04 July 2019

What is institutional care? 15 characteristics of orphanage-based systems

Despite decades of evidence documenting the ways in which institutional care is profoundly damaging for children, it is still difficult to provide a clear and all-encompassing definition of “institutional care of children”. Commonly used terms include ‘institutions’, ‘orphanages’, or ‘children’s homes’. Whatever they’re called, even the best-resourced institutions cannot replace the nurturing and individualised care that a loving family can provide.

What is “Institutional Care”?

Institutional care is a type of residential care for large groups of children. It is characterised by a one-size-fits-all approach according to which the same service is provided to all children irrespective of their age, gender, abilities, needs and reasons for separation from parents. The service provision is depersonalised and strict routines are followed to enable a small number of staff to deliver basic services. Children living in institutions, also known as orphanages, are isolated from the community, often far from their place of origin and unable to maintain a relationship with their parents and extended families. Siblings are often separated and children are segregated on the basis of age, gender and disability.

15 core characteristics of orphanage-based systems

Besides being residential facilities, one of the most frequently cited characteristics of institutional care is its size, meaning the number of places available for children in any given facility. The larger the setting, the fewer the chances to guarantee individualised care for children in a family-like environment, and the higher the chances for certain dynamics to appear.

However, size is only one indicator among other fundamental features that might describe institutional care appropriately. Institutional care can usually be identified by the presence of a significant number of characteristics described below, across the three core areas: care provision, family and social relationships and systemic impact.


1) In institutional care the delivery of care and protection is inadequate, the evidence showing that children experience delays in their emotional, cognitive and physical development, whilst being at heightened risk of developing challenging behaviours and being victims of emotional, physical, and sexual abuse. Institutional care facilities can hardly meet the requirements of suitable individualised care that responds to the needs and circumstances of each and every child.

2) Life in institutional care is governed by a regimented routine, which results in children following a prescribed daily schedule with little flexibility. A fixed timetable is usually enforced and children are ‘processed’ in groups, without consideration for privacy or individuality. The result is children sleeping, eating, playing, and sometimes even going to the bathroom at the same time or in a set order, regardless of their individual needs.

3) Institutional care, by its own nature, leads to depersonalisation, reducing children to a file in the system. Children are not encouraged or supported to develop and show their personal preferences and individuality. Clothes, towels and toys are often shared within the group and living space doesn’t allow for privacy.

4) The inadequate ratio of carers to children and the nature of their interaction is typical of institutional care. Children usually experience multiple caregivers throughout their stay and even on a daily basis. The instability and insufficiency of caregiving deprives the child of the opportunity to form a healthy attachment with a significant adult, which in turn leads to attachment disorders and difficulties with a wide variety of social relationships in later life.

5) Institutional care is utterly disempowering and fails to provide children with a basic set of practical and life skills required to live independently. Young people in institutional care often lack the experience of preparing food, cleaning, making their own bed or managing personal finance, such as pocket money. When leaving institutional care, they are faced with living an independent life in a world for which they are utterly unprepared.


6) Institutional care fails to support strong and meaningful relationships between children, their parents and siblings, and the wider family whilst isolating children and preventing them from learning relevant skills for community living. The evidence shows that most children in institutional care, are not orphans and yet they have very little or no connections with their families and communities and very little knowledge of their cultural heritage, traditions and values.

7) In institutional care children are often segregated according to age, gender, special needs or medical conditions. Groups of siblings are often split up and assigned to separate units, or even to other institutional care facilities at different and sometimes distant locations.

8) Institutional care facilities tend to be isolated from mainstream communities and are sometimes located in remote places, leading to children being segregated from society even further. Geographical isolation was and remains a particular feature of institutions for children with disabilities or challenging behaviour in Central and Eastern Europe and the Commonwealth of Independent States, with institutions purposely built or located in old, inadequate buildings away from broader society.

9) Social isolation is a common element. In the most closed and isolated environments, children’s entire lives are spent within the institution – including their education, leisure and healthcare. Even in relatively open structures (e.g. where children go to the local school), institutional care fails to provide a sense of ordinary life and belonging to the community. Institutionalised children usually lack adequate resources and professional support and have weak or no representation in schools. As a result, they tend to be stigmatised and perceived as ‘different’, which in turn leads to further marginalisation and exclusion.



10) Institutional care facilities also have systemic effects: their simple existence influences the way that authorities, professionals and communities operate and how they identify and support children who are perceived as being at risk. The evidence shows that the very existence of institutions creates a ‘pull effect’ offering local authorities and professionals an easy option for dealing with children and families in crisis.

11) Institutional care is often the only available and promoted service at community level where local authorities and professionals can easily place children without parental care. In some contexts it is also wrongly perceived as being the safest option for babies and very young children in need of alternative care (including orphaned or abandoned new-born babies, premature babies or those identified as having special needs).

12) Across the world, institutional care is sometimes the only mechanism available for families to access education or health services. It is not uncommon for one child from a family to be sent to institutional care in order to have access to school, medical care or other services. It is also not uncommon for children failing in mainstream education to be sent to institutional care facilities which specialise in providing education for children with learning disabilities.

13) ‘Specialist’ institutional care is largely perceived as the best option for children with special needs, often at the advice of a doctor or institution manager. Parents lacking information, counselling and access to medical and support services will often turn to institutional care as their only available option. Children with disabilities or special needs tend to remain in the institution for their entire life or are moved into facilities for adults.

14) In some cases, children are deliberately separated from their families and placed in institutional care so that they can be used to attract fee-paying volunteers and donors or to maintain the system in existence, ensuring the employment of those working there. In the worst instances, children are also kept in poor conditions to further enhance ‘the case for support’. Volunteering in institutional care facilities for limited periods of time can also contribute to the repeated sense of abandonment already felt by the children. The lack of background checks on visitors and volunteers exposes children to an increased risk of abuse and exploitation.

15) Institutional care for babies falsely creates the impression that there are numerous babies and young, healthy children in need of adoption. Over the past 20 years, whilst international adoption has continued to flourish, so has the evidence showing that babies in institutional care in many countries have been systematically bought, coerced and stolen from their birth families.

What can I do to help?

It is the State that is ultimately responsible for children’s rights. However, private and institutional donors have a key role to play by reallocating development assistance to support the transition from institutional to family-based care. You can fundraise for Hope and Homes for Children or explore our donation options and join a global movement working to see the elimination of orphanages in our lifetime!