Institutions in modern society: caretakers and subjects

The problems that relate to the outermost limits of institutional care, if such limits exist, will certainly be among the most salient problems during the coming years-no matter whether such care proceeds on an inpatient or an outpatient basis. Whatever course may be taken will certainly affect the lives of every citizen in urbanized and industrialized society. At present in California there is considerable shifting of individuals from one care status or category to another, in efforts to find accommodations that will better reflect the realities of modern existence. However, such shifting of caseloads as the moving of individuals from nursing and convalescent homes to hospitals and back again does not constitute a change, either from the standpoint of the subjects involved or from the standpoint of significantly affecting the overall caseload. Most commonly, the shifting of caseloads has been merely jurisdictional. Much the same can be said of the transfers from a police agency to welfare, or vice versa. Similarly, a shift from inpatient status to outpatient status does not constitute a significant change. Such transfers from one jurisdiction to another reflect a reduction in caseload for one agency, but a corresponding increase in caseload for another. Thus, there has been no significant change in the subject population as such. Jurisdictional transfers are often merely caretaking actions that reflect bureaucratic decisions. Equally often, such decisions do not address themselves to the basic priorities that guide the functions of caretaking. Explicitly stated priorities must supersede jurisditional transfers if the concept of caretaking is to include better resources for human development and if the subject population is to participate in the managing of institutions. On any given day during 1969 in the state of California, virtually 8 million people from an estimated population of 19,800,000 were under some form of institutional care or in some institutional program, or were employed to provide the care and administer the programs. Clearly this is a vast effort toward the training and retraining, as well as the rehabilitation of people, in the traditional sense of these words. The salient problems that have emerged from this context of urban and industrial development involve social control, social mobility, organizational behavior by caretakers and subjects, minority peoples, and the extensions of institutions into communities. Given these developments, is it not proper to ask whether or not the nature of urbanized and industrialized society has changed to such a point that a return to the past (and past solutions) is no longer feasible? Is it not also proper to ask what voice the subject population will have in helping to guide the urban and industrialized state into the future? And certainly there is a question that virtually everyone will ask: What percentage of tax revenues (whether shared or under direct programs) shall be destined to better meet the problems of this future society, which, it seems, is already upon us?