The following contribution arose as one of the outputs of a Specific Grant Competition carried out at the Faculty of Education of Palacký University in Olomouc in 2012. The Specific Grant Competition focused on inclusive approaches to adults with intellectual disabilities in later adulthood. The topic was selected in light of the widespread use of approaches of inclusive pedagogy primarily with pupils with disabilities. In the empirical investigation, the researchers were interested in what possibilities for inclusion exist (if any) in the context of adults with intellectual disabilities in conditions in the Czech Republic. The contribution is based on the practice of special-education andragogy.

Special-education andragogy as a scientific discipline began to develop relatively recently. It responded to the growing complexity of the situation of adults with special educational needs. Special-education andragogy relates to constantly referenced demographic changes in society (an increasing number of older people and the corresponding decrease in the number of economically active people, the declining birth rate, etc.). These changes result from population forecasts for the Czech Republic with predictions to 2030 and beyond. Kalnický, J. (2012) mentions in the population forecast also an increase in institutional and also individual support. Evidence is the existence of study fields focused on special-education andragogy, for example at Palacký University in Olomouc and Masaryk University in Brno (Krejčířová, O.; Vymazalová, E.; Hublar, J., 2011). Černá, M. (2008) notes that between about 600,000 and 1.6 million people worldwide live not only with intellectual disability but also with other psychiatric disorders in the age range over 60. Expected development indicates an increase in the number of people with intellectual disabilities in the population to around 7 million. Development also brings an increase in their age, which leads to changes in the services intended for this group of people. The fact that age is increasing is also linked to the onset of illness whose type and incidence correspond to age-related changes in the intact population. On the basis of the above, specialized experts need to be prepared in advance to provide the necessary support and guidance to adults with intellectual disabilities. (Křížkovská, P., Tomalová, P.; 2012).

The scope of the research investigation focused on the existence of facilities for adults with intellectual disabilities in the Czech Republic. Because only part of the investigation is presented in the contribution, the text will include only the objective that concerns this part. Research objective: To determine the existence of state facilities for adults with intellectual disabilities in the Czech Republic. In the investigation, individual facilities were selected according to an electronic register. Based on this database, individual attributes of each facility were found, including their number in the relevant region and the age limits set by each facility for client admission.

At the outset of the presented text, it is necessary to define in the article the concepts used, such as special-education andragogy, the term adulthood in the context of adults with intellectual disabilities, and the phenomenon of intellectual disability.

Special-education andragogy

In Czech special-education practice, different equivalents are used for this discipline, such as special andragogy, special pedagogy of adults, or special pedagogy and andragogy. From a terminological standpoint, the term special-education andragogy (hereinafter SPANDR) appears most appropriate to the authors, and for this reason it will be used further in the text. As for defining this term, the Andragogical Dictionary (2012, p. 235) states the following: “It is a field of andragogy focused on issues of persons with disabilities and their participation in the labour market.”

The area of SPANDR (its theory and practice) began to develop relatively recently. It responded to the increasing complexity of the situation of adults with special educational needs. SPANDR as a scientific field relates to the demographic changes in society that are increasingly mentioned. These changes arise as a result of population forecasts for the Czech Republic up to 2030. Evidence is the existence of study fields focused on special-education andragogy, for example at Palacký University in Olomouc and Masaryk University in Brno. Krejčířová (in Krejčířová, O.; Vymazalová, E.; Hublar, J., 2011) states that SPANDR, similarly to general andragogy, focuses on three core areas:

  • The first type is an andragogical direction aimed at workers who in their practice work with adults with disabilities (predominantly social workers, social service workers, health-care staff, volunteers).
  • The second area is the role of a special-education andragogue, whose profession should involve developing and guaranteeing educational programmes individually adapted to the needs of adults with intellectual disabilities (taking into account individual approach and life course).
  • The third pillar represents targeted education of adults carried out through activities supported by the respective facility.

The object of special-education andragogy is adults with special educational needs. Jesenský, J. (in Krejčířová, O., 2005) views the education and upbringing of adults as a complex process of cooperation. Its aspects are:

  • the offer that an adult with intellectual disabilities uses primarily on the basis of identified needs (not a forced process),
  • adult education can be seen as a combination of formal and informal learning (informal education prevails),
  • the assumption of motivation and the related active participation of adults with intellectual disabilities,
  • accompaniment within the educational process.

As with every scientific discipline, it has its objectives, forms, methods, means, and subsystems. Jesenský, J. (2000) describes the following subsystems of special-education andragogy:

  • etoandragogy,
  • psychoandragogy,
  • logoandragogy,
  • surdoandragogy,
  • tyfloandragogy,
  • somatoandragogy.

Each of these subsystems can be further subdivided. From the perspective of contemporary special pedagogy, we would add to the above list also special-education andragogy for persons with multiple disabilities, persons with partial deficits, and persons who are exceptionally gifted.

We will now briefly characterize the individual subsystems. Etoandragogy (special-education andragogy etopedics) is part of work with adults with behavioural, social relationship, and value-orientation disturbances. Information obtained through this discipline is primarily used in the non-profit sector. (Krejčířová, O.; Vymazalová, E.; Hublar, J., 2011) Its work also concerns prevention programmes, diagnostics, and support for the person and his or her surroundings. Psychoandragogy (special-education andragogy psychopedics) is a part of special-education andragogy that works with adults with intellectual disabilities, with people with mental illness, and with people with reduced cognitive performance. The field of work appears in motivation, stimulation of their potential, provision of counselling services, and support for achieving desired social participation. (Krejčířová, O., 2010) The last-mentioned aspect is important in how people with intellectual disabilities are viewed by the intact population, as persons with intellectual disabilities are often granted the least sympathy. Surdoandragogy (special-education andragogy surdopedics) focuses on adults with hearing impairments, with an emphasis on communication with the majority society. Surdoandragogical work is particularly concerned with people with acquired hearing impairment and is also oriented toward Deaf culture. It provides information on the possibilities of technical aids, events, and practical information for adults with hearing impairments. Tyfloandragogy (special-education andragogy typhlopedics) works with people with visual impairments, especially those who lost sight during their lives (especially older adults). It focuses on activities related to innovations in compensatory and technical aids and cultural events. Somatoandragogy (special-education andragogy somatopedics) primarily works with concepts of educating and educating adults with physical disabilities, health impairments, or health weakening. (Křížkovská, P.; Tomalová, P., 2012) Logoandragogy (special-education andragogy speech therapy) focuses on work with adults with impaired communication ability. Its goal is primarily to orient itself to prevention activities and to implement appropriate speech-therapy interventions. (Křížkovská, P.; Tomalová, P., 2012)

Adulthood from the perspective of special-education andragogy

Adulthood and the subsequent aging process of people with disabilities is mentioned in Czech special-education practice relatively briefly. Previously attention was paid exclusively to children and adolescents with special educational needs, as a result of which the basic-to-secondary education system for pupils and students with intellectual disabilities is relatively well developed. Only in connection with gradual age extension and continuously improving medical care did attention move beyond special pedagogy to the area of development, support, and guidance of adults with various types of disability. (comp. Šiška, J., 2005; Müller, O., 2006; Slowík, J., 2007). From the viewpoint of general and special-education andragogy, adulthood is a core concept that cannot be unequivocally defined and described. According to Jochmann, V. (2001), granting adult status is linked to completion of development in three basic dimensions:

  • somatic (connected with stabilization of somatic development, for example stabilization of body height),
  • psychological (stabilization of cognitive and imaginal-emotional functions),
  • social (taking up adult social roles, such as partnership or parenthood).

Other possible dimensions of adulthood may be (Müller, O., 2006):

  • Biological dimension: primarily represents an individual’s physical maturity.
  • Legal dimension: refers to a conception corresponding to legislative needs. It is related to acquiring full rights and obligations (including voting rights, the right to marry, legal capacity).
  • Sociological dimension: adulthood is characterized by taking on new social roles connected to the social roles of an adult person.
  • Psychological dimension: represents maturation and stabilization of behaviour, thinking, and experience.
  • Economic dimension: an adult is economically self-sufficient.
  • Pedagogical dimension: in this conception, adulthood does not exist; a person engages in continuous education with the aim of supporting lifelong learning. These aspects are anchored in the National Education Development Programme (White Paper), adopted by the Ministry of Education, Youth and Sports in 2001. Life-long learning is also part of the Framework Educational Programmes in key competencies, specifically in the learning competency.
  • General andragogical model: describes an adult who has completed education in the formal educational system and has simultaneously adopted adult social behaviour. (Beneš, M., 2003)
  • Special andragogical model: describes an adult who has completed education in the educational system defined by relevant legal norms, has taken on social roles and acquired full rights and duties, or has not completed education in the formal system but has assumed some adult social roles and acquired rights and duties. Legal norms in this definition include Act No. 561/2004 Coll., on preschool, basic, secondary, higher professional and other education, Decree No. 116/2011, amending Decree No. 72/2005 Coll., on providing counselling services in schools and school counselling facilities. The last legal document is Decree No. 147/2011, amending Decree No. 73/2005 Coll., on education of children, pupils, and students with special educational needs and children, pupils, and students who are exceptionally gifted.

In the context of adults with intellectual disabilities, it is important to note the view that mental retardation is a condition that can only progress over life without signs of positive change. Measured IQ is considered permanent from the time its level is established. This view unquestionably set and signaled limits to educational possibilities for persons with intellectual disabilities. Švarcová, I. (2006) notes that with appropriate pedagogical, special-education, and psychological intervention, it is possible to optimally develop the individual components of personality of adults with intellectual disabilities. In professional literature, various divisions of adulthood are presented. Differences mainly concern the length of stages of individual adulthood categories.

The World Health Organization considers an adult to be someone who has reached 18 years of age. It describes this classification of adulthood as:

  • period of full adulthood (18–30 years),
  • period of young adulthood (30–45 years),
  • period of middle adulthood (45–60 years),
  • period of aging (60–75 years),
  • period of old age (75–90 years),
  • senile period (over 90 years).

The Andragogical Dictionary (2012) offers the following conception of adulthood:

  • young adulthood (13–30 years),
  • middle adulthood (30–45 years),
  • older adulthood (45–60 years).

Finally, in the text we include Livečka’s classification (in Müller, O., 2006, pp. 23–24):

  • early adulthood (young adult), from 16–18 to 25–30 years,
  • middle adulthood (mature adult), from 25–30 to 45–50 years,
  • late adulthood (aging adult), from 45–50 to 65–70 years,
  • age of the older adult person, 65–70 to 80 years,
  • senium, from 80 years.

The above classification is from 1979. For special-education andragogy it appears the most suitable because age categories are variable, and for this reason can reflect earlier onset of age-related changes in adults with intellectual disabilities. (Müller, O., 2006, pp. 23–24)

Each classification reflects different authors’ conceptualizations of adulthood. Their enumeration shows that adulthood is a significant life dimension that for a long time lay outside the field of interest. Černá, M. (2008) distinguishes general and specific criteria of adulthood. Both categories can be used for adults with disabilities (where fulfillment is harder) as well as for intact persons (for whom fulfilment of nearly all listed areas is generally assumed). The general criteria are those expected to be acquired by most people in an automatic and natural manner. They include:

  • completion of school attendance,
  • entry into employment,
  • leaving the parental home,
  • administrative and legal factors.

For an adult with intellectual disabilities it is difficult to achieve at least two of the above areas. Specific criteria include:

  • the right to vote and be elected (this concerns not only legislative aspects but also choices or preferences within a social group),
  • receiving social benefits from the state,
  • attitudes of staff (behaviour can vary widely, from acceptance of specific needs to hostile attitudes),
  • attitudes of the adults themselves (which are shaped by their previous experiences),
  • prejudice in society.

It is clear that all the above classifications of adulthood can be challenging even for someone without a disability (most often the achievement of economic self-sufficiency). An adult with intellectual disabilities who has spent their entire life in an institutional facility may not have developed the required habits for participation in everyday social life.

Given the increasing number of people with disabilities, the further aspect of stimulating their human potential is important and should occur especially in families or within individual social services such as supported and protected housing, day service centres, day care centres, homes for people with disabilities, and similar services. (See, for example, Act No. 108/2006 Coll., on social services.) In Czech special-education practice, certain limitations remain that make admission to such facilities difficult and thus also limit provision of the content of each social service. The most common limiting factor is age limits. Usually up to age 40 is listed as the limit for individual social services. With increasing age, the range is lower and also decreases geographically across the Czech Republic (see the graphs below).

Concept of intellectual disability

Now attention will be devoted to defining the term intellectual disability. In current Czech special-education practice, the terms used are:

  • intellectual disability,
  • mental retardation.

Švarcová, I. (2006) and Bazalová, B. (in Pipeková, J. et al., 2010) mention only the term mental retardation in their publications. In psychological counselling practice, some authors use the term intellectual defect, for example Zacharová, E.; Hermanová, M.; Šrámková, J. in the publication Health Psychology from 2007. The terms intellectual disability and mental retardation are viewed by some authors as synonyms (comp. Kasíková, H., 2007; Slowík, J., 2007; Vítková, M., 2010; Plevová, I. and Slowik, R., 2010 etc.).

Other authors, such as Vašek, Š. et al. (1994); Müller, O., Kozáková, Z. 2005; Valenta, M., Müller, O., 2010 describe the concepts in different ways. Vašek, Š., in Valenta, M., Müller, O. (2010, p. 13) defines intellectual disability as “an umbrella term used in pedagogical documentation that loosely denotes all individuals with a measured intelligence quotient below 85 points.” Compared to mental retardation, intellectual disability is defined as a broader umbrella concept that includes reduced IQ for different etiological causes and primarily includes persons with an IQ below 85 points. (comp. Vašek, Š., 1994, Kozáková, Z., 2005). Valenta, M., Michalík, J., Lečbych, M. (2012) state that the term intellectual disability is applied primarily in counselling practice. In this sense, they mainly refer to Czech legislation (especially Decree No. 116/2011, amending Decree No. 72/2005 Coll., on providing counselling services in schools and school counselling facilities, and Decree No. 147/2011, amending Decree No. 73/2005 Coll., on education of children, pupils, and students with special educational needs and children, pupils, and students who are exceptionally gifted). These authors define this term as follows on page 30: “Intellectual disability is a broader umbrella term, including besides mental retardation also such borderline areas of cognitive-social disability that place the client at a disadvantage in education, especially in education at mainstream schools, and indicate compensatory and support measures of an educational (or psychosocial) character.” From the perspective of special-education andragogy, people with intellectual disabilities represent the largest client group; therefore, it is not only about persons with congenital mental retardation, but also people after injuries or illnesses.

Valenta, M.; Müller, O. (2009, p. 12) describe mental retardation as “a developmental mental disorder with reduced intelligence, manifesting primarily in reduced cognitive, motor, social, and speech skills with prenatal, perinatal, and postnatal etiology.”

In general, we can state that mental retardation can be defined in different ways. A special educator may define it in one way (and in accordance with inclusion principles should emphasize the positive areas of the individual rather than any possible intellectual deficit), while medicine will define it differently (primarily aimed at identifying causes, diagnostic process, and then targeting appropriate therapy with prognosis of “cure”); psychology will understand it differently (its purpose is the description of personality and the peculiarities relevant to it). Höchsl (in Mahrová, G.; Venglářová, M. et al., 2008, p. 88) views mental retardation as “a mental disability where below-average intellect was found through individual use of special testing, plus impaired adaptive behaviour in communication, self-care, school skills, and work.”

The term mental retardation began to be used officially after the World Health Organization (WHO) conference in 1959. Its use was the result of terminology standardization (Bartoňová, M.; Bazalová, B.; Pipeková, J., 2007). The origin of the term lies in the Latin expressions mens = mind, retardare = to lag behind (Kozáková, Z., 2005). In Czech special-education practice, a psychological definition of mental retardation by Mojmír Dolejší was used for a long time. He defined it as “a developmental disorder of integration of psychological functions of different hierarchy with variable boundaries and overall subnormal intelligence.” (Dolejší, M., 1973, p. 38).

Mental retardation is also defined differently in classification systems. In the International Classification of Diseases one can find the following definition of mental retardation: “It is a condition of arrested or incomplete mental development characterized especially by skill impairment that appears during the developmental period, affecting all components of intelligence, that is, cognitive, speech, motor, and social abilities. Retardation may occur alone or together with other somatic or mental disorders.” (http://www.sasp.cz/novinky/10052009.pdf) [citation as of 12 December 2012]

Within the ICD, degrees of mental retardation are defined as:

  • F 70 Mild mental retardation (corresponding to measured IQ 50–69),
  • F 71 Moderate mental retardation (corresponding to measured IQ 35–49),
  • F 72 Severe mental retardation (corresponding to measured IQ 20–35),
  • F 73 Profound mental retardation (corresponding to measured IQ up to 19),
  • F 78 Other mental retardation,
  • F 79 Unspecified mental retardation.

For diagnosing mental retardation, the following criteria must be met:

  • reduced intellectual functions (IQ 70 points or less),
  • concurrent deficit in adaptability,
  • onset before 18 years of age. (Valenta, M.; Michalík, J.; Lečbych, M., 2012)

It should be noted that the above definition is from 1992. Another classification system is the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM IV), which gives the following criteria necessary for diagnosing mental retardation:

  • reduced intellectual skills,
  • concurrent deficit in the individual’s adaptability,
  • onset of disorder before 18 years of life. (Valenta, M., Müller, O., 2010)

Finally, the concept of mental retardation according to the American Association on Mental Retardation (AAMR) will be mentioned. This organization understands the term mental retardation as “a disability characterized by significant limitations in both intellectual functioning and social behaviour and practical skills, and which began before the age of 18.” (http://www.heionline.org/docs/training/introduction_to_mental_retardation.pdf) [citation as of 16 November 2012]

People with mental retardation are a heterogeneous group. Each person in this category (just like each person from the intact population) has their own individual characteristics, such as personality specifics, variation in the degree of cognitive deficit, timing of onset (congenital mental retardation or acquired intellectual disability). Švarcová, I. (2006, p. 14) states that even on this basis, persons with intellectual disabilities are often spoken of as “almost a separate biological kind, whose individuals differ very little.”

Such an understanding undoubtedly negatively influences both inclusive and integration efforts and also how the majority society understands persons with intellectual disabilities. These views are tied to the perspective of the intact population and stem from previous encounters with these persons (the same clothing, same “gender-neutral” hairstyles, etc.) (Křížkovská, P., Tomalová, P. et al., 2012). The needs and wishes of adults with intellectual disabilities have become a concern for experts only relatively recently. In general, we can state that the greatest problem they subjectively feel is loneliness. Adults with intellectual disabilities especially lack fulfilment in the social sphere, particularly in friendship and partnership relationships. Often, when they try to form such relationships, they are rejected or their attempts are interpreted incorrectly. (Lečbych, M. 2010)

Within the text, the term “person with intellectual disability” is intentionally used, as this is the largest client group encountered by the special pedagogue-andragogue in practice.

Facilities for adults with intellectual disabilities

Facilities for adults with intellectual disabilities can be found in both the public and nonprofit sectors. The subject of the text is social services. The public sector is represented mainly by the Ministry of Labour and Social Affairs of the Czech Republic, specifically Act No. 108/2006 Coll., on Social Services, and its implementing Decree No. 505/2006 Coll. Social service facilities for persons with intellectual disabilities are established in individual regions, likely due to demand from the client group and/or the needs of the given region. The text will now focus on services of social care and prevention currently registered by the end of 2012. These data were obtained through the social service provider register - http://iregistr.mpsv.cz/. The findings are presented in graphics.

The text below comes from a publication issued within the Specific Grant Competition of the Faculty of Education of Palacký University in Olomouc in 2013 titled Inclusive approaches to adults with intellectual disabilities in later adulthood. Within the Act on Social Services, the following types of social services are registered (these are only selected types of social services):

  • day service centers,
  • protected housing,
  • day care homes,
  • homes for persons with disabilities,
  • homes for seniors,
  • homes with a special regime,
  • supported living assistance,
  • socially activating services,
  • weekly care homes.

The first service mentioned will be day service centers. A day service center is a social service provided in an ambulatory form through a specialized facility. Its aim is to strengthen the independence and self-sufficiency of persons with disabilities and seniors in an unfavorable social situation that can lead to social exclusion. The service includes help with personal hygiene or provision of conditions for personal hygiene, provision of food or help in securing food, educational, and activational activities, mediation of contact with the social environment, therapeutic activities, and help in asserting rights and interests. The service is provided for a fee. Figure 1: Frequency of day service centers for adults with intellectual disabilities in the Czech Republic

Comment to Figure 1: The above figure shows the number of day service centers in individual regions for adults with intellectual disabilities in the age groups 27–64 years and 65–80 years. From the table it is apparent that in the Karlovy Vary and Central Bohemian Regions there is no facility of this type for adults with intellectual disabilities within the specified age categories. Although the title of the contribution states age over 45, facilities that listed age limits within the range indicated in the graph are included. Note: Individual regions are shown in the graph table under their abbreviations. PHA – Hlavní město Praha, JHK – Jihočeský kraj, JHM – Jihomoravský kraj, KVK – Karlovarský kraj, VYS – Kraj Vysočina, HKK – Královéhradecký kraj, LBK – Liberecký kraj, MSK – Moravskoslezský kraj, OLK – Olomoucký kraj, PAK – Pardubický kraj, PLK – Plzeňský kraj, STC – Středočeský kraj, ULK – Ústecký kraj, ZLK – Zlínský kraj.

The service of protected housing is a long-term residential service provided to persons with disabilities whose situation requires another person’s assistance. Protected housing has the form of individual or group housing. Depending on need, support of a personal assistant is provided. The service includes provision of food or help in securing food, provision of accommodation, help in maintaining household functioning, educational and activational activities, mediation of contact with the social environment, therapeutic activities, help in asserting rights and interests. The service is provided for a fee. Through Act No. 206/2009 Coll., Act No. 108/2006 Coll., on Social Services, was amended—one of the changes is that the guaranteed minimum remainder of income after paying for food and accommodation was removed from users of protected housing, from 15% of income. At the same time, social assistance legislation changed, allowing a protected housing user who does not have sufficient finances to secure basic life conditions to use options of social protection within the system of social assistance in material need. This places emphasis on service providers to set fees for an individual protected housing user that allow him or her to secure not only accommodation and food, but also other essential personal needs, and to enable, as much as possible, integration into society and living in a way considered normal in society. Figure 2: Frequency of protected housing for adults with intellectual disabilities in the Czech Republic

Comment to Figure 2: Adults with intellectual disabilities who decide to become independent to the fullest extent so they can lead the most ordinary life possible are admitted to protected housing. The graph shows that the most social services of protected housing are for persons aged 27–64 years. Given the above information, people using protected housing can access subsistence allowance and housing supplement. Note: Individual regions are shown in the graph table under their abbreviations. PHA – Hlavní město Praha, JHK – Jihočeský kraj, JHM – Jihomoravský kraj, KVK – Karlovarský kraj, VYS – Kraj Vysočina, HKK – Královéhradecký kraj, LBK – Liberecký kraj, MSK – Moravskoslezský kraj, OLK – Olomoucký kraj, PAK – Pardubický kraj, PLK – Plzeňský kraj, STC – Středočeský kraj, ULK – Ústecký kraj, ZLK – Zlínský kraj. Day care homes provide ambulatory services to persons with reduced self-sufficiency due to age or disability, and to persons with chronic mental illness whose situation requires regular help from another person. The service provides help with everyday self-care tasks, help with personal hygiene or provision of conditions for personal hygiene, provision of food, educational and activational activities, mediation of contact with the social environment, social-therapeutic activities, help in asserting rights, legitimate interests, and handling personal matters. Figure 3: Frequency of day care homes for adults with intellectual disabilities in the Czech Republic

Comment to Figure 3: From the graph, it is clear that Karlovy Vary has the fewest day care homes, just as it has the fewest day service centers. The aim of these services is to maintain or improve quality of life for users with disabilities who live with their families but need support in some areas of life. (Kozlová, 2005) Note: Individual regions are shown in the graph table under their abbreviations. PHA – Hlavní město Praha, JHK – Jihočeský kraj, JHM – Jihomoravský kraj, KVK – Karlovarský kraj, VYS – Kraj Vysočina, HKK – Královéhradecký kraj, LBK – Liberecký kraj, MSK – Moravskoslezský kraj, OLK – Olomoucký kraj, PAK – Pardubický kraj, PLK – Plzeňský kraj, STC – Středočeský kraj, ULK – Ústecký kraj, ZLK – Zlínský kraj. Homes for people with disabilities provide long-term residential services to persons with disabilities whose situation requires help from another person. The service includes help with everyday self-care tasks, help with personal hygiene or provision of conditions for personal hygiene, provision of food, provision of accommodation, educational and activational activities, mediation of contact with the social environment, therapeutic activities, help in asserting rights and interests. The service is provided for a fee. Figure 4: Frequency of homes for people with disabilities in the Czech Republic

Comment to Figure 4: The highest concentration of homes for people with disabilities (with possibility to use services also for persons with intellectual disabilities) is in the Ústí Region—for all age categories. The lowest representation is again in the Karlovy Vary Region. Note: Individual regions are shown in the graph table under their abbreviations. PHA – Hlavní město Praha, JHK – Jihočeský kraj, JHM – Jihomoravský kraj, KVK – Karlovarský kraj, VYS – Kraj Vysočina, HKK – Královéhradecký kraj, LBK – Liberecký kraj, MSK – Moravskoslezský kraj, OLK – Olomoucký kraj, PAK – Pardubický kraj, PLK – Plzeňský kraj, STC – Středočeský kraj, ULK – Ústecký kraj, ZLK – Zlínský kraj. Homes for seniors provide long-term residential services for seniors whose situation requires another person’s assistance. The service includes help with everyday self-care tasks, help with personal hygiene or provision of conditions for personal hygiene, provision of food, provision of accommodation, mediation of contact with the social environment, activational activities, and help in asserting rights and interests. The service is provided for a fee. Figure 5: Frequency of homes for seniors in the Czech Republic

Comment to Figure 5: As shown in the graph, the number of homes for seniors with intellectual disabilities is not very high. The age limit up to 26 years is naturally one of no such facilities. However, even at later, pensionable age, the situation is not much different. It is worth noting that there are currently 464 homes for seniors in the age group 65–80 years and only 5 homes for seniors with intellectual disabilities. There, one can infer why this is the case... Note: Individual regions are shown in the graph table under their abbreviations. PHA – Hlavní město Praha, JHK – Jihočeský kraj, JHM – Jihomoravský kraj, KVK – Karlovarský kraj, VYS – Kraj Vysočina, HKK – Královéhradecký kraj, LBK – Liberecký kraj, MSK – Moravskoslezský kraj, OLK – Olomoucký kraj, PAK – Pardubický kraj, PLK – Plzeňský kraj, STC – Středočeský kraj, ULK – Ústecký kraj, ZLK – Zlínský kraj. Homes with a special regime provide residential services to persons who have reduced self-sufficiency due to chronic mental illness or substance dependence, and to persons with senile, Alzheimer, and other types of dementia, whose situation requires regular help from another person. The regime in these facilities is adjusted to the specific needs of these people in social-service delivery. The service provides accommodation, food, help with personal hygiene or provision of conditions for personal hygiene, help with everyday self-care tasks, mediation of contact with the social environment, social-therapeutic activities, activational activities, help in asserting rights, legitimate interests, and handling personal matters. Figure 6: Frequency of homes with a special regime

Comment to Figure 6: There are 228 homes with a special regime in the Czech Republic, of which 21 are also designated for persons with intellectual disabilities. The graph shows that in four regions this service does not exist. We may assume that homes with a special regime, which provide services to a narrowly defined target group, may not include mental disability in their list of diagnoses and may implicitly assume admission of clients with intellectual disabilities combined with mental illness into the facility. It depends on each home, for which target group the services are provided and then on medical diagnoses or a physician’s assessment. Note: Individual regions are shown in the graph table under their abbreviations. PHA – Hlavní město Praha, JHK – Jihočeský kraj, JHM – Jihomoravský kraj, KVK – Karlovarský kraj, VYS – Kraj Vysočina, HKK – Královéhradecký kraj, LBK – Liberecký kraj, MSK – Moravskoslezský kraj, OLK – Olomoucký kraj, PAK – Pardubický kraj, PLK – Plzeňský kraj, STC – Středočeský kraj, ULK – Ústecký kraj, ZLK – Zlínský kraj. Supported living is a social service provided to persons with disabilities whose situation requires help from another person. The service is provided in the person's home. It includes help in maintaining household functioning, educational and activational activities, mediation of contact with the social environment, therapeutic activities, and help in asserting rights and interests. The service is provided for a fee. Figure 7: Frequency of supported living

Comment to Figure 7: A social service that emerged from a “change in mindset” in society. With the establishment of this service, the concept of deinstitutionalization is connected, which is viewed in the EU as a managerial process of systemic change. We can also understand the term as a “shift toward the provision of social services focused on individualized support for a person’s life in the natural environment.” More information on the deinstitutionalization process in the Czech Republic can be found in Ministry of Labour and Social Affairs (MPSV) materials—for example, the Concept of Support for the Transformation of Residential Social Services into Other Types of Social Services, provided in the user’s natural community and supporting social inclusion of users. We may assume that transformation steps taken in residential services are indeed the correct ones. You can evaluate and reflect on what further possibilities for change exist and whether the breakup of large-capacity institutions into smaller units is one correct solution. Note: Individual regions are shown in the graph table under their abbreviations. PHA – Hlavní město Praha, JHK – Jihočeský kraj, JHM – Jihomoravský kraj, KVK – Karlovarský kraj, VYS – Kraj Vysočina, HKK – Královéhradecký kraj, LBK – Liberecký kraj, MSK – Moravskoslezský kraj, OLK – Olomoucký kraj, PAK – Pardubický kraj, PLK – Plzeňský kraj, STC – Středočeský kraj, ULK – Ústecký kraj, ZLK – Zlínský kraj. Socially activating services are ambulatory and/or outreach services provided to persons of pension age or persons with disabilities at risk of social exclusion. The service provides mediation of contact with the social environment, social-therapeutic activities, help in asserting rights and legitimate interests, and in handling personal matters. Figure 8: Frequency of socially activating services

Comment to Figure 8: The highest percentage of provided services for this target group is in the 27–64 age group. Most socially activating services provide clients with counselling, access to computers, professional lectures, various leisure activities—crafts, activational exercises, and various forms of expressive therapies and animotherapy, etc. Note: Individual regions are shown in the graph table under their abbreviations. PHA – Hlavní město Praha, JHK – Jihočeský kraj, JHM – Jihomoravský kraj, KVK – Karlovarský kraj, VYS – Kraj Vysočina, HKK – Královéhradecký kraj, LBK – Liberecký kraj, MSK – Moravskoslezský kraj, OLK – Olomoucký kraj, PAK – Pardubický kraj, PLK – Plzeňský kraj, STC – Středočeský kraj, ULK – Ústecký kraj, ZLK – Zlínský kraj. Weekly stacionaries provide residential services in specialized facilities to seniors, persons with disabilities, and persons at risk of substance-use disorders, whose situation requires regular help from another person. The service includes help with ordinary tasks of self-care, help with personal hygiene or provision of conditions for personal hygiene, provision of food or help in securing food, provision of accommodation or help in securing housing, and educational and activational activities, mediation of contact with the social environment, therapeutic activities, help in asserting rights and interests, and in handling personal matters. The service is provided for a fee. Figure 9: Frequency of weekly stacionaries

Comment on Figure 9: The very name weekly stacionary already indicates what type of service it is. In the case of adults with intellectual disabilities, there are 161 weekly stacionaries in total in the Czech Republic, divided by age periods. Each provider specifies from when to when the service operates and for how many persons it is intended. Note: Individual regions are shown in the graph table under their abbreviations. PHA – Hlavní město Praha, JHK – Jihočeský kraj, JHM – Jihomoravský kraj, KVK – Karlovarský kraj, VYS – Kraj Vysočina, HKK – Královéhradecký kraj, LBK – Liberecký kraj, MSK – Moravskoslezský kraj, OLK – Olomoucký kraj, PAK – Pardubický kraj, PLK – Plzeňský kraj, STC – Středočeský kraj, ULK – Ústecký kraj, ZLK – Zlínský kraj.

Conclusion

The contribution focuses on providing an overview of available facilities for adults with intellectual disabilities in the Czech Republic. The text includes facilities that fall within the remit of the Ministry of Labour and Social Affairs of the Czech Republic. Even though these are state-created social services, their number is not uniform and demand exceeds supply (especially for people in higher age categories). Across the Czech Republic, there are the least numbers of each type of social service in the Karlovy Vary Region (some types of social services are not established there at all). It was also found that throughout the Czech Republic there are only 5 facilities considered homes for persons with intellectual disabilities. It was surprising to find that in the whole country there are 228 homes with a special regime, and 21 of these are intended for adults with intellectual disabilities. The service most strongly represented for this target group is socially activating services. On the basis of the above findings, the following recommendations for practice were made:

  • Expand the social service system in the Karlovy Vary Region.
  • Create a regional coordinator position for the offer and provision of individual services.
  • Coordinate cooperation between individual social service facilities.
  • Raise age limits for admission of individual social service users.
  • Establish facilities specifically for adults and aging persons with intellectual disabilities.

Author: Mgr. Petra Křížkovská, Mgr. Petra Tomalová Institute of Special Pedagogy Studies, Palacký University in Olomouc

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