Selection of activities for assisted living for the disabled. Current issues of assisted living

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

“Assisted 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 the conditions of life and preservation stay in a familiar, favorable environment for him, ”the document says.

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

Depending on the state of the person, the nature of his disease, needs and opportunities, three options for the provision of social services are provided: constant support, regular and periodic. The option of accompanied accommodation is determined by the degree of disability: the ability to self-service, independent movement, orientation, communication, training and work, the ability to control one's behavior.

Permanent support is recommended for people with severe disabilities who need constant supervision, help and care every day. Regular accompaniment is recommended for people who can partially support themselves, but need regular help, frequent reminders, and sometimes substitute performance. But for people who need only a reminder several times a week and in some cases the help of escorts, periodic accompaniment is recommended.

Accompanied accommodation for persons with disabilities is recommended to be organized both in group and in individual form. Individual accommodation is recommended for those who need only occasional accompaniment, group accommodation for those who need regular or permanent accompaniment.

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

“The result of the organization of accompanied residence should be the residence (continuation of residence) of a recipient of social services with a disability at home with the provision of the necessary social services,” the document says.

Earlier we, that in St. Petersburg started a unique social project: the country's first house of assisted living for people with various forms of disability was opened in the Novaya Okhta residential complex. It will house disabled people who cannot be cared for by their parents and who had to go to social institutions

We are also talking about the opening of the House of Veronica 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, there is a network of organizations in Pskov that provide early assistance in the development of children at risk at the age of 0 to 4 years, the upbringing and education of children with disabilities from 4 to 18 years, employment after 18. It is important that at the same time children and adults live in families. The public organization of parents of children and adults with disabilities "Me and You" together with the Center for Curative Pedagogics and Differentiated Education developed the concept of assisted living.
This social practice is aimed at introducing a new model for the provision of social services to people with disabilities outside of stationary institutions. The implementation of the practice takes place 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 Center for Curative Pedagogy and Differentiated Education (hereinafter referred to as the Center for Curative Pedagogy), the public union "Pskov Initiative" participate in its implementation. (Germany).
Each of the partners has committed itself to creating 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 escort services. The Center for Curative Pedagogics organizes staff training in assisted living technologies for disabled people. The public organization "I and You" takes responsibility for coordinating the work of the practice, equips the apartments with furniture and necessary appliances, and organizes 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 the current expenses associated with their life in an apartment.
The practice is financed from different sources. A large one-time contribution was made by the municipality of Pskov, allocating within the framework of a long-term target program"Dwelling" 10,000,000 rubles. for the purchase of four apartments for assisted living. The administration of the Pskov region finances the expenses for the payment of 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 the payment of specialists. Residents themselves at the expense of their pensions cover the cost of food, utilities, expendable materials and soft inventory, as well as the organization of leisure.
From July 2013 to June 2015, a pilot stage of social practice is being implemented. During this period, it is planned to obtain the following results:
- work out a model of assisted living based on two apartments in an ordinary residential building with the participation of 10 permanent residents with disabilities;
- develop legal documents necessary for the introduction of assisted living in the Pskov region;
- involve volunteers and the public in solving socially significant problems related to the social integration of persons with disabilities.
Most importantly, people who cannot exercise their rights on their own, as a result of common efforts, will be able to find a decent life in society even after the death of their parents.
With the help of a survey, families were identified who were ready to actively participate in assisted living. Criteria were developed for selecting participants in the practice from among persons with disabilities and their families, a coordinating council was created, which was entrusted to select participants based on the developed criteria. Apartment equipment plans, various issues future life young people were discussed at meetings with parents. All future residents completed a four-month independent living training course at the Educational Residence Department of the Center for Curative Pedagogics.

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

Description:

The article describes 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 of the organization of assisted living are considered, its main characteristics are listed, the necessary resources are analyzed, as well as the problems of preparing people with disabilities for this form of living arrangement. It also touches upon the provision of necessary services for accompanied accommodation and the functions of accompanying persons.

Publication date:

01/10/18

Copyright holder:

Charitable Foundation "Downside Up"

18 years is a conditional milestone when we say to yesterday's child: you are already an adult. But how to determine whether a person has really matured? Perhaps the most important thing is his ability to independently make adequate decisions and be responsible for his actions. Parents and teachers of special children also dream of seeing them as adults, independent - to the extent possible. And nowhere is real independence brought up as well as in conditions of life apart from parents. True, when we enter this area, many questions and doubts arise, but there is also a life reality: parents leave, children grow up ... How can we ensure a full life for them 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 special needs. Article by Andrey Tsarev, Director of the Center for Curative Pedagogics and Differentiated Education of the Pskov Region, First Deputy Chairman of the Commission for the Development of the Non-Profit Sector and Support for Socially Oriented NGOs of the Civic Chamber of the Russian Federation, Chairman of the Council of the Interregional public organization in support of people with mental and psychophysical disabilities "Equal Opportunities" - about how to organize such living. Andrei Mikhailovich has been working in the field of helping people with mental disabilities for more than 25 years, and through the efforts of his team, in cooperation with German partners and authorities, a system of assisted living has been created in the city. The theoretical provisions set forth in the article, we, members of the editorial board of the journal “Down Syndrome. XXI century” by N. Groznaya and M. Fursova, supplemented with their own “marginal notes”, as they visited Pskov and saw with their own eyes: accompanied living is a chance for a worthy future for today's special children.

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

The least protected and most in need of state and society assistance are people with mental disabilities. As a rule, in childhood, continuous work is carried out with them 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 disabilities live in orphanages for children with mental retardation and physical disabilities and adult psycho-neurological boarding schools (PNIs). Young people with mental disabilities who grew up in families often end up in PNI as their parents age and die. Life in an isolated environment without any perspective and hope for change usually results in the degradation of the individual.

Today in society there is an urgent task to develop such forms of life arrangement 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 effectiveness of the use of 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 educating and adapting them to everyday life, preparing them for independent life outside the walls of boarding schools and accompanying them during their stay, in social daytime employment. The corresponding terms appeared: “accompanied living”, “educational (training) accompanied living”, “accompanied social daytime employment”.

Fundamentals of assisted living

All these practices are developed mainly by socially oriented non-profit organizations (NPOs) and parent associations. The latter are most interested in creating decent living conditions and daily employment for their adult children. In addition, in some regions, the authorities meet the needs of public organizations and make positive decisions in this area, including within the framework of social partnership. Innovative experience of assisted living and assisted 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 the support of persons with severe developmental disorders is a complex, continuous process that is carried out at all stages of a person's life. The main characteristics of assisted living include the following:

1. Life at home, not in an institution. By "home" is meant, firstly, the homely atmosphere, way of life, the availability of personal space, etc.; secondly, housing, documented for a 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, municipalities. It is possible to use residential premises located on the territory of boarding schools only at the stage of study residence;
2. Life with an escort. Accompanying accommodation is the provision of a range of services and activities that , firstly, they allow to satisfy the basic vital needs of a person (in the organization of everyday life, communication and leisure); secondly, they support the maximum possible independence in solving various life tasks. Independence support is teaching a person in the process of everyday life to independently or with minimal help make choices, make decisions, perform actions at an accessible level, i.e. take an active life position. Escort motto: " Help as much as needed, self-reliance as much as possible».
3. Living in places where people normally live- in locality, in a separate residential building or in an apartment of a residential building in the vicinity of other people and with the necessary infrastructure (shop, public transport, clinic, post office, etc.).
4. Having an accompanying day job or employment. A person with a mental disability should not be at home 24 hours a day. Like most adults, in the morning he must go to work or to an organization where he is provided with social employment services, and return home in the late afternoon.

Thus, assisted living is understood as such a form of life arrangement for a person with a disability who is not able 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 the organization of life, leisure, communication and social relations, taking into account his individual needs.

Today, the issues of legislative consolidation of the concepts of "accompanied residence", "accompanied social daytime employment" and "accompanied labor activity" remain the most acute. In this regard, public organizations are making proposals to fix these concepts in two federal laws - in Federal Law No. 181 "On the Social Protection of the Disabled" and Federal Law No. 442 "On the Fundamentals of Social Services for Citizens of the Russian Federation". In addition, there are still legal provisions that do not allow able-bodied people to voluntarily leave PNI. We are talking about Federal Law No. 3185 “On Psychiatric Care and Guarantees of the Rights of Citizens in its Provision,” which also needs to be amended.

How to Organize Accompanied Accommodation: Theory and Practice

Residential premises and its arrangement

A dwelling 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 dwelling located in a city or in countryside that meets the required parameters. What housing options are we talking about? First, its location in the village. It is important to provide that within walking distance from such housing there are infrastructure facilities used by other local residents (shop, post office, clinic or first-aid post, public transport stop, etc.). Secondly, this is a set interior spaces 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, adjust it to the needs of special people. As a result, two large five-room apartments were made from four apartments, which are located in neighboring entrances. When you enter the apartments, you immediately understand that this is not ordinary housing. What makes him different? Spacious entrance hall, wide corridors - interior passages, large living-dining room, several bathrooms (bathroom and toilet are combined), technical room (laundry room). In the children's rooms (they live one or two), each has an individual design, because they themselves, together with their parents, thought out what their room would be like. The rooms have everything you need, but at the same time there is no feeling of clutter: nothing superfluous, everywhere is order and cleanliness. The apartment has a room for accompanying persons and a small office where documents are stored. If people who need additional equipment live in the apartment, then it is installed. So, for example, for Sergei, who uses a wheelchair, a special ceiling rail system has been installed, which helps social workers lift him up and put him on the bed. Both apartments are located on the first floor of the house, curbs were removed in front of the entrance to the entrance, a ramp was installed, a folding ramp was also made 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 it is harmful to quarrel. In order for the neighbors to treat special residents well, the guys try to keep order and cleanliness. When they arrived at the houses, they arranged a yard festival for families with children who live in the neighborhood on the playground. At this holiday, in games and easy communication, they met their neighbors, answered all the questions that they were afraid to ask. Now special people are full-fledged 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 you can find the necessary things, how and in what sequence perform any household action (make tea, set the table, wash clothes, etc.). But one cannot talk about the independence of people with developmental disabilities if they are constantly given oral instructions. It is better to create a system of reference points in a residential area that will allow a person with intellectual disabilities to independently (as a result of targeted training) solve accessible everyday problems. Such landmarks can be graphic images of objects and actions with them, action algorithms made up of them.

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

Type of ownership

The form of ownership of the residential premises in which assisted living takes place may be different. There are pros and cons in each of the options, so it is important that the 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 in the shared ownership of the participants of the accompanied residence; may be the property of one person, including a benefactor; may be owned by an organization, local authorities or state structures. With all the variety of forms of ownership, it is important that the dwelling be documented for the person living in it - a participant in the accompanied residence (or his guardian). If the dwelling is not owned by the resident, it can be provided to him on the basis of a contract of employment, lease, gratuitous use, etc.

In Pskov, assisted living apartments belong to the city, i.e., they are in municipal ownership. The city rents them out to residents for a minimal fee (about 500 rubles per person per month). Lease agreements are drawn up either with capable people with developmental disabilities, or with legal representatives of incapacitated tenants. The question arises: do families have guarantees that tomorrow the city will not change its mind and take 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 this - it is politically unprofitable for them. On the contrary, in Pskov the regional administration even finances escort services, which is very important. This is a serious guarantee of the stability of the entire system of assisted living. The public organization "Me and You" equipped the apartments with furniture and necessary appliances, organized the training of escorts and organizes the process of assisted living in general. In addition, it attracts volunteers who provide individual assistance to residents.

Assisted Living Resources

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

• the budget of the subject of the federation (for example, in the form of a subsidy of state authorities in the field of social protection of the population of the subject of the federation for the provision of social services);
• charity (including targeted donations);
• grants provided to organizations - service providers;
• own funds of service recipients (pension, savings, housing, etc.).

As an example, let's take an estimate of the current costs incurred by a service provider in Pskov (this is a socially oriented NGO "Me and You") in the conditions of two apartments of assisted living with eleven participants.

Table 1. Information on the average monthly expenses for accompanied living of one person (for 2017)

The calculation does not include the cost of capital investments - the acquisition and overhaul of housing, the purchase of equipment.

In the above example, escort is provided to people with a severe form of disability who need constant (from 8 to 24 hours a day) or regular (from 4 to 8 hours a day) escort. In the case of residence of disabled people who receive accompaniment periodically (from 4 to 12 hours per week), the costs under this item are significantly reduced.

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

Formation of a group of people with disabilities and its training 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) help to solve certain life tasks (for example, when distributing money for purchases, etc.). According to this system, Olga Chobur, a woman with Down syndrome, lives in Pskov.

2) in small groups - usually from 3-4 to 7 people living in the same 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 need regular (from 4 to 8 hours a day) and permanent (up to 24 hours a day) accompaniment.

When forming a group of residents, the rule "Measure seven times - cut one" should apply. Experience shows how important it is to initially involve all interested participants in the process of creating a group: the people with mental disabilities themselves, their parents, and those who accompany them.

To form such groups in Pskov in 2011, a survey was conducted of parents of adults with mental disabilities. It was assessed that they know about assisted living, whether they need it and whether they are ready to actively participate in this project. The results of the survey 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 unwillingness of the youngest person to live separately from his parents;

Fear of parents to let go of an adult child;

Uncertainty about the appropriateness of such a residence;

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

Uncertainty in the ability of a young person to live separately from his parents, even with accompaniment;

Uncertainty about the quality of services provided.

Of the 140 families who completed the questionnaires, only 13 expressed their 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, at which the main desires and hopes of families were expressed. In most cases, parents would like their adult children to stay in the city, in familiar and comfortable conditions, to continue working and studying throughout their lives. Young people themselves expressed a desire to "live independently."

In this way, first condition group formation is man's desire with a mental disability and their loved ones to participate in assisted living.

Unfortunately, not all the children living in Pskov apartments of assisted living have parents alive. But it so happened that everyone has brothers and sisters. Nastya got into the apartment according to an accelerated scheme: her mother died, and her sister, who became a guardian, lives in another city. The sister decided that the option with accompanied accommodation would suit Nastya, she 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 cohabitation and the passage of an appropriate training (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, escorts try to teach people with disabilities basic skills, primarily in the course of solving specific life tasks (for example, in order to have dinner, you need to plan a menu, buy groceries in a store, cook meals from them, set the table, etc.). d.). It is important that escorts provide assistance only to the extent necessary for a person with a mental disability to be able to independently perform a particular activity.

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 different form: in small groups, in the form of trainings and general meetings with teachers, a psychologist, a lawyer (Table 2). At the meetings, young people with disabilities and their parents worked separately, but addressed the same issues. There was not only discussion, but also modeling different situations living together, 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 parents of the children to agree on the rules. Between them there were discussions, disputes, misunderstanding. After all, even the simplest things in everyday life (like washing dishes, cooking dinner, cleaning) each owner does in his own way. But in order for the children to live peacefully and calmly in the future, the parents needed to agree. Which is what they ended up doing.

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

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

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

Fourth condition – inclusion in a group of participants with a need for a different scope of services. If we accept into the group only people with severe disorders of the musculoskeletal functions who need 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 ​​\u200b\u200bliving quarters and massive lifting equipment will be required. Inclusion in the group only people with severe violations behaviors that need constant supervision will also require a large number companions, and in addition, there will be a risk of turning 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 a chance to other, more “severe” disabled people?

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

Fifth condition organization of assisted living – the presence of day labor or social employment separately from the place of residence. The need to separate the place of residence and place of work (employment) is dictated by the principle of normalization of life.

Assisted Accommodation Services

The essence of assisted living is that people with mental disabilities are provided with social services at home in the necessary and sufficient volume. Unlike traditional social services, in assisted living, the social worker does not do for the client what his ward can and knows how to do on his own, but provides as much assistance as 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 in certain services. This will allow, on the one hand, to identify their ability to independently perform a particular activity, on the other hand, to determine their individual needs for assistance and care. Based on the assessment data, an individual program for supporting residence (IPSP) is being developed, the development of which also takes into account the individual program of the recipient of social services (IPSSU) and the individual program for the rehabilitation and habilitation of the disabled (IPRA).

Assisted living 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 of social services and their standards. Unfortunately, today the current lists and standards largely diverge from the above principles and requirements for the organization of assisted living. In particular, the standards and other normative acts do not provide the required scope of services, educational orientation in the process of support, developmental care.

Functions of maintainers

Accompaniment of accommodation is carried out by an interdisciplinary team of specialists, including full-time employees: a social pedagogue, a psychologist, social workers, a manager, as well as specialists involved on an hourly basis: doctors (psychiatrist, neurologist) and lawyers. All professionals must receive appropriate training.

The mode of work of accompanying persons can be organized in shifts: morning, afternoon and night shifts, taking into account the fact that on weekdays the residents will be at work or in organizations that provide daytime employment. On weekends, escort takes place around the clock, taking into account the needs of residents.

A team of specialists takes a comprehensive approach to working with residents, which is based on respect for the dignity of the individual of each person. Together, specialists 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 tasks that relate to his professional competence and are included in job descriptions. Thus, a social pedagogue teaches residents the skills of everyday and social and communicative activities, deals with organizational and legal issues, communicates with organizations and specialists that provide services to his clients, maintains contacts with relatives, etc. Social workers directly provide support: they help those living in everyday life , self-service and hygiene procedures, leisure. The head organizes and coordinates the work of assisted accommodation specialists, monitors the maintenance of documentation, resolves logistical and financial issues, and also participates in accompanying residents.

An important role, especially in the initial stages of accompanied living, is played by a psychologist. As the Pskov specialists admitted, for the first two years the psychologist almost always worked 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 to create a suitable psychological climate in the apartments, to establish friendly, constructive relations between all participants of the assisted living: disabled people, their relatives, accompanying people, housemates. Of course, when the life of the apartments is established, the help of a psychologist is needed, albeit 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 "Me and You" (http://me-and-you.ru) and the Center for Curative Pedagogics Pskov region (http://clp.pskov.ru/).

The development of 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 assisted living, the legal framework of organizations that deal with assisted living, and to prove to the state that it is more profitable to develop assisted living than to maintain a boarding school system. It is important that the accompanied accommodation itself be variable, the system flexible. Today, the main thing is that the public and the state are working in this direction, which means that parents have a chance for a worthy 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 assisted living projects or to support the projects of other parents. And when such a 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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Article 19. Independent way of life and involvement in the local community
States Parties to this Convention recognize the equal right of all persons with disabilities to live in habitual places of residence, with equal choices as others, and shall take effective and appropriate measures to promote the full realization of this right by persons with disabilities and their full inclusion and involvement in the local community, including ensuring that:
(a) Persons with disabilities have the opportunity to choose, on an equal basis with other people, their place of residence and where and with whom to live, and were not required to live in any specific housing conditions;
(b) Persons with disabilities have access to a variety of home, community and other community-based support services, including the personal assistance needed to support life in and inclusion in the community, and avoid isolation or segregation from the community ;
(c) Community services and facilities for the general population are equally accessible to persons with disabilities and meet their needs.
In the Initial Report of the Russian Federation on the implementation of the UN Convention on the Rights of Persons with Disabilities in relation to obligations under Article 19, the following measures undertaken to implement:
Article 19. Independent way of life and involvement in the local community
27. The Russian Federation recognizes the equal right of all persons with disabilities to an independent lifestyle and involvement in the life of the local community in accordance with Article 130 of the Constitution of the Russian Federation and Federal Law No. 131-FZ of October 6, 2003 “On general principles organizations of local self-government in the Russian Federation”.
28. In accordance with the norms of the Constitution of the Russian Federation (Article 40), everyone has the right to housing (a). No one may be arbitrarily deprived of their home.
In order to ensure the right of persons with disabilities to their place of residence, the Housing Code of the Russian Federation (Article 52) and the Law on the Social Protection of Persons with Disabilities in the Russian Federation (Article 17) establish that persons with disabilities and families with disabled children who need to improve their living conditions, who have embarked on registration before January 1, 2005, have the right to housing, including at the expense of the federal budget, and other disabled people - the right to social housing at the expense of the budget of the regions.
Registration of citizens in need of residential premises is carried out by the local self-government body at the place of residence.
Judicial authorities implement the practice of protecting the rights of disabled people to receive housing, which is confirmed by the attached decision of the Judicial Collegium of the Samara Regional Court (Appendix 11).
29. Residential premises occupied by disabled people are equipped by special means and devices in accordance with the individual rehabilitation program for the disabled. Payment for housing, housing and communal services for the disabled and families with disabled children is set in comparison with other persons in a preferential regime (with a discount of at least 50 percent) (c).
30. The draft law on the implementation of the Convention provides for the obligation of state authorities and local self-government to create conditions for persons with disabilities to have unhindered access to common property in apartment buildings, as well as a requirement to ensure that living quarters are adapted for use by persons with disabilities (c).
31. In order to ensure equal accessibility for persons with disabilities to receive services accompanied by personal assistance, the draft law on the implementation of the Convention for the first time provides for measures to form a system for assisting persons with disabilities in overcoming barriers from assistants and intermediaries as staff of institutions providing services (in particular , at social and transport infrastructure facilities, polling stations) and social service personnel. Determining the procedure for providing such assistance is the responsibility of the federal and regional authorities. (b, c)
32. The provisions of the Law on the Fundamentals of Social Services adopted in December 2013, which introduced social support citizens, including the disabled, in the provision of social services, involving assistance in the provision of medical, psychological, pedagogical, legal, social assistance, not related to social services, based on interdepartmental interaction of organizations providing such assistance. Social support activities are carried out using succession methods and in accordance with an individual program for the provision of social services. (b)
33. In order to improve the targeting of personal assistance necessary to support an independent lifestyle of disabled people in the local community, after the ratification of the Convention, Federal Law No. 258-FZ of December 25, 2012 “On Amendments to the Federal Law “On State Social Assistance” was adopted, who have been introduced to provide state assistance on the basis of a social contract and to poor families, including disabled people who want to take active steps to overcome poverty, regional authorities provide more significant material support compared to other persons if a social contract and adopted an individual program for their social adaptation. (b)
34. In the Russian Federation, there are over 2,200 centers (complex centers) of social services with 477 temporary residence departments and 808 day care departments. Nearly 13,000 home social service departments operate successfully at social service centers. A diverse range of services provided by social workers, including at home (socio-medical, rehabilitation, psychological, social services), are received on a daily basis by about 627,000 disabled people (adults and children). (b) Starting from 2012, the processing of applications for the provision of social services at the request of a disabled person can be carried out electronically, as well as using the application to multifunctional centers and “single window” technology at the place of residence.
The increase over the past 3 years by 40% of the proportion of citizens, including disabled people, receiving social services at home in the forms corresponding to the provisions of the Convention (foster family, home services, sanatorium at home), contributes to increasing the ability of a disabled person to choose a place of residence, including number in the family without undue burden on other family members, without elements of segregation and isolation from the local community. (b)
35. Key areas for further improvement social policy in order to ensure an independent lifestyle for disabled people in the local community, it is the development of innovative forms of social services, the expansion of the practice of placing disabled people in foster families, the introduction of public-private partnerships and the development of a competitive environment in the provision of social services to them. To this end, the preparation of regulatory legal acts on the approval of relevant standards and rules for rehabilitation and social services is being carried out.

Comments of public organizations of disabled people:

1. Currently, almost half of the citizens with mental disabilities, recognized as incompetent, live in stationary institutions 8 . The practice of placing citizens in stationary institutions without giving them a real opportunity to independently choose their place of residence or participate in making such a decision is contrary to the Convention.
2. Living conditions in public hospitals are gradually improving in some regions, but in many regions they not only do not meet sanitary standards, but are actually close to psychiatric hospitals. Systemic changes are needed in the organization of living conditions in these institutions and the development of internal regulations that meet the requirements of the current legislation and the Convention. Living conditions in public hospitals should be reviewed in terms of ensuring the dignity of the individual, autonomy of will and the maximum possible participation of residents in the life of the local community.
Commentary of VOOO ARDI "Svet", Vladimir: it should be noted that there are no alternative PNI 9 accommodation options for people over 18 years old. Of course, living in a psycho-neurological boarding school is a state-guaranteed form of accommodation for a person with special needs. This form could be quite acceptable if all the conditions for the development of the personality and individuality of a person were created in boarding schools, if there were labor workshops, circles for creative work. However, this is impossible due to the very specifics of such institutions, since living under the same roof of hundreds, and in some cases more than a thousand people, and even with severe health disorders, will inevitably make such institutions closed and based on a strict regime. That is why the openness of such institutions for public control is important,

8 Stationary social service institutions are organizations that provide services in a stationary form. According to paragraph 3 of Article 19 of the Federal Law “On the Fundamentals of Social Services for Citizens in the Russian Federation” dated December 28, 2013 No. 442-FZ, social services in a stationary form are provided to their recipients for a permanent, temporary (for a period determined by an individual program) or five-day (in week) 24-hour accommodation in a social service organization. Recipients of social services in a stationary form are provided with living quarters. The names of such institutions may be different - for example, a boarding house, a psycho-neurological boarding school; they can be specialized, that is, provide social services to a specific group of citizens (elderly citizens and disabled people, disabled children, etc.)
9 Psychoneurological boarding school (abbr. PNI).

which has not yet been observed. This creates a situation where violations of the rights and legitimate interests of citizens living there become part of official practice 10 .
Commentary of the Association Desnitsa, Samara: independent living for a person with a mental disability is not necessarily living in a family, it can be living outside the family, including in an institution, but the choice should depend on the desire, preferences and needs the person himself. The choice should be made by him, and not by other people for him. key point in deciding which type of residence is suitable for a person, it must be the choice of the individual... The right to live in a small institution can also be considered as a right to independent residence, it cannot be said that this is inconsistent with the Convention. Living independently can also include living together with several people with disabilities in a small family-type community - however, it can also be called “living at home”. But the PNI system in its current form can hardly be called independent living... 11
3. According to the Law of the Russian Federation "On psychiatric care and guarantees of the rights of citizens in its provision" dated 02.07.1992 No. 3185-1, an extract of a citizen suffering from a mental disorder from an inpatient institution (boarding school) is possible upon a personal application of a person, including a person recognized in the manner prescribed by law as legally incompetent, if there is a conclusion of a medical commission with the participation of a psychiatrist that, for health reasons, such a person is able to live independently (Article 44). This law does not provide for guarantees of free legal assistance in making such decisions, as well as the participation of independent experts and the participation of a citizen in making such decisions. In practice, for citizens living in a boarding school, making decisions about independent living depends entirely on the opinion of the doctor of this institution or the administration.
The studies reflect dissatisfaction with the current system of rights protection and the lack of information about rights. Surveys conducted in a number of Russian regions in 2011 showed that more than 89% of the interviewed persons with mental disabilities and their family members are not satisfied with the existing system of rights protection and the lack of accessible information about their rights. More than 68% of this number would like to receive legal assistance 12 .
4. A typical situation in a stationary institution (hospital or boarding school) is that the citizen is ready, according to experts, to live an independent life outside the institution, the citizen himself wants this. However, there is no way to find a guardian for him, because he does not have relatives who are ready to take on the duties of a guardian, and in the regions there are no state or municipal services of professional guardians.
An example from the city of Samara: “A journalist contacted our organization after learning about a young man of 27 years old who is in a psychiatric hospital due to the fact that his father and stepmother, having recognized him as legally incompetent, subsequently refused guardianship,

10 Situation report on the project “Legal education and increasing civic engagement in the field of protecting the rights and freedoms of people with disabilities” (January-September 2014), p. 12 // http://perspektiva-inva.ru/protec-rights/articles/vw-2051/
11 Analytical reference SGOOIK "Association Desnitsa" (Samara), p. four.
12 Monitoring violations of the rights of persons with mental disabilities and their families. M.: ROOI "Perspective", 2011. S. 13.

after which he was placed in a psychiatric hospital without the right to leave. He is not even allowed to walk on the territory of the hospital. At the same time, according to the chief physician of the hospital, his condition is currently satisfactory, but there is no person who would be ready to issue guardianship over him.
Particularly noteworthy is the fact that at the time the court considered the application for declaring him incompetent, neither he nor the persons who could confirm his legal capacity were present, which was ignored by the court despite the fact that, according to paragraph 1 of Art. 284 of the Code of Civil Procedure of the Russian Federation, the court considers an application for declaring a citizen incompetent with the participation of the citizen himself, the applicant, the prosecutor, the representative of the guardianship and guardianship authority. A citizen in respect of whom a case is being considered on declaring him incompetent must be summoned to the court session, if his presence at the court session does not endanger his life or health or the life or health of others, in order to give him the opportunity by the court to state his position in person or through their chosen representatives. The current legislation provides as a mandatory condition for questioning the person in respect of whom an application for recognition as incapacitated is filed, in order to form the court's own objective opinion about his state and ability to be aware of his actions and their consequences. The role of community organizations in documenting such cases should be more recognized and demanded by the public authorities that are responsible for implementing policies to support independent living.
4. The issue of supporting independent living needs a systematic solution and more detailed legislative formulation. Thus, the system of services close to the place of residence of a citizen, the provision of social services at home, needs to be developed. The institution of support for citizens living independently in their own housing, in the form of the appointment of a professional guardian (that is, an organization or citizen whose permanent professional activity is related to the performance of the duties of a guardian and is performed by them for a fee), is developing poorly. The institution of patronage and the appointment of an assistant, which is provided for in Article 41 of the Civil Code of the Russian Federation, is very rarely used.
For example, according to 2010 data, Arkhangelsk region 6641 people have a disability due to mental illness, including 2881 recognized as incapacitated. Of these, slightly less than half (1265 people, 43.9%) live in stationary institutions of social protection. The remaining 1,616 citizens live with families, or are single or are in psychiatric hospitals 13 . Accordingly, only a small part of citizens living independently has the opportunity to receive the support of a professional guardian. Considering that the only municipal institution in the region (MBU Center for Assistance to Adults in Arkhangelsk) provides professional guardian support, only citizens living in Arkhangelsk can receive such a service, it is not available in other municipalities of the region. Under patronage, according to the data of the social protection authorities for 2012, 478 people in the Arkhangelsk region (including citizens with mental disorders) have an assistant in accordance with the patronage agreement concluded in accordance with Art. 41 of the Civil Code of the Russian Federation.

13 Public report on the observance of the rights of people with mental disorders and mental disabilities in the Arkhangelsk region and recommendations for the implementation of their rights in accordance with the UN Convention on the Rights of Persons with Disabilities. Arkhangelsk, 2013, p. 16.

At the same time, 90% of them (423 people) are under patronage in the city of Arkhangelsk 14 . In other municipalities, patronage practically does not develop, which is due to insufficient attention on the part of the authorities to the development of patronage, the lack of legal and organizational mechanisms for its development at the regional level. Patronage services on a professional basis (trained assistants) are implemented only by the only institution in the city of Arkhangelsk (the aforementioned center for assistance to adult wards).
About 40% of citizens recognized as legally incompetent live in social service institutions in the Nizhny Novgorod region. According to the Ministry of Social Policy of the Nizhny Novgorod Region, as of January 1, 2013, 8,100 adult incapacitated citizens are registered with guardianship and guardianship authorities in the region. There are 10 psycho-neurological boarding schools for 3927 places in the region. The institutions are fully staffed. Of the 3927 people who are on stationary social services, 3079 were recognized as incompetent by a court decision.
5. The right to live independently remains largely a theoretical guarantee due to the fact that the ability to receive social services and support services at the place of residence or at home is significantly limited, despite changes in legislation. In the former Law on Social Services for Elderly Citizens and the Disabled (dated August 2, 1992 No. 122-FZ), the grounds for refusing to provide social services at home were, in particular, the presence of severe mental disorders. The new law does not provide such a basis. According to Federal Law No. 442-FZ of December 28, 2013, the provision of social services in a stationary form may be denied due to the presence medical contraindications. The law came into force on January 1, 2015, and its implementation is just beginning. However, it should be taken into account that until now the practice of restricting the provision of social services to people with mental disabilities has been supported. The list of medical contraindications at the time of this note was not approved by the Ministry of Social Development of the Russian Federation.
For example, in Nizhny Novgorod in social protection institutions such as comprehensive centers social services - cases of inclusion of persons with mental disabilities in day care groups are isolated. According to the established practice, this category of citizens is also denied the provision of social services in semi-stationary conditions, as well as at home. Most of the regulatory documents adopted at the regional level, both in terms of the accessibility of social and transport infrastructure facilities, and in the provision of medical, social and educational services, are focused on people with a violation of the musculoskeletal system, people with limited mobility, people with disabilities due to general illness. But, unfortunately, most often this does not take into account the needs of people with mental disabilities 15 .
6. With regard to children with disabilities (especially children with severe and multiple disabilities), it is still in the state social policy

14 Ibid., p. thirty.
15 Analytical note to the report “On observance of the rights of citizens with mental disabilities in the Russian Federation” for the Nizhny Novgorod region. NROOPDIM "Veras", p. ten.

supports residential device priority over homestay support.
Both federal and regional legislation lack the necessary guarantees of support for a family raising a child with severe and multiple disabilities. The currently available guarantees provide only material support, but not assistance and assistance in development family relations and quality of life.
So, for example, in the Law of the Voronezh Region "On social support for certain categories of citizens in the Voronezh Region" dated November 14, 2008 No. 103-OZ, measures of social support for children with disabilities include monetary compensation, preferential drug provision, the right to extraordinary admission to nursing homes for the elderly and disabled, neuropsychiatric boarding schools and others (Articles 77, 78 of Law No. 103-OZ).
From the materials of the regional report (Voronezh): “ social status of a family raising a child with mental problems is extremely low. As a rule, these are incomplete families, mothers do not have the opportunity to work and, therefore, cannot adequately support their family. More often than not, families survive on meager pensions and social benefit» 16 17 .
7. Regional legislation only partly compensates for the lack of systemic measures to protect the rights of children with severe and multiple disabilities and their families. In some regions, social precinct services are being developed, and “Respite” programs are being developed to provide assistance to families raising children with severe and multiple disabilities.
For example, in the Voronezh region, innovative areas of rehabilitation are being implemented, the most popular of which are:
- social support for families with disabled children;
- cohabitation parents with children in rehabilitation centers. So, in the regional children's rehabilitation center for children and adolescents with disabilities "Sail of Hope" a social hotel with 28 beds was created, in which children with disabilities (including children with disabilities with mental illnesses) are accommodated with their parents for the period of rehabilitation services. Social services are provided free of charge1.
It is necessary to analyze regional experience and develop the most successful forms of support at the federal level.
8. The state as a whole does not sufficiently recognize the role of the non-profit sector in the formation of a system of services that provide support and support, and thus contribute to the realization of legal capacity and promote the participation of citizens with mental disabilities in public life. For example, public organizations of parents of children with mental disabilities use effective forms organization of education, employment, social services, such a resource should be

16 Public report on the observance of the rights of people with mental disabilities. VROOI "Spark of Hope". Voronezh, 2012, p. 5.
17 Analytical note on the situation of people with mental disabilities in the Voronezh region in the light of the implementation of the Convention on the Rights of Persons with Disabilities. VROOI "Spark of Hope", p. 3.

take into account when forming social policy and fix at the legislative level in the form of state social order. The main problem that arises in the way of any social programs for persons with mental disorders- this is the low interest of authorities at all levels, institutions and organizations in supporting public organizations of the disabled and the non-profit sector as a whole.
The participation and assistance of disabled people's organizations in the development of conditions for independent living is very important.
It should be noted that in accordance with the No. federal law about social services with a new approach to regulating relations for the provision of services based on a social contract, the successful experience of non-profit organizations can be obtained state support. The law provides for the possibility of including non-profit organizations in the register of social service providers, as well as the possibility of choosing a service provider when drawing up an individual program for a citizen receiving social services.
Positive regional forms of support for independent living of citizens with mental disabilities:
Since 2010, NROOPD&M "Veras" has been implementing a project on educational assisted living for young people with intellectual disabilities in Nizhny Novgorod. At first, the course of study accommodation was held on the basis of a two-room training apartment, and since 2014 - on the basis of a three-room apartment allocated to the Veras public organization for free and unlimited use by the city administration.
The course of study residence began with two weeks, and now it lasts up to two months. Accompanied by social workers and teachers, two boys and two girls live according to the schedule. Two of them with more mild disorders development, and two - with more severe. This is how mutual assistance is provided.
The learning process is carried out in three main areas:
1. Household activities: cooking, cleaning the apartment, taking care of things, choosing clothes depending on weather conditions, performing hygiene procedures, shopping, etc.
2. Social and communication skills: development of interpersonal relationships,
orientation in the social space, the assimilation of generally accepted norms and rules and their application in everyday life.
3. Leisure activities: learning to choose activities and organize your free time, forming the need and ability to receive guests, visit social and cultural places, go for a walk, etc.
In their free time, the guys play board games, listen to music, watch TV, communicate with loved ones on the phone.
On one Thursday, young people invite friends and parents to visit. The guys think over the menu, prepare different dishes and set the table.
Weekend and holidays Pupils of service of educational accommodation carry out in the family. At this time they perform homework to consolidate the acquired skills. Children attending the workshops of the Center for Curative Pedagogics and Social Adaptation of the NROOPDiM "Veras" (http://veras-nn.ru/work_cat/uchebny-e-tsentry/) participate in the accommodation.
To realize the rights of single people with disabilities to a decent life in Vladimir region implemented and working different forms devices of these people:
Since August 2012, "Foster families for the elderly and disabled (capable)" have been introduced and are operating on the basis of the Decree of the Governor of the Vladimir Region dated August 16, 2012 "On the introduction in the Vladimir Region of the hospital-replacing technology "Foster family for the elderly and disabled" .
The device of incompetent citizens at home, with a non-native guardian. In the Vladimir region, a law “On remuneration due to guardians of incapacitated citizens” was adopted, which entered into force on January 1, 2014.
The device of incapacitated citizens at home in a separate apartment of permanent supported (accompanied) residence.
Preparation of children and young people with a complex structure of the defect for independent, accompanied life in the conditions of "training" apartments. Since September 1, 2005, the Association of Parents of Disabled Children "Svet" has been teaching independent (supported) living in "study apartments" for young people with a complex form of disability.
In Arkhangelsk, since 2005, the municipal budgetary institution "Center for Assistance to Adults" has been operating, which provides guardianship, guardianship and patronage services for citizens living in their own housing (including under a social tenancy agreement), as well as social services of various types, assistance in adaptation, overcoming conflicts, assistance in employment, budget planning, leisure activities, socio-psychological support. Services are provided free of charge and with the consent of the citizen, and the provision of assistance is based on partnership with the client and his immediate social environment.
In the city of Novodvinsk, Arkhangelsk Region, the state budget institution"Novodvinsk orphanage-boarding school for children with serious disabilities in intellectual development"Since 2000, a project of independent living for graduates with mental retardation in an open society - "Service Housing" has been implemented. The project appeared as a result of cooperation between the Regional Department of Social Protection of the Population and the charitable Swedish organization MI-Individual Assistance in Sweden, and was implemented on the basis of a boarding house. Members of the Serviced Housing Program live, work and maintain their own household. 16 graduates live independently in an open society (4 of the first participants of the program created families). Today, the Service Housing project includes two service apartments, and has expanded by renting additional housing (2 graduates have purchased their own housing), which makes this program relevant and viable (http://novodvinsk-intemat.narod.ru/).