the final fourth stage For each student, a profile was again compiled, reflecting the changes that occurred after the residential course. The leading criterion for the effectiveness of training was both the level of mastery of certain skills and the reduction in the amount of outside assistance provided.

Analyzing the work done, we can say that of the three designated areas of training, the greatest progress is observed in the first of them - “Household activities”. The most significant results were obtained in training in cleaning premises. By the time the project began, only a few students had previously been involved in cleaning at home; the quality of cleaning often left much to be desired, but at the end of the training, 90% of students learned to perform certain types of cleaning work (with help or independently), half of them learned to clean the apartment on their own . The same result is observed in the area of cooking training.

Almost all students (90%) were able to correct their ideas about food intake, practice individual operations for processing food and preparing dishes, or significantly expand their existing experience in this type of activity. Cooking skills were most successfully transferred to the home.

The majority of young people (85%) have reduced the need for outside help when performing hygiene procedures and caring for things. Such high indicators are partly explained by the fact that at home parents often do everything themselves for their child, although most children have the ability to independently care for themselves and things, but such skills are not supported in the family.

Many students (35%) learned to dress, undress, fasten their shoes, and choose clothes according to the situation on their own.

To achieve sustainable results in such areas as social-communicative and leisure activities, longer work is required. However, positive changes were noted in these areas as well. All young people have expanded their ideas about options for spending their free time. They learned to choose the most attractive type of recreation for them from those they already knew.

All students already had experience using public transport, shopping, and visiting social and cultural places, but the degree of their independence in performing these tasks was very low. Activities such as budget planning and utility payments were familiar to only 3 students.

At the end of the course, 50% of students gained experience in paying for utility services and knew where and why they are paid. However, the cost planning training provided to three students requires further work.

Changes in behavior, emotional state, and self-esteem of students should be noted. According to our observations and in the opinion of parents, most young people became more relaxed and self-confident; some students began to be more attentive to the work and feelings of others.

Unfortunately, it should be noted that the skills acquired in the educational residence department were not always used at home. This is due both to the developmental characteristics of the students themselves and to manifestations of overprotection on the part of parents.

Thus, over the two years of operation of the educational residence department, the following results were obtained:

all students who completed the course in the educational residence apartment showed positive dynamics. This manifested itself in the formation of new self-service skills, management household, expanding the range of communication and ways of spending free time,
qualitative changes in the development of students’ everyday skills led to a decrease in the amount of assistance provided to them by accompanying persons;
a daily routine for disabled people in a study apartment was developed and tested;
a package of documents has been developed for organizing student training: characteristics, program, observation diary, questionnaires, contract forms;
The need of students for the amount of outside assistance (from partial to full) has been established. During the project, young people with varying levels of independence were trained in an apartment. Establishing the need for outside assistance made it possible to determine the number of accompanying persons and the time of their work;
Increased awareness and interest among parents in teaching their adult children to live independently.

The following problems have been identified as requiring further development:

transfer of developed skills to new conditions, for example, to the conditions of the parental home;
the lack of development of legislative mechanisms for the functioning of accompanied accommodation;
During the implementation of the program, we are faced with difficulties due to the unpreparedness of society to accept people with disabilities. disabilities as citizens with equal rights. Unfortunately, we often have to deal with the intolerant attitude of individuals towards people with disabilities. Difficulties arise due to the inability of the infrastructure of many shops, cafes, cinemas, halls and other public institutions to meet the needs of this category of people. The lack of ramps, specially equipped toilets, and narrow doorways make it difficult for disabled people to visit public places. At the same time, it should be noted that many institutions and organizations accommodate people with disabilities, give them discounts on the provision of services, and show interest in working with them.

The work of the educational residence department did not stop after the completion of the project. The department has become a structural subdivision of the Municipal Educational Institution “Center for Curative Pedagogy”, and its students remain workers from production and integration workshops.

At the same time, it remains unsolved problem accompanied accommodation for disabled people whose parents cannot provide them with accompaniment in their own home, so we have developed the concept of an assisted accommodation service in Pskov. Below we will briefly discuss the main provisions of this concept.

When developing the concept, we proceeded from the fact that the purpose of creating a residential support service is to provide conditions for the realization of the rights of a person with severe and multiple developmental disabilities to a decent life in his community, in which he grew up, received accessible education and employment.

The involvement of a person with severe and multiple developmental disorders in the process of “independent” living presupposes a greater or greater to a lesser extent accompanying a person with a disability. Completely independent living is not feasible for a person with such disabilities, however, in conditions of accompanied living, he gets the opportunity to increase the level of his independence in accessible household, leisure, and other activities. social activities. In most cases, this population group requires regular or ongoing assistance in daily life from others, because has 2 and 3 degrees of severity of limitations in the main categories of human life: the ability to self-service; ability to move independently; ability to orientate; ability to communicate; the ability to control one's behavior; ability to learn; ability to work.

The concept reveals the main conditions for organizing accompanied accommodation: regulatory, organizational, pedagogical and resource.

The legislation of the Russian Federation provides for the creation by executive authorities of special services for social services for disabled people (Federal Law No. 181 “On the social protection of disabled people in the Russian Federation”, Federal Law “On social services elderly citizens and disabled people"). In particular, the following forms of social services for disabled people are proposed:

social services at home (including social and medical services);
semi-stationary social services in day (night) departments of social service institutions;
stationary social services in stationary social service institutions (boarding homes, boarding houses and other social service institutions, regardless of their name). (Clause 1, Article 16 of the Federal Law “On social services for elderly citizens and the disabled” dated August 2, 1995 N 122-FZ (as amended on January 10, 2003, August 22, 2004)

According to clause 1, art. 17 of the above-mentioned federal law “Social services at home is one of the main forms of social services aimed at maximizing the possible extension of the stay of elderly citizens and disabled people in their usual social environment in order to maintain them social status, as well as to protect their rights and legitimate interests.” All forms of social services for disabled people involve a set of social services that can be provided to a disabled person, both free and for a fee.

Legislative documents of the Russian Federation provide for the provision of wide range social services that could be in demand in assisted living conditions for persons with severe developmental disabilities. However, existing mechanisms for the implementation of this right do not meet the special needs of people with severe and multiple developmental disabilities. Thus, according to the Methodological Recommendations for organizing the activities of the state (municipal) institution "Comprehensive Center for Social Services for the Population", one social worker serves 5 - 8 needy citizens, at least 3 - 4 times a week, whereas when organizing accommodation for disabled people with severe and multiple disabilities the constant presence of a social worker is necessary.

Thus, there is a contradiction between Federal laws, guaranteeing the right of disabled people to services and instructions drawn up in such a way that a disabled person cannot exercise his rights. In this regard, the concept indicates the need to eliminate contradictions in legislation.

The concept provides for the possibility of creating a Service for Accompanying the Residence of Persons with Severe Developmental Disabilities as a separate organization, or as structural subdivision any existing social service institution for the population of Pskov.

The structure of the escort service may include several branches. The first department, a centralized residence (dormitory), is created to accompany persons primarily of the first and second of the above groups and who have 2 and 3 degrees of severity of restrictions in the main categories of human life: in self-care, movement, orientation, communication, control of one’s behavior. The extent of their need for outside help is complete. The centralized housing department is created in the form of a small dormitory house for 12 - 16 people. The number of staff should be based on the calculation of at least one accompanying person for 2 residents.

The second department - permanent support - is created on the basis of adapted apartments of an ordinary residential building. This department provides support for persons with various disabilities. The degree of need for outside assistance of those living in apartments is partial or complete. Up to 4 disabled people can live in one three-room apartment with the constant support of one or two social workers.

The third department - periodic accompaniment of living of persons with disabilities - provides services to those people who are able to live independently, but from time to time need help. One social worker can serve up to 8 people.

When staffing departments, it is important to use integration capabilities. Groups of residents in the first and second departments should be heterogeneous in terms of the degree of need for outside help. The heterogeneous composition of residents will make it possible to organize mutual assistance between the disabled themselves and reduce the need for service personnel.

The pedagogical conditions presented in the concept are determined by the need not only for assistance, but also for teaching residents to live independently. The objectives and content of the training were transferred from the experience of the Study Residence Department.

According to the concept, the resources necessary for the operation of the assisted living service can be generated from various sources: the budget of the subject of the federation and/or the local budget, payments from the disabled themselves, Federal funds allocated for implementation activities individual program rehabilitation of a disabled person, donations, grants and other funds.

Taking into account the experience of Western European countries, it is not at all necessary that accommodation and support services be provided to disabled people free of charge, but they need help to pay. Such assistance could be provided for by the existing list of state-guaranteed social services provided to elderly citizens and disabled people by state and municipal institutions social services. In addition, it is important that organizations providing assisted living services do not manage residential premises in which people with disabilities live. Such a division will create a market for social services and ensure their choice for a person with developmental disabilities and his legal representatives.

The implementation of the concept in Pskov and other cities will create an alternative system to the existing PNI network. The creation of an assisted living service will save public funds, because is less expensive, as evidenced by the experience of the Educational Accommodation Department of the Fund (on average, for 2006, expenses per resident per month amounted to 5,760 rubles).

The undoubted advantage of assisted living is that it allows you to implement the principle of normalizing the lives of disabled people: there is a job, there is a home, and they are not under the same roof. Finally, the main thing is that people can live in their own city, among other citizens.

From the development to implementation of the concept of an assisted living service, of course, the distance is more than one year, but the experience of Pskov shows that the interested cooperation of the parent community, government officials and philanthropists will make it possible in the near future to solve the problem of creating conditions for a decent life for fellow citizens with severe developmental disabilities.

Vinogradova Elena Anatolyevna, teacher of the Central Children's Center
Nesterova Anastasia Gennadievna, social teacher of the Central Clinical Hospital
Tsarev Andrey Mikhailovich, director of the Center for Clinical Practice

Appendix to the order of the Ministry of Health and social development RF dated August 22, 2005 N 535