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An examination of citizen participation in health planning in the Northwest Territories: the Fort Providence… Cawsey, James Frederick 1981

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AN EXAMINATION OF CITIZEN PARTICIPATION IN HEALTH PLANNING IN THE NORTHWEST TERRITORIES: The For t Prov idence Sen ior C i t i z e n s ' Home by JAMES FREDERICK CAWSEY B.A. , The U n i v e r s i t y o f Saskatchewan, 1972 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE i n THE FACULTY OF GRADUATE STUDIES DEPARTMENT OF HEALTH CARE AND EPIDEMIOLOGY HEALTH SERVICES PLANNING We accept t h i s t h e s i s as conforming to the requ i r ed standard THE UNIVERSITY OF BRITISH COLUMBIA May 1981 © James F rede r i c k Cawsey, 1981 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f the requirements f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h Columbia, I agree t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and study. I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be gran t e d by the head o f my department or by h i s or her r e p r e s e n t a t i v e s . I t i s understood t h a t copying or p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be allowed without my w r i t t e n p e r m i s s i o n . Department o f The U n i v e r s i t y o f B r i t i s h Columbia 2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5 Abs t rac t In the 1970 1s the Government o f the Northwest T e r r i t o r i e s was seek ing to i nvo l ve communities i n the d e c i s i o n -making process about the a l l o c a t i o n , p r i o r i t y s e t t i n g and program and f a c i l i t i e s des ign i s sues in the sphere o f hea l th s e r v i c e s . As a r e s u l t o f t h i s d e s i r e , r e l a t i o n s h i p s were being forged which emphasized a sense o f pa r tne r sh i p between government a t d i f f e r e n t l e v e l s and community groups. In f a c t , cons ide rab le bu reauc ra t i c e f f o r t was put i n t o the dete rminat ion o f how the communities should prov ide t h e i r p a r t i c i p a t i o n . Th is e ven tua l l y became known, i n f o rma l l y at l e a s t , as the "community p a r t i c i p a t i o n methodology". During a f o r t y - one month pe r iod (March, 1977 to August , 1980) t h i s methodology was implemented and even tua l l y cu lminated in the c on s t r u c t i o n o f a sen i o r c i t i z e n s ' home i n the community of For t P rov idence . I t i s the concern o f t h i s t h e s i s to examine tha t method-o logy by ask ing the f o l l o w i n g ques t i on : "How use fu l and a pp l i c a b l e i s the Northwest T e r r i t o r i e s ' community p a r t i c i p a t i o n approach i n the p lann ing and development o f f a c i l i t i e s , s p e c i f i c a l l y f o r the e l d e r l y ? " In address ing t h i s ques t ion severa l i s sues had to be cons i de red . F i r s t , what were the ob j e c t i v e s o f the p a r t i c i p a n t s " i i . and were they compat ib le? What were the p o t e n t i a l ob s t a c l e s to the p a r t i c i p a t i o n process and were they reckoned w i th? How d i d the p a r t i c i p a t i o n process a c t u a l l y occur i f , i n f a c t , i t d i d occur? In o the r words, the e f f o r t s o f the bureaucrats had to be ana lyzed i n terms o f what they hoped to accomp l i sh , how they attempted to accompl ish t h e i r goa l ( s ) and what they a c t u a l l y ach ieved . Another problem faced by t h i s examinat ion was the ques t ion o f t h e o r e t i c a l framework. The t h e s i s was a r e t r o -spec t i v e examinat ion which meant the p l anne r s ' concepts had to be d i s cussed i n terms o f t h e o r e t i c a l concepts to determine i f there i s a t h e o r e t i c a l ba s i s f o r the app l i e d concepts and whether o r not these s t r a t e g i e s were approp r i a te to t h i s example. I t was suggested tha t the t heo r i e s o f John Fo ske t t , Edmund Burke and She r r i A rn s t e i n were i n support o f the bu reauc ra t s ' e f f o r t s . The f i n d i n g s o f the examinat ion were tha t the p a r t i c i p a n t s ' o b j e c t i v e s were compat i b l e ; the p lanners were cogn i zant o f the p o t e n t i a l c o n s t r a i n t s inherent i n t h i s p r o j e c t and endeavoured to e l im i n a t e or min imize the consequences o f these c o n s t r a i n t s ; and, the methodology was succes s fu l i n a ch i ev i ng p a r t i c i p a t i o n . With respec t to the p a r t i c i p a t i o n , the t h e s i s concludes tha t the p a r t i c i p a t i o n ach ieved was a c t u a l l y on l y tokenism and tha t t r ue p a r t i c i p a t i o n d i d not r e a l l y occu r . Th i s then throws the ques t ion o f u t i l i t y and a p p l i c a b i l i t y o f the methodology i n t o doubt. The t h e s i s concludes tha t eve ry th ing worked t h i s t ime because IV'. the assumptions o f the p a r t i c i p a n t s were the same. The t h e s i s c l o s e s , however, w i th a suggest ion tha t the bas i c assumptions concern ing hea l th care are chang ing. ACKNOWLEDGEMENTS I wish to express my s i n ce r e app re c i a t i on to Dr. Morton Warner and extend a spec i a l bouquet to C h e r y l . v i , TABLE OF CONTENTS Page CHAPTER ONE - Theo re t i c a l Framework In t r oduc t i on 1 C i t i z e n P a r t i c i p a t i o n as a Concept i n Heal th P lann ing 2 S t r a t eg i e s o f C i t i z e n P a r t i c i p a t i o n 6 The Hea l th Care M i l i e u 13 The Heal th Care System Def ined 14 The Heal th Care System i n Operat ion 14 Demand-Need-Supply Model 15 Want-Need-Use-Demand and Supply 16 Want-Need-Use-Demand and Supply I n t e r a c t i o n 17 C i t i z e n P a r t i c i p a t i o n in the Hea l th Care M i l i e u -A Review 20 Approach and Methodology to Data Ana l y s i s 22 Case Study 22 Data Sources 23 Summary 24 Chapter One References 25 CHAPTER TWO z T n e C a s e s t u d v Presented In t r oduc t i on 27 The Northwest T e r r i t o r i e s 27 For t Prov idence - 30 H i s t o r y o f Fo r t Prov idence 30 For t Prov idence Today 31 For t Prov idence Demography 33 Fo r t Prov idence I n f r a s t r u c t u r e 36 The Indigenous People o f the Northwest T e r r i t o r i e s 38 The Se l e c t i o n o f Fo r t Prov idence 40 De s c r i p t i o n of the Fo r t Prov idence Sen ior C i t i z e n s ' Home 40 Loca t i on . 4 1 General De s c r i p t i o n 41 Summary 45 Chapter Two References 47 vn , Page CHAPTER THREE - The Community P a r t i c i p a t i o n Methodology In t r oduc t i on ^8 4.9 The Ph i losophy and P o l i c i e s Emerge Sen ior C i t i z e n s 1 Housing Working Group 55 Community Educat ion 55 Community Group o r Committee 56 Determinat ion o f Need 57 I nd i v i dua l Assessments 57 Community Resources P r o f i l e . 57 Housing Needs Survey 58 U t i l i z a t i o n o f E x i s t i n g Resources 59 U t i l i z a t i o n o f Resources i n Other Communities 60 Data Ana l y s i s 61 Se rv i ce or F a c i l i t y Development 61 Summary 62 Chapter Three References 64 CHAPTER FOUR - The Process o f P a r t i c i p a t i o n In t r oduc t i on 66 The Case Presented 67 Chapter Four References 94 CHAPTER FIVE - D i s cuss i on o f the Case Study and Ana l y s i s o f the Community P a r t i c i p a t i o n Methodology In t roduc t i on 96 Case Study D i s cuss i on 96 Readiness to P a r t i c i p a t e 96 Theory App l i ed to R e a l i t y 99 Conc lus ions 107 Chapter F i ve References I l l BIBLIOGRAPHY AND ADDITIONAL READINGS Community P a r t i c i p a t i o n 113 Fo r t Prov idence and the Northwest T e r r i t o r i e s 115 Se rv i ces and F a c i l i t i e s f o r the E l d e r l y 118 TABLE OF TABLES Page Table # One: Popu la t i on by Community, N.W.T. 1971-1978 34 Table # Two: E t h n i c i t y by Community, N.W.T. 31 December, 1978 35 Table # Three: Community and Age D i s t r i b u t i o n , N.W.T., 31 December, 1978 35 Table # Four: P r o f i l e s o f L i v i n g S i t u a t i o n o f Se lec ted Sen ior C i t i z e n s of Fo r t Prov idence 80 TABLE OF FIGURES Page F igure # One: A r n s t e i n ' s Ladder o f C i t i z e n P a r t i c i p a t i o n 11 F igure # Two: Demand-Need-Supply Model 15 F igu re # Three: Map o f the Northwest T e r r i t o r i e s 29 F igure # Four: For t Prov idence Sen io r C i t i z e n s ' Home.. 42 F igure # F i v e : Fo r t Prov idence Sen io r C i t i z e n s ' Home.. 43 F igure # S i x : For t Prov idence Sen io r C i t i z e n s ' Home.. 44 TABLE OF MAPS Page Map # One: Map o f the Northwest T e r r i t o r i e s 29 CHAPTER ONE - THEORETICAL FRAMEWORK INTRODUCTION Canadian hea l th s e r v i c e s have, over the past t h i r t y y e a r s , moved deve lopmenta l ly through a number o f i d e n t i f i a b l e phases* The 1940's and 1950's were c ha r a c t e r i z ed by a demand on governments to develop f a c i l i t i e s , main ly h o s p i t a l s , f o l l ow i ng the pass ing o f the Hosp i t a l and D iagnos t i c Se rv i ces Act i n 1957 and the c o s t - s ha r i ng agreements which had been i n e f f e c t f o r some prov inces s i nce 1948. The 1960's represent a pe r i od when a t t e n t i o n turned to the p r o v i s i o n of p u b l i c l y f i nanced medical s e r v i c e s r e s u l t i n g in the Medicare Ac t o f 1966. The 1970 's , however, mark the p i v o t a l p o i n t , f o r t h i s was when the emphasis changed from p r o v i s i o n o f s e r v i c e s to con t ro l o f supp ly . During t h i s decade, governments, faced w i th resource shor tages , sought to i n vo l ve communities i n dec i s ion-mak ing about a l l o c a t i o n , p r i o r i t y s e t t i n g , program and f a c i l i t y des ign i s s ue s . The motives f o r t h i s are many and not c en t r a l to t h i s work, but s u f f i c e i t to say tha t the Government of the Northwest T e r r i t o r i e s was faced w i th these same i s s ue s . Therefore r e l a t i o n -sh ips were being forged which emphasized a sense o f pa r tne r sh i p between government a t d i f f e r e n t l e v e l s and community groups. In the Northwest T e r r i t o r i e s such an approach became r e f e r r ed t o , i n f o rma l l y a t l e a s t , as a "community p a r t i c i p a t i o n methodology". - 1 -- 2 -Th is approach was a co -o rd ina ted e f f o r t by the Government o f the Northwest T e r r i t o r i e s to i nvo l ve community members i n the development-of community-based se r v i c e s and f a c i l i t i e s f o r the e l d e r l y . To t h i s end the T e r r i t o r i a l Departments of S o c i a l Se rv i ces and Hea l th entered i n t o a work ing agreement w i th the T e r r i t o r i a l Housing Corporat ion whereby a working group was s t ruck to determine the need f o r , to p lan and to develop se r v i c e s and f a c i l i t i e s f o r the e l d e r l y . The working group, i n t u r n , sought the p a r t i c i p a t i o n o f p o t e n t i a l r e c i p i e n t s and o ther community members. During a fo r t y -one month pe r i od ( March, 1977 to August , 1980) t h i s community p a r t i c i p a t i o n methodology was implemented and e ven tua l l y cu lminated w i th the opening o f a s en i o r c i t i z e n s ' home i n the community of For t P rov idence . I t i s the concern o f t h i s t h e s i s to examine tha t approach by ask ing the f o l l ow i ng que s t i on : "How usefu l and app l i c ab l e i s the Northwest T e r r i t o r i e s ' community p a r t i c i p a t i o n approach i n the p lann ing and development o f f a c i l i t i e s , s p e c i f i c a l l y f o r the e l d e r l y ? " I . CITIZEN PARTICIPATION AS A CONCEPT IN HEALTH PLANNING The ex ten t to which the re shou ld be " c i t i z e n " o r "consumer" p a r t i c i p a t i o n i n the p lann ing and management o f hea l th s e r v i c e s - 3 -has been an i s sue o f cons i de r a t i on i n recent y ea r s . Even advocates o f the bas i c concept o f c i t i z e n p a r t i c i p a t i o n , however, cont inue to d i scuss the purpose o f c i t i z e n involvement and the manner i n which the purpose can be best ach ieved. There are many views about the purpose of i n v o l v i n g lay people i n the p lann ing and management o f hea l th s e r v i c e s . Th is involvement cou ld be cons idered a na tu ra l growth o f hea l th f a c i l i t i e s boards o r p ub l i c hea l th boards. Wi th in t h i s context the c i t i z e n ' s r o l e u sua l l y becomes one of b r i ng i ng in fo rmat ion to the hea l th s e r v i c e p rov ide r s regard ing the needs o f the community; i t i s a l s o a means o f p ub l i c a c c o u n t a b i l i t y and gene ra l ' po l i c y -mak i ng , mainly i n rev iew ing a l t e r n a t i v e s to meeting i d e n t i f i e d needs. Or, hea l th boards and hea l th p lann ing counc i l s may be viewed as important mechanisms f o r community change and re fo rm, and thus , be ing more r ep re sen ta t i ve o f the community than the hea l th p lanners o r p r o v i d e r s . The ph i losophy tha t the purpose o f c i t i z e n boards i s to promote community hea l th educat ion i n i t s broadest sense i s y e t another way i n which the r o l e o f c i t i z e n involvement may be conce ived. In a l l cases , a major problem to be overcome i s the presence o f proponents of the d i f f e r e n t schoo ls being i nvo l ved on the same p r o j e c t a t the same time w i t h the net r e s u l t be ing counte r -p roduc t i ve debate and con fus ion . - 4 -Those who support the growth of hea l th management and s i m i l a r boards are a l s o faced w i th the dilemma being exper ienced by e x i s t i n g management and p lann ing boards. Government i s p l a y i ng an ever i n c r e a s i ng r o l e i n the dete rminat ion o f hea l th programs and se r v i c e s because o f the dependence upon government f o r fund ing . The re fo re , what r o l e can a community board p lay when government funding reduces the need f o r the t r a d i t i o n a l f u nd - r a i s i n g a c t i v i t i e s o f such boards w h i l e , a t the same t ime, imposing gu i de l i n e s upon the opera t ion o f s e r v i c e s ? Perhaps an adv i so ry committee o r p a t i e n t ombudsman i s the on ly r o l e l e f t ; but then, maybe the consumer i s r e a l l y on ly concerned w i th h i s own needs and not whether he exe r c i s e s any au t ho r i t y when i t comes to the management of the s e r v i c e . In the N.W.T. there i s an expressed des i r e (. as evidenced by the land c la ims movements) by the Nat ive Peop les ' to con t ro l the d i r e c t i o n o f t h e i r own de s t i n y . Th is des i r e extends to the management of hea l th s e r v i c e s . Advocates o f c i t i z e n p a r t i c i p a t i o n as a means of community i npu t i n t o the development and d e l i v e r y o f hea l th s e r v i c e s s t r e s s the need f o r " t r ue " r ep resen ta t i on from the program r e c i p i e n t s . " The ques t ion o f r ep resen ta t i on must be addressed. Who i s a t rue r ep resen ta t i ve and how i s he se lec ted? How many people c on s t i t u t e a r ep re sen ta t i ve s e l e c t i o n from the community? Some o f these quest ions may be unanswerable because o f the dilemma o f t r y i n g to determine " t r ue " r ep r e sen t a t i on . - 5 -There i s no s i n g l e answer to the quest ions of what i s the d e f i n i t i o n o f the purpose or what i s to be the nature o f c i t i z e n p a r t i c i p a t i o n i n the p lann ing and management o f hea l th s e r v i c e s . The r i g h t s o l u t i o n s are those tha t are workable and most e f f e c t i v e f o r a p a r t i c u l a r community. S ince the a t t i t u d e o f the approp r i a te l e v e l o f government i s very i n -f l u e n t i a l to the outcome o f any c i t i z e n p a r t i c i p a t i o n p r o j e c t , the l i m i t a t i o n s be ing p laced upon the c i t i z e n group must be c l e a r l y de f ined and understood. The c i t i z e n s must know t h e i r r o l e o r the net r e s u l t w i l l be u n r e a l i s t i c e xpe c t a t i on s , con-f l i c t s and d isappo intment . In t h i s case the government bureaucracy was the i n i t i a t o r o f the u t i l i z a t i o n o f c i t i z e n p a r t i c i p a t i o n . As such, the govern-ment p lanners were suppor t i ve o f the idea and were not f e a r f u l o f there being an a f f r o n t to t h e i r p r o f e s s i ona l power and p o s i t i o n . This p o s i t i o n of seek ing consumer involvement was a l so expressed by the l o c a l hea l th pe r sonne l . The re fo re , w i th t h i s p r o j e c t , the a t t i t u d e s and p o s i t i o n s o f the p r o f e s s i ona l s were not ones of p r o t e c t i n g t h e i r personal t e r r i t o r i e s as may occur i n some c i t i z e n p a r t i c i p a t i o n endeavours. Rather, the p r o f e s s i ona l s sought to i n vo l ve p o t e n t i a l s e r v i c e r e c i p i e n t s and o ther community members to ensure the hea l th s e r v i c e was appropr i a te and acceptab le to the needs and des i r e s o f the community. I I . STRATEGIES OF CITIZEN PARTICIPATION As mentioned, th is thesis i s a retrospect ive examination of an already implemented community par t i c ipa t ion methodology. As such, the question ar ises - - by what c r i t e r i a i s the method-ology to be examined? A l i t e r a tu re review was conducted and the theories of Burke, Foskett and Arnstein were found to purport compatible theories to that of the planners in th i s study. That i s , the purpose of th is thesis i s not to devise an appropriate or appl icable method of pa r t i c i pa t i on . Therefore, the examination • must attempt to u t i l i z e the avai lab le l i t e ra tu re to f ind a "best f i t " with which comparisons can be made. As w i l l become apparent, the planners and the community were faced with certain constraints which had to be overcome i f the project was to completed as desired. Foskett 1 s theory a ler ts the planner to the possible constraints which may apply to a given project. The writ ings of Edmund Burke provide possible so lut ions. Arnsteins' work provides a tool for measuring to what degree par t i c ipat ion actua l ly occurred. P r io r to presenting these theories i t should be remembered that , "To imply that c i t i z en par t i c ipa t ion i s a s ing le , undi f ferent iated, and overr id ing strategy is mis-leading. I t i s more accurate to speak of s eve ra l . . . - 6 -- 7 -... strategies of citizen participation, defined in the terms of given objectives... (furthermore) the relevancy of a strategy depends upon an organization's a b i l i t i e s to f u l f i l l the requirements necessary for the strategy's effectiveness, and upon the adaptability of the strategy to an organi-zational environment". 1 In his a r t i c l e , "The Influence of Participation on Community Programs and Activities", John Foskett suggests there are a number of strategies or practical means for increasing the distribution of community endeavours.2 " ( 1 ) leaders and those already active will have to find ways of making community issues and undertakings relevant to a wider range of people...people often can best perceive the relevancy of a given program i f they have participated in locating and defining the problem; (2) there are possible strategies that will recognize the diversity of value systems; (3) there are strategies that can compensate for or modify a b i l i t i e s to communicate; (4) innovations in the time, place and c i r -cumstance of participation whereby differences between people in regard to free time and resources would be made less important; and (5) participation needs to be made respectable and a source of prestige for anyone".3 Furthermore, for Foskett these strategies are predicated on the belief that "participation often depends upon the relevancy of a problem. Those problems which affect one most personally will result in a high degree of social participation."^ ...and, ..."problems are solved and programs initiated in consonance with 5 the orientation and values of the participators... - 8 -Burke would respond tha t a l l the v a r i e t i e s o f c i t i z e n • f i p a r t i c i p a t i o n can be ana lyzed in terms"of f i v e bas i c s t ra teg ies ; . (1) Educat ion - Therapy S t ra tegy P a r t i c i p a t i o n has the ob j e c t i v e o f c i t i z e n s h i p t r a i n i n g based upon the involvement o f the p a r t i c i p a n t s l e a r n i ng through t h e i r p a r t i c i p a t i o n . The major d i f f i c u l t y w i th t h i s s t r a t egy i s tha t the o rgan i z a t i on has to be prepared to a l l ow the " p a r t i c i p a n t s to become the determiners o f dec i s i ons and p o l i c i e s even to the po i n t o f a l l ow ing them to make un iverse dec i s i ons o r to c rea te c o n f l i c t and con t rove r sy " . Thus, the o rgan i z a t i on has to recogn ize and be w i l l i n g to accept tha t a p r o j e c t may not proceed as o r i g i n a l l y conce ived because the p a r t i c i p a n t s may d i sagree w i th the o r g an i z a t i o n . The p a r t i c i p a n t s ' goa ls come i n t o c o n f l i c t w i th the o r g a n i z a t i o n ' s goa l s . In such cases , the f i n a l product becomes a r e s u l t o f the nego t i a t i on process r equ i r ed to reso l ve the c o n f l i c t . .(2) Behav ioura l - Change S t ra tegy The bas i s o f t h i s s t r a t egy i s t ha t i n d i v i d u a l behaviours can be i n f l uenced or changed through group membership. Change i s induced i n a system or subsystem by changing the behaviour o f e i t h e r the system members o r i n f l u e n t i a l r ep re sen ta t i v e s of the system. Th is i s based upon the assumption tha t people are more l i k e l y to support a d e c i s i o n and to a s s i s t i n c a r r y i ng i t out i f they have p a r t i c i p a t e d in the dec i s ion-mak ing process . - 9 -(3) S t a f f - Supplement S t ra tegy The s t reng th o f t h i s s t r a t egy r e s t s upon the p r i n c i p l e o f vo lun ta r i sm. The ob j e c t i v e i s to e x p l o i t the a b i l i t i e s , f r ee time and/or the e xpe r t i s e o f i n d i v i d u a l s to achieve a des i r ed goa l . Some o f the drawbacks o f t h i s s t r a t egy a re : ( i ) vo lun teers u s u a l l y do not p a r t i c i p a t e in p o l i c y making r o l e s ou t s i de o f the s p e c i f i c a c t i v i t i e s i n which they may be i n vo l v ed ; ( i i ) the o v e r a l l s t r a t egy depends upon the c l a s s i c a l not ions o f r a t i o n -a l i t y i n p l ann i ng , about which there i s now cons ide rab le doubt; and, ( i i i ) a dd i t i o na l s t r a t e g i e s need to be employed which take i n t o account the p o l i t i c s o f dec i s ion-mak ing o r are aimed a t overcoming value d i f f e r e n c e s . ..(4) Co -op ta t i on S t ra tegy Co-opta t ion i s the involvement o f c i t i z e n s i n an o rgan i z a t i on i n o rder to prevent ob s t r u c t i on i sm . Th i s s t r a tegy uses c i t i z e n s as a dev ice f o r secu r i ng corranunity sanc t i on w i thout p r ov i d i ng f o r genuine p a r t i c i p a t i o n . Co-opta t ion may take e i t h e r of two forms: ( i ) in formal - persons , who are cons idered to have s u f f i c i e n t resources or i n f l u ence to v i t a l l y a f f e c t the opera t i on o f the o r g an i z a t i o n , are brought i n t o the o r gan i z a t i on a t the p o l i c y -making l e v e l ; and - 1 0 -( i i ) formal - groups who r e f l e c t the sent iments of the community are absorbed i n t o the o rgan i z a t i on i n o rder to gain l e g i t imacy . Thus, in formal co -op ta t i on imp l i e s a shar ing o f power i n response to s p e c i f i c o r p o t e n t i a l p r e s su re s , whereas, formal co -op ta t i on merely seeks pub l i c acknowledgement o f the agency -cons t i t uency r e l a t i o n s h i p . To summarize, i t must be remembered tha t co -op ta t i on i s a means o f p e rm i t t i n g l i m i t e d p a r t i c i p a t i o n to achieve o rgan i za -t i o n a l goals wh i l e ensur ing progress towards these goals i s not impeded. (5) Community Power S t ra tegy There are two s t r a t e g i e s o f c i t i z e n p a r t i c i p a t i o n based on the t heo r i e s o f community power, both are designed to e x p l o i t com-munity power. The f i r s t i s the p r e v i ou s l y d i scussed in formal c o - op t a t i o n . The second i s c o n f r o n t a t i o n , tha t i s , e x i s t i n g powers are conf ronted by an o rgan i zed and committed mass o f c i t i z e n r y . Th is i s a c t u a l l y an attempt to c reate a new power by and f o r the c i t i z e n r y which w i l l then nego t i a te w i th the e s t a b l i s h ed power and thereby ach ieve change. For t h i s s t r a t egy power i s de f ined as the a b i l i t y to e x e r c i s e one 's w i l l even over the oppos i t i on of o t he r s . In her a r t i c l e "A Ladder o f C i t i z e n P a r t i c i p a t i o n " 7 A rns t e i n suggests a l l cho ices o f c i t i z e n p a r t i c i p a t i o n s t r a t e g i e s - n -are dependent upon the ex ten t to which the c i t i z e n group i s going to e x e r c i s e c o n t r o l . That i s , does the c i t i z e n group a c t i v e l y e xe r c i s e i t s con t ro l o r i s there a pass ive acceptance o f i t s a b i l i t y to con t ro l ? To her , c i t i z e n power and the l e ve l o f c i t i z e n p a r t i c i p a t i o n are autonomous and a l l such endeavours can be measured aga ins t her ladder o f c i t i z e n p a r t i c i p a t i o n . F igure #1 - A r n s t e i n ' s Ladder of C i t i z e n P a r t i c i p a t i o n 8 C i t i z e n Contro l Degrees 7 Delegated Power of 6 Pa r tne r sh i p C i t i z e n Power 5 P l a c a t i o n Degrees 4 Consu l t a t i on o f 3 Informing Tokenism 2 Therapy 1 Man ipu la t i on A rn s t e i n summarizes her ladder as f o l l o w s : "The bottom rungs o f the ladder are (1) Man ipu la t ion and (2) Therapy. These two rungs desc r i be l e v e l s o f ' n o n - p a r t i c i p a t i o n ' tha t have been con t r i v ed by some to s u b s t i t u t e f o r genuine p a r t i c i p a t i o n . The i r r ea l o b j e c t i v e i s not to enable people to p a r t i c i p a t e i n p l ann ing o r conduct ing programs, but to enable power-ho lders to ' educate ' or ' c u r e ' the p a r t i c i p a n t s . Rungs 3 and 4 progress to l e v e l s o f ' t oken i sm ' t ha t a l l ow the have-nots to hear and have a v o i c e : (3) Informing and (4) Con su l t a t i o n . When they are p r e f e r r ed by power-holders as the t o t a l ex tent o f p a r t i c i p a t i o n , c i t i z e n s may indeed hear and be heard. But under these cond i t i on s they l a ck the power to i n su re tha t t h e i r views w i l l be heeded by the power fu l . When p a r t i c i p a t i o n i s r e s t r i c t e d to these l e v e l s , there i s no f o l l ow th rough , no 'mu s c l e ' , hence no assurance o f changing the s ta tus -quo . Rung (5) !P1 a c a t i o n , i s . - . . - 12 -. . . s i m p l y a h igher l e v e l o f tokenism because the groundru les a l l ow the have-nots to adv i s e , but r e t a i n f o r the power-holders the cont inued r i g h t to dec i de . Fur ther up the ladder are l e v e l s o f c i t i z e n power w i th i n c r ea s i ng degrees o f dec is ionmaking c l o u t . C i t i z e n s can en te r i n t o a (6) Pa r tne r sh ip t ha t enables them to nego t i a te and engage i n t r a d e - o f f s w i t h t r a d i t i o n a l powerho lders . At the top most rungs (7) Delegated Power and (8) C i t i z e n C o n t r o l , have-not c i t i z e n s ob ta in the ma j o r i t y o f d e c i s i o n -making s e a t s , or f u l l managerial power." 9 The Fo r t Prov idence P ro j e c t i s a t y p i c a l example o f the problems which are present i n the ma j o r i t y o f the hea l th p lann ing exe r c i s e s i n the Northwest T e r r i t o r i e s . The se l e c t ed authors have addressed the three major i s sues a s soc i a t ed w i th these problems. In most cases the p lanners are of a d i f f e r e n t c u l t u r a l b ias than the po t en t i a l r e c i p i e n t s . The re fo re , the problems a s soc i a t ed w i th the presence o f d i ve r se va lue systems and the accompanying problems assoc i a ted w i th a language b a r r i e r must be reso l ved before any j o i n t p lann ing can occu r . A l s o , the p lanners u sua l l y have to t r a v e l g reat d i s t ances to v i s i t the communities i n ques t ion on ly to deal w i t h an uninformed p u b l i c . F i n a l l y , the community may not see the va lue o f the proposed p lan to t h e i r personal hea l th s t a t u s . Th is a t t i t u d e i s o f ten ev iden t i n the areas o f d i sease prevent ion and pub l i c h e a l t h . F o s k e t t ' s t h e o r y ^ draws the p l anne r s ' a t t e n t i o n to these f a c t o r s o r the po t en t i a l f o r t h e i r presence. I t i s the r e s p o n s i b i l i t y o f the p lanner to be cogn i zant o f t h i s p o t e n t i a l and to p lan a c co r d i ng l y . - 13 -Bu rke ' s theory ^  p rov ides the next l o g i c a l s tep f o r the p lanner . U t i l i z i n g Burke ' s ideas the p lanner can choose from a s e r i e s o f a l t e r n a t i v e s how to overcome the i d e n t i f i e d c on s t r a i n t s wh i l e being aware o f some o f the po s s i b l e consequences o f a chosen a l t e r n a t i v e . F i n a l l y , A r n s t e i n^ 2 p rov ides a q u a l i t a t i v e measure o f judg ing to what degree p a r t i c i p a t i o n i s a c t u a l l y o c c u r r i n g . I I I . THE HEALTH CARE MILIEU As ment ioned, due cons i de r a t i on must be g iven to the environment w i t h i n which a community p a r t i c i p a t i o n methodology i s to be implemented. In t h i s case a major component o f the environment i s the hea l th care system. A l s o , the i n t e n t o f t h i s methodology being examined i s to b r i ng about community p a r t i c i p a t i o n i n the p lann ing and development of f a c i l i t i e s f o r the e l d e r l y . P lann ing and development imp l i e s the requirement f o r a thorough understanding o f a l l f a c t o r s a f f e c t i n g the p lann ing and placement o f a f a c i l i t y i n a community. An examinat ion o f the hea l th care system w i l l i d e n t i f y the components o f the system, e x p l a i n how they r e l a t e to each o ther and i d e n t i f y when or how the system can be out o f e q u i l i b r i u m . Fu r t he r , an exp l ana t i on of the system a l e r t s one to the i n fo rmat i ona l requirements necessary when p lann ing i n the hea l th care environment. - 14 -A. The Hea l th Care System Def ined B a k e r ^ has de f i ned a system as being "a se t o f un i t s which are a c t i v e l y i n t e r - r e l a t e d and which operate i n some sense as a bounded u n i t . " And, an open system has been de f ined as "one through which there i s a con t inu ing f low of component ma te r i a l s from the environment, and a cont inuous output of products o f the sys tem's a c t i on back to the env i r onmen t . "^ The hea l th care system i s one example of an open system because of the dependent r e l a t i o n s h i p e x i s t i n g between the system and i t s environment. The hea l th care system's s u r v i v a l i s de te r -mined by the nature o f i t s components - people. A d i s cu s s i on of the hea l th care system i n opera t i on and the r e l a t i o n s h i p among, the demand, need and supply o f hea l th care s e r v i c e s w i l l i l l u s t r a t e the dynamics o f hea l th care se r v i ce s and the i n t e r - r e l a t e d n e s s o f the components o f the hea l th care system. B. The Hea l th Care System i n Operat ion In the hea l th care system the component ma te r i a l s from the environment are peop le . People have con t inuous l y changing wants , needs and u t i l i z a t i o n o f the system depending upon t h e i r s t a t e o f h e a l t h . Furthermore, people are con t i nuous l y returned to the environment f o l l ow i ng system a c t i o n . I f a pe r son ' s hea l th i s r e s t o r e d , the person re tu rns to the environment u n t i l there - 15 -i s another change i n the person ' s hea l th s ta tus r e qu i r i n g a dd i t i o n a l a c t i on by the system. I f a pe rson ' s hea l th s ta tus i s not r e s to red the person cont inues to u t i l i z e the system or d i e s . In e i t h e r s i t u a t i o n the un i t s o f the system are an i n t e r -r e l a t e d and c y c l i c a l sequencing o f events . The hea l th care system can a l s o be desc r ibed i n terms of a demand-need-supply model. C. Demand-Need-Supply Model The model i s used to e xp l a i n the dependent nature between the demand and need f o r and the supply of hea l th s e r v i c e s . As i l l u s t r a t e d i n the f o l l o w i n g d iagram, demand-need i s expressed i n terms o f community wants, u t i l i z a t i o n and morb id i t y da ta . Supply i s expressed i n terms o f manpower, f a c i l i t i e s and se r v i c e s , F igure #2 - Demand-Need-Supply Mode l^ DEMAND I Comm'uni ty Ut i 1 i z a t i on Morbi d i ty Expressed Data Data Wants SUP 3LY N / t ->- 1 Manpower F a c i l i t i e s Se rv i ce s COMMUNITY HEALTH NEEDS - E qu i l i b r i um - Gaps - Surp lus - 16 -The community hea l th needs are expressed as a f un c t i on o f the demand-supply r e l a t i o n s h i p . When the demand equals the supp l y , the system i s i n a s t a t e o f e q u i l i b r i u m . E q u i l i b r i u m , however, i s r a r e l y , i f e ve r , ach ieved. When the demand i s g rea te r than the supp ly , there i s s a i d to be a gap i n the system„ And, when the supply i s g rea te r than the demand a su rp lus i s s a i d to e x i s t . D. Want-Need-Use-Demand And Supply Chambers^ e t a l have prov ided the f o l l ow i ng d e f i n i t i o n s : "Want o r "expected" s e r v i c e s The percept ions by the pub l i c o f t h e i r own wants , expec ta t i ons or r i g h t s . I t should be noted tha t the p u b l i c ' s pe rcep t i on o f hea l th s ta tus may d i f f e r from the hea l th p r o f e s s i o n a l ' s view o f the opt ima l hea l th s t a t u s ; and, to an economist , wants apply to the consumer's des i r e s f o r hea l th s e r v i c e s p r i o r to any knowledge o f the costs or p r i c e s i n vo l v ed . Need o r "ought to be" s e r v i c e s The s e r v i c e s t ha t should be prov ided to the pub l i c on the bas i s o f the percept ions o f the expe r t s . Th i s i n c l udes the i n t e r p r e t a t i o n o f need f o r hea l th s e r v i c e s on the bas i s o f hea l th s t a tu s i n fo rmat ion about t a r g e t groups. Demand The types and amounts o f hea l th s e r v i c e s requested o r des i r ed by the p ub l i c once they know the costs and p r i c e s i n vo l v ed . Wants change w i th a dd i t i o n a l knowledge of what i t w i l l cos t (or what a l t e r n a t i v e s would be forgone) to f u l f i l l them. And, demand i s f r equen t l y expressed i n p u b l i c a c t i on by informed consumers. Use The hea l th s e r v i c e s a c t u a l l y u t i l i z e d . - 17 -Supply or " g e t - a t - a b l e " hea l th s e r v i c e s Th is i s determined e i t h e r q u a n t i t a t i v e l y by cons i de r i ng the numbers and d i s t r i b u t i o n o f f a c i l i t i e s , programs and hea l th personnel r e l a t i v e to the popu la t i ons they may se rve . Or , by q u a l i t a t i v e l y cons i de r i ng the q u a l i t y o f care prov ided by these s e r v i c e s . " E. Want-Need-Use-Demand-Supply I n t e r a c t i o n 1 ' As ment ioned, the hea l th care system i s s a i d to be i n e q u i l i b r i u m when the demand-need i s equal to supp ly . Or , WANT= NEED=DEMAND=USE=SUPPLY AND QUALITY=QUANTITY. But the system i s u s ua l l y not i n e q u i l i b r i u m and one o f the f o l l ow i ng s i t u a t i o n s e x i s t s : Want^> Need Th i s i s when a community's de s i r e f o r a hea l th s e r v i c e i s g rea te r than the need f o r the s e r v i c e . An example o f want being g rea te r than need i s when a community requests a s en i o r c i t i z e n s ' home based s t r i c t l y upon the f a c t t ha t the community i s the on l y one i n a reg ion tha t does not have a f a c i l i t y , w h i l e i gno r i ng a l l o ther r e l e van t data such as the number of e l d e r l y o r l o c a t i o n of the nearest f a c i l i t y . Heedy Demand Th is i s when a community o r a segment o f s o c i e t y f a i l s to u t i l i z e a r equ i r ed hea l th s e r v i c e even though the c on s t r a i n t s to u t i l i z a t i o n have been removed or decreased. - 18 -An example of need being g rea te r than demand i s when a new s en i o r c i t i z e n s ' home w i th low un i t r en ta l fees i s not u t i l i z e d even though the community i s c ha r a c t e r i z ed by poor, overcrowded and expensive housing f o r the e l d e r l y . Demand^ Need Th is i s when the hea l th s e r v i c e s f a c i l i t i e s have been e s t a b l i s h e d , but the requ i r ed hea l th p r o f e s s i ona l s t a f f cannot be p rov ided . An example o f the demand being g rea te r than the need i s the high tu rnover ra tes o f hea l th p r o f e s s i ona l s i n some communities w i th a r e s u l t a n t absence o f s u f f i c i e n t personnel f o r per iods of t ime. Use { S u p p l y Th is i s when there i s a concen t ra t i on of medica l f a c i l i t i e s o r personnel i n one area or reg ion which cannot support these personnel o r f a c i l i t i e s . An example of use be ing l e s s than supply would be the c on s t r u c t i o n o f a hea l t h f a c i l i t y i n a l o c a t i o n which does not have s u f f i c i e n t popu la t i on to j u s t i f y i t s ex i s t ence w i th the net r e s u l t be ing the t r a n spo r t a t i o n o f people from o ther l o c a l e s to ensure the f a c i l i t y i s u t i l i z e d . Q u a n t i t y ^ Qua l i t y Th is i s when there i s present an over-abundance o f a hea l th s e r v i c e or hea l th personnel even though they are o f - 19 -ques t ionab le va lue to the hea l th s ta tus o f the consumers and y e t the hea l th care system cont inues to prov ide the s e r v i c e -or produce the pe rsonne l . An example o f quan t i t y be ing g rea te r than q u a l i t y would be a p o l i c y r e s u l t i n g in the automat ic c on s t r u c t i on o f a s en i o r c i t i z e n s ' home in a community whenever there were ten persons over the age o f s i x t y - f i v e i n t ha t community. Th is p o l i c y would not be t a k i ng i n t o cons i de r a t i on the ma r i t a l s t a tus o r l i v i n g cond i t i on s o f these ten persons nor the a v a i l a b i l i t y o f e x i s t i n g s en i o r c i t i z e n ' s home o r the a v a i l a b i l i t y o f o ther community resources which support the e l d e r i n h i s present s i t u a t i o n (home c a r e , e t c . ) . Th is s e c t i o n on the r e l a t i o n s h i p between want, need, demand, use, supp ly , q u a l i t y and quan t i t y o f hea l th s e r v i c e s i s important to the understanding o f why the u t i l i z a t i o n of c i t i z e n p a r t i c i p a t i o n i n t h i s p r o j e c t was de s i r ed . Ra re l y , i f e ve r , i s the hea l th care system i n e q u i l i b r i u m , e s p e c i a l l y i n the Northwest T e r r i t o r i e s . The ac tua l occurrence can be documented of the ex i s t ence of the examples c i t e d to i l l u s t r a t e the r e l a t i o n s h i p between the compo-nents o f the system. Furthermore, the reoccurrence o f the s i t u a t i o n s cou ld happen at anyt ime. In the op in ion o f the p l anne r s , involvement o f c i t i z e n s would lead to a b e t t e r under-s tand ing o f the a l l o c a t i o n of hea l th se r v i ce s and some of the f a c t o r s which c o n s t i t u t e to the u t i l i z a t i o n and cont inued - 20 -ex i s t ence o f those s e r v i c e s and, h ope f u l l y , prevent o r minimize the p o s s i b i l i t y o f imbalances o c cu r r i ng i n the f u t u r e . F. C i t i z e n P a r t i c i p a t i o n In The Hea l th Care M i l i e u - A Review Perhaps i t i s adv i sab le to review some o f the reason ing in support o f c i t i z e n p a r t i c i p a t i o n in the p l ann i ng , development and management o f hea l th s e r v i c e s and f a c i l i t i e s . People who are to be a f f e c t ed by hea l th p lann ing should be d i r e c t l y i n vo l ved i n the p lann ing process and the making o f cho ices to ensure tha t the p lan i s a p p l i c a b l e , f e a s i b l e and acceptab le to the p o t e n t i a l r e c i p i e n t s . I t i s becoming more ev iden t t ha t w i t h i n the l i m i t a t i o n s o f f i s c a l a pp r op r i a t i o n s , p o l i c i e s must be s e t , cho ices made and some de s i r ab l e p r o j e c t s s a c r i f i c e d . Usua l l y bureaucrats bear the r e s p o n s i b i l i t y o f those c ho i c e s , based upon r e sea r ch , documentation and p o l i c y f o rmu la t i ons . But the bureaucrats may not have to bear the burden o f l i v i n g w i th those c ho i c e s , o f d i r e c t l y expe r i enc i ng the consequences. C i t i z e n p a r t i c i p a t i o n may be the on ly guarantee tha t people w i l l be w i l l i n g to endure and to have s u f f i c i e n t f a i t h i n the hea l th care system. A f t e r be ing asked to address the i ssue o f p a r t i c i p a t i o n by the Ind ian people and the I n u i t people i n dec i s i ons a f f e c t i n g the p r o v i s i o n o f hea l th care f o r them,. Mr. J u s t i c e B e r g e r ^ r e f e r s to a speech on the r am i f i c a t i o n s o f s e l f - d e t e rm i na t i o n in the f i e l d o f hea l th care f o r the Ind ians and I n u i t . The speech was given by Mr. Noel S t a r b l a n ke t , P r e s i den t o f the Nat iona l Indian Brotherhood at the opening o f the B a t t l e f o r d Ind ian Hea l th Cent re , J u l y 26, 1979. - 21 -Mr. S t a rb l anke t s t a t e d , "Our people are becoming i n c r e a s i n g l y vocal i n exp ress ing tha t the a l l - i m p o r t a n t f i r s t . step i n combatt ing these s o c i a l pa tho log ies i s f o r our communities to take t h e i r des t i ny back i n t o t h e i r own hands, and to s e t t h e i r own goals and p r i o r i t i e s . The few Ind ian communities t ha t have succeeded i n the s t r ugg l e to rega in con t ro l o f t h e i r own a f f a i r s have demonstrated a remarkable inc rease in community s p i r i t , and a cor respond ing decrease i n problems w i th s o c i a l d i seases and v i o l e n c e . Such communities serve as l i v i n g proof tha t the main b a r r i e r s to improved Ind ian hea l t h are both s o c i a l and p o l i t i c a l , not s imp ly medical and tha t the r e l a t i o n s h i p between p a t e r n a l i s t i c government a t t i t u d e s and the i l l - h e a l t h of our people i s a very rea l phenomenon."'9 In t h i s same r e p o r t ^ J u s t i c e Berger went on to say t h a t , " Ind ian people aim to achieve s e l f - r e l i a n c e i n the f i e l d o f hea l th care through meaningful p a r t i c i p a t i o n , w i th con t ro l o f t h e i r own hea l th care a t a l l l e v e l s -community, r eg iona l and na t i ona l - as the u l t ima te goa l . The process must, o f course , be founded upon p a r t i c i p a t i o n at the community l e v e l . . . " But as Burke sugges ts , "The e f f e c t i v ene s s o f a p a r t i c u l a r s t r a t egy o f c i t i z e n p a r t i c i p a t i o n depends upon c e r t a i n cond i t i ons and assumptions p e c u l i a r to i t s e l f ; l i k e w i s e , each s t r a t egy has i t s own advantages and l i m i t a t i o n s . The p r i n c i p l e d i f f i c u l t y i s i n adapt ing a s t r a t egy o r s t r a t e g i e s to the demands o f the p a r t i c u l a r type o f o r gan i z a t i on and the environment w i t h i n which i t f unc t i ons . "21 The re fo re , i n ana l y z i ng a c i t i z e n p a r t i c i p a t i o n p r o j e c t w i t h respec t to i t s u t i l i t y and appropr ia teness the p r o j e c t must be put i n con tex t . That i s , the f o l l ow i ng must be asked: - 22 -(a) Who c o n t r o l l e d and who e xe r c i s ed power? Did i t change f o r d i f f e r e n t s i t u a t i o n s ? (b.) What was the ob j e c t i v e o f each p a r t i c i p a n t group. Were t h e i r ob j e c t i v e s the same? Were t h e i r ob j e c t i v e s compat ib le? (c) Accord ing to A r n s t e i n ' s Ladder , what l e v e l o f p a r t i c i p a t i o n was achieved? (d) What type o f c i t i z e n p a r t i c i p a t i o n s t r a t egy was u t i l i z e d ? Did the s t r a t egy change over t ime? Was a d i f f e r e n t s t r a tegy u t i l i z e d f o r d i f f e r e n t s i t u a t i o n s ? IV. APPROACH AND METHODOLOGY TO DATA ANALYSIS A. Case Study A r e t r o s pe c t i v e case study o f the development of a f a c i l i t y f o r the e l d e r l y o f Fo r t P rov idence , N.W.T. w i l l be u t i l i z e d to address the t h e s i s ques t i on . The implementat ion of the "Northwest T e r r i t o r i e s community p a r t i c i p a t i o n approach" as app l i ed to the Fort Prov idence p r o j e c t w i l l be used to examine the quest ion of u t i l i t y and a p p l i c a b i l i t y as i t pe r t a i n s to the development o f f a c i l i t i e s f o r the e l d e r l y o f the Northwest T e r r i t o r i e s . B. Data Sources The data f o r t h i s paper i s from secondary sources compi led from N.W.T. Government p o l i c y papers , documents and correspondence which were ob ta ined from the N.W.T. Depart-ment o f S o c i a l Se rv i ce s and the N.W.T. Housing Co rpo ra t i on . - 23 -S p e c i f i c a l l y , the sources were: (1) correspondence between ac to r groups; (2) minutes o f meetings between the ac to r groups; (31) So c i a l Se rv i ces to the Aged - In te r im Statement, Department o f S o c i a l S e r v i c e s , February, 1978. (An i n t e r n a l working document of the Department); (4) Sen io r C i t i z e n s ' Accomodation Task Force Report , N.W.T. Housing Co rpo ra t i on , A p r i l , 1978. ( An unpubl i shed working pape r ) ; and (5) Memorandum o f Agreement, 4 December, 1978 between N.W.T. Housing Corporat ion and the N.W.T. Departments o f Soc i a l Se rv i ces and Hea l th . F i n a l l y , i t shou ld be noted that t h i s author was a p a r t i c i p a n t o f the p r o j e c t as the Department o f S o c i a l Se rv i ces r ep re sen ta t i v e on the Working Group. As such, most o f the data was obta ined by pe r sona l l y perus ing the p r o j e c t f i l e s o f the i n d i v i d u a l s i nvo l ved in the p r o j e c t . C. Data Ana l y s i s The method o f data ana l y s i s f o r t h i s t he s i s w i l l be d e s c r i p t i v e a n a l y s i s . Th is i nvo l ves p resen t ing a ch rono l og i ca l l i s t i n g of documented events or a p o r t r a i t o f the p r o j e c t as opposed to a s t a t i s t i c a l a n a l y s i s . The events w i l l then be d i s cussed w i t h i n the contex t o f the methodology as i t r e l a t e s to the chosen theo r i e s of community p a r t i c i p a t i o n . 24 -V. SUMMARY This chapter e s t a b l i s h ed the purpose of t h i s paper as be ing an e f f o r t to assess the u t i l i t y and a p p l i c a b i l i t y o f a community p a r t i c i p a t i o n methodology as i t pe r ta ined to the development o f a f a c i l i t y f o r the e l d e r l y i n the Northwest T e r r i t o r i e s . The r o l e o f c i t i z e n p a r t i c i p a t i o n was addressed and i t was s t a t ed tha t the government p lanners sought the involvement of the c i t i z e n r y . Th is p a r t i c i p a t i o n was requ i r ed to i n vo l ve the community i n dec i s ion-mak ing about a l l o c a t i o n , p r i o r i t y s e t t i n g and program and f a c i l i t y des ign to b e t t e r ensure tha t the f a c i l i t y was accep-t ab l e to the community and approp r i a te to i d e n t i f i e d needs. A l s o , the c i t i z e n p a r t i c i p a t i o n approach was o f nece s s i t y g iven the very r ea l p lann ing c on s t r a i n t s o f d i ve r se c u l t u r e , language b a r r i e r and the phys i ca l sepa ra t i on e x i s t i n g between the p lanners and p o t e n t i a l r e c i p i e n t s o f the hea l th s e r v i c e . A committed, a c t i v e , suppor t i ve community cou ld on ly enhance the e f f o r t s o f the p lanners . Th is chapter a l so p rov ided a thorough d i s cu s s i on of the hea l th care system. The composi t ion and opera t i on of the system were presented and the r o l e o f c i t i z e n p a r t i c i p a t i o n w i t h i n the contex t o f the hea l th care system was e l abo ra ted upon. F i n a l l y , the chapter c losed wi th a few comments as to the approach and methodology of data ana l y s i s to be u t i l i z e d i n t h i s t h e s i s . - 25 -CHAPTER ONE REFERENCES (1) BURKE, Edmund M., C i t i z e n P a r t i c i p a t i o n S t r a t e g i e s . American I n s t i t u t e o f P lanners J o u r n a l , September, 1968. p. 288 (2) FOSKETT, John M., The In f luence of P a r t i c i p a t i o n  on Community Programs and A c t i v i t i e s i n Sussman, Marvin B., e d i t o r , 1959. Community S t r u c tu r e and  A n a l y s i s . New York, Thomas Y. Crowel l Company, p. 328 (3) IBID, pp. 328-330 (4) IBID, p. 313 (5) IBID, p. 313 (6) BURKE, Edmund M., C i t i z e n P a r t i c i p a t i o n S t r a t e g i e s . American I n s t i t u t e o f P lanners J o u r n a l , September, 1968. pp. 287-294 (7) ARNSTEIN, Sherry R., A Ladder o f C i t i z e n P a r t i c i p a t i o n , American I n s t i t u t e o f P lanners J o u r n a l , J u l y , 1969. pp. 216-224 (8) IBID, p. 217 (9) IBID, p.217 (10) FOSKETT, John M., The In f luence o f P a r t i c i p a t i o n  on Community Programs and A c t i v i t i e s i n Sussman, Marvin B., e d i t o r , 1959. Community S t r u c tu r e and  A n a l y s i s . New York, Thomas Y. Crowel l Company, p. 328 (11) BURKE, Edmund M., C i t i z e n P a r t i c i p a t i o n S t r a t e g i e s . American I n s t i t u t e o f P lanners J o u r n a l , September, 1968. pp. 287-294 (12) ARNSTEIN, Sherry R., A Ladder o f C i t i z e n P a r t i c i p a t i o n , American I n s t i t u t e of P lanners J o u r n a l , J u l y , 1969. pp. 216-224 (13) BAKER, F., "General Systems Theory, Research and  Medical Care" i n She ldon, A . , Baker , F., and McLaugh l in , C P . , ( eds ) , Systems and Medical Care. Cambridge, Mass: The M.I .T. P re s s , 1970 p.5 - 26 -(14) IBID, p.7 (15) WARNER, Morton M., Hea l th Needs i n Northern A l b e r t a : A P lann ing P roposa l . A Report prepared f o r the Northern A l b e r t a Development Coun c i l , A p r i l , 1980. p. 7 (16) CHAMBERS, L.W., WOODWARD, C. and DOR, D., Guide to  Hea l th Needs Assessment: A C r i t i q u e o f A v a i l a b l e  Se rv i ce s of Heal th and Heal th Care In fo rmat ion . Department of C l i n i c a l Epidemiology and V i o s t a t i s t i c s , McMaster U n i v e r s i t y , November, 1979, (mimeo). (17) WARNER, Morton M., Hea l th Needs i n Northern A l b e r t a : A P lann ing P roposa l . A repo r t prepared fo r the Northern A l be r t a Development Coun c i l , A p r i l , 1980. pp. 8-10 (18) BERGER, Mr. J u s t i c e Thomas, Report o f Adv i so ry  Commission on Indian and I n u i t Hea l th Con su l t a t i o n . A Report prepared f o r the M i n i s t e r o f Nat iona l Hea l th and We l fa re , 28 February, 1980. p. 5 (19) STARBLANKET, Noe l , " Ind ian Hea l t h : The Dawn o f a New E r a " , a speech presented a t the opening ceremonies o f the B a t t l e f o r d s Indian Hea l th Cent re , 26 J u l y , 1979. p. 6 (20) BERGER, Mr. J u s t i c e Thomas R., Report o f Adv i so ry  Commission on Indian and I nu i t Hea l th Con su l t a t i o n , A Report prepared f o r the M i n i s t e r o f Nat iona l Hea l th and We l fa re , 28 February, 1980. p. 6 (21) BURKE, Edmund M., C i t i z e n P a r t i c i p a t i o n S t r a t e g i e s . American I n s t i t u t e o f P lanners J o u r n a l , September, 1968. p. 293 CHAPTER TWO - THE CASE STUDY PRESENTED INTRODUCTION To most Canadians the Northwest T e r r i t o r i e s i s an un f am i l i a r pa r t o f Canada. Th is Chapter prov ides the reader w i th the bas i c i n fo rmat ion about the T e r r i t o r i e s , i t s people and the community o f Fo r t P rov idence . In a d d i t i o n , some space has been devoted to a d e s c r i p t i o n o f the Sen i o r C i t i z e n s 1 Home at Fo r t Prov idence. The development o f the f a c i l i t y des ign i s an i n t e g r a l pa r t o f the p r o j e c t which nece s s i t a t e s i t s being o f importance to t h i s t he s i s and, thus , the requirement f o r i t s be ing des c r i bed . I . THE NORTHWEST TERRITORIES The Reverend Father Duchausso is , Oblates o f Mary Immaculate, a long- t ime r e s i den t o f the T e r r i t o r i e s , has prov ided a c l a s s i c n a r r a t i v e o f what he c a l l e d the "Mackenzie Country" . Th is des-c r i p t i o n i s a c l a s s i c because o f h i s method o f comparison to the r e s t o f Canada but a l so due to the f a c t t ha t i t was w r i t t e n over s i x t y years ago, y e t i s s t i l l a p p l i c a b l e . Father Duchaussois desc r ibes the "Mackenzie Country" as f o l l o w s : - 27 -- 28 -"Few people - even Canadians - r e a l i z e tha t the Dominion o f Canada i s bounded on the nor th by the A r c t i c Ocean: fewer s t i l l r e a l i z e i n the s l i g h t e s t degree what t ha t means. Perhaps even i t would be more c o r r e c t to say t h a t ' C anada ' i s 'bounded' on the north by the North Po l e . North of the prov ince of B r i t i s h Columbia, A l b e r t a , Saskatchewan and Man i toba, there i s a tremendous t e r r i t o r y - ex tend ing from the 60th p a r a l l e l to the A r c t i c Ocean and the i s l and s the reo f : V i c t o r i a , Banks, P r i n ce o f Wales, North Devon, E l l e smere , M e l v i l l e , B a f f i n - ' i s l a n d s ' i n mere s i z e comparable t o , and some o f them i n d i v i d u a l l y g rea te r than the e n t i r e area comprised i n the Mar i t ime p rov i nces . These are the Northwest T e r r i t o r i e s o f Canada. East o f the Rocky Mounta ins , a l l o f the t e r r i t o r y i s on the A r c t i c o r on the Hudson Bay s l ope . The Yukon T e r r i t o r y (west o f the mountains) d ra ins i n t o the North P a c i f i c . The Mackenzie R i ve r ( the g rea t highway o f the nor th) c a r r i e s o f f to the A r c t i c the waters o f the Great Bear Lake, Lake Athabasca, w i th t r i b u t a r y r i v e r s r i s i n g as f a r south as the Ye l low Head Pass , almost due west o f Edmonton. The mighty Peace R i v e r , r i s i n g i n B r i t i s h Columbia, foaming through magn i f i cen t canyons, p ieces the Rockies to pour i t s f l ood i n t o the a l ready sp l end id volume o f Mackenzie (500,000 cub i c f ee t per second). The dra inage area o f the Mackenzie and t r i b u t a r i e s i s es t imated a t 985,000 square m i l e s . . . G r e a t S lave Lake i s about equal i n area to Ontar io and E r i e combined, and Great Bear Lake to Lake Huron, i n c l u d i n g the Georgian Bay. The A r c t i c Bas in comprises 1,486,000 square m i l e s . The e n t i r e A t l a n t i c bas in ( o f Canada) e x c l u s i v e , o f course , o f Hudson Bay, on ly 554,000 square m i l e s . The Mackenzie coun t r y , the most no r the rn l y i nhab i t ed pa r t o f the c on t i n en t , a land e i gh t t imes as l a rge as Great B r i t a i n and I r e l a nd ; i n which lakes and r i v e r s are f rozen f o r e i gh t months o f the y ea r ; where communication i s made between f o r t s one hundred and two hundred mi les d i s t a n t from each o ther by l i g h t l y laden dog s l e d s . . . Figure #3 Map of Northwest Territories Source: Department of Information, Government of the Northwest Territories KO - 30 -A modern d e s c r i p t i o n would a l so begin w i th a re ference to s i z e . The Northwest T e r r i t o r i e s s t r e t ches some 2,000 m i l es eas t to west and from the 60th p a r a l l e l to the North Po l e . The t o t a l area i s approx imate ly 1.3 m i l l i o n square m i l e s , o f wh i ch , more than 1.2 m i l l i o n square m i l e s i s land mass and 51,000 square m i l es i s f r e sh water . The T e r r i t o r i e s i s d i v i d ed by two c l i m a t i c zones - the s ub -A r c t i c and the A r c t i c . The ma jo r i t y o f the T e r r i t o r i e s , i n c l u d i n g the e n t i r e Mackenzie V a l l e y , l i e s w i t h i n the sub-A r c t i c zone. By way o f compar ison, t h i s c l i m a t i c zone i s a l s o a pp l i c a b l e to most o f the Canadian p r a i r i e s and the northern Un i ted S t a t e s . I I . FORT PROVIDENCE A. H i s t o r y Of For t Prov idence "The h i s t o r y o f Fo r t Prov idence can be summarized as f o l l ow s . I n i t i a l l y e s t ab l i s hed by Pe te r Pond i n 1786, i t was operated f o r about two seasons then i t was c l o sed . The f o r t was re-opened and en la rged i n 1789 by Laurent Le Roux, Mackenz ie ' s a s s i s t a n t . I t f l o u r i s h e d as an important p r o v i s i o n depot i n the 1790 ' s , de c l i n ed i n importance before the time o f F r a n k l i n , and was c losed in 1823 by an order i n counc i l o f the Hudson Bay Company: a t o t a l l i f e s p a n o f 37 y ea r s . " 2 The present day se t t l ement was f i n a l l y l o ca t ed on the Mackenzie R i v e r , 45 mi les downstream from Great S lave Lake i n - 31 -1861 by Mgr. Grand in , a Roman Ca t ho l i c m i s s i ona ry . La te r another Hudson Bay Company t r ad i ng post was a l so e s t a b l i s h e d . The community then evo lved l i k e and su f f e red the f a t e o f the t r ad i ng post community. I n i t i a l l y the community and i t s r e s i den t s were dependent upon the f u r t rade f o r t h e i r s u r v i v a l . G r adua l l y , educa t iona l and medical f a c i l i t i e s and oppo r t un i t i e s f o r wage employment were in t roduced i n t o the no r t h . The net r e s u l t was a s h i f t towards se t t l ement as opposed to a nomadic l i f e accompanied by a d e c l i n e i n the importance o f the f u r t rade i n the d a i l y l i v e s o f community r e s i den t s and the northern economy. Today, i n f a c t , the o l d pa t t e rn o f a mobi le s c a t t e r ed popu la t i on dependent upon faunal resources has now almost d i sappeared. B. For t Prov idence Today Present day For t Prov idence i s a very peacefu l community o f 556 peop le( as of 31 December, 1978), most o f whom are o f S lavey Ind ian descent w i th the remainder be ing o f "o ther " descent. (See Table I I ) . The community i s thus cha r a c t e r i z ed by the presence o f two cu l t u r e s and languages; a s i t u a t i o n which i s common to most o f the communities i n the Northwest T e r r i t o r i e s . Fu r the r , the popu la t i on i s a l s o s p l i t accord ing to occupa t i on . The "o ther " peoples are the community's t eache r s , nurses , s to re and ho te l owners, pol icemen and other government departmental - 32 -r ep re sen ta t i v e s and t h e i r f a m i l i e s . The S lavey peop le , the indigenous members o f the community, are u sua l l y ma in ta i n i ng a "mixed" employment pa t t e rn c o n s i s t i n g o f wage employment w i th one o f the government agencies o r support f a c i l i t i e s and se r v i c e s ( h o t e l , s t o r e , e t c . ) which i s supplemented by f u r t r a d i n g and/or a government we l fa re program ( f i n a n c i a l a s s i s t a n c e , unemployment i n su rance , f am i l y a l l owance , e t c . ) . The presence of t h i s phenomenon c rea tes another charac-t e r i s t i c o f the T e r r i t o r i a l community. Very few of the "o the r s " become permanent members o f the community. The re fo re , p lann ing o f programs o r f a c i l i t i e s f o r the e l d e r l y must take i n t o con-s i d e r a t i o n the f a c t tha t the p o t e n t i a l consumers are the ind igenous people o f the community. Present day Fo r t P rov idence , l o ca ted on the Mackenzie Highway system, has become renowned f o r two t h i ng s . Twice y e a r l y , Fo r t Prov idence i s the scene o f a "wa i t and see game". Fo r t Prov idence i s the l o c a t i o n o f a summer f e r r y and w i n t e r i c e br idge c r o s s i n g o f the Mackenzie R i v e r . The s i x weeks to two months annual wa i t u n t i l the a pp l i c a b l e mode o f c r o s s i ng becomes ope ra t i ve sparks renewed cont roversy concern ing the cons t r u c t i on o f ' a permanent br idge c r o s s i n g . The second reason f o r renown f o r present day For t Prov idence i s the moose h a i r t u f t i n g s which are done by the - 33 -Slavey women o f the community. Th is i s an a r t form which has d isappeared i n most o ther a reas . The women use t u f t s o f dyed moose h a i r to make p i c t u r e s on s t r o ud , ve l ve t or moosehide ( w h i c h are then framed) and to decorate s l i p p e r s , mukluks and o the r a r t i c l e s o f c l o t h i n g . C. For t Prov idence Demography The f o l l o w i n g tab les serve to i l l u s t r a t e the community o f Fo r t Prov idence in comparison w i th the Northwest T e r r i t o r i e s as a whole. These s t a t i s t i c s have been taken from l a r g e r t ab l e s and, thus , each t ab l e r e t a i n s the t i t l e and format o f the source t a b l e . TABLE ONE: Popu l a t i o n by Cat imjn i ty , N.W.T. 1971 t o 1978 * (Table A - l ) SOURCE Census o f Canada Government o f t he N.W.T. DATE 1 June, 1971 1 June, 1976 ( Census N.W.T. \ 31 December, 1977 P opu l a t i o n E s t ima te - N.W.T. 31 December, 1978"" POPULATION: . F o r t Prov idence N.W.T. T o t a l 587 34,807 602 42,609 566 46,375 556 46,398 *SOURCE^PopiilatdLon P r o j e c t i o n s : Me thodo log i ca l Repor t , Northwest •rD&aAtati^^^S^St988; -Statistics S e c t i o n , Government o f the Northwest T e r r i t o r i e s , Tab le A - l 1 ' ' - 35 -TABLE TWO: Ethnicity by Carrnuriity, N.W.T., 31 December, 1978 * (Table A-2) ^"^v^Ethnicity Indian Inuit Other Total # % # # # % Fort Providence N.W.T. Total 425 8083 76.4 17,5 0.00 15054 0.00 32.4 131 23261 23.6 50,1 556 45398 1.22 ' 100.00 TABLE THREE:Ccrariunity and Age Distribution, N.W.T., * (Table A-3) 31 December, 1978 Aqe Groupings Fort Providence N.W.T. Total 0-4 55 55560 5-9 92 5584 10-14 77 5311 15-19 58 4990 20-24 49 4882 25-29 44 4997 30-34 44 3606 35-39 29: 2736 Age Groupings Fort Providence .. N.W.T. Total 40-44 24 2418 45-49 24 1803 50-54 20 1464 55-59 10 1067 60-64 10 738 65+ 20 1215 TOTAI 556 4639E *SOURCE:^copulation Projections: Itethodological Report, Northwest • Territories, 1978 to <L988; Statistics Section, Government of the Northwest Territories, Tables A-2 and A-3 - 36 -As ment ioned, the ma j o r i t y (76.4%) o f the community r e s i den t s are S lavey Indians ( r e f e r to Table I I ) . As per Table I I I , Fo r t Prov idence has a young popu l a t i on ; on ly f o r t y (40) people o r 7.2% o f the popu la t i on are f i f t y - f i v e years o f age o r o l d e r . There fo re , the p lann ing o f s e r v i c e s o r f a c i l i t i e s f o r the e l d e r l y would be on beha l f o f a very smal l number of peop le . Only twenty (20) people o r 3.6% o f the community are s i x t y - f i v e years o f age o r o l d e r . D. Fo r t Prov idence I n f r a s t r u c t u r e For t Prov idence i s governed, m u n i c i p a l l y , by a l o c a l l y e l e c t e d se t t l ement c o u n c i l . The c o u n c i l s ' compos i t ion c on s i s t s o f a cha i rperson and f i v e c o u n c i l l o r s . The mandate of the counc i l i s l i m i t e d to the implementat ion of government p o l i c i e s and programs because the counc i l does not have the au t ho r i t y to l e v y t axes . The counc i l can , however, i n f l u ence government p o l i c y as i t pe r t a i n s to Fo r t P rov idence . I t shou ld be noted tha t the c o u n c i l s ' mandate i s r e s -t r i c t e d to on ly those matters concerned w i th the maintenance o f the m u n i c i p a l i t y . That i s , the counc i l dea ls w i th such matters as the p r o v i s i o n of water and sewer s e r v i c e s , the maintenance of the roads , the p r o v i s i o n o f f i r e f i g h t i n g s e r v i c e s , e t c . The counc i l i s not r e spons i b l e f o r the p r o v i s i o n of any h e a l t h , s o c i a l s e r v i c e s o r s o c i a l hous ing. - 37 -Hea l th s e r v i c e s are a v a i l a b l e at a Federal government nurs ing s t a t i o n . The s t a t i o n i s manned by two nurses who prov ide p r i m a r i l y p reven ta t i ve and pub l i c hea l th s e r v i c e s . A nurs ing s t a t i o n has r e s t r i c t e d i n - p a t i e n t c a p a b i l i t i e s . S o c i a l s e r v i c e s are prov ided on a d r i v e - i n / f l y - i n bas i s from Hay R i ve r . 0n a r e g u l a r l y scheduled bas i s a s o c i a l worker from Hay R ive r comes to prov ide the s o c i a l s e r v i c e s . When requ i red add i t i o n a l or emergency v i s i t s are made. There-f o r e , any re ference to the l o c a l s o c i a l s e r v i c e personnel i s a c t u a l l y r e f e r r i n g to a s o c i a l worker r e s i d i n g i n Hay R ive r not Fo r t P rov idence . S o c i a l housing i s p rov ided by the N.W.T. Housing Cor-p o r a t i o n . The Corporat ion cons t ruc t s the housing un i t s then funds and t r an s f e r s the d a i l y management o f the un i t s to a l o c a l Housing A s s o c i a t i o n . The A s s o c i a t i o n i s comprised o f r e s i den t s o f the un i t s who are voted onto the A s so c i a t i o n by t h e i r f e l l ow r e s i d en t s . Thus, membership i s r e s t r i c t e d to r e s i den t s o f s o c i a l housing u n i t s . The A s s o c i a t i o n u sua l l y e l e c t s a cha i rperson and fou r o r f i v e c o u n c i l l o r s (ac tua l s i z e va r i e s accord ing to community s i z e and the number of housing u n i t s ) . F i n a l l y , the A s s o c i a t i o n employs a manager and maintenance pe r sonne l . A l s o , i n For t Prov idence there i s a du ly e l e c t e d Band Counc i l . The Band Counc i l i s e l e c t e d by the s t a tu s Indians - 38 -of the community and i s concerned w i th a l l matters p e r t a i n i n g to the Band. I I I . THE INDIGENOUS PEOPLE OF THE NORTHWEST TERRITORIES Perhaps the most exhaust i ve and best p u b l i c i z e d study o f the people o f the North was the Mackenzie Va l l e y P i p e l i n e Inqu i ry cha i r ed by Mr. J u s t i c e Thomas Berger . In h i s r epo r t , he s t a t e s , "The na t i ve peoples o f the North have values tha t are i n many respects q u i t e d i f f e r e n t from our own. These values are r e l a t e d to the s t r ugg l e f o r su r -v i v a l waged by t h e i r ances to r s , and they p e r s i s t i n t h e i r s t r ugg l e to su r v i ve as d i s t i n c t p e o p l e s . " 5 J u s t i c e Berger a l s o devoted some words to the r o l e o f the e l d e r s . "There e x i s t s among the na t i v e people a s pe c i a l respec t f o r the o l d . The e lde r s are t h e i r h i s -t o r i a n s , the keepers of t h e i r customs and t r a d i t i o n s . They are respected f o r what they a re , f o r the exper ience and the knowledge tha t t h e i r age has g iven them, and f o r a l l t ha t they can i n turn g ive to o t he r s . George Barnaby put i t t h i s way: 'Respect f o r the o l d people i s another law, s i nce a l l the laws come from the teach ing by our e l d e r s , from s t o r i e s t ha t g ive us p r i de i n our c u l t u r e , from t r a i n i n g s ince we are young; we l ea rn what i s expected o f us. Wi th -out t h i s l e a r n i ng from the e l de r s our c u l t u r e w i l l be des t r oyed . 1 - 39 -The r o l e o f the e l de r s and the respec t they rece i ve are important i n the na t i ve peop le ' s attempts to deal w i th the problems tha t face them today. Rene Lamothe ( respected community e l de r ) t o l d the Inqu i ry a t For t Simpson about the a c t i v i t i e s o f the Koe Go Cho S o c i e t y , a community resource centre tha t serves the e d u c a t i o n a l , c u l t u r a l and s o c i a l needs o f the na t i ve people o f Simpson. He exp l a i ned the c en t r a l r o l e of the e l de r s i n the s o c i e t y ' s a c t i v i t i e s : 'We don ' t look at s en i o r c i t i z e n s ' homes as they are looked a t i n the South o r by the i n d u s t r i a l economy...The reason f o r having s en i o r c i t i z e n s (homes) here i s a s e r v i c e to them o f course. I f they choose to come here there would be no charge to them..We would ask them to come as leaders o f the peop le , as people who have the know-ledge o f the.ways o f l i f e o f the people to teach to the young here . They would come, not as people who have no f u r t h e r p roduc t i ve r e a l i t y i n the ex i s t ence of the peop le , but as the c r u c i a l e lement, the age which passed on the l i f e to young. One o f the pe r spec t i ves o f l i f e tha t i s l a c k i ng i n the i n d u s t r i a l economy, which i s a very rea l t h i n g . . . i n the Ind ian wo r l d , i s the f a c t tha t we are born every day, and t ha t every l i t t l e b i t o f i n f o r -mation tha t we l ea rn i s a b i r t h . As we l e a rn the way of l i f e from the o l d , as we get o l d e r , we understand d i f f e r e n t t h i ng s , we hear a legend, we hear i t aga i n , we hear i t aga in , we hear i t aga i n , and every time at a g iven age t h i s legend takes on new meaning. ' So the s en i o r c i t i z e n s by t h e i r presence, t h e i r knowledge of the pas t , o f language, o f songs and dances, o f the l egends , the mate r i a l aspects o f t h e i r c u l t u r e , such as the b u i l d i n g o f canoes, snowshoes, t h i s k i nd o f t h i n g , w i l l be very ins t rumenta l i n c r e a t i n g the s p i r i t , the atmosphere in which the c u l t u r e t h r i v e s . The s en i o r c i t i z e n s w i l l be present to a s s i s t the research and i n f o r -mation crews to b u i l d a l i b r a r y o f na t i ve f o l k l o r e . The i r presence in the educat ion system as i t i s deve lop ing w i l l make i t p o s s i b l e f o r them to take up t h e i r r i g h t f u l . a n d ances t r a l r o l e as the teachers of t h e i r p e o p l e . " 6 - 40 -IV. THE SELECTION OF FORT PROVIDENCE In l a t e 1976, the Government o f the Northwest T e r r i t o r i e s was beg inn ing to r e th ink i t s p o l i c i e s regard ing the c on s t r u c t i on o f s e n i o r c i t i z e n s ' homes. The government was seek ing a more r a t i o n a l means o f determin ing when and where such a f a c i l i t y shou ld be b u i l t . E v en t ua l l y , a p o l i c y o f s ub s t an t i a t i o n o f need emerged. The Fo r t Prov idence Housing A s so c i a t i o n request f o r the c on s t r u c t i o n o f a s en i o r c i t i z e n s ' home i n 1977 prov ided an oppo r tun i t y to implement the p o l i c y and the N.W.T. community p a r t i c i p a t i o n approach. V. DESCRIPTION OF THE FORT PROVIDENCE SENIOR CITIZENS' HOME Without p r e j u d i c i n g l a t e r chap te r s , i t can be mentioned tha t the For t Prov idence s en i o r c i t i z e n s ' home i s unique to the Northwest T e r r i t o r i e s . In deve lop ing t h i s f a c i l i t y , f o r the f i r s t t ime , there was concer ted e f f o r t to make i t p r a c t i c a l and acceptab le as pe rce i ved by the po t en t i a l r e s i d en t s . The ques t i on o f s c a r c i t y o f resources and the need f o r f l e x i b l e u t i l i z a t i o n of scarce resources was a l s o addressed by at tempt ing to cons t ruc t a f a c i l i t y meeting the present needs o f the community wh i l e having the c a p a b i l i t y o f responding to the f u tu re needs o f r e s i d en t s . As a r e s u l t , there are bache lor un i t s f o r those - 41 -persons r e qu i r i n g persona l care which enable the person to l i v e w i th a companion, as the bedroom can be d i v i ded from the l i v i n g room and ; , w i l l accommmodate two s i n g l e beds, should t h i s be necessary . A. Loca t i on The bu i l d i ng s are l oca ted adjacent to the Roman Ca t ho l i c Church on land which i s f l a t and o f good s o i l q u a l i t y , near the Mackenzie R i v e r ; and, ad jacent to the Hea l th and We l f a re , Canada, nu r s i ng s t a t i o n . Genera l l y speak ing , the view from t h i s s i t e i s p leasant i n a l l aspects but s pe c i a l a t t e n t i o n was g iven to o r i e n t i n g the lounge and personal care un i t s f o r maximum sunsh ine. B. General De s c r i p t i on The f a c i l i t y a c t u a l l y c on s i s t s o f three b u i l d i n g s . The main b u i l d i n g has fou r bache lo r un i t s (one f o r the p h y s i c a l l y handicapped) each w i th i t s own p r i v a t e bathroom, k i t chen and bedroom (which can be i s o l a t e d by a f o l d i n g s l i d i n g door) and e x t e r i o r and i n t e r i o r e n t r i e s . Each un i t a l s o has i n d i v i d u a l s torage and windows in the l i v i n g and bedrooms. Add i t i o na l un i t s i n t h i s b u i l d i n g are the personal care un i t s which are equipped w i th a smal l s i n k , r e f r i g e r a t o r , two burner elements and l i v ing-bedroom areas which can be combined to form double rooms by opening a f o l d i n g s l i d i n g p a r t i t i o n . These fea tu res make i t p o s s i b l e f o r the r e s i den t s o f these un i t s to a s s i s t each o ther w i th regard to t h e i r i n d i v i d u a l handicaps. Figure #4 Fort Providence Senior Citizens Home Source: John Murray, Architect (7) FORT PROVIDENCE N.W.T.—SENIOR CITIZENS 16 unit LODGE Road ^••-••••:!M:v.:^Ti^.;T;r7f-sheet no.l -p=. ro ^L. 83.8 ROAD Figure #5 Fort Providence Senior Citizens Home sheet no.2 Source: John Murray, Architect (7) -F=> 45.975 ! --4 i 17.65 9.35 sheet no. 3 -F* - 45 -Adjacent to the personal care un i t s are support f a c i l i t i e s such as a c en t r a l f r e e - s t and i ng bath and a whee l cha i r shower, laundry room and smal l lunch room. The lunch room i s equipped f o r the p r o v i s i o n o f d a i l y lunches and d inners as we l l as an enc losed screen pa t i o area s u i t a b l e f o r ea t i ng summer meals. The remaining un i t i n the main b u i l d i n g i s a s e l f -conta ined s u i t e . I t i s l o ca ted to a l l ow f o r supe r v i s i on o f the f a c i l i t y wh i l e being adjacent to a l l common-use and mechan ica l -j a n i t o r i a l a reas . The two add i t i o na l new housing type bu i l d i n g s c on s i s t o f two one-bedroom un i t s and one bache lo r u n i t . Each un i t has been b u i l t w i t h f r o n t and back entranceways, one o f which doubles as a s torage a rea . The one bedroom un i t s have a l a rge l i v i n g -d i n i n g a rea , ad j o i n i ng k i t c h e n , separate bedroom and bathroom o f f a smal l c o r r i d o r approach. The bache lor un i t s have a main s torage room o f f the en t rance , a l i v i n g - d i n i n g room w i th the bedroom having c l o s e t space and a k i t chen counter which may be separated from the l i v i n g room by f o l d i n g doors. Each u n i t ' s bathroom i s a c ce s s i b l e from a recess o f f the bedroom. V I . SUMMARY Chapter Two has informed o f some of the fea tu res of Fort Prov idence tha t must be taken i n t o cons i de ra t i on when p lann ing a - 46 -hea l th s e r v i c e or f a c i l i t y f o r the e l de r s of the community. There are smal l numbers o f e l de r s who are o f S lavey descent. For t P rov idence ' s h i s t o r y i s one of e vo l u t i on from being a f u r t r ad i ng community to one w i th a mixed economy; an e vo l u t i o n of which the communities e l de r s would have been pa r t . And, "The na t i ve peoples o f the North have va lues tha t are i n many respec ts qu i t e d i f f e r e n t . Values which are r e l a t e d to the s t r ugg l e f o r s u r v i v a l waged by t h e i r ancestors and t h e i r pe r s i s t ence to su rv i ve as a d i s t i n c t peoples t o d a y . " 8 Chapter Two a l so prov ided a w r i t t e n and v i s u a l d e s c r i p t i o n o f the For t Prov idence Sen io r C i t i z e n s ' Home. The next chapter serves to demonstrate how the charac-t e r i s t i c s o f For t Prov idence meshed w i th the ph i losophy and p o l i c i e s o f the Government o f the Northwest T e r r i t o r i e s w i th respec t to the p r o v i s i o n o f s e r v i c e s and f a c i l i t i e s f o r the e l d e r l y . - 47 -CHAPTER TWO REFERENCES (1) DUCHOUSSOIS, Reverend Father P., 1919. The Grey Nuns in the Far Nor th . Toronto , McC le l l and and Stewar t , pp. 65 - 66 (2) PERRY and CLARK, The Muskox, Number 8 , 1971. pp. 6 - 7 (3) In the Northwest T e r r i t o r i e s the term "o ther " i s used to denote a l l persons who are not o f Ind ian o r I nu i t (Eskimo) descent . The o ther group u s ua l l y r e f e r s to persons o f European decent but a l s o i nc ludes Met i s and o ther persons o f non-European descent . (4) Popu la t i on P r o j e c t i o n s : Methodo log ica l Repor t , Northwest  T e r r i t o r i e s , 1978 to 1988; S t a t i s t i c s S e c t i o n , Government o f the Northwest T e r r i t o r i e s , Tables A - 1 , A - 2 , and A -3 . pp. 27 - 35 (5) BERGER, Thomas R., 1977. Northern F r o n t i e r , Northern Homeland;  The Report o f the Mackenzie V a l l e y P i p e l i n e Inqu i r y : Volume One. Ottawa, M i n i s t e r o f Supply and S e r v i c e , Canada; P r i n t i n g and P u b l i s h i n g , Supply and S e r v i c e s , Canada, p. 93„ (6) IBID. pp. 97 - 98 (7) A l e t t e r g ran t i ng permiss ion f o r the use o f t h i s drawing i s on f i l e w i th Hea l th Se rv i ces P l ann ing , Department o f Heal th Care and Ep idemio logy, U n i v e r s i t y o f B r i t i s h Columbia. (8) BERGER, Thomas R., 1977. Northern F r o n t i e r , Northern Homeland; The Report o f the Mackenzie~Val ley P i p e l i n e I nqu i r y : Volume One. Ottawa, M i n i s t e r o f Supply and S e r v i c e , Canada; P r i n t i n g and P u b l i s h i n g , Supply and S e r v i c e s , Canada, p. 93 CHAPTER THREE - THE COMMUNITY PARTICIPATION METHODOLOGY INTRODUCTION The cons t r u c t i on o f the very f i r s t s en i o r c i t i z e n s ' home i n the Northwest T e r r i t o r i e s was the seed of development f o r the i n t r o du c t i o n o f the "community p a r t i c i p a t i o n methodology". The indigenous people o f the T e r r i t o r i e s l ed a nomadic l i f e w i th a dependence upon the land and i t s p roducts . But w i th the whi te man came the r e s i d e n t i a l schoo ls which neces s i t a t ed a major change in l i f e s t y l e . The people were be ing fo rced to l ead a sedentary l i f e . Today's e l de r s remember the t r a d i t i o n a l l i f e -s t y l e wh i l e knowing they were pa r t o f the f i r s t generat ion to be a f f e c t ed by the i n t r o du c t i o n of a sedentary l i f e s t y l e . Thus, i t i s not s u r p r i s i n g tha t these e l de r s have a sub t l e r e s i s t an ce to a f u r t h e r e ros ion o f t h e i r l i f e s t y l e . The i n t r o du c t i o n o f "southern s t y l e " s en i o r c i t i z e n s ' homes was perce i ved as a f u r t h e r e r o s i o n . The people d i d not t r u s t an apartment b lock s t y l e b u i l d i n g cha r a c t e r i z ed by s e c u r i t y doors , narrow a r t i f i c i a l l y l i t ha l lways and locked apartments. A l s o , the c l u s t e r i n g together o f the e l de r s and c a r i ng f o r them i n one b u i l d i n g was con t ra ry to t r a d i t i o n a l custom. Thus, these s en i o r c i t i z e n s ' homes were misunderstood and, consequent ly , u n d e r u t i l i z e d . - 4 8 -- 43 -T h i s , i n t u r n , had another e f f e c t . I t drew together the N.W.T. Housing Corpora t ion and the Department o f S o c i a l Se rv i ces over an i s sue of common concern - housing f o r the e l d e r l y . I . THE PHILOSOPHY AND POLICIES EMERGE Th i s s e c t i o n has been r e f e r r ed to as e vo l u t i ona r y because the ph i l o sophy , p o l i c i e s and s t r a t e g i e s emerged over t ime. The f i r s t rea l response of the importance o f the i ssue o f housing f o r the e l d e r l y was the des igna t i on o f a departmental l i a i s o n person by the Department o f Soc i a l Se rv i ces i n l a t e 1976^ In May o f 1977, the Housing Corporat ion and the Department i n i t i a t e d a j o i n t review o f the housing needs o f the e l de r l y^ . Co i n c i d i ng w i th t h i s development was the f r u i t i o n o f the j o i n t e f f o r t s o f the two agencies i n the development of conceptua l drawings f o r a new f a c i l i t y i n the community o f A k l a v i k . Th is f a c i l i t y would combine s e l f - c o n t a i n e d un i t s w i th personal care u n i t s . A major development i n the e vo l u t i on o f the methodology occur red a t a September 27, 1977 meeting^ between Corpora t ion and Soc i a l Se rv i ces pe r sonne l . A t t ha t meeting i t was agreed tha t p r i o r to f i n a l approval be ing g iven f o r the cons t r u c t i on o f - 50 -a f a c i l i t y there must be a community assessment o f "need" and "ac tua l demand" f o r s e l f - c o n t a i n e d and personal care s en i o r c i t i z e n hous ing. I t was a l s o agreed tha t there must be c i t i z e n input i n t o the design of any proposed f a c i l i t y . Th i s agreement was f u r t h e r e l abo ra ted upon a t a subsequent December 20, 1977 meeting^ which had been c a l l e d to d i s cuss For t P rov idence . At t h i s meeting i t was decided by the Government personnel t ha t the community d i d not r e a l l y understand tha t the process which was being suggested must be completed p r i o r to s e r v i c e development o r c on s t r u c t i o n . Thus, i t was f e l t the agencies had a r e s p o n s i b i l i t y to in form the c i t i z e n s o f the community about the process but a l s o (and more impor tan t l y ) to in form the community of the var ious a l t e r n a t i v e s from which they may choose ranging from se r v i c e s to f a c i l i t i e s o r any combinat ion the reo f . To accompl ish t h i s ob j e c t i v e a t h r e e - f o l d s t r a t egy was adopted: (1) format ion o f a l o c a l community work ing committee; (2) ' p repa ra t i on and p r e sen t a t i on o f i n fo rmat i ona l mate r i a l d e s c r i b i ng or i l l u s t r a t i n g the var ious a l t e r n a t i v e s to the community by Government pe r sonne l ; and, (3) po s s i b l e exposure o f the work ing committee, p o t en t i a l r e c i p i e n t s and o ther community members v i a o n - s i t e v i s i t a t i o n to examples o f some o f the f a c i l i t i e s i n the N.W.T. - 51 -At the same t ime, i t was a l so determined t ha t a p r o f i l e , compi led d i s c r e e t l y , o f the need f o r s e r v i c e s would be prepared by the community p u b l i c hea l th and s o c i a l s e r v i c e s o f f i c e s . Th is p r o f i l e was: ( i ) to determine the care requirements o f s en i o r c i t i z e n s in For t Prov idence by i d e n t i f y i n g i n d i v i d u a l s r e q u i r i n g a s s i s t ance w i th a c t i v i t i e s o f d a i l y l i v i n g due to f r a i l t y , i l l n e s s o r d i s a b i l i t y ; and ( i i ) ) ' t o i d e n t i f y the l e v e l o f care requ i r ed f o r each i n d i v i d u a l as f o l l o w s : a) home support s e r v i c e s b) day care s e r v i c e c) no s e r v i c e requ i rement . d) f o s t e r home or board ing home e) 24 hour supe rv i so r y care i n a s en i o r c i t i z e n s ' home or group home. In February, 1978, the Department o f So c i a l Se rv i ces prepared a p o l i c y paper t i t l e d , S o c i a l Se rv i ce s to the Aged -In te r im S ta tement . 5 This paper s t a t ed the ph i losophy o f the Department as be ing : "To r e i n f o r c e the independence and personal autonomy o f the e l d e r l y by encouraging the development o f s e r v i c e s , where necessary , which enable e l d e r l y persons to l i v e w i t h i n t h e i r own home and/or community as long and as independent ly as p o s s i b l e . " Furthermore, the Departmental ob j e c t i v e s i n the area o f s e r v i c e s to the aged were s t a t ed as be ing : "To a s s i s t s en i o r c i t i z e n s to remain as long as po s s i b l e i n t h e i r own homes and/or communit ies; - 52 -To ensure tha t e l d e r l y persons who r equ i r e a g rea te r amount o f care than can be prov ided on a v i s i t i n g b a s i s , are prov ided w i th the l e v e l o f care needed; and, To p a r t i c i p a t e i n p l ann ing phys i ca l f a c i l i t i e s f o r the e l d e r l y , where necessary , which w i l l prov ide smal l s e l f - c o n t a i n e d su i t e s and/or b e d s i t t i n g rooms where a l e v e l o f personal care i s a v a i l a b l e . " In A p r i l , 1978, the Sen io r C i t i z e n s ' Accomodation Task  Force Repor t 6 , i n i t i a t e d i n May o f 1977, was approved by the N.W.T. Housing Corporat ion Board o f D i r e c t o r s . The recommendations o f the Report were as f o l l o w s : (1) That no sen i o r c i t i z e n s ' accomodation be b u i l t t ha t  does not i n c l ude p lans f o r the p re sen t / f u tu re p r o v i s i o n  o f needed home support and personal care s e r v i c e s . A l l p lann ing f o r s en i o r c i t i z e n s ' accomodation should assume t ha t home support and personal care s e r v i c e s w i l l a t some po i n t i n time be an i n t e g r a l pa r t o f the program. The phys i ca l f a c i l i t y shou ld be designed to accomodate the f u l l program o f se r v i ce s ( to be e s t ab l i s h ed v i a recommendation #3). The ac tua l needs w i l l determine the nature of the s e r v i c e s p rov ided . (2) That the p r o v i s i o n o f necessary home suppor t /persona l  care s e r v i c e s to e x i s t i n g s en i o r c i t i z e n s ' accomodation  be p lanned. Se rv i ces should be made a v a i l a b l e to the e x i s t i n g s en i o r c i t i z e n s ' accomodation us ing the program gu i de l i n e s t ha t are e s t a b l i s h ed f o r new u n i t s . N.W.T. Housing Corpora t ion should begin cons t ru c t i on requ i r ed to accomodate the s e r v i c e s . (3) That a j o i n t committee be e s t a b l i s h ed w i th r ep resen ta t i on  from the Department o f Heal th and So c i a l Se rv i ces and  N.W.T. Housing Corpora t ion to f a c i l i t a t e the necessary  merging o f housing and se r v i c e s i n long- term development  and maintenance o f the s en i o r c i t i z e n s ' accomodation  program. The s p e c i f i c tasks o f the committee would be as f o l l o w s : - 53 -a) To develop measureable c r i t e r i a o f need tha t can be employed i n deve lop ing p r i o r i t i e s f o r c o n s t r u c t i o n . The a p p l i c a t i o n o f these c r i t e r i a should exhaust p o s s i b i l i t i e s o f a l t e r n a t e forms o f accomodation and care f o r the community's e l d e r l y . h) To develop program gu i de l i n e s f o r p r o v i s i o n o f s e r v i c e s and the eva l ua t i on o f same. These gu i de l i n e s would e s t a b l i s h the spectrum o f s e r v i c e s which may be developed f o r s en i o r c i t i z e n s by community groups/ o rgan i z a t i on s which are able to demonstrate the need/ demand f o r s e r v i c e s and the procedures to be used i n the management o f s e r v i c e s . c) To p r i o r i z e documented a p p l i c a t i o n s and submit a l l o c a t i o n o f un i t s to NWTHC Board o f D i r e c t o r s and Department o f Hea l th and So c i a l Se rv i ces f o r app rova l . d) To co -o rd ina te e xpe r t i s e f o r f i e l d s t a f f i nvo l ved i n p lann ing approved f a c i l i t i e s . (4) That NWTHC and the committee accept as a gu ide l ine , -the a t tached statement o f ob j e c t i v e s o f the Department  o f Hea l th and So c i a l Se rv i ce s r e spec t i ng housing and  s e r v i c e s f o r the e l d e r l y . (5) That the funding or p r o v i s i o n o f necessary s e r v i c e s to  the aged i n s en i o r c i t i z e n s ' homes be the r e s p o n s i b i l i t y  o f the Department of Hea l th and Soc i a l S e r v i c e s . That  the p r o v i s i o n and management o f a l l p roper ty management  f unc t i ons be the r e s p o n s i b i l i t y o f NWTHC through t h e i r  agent , the l o c a l Housing A s s o c i a t i o n / A u t h o r i t y . The  a l l o c a t i o n o f un i t s to tenants should be made by an  admiss ions committee composed o f members from the Housing  A s s o c i a t i o n / A u t h o r i t y , l o c a l Hea l th and So c i a l S e r v i c e s ,  and Heal th and Wel fare Canada. (6) That the Cons t ruc t i on D i v i s i o n o f the NWTHC begin  assembl ing a p o r t f o l i o o f po s s i b l e designs f o r s en i o r  c i t i z e n s ' f a c i l i t i e s to be j o i n t l y approved by the NWTHC  and the Department o f Hea l th and Soc i a l S e r v i c e s . Th i s  would f a c i l i t a t e community i npu t i n the process of des ign  and a i d the committee i n matching the s e r v i c e program to  the phy s i c a l f a c i l i t y . - 54 -On December 4 , 1978, a Memorandum o f Agreement' was f i n a l l y s igned by the N.W.T. Housing Corpora t ion and the T e r r i t o r i a l Departments of So c i a l Se rv i ces and Hea l th . Th is Memorandum o f Agreement " l e g i t i m i z e d " the community p a r t i c i p a t i o n approach which had evo l ved . To summarize, based upon the s t a t ed ph i losophy and o b j e c t i v e s , the community p a r t i c i p a t i o n approach can be s a i d to c on s i s t o f s i x major aspec t s : 1) s en i o r c i t i z e n s housing working group; 2) community educa t i on ; 3) community group or committee f o rmu l a t i o n ; 4) de te rm ina t i on of need; 5) data a n a l y s i s ; and 6) s e r v i c e o r f a c i l i t y development. I t cou ld be argued tha t the data ana l y s i s and s e r v i c e or f a c i l i t y development are not r e a l l y par t o f c i t i z e n p a r t i c i p a t i o n . But the i n t e n t i s to i nvo l ve the community i n the ana l y s i s o f the data and the de c i s i o n as to what i s r equ i red or not r equ i r ed . Then they w i l l a l s o be expected to p a r t i c i p a t e in the development o f the s e r v i c e o r f a c i l i t y by c on t r i b u t i n g to the program content or f a c i l i t y des ign . The remainder of t h i s chapter i s devoted to an e l a bo r a t i o n o f the purpose and intended f unc t i on o f the s i x major aspects compr is ing the adopted approach. - 55 -I I . SENIOR CITIZENS' HOUSING WORKING GROUP The Working Group i s an i n te r -depa r tmenta l committee whose membership c on s i s t s o f r ep resen ta t i ve s of the f o l l o w i n g : - N.W.T. Housing Co rpo ra t i on , - Department of So c i a l S e r v i c e s , and - Department o f Hea l t h . The f unc t i on of the Working Group was i n i t i a l l y e s t a b l i s h ed w i t h the adopt ion o f the Sen io r C i t i z e n s ' Accomodation Task Force Report^ i n Recommendation Number Three o f the Report. The terms o f re fe rence were f i n a l i z e d in the December, 1978 Memorandum o f Agreement! 0 . I I I . COMMUNITY EDUCATION The development o f s e r v i c e s and f a c i l i t i e s f o r the e l d e r l y was a t a c ro s s road . The t r a d i t i o n a l extended f am i l y method of ca r i ng f o r the e l d e r l y was being rep laced by a r e l i a n c e upon government. Government's i n i t i a l response, the cons t r u c t i on o f s en i o r c i t i z e n s ' homes, was i n app rop r i a t e . One po s s i b l e s o l u t i o n to the dilemma was to in form the communities o f the wide range o f a l t e r n a t i v e s tha t may be p o s s i b l e . Community educat ion would be u t i l i z e d to t e l l the community's l e a de r s , hea l th p r o f e s s i o n a l s , e l d e r l y and o the r - 56 -i n t e r e s t e d persons the s e r v i c e opt ions the government was prepared to promote, fund , develop and d e l i v e r . Fu r the r , the i n fo rmat i on would e xp l a i n what needs the s e r v i c e s would meet (a home d e l i v e r y program as opposed to a r e s i d e n t i a l t reatment f a c i l i t y ) , how to assess i n d i v i d u a l and community needs (what does one person need versus what w i l l one hundred people r equ i r e ) and how to i n i t i a t e the development o f a s e r v i c e . Informed community l e ade r s , hea l th p r o f e s s i o na l s and po t en t i a l users would be ab le to make educated dec i s i ons regard ing what s e r v i c e s or f a c i l i t i e s f o r the e l d e r l y were r equ i r ed i n t h e i r community. The Working Group had the r e s p o n s i b i l i t y o f ensur ing t h a t the community and i t s leaders became knowledgeable about the approach, i t s i n t e n t and implementat ion as we l l as the op t ions a v a i l a b l e to the community. IV. COMMUNITY GROUP OR COMMITTEE The approach advocated was community r e s p o n s i b i l i t y f o r the s ub s t an t i a t i o n and the development of s e r v i c e s f o r the community. To be succes s fu l the approach must have the support and a c t i v e p a r t i c i p a t i o n of the community members. Fu r t he r , there must a l s o be an acknowledged and accepted community l eade r sh i p to focus and co -o rd ina te the e f f o r t s o f the p a r t i c i p a n t s . The community has the r e s p o n s i b i l i t y of des i gna t i ng t h i s l e ade r sh i p . - 57 -The Working Group would ac t as a c on su l t a t i v e support group to the community l e ade r sh i p . V. DETERMINATION OF NEED P r i o r to any s e r v i c e o r f a c i l i t y be ing deve loped, the need must be e s t a b l i s h e d . I t was dec ided tha t f i v e v eh i c l e s o f measurement or assessment would be u t i l i z e d i n determin ing the need f o r a s e r v i c e o r f a c i l i t y f o r the e l d e r l y o f a community. A. I nd i v i dua l Assessments Persona l p r o f i l e s des igned to i d e n t i f y the i n d i v i d u a l ' s p resent l e v e l o f f un c t i on i ng and personal needs were compi led f o r each p o t e n t i a l r e c i p i e n t o f a s e r v i c e ( r e s i d e n t i a l or o the rw i se ) . That i s , an attempt was be ing made to assess i n d i v i d u a l a b i l i t y to independent ly perform the a c t i v i t i e s o f d a i l y l i v i n g . Given the nature o f the p r o f i l e s , complet ion was dependent upon the co -ope ra t i ve involvement o f the p o t e n t i a l r e c i p i e n t , med i c a l , s o c i a l s e r v i c e s and l o ca l housing a u t ho r i t y pe rsonne l . B. Community Resources P r o f i l e The community resources p r o f i l e i s a c ap su l i z ed d e s c r i p t i o n o f the community. Reference to t h i s p r o f i l e w i l l i d e n t i f y what community i s be ing d i s c u s s ed , prov ide a d e s c r i p t i o n of the geographic area and the popu la t i on o f the area by predetermined age group ings. I t w i l l a l so l i s t e x i s t i n g community resources such as home care programs, mea ls -on-whee ls , t r a n s p o r t a t i o n , e t c . - 58 -Res ident p r o f e s s i ona l s such as pub l i c hea l th nu rses , ph y s i c i a n s , p h y s i o t h e r a p i s t s , s o c i a l workers , speech t h e r ap i s t s are l i s t e d . P r o f e s s i ona l s e r v i c e s a v a i l a b l e to community r e s i den t s on a v i s i t i n g c on su l t a t i v e bas i s are a l so determined. F i n a l l y , the community p r o f i l e l i s t s the e x i s t i n g community f a c i l i t i e s such as nurs ing s t a t i o n , h o s p i t a l , ex tended/chron ic care u n i t , s en i o r c i t i z e n s ' home, personal care u n i t and r e c r e a t i o n f a c i l i t i e s . To summarize, the community resources p r o f i l e i s an attempt to i d e n t i f y the t a r ge t group, where they l i v e and what pe r sonne l , s e r v i c e s and f a c i l i t i e s are a v a i l a b l e to them. The community resources p r o f i l e i s compi led by the community. C. Housing Needs Survey The housing needs survey i s a p lann ing too l used by the N.W.T. Housing Corpora t ion i n an e f f o r t to determine how many and what type o f housing un i t s may be requ i red i n a community. Two types of i n fo rmat ion are a v a i l a b l e from t h i s survey. F i r s t , the e x i s t i n g housing stock i s determined accord ing to type ( p r i v a t e , p u b l i c , s i n g l e or m u l t i - f a m i l y ) , number and phys i c a l c ond i t i on o f the u n i t s . Second, some bas i c persona l i n fo rmat ion about the r e s i den t s i s a v a i l a b l e such as name, age, sex and ma r i t a l s t a t u s . - 59 -With t h i s i n fo rmat ion some p r ed i c t i o n s can be made of the number and type o f housing un i t s needed i n a community. Such dec i s i ons would be based upon whether or not e x i s t i n g un i t s were overcrowded and the expected l i f e o f the housing u n i t . . A l so the age, sex and ma r i t a l s t a tu s f i gu r e s a s s i s t w i t h these p r ed i c -t i o n s . I f a s i n g l e f am i l y housing un i t had an expected l i f e o f two years and i t s r e s i den t s cons i s t ed o f an extended f am i l y o f t h i r t e e n - grandparents , husband, w i f e and n ine c h i l d r e n , the o l de s t o f whom i s twelve - the p lanner cou ld assume t ha t t h i s f am i l y un i t would r equ i r e two housing un i t s i n the shor t term f u t u r e . One housing u n i t would be requ i r ed by the grandparents and a second un i t would be u t i l i z e d by the remaining f am i l y membe The housing needs survey was u sua l l y the r e s p o n s i b i l i t y o f the Housing Corpora t ion and the l o c a l housing a u t h o r i t y . D. U t i l i z a t i o n o f E x i s t i n g Resources The c a l c u l a t i o n o f u t i l i z a t i o n data i s a c o n t r i b u t i n g measurement i n the dete rminat ion of need process . Determining how of ten an a v a i l a b l e s e r v i c e i s used by a t a rge t group helps to assess whether or not tha t s e r v i c e i s needed by the group. For example, i f a community has a meals-on-wheels program i t s c a pa c i t y , cu r ren t u t i l i z a t i o n by the communi ty-at- large as we l l as u t i l i z a t i o n by the segment o f the popu la t ion under study must be determined. - 6 0 -U t i l i z a t i o n data in i s o l a t i o n i s no t , however, a t o t a l i n d i c a t o r o f need. I f , i n our example, the average cos t to the t a r ge t group to purchase a n u t r i t i o u s meal i s f i v e d o l l a r s , and a meals-on-wheels produced meal i s s o l d f o r three d o l l a r s , the demand might be due to the f i n a n c i a l s i t u a t i o n o f the t a r ge t group. Thus, a more app rop r i a te response to the demand might be a f i n a n c i a l program as opposed to i n c r ea s i ng the output c a p a b i l i t i e s o f the meals-on-wheels program. Neve r the l e s s , once a v a i l a b l e community resources have been i d e n t i f i e d , determin ing the u t i l i z a t i o n by the t a rge t group i s an asse t i n p lann ing f o r fu tu re s e r v i c e s or f a c i l i t i e s f o r t h i s segment o f a community. E. U t i l i z a t i o n o f Resources In Other Communities U t i l i z a t i o n of s e r v i c e s and f a c i l i t i e s i n another community by the r e s i den t s of a f i r s t community i s another c o n t r i b u t i n g measurement of need, e s p e c i a l l y , i f the s e r v i c e o r f a c i l i t y i s not a v a i l a b l e i n the f i r s t community. Th i s l a s t comment becomes even more important when s t a t ed w i t h i n the context o f the ph i losophy of " r e - i n f o r c i n g the independence and personal autonomy o f the e l d e r l y by encouraging the development o f s e r v i c e s , where necessary , which e nab l e ; e l d e r l y persons to l i v e w i t h i n t h e i r own home and/or community as long and as independent ly as p o s s i b l e " . - 61 -V I . DATA ANALYSIS The data ana l y s i s o f t h i s methodology was to be a s imple mat r i x comparison o f i d e n t i f i e d needs to the i den -t i f i e d a v a i l a b l e s e r v i c e s and f a c i l i t i e s . That i s , to determine what was requ i r ed by a community the p a r t i c i p a n t s were to f o l l ow a se t procedure. F i r s t , the community needs (as determined by the dete r -minat ion o f needs phase) were l i s t e d regard less o f whether they were s e r v i c e s or f a c i l i t i e s . Next , a l l p r e sen t l y a v a i l a b l e s e r v i c e s and f a c i l i t i e s were l i s t e d . Then a matching o f needs to a v a i l a b l e resources was conducted to i d e n t i f y s e r v i c e o r f a c i l i t y vo id s . V I I . SERVICE OR FACILITY DEVELOPMENT Once the ac tua l need had been determined, the p a r t i c i p a n t s focused upon the development and implementat ion of the requ i red s e r v i c e or f a c i l i t y . I f a s e r v i c e was requ i red the p a r t i c i p a n t s d i scussed a l l aspects of p r ov i d i ng the s e r v i c e . Who was going to prov ide the se r v i c e ? Who was going to fund the se r v i c e? Would there be a charge to the se r v i c e? From where was the s e r v i c e to be de l i ve red? - 62 -I t was dur ing these d i s cus s i ons every e f f o r t was made to make the s e r v i c e acceptab le and app l i c a b l e to the community. I f a f a c i l i t y was i d e n t i f i e d as being requ i r ed s i m i l a r d i s cu s s i on s took p l a ce . Where was the f a c i l i t y to be located? What was going to be the des ign o f the f a c i l i t y ? Aga in , the i n t e n t was to make the f a c i l i t y acceptab le and app l i c a b l e to the community. V I I I . SUMMARY Chapter Three presented a b r i e f h i s t o r y o f the development o f s en i o r c i t i z e n s ' housing in the Northwest T e r r i t o r i e s ; the problems which were a s soc i a t ed w i th that development and the subsequent e vo l u t i o n o f the "community p a r t i c i p a t i o n methodology". The h i s t o r y o f the methodology was t raced back to the i n t r o du c t i o n o f the f i r s t s en i o r c i t i z e n s ' home i n the T e r r i t o r i e s and the l ack of t o t a l acceptance o f tha t f a c i l i t y by the r e s i d en t s . Ac tua l development was begun i n l a t e 1976^ when the Department o f So c i a l Se rv i ce s des ignated a departmental l i a i s o n person to be r e spons i b l e f o r a l l matters p e r t a i n i n g to s en i o r c i t i z e n s ' hous ing. The e vo l u t i on was completed i n December o f 1978 w i th the s i gn i ng o f a Memorandum o f Agreement^ between the N.W.T. Housing Corpora t ion and the T e r r i t o r i a l Departments o f Soc i a l Se rv i ces and Hea l th . - 63 -The ph i losophy p r ed i c a t i n g the development o f the methodology was s ta ted as be i ng , "To r e i n f o r c e the independence and personal autonomy o f the e l d e r l y by encouraging the development o f s e r v i c e s , where necessary , which enable e l d e r l y persons to l i v e w i t h i n t h e i r own home and/or community as long and as independent ly as p o s s i b l e . " ' ^ F i n a l l y , the methodology was s a i d to c o n s i s t o f s i x major aspects which were then e l abo ra ted upon w i th respect to purpose and intended f u n c t i o n . - 64 -CHAPTER THREE REFERENCES (1) Department of Soc i a l Se rv i ces f i l e s ; a l e t t e r o f n o t i f i c a t i o n to a l l Departmental s t a f f from the Departmental D i r e c t o r . (2) Th i s j o i n t rev iew was to be the Sen ior C i t i z e n s ' Accommodation Task Force. (3) Department o f Soc i a l Se rv i ces and Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (4) Department o f Soc i a l Se rv i ces and Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (5) Department o f Soc i a l S e r v i c e s , N.W.T.; Soc i a l  Se rv i ce s to the Aged: In te r im Statement, February, 1978. (An i n t e r n a l Departmental working document). (6) Northwest Housing Co rpo ra t i on , N.W.T.; Sen ior  C i t i z e n s ' Accommodation Task Force Report , A p r i l , 1978. (An i n t e r n a l Departmental working document). (.7) A working agreement s igned by the r e spec t i v e D i r e c t o r s o f the Departments o f Hea l th , Soc i a l Se rv i ces and the Northwest T e r r i t o r i e s Housing Corpora t ion dated 4 December, 1978. (8) Northwest T e r r i t o r i e s Housing Co rpo ra t i on ; Sen ior  C i t i z e n s ' Accommodation Task Force Report , A p r i l , 1978. (An i n t e r n a l working document). (9) A working agreement s igned by the r e spec t i v e D i r e c t o r s of the Departments o f Hea l th , Soc i a l Se rv i ces and the Northwest T e r r i t o r i e s Housing Corpora t ion dated 4 December, 1978. (10) Department o f S o c i a l Se rv i ce s f i l e s ; a l e t t e r o f n o t i f i c a t i o n to a l l Departmental s t a f f from the Departmental D i r e c t o r . (11) A working agreement s igned by the r e spec t i v e D i r e c t o r s o f the Departments o f Hea l t h , Soc i a l Se rv i ces and the Northwest T e r r i t o r i e s Housing Corpora t ion dated 4 December, 1978. - 65 -(12) Department o f Soc i a l S e r v i c e s , N.W.T.; Soc i a l Se r v i c e s to the Aged: In te r im Statement, February, 1978. (An i n t e r n a l Departmental working document). CHAPTER FOUR - THE PROCESS OF PARTICIPATION INTRODUCTION The turnover, in March of 1980, of the Fort Providence Senior Cit izens' Home to the Fort Providence Housing Assoc-iation marked the end of a process that began in March of 1977. This chapter deals with the intervening months and the appl i -cation of the "community participation methodology" as i t pertained to Fort Providence. The approach used wil l be to summarize and present in chronological order the events that occurred during this time period. In so doing a standard format wil l be used to identify the salient facts of each: - date of event; - type of event, that is , correspondence, meeting, e t c . ; - topic of concern; - group or organization represented; - major positions(s) of each group ( i f applicable); and - the outcome ( i f applicable). The Terr i tor ia l Government is organized so that each department and the Housing Corporation has a regional administra-tion which is responsible for the delivery of the respective government services in the region. The Yellowknife central or headquarters section of each department and the Housing Corporation is responsible for overall program administration, development and co-ordination. As such, some program decisions require the approval of the headquarters administration. The - 66 -- 67 -c on s t r u c t i o n o f a s en i o r c i t i z e n s ' home requ i r e s t h i s type o f app rova l . Thus, t h i s p re sen ta t i on w i l l make the app rop r i a te d i s t i n c t i o n between headquarters and reg iona l personnel when r e qu i r e d . The Housing Corpora t ion a l s o devolves some aspects o f program d e l i v e r y to l o c a l boards and a s s o c i a t i o n s . Dur ing t h i s t ime pe r iod the Department o f So c i a l Development evo lved i n t o the two separate departments o f Heal th and So c i a l S e r v i c e s . Th i s had no e f f e c t upon the case study but the i d e n t i f i c a t i o n of the group(s) represented w i l l r e f l e c t t h i s e v o l u t i o n . The re fo re , the major a c t o r groups were: (1) the Working Group c o n s i s t i n g o f one r ep re sen ta t i v e each from the N.W.T. Department o f Hea l t h , the N.W.T. Department o f Soc i a l S e r v i c e s , the N.W.T. Housing Corpora t ion c on s t r u c t i o n d i v i s i o n and the N.W.T. Housing Corpora t ion program d i v i s i o n ; (2) the Fo r t Prov idence Housing A s s o c i a t i o n ; (3) the app rop r i a t e d i s t r i c t s t a f f o f the Department o f Soc i a l S e r v i c e s . On d i f f e r e n t occas ions the re was a l s o input from the For t Prov idence Set t lement and Band Coun c i l s , the pub l i c hea l th nurses and i n d i v i d u a l s en i o r c i t i z e n s o f Fo r t P rov idence . I . THE CASE PRESENTED Date o f Event: 15 March, 1977 (1) Type o f Event: Correspondence from the D i s t r i c t Manager, Hay R ive r to the Manager, Programs D i v i s i o n , Housing Corpora t i on - 68 -Top ic o f Concern: The D i s t r i c t Manager was r epo r t i ng on a 09 March, 1977 meeting at Fo r t Prov idence between h imse l f and the Fo r t Prov idence Housing A s so c i a t i o n Group(s) Represented: Fo r t Prov idence Housing A s s o c i a t i o n and the Northwest T e r r i t o r i e s Housing Corpora t i on Major P o s i t i o n ( s ) : The D i s t r i c t Manager repor ted tha t the Fo r t Prov idence Housing A s s o c i a t i o n had requested con s i de r a t i on be g iven to c on s t r u c t i ng sen io r c i t i z e n s ' accommodation i n Fo r t P rov idence . The A s s o c i a t i o n had in te rv iewed most o f the sen io r c i t i z e n s r e s i d i n g i n For t P rov idence . Eleven a p p l i c a t i o n s f o r s a i d housing r e s u l t e d from these i n t e r v i ews ( f i v e s i n g l e s and th ree c oup l e s ) . A commitment f o r land from the Roman Ca t ho l i c M i s s i on had been ob ta i ned . The A s s o c i a t i o n was seek ing the support o f the Band and Set t lement C oun c i l s . The A s s o c i a t i o n was a t tempt ing to fund a v i s i t f o r some of the l o c a l sen io r s to v i s i t e x i s t i n g f a c i l i t i e s i n another community. The D i s t r i c t Manager responded tha t c on s t r u c t i o n i n 1977 was not p o s s i b l e and informed tha t c on s i de r a t i on cou ld be g iven to 1978. The D i s t r i c t Manager in t roduced the ques t ion of home care o r support s e r v i c e s f o r a f a c i l i t y and suggested the A s so c i a t i o n look a t a l t e r n a t i v e s to the type o f Sen io r C i t i z e n s ' homes - 69 -prov ided i n the past i n the N.W.T. The Outcome: The l e t t e r c l osed w i th support f o r the A s so c i a t i o n and encouraged working w i th the A s so c i a t i o n i n the f u t u r e . Date o f Event: 27 September, 1977 (2) Type o f Event: Meet ing i n Ye l l owkn i f e Top ic o f Concern: The correspondence from the Hay R i ve r D i s t r i c t Manager, Housing Corpora t ion r e : Fo r t P rov idence . Group(s) Represented: Sen io r C i t i z e n s ' Working Group Major P o s i t i o n ( s ) : The Housing Corpora t ion assessment o f the s i t u a t i o n was tha t they were i n no p o s i t i o n to comment due to a lack o f i n f o rma t i on . The Department o f So c i a l Development's p o s i t i o n , based upon f i e l d s t a f f i n f o rma t i on , was tha t there was no need f o r s a i d housing i n Fo r t Prov idence a t t h i s t ime . The Outcome: Based upon the assessment of headquarters and reg iona l personnel t h i s meeting o f headquarters personnel dec ided tha t s en i o r c i t i z e n accommodation f o r Fo r t Prov idence was not urgent and should not be g iven f u r t h e r c on s i d e r a t i o n a t t h i s t ime . Date o f Event: 05 October , 1977 (3) Type o f Event: Correspondence from Department o f S o c i a l Development f i e l d s t a f f to headquarters Topic o f Concern: Housing s i t u a t i o n o f Fo r t Prov idence e l de r s - 70 -Group(s) Represented: Department o f Soc i a l Development f i e l d and headquarters personnel Major P o s i t i o n ( s ) : Department of Soc i a l Development f i e l d s t a f f r e p o r t , by a l e t t e r to headquar te rs , presented the f o l l o w i n g breakdown o f Fo r t Prov idence sen io r c i t i z e n s accord ing to t h e i r l i v i n g s i t u a t i o n : TYPE OF HOUSING NUMBER OF PERSONS Housing Corpora t ion 8 Own Homes w i th Extended Fami ly 26 With F r iends 2 Date o f Event: 07 December, 1977 (4) Type o f Event: Correspondence from the Fo r t Prov idence Housing A s s o c i a t i o n to the Managing D i r e c t o r , Housing Corpora t ion Group(s) Represented: Fort [Providence Housing A s so c i a t i o n and the Northwest T e r r i t o r i e s Housing Corpora t ion Major P o s i t i o n ( s ) : The l e t t e r makes re fe rence to the March request and s t r e s se s t ha t four teen persons had expressed i n t e r e s t i n s a i d hous ing . A l s o , the present housing cond i t i on s are commented upon and u t i l i z e d as par t o f an argument i n support o f the reques t . Date o f Event: 12 December, 1977 (5) Type o f Event: Correspondence from the So c i a l Development f i e l d s t a f f to the Managing D i r e c t o r , Housing Corpora t ion Topic o f Concern: Support f o r a sen i o r c i t i z e n s ' home i n Fo r t Prov idence - 71 -Group(s) Represented: Department of So c i a l Development f i e l d personnel Major P o s i t i o n ( s ) : The l e t t e r suggested the f o l l o w i n g , i n support o f a s en i o r c i t i z e n s ' home i n Fo r t P rov idence: 1. The l ack o f p r i v a cy f o r Sen io r C i t i z e n s who are a t the present t ime l i v i n g w i th o ther f a m i l i e s . 2. The cont inued baby s i t t i n g s e r v i c e they prov ide f o r o ther people i n the home. 3. Abuse o f Soc i a l S e cu r i t y monies by o thers l i v i n g i n the home. 4. Old age person, such as someone l i v i n g a t Kak isa Lake, i n a l og house by h imse l f , having t o depend on neighbours f o r care . The care i s most inadequate e . g . abuse o f h i s money s i n ce he depends on o thers to shop f o r him. He would need personal c a r e . 5. Under aged d i s ab l ed persons i n the community who are unable to look a f t e r themselves and depend on o thers f o r c a r e . There are a t l e a s t two people who f a l l i n t o t h i s ca tegory ; they are a l s o homeless. Fu r t he r , the l e t t e r suggests there are at l e a s t f o r t y people i n the Fo r t Prov idence and Kakisa Lake area tha t need such hous ing . A l s o , there i s a requirement to r e a l i s t i c a l l y f o r e c a s t a need f o r a spec i a l f a c i l i t y f o r a t l e a s t some o f these persons f o r reasons o f ch ron i c poor h e a l t h , hardsh ip and d i s a b i l i t y due to advanced age. - 72 -Date of Event: 16 December, 1977 (6) Type o f Event: Correspondence from the Fo r t Prov idence Set t lement Counc i l to the Housing A s so c i a t i o n Topic o f Concern: Cons t ruc t i on o f a s en i o r c i t i z e n s ' home' in Fo r t Prov idence Group(s) Represented: For Prov idence Set t lement Counc i l Major P o s i t i o n ( s ) : Counc i l s t a t e s , " there i s an urgent need f o r a home f o r the e l de r s o f t h i s (For t Prov idence) se t t l ement . L i v i n g w i th o thers o f ten r e s u l t s i n abuse o f Old Age Pension monies, l a ck of p r i v a cy and some are unable to look a f t e r themselves i n regards to g e t t i n g f i r ewood , e t c . " Date o f Event: 20 December, 1977 (7) Type o f Event: Sen ior C i t i z e n s ' Housing Committee meeting Topic o f Concern: For Prov idence Sen io r C i t i z e n s ' housing developments Group(s) Represented: Sen ior C i t i z e n s ' Working Group Major P o s i t i o n ( s ) : The Housing Corpora t ion repor ted a recent t r i p to the community has r e su l t e d in a f o rmu la t i on o f an invento ry of persons aged s i x t y years and ove r . The count was t h i r t y - s e v e n persons w i th another n ine persons aged f i f t y to s i x t y who are supporters o f s en i o r c i t i z e n s accommodation. A l s o , the Housing A s s o c i a t i o n has been very a c t i v e i n propos ing sen i o r c i t i z e n s ' hous ing . The Outcome: Committee agreement t ha t the community should be g iven - 73 -oppo r tun i t y to l ea rn about and have d e f i n i t e input i n t o the cho ice o f s en i o r c i t i z e n s ' s e r v i c e s r equ i r ed i n Fo r t P rov idence . To accompl ish t h i s the f o l l o w i n g s t r a t egy was agreed upon: (1) fo rmat ion o f a l o c a l community working committee, (2) p repa ra t i on and p resen ta t i on of i n fo rmat i ona l ma te r i a l d e s c r i b i n g and i l l u s t r a t i n g the va r i ous s e r v i c e and f a c i l i t y a l t e r n a t i v e s , (3) p o s s i b l e v i s i t to f a c i l i t i e s i n o ther communities by p o t e n t i a l r e s i den t s o f s en i o r c i t i z e n s ' accommodation. The Housing A s s o c i a t i o n would be u t i l i z e d t o : (1) determine i f s t r i k i n g a l o c a l c i t i z e n s committee would be workable and, i f so (2) have committee as v e h i c l e t o a s s i s t community i n d e t e r -mining what s e r v i c e s / f a c i l i t i e s are requ i red and how to best p r ov i de , o r I f a committee cou ld not be s t ruck by t h i s method then the f o l l o w i n g would be asked to p a r t i c i p a t e : (1) one person from the Housing A s s o c i a t i o n , (2) one person from Band or Sett lement C o u n c i l , (3) one r ep re sen ta t i v e from the a pp l i c a b l e Soc i a l Se rv i ces o f f i c e , (4) the l o c a l Hea l th and Welfare nurse , (5) one person from the N.W.T. Housing Co rpo ra t i on . I t was a l s o dec ided tha t a d i s c r e e t l y prepared p r o f i l e o f the need f o r s e r v i c e s would be compi led by the l o c a l Pub l i c Hea l th Nurse and Soc i a l Se rv i ces f i e l d s t a f f . Th is p r o f i l e would: (1) determine the care requirements o f s en i o r c i t i z e n s i n Fo r t Prov idence by i d e n t i f y i n g i n d i v i d u a l s r e q u i r i n g a s s i s t an ce w i th a c t i v i t i e s of d a i l y l i v i n g due to f r a i l t y , i l l n e s s o r d i s a b i l i t y , (2) i d e n t i f y the l e v e l o f care requ i r ed f o r each i n d i v i d u a l as f o l l o w s : - 74 -(a) home support s e r v i c e , (b) day care s e r v i c e , (c) no s e r v i c e requ i rement , (d) f o s t e r home or board ing home, (e) 24 hour supe rv i so r y care i n a s en i o r c i t i z e n s ' home or group home. Date o f Event: 20 December, 1977 (8) Type o f Event: Te lex from headquarters Department o f Heal th and Soc i a l Se rv i ces to f i e l d personnel Topic o f Concern: D i r e c t i o n to have prepared a p r o f i l e o f care requirements o f e l de r s o f Fo r t Prov idence Group(s) Represented: Department o f Heal th and Soc i a l Se rv i ces Major P o s i t i o n ( s ) : Te lex from headquarters Department of Heal th and Soc i a l Se rv i ces to f i e l d s t a f f reques t ing p a r t i c i p a t i o n w i th the l o c a l p ub l i c hea l th nurse to prepare d i s c r e e t l y , a p r o f i l e o f the care requirements of sen i o r c i t i z e n s i n For t P rov idence . Suggested dead l ine date i s 31 January , 1978. The p r o f i l e was to i d e n t i f y those i n d i v i d u a l s r e q u i r i n g a s s i s t an ce w i th the a c t i v i t i e s o f d a i l y l i v i n g due to f r a i l t y , i l l n e s s or d i s a b i l i t y and to i d e n t i f y the l e v e l o f care r equ i r ed f o r each i n d i v i d u a l accord ing to the f o l l ow i ng de s i gna t i o n s : - no s e r v i c e requ i rements , - day c a r e , - f o s t e r care o r board ing c a r e , - 24 hour supe rv i so r y care i n a sen io r c i t i z e n s ' home or group home. The p r o f i l e was to be prepared from e x i s t i n g s o c i a l s e r v i c e and hea l th i n fo rmat ion r a t he r than drawing undue a t t e n t i o n to the survey i n the community. - 75 -The Outcome: Department of Heal th and Soc i a l Se rv i ces f i e l d personnel were d i r e c t e d to a s s i s t w i th the de te rmina t ion o f need f o r a s en i o r c i t i z e n s ' home i n For t P rov idence . Date o f Event: 03 January , 1978 (9) Type of Event: Correspondence from the Ac t i ng General Manager, Housing Corpora t ion to the Chairman o f the Board o f D i r e c t o r s Topic o f Concern: Up-date o f developments w i th respec t to the ques t ion o f a sen i o r c i t i z e n s ' home i n For t Prov idence Group(s) Represented: Sen io r C i t i z e n s ' Working Group, N.W.T. Housing Corpora t ion Major P o s i t i o n ( s ) : The l e t t e r was an i n fo rmat i on i tem f o r the N.W.T. Commiss ioner 's v i s i t to Fo r t P rov idence . The l e t t e r commented upon the f o l l o w i n g : Current S i t u a t i o n A number o f requests f o r Sen ior C i t i z e n s ' housing have been rece i ved from the Housing A s s o c i a t i o n over the past yea r . D i s cuss ions w i th Department of Heal th and Soc i a l S e r v i c e s , i n a j o i n t Sen io r C i t i z e n s ' Housing Committee, have concluded tha t i n fo rmat i on w i th GNWT adm in i s t r a t i o n and the community i s ske t chy ; unce r t a i n t y e x i s t s about the des ign o f app rop r i a te Sen io r C i t i z e n s ' housing u n i t s a t a Corporat ion/Department of Hea l th and So c i a l Se r v i c e s l e v e l ; un ce r t a i n t y e x i s t s i n the community about what opt ions i n care f o r the e l d e r l y r e a l l y e x i s t . L e t t e r s o f support from the community would i n d i c a t e tha t they are genu ine ly i n t e r e s t ed i n d i s c u s s i ng the i s sue i n depth; t h i s i s conf i rmed by our s t a f f who have v i s i t e d the community. Proposed Approach The es tab l i shment o f a p lann ing procedure emphasiz ing p r a c t i c a l a l t e r n a t i v e s and mutual commitment by community, Housing Corpora t ion - 76 -and Department o f Hea l th and Soc i a l S e r v i c e s , has been dec ided upon: (a) Formation o f For t Prov idence Sen io r C i t i z e n s ' P lann ing Committee c o n s i s t i n g o f the f o l l ow i ng i n v i t e d r e p r e s en t a t i o n : Fo r t Prov idence Set t lement Counc i l Fo r t Prov idence Housing A s so c i a t i o n Fo r t Prov idence Band Counc i l Fo r t Prov idence Nurs ing S t a f f Department o f Hea l th and Soc i a l Se rv i ces Housing Corpora t ion F i e l d S t a f f Housing Corpora t ion Headquarters S t a f f (b) D i s c r e e t l y prepared p r o f i l e of care needs compi led by Department of Hea l th and Soc i a l Se rv i ces i n co -ope ra t i on w i th Fo r t Prov idence Nat iona l Heal th and Wel fare s t a f f . (c) A f i e l d t r i p by a group o f Housing A s s o c i a t i o n se l e c t ed Sen io r C i t i z e n s to Hay R i v e r , Fo r t Reso lu t i on and Fo r t Smith to view a l t e r n a t i v e e x i s t i n g Sen io r C i t i z e n s ' F a c i l i t i e s . Ten ta t i ve t i m i n g : mid-January . (d) A j o i n t Housing Corporat ion/Department o f Hea l th and So c i a l Se rv i ces low-key 3 to 4 day p resen ta t i on i n g r aph i c s , models and photos o f implementable a l t e r n a t i v e s f o r Sen ior C i t i z e n s ' accommodation. Ten ta t i v e t i m i n g : l a t t e r par t o f January . (e) F i n a l l y , the a p p l i c a t i o n o f a Housing Co rpo ra t i on / Department o f Hea l th and Soc i a l Se rv i ces s t r u c t u r ed ques t i onna i r e to each po t en t i a l c l i e n t by Housing A s so c i a t i o n to e l i c i t preferences and r eac t i ons i n r e l a t i o n to a c t i v i t i e s (c) and (d) above. Ba r r i ng any unforeseen d i f f i c u l t i e s , i t i s est imated the e n t i r e p lann ing e xe r c i s e cou ld be concluded by the middle o r end o f February w i th ac tua l c on s t r u c t i o n s t a r t i n g in the 1978 season. The Outcome: The Commissioner o f the Northwest T e r r i t o r i e s i s appr i sed o f the proceedings and a p o t en t i a l t ime frame i s e s t a b l i s h e d . - 77 -Date o f Event: 04 January , 1978 (10) Type o f Event: Correspondence from the Research Manager, Housing Corpora t ion to the Chairman, For t Prov idence Housing A s so c i a t i o n Topic o f Concern: To in form the Fo r t Prov idence Housing A s s o c i a t i o n o f proposed p lann ing process Group(s) Represented: Sen ior C i t i z e n s ' Housing Working Group Major P o s i t i o n ( s ) : The Research Manager in formed, "We wish to study t h i s i s sue i n more d e t a i l because we are unce r t a i n about the type of housing tha t would be approp-r i a t e to the needs of the s en i o r c i t i z e n s ; and have a l s o sensed i n the community t ha t s en i o r c i t i z e n s and t h e i r f a m i l i e s are unce r t a i n about what k inds of care o r housing f o r the e l d e r l y are a v a i l a b l e . " "Here are some of the ac t i ons we are cons i de r i ng f o r t h i s p lann ing s tudy , some o f which have been suggested to us by community peop le : (a) The format ion of an in formal P lann ing Adv i so ry Group c o n s i s t i n g o f i n d i v i d u a l r ep re sen ta t i v e s from the r e c i p i e n t s o f t h i s l e t t e r to d i s cuss the o v e r a l l d i r e c t i o n and progress o f the p lann ing s tudy . (b) A f i e l d t r i p around the middle o f January by four teen Housing A s so c i a t i o n - s e l e c t ed s en i o r c i t i z e n s to Hay R i v e r , Fo r t Reso lu t i on and For t Smith to see d i f f e r e n t k inds o f e x i s t i n g sen i o r c i t i z e n s ' accommodation. (c) A 3-4 day p r e s en t a t i o n , i n For t Prov idence a t the end o f January , c o n s i s t i n g of models, p l a n s , drawings and photographs o f r e a l i s t i c housing des igns which cou ld be o f f e r ed through the N.W.T.H.C., as we l l as f u l l d e s c r i p t i o n s o f the va r i ous k inds o f care s e r v i c e s f o r the e l d e r l y which cou ld be o f f e r ed through the Depart -ment o f Heal th and Soc i a l S e r v i c e s . (d) In e a r l y to mid-February , the adm in i s t r a t i o n o f a s imple ques t i onna i r e by l o c a l i n t e r v i ewe r s to each i n t e r e s t ed sen i o r c i t i z e n i n which he or she cou ld express h i s o r her pre ferences i n the prev ious a c t i ons (b) and ( c ) . - 78 -The p lann ing procedure desc r ibed above i s one in which a l t e r n a t i v e s w i l l be examined and f r ee exchange o f ideas w i l l be encouraged." The Outcome: The For t Prov idence Housing A s so c i a t i o n i s made aware o f Sen ior C i t i z e n s ' Housing Working Group d e l i b e r a t i o n s and informed o f how the p lann ing process i s to proceed. Date o f Event: 19 January , 1978 (11) Type o f Event: Meet ing in Ye l l owkn i f e Topic o f Concern: D i s cuss ion of developments to date Group(s) Represented: The Cha i rperson and the Manager o f the For t Prov idence Housing A s s o c i a t i o n , Department o f Hea l th and So c i a l Se rv i ce s f i e l d pe r sonne l , Sen io r C i t i z e n s ' Housing Working Group. Major P o s i t i o n ( s ) : Community members suggested: -hous ing should be "row" housing which would u t i l i z e economics o f c on s t r u c t i o n and, p o s s i b l y , o pe r a t i o n ; - requ i rement would be f o r f i v e couples and ten s i n g l e persons; - the re should be one l a r g e r u n i t w i th a k i t chen capable o f p repar ing meals f o r 30-40 peop le , a l a rge room which cou ld normal ly be used as a recreation/common room and when requ i r ed a "banquet room"; a laundry f a c i l i t y , space f o r a " ca re take r c oup l e " , p o s s i b l y three personal care u n i t s ; - the " ca re take r coup le" would have as pa r t o f t h e i r job d e s c r i p t i o n the ma in tenance/superv i s ion o f the housing and the personal care o f the few persons l i v i n g i n the personal care s e c t i o n ; - thought t ha t " s e c u r i t y " cou ld be mainta ined by c o n t r o l l e d v i s i t i n g hours and r e s t r i c t e d ove rn igh t occupancy. The community r ep re sen ta t i v e s a l s o quest ioned r en t a l fees - 79 -and t im ing o f c on s t r u c t i on The Outcome: Th i s was the f i r s t t ime a f a c i l i t y was c oncep tua l i z ed ; committee was informed tha t ren ts would be determined accord ing to the a pp l i c a b l e Housing Corpora t ion . rent- to- income s c a l e ; no commitment was g iven regard ing ac tua l p r o j e c t app rova l . Date o f Event: 25 January, 1978 (12) Type o f Event: " f i e l d t r i p " to o the r communities Topic o f Concern: s i t e v i s i t s to f a c i l i t i e s i n o ther communities Group(s) Represented: 9 s en i o r c i t i z e n s , 2 Housing A s so c i a t i o n r e p r e s en t a t i v e s , 1 Soc i a l Se rv i ce s Headquarters s t a f f The Outcome: Three f a c i l i t i e s i n three o ther communities were v i s i t e d ; p a r t i c i p a n t s had an oppo r tun i t y to view the f a c i l i t y as we l l as to converse w i t h r e s i den t s and managers of the f a c i l i t i e s . Date o f Event: 17 February , 1978 (13) Type o f Event: Correspondence from Department o f So c i a l Se rv i ces f i e l d personnel to headquarters Top ic o f Concern: P r o f i l e o f needs of For t Prov idence e l d e r l y The Outcome: Informat ion was rece i ved about t h i r t y - n i n e r e s i d e n t s . - 80 -Table # 4 P r o f i l e o f L i v i n g S i t u a t i o n o f Se lec ted Sen io r C i t i z e n s o f Fo r t Prov idence PRESENT ACCOMMODATION SERVICE REQUIREMENT ASSESSMENT Own 4 No Se rv i ces 17 Fami ly 13 Fami ly Resources 11 Low Rental 10 Homemaker Only 2 No Home 11 A l l Se rv i ces 9 Other 1 39" 35". SITUATIONAL ASSESSMENT Overcrowded 14 No Modern F a c i l i t i e s 6 No Home - Poor 9 Good 10 39" Date o f Event: 07 - 10 March, 1978 (14) Type o f Event: Con su l t a t i v e t r i p to Fo r t Prov idence Topic o f Concern: The purpose o f the t r i p was to d i s c u s s : - l o c a t i o n - number o f un i t s - des ign o f f a c i l i t i e s - range of care requ i r ed Group(s) Represented: Sen io r C i t i z e n s ' Housing Working Group, Fo r t Prov idence Housing A s s o c i a t i o n , community e l d e r s , o ther i n t e r e s t ed community members Major P o s i t i o n ( s ) and Outcome(s): Loca t i on The community approached and rece i ved a commitment from the Roman Ca t ho l i c p r i e s t t ha t church land immediate ly behind the church w i l l be made a v a i l a b l e f o r housing f o r the community's o l d . The o l d are i n t e r e s t ed in t h i s s i t e because: - 81 -- the s o i l i s good f o r growing; - the land s i t e i s f l a t ; - they w i l l be removed from the main housing i n the community and the younger peop l e ( t h i s i s most important to them as they see t h i s as being a s o l u t i o n to the problems they are having w i th the young); - the s i t e i s near the r i v e r where they go to t r ap and f i s h ; - the s i t e i s c l o s e to the nurs ing s t a t i o n . Design D i scuss ions were he ld w i th va r i ous community members and the "ad hoc committee" regard ing the d e s i g n / s t y l e o f any f a c i l i t y which might be b u i l t . The op in ions to date a r e : - the o l d do not want a p lace which " l ocks them up" r a the r they want as much freedom o f movement as p o s s i b l e ; - they have suggested a concept which would u t i l i z e a l a r g e r b u i l d i n g housing a ca re take r coup l e , common f a c i l i t i e s such as a laundry room, mu l t i -pu rpose room and a few personal care u n i t s ; - severa l v a r i a t i o n s on t h i s theme were d i s c u s s ed ; - i t was dec ided to leave the models w i th the Manager of the Housing A s so c i a t i o n who would get some o f the po s s i b l e tenants to "des ign" t h e i r own f a c i l i t y . She w i l l record the va r i ous p o s s i b i l i t i e s and pass them on . The f e e l i n g was expressed t ha t whatever the f i n a l des ign i s i t must not con f ine the t enan t s . A major i s sue r e l a t e d to confinement i s s e c u r i t y . The o l d wish personal freedom o f movement but r e s t r i c t e d / c o n t r o l l e d v i s i t -a t i o n . They expressed the thought tha t a ca re take r couple cou ld p lay a major r o l e i n t h i s a r ea . I t was a l s o thought t ha t a communication system cou ld be used which would be an emergency help - 82 -c a l l system. The des ign of the f a c i l i t y must be capable o f accommodating the o l d ' s wish f o r some gardening and the p o s s i b i l i t y o f having smoke houses. Number o f Un i t s The number o f un i t s to b u i l d i s s t i l l undetermined. I t has been suggested tha t the immediate housing need i s twenty-one u n i t s . Seventeen un i t s (e leven s i ng l e s and s i x doubles) f o r Fo r t Prov idence r e s i den t s and fou r un i t s (two s i n g l e s and two doubles) f o r Kak isa r e s i d e n t s . There would a l s o be a requirement f o r a few personal care u n i t s . Date o f Event: 09 May, 1978 (15) Type o f Event: Correspondence Top ic o f Concern: H i r i n g o f an a r c h i t e c t u r a l consu l t an t f o r the p r o j e c t Group(s) Represented: Housing Corpora t ion The Outcome: A consu l t an t a r c h i t e c t i s h i r ed to f i n a l i z e the f a c i l i t y de s i gn . Date, o f Event: 31 May, 1978 (16) Type o f Event: Con su l t a t i v e t r i p to For t Prov idence Topic o f Concern: Introduce the a r c h i t e c t to the community Group(s) Represented: the a r c h i t e c t , Fo r t Prov idence Housing A s s o c i a t i o n , Fo r t Prov idence Set t lement C o u n c i l , Sen ior C i t i z e n s ' Housing Working Group - 83 -Major P o s i t i o n ( s ) : The a r c h i t e c t had severa l quest ions about the community i s sues i n f l u e n c i n g the des ign o f a s en i o r c i t i z e n f a c i l i t y . Some noteworthy i s sues were d i s cu s sed : (a) Se cu r i t y f o r s en i o r c i t i z e n s ; (b) A b i l i t y o f s en i o r c i t i z e n s to move outdoors between b u i l d i n g s ; (c) Smoke houses. Corpora t ion s t a f f touched on heat ing c on s i d e r a t i o n s , energy conse rva t i on and the economics o f compact de s i gn . The Housing A s s o c i a t i o n r e - s t a t e d t h e i r gu id ing p r i n c i p l e o f p r ov i d i ng a s en i o r c i t i z e n s ' home which would r e t a i n many of the l i f e s t y l e f ea tu res to which the e l d e r l y had become accustomed ( l i v i n g i n smal l homes i n the bush, e t c . ) The Outcome: The meetings concluded w i th the suggest ion tha t the a r c h i t e c t would r e tu rn i n about th ree weeks w i th i n i t i a l drawings o f a s en i o r c i t i z e n s ' home which cou ld be mod i f i ed i n f u r t h e r d i s c u s s i o n s . Date of Event: 08 June, 1978 (17) Type o f Event: Correspondence from Managing D i r e c t o r , Housing Corpora t ion to consu l t an t a r c h i t e c t Top ic o f Concern: c on s t r u c t i o n year Group(s) Represented: Housing Corpora t ion Major P o s i t i o n ( s ) : The Managing D i r e c t o r , Housing Corpora t ion informed the consu l t an t a r c h i t e c t t ha t the " t a rge t yea r " f o r 1 - 84 -c on s t r u c t i o n was 1978. The Outcome: Cons t ruc t i on year e s t a b l i s h e d . Date o f Event: 30 June, 1978 (18) Type o f Event: Meet ing of the Housing Corpora t ion A l l o c a t i o n Committee Top ic o f Concern: Number o f housing un i t s to be a l l o c a t e d to the For t Prov idence Sen ior C i t i z e n s ' home p r o j e c t Group(s) Represented: Housing Corpora t ion The Outcome: N.W.T. Housing Corpora t ion A l l o c a t i o n Committee determine breakdown and number o f un i t s f o r Fo r t Prov idence as f o l l o w s : 4 un i t s - personal care 7 un i t s - bache lor 4 un i t s - 1 bedroom 15 un i t s 1 u n i t - c a r e t a k e r ' s s u i t e (2 bedroom) ~T5" un i t s Date of Event: 12 J u l y , 1978 (19) Type of Event: Meeting between Sen io r C i t i z e n s ' Housing Working Group and consu l t an t a r c h i t e c t Group(s) Represented: Consu l tant a r c h i t e c t , Department o f Soc i a l S e r v i c e s , Housing Corpora t ion Cons t ruc t i on and Research D i v i s i o n s Major P o s i t i o n ( s ) : - 85 -The f o l l ow i ng impress ions were made by the Department o f Soc i a l S e r v i c e s : The major concerns i n Fo r t Providence were f o r housing which would enable the e l de r s to ma in ta in as t r a d i t i o n a l a l i f e s t y l e as p o s s i b l e i n an independent s e t t i n g . The e l d e r s wished to ma in ta in f am i l y l i nkages but a t t h e i r convenience not the f a m i l y ' s . Thus, the housing would: - be removed from the cen te r o f the community; - o f f e r some form o f " s e c u r i t y " to prevent f am i l y i n t e r f e r en ce w i t h t h e i r l i v e s ; - f ea tu re smal l s e l f - c o n t a i n e d u n i t s ; - a l l ow f o r garden ing , i f d e s i r e d ; - have space f o r smoke houses, to be b u i l t by the Band C o u n c i l , i f d e s i r e d ; - not be a p lace which would " lock the e l de r s up" . There i s a need to be very cogn i zant o f the f i n e l i n e between ma in ta i n i ng independence and c r e a t i n g dependence. I f s o , we must be very c a r e f u l to avo id do ing something f o r someone e l s e when they are capable o f do ing i t f o r themselves . These drawings i n a t tempt ing to i n co rpo ra te the e a r l i e r mentioned fea tu res are " g u i l t y o f t h i s s i n " . In t r y i n g to comply w i th the de s i r e f o r s e c u r i t y the present drawings w i l l c r ea te an atmosphere o f i s o l a t i o n . A l l t r a f f i c f l ow must go through one passageway i n the c en t r a l b u i l d i n g . The focus of a t t e n t i o n o f a l l i n d i v i d u a l un i t s i s towards the c en t r a l cour tya rd o n l y . Fu r t he r , each u n i t has i t s own fenced c ou r t y a r d , i n c l u d i n g a smoke house. The r e s u l t a n t atmosphere would be r a the r upse t t i ng to the occupants and would not be conducive to encouraging the e l de r s to remain a c t i v e members o f the community nor to the community f e e l i n g tha t the e l de r s were s t i l l p a r t i c i p a t i n g members o f the community. The f o l l ow i ng comments are s p e c i f i c to the i n d i v i d u a l drawings: S i t e P l an : As ment ioned, the concept o f s e c u r i t y through phy s i c a l s t r u c t u r e i s predominant. Th is may s a t i s f y the shor t term need but would most c e r t a i n l y be harmful i n the long run . S e cu r i t y ach ieved w i th minimal phy s i c a l s t r u c t u r i n g means the people themselves must face up to t h e i r own r e s p o n s i b i l i t i e s which would be the i d e a l . The idea o f i n d i v i d u a l fenced cour tyards focus ing to the c en t r a l i n t e r i o r cour tya rd i s i s o l a t i n g to the i n d i v i d u a l occupants . These people have probably never l i v e d i n such a s e t t i n g and would l i k e l y f e e l "boxed i n " . A l s o , the people would be more r e cep t i v e - 86 -to a l a r ge communal p l o t o f land f o r gardening o r i n d i v i d u a l p l o t s on the e x t e r i o r o f the complex. The i n co r po r a t i on o f the smoke houses i s doing something f o r the people they are qu i t e capable o f doing themselves . At p resen t , the community does not have a smoke house f o r every u n i t . Why i nc rease cos t s by b u i l d i n g a " l u xu r y " i tem which may not be used now, e s p e c i a l l y when the community has a l r eady expressed a w i l l i n g n e s s to do so? F i n a l l y , as p r e sen t l y conce i ved , there i s no room f o r expans ion , i f r e qu i r e d . B locks "A" and " B " F l oo r P l ans : The un i t s have on l y one entrance which i s o f f the c en t r a l c o u r t y a r d . The people had expressed a d e s i r e , i f p o s s i b l e , f o r two entrances w i th a porchway f o r s t o r i n g personal i t ems. A l s o , a l l windows face the c en t r a l c ou r t y a r d . The s i z e o f the un i t s may be too l a rge to comply w i th CMHC r e g u l a t i o n s . The B lock "B" un i t s may have ques t ionab le f l e x i b i l i t y w i th respec t to f u t u r e convers ion t o personal care u n i t s . B lock "C" F l oo r Plan The c en t r a l l ounge/k i t chen area should be rev iewed. The k i t chen w i l l p robab ly have i n f r equen t usage and thus would not r equ i r e a f r e e z e r , c oo l e r and dry s t o rage , e t c . The needs cou ld most l i k e l y be served by a k i t chen l a rge enough f o r a group e f f o r t w i t h ample s torage f o r a one day a f f a i r (such as a Chr istmas meal or b i r t hday c e l e b r a t i o n ) . The lounge area should be f l e x -i b l e enough to accommodate a meal o r b ingo o r a smal l pa r t y and would be b e t t e r served by a combinat ion o f c o l l a p s i b l e and non-c o l l a p s i b l e f u r n i t u r e w i th ample s torage space. The Outcome: 1. The drawings f o r d i s cu s s i on s w i th the community are to be l e s s d e t a i l e d and more i n the form o f showing the r e l a t i o n -sh ips between b u i l d i n g s . 2. The a r c h i t e c t was to produce two or three c on f i gu r a t i o n s f o r c on s i de r a t i on by and w i th the community. 3. The next se t o f drawings were not to emphasize the predom-inance o f s e c u r i t y through phys i ca l de s i gn . - 87 -4. The next set of drawings were to allow for more separation within the complex which would not create such an "insular" effect. 5. The individual units were not to be so isolated from one another (no individual fenced-in courtyards) and should have some additional window space or different orientation which would allow the inhabitants to focus on more than just a central courtyard. 6. For future f l e x i b i l i t y the complex was to allow for the possibility of expansion and some of the bachelor/ singles units were to be attached to the main building which would allow for, i f needed, conversion to personal care units. Main Building: (a) - the personal care units are that and not hospital wards; they are to be made "homier" and allow for more independence of the occupant - a l i t t l e larger, addition of sink, cupboards, small fridge, space for small couch, etc. - one set of units would have a sliding partition; - the washroom, bathroom arrangement was thought to be suitable. (b) - the kitchen was not intended as a commercial kitchen but rather a large residential kitchen and would not require freezer, cooler, dry storage; - the kitchen was to be moved closer to the personal care units to encourage usage by personal care occupants; - the kitchen is not intended to be used for preparing meals for every resident every day. (c) - the lounge is to have storage room and will also be moved to maintain the relationship to the kitchen; - access directly between kitchen and lounge by way of a doorway and a serving passageway; - the lounge is intended as a multi-purpose room. (d) - the washrooms (public) in the lounge/kitchen area should be designed for handicapped; only one would be needed. (e) - the laundry room is intended for usage by a l l residents -probably contain two washers, two dryers, double sink. - 88 -( f ) - the ca re take r couple apartment should be a two bedroom w i th a smal l o f f i c e ; - the apartment should have a p r i v a t e entrance and o r i e n t a t i o n to a l l ow f o r a degree o f p r i v a cy f o r the occupants . (g) - the lobby/ent rance to the main b u i l d i n g should have space f o r " s i t - i n " and "wa tch - i n " and c loak room/coat hanging space. I t was a l s o dec ided tha t the f o l l o w i n g w i l l be d i scussed w i th the community: - the general l ayout /schemat i cs - o r i e n t a t i o n o f the bu i l d i n g s - f a c i ng the r i v e r , e t c . - the ques t ion of ou t s i de s torage - smokehouses - garden p l o t s Date o f Event: 21 J u l y , 1978 (20) Type of Event: Meet ing i n Fo r t Prov idence Topic o f Concern: D i s cuss i on of a r c h i t e c t u r a l drawings Group(s) Represented: Sen io r C i t i z e n s ' Housing Working Group, consu l t an t a r c h i t e c t , Fo r t Prov idence Housing A s s o c i a t i o n , severa l p o t en t i a l r e s i d e n t s , o ther community members The Outcome: (1) Agreement among a l l present t ha t the f o l l ow i ng was accep tab l e : - a t o t a l o f s i x t e en un i t s would be b u i l t (one apartment f o r ca re take r and f i f t e e n un i t s f o r aged) , - one main b u i l d i n g con ta i n i ng a two bedroom apartment f o r a ca re take r coup le , a l a rge common/multi-purpose room, a k i t chen f o r the mu l t i -purpose room, p ub l i c washrooms, s to rage , f ou r personal care u n i t s , f i v e bache lo r u n i t s , - 89 -- two three u n i t b u i l d i n g s each con ta i n i ng two one bedroom un i t s and one bache lor u n i t connected to the main b u i l d i n g v i a covered walkway, - the personal care un i t s would share bath f a c i l i t i e s and each two-un i t se t -up would share washroom f a c i l i t i e s ; the ad j o i n i ng un i t s w i l l be d i v i d ed by a f o l d i n g w a l l ; each u n i t w i l l con ta in a s i nk and smal l f r i d g e , counter and s h e l f space, - the f i v e a t tached bache lo r u n i t s would face each o ther on a th ree faces two b a s i s , being separated by a common c O r r i d e r ; each u n i t would have two doors , one opening i n t o a common c o r r i d o r the o ther t o the o u t s i d e , - a l l o ther un i t s are a l s o to have two en t rances , one opening i n t o the covered walkway and one opening i n t o a p r i v a t e yard a r e a . (2) Another meeting would be he ld i n Fo r t P rov idence , F r i d a y , August 4 , 1978. Date o f Event: 04 August , 1978 (21) Type o f Event: Meeting i n Ye l l owkn i f e Topic o f Concern: A r c h i t e c t u r a l drawings o f Fo r t Prov idence Sen io r C i t i z e n s Home Group(s) Represented: Sen io r C i t i z e n s ' - Housing Working Group and Canada Mortgage and Housing Corpora t ion The Outcome: The f o l l o w i n g was dec ided : - the personal care un i t s bathroom would i n c l ude a handicapped person shower; - there would be more storage f o r the personal care u n i t s ; - the laundry room had been omi t ted from t h i s se t o f drawings and w i l l be i nco rpora ted back i n t o the next set o f drawings; - the common k i t chen would have a serve- through counte r ; - 90 -- the lunch room would have a "co f fee counter" f o r use which would a l l ow f o r l o c k i ng o f the common k i t c h e n ; - one o f the bache lo r un i t s would be made a handicapped pe rson ' s u n i t ; - a l l doorways would be the same width and would ensure whee l -c h a i r usage; - the pub l i c washrooms and main entranceway would be reviewed f o r a l t e r a t i o n / r e l o c a t i o n to i n co rpo ra te more economic hea t i ng ; - the heat ing system w i l l have to be designed so tha t maintenance and ope ra t i on does not r equ i r e a person w i th a 3rd C lass Steam Eng inee r ' s T i c k e t . Date o f Event: 04 August , 1978 (22) Type o f Event: Meet ing i n Fo r t Prov idence Topic o f Concern: Review a r c h i t e c t u r a l drawings Group(s) Represented: Present a t the meeting were the Working Group, a r c h i t e c t , Housing A s s o c i a t i o n cha i r pe r son , manager, severa l community e l de r s and o ther community members. The Outcome: Agreement was reached as f o l l o w s : - the conceptual des ign was accepted by the community r ep re sen ta t i v e s present a t the meet ing; - personal care un i t s o r i e n t a t i o n would a l l ow occupants v i s i b i l i t y o f community; - agreement t ha t d e t a i l e d drawings cou ld now be prepared; - agreement tha t any major a l t e r a t i o n s to the concept because o f C.M.H.C. requirements would be shown/discussed w i th the community; - the community, through the Housing A s s o c i a t i o n , would be kept abreast o f developments; - the f i n a l C.M.H.C. approved drawings would be shown to the -. community. - 91 -Date o f Event: 23 November, 1978 (23) Type o f Event: Correspondence from Housing Corpora t ion to Canada Mortgage and Housing Corpora t ion Top ic o f Concern: Cons t ruc t i on t imeframe Group(s) Represented: Housing Corpora t ion and Canada Mortgage and Housing Corpora t ion The Outcome: Timeframe f o r the Fo r t Providence Sen io r C i t i z e n s ' Home p r o j e c t was e s t a b l i s h e d : January, 1979 - i n v i t a t i o n to tender February , 1979 - c l o s e pub l i c tender f o r supply and c on su l t a t i o n March, 1979 - intended con s t r u c t i on commencement. Date o f Event: A p r i l , 1979 (24) Type o f Event: Correspondence Topic o f Concern: Cons t ruc t i on o f For t Prov idence Sen ior C i t i z e n s ' Home Group(s) Represented: N.W.T. Housing Corpora t ion The Outcome: I n v i t a t i o n s f o r tenders to cons t ruc t the Fo r t Prov idence Sen ior C i t i z e n s ' Home were i n v i t e d . Date o f Event: 31 May, 1979 (25) Type o f Event: Meet ing i n Ye l l owkn i f e Topic o f Concern: Review o f tenders f o r c on s t r u c t i on Group(s) Represented: N.W.T. Housing Corpora t ion - 92 -The Outcome: Cont rac t awarded Date o f Event: 05 June, 1979 (26) Type o f Event: Cons t ruc t i on The Outcome: Cons t ruc t i on of Fo r t Prov idence Sen io r C i t i z e n s ' home was i n i t i a t e d . Date o f Event: 15 February , 1980 (27) Type o f Event: Meet ing Topic o f Concern: P r o j e c t turnover Group(s) Represented: N.W.T. Housing Co rpo ra t i on , Fo r t Prov idence Housing A s so c i a t i o n The Outcome: The r e s p o n s i b i l i t y f o r the maintenance and ope ra t i on o f the Fo r t Prov idence Sen io r C i t i z e n s ' Home was turned over to the Fo r t Prov idence Housing A s s o c i a t i o n . Date o f Event: 22 August , 1980 (28) Type o f Event: O f f i c i a l Opening Group(s) Represented: Mr. K i t Spence, Spec ia l A s s i s t a n t , Nor the rn , to the M i n i s t e r o f Ind ian and Northern A f f a i r s , Mr. Nick S i bbes ton , Member o f L e g i s l a t i v e Assembly, Mr. Joachim Bonnetrouge, Ch i e f , Fo r t Prov idence Band C o u n c i l , Mrs. M. V a n d e l l , Chairman, Fo r t Prov idence Housing A s s o c i a t i o n , - 93 -Mr. Robert P i lo t , Deputy Commissioner, Government of the Northwest Terr itories and Chairman, Board of Directors, Northest Housing Corporation, Mr. George Forrest, Managing Director Northwest Territories Housing Corporation, Mr. John Soderbert, Manager, Canada Mortgage and Housing Corporation, Northwest Terr i tor ies , Mr.John Murray, architect, Mr. Henry Sklar, contractor, Mr. Dave McCann, Senior Cit izens' Housing Working Group, Housing Corporation, Mrs. M. Crown, Senior Cit izens' Housing Working Group, Department of Health, Mrs. D. Doyle, Co-Ordinator, Aged and Handicapped Services, Department of Social Services. The Outcome: Chief Joachim Bonnetrouge chaired the o f f i c i a l opening which was addressed by Messieurs Spence, Sibbeston, P i lo t , Soderberg and Chief Bonnetrouge. Unfortunately, there are no records of the proceedings. Postscript: When this was written the f a c i l i t y was fu l l y occupied, staffed and operational but the occupancy and operation has evolved according to community customs. When f i r s t available for occupancy the elders of the community were, as expected, cautious about moving into the f a c i l i t y . Although they had been involved in the design there was s t i l l a reluctance to accept the new building with i ts associated concepts. Since being opened, occupancy has varied according to season, too. Some of the residents s t i l l epend up to three or four months maintaining a traditional l i f es ty le of l iv ing on the land, hunting, trapping and f ish ing. F inal ly , occupancy is a function of the informal "word-of-mouth" reputation of the home. Operationally, the f a c i l i t y was designed to allow for a specif ic "treatment" modality of informal assistance with the act iv i t ies of daily l i v i n g . As yet, there is not a demand for this service. Tather, the residents rely upon each other or family. In fact , one of the personal care units is occupied by a mother and her daughter. The daughter, who would not normally qualify for residency in the f a c i l i t y , cares for her mother. - 94 -CHAPTER FOUR REFERENCES The documentation suppor t ing chapter four was obta ined from the va r i ous f i l e s o f the Northwest T e r r i t o r i e s Housing Corpora t ion and the Department o f Soc i a l S e r v i c e s . The c i t a t i o n s l i s t e d here make re fe rence to the source o r gan i z a t i on on (1 (2 (3 (4 (5 (6 (7 (8 (9 CIO (11 (12 (13 (14 y. Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . Northwest T e r r i t o r i e s Housing Corpora t ion and Department of Soc i a l Se rv i ce s f i l e s . Department of Soc i a l Se rv i ces f i l e s - t e l e x from departmental f i e l d s t a f f to departmental headquarters . Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . Department o f Soc i a l Se rv i ces and Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . Department of Soc i a l Se rv i ces f i l e s . Northwest T e r r i t o r i e s Housing Corpora t ion and Department of Soc i a l Se rv i ces f i l e s . Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . ices and Northwest T e r r i t o r i e s Department o f Soc i a l Serv Housing Corpora t ion f i l e s Department o f So c i a l Serv Housing Corpora t ion f i l e s ces and Northwest T e r r i t o r i e s Department o f Soc i a l Se rv i ces f i l e s . Northwest T e r r i t o r i e s Housing Corpora t ion and Department o f Soc i a l Se rv i ce s f i l e s . - 95 -CHAPTER FOUR REFERENCES (cont inued) (15) Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (16) Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (17) Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (18) Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (19) Department o f Soc i a l Se rv i ce s and Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (20) Department o f Soc i a l Se rv i ces and Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (21) Department o f Soc i a l Se rv i ces and Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (22) Department of Soc i a l Se rv i ces and Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (23) Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (24) News o f the Nor th , Y e l l owkn i f e , 11 A p r i l , 1979. (25) Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (26) Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (27) Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . (28) Northwest T e r r i t o r i e s Housing Corpora t ion f i l e s . CHAPTER FIVE - DISCUSSION OF THE CASE STUDY AND ANALYSIS OF 'THE COMMUNITY PARTICIPATION METHODOLOGY INTRODUCTION Th is chapter draws toge ther the prev ious chapters to address the ques t i on "How use fu l and a p p l i c a b l e i s the Northwest T e r r i t o r i e s community p a r t i c i p a t i o n approach i n the development of f a c i l i t i e s , s p e c i f i c a l l y f o r the e l d e r l y ? " In so do i ng , the sub-quest ions p r e v i ou s l y r a i s ed a t the end of Chapter One w i l l a l s o be addressed. These were: "Who c o n t r o l l e d and who exe r c i s ed power? Did i t change f o r d i f f e r e n t s i t u a t i o n s ? What was the o b j e c t i v e o f each p a r t i c i p a n t group? Were t h e i r ob j e c t i v e s the same? Were t h e i r ob j e c t i v e s compat ib le? Accord ing to A r n s t e i n ' s Ladder o f C i t i z e n P a r t i c i p a t i o n , what l e v e l of p a r t i c i p a t i o n was ach ieved? What type o f c i t i z e n p a r t i c i p a t i o n s t r a tegy was u t i l i z e d ? Did the s t r a t egy change over t ime? Was a d i f f e r e n t s t r a t egy u t i l i z e d f o r d i f f e r e n t s i t u a t i o n s ? " I . CASE STUDY DISCUSSION A. Readiness to P a r t i c i p a t e The s t a ted ph i losophy of the Government o f the Northwest T e r r i t o r i e s agenc ies r e spons i b l e f o r the p r o v i s i o n o f housing - 96 -- 97 -f o r the e l d e r l y was "To r e i n f o r c e the independence and personal autonomy of the e l d e r l y by encouraging the development o f s e r v i c e s , where necessary , which enable e l d e r l y persons to l i v e w i t h i n t h e i r own home and/or community as long and as independent ly as p o s s i b l e . " (1) The ob j e c t i v e s of the Northwest T e r r i t o r i e s Departments of Hea l th and Soc i a l Se rv i ces and the Northwest T e r r i t o r i e s Housing Corpora t ion were s ta ted as be i ng , "To a s s i s t s en i o r c i t i z e n s to remain as long as po s s i b l e i n t h e i r own homes and/or communit ies; To ensure tha t e l d e r l y persons who r equ i r e a g rea te r amount o f care than can be prov ided on a v i s i t i n g bas i s are prov ided w i th the l e ve l o f care needed; and To p a r t i c i p a t e i n p lann ing phys i ca l f a c i l i t i e s f o r the e l d e r l y , where necessary , which w i l l p rov ide smal l s e l f -conta ined s u i t e s and/or b e d s i t t i n g rooms where a l e v e l o f personal care i s a v a i l a b l e . " (2) A l s o , as mentioned i n Chapter One, 0the T e r r i t o r i a l Govern-ment was seek ing to i nvo l ve the community i n the dec i s ion-mak ing f o r p r i o r i t y s e t t i n g i n the development o f and a l l o c a t i o n of f a c i l i t i e s . Or, p a r t i c i p a t i o n was sought to ensure the communitys 1 l eaders were we l l informed and ab le to draw conc lus i ons based upon f a c t not pe r cep t i on s . With respec t to the people o f For t P rov idence , t h e i r o b j e c t i v e s were s t a t ed i n the 15 March, 1977 meeting between the Hay R i ve r D i s t r i c t Manager o f the Housing Corpora t ion and the Fo r t Prov idence Housing A s s o c i a t i o n . As s ta ted in Chapter Four , the A s s o c i a t i o n requested c on s t r u c t i o n o f a s en i o r c i t i z e n s ' home i n For t P rov idence . I t was, a l s o revea led tha t e leven a p p l i c a t i o n s - 98 -f o r sen i o r c i t i z e n s ' housing had been rece i ved from community r e s i den t s a f t e r the A s so c i a t i o n had in te rv i ewed most of the community's e l d e r l y . A commitment from the Roman Ca t ho l i c M i s s i on f o r a g i f t o f p roper ty had been obta ined and the A s so c i a t i o n was at tempt ing to r a i s e funds to pay f o r a v i s i t by some of the l o c a l e l de r s to e x i s t i n g f a c i l i t i e s i n o ther communit ies. An add i t i o n a l f a c t o r f u s i n g the ob j e c t i v e s of the community w i th those of the bureaucracy was tha t through i n v e s t i g a t i o n i t became apparent t ha t Fo r t Prov idence was f a c i n g the emerging problem o f the needs of the e l d e r l y . In some ins tances government p lanners o r the medical p ro f e s s i on forge ahead independent ly o r c o l l e c t i v e l y to p lan f o r the care of the e l d e r l y w i thout consu-l t a t i o n w i th them. In t h i s case there was a s t rong commitment to the ph i losophy tha t de c i s i on s are more l i k e l y to be accepted when the persons to be a f f e c t ed ( d i r e c t l y o r i n d i r e c t l y ) are i nvo l ved i n the making o f those d e c i s i o n s . To conc lude , a l l i n d i c a t i o n s were tha t the implementat ion o f the community p a r t i c i p a t i o n methodology was approp r i a te to t h i s p r o j e c t . The ob j e c t i v e s of the bureaucracy were compat ib le to those o f the people of Fo r t P rov idence . The bureaucracy was des i rous o f having community members p a r t i c i p a t e . C o i n c i d e n t a l l y , the community was a l ready lobby ing f o r a s en i o r c i t i z e n s ' home and i t was apparent t ha t t h i s pressure cou ld be expected to be u t i l i z e d i n the form o f p a r t i c i p a t i o n . - 99 -B. Theory App l i ed to R e a l i t y 3 The f i r s t chosen t h e o r i s t , Fo ske t t , developed f i v e bas i c premises o f p a r t i c i p a t i o n which were p red i ca ted i n the b e l i e f t h a t , " p a r t i c i p a t i o n o f ten depends upon the re levancy o f a problem. Those problems which a f f e c t one most pe r sona l l y w i l l r e s u l t i n a h igh degree o f s o c i a l p a r t i c i p a t i o n . " and , . . . . " p r ob l ems are so lved and programs i n i t i a t e d i n consonance w i th . the o r i e n t a t i o n and va lues o f the p a r t i c i p a t o r s . . . B r i e f l y summarized, h i s f i v e bas i c premises f o r c on s i d e r a t i o n when endeavouring to i n vo l ve community p a r t i -c i p a t i o n can be app l i ed to t h i s p r o j e c t as f o l l o w s : Community leaders can he lp perpetuate acceptance o f a program a f t e r t h e i r involvement i n a process of problem d e f i n i t i o n . Evidence o f t h i s i s apparent i n t h i s p r o j e c t . I n i t i a l l y , community members de f ined what they saw as a problem i n t h e i r community and dec ided upon the need f o r a s en i o r c i t i z e n s ' home. Severa l months l a t e r the bureaucracy i nd i c a t ed agreement. The re fo re , a l though the community and the government p lanners l o ca ted and de f ined a problem i n i s o l a t i o n o f each o the r the i n s t i g a t o r s , the community, c rea ted v i s i b l e a c t i o n on the i s s u e . They made the i s sue o f s en i o r c i t i z e n s ' housing i n Fo r t Prov idence r e l e van t to a wide range o f peop le . 2. and 3. S t r a t eg i e s can be u t i l i z e d which recogn i ze the d i v e r s i t y o f va lue systems among the p a r t i c i p a n t s and there are s t r a t e g i e s which compensate f o r the d i f f e r i n g a b i l i t i e s o f the p a r t i c i p a n t s to communicate. Th i s i s ev idence tha t e f f o r t s were made t o - 100 -implement these s t r a t e g i e s . The l o c a l Housing A s s o c i a t i o n was u t i l i z e d as the v e h i c l e to c i rcumvent the problems as soc i a t ed w i th the presence o f d i f f e r i n g va lue systems and a language b a r r i e r . The Assoc i a t i on ' s ' membership was comprised o f community r e s i den t s who were b i l i n g u a l i n S lavey and E n g l i s h . A l s o , some o f the community:'s e l de r s were members of the A s s o c i a t i o n which meant they were i n a p o s i t i o n to comment upon any stances taken by themselves based upon t h e i r va lues and l i f e expe r i ences . An example o f t h i s was the i s sue o f the need f o r two entrances to each housing u n i t . The p lanners were accustomed to apartment l i v i n g and un i t s w i t h on ly one en t rance . The e l d e r s , however, had never l i v e d i n t h i s s t y l e o f housing and f e l t i t was too c on f i n i ng i n comparison to a house or t en t s i t u a t e d by a r i v e rbank . 4, Innovat ions i n the t ime , p lace and c i rcumstance o f p a r t i -c i p a t i o n must be u t i l i z e d to decrease the importance o f the u t i l i z a t i o n o f the p a r t i c i p a n t s f r e e t ime and resou rces . There i s ev idence tha t t h i s was a l s o recogn i zed . As mentioned i n Chapter Two none o f the th ree government agenc ies i nvo l ved i n the p r o j e c t a c t u a l l y had a r e s i d en t r ep r e sen t a t i v e i n Fo r t P rov idence . The re fo re , there was not a government employee i n For t Prov idence charged w i th the r e s p o n s i b i -l i t y o f p lann ing f o r a s en i o r c i t i z e n s ' home i n the community. Thus, a l l community p a r t i c i p a n t s were vo lun tee rs which p laced se r i ous r e s t r i c t i o n s upon t h e i r t ime and t h e i r resources to be - 101 -ab le to t r a v e l to Ye l l owkn i f e to meet With the p l anne r s . In an e f f o r t to a l l e v i a t e t h i s s i t u a t i o n , meetings and working sess ions were he ld i n Fo r t Prov idence a t t imes convenient to the community p a r t i c i p a n t s . Any cos t s i nvo l ved were absorbed by the government. In a d d i t i o n , whenever community p a r t i c i p a n t s were i n Ye l l owkn i f e the p lanners made themselves a v a i l a b l e to the v i s i t o r s . 5. P a r t i c i p a t i o n must be made respec tab le and p r e s t i g i o u s before persons w i l l become i n v o l v ed . Th is was not an i s sue w i th t h i s p r o j e c t . There was ample ev idence o f an expressed de s i r e to p a r t i c i p a t e . The Housing A s s o c i a t i o n i n i t i a t e d the p r o j e c t w i th i t s March 1977 reques t . Th is request fo l l owed a per iod o f i n v e s t i g a t i o n and r e s o l u t i o n . The proposed s i t e of the f a c i l i t y was donated l a nd . A l s o , the Band Counc i l was committed to p rov i d i ng smoke houses. The p lanners had, accord ing to F o s k e t t ' s c r i t e r i a , prepared to deal wi th some o f the l o g i s t i c a l c o n s t r a i n t s which may have h indered the process o f p a r t i c i p a t i o n . How they a c t u a l l y ach ieved g t h i s i s b e t t e r addressed in the terms of Burkes theo ry . Burke de f ined f i v e bas i c s t r a t e g i e s^ o f p a r t i c i p a t i o n . These s t r a t e g i e s , de f ined i n terms o f o b j e c t i v e s , may be changed over t ime or as the s i t u a t i o n changes. That i s , j u s t because one s t r a t egy was used to i n i t i a t e a p a r t i c i p a t i o n process the same s t r a t egy may not be requ i r ed i f the c i rcumstances o f the process change. Or , because ob j e c t i v e s may va r y , by des ign o r no t , dur ing - 102 -a p a r t i c i p a t i o n p ro j e c t the p a r t i c i p a t i o n s t r a t e g i e s may a l s o va ry . For rev iew purposes these s t r a t e g i e s may be summarized as : (1) Educat ion - Therapy S t ra tegy which has the o b j e c t i v e o f c i t i z e n s h i p t r a i n i n g based upon t h e i r l e a rn i ng through involvement i n the form o f p a r t i c i p a t i o n ; (2) Behav ioura l - Change S t ra tegy which attempts to change i n d i v i d u a l behaviours through group membership; (3) S t a f f - Supplement S t ra tegy e x p l o i t s the a b i l i t i e s , f r e e t ime and e xpe r t i s e o f i n d i v i d u a l s to ach ieve a predetermined g o a l ; (4) Co -op ta t i on S t ra tegy uses c i t i z e n s as a dev ice f o r secur ing community sanc t i on w i thou t p r o v i d i ng f o r genuine p a r t i c i p a t i o n ; and (5) Community Power S t ra tegy which has the o b j e c t i v e o f e s t a b l i s h i n g a new p o l i c y and ob j e c t i v e s e t t i n g group i n the community. A l s o , i t should be r e c a l l e d f o r purposes o f comparison t ha t i n Chapter Three the "Northwest T e r r i t o r i e s community p a r t i c i p a t i o n methodology" was i d e n t i f i e d as c o n s i s t i n g o f : (1) Sen ior c i t i z e n s ' housing working group; (2) Community educa t i on ; (3) Community group o r committee f o rmu l a t i o n ; (4) Determinat ion of need; (5) Data a n a l y s i s ; and - 103 -(6) Se r v i ce or f a c i l i t y development. C l e a r l y , the p r o j e c t cons i s t ed of d i f f e r e n t phases each o f which had a separate o b j e c t i v e . Thus, the s t r a t e g i e s o f c i t i z e n p a r t i c i p a t i o n u t i l i z e d would have to be changed over t ime to meet the d i f f e r e n t o b j e c t i v e s . Chapter One informed o f the government's d e s i r e to i n vo l ve the community i n the dec i s ion-mak ing about a l l o c a t i o n , p r i o r i t y s e t t i n g and program and f a c i l i t y des ign to be t t e r ensure tha t the f a c i l i t y was acceptab le to the community wh i l e being app rop r i a te to the i d e n t i f i e d needs. Chapters Two and Three i d e n t i f i e d the t r a d i t i o n a l way i n which f a c i l i t i e s f o r the e l d e r l y were perce i ved by the peop le . These chap te r s , e s p e c i a l l y Chapter Three, a l s o i d e n t i f i e d the l ack o f c ompa t ab i l i t y between these percep t ions and the "southern" s t y l e o f housing the e l d e r l y . The re fo re , there i s ev idence to suggest the need f o r an educat ion- therapy s t r a t e g y . Th i s s t r a t egy took the form o f the 25 January, 1978 v i s i t to o the r communities to view f a c i l i t i e s and the Working Group f i e l d t r i p to Fo r t Prov idence from the 7th to the 10th of March, 1978. I t was hoped tha t through these e f f o r t s the e l de r s and the community committee members would be ab le to p a r t i c i p a t e i n a f a c i l i t y des ign e x e r c i s e . The e x i s t i n g sen i o r c i t i z e n s ' homes i n o ther communities would have been viewed so they cou ld be concep tua l i zed dur ing d i s c u s s i o n s . A l s o , the use of cardboard models a l lowed the p a r t i c i p a n t s to cons t r u c t t h e i r own des i gns . In the f i n a l a n a l y s i s , the people themselves would be des ign ing t h e i r f a c i l i t y . - 104 -The s ta f f - supp lement s t r a t egy p lays an important r o l e throughout the l i f e o f the p r o j e c t due to the absence o f any r e s i d en t Departmental r ep r e sen ta t i v e in Fo r t P rov idence . Of n e c e s s i t y , the a b i l i t i e s , f r ee t ime and e xpe r t i s e o f l o c a l vo lun tee r s was a must. The p lanners r e l i e d upon the l o c a l Housing A s s o c i a t i o n to i n t e r p r e t the r e s u l t s o f a l l d i s cu s s i on s between themselves and the p lanners back to the community. I t was a l s o the r o l e o f the l o c a l Housing A s s o c i a t i o n to pass-on the feedback rece i ved from the community to the p l anne r s . The behaviour - change s t r a t egy was imp l i ed throughout the p r o j e c t because o f the " c l a sh o f l i f e s t y l e s " and may be a consequence o f the p r o j e c t . The human s e r v i c e s f a c i l i t y in t roduced to the community of For t Prov idence has attempted to p l a ca te the t r a d i t i o n a l l i f e s t y l e wh i l e i n t r oduc i ng some "new" concepts o f c a r i n g f o r the e l d e r l y . That i s , t h i s f a c i l i t y which i s a product o f a behaviour-change process may even r e s u l t i n a behav iour change because of t h i s i n t r o d u c t i o n . Co-op ta t ion s t r a t egy p layed a r o l e dur ing the ac tua l des i o f the f a c i l i t y . A l though the community p a r t i c i p a n t s had input i n t o the des ign a l l major des ign dec i s i on s were made by the bu reauc ra t s . Community p a r t i c i p a t i o n merely sanct ioned the de c i s i on s made by the p lanners i n c on su l t a t i o n w i th the a r c h i t e c t At no t ime dur ing t h i s p r o j e c t was a community power s t r a t egy u t i l i z e d . g App ly ing Burke ' s theory enables the l a b e l l i n g of the - 105 -s t r a t e g i e s u t i l i z e d i n t h i s p r o j e c t and the de te rmina t ion of when they were u t i l i z e d . His theory does no t , however, address the ques t ion o f degree o f p a r t i c i p a t i o n ach i eved . 9 A rn s t e i n addresses the i s sue of degree o f p a r t i c i p a t i o n when she s t r e s sed the importance o f the e x e r c i s i n g o f power o r con t ro l i n a community p a r t i c i p a t i o n p r o j e c t . Accord ing to he r , " t r ue " p a r t i c i p a t i o n does not occur u n t i l there i s an equal e x e r c i s i n g o f power by a l l p a r t i c i p a n t s and an important measurement o f t h i s i s the p r o j e c t d e f i n i t i o n phase. In t h i s p r o j e c t community p a r t i c i p a t i o n was not a c t i v e l y sought u n t i l the p r o j e c t d e f i n i t i o n had been e s t a b l i s h ed by the bureaucracy . The community i n i t i a t e d t h i s by reques t ing c on s t r u c t i on o f a sen i o r c i t i z e n s ' home. The response to the request was t ha t p r i o r to any c on s t r u c t i o n o c c u r r i n g , the need f o r c on s t r u c t i o n must be v a l i d a t e d . V a l i d a t i o n was to be dependent upon the e xp l o r a t i o n of a l l a v a i l a b l e s e r v i c e opt ions i n c l ud i ng non-phys i ca l resources and an eva l ua t i on o f the a p p l i c a b i l i t y o f these opt ions be ing ab le to meet the i d e n t i f i e d need(s ) . Furthermore, the method of v a l i d a t i o n was to i n c l ude c i t i z e n p a r t i c i p a t i o n i n the de te rmina t ion o f need and a matching o f these needs to the a v a i l a b l e r e sou rces . Or, accord ing to A r n s t e i n , the bureaucracy was "man ipu la t ing" the community by say ing these are the r u l e s which must be f o l l owed . The consequence of not ab id ing by the f u l e s was tha t a requ i red s e r v i c e or f a c i l i t y would not be put i n t o the community. - 106 -Once the community d i d p a r t i c i p a t e the ma j o r i t y o f the p a r t i c i p a t i o n was token ism. A l l major de c i s i on s were made by the Working Group. For i n s t an ce , (1) A p r o f i l e o f need was " d i s c r e e t l y " compi led by government personnel not community members. (2) The e va l ua t i on o f s e r v i c e op t ions versus c on s t r u c t i o n o f a f a c i l i t y was performed by the p l anne r s . The re fo re , the major d e c i s i o n o f whether a f a c i l i t y was needed o r not was made by a government body i n i s o l a t i o n from the community p a r t i c i p a n t s . (3) Community input i n t o the des ign o f the f a c i l i t y a l though conducted i n pa r tne r sh i p was a c t u a l l y p l a c a t i o n . F i na l approval o f the f a c i l i t y des ign was dependent upon the nego t i a t i on s between the N.W.T. Housing Corpora t ion and the Cent ra l Mortgage and Housing Co rpo ra t i on . At no t ime d i d a r ep r e sen t a t i v e o f Cent ra l Mortgage and Housing Corpora t ion en te r i n t o the des ign d i s cu s s i ons w i th the community. In f a c t , a t no t ime dur ing the p ro j e c t d i d the community group e s t a b l i s h the p o l i c i e s o r ob j e c t i v e s a p p l i c a b l e to the p r o j e c t . Rather , t h i s l o c a l body was a c o n s u l t a t i v e body u t i l i z e d to sanc t i on bu reauc ra t i c i n i t i a t i o n s . To summarize, i n Chapter One i t was s ta ted tha t t h i s t h e s i s was a r e t r o s p e c t i v e examinat ion o f an a l ready implemented community p a r t i c i p a t i o n methodology. As such , the a v a i l a b l e l i t e r a t u r e was u t i l i z e d to f i n d a "best f i t " to compare what had a l ready occurred - 107 -to the t h e o r e t i c a l concepts most app rop r i a te to the i n t en t o f the p r o j e c t . With t h i s "best f i t " the po t en t i a l c o n s t r a i n t s to be overcome were i d e n t i f i e d [ p o s s i b l e s t r a t e g i e s u t i l i z e d were a l s o i d e n t i f i e d (11) and f i n a l l y the degree of ac tua l p a r t i c i p a t i o n achieved was determined. (12) The major c on s t r a i n t s were the need f o r s t r a t e g i e s r e cogn i z i ng the presence of d i ve r se va lue systems; the need to compensate f o r d i f f e r i n g a b i l i t i e s to communicate, e s p e c i a l l y where a language b a r r i e r e x i s t s ; and, the need to accommodate d i f f e r i n g degrees o f f r ee t ime and a v a i l a b i l i t y o f resources i n terms o f the time requ i r ed f o r and the p lace of p a r t i c i p a t i o n . The i d e n t i f i e d s t r a t e g i e s of b ene f i t to the p r o j e c t ( i n terms o f he l p i ng to overcome the c o n s t r a i n t s ) were (1) educa t i on -the rapy , (2) behav ioura l - change , and (3) s t a f f - supp l emen t . F i n a l l y , the ex ten t to which p a r t i c i p a t i o n occur red may be l a b e l l e d as token ism. I I . CONCLUSIONS In the f i n a l a n a l y s i s the ques t ion o f u t i l i t y and a p p l i c a b i - ' l i t y o f the methodology must be answered i n terms o f the ob j e c t i v e s o f the p a r t i c i p a n t s . The ob j e c t i v e o f the community o f Fo r t Prov idence was to have a sen i o r c i t i z e n s ' home. Th i s o b j e c t i v e was met. The ob j e c t i v e s of the N.W.T. Housing Corpora t ion and the Department o f Hea l th and Soc i a l Se rv i ce s were s ta ted e a r l i e r . They - 108 -were a l s o met, t ha t i s , - they d i d a s s i s t i n ensur ing tha t the e l d e r s o f For t Prov idence w i l l be ab le to remain as long as po s s i b l e i n t h e i r own community; - they d i d ensure tha t the e l d e r s o f For t Prov idence who r equ i r e a g rea te r amount o f care than can be prov ided on a v i s i t i n g bas i s were prov ided w i th the l e v e l o f care needed; and - they d i d p a r t i c i p a t e i n p lann ing a phys i c a l f a c i l i t y f o r the e l d e r l y , where i t was necessary , which prov ides s e l f -conta ined s u i t e s and b e d - s i t t i n g rooms where a l e v e l o f personal care i s a v a i l a b l e . Therefore i t can be sa i d tha t the community p a r t i c i p a t i o n methodology, as implemented, was use fu l and a p p l i c a b l e to the For t Prov idence p r o j e c t . Un fo r t una te l y , as y e t , i t cannot be s t a t ed t ha t t h i s methodology i s g ene r a l l y use fu l and a pp l i c a b l e throughout the e n t i r e Northwest T e r r i t o r i e s . Perhaps the p r o j e c t was on l y success fu l because the ob j e c t i v e s o f a l l p a r t i c i p a n t s were compat ib le . Would t h i s methodology prove to be use fu l i f the community arid the bureau-cracy were o f oppos i te op in i ons? As ment ioned, i n terms of A r n s t e i n ' s ^ c r i t e r i a t h i s p r o j e c t was an e xe r c i s e i n tokenism because the s t r a t egy u t i l i z e d was one o f c o -op t a t i on (as per Burke ' s c l a s s i f i c a t i o n ) . ^ what would the outcome have been i f " t r u e " p a r t i c i p a t i o n was to occur? 109 -What would the r e s u l t be i f the r e spec t i v e departments had r e s i d en t r ep re sen ta t i v e s i n the community? Al though these andmasiy ques t ions may be asked , c on s i d e r a t i o n o f the u t i l i t y and a p p l i c a b i l i t y must be addressed w i t h i n the context o f the approp r i a te assumpt ions. Th is approach has assumed the community o b j e c t i v e w i l l always be the p r o v i s i o n o f s e r v i c e s or the c on s t r u c t i o n o f a f a c i l i t y f o r the community's e l d e r s . The bureaucracy i s assumed to have the ob j e c t i v e s o f ensur ing the e l de r s are ab le to remain as long as po s s i b l e i n t h e i r own community e i t h e r through the p r o v i s i o n o f s e r v i c e s o r the c on s t r u c t i o n o f a f a c i l i t y . I f app l i ed as intended and prov ided these assumptions are cons t an t s , the community p a r t i c i p a t i o n methodology w i l l , at the l e a s t , p rov ide a means o f communication between the community and the bureaucracy. The community p a r t i c i p a t i o n methodology, as o u t l i n e d in t h i s paper , w i l l i n vo l ve communities i n the dec i s ion-mak ing about a l l o c a t i o n , p r i o r i t y s e t t i n g , program and f a c i l i t y des ign in the p r o v i s i o n o f s e r v i c e s and f a c i l i t i e s f o r the e l d e r l y i n the Nor th -west T e r r i t o r i e s . Or ,uthe Northwest T e r r i t o r i e s community p a r t i -c i p a t i o n i s use fu l and a pp l i c a b l e to the p lann ing and development o f f a c i l i t i e s f o r the e l d e r l y i n the Northwest T e r r i t o r i e s . But , perhaps the bas i c assumptions are chang ing. " . . . h e a l t h care i s not on ly everyone 's r i g h t , but every -one ' s r e s p o n s i b i l i t y . Informed s e l f - c a r e should be the main goal o f a hea l th program, g iven tha t peop le , prov ided w i th c l e a r s imple i n fo rmat i on can prevent and t r e a t most common hea l th problems i n t h e i r own homes, e a r l i e r , c h e a p e r , and most o f ten be t t e r than can do c t o r s . Consequent ly , - 110 -ba&'tc knalth caAe should not be. dnllv2,K2.d bat £ncousiage.d, and medical knowledge should not be the guarded secret of a select few - but should be freely shared by everyone. Ultimately the health system must encourage wellness, self-care, prevention, and family development. It must u t i l i z e traditional medicine mechanisms, and encourage self-reliance and dignity in the delivery of an essential community service." - I l l -CHAPTER FIVE REFERENCES (1) Department of Soc i a l S e r v i c e s , N.W.T.; Soc i a l  Se rv i ce s to Aged: In te r im Statement, February, 1978. (An i n t e r n a l working document) (2) IBID. (3) FOSKETT, John M., The In f luence o f P a r t i c i p a t i o n  on Community Programs and A c t i v i t i e s i n Sussman, Marvin B., e d i t o r , 1959. Community S t r u c t u r e and  A n a l y s i s . New York, Thomas Y. Crowel l Company, p. 328 (4) IBID. (5) IBID. (6) BURKE, Edmund M., C i t i z e n P a r t i c i p a t i o n S t r a t e g i e s , American I n s t i t u t e o f P lanners J o u r n a l , September, 1968. pp. 287-294 (7) IBID. (8) IBID. (9) ARNSTEIN, Sherry R, A Ladder o f C i t i z e n P a r t i c i p a t i o n , American I n s t i t u t e of P lanners J o u r n a l , J u l y , 1969. pp. 216-224 (10) FOSKETT, John M., The In f luence o f P a r t i c i p a t i o n  on Community Programs and A c t i v i t i e s i n Sussman, Marvin B., e d i t o r , 1959. Community S t r u c tu r e and  A n a l y s i s . New York, Thomas Y. Crowel l Company. p. 328 (11) BURKE, Edmund M., C i t i z e n P a r t i c i p a t i o n S t r a t e g i e s , American I n s t i t u t e o f P lanners J o u r n a l , September, 1968. pp. 287-294 (12) ARNSTEIN, Sherry R., A Ladder o f C i t i z e n P a r t i c i p a t i o n , American I n s t i t u t e o f P lanners J o u r n a l , J u l y , 1969. pp. 216-224 - 112 -(13) FOSKETT, John M., The In f luence of P a r t i c i p a t i o n  on Community Programs and A c t i v i t i e s i n Sussman, Marvin B., e d i t o r , 1959. Community S t r u c t u r e and  A n a l y s i s . New York, Thomas Y. Crowel l Company, p. 328 (14) BURKE, Edmund M., C i t i z e n P a r t i c i p a t i o n S t r a t e g i e s , American I n s t i t u t e of P lanners J o u r n a l , September, 1969. pp.287-294 (15) ARNSTEIN, Sherry R., A Ladder of C i t i z e n P a r t i c i p a t i o n , American I n s t i t u t e o f P lanners J o u r n a l , J u l y , 1969. pp. 216-224 (16) IBID. (17) BURKE, Edmund M., C i t i z e n P a r t i c i p a t i o n S t r a t e g i e s , American I n s t i t u t e o f P lanners J o u r n a l , September, 1968, pp. 287-294. (18) STARBLANKET, Noe l , " Ind ian Hea l th : The Dawn o f a New Era" a speech presented a t the opening ceremonies o f the B a t t l e f o r d s Indian Hea l th Cent re , J u l y 26, 1979. pp. 2-3 - 113 -BIBLIOGRAPHY AND ADDITIONAL READINGS I . COMMUNITY PARTICIPATION AITKEN, Michael and Paul E. Mott. The S t r u c tu r e o f  Community Power. Random House, New York. 1970 ARNSTEIN, Sherry R. A Ladder o f C i t i z e n P a r t i c i p a t i o n , American I n s t i t u t e o f P lanners J o u r n a l , J u l y , 1969. pp.216-224 BENDIX, R ichard and Seymour Mar t in L i p s e t , eds. C l a s s , S ta tus  and Power: S o c i a l S t r a t i f i c a t i o n i n the Comparative  Pe r spec t i v e . 2nd E d i t i o n , The Free P res s , New York. 1966 BURKE, Edmund M. C i t i z e n P a r t i c i p a t i o n S t r a t e g i e s . American I n s t i t u t e o f P lanners J o u r n a l , September, 1968. pp. 287-294 COHEN, Mark W. C i t i z e n P a r t i c i p a t i o n i n the Dec i s i o n - Making A c t i v i t i e s of Formal Soc i a l Se rv i ce Agenc ies: An Unreasonable Goa l . Community Mental Heal th J ou r na l , Volume 12(4) , 1976. pp. 355-364. ETZIONI, A m i t a i . The A c t i v e S o c i e t y : A Theory o f S o c i e t a l  and P o l i t i c a l P rocesses . The Free P r e s s , New York. 1968 FALUDI, Andreas, A Reader i n P lann ing Theory, Pergamon P ress , 1973. HOCHBAUM, G.M. Consumer P a r t i c i p a t i o n i n Hea l th P l ann ing : Toward Conceptual C l a r i f i c a t i o n . American Journa l o f Pub l i c Hea l th . -Volume 59, Number 9, September, 1969. pp. 1698-1705. HOLLAND, Winford E. and Har r i son H. Huntoon, The Eva lua t i on  o f Exper imental Soc i a l Se r v i c e De l i v e r y Systems at the  Community L e v e l : An Organ i za t i ona l E f f e c t i v ene s s View, Community Mental Hea l th J o u r n a l , Sp r i ng , Volume 10(1) , 1974. pp. 41-51. INGLIS, Gordon. G i v ing Community Development Back to the  Peop le , Canadian We l fa re , January - February, 1975. pp. 14-16 INSTITUTE FOR PARTICIPATORY PLANNING, C i t i z e n P a r t i c i p a t i o n  Handbook f o r Pub l i c O f f i c i a l s and Other P r o f e s s i ona l s  Se rv ing the P u b l i c . 3rd E d i t i o n , 1978. LASSWELL, Haro ld D., P o l i t i c s : Who Gets What, When, How. Peter Smi th , New York, 1950. - 114 -BIBLIOGRAPHY AND ADDITIONAL READINGS (Continued) NEUBER, Ke i t h e t a l , Needs Assessment; A Model f o r Community  P l ann ing . Gage P u b l i c a t i o n s , 1980. STEELE, M a r i l y n , C i t i z e n P a r t i c i p a t i o n i n the P l ann ing /  Eva lua t i on Process . Community Educat ion J o u r n a l , Ma r c h /Ap r i l , 1975. pp. 28-30. WARNER, Morton M. An Annotated B i b l i og r aphy o f Hea l th Care  Teamwork and Hea l th Centre Development. Department o f Hea l th Care and Epidemio logy, U n i v e r s i t y o f B r i t i s h Columbia. - n s -I I . FORT PROVIDENCE AND THE NORTHWEST TERRITORIES CAMERON, Agenes Deans. The New North . D.A. Appleton and Company, New York and London, 1912. CAMPBELL, M.E. The North West Company. New York, S t . Mar t ins P ress . 1957. COHEN, Ronald. An An th ropo log i ca l Survey of Communities  i n the MacKenzie S lave Lake Region o f Canada. 1962. COOKE, A lan and C l i v e Ho l l and . The Exp l o r a t i on o f Northern  Canada 500 to 1920, A Chronology. The A r c t i c H i s t o r y P res s , Toronto. 1979. COUES, ELLIOTT, ed. The Manuscr ipt Journa l s o f A lexander  Henry and David Thompson, 1799-1814. M inneapo l i s , Ross and Ha ines, Inc . 1897. DAVIDSON, G.D. The North West Company. Be rke ley , U n i v e r s i t y o f C a l i f o r n i a P ress . 1918. DUCHAUSSOIS, Reverend P. , O .M. I . Mid Snow and I ce , The  Apos t l e s o f the North-West. Burns Oates and Washbourne L t d . London. 1923 EPP Henry T. and Tim Hones. The Methy Portage - Proposal  f o r a Saskatchewan H i s t o r i c and Nature T r a i l . The Blue Jay 27(2 ) : 101-107. 1969^ FLEMING, R .H . , ed. Minutes o f C o u n c i l , Northern Department  o f Ruperts Land, 1921-31. Toronto , The Champlain Soc i e t y . 1940. FRANKLIN, John. Na r r a t i v e o f a Journey to the Shores o f  the Po l a r Sea in 1819-20 21 22, Volume 1. London, John Murray. 1924 (1823). FUMOLEAU, Rene, As Long As Th is Land Sha l l Las t . McC le l l and and Stewar t , L im i t ed . HUME, Ivor Noe l , H i s t o r i c a l Archaeology. New York, A l f r e d A. Knopf. 1969. INNIS, H.A. The Fur Trade i n Canada. Forge V i l l a g e , The Murray P r i n t i n g Co. 1967 (930) . - 116 -I I . FOR PROVIDENCE AND THE NORTHWEST TERRITORIES INNIS, H.A. Pe te r Pond, The Fur Trade and .'Adventurer. Toronto , I rwin and Gordon, L t d . 1930. JENNESS, Diamond. Indians o f Canada. Ottawa, The Queen's P r i n t e r , 1963. KUPSCH, W.O., comp. Set t lements o f the Northwest T e r r i t o r i e s . 1966. LANGDON, John E. Canadian S i l v e r sm i t h s and The i r Trade Marks, 1667 - 1867. Lunenburg, S t inehour P re s s . 1960. LYALL, E r n i e , An A r c t i c Man: S i x t y - F i v e Years i n Canada's Nor th , Hu r t i g P u b l i s h e r s , Edmonton, 1979. McDONALD, T .H . ( e d i t o r ) ; Exp l o r i ng the Northwest T e r r i t o r y , S i r A lexander Mackenz ie ' s Journa l o f a Voyage by Bark Canoe from Lake Athabasca to the P a c i f i c Ocean i n the Summer o f 1789. U n i v e r s i t y o f Oklahoma P r e s s , Norman. 1966. MACKENSIE, A lexander . Voyages from Montreal through the Cont inent o f North America to the Frozen and P a c i f i c Oceans i n the Years 1789 and 1793. New York, G.F. Hopkins, 1802. MacNEISH, H.H. and D. Damas. The Contact - T r a d i t i o n a l A l l - N a t i v e Community o f the Canadian No r th : The Upper Mackenzie "Bush" Athapaskans and the I gu l i gm iu t . An th ropo log i ca 1963. V o l . 5 , no. 1, p .9 -21 . MORSE, E r i c W., Fur Trade Canoe Routes of Canada - Then and Now. The Queen's P r i n t e r . 1969. MORTON, A . S . , A H i s t o r y o f the Canadian West to 1870-71. London, Thomas Nelson and Sons, L t d . 1939. PEARSON, R., Set t lement Pa t te rns and Suba r c t i c Development: the South Mackenz ie , Northwest T e r r i t o r i e s . (Anthropo log i ca 1971. v . 13, no. 1/2, p.255-270, maps, t a b l e s ) . RAE, George R., The Sett lements of the Great S lave Lake F r o n t i e r , N.W.T., From the 18th to 20th Cen tu r i e s . Ann A rbo r , U n i v e r s i t y M i c r o f i l m s , Inc . 1963. RICH, E .E . , The H i s t o r y o f the Hudson's Bay Company, 1670-1870 Volume I I , 1763-1870. London, The Hudson's Bay Record S o c i e t y . 1959. - 1 1 7 -I I . FORT PROVIDENCE AND THE NORTHWEST TERRITORIES RICH, E . E . , The Fur Trade and the Northwest to 1857. Toronto , McC le l l and and Steward, L t d . 1967. ROBINSON, M . J . and J . L . E xp l o r a t i o n and Set t lement o f Mackenzie D i s t r i c t , N.W.T. Canadian Geographica l Journa l 32:246-255. 1946. ROBINSON, M. J . and J . L . E xp l o r a t i on and Set t lement o f Mackenzie D i s t r i c t , N.W.T. Canadian Geographica l Journa l 33:43-49. 1946. VOORHIS, E rnes t . H i s t o r i c For t s and Trad ing Posts o f the French Regime, and o f the Eng l i sh Fur Trad ing Companies. Ottawa. 1930. WADE, Mark S . , Mackenzie o f Canada. London, W. Blackwood and Sons. 1927. WAGNER, H.R., Peter Pond, Fur Trader and E xp l o r e r , New Haven, Ya le U n i v e r s i t y P re s s . 1955. WOODWARD, A r t h u r . , Ind ian Trade Goods. P o r t l a n d , B in fo rds and Mor t . 1967. W00LLAC0TT, A . P . , Mackenzie and His Voyageurs by Canoe to the A r c t i c and the P a c i f i c , 1789-93. London, Dent and Sons. 1927. ZASLOW, M o r r i s . The Opening o f the Canadian No r th , 1870-1914. The Canadian Centenary S e r i e s , McC le l l and and S tewar t , L i m i t e d . Toronto and Mon t r ea l . 1971. - 118 -I I I . SERVICES AND.FACILITIES FOR THE ELDERLY BERT, Robert L. e t a l , Assess ing the Heal th Care Needs o f  the Aged. Heal th Se rv i ces Research, Sp r i n g , 1970. pp. 39-59. BLENKNER, Margaret et a l , S e r v i c i n g the Ag ing: An Experiment  i n So c i a l Work and Pub l i c Hea l th Nu r s i ng . Community Serv i ces Soc i e t y o f New York, March, 1964. BLYTHE, Rona ld , The View i n Winter : R e f l e c t i o n s on Old Age, Harcourt Brace Jovanov i ch , New York and London, 1979. BRODY, E l a i ne M. et a l , A So c i a l Work Guide f o r Long-Term Care  F a c i l i t i e s , U.S. Department o f Hea l t h , Educat ion and We l fa re . 1976 The Canadian Counc i l on So c i a l Development, Beyond She ! t e r : A Study o f N.H.A. F inanced Housing f o r the E l d e r l y . 1973 Housing the E l d e r l y . 1976 Re s i den t i a l and Community Se rv i ces f o r Old Peop le . 1975 Canada Mortgage and Housing Co rpo ra t i on , Nurs ing Homes and Hoste l s  w i th Care Se rv i ces f o r the E l d e r l y : Design Gu i d e l i n e s . 1979 COOMBS, John, Cdmmunity Suppor t ive Hea l th : Rebu i l d ing the Tota l  Hea l th o f Ind ian Communities, unpubl ished paper, March, 1979 EHRLICH, I ra A . , A Se rv i ce De l i v e r y Model f o r the Aged a t the  Communal L e v e l , The Ge r on t o l o g i s t , June, 1974. pp. 241-244 Government o f Saskatchewan, Report o f the J o i n t M i n i s t e r i a l Task  Force on Se rv i ces f o r Sen ior C i t i z e n s i n Saskatoon and Rural  Community. August , 1978. Government o f the Yukon T e r r i t o r y , Beyond S i x t y : A Report on Yukon's  E l d e r l y . 1976. Heal th and We l fa re , Canada. Hea l th Se rv i ces f o r the E l d e r l y , The F i na l Report o f a Working Group of the Federal P r o v i n c i a l Adv i so ry Committee on Community Hea l t h , August , 1976. KATZ, S idney , e t a l , S tud ies o f I l l n e s s i n the Aged: The Index o f  ADL: A S tandar i zed Measure of B i o l o g i c a l and Psychosoc ia l Func t i on , Journa l o f American Medical A s s o c i a t i o n , 21 September, 1963. pp. 914-919. LAWTON, M. Powe l l , The Func t iona l Assessment o f E l d e r l y Peop le , Journa l o f American G e r i a t r i c s S o c i e t y , Volume XIX, Number 6 , June, 1971. pp. 465-481. - 119 -I I I . SERVICES AND FACILITIES FOR THE ELDERLY (Continued) LEWIS, S teven , An Assessment o f the Need f o r Community Hea l th  Se rv i ce s Among the E l d e r l y i n the P r i n ce Albert, Hea l th Reg ion , Research and P lann ing Branch, Department o f Hea l t h , Government o f Saskatchewan, October , 1975. LIPMAN, A lan and Robert S l a t e r , Homes f o r Old Peop le: Towards a P o s i t i v e Environment. The Ge r on t o l o g i s t , Volume 17, Number 2, 1977. pp. 146-156. McPHEE, Margaret , Hea l th Care o r Hea l t h : The Development o f a  P lan to Address the Hea l th Needs o f the E l d e r l y i n B r i t i s h  Columbia^ D i v i s i o n of Hea l th Se rv i ce s Research and Development, U n i v e r s i t y o f B r i t i s h Columbia, March, 1977. RENGERS, Rosemary, Design and So c i a l P lann ing in Housing f o r the  E l d e r l y , 1975 - 1977; An Annotated B i b l i o g r aphy . Vance B i b l i o g r a p h i e s , P.O. Box 229, M o n t i c e l l o , I l l i n o i s , 61856 September, 1978. SIMPSON, Ida Harper and John C. McKinney, (eds) Soc i a l Aspects  o f Ag ing , Duke U n i v e r s i t y P r e s s , 1966. 

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