Marilyn Lamb

541 Days Road, Kingston, ON K7M3R8, CA

The Reclamation Project: The Value of Living Life at the Helm

Stories of life in an institution and the voices that closed them

Marilyn Lamb

I started my career in 1966, working at the Adult Occupational Center in Edgar, Ont. Previously an air force base, this center was the beginning of the downsizing of larger facilities in Ontario. It was a complex where residents were free to wander within the grounds. There were a number of living options including homes or ward like settings that accommodated two or four individuals.

The people that lived there were not only there as a result of intellectual disabilities. Residents were sent from Penetanguishene, and 999 Queen St Toronto. Many of these individuals were dually diagnosed, not only with significant mental health issues but with serious criminal charges as well. Members of this population often preyed upon those with intellectual disabilities. The justice system was not able to accommodate these individuals because of their intellectual disabilities and the large mental health institutions were closing.

The behaviour protocols used at Edgar were hold overs from old institutional care, such as cold showers for anyone exhibiting noncompliant or deviant behaviour. Some staff took pride in documenting these sessions in the daily log book. Thankfully, through training and developmental opportunities, staff slowly recognized how terribly wrong these archaic approaches were. This could have been an idyllic setting to transfer from the large facilities to more independent living but the problem was a shortage of staff. As a result, there was not the ability to interact on a one to one basis to help promote individual growth.

Edgar had onsite vocational services and a heavy focus on recreation. I was a graduate of the very first MRC course that was taught at Huronia. Most of the Edgar staff came from here. This was a mixed blessing, as the staff knew many of the clients and could interpret their needs. The majority of staff also really cared for the people who transferred to Edgar but, unfortunately, the old institutional approaches were implemented.

In 1973 I began working at Prince Edward Heights in Picton. I started in the village setting, Training and Rehabilitation (T&R) where individuals had the freedom to wander around the community. They had a church/assembly hall, a recreation center, an arts/crafts building, a canteen to buy treats, a playground and a school complete with gymnasium. Another section (the Craig Building) contained wards, offices, the infirmary, the main kitchen where meals were made, transportation, stores, a playground, and day programs including a bakery, carwash, and leisure center.

Staff shortage in the village was a big problem as there was only 1 staff assigned to look after 3 or 4 houses. Each house had 4 to 6 inhabitants. Beyond basic personal care, meals and medications there was not enough time for staff to facilitate quality time or have a developmental focus. Residents were free to go into others homes and would often harass other residents both physically and sexually. This was understandable because the people had never been exposed to social norms and certainly not an understanding of appropriate relationships. The very basic social cues were missing. The only answer would have been a much larger budget with staff available for one to one training, particularly in community interaction regarding acceptable behaviour. In hindsight, the later evolution of person centred planning including the individual, their family, and involved staff would have been invaluable.

At the time, most behavioural measures included Compliance Training, physical restraint and time-out rooms. These measures also included increased medications. The reasons for the increase behaviours were not explored and were documented by many different staff who were not qualified to do so.

I then went from working in the village to the ward setting. I can only use the term “culture shock” to describe my experience here. I was disheartened to see wards where 20 men would line up naked in the bathroom to have their showers, line up in the hallway to be allowed into the dining room to eat, and the amount of medications individuals were prescribed. The time out room was also utilized to control anger outbursts. This was done to protect others living on the ward and also, hopefully, the individual would calm down. Thankfully, the timeout room quickly became a linen closet.

Only a small percentage of individuals had any family involvement at all. Throughout the years, family involvement had not been maintained. Families did not feel able to question decisions made by the facility. Eventually, many families were reconnected but at that time they were not involved in the individual planning.

With the plan to close facilities in the late 1980’s, Prince Edward Heights’ Executive Director, Rick Williams, became very frustrated with the Ministries’ slow response and began developing group homes and a family home program.

In the new homes, individuals began to thrive. I think the reasons for their success were that clients were moved into homes with people who were their friends or at least were familiar with each other. Also, the staff were consistently assigned to one home so there was a small team of staff who were able to work together, to communicate and to relate to the people they were supporting.

Prior to the facility closing, the community developments were transferred to a community based board of Directors. The Crown Transfer Act allowed staff to transfer to the new agency, Pathways to Independence, while maintaining salary and benefit levels. It is interesting to note that eighty-two positions were transferred to the new agency. It was amazing that eighty-two staff chose to leave the ministry at a time when many institutional staff were fighting to stay. The majority of the staff were thrilled to be able to support people in a new progressive environment.

As for the transition of individuals from the institute to group homes, I was amazed at the ease in which people transitioned. Many people were excited to pick their own furniture, or to sweep their own floors.

Staffing shortages were still an issue as people began to access services in the community. The Ministry also had an “across the board” 2% cutback in funding. As a result, the PSW/CSW role was introduced.

There were staffing issues where many staff from the institutions would not get on board with visions of inclusion and showed a general lack of a global picture. It was determined that the agency itself was not clearly defining its mission and goals. The Board of Directors, Executive Director, family members and staff from all divisions of the organization spent considerable time defining our direction. Through much debate and at times heated discussions we evolved from the "taking care model" to a support model, supporting individuals and their family, friends, volunteers and assigned staff to participate in Person Centred Planning. Some tasks that were identified were then assumed by family and others, who were part of the team. Many goals were small and others were not feasible at the time but could be planned for. Certainly, the power shifted to where it belongs.

This all happened many years ago and I have been gone for many years but I do know the direction of the organization has not changed. Future goals include smaller homes, with smaller numbers of people who all choose and want to live together. Families will be more involved in decision making. Family home providers will be selected to focus more on providing a developmental environment, as well as trained to deal with behavioural and medical concerns. More funding and incentives will be offered to family home providers.

The government has to realize what funding cuts do to service provision. Eighty percent of an agency’s budget is for staff. When cuts come, that is the only place where this can happen. This is definitely the most significant issue throughout the province.

We must think beyond the current options. We must be creative and make sure we never go back to large, segregated institutions.