Why is LHB preferred over ICF


2.1.2 The concept of changing disabilities

For about forty years, a worldwide, epoch-making upheaval has been emerging, which affects the entire area of ​​our culture. With the term turning point (Fritjof Capra) he can be summarized. This upheaval can also be felt across the spectrum of the human sciences. As a result of reform movements from Northern Europe and the Anglo-American area, new central ideas emerged in Germany and Austria from around the 80s of the last century, which have triggered paradigm shifts and continue to do so in the field of activity that is called "work for the disabled". These changes can only be described in brief here, although they can also be paradigmatic for dealing with people with dementia. Since these terms can be found in almost every specialist literature, references are not given here. normalization; De-institutionalization

The Normalization principle the 1960s (Bank-Mikkelsen in Denmark, Bengt Nirje in Sweden, later Wolf Wolfensberger in the USA): a life as normal as possible with separation of work, leisure and living; normal rhythms of life, as normal life patterns as possible and experiences in all areas of life.

De-institutionalization: As a result, the institutions are criticized for the first time (Wolfensberger; Goffman: Asyle). The "total institution" with all-encompassing restriction of the inmates and surveillance hinders development and does not comply with human rights.

Disabled people have also had to experience that social benefits are linked to paternalism and external control under the dictum of care (Graumann S., 2008).

De-institutionalization is required from around the 80s of the last century and implemented in several countries (e.g. Scandinavia, the Netherlands). It is currently a socio-political demand of the EU in the direction of the new member states. Self-determined life; Empowerment; Non-discrimination

The Independent living initiatives: The "Disability Rights Movement," a human rights-based movement from the United States in the 1960s, came out almost forty years late as Self Advocacy Movement / People-First Movement in the German-speaking countries and allowed a self-confident attitude. It is changing the self-image of the disabled in the direction of equal opportunities and self-determination (Wikipedia English: Disability Rights Movement, 2011). With the slogan "Nothing about us without us" in the USA and later with "Nothing about us without us!" In German-speaking countries, groups of disabled people express violent criticism of the paternalistically run institutions for disabled people's assistance (protective workshops, hospital-like dormitories, "hospitals" in the UK) and demand that those affected be included as "experts in their own right" in planning their own lives and accessibility as possible in all areas of life. The peer approach extends from counseling those affected to scientific research with people with GB. This also corresponds to the socio-political phenomenon of the Empowerment, the self-empowerment of people who have not been granted political influence on all levels and who now demand and take it over: "Make it happen!"

These movements are or were embedded in the comprehensive social policy strategy of the Non-discrimination. The European Union obliged its member states to enshrine the prohibition of discrimination in their constitutions. Only after arduous discussion was Austria ready for this constitutional amendment:

"Nobody should be disadvantaged because of their disability. The republic (federal, state and local governments) is committed to guaranteeing equal treatment of disabled and non-disabled people in all areas of daily life."

Austrian Federal Constitution, Article 7 Paragraph 1. (Decision of the NR on July 9, 1997) Integration and inclusion

The call for integration in the area dealt with here is originally a request from parents for joint education in kindergarten and school. In Vorarlberg, separating special kindergartens have been largely abolished since the 1980s. All children can attend kindergartens together. In the school sector, the discourse on school integration and the changeover has been going on since the late 1970s and has not yet been implemented satisfactorily. The UN Convention on the Rights of Persons with Disabilities (UN Convention on the Rights of Persons with Disabilities, 2010), which is legally binding worldwide, has decided that all children should have access to normal school and thus the abolition of separate schooling. However, there is great resistance and the search for a consensus among the interest groups has not yet been completed.

The vision of the inclusion was introduced in 1994 at a UNESCO conference in Salamanca (Salamanca Declaration) and described as the most important goal of international education policy: a school for everyone. The UN Convention on the Rights of Persons with Disabilities, adopted in 2006, deepens the inclusion approach. Unfortunately, "Inclusion" was translated as "Integration" in the official German translation. Also because the people affected were not included in the translation, contrary to all requirements of the UN authorities, there is a "shadow translation" of the German "Network Article 3". This deficiency can be read several times in current specialist literature (Graumann S., 2011, p. 47 f.) (Schöler, Merz-Atalik, & Dorrance, undated, p. 10 f.). Because the term inclusion is often used for the question of school education (cf. Boban Ines and Hinz Andreas) and at the same time definitions are difficult to find (Theunissen, Inklusion, Inclusion, 2007), an own attempt should be made here:

Under inclusion one can understand a real utopian model of an open, human rights-oriented society with principles such as de-categorization and diversity. It is the desired attitude of a society that does not close itself off to the strange and incomprehensible, but is actively at least partially ready to grant accessibility, individualized support and participation to people with a different culture or psychosocial or physical conditions that do not conform to the norm, or to engage in processes with these Lets people in, participates and generally values ​​them. To use an art term for the implementation dimension: Inclusion is "work in progress". The route is the goal.

De-categorization means the dissolution of the stigmatizing categories of the mentally handicapped, foreigners, etc. The social model of disability

The social model of disability breaks away from the defect-oriented view of the individual and includes a multiple perspective. It names people as "disabled" by society and thus reverses the individualizing medical perspective (Kruse, 2010). It sees the topic of "disability" as comprehensively as possible and takes the environment of these people into the focus of discussion. At the same time, it expands the understanding of normality with the so important and yet difficult to learn attitude "It is normal to be different!" Diversity management as a socio-political strategy tries to accentuate the resources of people with disabilities for society as well as those of people of migrant origin up to people with dementia. Back to the subject of disability: social conditions or, viewed more globally, social conditions are the context for human development. This is evidenced by the development of the terminology within the World Health Organization (WHO) from the "International Classification of Impairment, Disabilities and Handicaps" published in 1980 ICIDH (Pflüger, 1992) on the 1980 Classification of Impairments, Disabilities, and Handicaps ICIDH-2 towards the ICF, the International Classification of Functioning, Disability and Health (WHO, 2005). Fornefeld compares the two ICIDH structural models (Fornefeld, 2000, p. 49):

ICIDH (1980)

ICIDH-2 (1999)


Impairment, loss of substance or change in a psychological, physical or anatomical structure


(functions and structure)

concern organic damage and functional disorders; with the medical disciplines of anatomy and physiology


Disorder or impairment, the partial or complete reduction in a normal ability or skill of a person that has arisen as a result of damage


(activity limitation)

defines the activities that allow people with impairments and disorders to lead an independent, self-determined life within the scope of their possibilities; the degree of personal realization.


Disability, social disadvantage of an individual, which results from a disability and / or disorder and which limits or makes impossible the perception of a role that is regarded as normal (with regard to age, gender, social and cultural factors).


(participation restriction)

describes social participation in the life of society; it asks how health impairments affect participation in public, societal, cultural tasks, affairs, and achievements.

Context factors

Contain milieu-dependent and personal conditions, living conditions, backgrounds and environments with which people communicate and which can promote or hinder their integration

A first, fundamental difference between the ICIDH and the ICF is that in the ICF the units of classification are no longer people, but situations. It becomes more clear that disability represents an interplay between the health impairment and the contextual factors (Lindmeier, 2007). This comparison clearly shows how the focus is no longer on the deficits of a person, but on the relevant skills and social participation. With its approach, the ICF 2005 builds a bridge between the concept of illness and the phenomenon of disability. In the "participation" the commonality of the phenomena disability and dementia becomes clear. The graphic from the ICF manual shows this impressively:

The worldwide electronic networking and globalization of knowledge, research and political activities and movements, not least through the Internet, that suddenly emerged from the mid-1990s onwards, created a new awareness within a few years with new dynamics and fueled the question of terminology. The UN Convention on the Rights of Persons with Disabilities, which was adopted in 2006 and ratified in Austria in 2008 (UN Convention on the Rights of Persons with Disabilities, 2010) is of outstanding importance. For the first time, a legally binding convention obliges the 103 countries with ratification of the treaty (as of July 21, 2011) to implement this common approach:

... a concluded international treaty that specifies human rights for the living situation of disabled people in order to enable them to participate in society on an equal basis. In addition to fundamental parts of general human rights, such as: B. the right to life or the right to freedom of movement, many special provisions that address the living situation of disabled people "(WIKIPEDIA, 2011).

A resolution of the Council of Europe in the "European Social Charter" also obliges politics to develop in a similar direction (Austria ratified this charter on May 20, 2011):

15. Disabled persons have the right to independence, social integration and participation in the life of the community. (Council of Europe)

Equal rights, non-discrimination, participation, comprehensive accessibility, inclusion, self-determination and mobility are defining terms of this convention. The aim is to adapt all areas of society to the needs of people with disabilities. Associated with this are social performance rights and a ban on paternalistic tutelage (Graumann S., 2011). This applies to the wide range from the discussion about the special school to the questioning of the existing regulation of guardianship. Biopolitical context

Currently, forms of disability are also being described in a biopolitical context. In addition to many important findings, such as for human interaction ("I feel what you feel") also poses a new hazard. Disability may again be increasingly attributed to biological causes. Ursula Naue, scientific member of the very active Austrian monitoring committee for the UN Disability Rights Convention (www.monitoringausschuss.at), writes in her article" Biopolitics of Disability: The power of the norm and the 'normal' ":

Genetic diagnostics as an aspect in connection with the increase in genetic and biomedical knowledge and its implications ... now have the possibility of slowing down this development (from the medical to the social model of disability G.H.) or even to reverse it in a certain way.

Admittedly, the advances in biomedicine hold great potential for reshaping society and life, but in the case of disability, current biopolitical practices and discourses based on existing norms and power relationships have the potential to convey traditional views of disability reinforce rather than change them "(Naue U., 2005). Assisted freedom

For years, activists of the "self-determined life movement", which has developed primarily from the group of physically handicapped people, have been calling for assistance services to be financed. In this context one encounters the term "personal assistance". This means any form of personal help that helps the assistant to live their life as independently as possible. Personal assistance encompasses the areas of personal hygiene, nursing, housekeeping and communicative aids such as sign language interpreters for people with hearing impairments or reading services for people with visual impairments (Niehoff, 2003, p. 53). It is also possible throughout Austria to receive personal assistance at work. There are currently negotiations as to the form in which personal assistance can be financed as a right for users. The term "personal assistance" wants to clarify through the choice of words that self-determined assistance should be distinguished from externally determined assistance for the disabled. The originally neutral words "care" or "care" are often synonymous with external control and tutelage for people with disabilities. This is an aspect that would be worth discussing in detail in the case of people with dementia.

The rights-based disability policy currently under discussion in German-speaking countries is the result of many years of commitment by the disability movement and the UN Convention. "From a disability policy of charity to a policy of human rights" is the subtitle of a recently published book by Sigrid Graumann (Graumann S., 2011). It questions our understanding of social justice and tries to justify the rights of people with disabilities in a moral-philosophical way.

The convention (UN Disability Rights Convention, G.H.) explicitly wants to include all disabled people, including those with a high need for support (Inclusivity of the scope of human rights) ... The right to equal respect for human rights (Universality of the validity of human rights