What is institutional care?

A child reaching out of a cot in an institution

There are 13 characteristics of orphanage care systems

Despite decades of evidence showing how institutional care is profoundly damaging for children, it’s still difficult to provide a clear, 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 child needs, and 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.

‘Institutional care’ is an oxymoron – institutions cannot by definition care for children

What are the 13 characteristics of orphanages?

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. There are other fundamental features. Institutional care can usually be identified by the presence of several of the characteristics described below, across the three areas: care provisionfamily and social relationships, and systemic impact.

Care provision

1. In institutions, the delivery of care and protection is inadequate. Children experience 

  • delays in their emotional, cognitive and physical development
  • heightened risk of developing challenging behaviours and being victims of emotional, physical, and sexual abuse.
  • A lack of suitable individualised care that responds to the needs and circumstances of each and every child.
  • a regimented routine, which results in children following a prescribed daily schedule with little flexibility.

2. Living in an institution, by its own nature, leads to depersonalisation, reducing children to a file in the system. Children are

  • ‘processed’ in groups according to a fixed timetable, 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.
  • 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.

3. 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.

4. 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 experience in

  • 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.

Family and social relationships

5. The way institutions operate fails to support the development of strong and meaningful relationships between children, their parents and siblings, and the wider family. Around 80% of children in institutional care are not orphans, but they have very little or no connection with their families. Groups of siblings are often split up and sent to separate units, or even to other orphanages at different and sometimes distant locations.

6. Institutions tend to be isolated from mainstream communities, sometimes located in remote places. This segregates children in them from society even further, and the isolation stops them from learning relevant skills for living in communities, or gaining knowledge of their cultural heritage, traditions and values. 

Geographical isolation was and is a particular feature of institutions for children with disabilities or challenging behaviour in Central and Eastern Europe and Commonwealth nations, with institutions purposely built or located in old, inadequate buildings away from broader society.

7. 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, for example 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.

Moreover, orphanages often segregate children according to age, gender, disability or other requirement, leading.

Systemic impact

8. Institutions also affect wider societal systems: their very existence influences the way that authorities, professionals and communities operate and how they identify and support children who are perceived as being at risk. They create a ‘pull effect’, offering local authorities and professionals an easy option for dealing with children and families in crisis.

9. Orphanages are 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 additional needs or impairments.

10. Across the world, placing their child in an institution is the only way for families to access education or health services. It’s not uncommon for one child from a family to be sent to an orphanage for school, or to get medical care or other services. Equally, children failing in mainstream education are often sent to institutions which specialise in education for children with learning disabilities.

11. ‘Specialist’ institutions are largely perceived as the best option for children with disabilities, 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 orphanages as their only available option. Children with disabilities or additional needs tend to stay in the institution for their entire life or are moved into facilities for adults.

12. In some cases, children are deliberately separated from their families and placed in institutional care 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 elicit more sympathy and donations. Volunteering in orphanages for limited periods of time also contributes 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.

13. 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.