Slavomír Krupa, a senior member of Slovakia's institutional care community, is re-examining and improving its systems for providing institutional care to the elderly and disabled.
The New Idea
Slavomír Krupa, an eminent psychologist, is raising the standard of care provided by Slovak institutions. One of the distinguishing qualities of Krupa's work is his commitment to making institutions better places; he thus provides a distinctive voice in defense of their value for both long and short-term care in some situations, at a time when there is a general trend in many countries toward deinstitutionalization. On the other hand, far from defending the status quo in Slovakian institutions, Krupa sees the current structural transformations of Central European society and its health care industry as an opportunity to reverse the practices of minimal custodial care and social isolation commonplace in the institutions established during the communist era. Krupa is a reformer from within the system. As the founder and director of the leading Slovak institution for disabled children, with a record of introducing innovations over twenty years within the care establishment, Krupa is well-placed to judge what is needed for improvement. He is convinced that the quality of care ultimately depends upon the people who provide it, and he has developed mechanisms to enable caregivers to provide a more human face for institutions.
A rapidly aging population and a high rate of birth defects due to environmental degradation have resulted in thousands upon thousands of Slovaks who live in social care institutions. Living conditions in these environments, which are typically overcrowded and understaffed, are characterized by lack of privacy, low quality of provided services and excessive use of drugs and medications rather than socialization and therapy. As an insider, Krupa has observed that, "If we took the declaration of rights of disabled people seriously, we would have to close most of our social care institutions."
The underlying problem is a culture that persists in these institutions. Old stereotypes about disabilities and the needs of the disabled still persists; people are thrown together in the institutions without regard for age or degree of disability, a practice which discourages the kind of specialized care that would allow patients to improve their conditions or lead the most normal lives possible. There is a low qualification threshold for many health care professionals, especially those who work in institutions, and the hierarchical structure of the system fails to provide an environment where initiative and collaboration can thrive and thus inhibits the provision of the highest standard of service.
By training and experience Krupa is a big-picture thinker, and his strategy, which has three main strands, reflects this perspective. First, he has created peer-based mechanisms for existing health care workers to share their experience and improve their expertise informally; second, he has created an academic training program; and finally, he has established pilot models to shift the institutional template to smaller and more personalized centers.
Krupa founded the Council of Institutional Social Care Workers to create a forum for the exchange and development of ideas. The council brings together professionals (medical doctors, psychologists, special education teachers and social workers) who are directly or indirectly involved in social care. They participate in conferences, workshops and meetings according to needs which they have identified. Consultations among members address the problems of specific institutions, help to develop creative programs and provide management training. The council publishes a magazine, "Integracia" (Integration), which stimulates a broader distribution of ideas among the professional community.
Krupa has helped to establish a program of part-time university study for social workers who work with the disabled and others, such as some elderly people, who need long-term care. This program focuses on an increase in both the students' professional skills and their personal development. It is exceptional in Slovakia, the only program in the field aside from the government training program. The students learn an attitude and value system that helps them to accept and understand a disabled person as a whole person and not just the sum of isolated disabilities or "defects."
The third part of Krupa's work involves the development of new models of social care institutions; it is coordinated through a nonprofit Social Services Center which he has founded near Bratislava. There he develops smaller and more specialized institutions which better reflect the specific needs of children, the elderly and disabled people. For example, he cooperates with Ashoka Fellow Marek Rohácek in the development of a social accommodation scheme for foster families that participate in the Center. The Center's projects include an activation center for elderly people coming from long-term hospital stays; it facilitates the transition between the hospital and home. Often patients continue to need short-term specialized care which families are unable to provide, and Krupa's facility provides this care as well as counseling for people to help ease their transition back into their communities. Two new residential centers have been established for elderly people, which, because they are relatively small and well-staffed, can provide quality care with a more personal touch. The Center has also founded several socio-domky (social houses) for physically and mentally disabled people. These small houses are placed within communities so that the "special" individuals are given the opportunity to interact with local people.
Slavomír Krupa inspires trust. He has been working in the field of social care for more than two decades. Even during the Communist period, he forged a series of innovations for improving the quality of life of disabled children. He has had a distinguished career, including senior administrative responsibilities within the government, during which he has maintained an independent personal perspective despite the centralized nature of social services during the Communist regime. While director of an institution for children, he never agreed with the prevalent idea that mentally retarded children were "uneducable," which informed the official view. He started a project school designed to provide the children with skills that would maximize their self-reliance and integration into society. Within his institution, Krupa also established Slovakia's first integrated nursing education program, in which nursing students engaged in practical studies as part of their training. He has set up, protected and supervised housing projects and workshops for adults and children who are leaving institutions, to ease their transition into society. Always his work has reflected his deep spiritual commitment to the service of others and to the provision of care.