The impact of war on Ukraine’s residential care institutions

Russia’s invasion of Ukraine has brought attention to residential institutions that house people who have been assessed as unable to live independently.

These include children’s homes, homes for people with disabilities, neuropsychological facilities for adults with mental health, cognitive or neurodevelopmental conditions, and general facilities for older people.

These are often large buildings – sometimes over two hundred residents – run by local government with limited resources. They are usually in remote areas, meaning residents have few opportunities to engage in community life. Some are located on unsuitable premises: we know of one in a former monastery and another in an old NKVD (Soviet secret police) warehouse. Media and human rights monitoring groups have reported widespread malpractice and poor conditions in these institutions, including residents being confined 24/7 without any stimulation, lack of privacy, over-prescription of psychotropics, unsafe restraint and poor sanitation.

Rather than malevolence, this malpractice is often due to insufficient staffing (an Amnesty International investigation found institutions with staff ratios of 1:35), insufficient training and, in institutions housing older people, a lack of understanding about what ageing well can look like.

Efforts to reform residential care

State, domestic and international NGOs have increased efforts to reform Ukraine’s residential care system, focusing mostly on children’s homes. In 2017, the Ukrainian government launched reforms to the children’s care sector, committing to keep children in families wherever possible, strengthen foster care, and replace large institutions with smaller “family-type” residential facilities. The reforms are positive, although the 2021 decision to exclude facilities for children with disabilities from the process has been widely criticised.

The increased pressure of wartime makes reform difficult to implement. Institutions in the worst-affected areas were evacuated and residents moved to institutions in safer locations which were suddenly accommodating double their usual capacity. Often, staff refused to evacuate and leave their families, meaning that receiving institutions were not only beyond their physical capacity but also had no extra staff.

The strain on capacity is compounded by rising admissions of people who had previously lived independently. By July 2022, over 4,000 older internally displaced people (IDPs) had newly moved into governmental institutions because they could not find suitable housing, were separated from their caregivers, because their pensions did not cover private rents, or found that the strain of the war impacted their mobility and reduced their ability to live independently.

Increased pressure on the care sector

Meanwhile, the war has increased scrutiny on the care sector from Ukrainian and international civil society. Organisations have cautioned that housing evacuees in institutions could undo efforts to deinstitutionalise, and advised using recovery funds to “build back better” rather than rebuilding destroyed institutions. Others go further, appealing to the international community not to give aid to these institutions at all.

European Union (EU) accession also provides both pressure and opportunities to reshape the care system. While Ukraine’s deinstitutionalisation plan exclusively targets children’s facilities, accession to the EU would require Ukraine to meet its standards on all residential care and to uphold the commitments set out in its National Action Plan on the Implementation of the UN Convention on the Rights of Persons with Disabilities, including deinstitutionalisation.

While we fully support deinstitutionalisation, our role as humanitarian actors dictates a responsive approach. We know of institutions unable to provide basic sanitary equipment like bed pads and soap or left windowless by shelling. In one case, staff took residents into their homes after their institution was left without heat.

Would these residents have a better quality of life if they were cared for in their communities? Undoubtedly. But reform will take years. The policy framework has been in place for children’s institutions for six years, yet implementation only began in 2021. No policy framework exists yet for adult social care. Meanwhile, thousands of people in residential facilities are facing extreme hardship. Helping someone readapt from institutional care to community living is complex; for some – particularly older people – it may prove impossible. Moving someone who has limited mobility, and/or who is receiving end-of-life care, can be extremely risky. For people with dementia, a change of environment can be traumatic. Moreover, the lack of stimulation in these institutions can lead residents to lose the independent living skills they previously had.

Supporting residential institutions to improve conditions and build trust

World Jewish Relief continues to support residential institutions, primarily those housing older people. In partnership with the Jewish-Ukrainian Social Initiative and Turbota Pro Litnikh v Ukraini (“Age Concern Ukraine”), we have been providing supplies (including personal hygiene equipment, clothing, shoes, bedding, and kitchen equipment) and funding basic repairs to facilities damaged by shelling, such as reglazing windows and repairing pipework.

We see this not as contradictory to deinstitutionalisation reforms but as part of the same process. It improves conditions as an interim measure. It also builds goodwill and trust with their management, which in turn can give civil society actors valuable access to provide training and voluntary activities. We are supporting our partners to provide additional volunteer capacity, run training to help staff find meaningful occupations for residents, and run social and recreational activities.

Of course, this is not sustainable. Of course, Ukraine needs to close these institutions and develop care in the community. Of course, international aid should not be used to fund the construction of new institutions of this nature and we are concerned by government plans to do so. Nonetheless, we must accept the reality that we are faced with, and at times this means continuing to fund and support residential institutions, to give people who have already gone through immeasurable hardships at least basic standards of living.