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Planning for British Columbia’s aging population : information, paradigms, and strategies Campbell, Alan Glen 1982

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PLANNING FOR BRITISH COLUMBIA'S AGING POPULATION: INFORMATION, PARADIGMS, AND STRATEGIES by ALAN GLEN CAMPBELL B. Math. The University of Waterloo, 1970 M.S.W. The University of Toronto, 1976 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF' THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in THE FACULTY OF GRADUATE STUDIES (Department of Health Care and Epidemiology) Health Services Planning Program) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA May 1982 cJ Alan Glen Campbell, 1982 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 of the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree th 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 reference and study. I f u r t h e r agree t h a t permission 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 granted by the head of 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 th a t copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed'without my w r i t t e n permission. Department of Health Care and Epidemiology The U n i v e r s i t y of B r i t i s h Columbia 2075 Wesbrook Place Vancouver, Canada V6T 1W5 Date A p r i l 1, 1982 DE-6 (2/79) i i ABSTRACT Planners f o r B r i t i s h Columbia's aging population are beginning to con-template the d i f f i c u l t problem of ensuring the future adequacy of supportive programs for the e l d e r l y i n the key areas of health, income, and housing. It now appears that these programs may well be squeezed between increased demand r e s u l t i n g from a rapid r i s e projected i n the number and proportion of older people early i n the next century, and lower rates of p r o v i n c i a l and na-t i o n a l growth foreseen by most economists. This d e s c r i p t i v e study draws on available relevant information (much of i t included i n tables, f i g u r e s , and appendices) to explore the problem from i t s o r i g i n s i n previous p o l i c y deve-lopment to the s i t u a t i o n at the present time. From t h i s perspective the im-p l i c a t i o n s of current demographic, economic, and p o l i t i c a l / b u r e a u c r a t i c . trends f o r programs f o r the e l d e r l y are assessed i n both the national and i n t e r n a t i o n a l contexts. After a consideration of the r o l e s of philosophy and ideology i n s o c i a l theory, a wide range of s o c i a l gerontological theories are examined using a s o c i o l o g i c a l scheme which c l a s s i f i e s them according to four major paradigms i n order to determine t h e i r a b i l i t i e s to describe accurately the information presented, and to prescribe useful p o l i c y a l t e r n a t i v e s . It i s concluded that a t h e o r e t i c a l approach which advocates r a d i c a l change from.a s t r u c t u r a l pers-pective i s both most v a l i d and most productive as a paradigm f o r planning f o r the aging population. A d e s c r i p t i o n of the r e l a t i o n s h i p of planning to s o c i a l change, and a systems analysis of the process of p u b l i c p o l i c y making together introduce a discussion of s t r a t e g i e s based upon the selected plan-ning paradigm. Once the approaches used i n planning f o r the e l d e r l y i n the past are c r i t i c a l l y reviewed, the o u t l i n e of a r a d i c a l s t r u c t u r a l plan f o r the aging population i s described, and then a strategy f o r i t s implementation over the next two or three decades i s presented. The report concludes with a b r i e f summary, and a number of s p e c i f i c recommendations f o r action by the appropriate p u b l i c a u t h o r i t i e s , including several suggestions f o r enhancing the capacity f o r p o l i c y and program re-search i n t h i s f i e l d . One important recommendation i s f o r the early esta-blishment i n B r i t i s h Columbia of an inter-departmental agency on aging to co-ordinate information and planning f o r the province's e l d e r l y . i v TABLE OF CONTENTS ABSTRACT i i LIST OF TABLES v i i LIST OF FIGURES v i i i ACKNOWLEDGEMENTS x CHAPTER 1 INTRODUCTION 1 1.1 Research Focus 1 1.1.1 Problem 1 1.1.2 Purpose 2 1.1.3 Context 3 1.1.4 Question 3 1.2 Research Design 3 1.2.1 Methodology 3 1.2.2 Scope and Limitations 4 1.2.3 Format. 4 CHAPTER 2 INFORMATION 7 2.1. H i s t o r i c a l Development of Programs f o r the E l d e r l y 7 2.1.1 Federal and P r o v i n c i a l Roles 7 2.1.2 Federal Program Developments 9 2.1.2.1 Health 9 2.1.2.2 Income 11 2.1.2.3 Housing 14 2.1.3 B r i t i s h Columbia Program Developments 15 2.1.3.1 Health 15 2.1.3.2 Income 18 2.1.3.3 Housing 20 2.1.4 Roles of the Municipal and Voluntary Sectors 22 2.2 Current Status of Programs i n B r i t i s h Columbia 23 2.2.1 Health 23 2.2.2 Income. 26 2.2.3 Housing 27 2.2.4 U t i l i z a t i o n 28 2.2.5 Adequacy 30 V 2.3 Future Trends A f f e c t i n g Programs f o r the E l d e r l y 36 2.3.1 Limitations 36 2.3.2 Demographic Trends 38 2.3.3 Economic Trends 52 2.3.4 P o l i t i c a l / B u r e a u c r a t i c Trends 55 2.3.5 Implications f o r the Programs. 59 2.4 The International Context 67 2.4.1 Canada's Elders. 67 2.4.1.1 The United Kingdom 70 2.4.1.2 The Federal Republic of Germany 75 2.4.2 Canada's Peers 77 2.4.2.1 The United States 78 2.4.2.2 Yugoslavia 80 2.4.3 Understanding So c i a l Development 83 2.5 The Problem of Data 84 CHAPTER 3 PARADIGMS • 86 3.1 Values, Philosophies, and Ideologies.. 86 3.1.1 D e f i n i t i o n s and Concepts 87 3.1.2 P o l i t i c a l and So c i a l Ideologies 89 3.1.3 Bar r i e r s to So c i a l Analysis 94 3.2 A Meta-Paradigm f o r S o c i a l Theory 94 3.2.1 The Subjective-Objective Dimension 95 3.2.2 The Regulation-Radical Change Dimension 99 3.2.3 Four S o c i o l o g i c a l Paradigms 102 3.3 Mapping So c i a l Gerontological Theory 112 3.3.1 F u n c t i o n a l i s t S o c i a l Gerontology 112 3.3.2 Interpretive S o c i a l Gerontology 117 3.3.3 Radical Humanism 120 3.3.4 Radical Structuralism 122 CHAPTER 4 STRATEGIES 131 4.1 Change Theory and Practice 131 4.1.1 Planning and Change 131 4.1.2 Public P o l i c y Making: A Systems Perspective 133 v i 4.2 Planning Strategies f o r an Aging Population 140 4.2.1 Strategies f o r the E l d e r l y i n Retrospect 141 4.2.2 The Elements of a Radical Plan 143 4.2.3 A Strategy f o r Implementation 148 CHAPTER 5 CONCLUSION 154 5.1 Summary 154 5.2 Recommendations . 155 NOTES 159 APPENDICES 1. D e t a i l s of Program Conditions f o r OAS/GIS/SPA 169 2. Details of Program Conditions f o r CPP/QPP 171 3. Details of Tax Exemptions and Deductions 173 4. Current U t i l i z a t i o n of Programs f o r the E l d e r l y i n B.C.. 174 5. Comparison of S t a t i s t i c s Canada, CCSD and Senate Committee Poverty Lines, 1981 Estimates 191 6. Al t e r n a t i v e Population and Labour Force Projections: The Underlying Assumptions 192 7. Assumptions Underlying B r i t i s h Columbia Population Projection 10/80 196 8. The Canadian Charter of Rights and Freedoms: Equality Rights 201 9. E l d e r l y Program Expenditure Projection Methodology 202 10. Pensions i n Canada 206 11. Data on the E l d e r l y i n B r i t i s h Columbia.. 216 BIBLIOGRAPHY 221 v i i LIST OF TABLES l'y.lH The Organization of the Report 5 2.1' Canadian Population Projections by Age :•' 41 2.2 Projected Dependency Ratios i n Canada 44 2.3 Projected B r i t i s h Columbia Population by Age, 1980-2001 46 2.4 Projected Population 65 and Over, and Total Population, B r i t i s h Columbia, 1981-2031 47 2.5 Projected E l d e r l y Dependency Ratios, B r i t i s h Columbia, 1981-2001 48 2.6 - Assumptions of Labour Force P a r t i c i p a t i o n Rates, by Age and by Sex, Canada, 1981 and 1991 53 2.7 Projected Labour Force, Canada, 1976 to 2051 54 2.8;' Projected Expenditures on Current Programs: Implications of the Changing Age Structure 60 2/9... Projected Number of F a c i l i t y C l i e n t s Over Age 65 Based on P r o v i n c i a l U t i l i z a t i o n Rates of A p r i l , 1981 (E.C.U's i : Included) 63 2.10 Projected Number of Homemaker and Adult Day Care C l i e n t s Over Age 65 Based on P r o v i n c i a l U t i l i z a t i o n Rates of A p r i l , 1981 64 2.11 The E l d e r l y as a Percentage of Total Population i n Ontario, B.C., and Canada: 1986 and 2001 68 2.12 Percentage of Population Aged 65 Years and Over, Selected Countries, 1980 69 2.13 Percentage of Population Aged 65 Years and Over, Selected Countries, 1950-2050 71 2.14 Some Aspects of Community-Based Provision, UK, 1973 and 1976. 73 , 2.15 A Summary of the Main Forms of Long-Term I n s t i t u t i o n a l Care.. 74 3.1 Philosophy and Ideology i n So c i a l Theory 92 3.2 The Regulation - Radical Change Dimension 101 v i i i LIST OF FIGURES 2.1 Median Income of the E l d e r l y and of A l l Canadians, 1980 i 31 2.2 Disposible Incomes of Couples Age 57-62 and Age 67-72, by Decile, 1979 32 2.3 Percent of Old Age Security Recipients i n Each Province Also Receiving Guaranteed Income Supplement, August, 1981... 33 2.4 Old Age Security/Guaranteed Income Supplement, 1981 35 2.5 B i r t h Rates, Canada, 1901 to 2031 39 2.6 Canadian Population Projections by Age 42 2.7 Projected Dependency Ratios i n Canada 45 2.8 Population Age D i s t r i b u t i o n f o r B r i t i s h Columbia Estimated and Projected: 1951-2011 49 2.9 Comparison of B r i t i s h Columbia Dependency Ratios Estimated and Projected: 1951-2001 50 2.10 Projected Population 65 and Over, and Total Population, B r i t i s h Columbia, 1981-2031. 51 2.11 Projected Number of F a c i l i t y C l i e n t s Over Age 65 Based on P r o v i n c i a l U t i l i z a t i o n Rates of A p r i l , 1981 (E.C.U's Included) 65 2.12 Projected Number of Homemaker and Adult Day Care C l i e n t s Over Age 65 Based on P r o v i n c i a l U t i l i z a t i o n Rates of A p r i l , 1981 66 3.1 Paradigm Showing Stages in' the Process of Translating S o c i a l Philosophies into S o c i a l Services 88 3.2 Distinguishing Features of P o l i t i c a l Ideologies 91 3.3 The Subjective - Objective Dimension 96 3.4 Four Paradigms f o r the Analysis of S o c i a l Theory 103 3.5 I n t e l l e c t u a l Influences upon the F u n c t i o n a l i s t Paradigm 106 •3.6 The Four S o c i o l o g i c a l Paradigms 107 3.7 Some Possible Types of Systems Models 109 3.8 A Map of S o c i a l Gerontological Theory 113 3.9 S o c i a l Gerontological Paradigms by t h e i r A b i l i t y to Describe and Prescribe 124 4.1 Systems Model of the P o l i c y Process 134 4.2 Amended Systems Model of the Pol i c y Process 136 4.3 Public P o l i c y Flow Model 137 4.4 Planning Strategies f o r the E l d e r l y i n Retrospect 142 "4.5 The Sequence of Planning Strategies i n Po l i c y Development.. 150 4.6 A Strategic Timetable.for Planning f o r B.C.'s Aging. Population. 152 X ACKNOWLEDGEMENTS The opportunity for me to complete the Health Services Planning Program at the University of B r i t i s h Columbia was provided by the Minis t r y of Health which granted me educational leave from 1980 to 1982 f o r t h i s purpose. This thesis has benefitted g r e a t l y from the he l p f u l involvement of my readers, Mary H i l l (Social Work) and John Milsum (Health Systems), and e s p e c i a l l y that of my advisor, Anne Crichton (Health Care and Epidemiology), a l l of the University of B r i t i s h Columbia. I would also l i k e to acknowledge the fi n e work of Germaine Dore i n typing the report, and the toler a n t support of my wife Catriona despite her preoccupation with a f a r more s i g n i f i c a n t creative endeavour. Acknowledgements of permissions to reproduce are made following the source reference for each of the tables, f i g u r e s , and appendices i n question. 1 1. INTRODUCTION : This introductory chapter describes both the focus of the present study, and the nature of i t s design. 1.1 RESEARCH FOCUS In t h i s section the general problem i s outlined, the purpose and con-text of the study are described, and the research question to be addressed i s stated. 1.1.1 Problem Planning f o r the e l d e r l y 1 i n B r i t i s h . Columbia i s presently at a major turning point. The d i r e c t i o n taken at t h i s juncture could well determine the shape of p o l i c y f o r the aged, and indeed much of s o c i a l p o l i c y , f o r de-cades to come. The problem which p u b l i c policy-makers are now wrestling with i s b a s i c a l l y t h i s : How can the l e v e l s of -health-care, income security, housing and other s o c i a l programs and services of special importance f o r today's e l d e r l y 2 be increased or even maintained when a l l recent projections indicate both a rapid increase i n the proportion of older people, and a slower rate of economic growth? Those responsible f o r planning the f i s c a l , i n s t i t u t i o n a l , and human resource : requirements involved can take l i t t l e comfort i n the f a c t that most of the demographic s h i f t i s expected to occur a f t e r the turn of the century since the lead-times necessary f o r r a t i o n a l pension and health service planning are s u b s t a n t i a l . Moreover the current economic recession has demonstrated that even present l e v e l s of s o c i a l programs may not be assured when trade-o f f s must be made i n the p o l i t i c a l arena. The anticipated squeeze between escalating demand and d e c l i n i n g a b i l i -t y to supply promises to be so intense that p o l i c y a l t e r n a t i v e s thought 2 r a d i c a l only a decade ago are now under consideration. The opposing approaches of considerable " r e - p r i v a t i z a t i o n " , and substantial additional s o c i a l i z a t i o n of programs for the e l d e r l y each have t h e i r vocal exponents i n B r i t i s h Columbia, a province i n which almost every debate seems to be coloured by e x i s t i n g p o l i t i c a l p o l a r i t i e s . This study has been motivated i n part by the b e l i e f that the best planning decisions are those based on a wide range of data and analysis. 1.1.2 Purpose This study seeks to inform the debate over planning f o r the e l d e r l y by laying out a base of information concerning programs for the aged. Past development, present experience, and future trends r e l a t i n g to ser-vices f o r the e l d e r l y ' i n B r i t i s h Columbia are a l l considered i n the context of the Canadian and i n t e r n a t i o n a l s i t u a t i o n . This information i s analyzed using a v a r i e t y of s o c i a l t h e o r e t i c a l frameworks i n order to a r r i v e at an optimum planning strategy including s p e c i f i c p o l i c y recommendations f o r p r o v i n c i a l and federal a u t h o r i t i e s . 1.1.3 Context Since the e l d e r l y , a f t e r a l l , are only a s p e c i a l subset of the general population, ;-.their problems must ne c e s s a r i l y be considered i n the context of the s o c i a l , economic, and p o l i t i c a l r e a l i t i e s that are modern society. Any attempt to develop a plan f o r the e l d e r l y , then, must come to terms with the complexities of the s o c i a l policy-making environment, and of the aged themselves as a group. In so doing one must r e l a t e empirical material from Demography and Economics to t h e o r e t i c a l frameworks developed i n Socio-logy and S o c i a l Gerontology, and consider the p h i l o s o p h i c a l and p r a c t i c a l issues r a i s e d by those i n the f i e l d s of Public Administration and Planning. This i n t e r d i s c i p l i n a r y approach, while cumbersome and demanding, eventually y i e l d s an analysis that can be both comprehensive and powerful. 1.1.4 Question The research question to be addressed i n t h i s study, i s : What are the main elements of a plan to ensure the adequacy of health, income security, housing and s o c i a l service p o l i c y f o r B r i t i s h Columbia's e l d e r l y i n the early part of the next century? ^The e l d e r l y w i l l be considered as those aged 65 or over, and the planning horizon w i l l be taken as the year 2031, f i f t y years from now. 1.2 RESEARCH DESIGN Once the focus of research has been delineated, the way i n which the inv e s t i g a t i o n i s to proceed must be chosen from a v a r i e t y of possible re-search designs. This section discusses the study's methodology, scope, and l i m i t a t i o n , and outlines the format of the report as a whole. 1.2.1 Methodology This i s a d e s c r i p t i v e study that u t i l i z e s data from a v a i l a b l e catalo-gued documents, as well as information derived from mail enquiries, and personal interviews. There i s an urgent need f o r more o r i g i n a l s t a t i s t i -c a l research on the aging population but the paucity of su i t a b l e data made i t impossible to include such an approach i n t h i s study. Suggestions are made f o r the improvement of e x i s t i n g data to enable such analyses to be made i n future. 4 1.2.2 Scope and Limitations The study surveys the problems of B r i t i s h Columbia's e l d e r l y i n the context of those i n Canada as a whole, and i n selected foreign nations to o f f e r useful comparisons. While h i s t o r i c a l developments are traced through-out t h i s century, the emphasis i s on the period a f t e r World War I I , and, p a r t i c u l a r l y , on the l a s t two decades. This sets the stage for an exami-nation of the current status of programs f o r the e l d e r l y i n B r i t i s h Colum-bi a i n terms of b e n e f i t s , u t i l i z a t i o n , and adequacy. Demographic projec-tions and other trends well into the next century are considered, although the uncertainty of forecasts i n general, and of those extending as f a r as f i f t y years ahead i n p a r t i c u l a r , constitutes the p r i n c i p a l l i m i t a t i o n to the study. Notwithstanding t h i s uncertainty, planners must now consider the possible extreme scenarios f o r the aged f a r i n advance simply because the s o c i a l , economic, and p o l i t i c a l implications are so enormous. 1.2.3 Format The completion of t h i s study has involved formulating answers to f i v e basic questions, each of which constitutes a chapter i n t h i s report as shown i n Table 1.1. The f i r s t step involves i d e n t i f y i n g the problem f o r study, and posing a re l a t e d research question. These and other p r e l i m i -nary matters are covered i n t h i s introductory chapter. Following the structure implied i n the report t i t l e , the next three chapters set out an information base f o r planning f o r B r i t i s h Columbia's aging population (Chapter 2), evaluate the explanatory power with respect to t h i s material of a number of a n a l y t i c a l paradigms (Chapter 3), and, based upon the best of these, formulate a planning strategy intended to ensure the adequacy of programs f o r the e l d e r l y i n the years ahead (Chapter 4). The relevant l i t e r a t u r e i s reviewed as part of the analysis i n each of the three chap-5 TABLE 1.1 THE ORGANIZATION OF THE REPORT Chapter Question to be Addressed 1. Introduction What i s the task? 2. Information What are the "facts"? 3. Paradigms How can these best be understood? 4. Strategies What action does t h i s suggest? 5. Conclusion What i s the plan? t e r s . The f i n a l chapter summarizes the conclusions of the study, and makes a number of recommendations f o r consideration by those responsible f o r planning f o r the province's future senior c i t i z e n s . Lengthy tabular presentations, or those of i n t e r e s t to only a few readers are attached as appendices, while others are included i n the text-; notes follow the f i n a l chapter. INFORMATION This chapter explores the data a v a i l a b l e f o r planning taking into account the h i s t o r i c a l development of programs f o r the e l d e r l y , t h e i r current status i n the province, future trends a f f e c t i n g them, and the experience of other selected countries. Suggestions are also made for the improvement of e x i s t i n g data sources r e l a t i n g to the aged i n B r i t i s h Columbia to permit more empirical research i n future. 1 HISTORICAL DEVELOPMENT OF PROGRAMS FOR THE ELDERLY This section reviews program development at the federal and provin-c i a l l e v e l s , ^ a f t e r noting the s h i f t i n g r o l e s played by each l e v e l of government over the years, and summarizes b r i e f l y the involvement of the municipal and voluntary sectors i n service p r o v i s i o n . 1.1 Federal and P r o v i n c i a l Roles No account of s o c i a l program development i n Canada can ignore the e f f e c t s of the d i f f e r i n g r o l e s played over the years by the two senior lev e l s of government. There i s l i t t l e doubt that Canada's fathers of Confederation intended to create a strong federal state, with r e l a t i v e l y weak p r o v i n c i a l bodies. 2 Most important powers (economic, secu r i t y , and residual) were accorded to the federal government under the British North America (BNA) Act, while duties seen as l o c a l and minor (education, health, and s o c i a l services) were assigned to the provinces.^ I r o n i c a l l y , many provinces now exercise considerable p o l i t i c a l and economic power by v i r -tue- of t h e i r control over important natural resources.underestimated or unknown i n the l a s t century. At the same time the human services, seen as i n s i g n i f i c a n t i n 1867, have become e a s i l y the largest budget item of a l l governments today. The i n a b i l i t y of most provinces to cope with the 8 cost of health and welfare programs, e s p e c i a l l y during the Depression years, helped to expand f e d e r a l / p r o v i n c i a l cost-sharing agreements. In t h i s way the federal government assumed a growing r o l e i n the design and opera-t i o n of many health and s o c i a l programs.4 There has been a s h i f t , then, i n the roles played by these two le v e l s of government i n Canada i n developing the s o c i a l programs of which those f o r the e l d e r l y form a part. This s h i f t derives p a r t l y from the changing economic and s o c i a l r e a l i t i e s alluded to above, and p a r t l y from emerging p o l i t i c a l philosophies at each l e v e l . The federal government's, early preoccupation with f o s t e r i n g economic growth i s now shared by most pro-vinces concerned with developing regional i n d u s t r i e s . At the same time the senior government has increasingly taken the lead i n es t a b l i s h i n g s o c i a l programs by intergovernmental agreement across the country (e.g. ho s p i t a l and medical insurance), although the pioneering r o l e of Saskat-chewan has provided a consistent spur to federal e f f o r t s i n t h i s regard. The growing influence of the federal government i n s o c i a l program development has had a r e l a t i v e l y greater impact on provinces l i k e B r i -t i s h Columbia which have f a i r l y s t e a d i l y followed a conservative u t i l i t a -r i a n philosophy i n t h i s regard. The l i b e r a l welfare state philosophy of the national government has led to the development of programs f o r the e l d e r l y i n t h i s province that, arguably might not have occurred otherwise. A case i n point to be considered l a t e r i s the highly successful Long-Term Care Program. In the sections that follow, the development of programs fo r the aged i s considered at both the federal and p r o v i n c i a l l e v e l s . 9 2.1.2 Federal Program Developments Developments at the federal l e v e l concerning programs f o r the elder-l y w i l l be considered below i n each of the areas of health, income, and housing. 2.1.2.1 Health Although the national L i b e r a l Party was on record as committed to health insurance as early as 1919,5 there was l i t t l e concrete federal action u n t i l the h i s t o r i c 1945 Federal-Provincial Conference on Post-War Reconstruction. Basing i t s proposals on the innovative Heagerty Report (1943), 6 the senior government offered to pay 60% of the estimated costs of p r o v i n c i a l programs of medical, h o s p i t a l , dental, pharmaceutical, and nursing b e n e f i t s , i n exchange f o r tax concessions from the provinces. When t h i s was rejected, the federal government u n i l a t e r a l l y introduced a National Health Grants Program i n 1948 to assist the provinces i n ex-tending and improving p u b l i c health and h o s p i t a l services. Grants were made available f o r h o s p i t a l construction, health surveys, professional t r a i n i n g , p u b l i c health research, general p u b l i c health, mental health, c r i p p l e d c h i l d r e n , and the control of tuberculosis, cancer, and venereal disease. The stimulus to i n s t i t u t i o n a l acute health care provided by these grants, and e s p e c i a l l y by the Hospital Insurance and Diagnostic Services (HIDS) Act of 1957 was to skew health care organization i n Cana-da r i g h t up to the present time with important implications f o r the care of the country's aging population. Under the HIDS Act the federal govern-ment agreed to pay h a l f the cost of in-patient and out-patient services provided i n active treatment, convalescent, chronic and r e h a b i l i t a t i o n h o s p i t a l s i n provinces whose schemes conformed to the federal standards of u n i v e r s a l i t y , uniformity, and p o r t a b i l i t y . Nursing homes and home 10 care programs were excluded from coverage under t h i s agreement. By 1961 a l l provinces had accepted the federal o f f e r and Canada's national hospi-t a l insurance program was i n place. Following the H a l l Commission Report (1964)7 the federal government passed the Medical Care Act i n 1966 p r o v i -ding f o r matching funds f o r services rendered or di r e c t e d by physicians under p r o v i n c i a l plans that were comprehensive, u n i v e r s a l , portable, and under p u b l i c non-profit administration. As McPhee has pointed out, how-ever, none of these programs was aimed s p e c i f i c a l l y at the aging popula-t i o n since t h i s appears to have been seen as a problem f o r consideration at some future time.^ The o v e r a l l emphasis was c l e a r l y on cure, and not care. Several federal reports i n the early 1970's reviewing the organiza-t i o n and effectiveness of health programs drew attention to t h i s imba-lance between cure and care, and made recommendations concerning the spe c i a l health needs of the e l d e r l y among others. The Report of the Task Force on the Costs of Health Care (1969)9 suggested that more e f f o r t should be made to define the needs of older people, and evaluate programs fo r them. The Community Health Centre in Canada (1972-73)10 viewed the aged as a group i n special need of innovative, problem-oriented approaches to service d e l i v e r y , and advocated day and home care services. A New Perspective on the Health of Canadians (1974)H emphasized i n d i v i d u a l r e s p o n s i b i l i t y f o r health, and mentioned the e l d e r l y as one of the groups under-serviced as a r e s u l t of the system's preoccupation with cure. At l a s t i n 1977 the Federal-Provincial Fiscal Arrangements and Esta-blished Programs Financing (EPFA) Act ended the former cost-sharing arrangements f o r health-.:and other services and introduced block-funding i n t h e i r place. Designed to enhance f i s c a l a c c o u n t a b i l i t y and p r o v i n c i a l program f l e x i b i l i t y the EPFA agreement resulted i n the establishment of an Extended Health Care Program under which the federal government would 11 cover nursing home intermediate care, adult r e s i d e n t i a l care,converted mental h o s p i t a l s , home care, and ambulatory health care to a s p e c i f i e d per c a p i t a maximum. This program was s p e c i f i c a l l y aimed at the growing number of e l d e r l y people for whom the e x i s t i n g acute-care i n s t i t u t i o n a l health system was often inappropriate. However, despite these changes, a l l was not well with Canada's health system. Continuing cost pressures on the federal government gave r i s e to a review of health services by Ju s t i c e Emmett H a l l , Canada's National-Pro-vincial Health Program for 1980 's (1980),12 a n ^ to the report of the Parliamentary Task Force on Federal-Provincial F i s c a l Arrangements, Fis-cal Federalism in Canada (1981).13 Both these documents acknowledged the serious challenge to the e x i s t i n g health system posed by an aging population, and recommended the expansion of alt e r n a t i v e s to i n s t i t u t i o n -a l health services under the Extended Health Care Program. The federal budget of November 1981 indicated Ottawa's inte n t i o n to reduce s i g n i f i -c a l l y t r a n s f e r s to the provinces under the EPFA Act over the five-year period 1982-87, and p r o v i n c i a l protests appear so f a r to have made l i t t l e impact on t h i s resolve. Federal leadership i n health service develop-ment appears to be waning at p r e c i s e l y the time when major r e s t r u c t u r i n g seems necessary i f the system i s to cope with the increasing number of older people expected i n the years ahead. 2.1.2.2 Income At the beginning of the century trade unionists i n Canada were pres-sing f o r p u b l i c pensions l i k e those adopted i n Germany (1889), Denmark (1891), New Zealand (1898), A u s t r a l i a (1901, 1908), and Great B r i t a i n (1908).14 Instead, the federal government i n i t i a t e d a system of govern-ment annuities i n 1908 which, l i k e the priv a t e insurance companies' coun-12 t e r p a r t s , induced only a t i n y f r a c t i o n of the population to plan for t h e i r own future f i n a n c i a l s e c u r i t y . Though the notion of pub l i c pensions was debated before and a f t e r World War I, i t was not u n t i l 1927 that the f e -deral government passed the Old Age Pension (OAF) Act. This Act Pro-vided f o r federal sharing of the costs of pension payments to needy i n d i -viduals over the age of 70 i n provinces p a r t i c i p a t i n g i n the plan. After the catastrophic events of the 1930's (the Great Depression) and early 1940's (World War 2) there was wide pu b l i c support i n Canada f o r a range of s o c i a l welfare programs, and the example of B r i t a i n ' s s o c i a l recon-s t r u c t i o n scheme proposed by Lord BeveridgelS eventually led the Canadian government also to introduce a comprehensive s o c i a l s e c u r i t y program. In 1951 the OAP Act was superseded by two pieces of l e g i s l a t i o n f o l -lowing a c o n s t i t u t i o n a l amendment that permitted the federal government to l e g i s l a t e i n t h i s area along with the provinces. The Old Age Security (OAS) Act provided a universal f l a t - r a t e pension at age 70 to those who had l i v e d i n Canada f o r twenty years. In that same year the Old Age Assistance Act was passed, providing f o r federal contributions to means-tested p r o v i n c i a l pension programs f o r i n d i v i d u a l s between the ages of 65 and 69. The amounts paid under these programs, however, (up to $40 per month i n 1951) s t i l l l e f t many people i n need i n t h e i r l a t e r years. Although an amendment to the federal Income Tax Act i n 1957 allowed tax d e f e r r a l s f o r contributions paid into Registered Retirement Savings Plans (RRSP's), and i n s t i t u t i o n a l i z e d occupational plans continued to expand, widespread recognition of continuing inadequacies i n the pension system led to a series of changes i n 1965-66. The Canada and Quebec Pension Plans (C/QPP) introduced i n 1965 were compulsory contributory schemes aiming to ensure a minimum rate of earnings replacement for those over 65, while allowing considerable scope f o r private pensions and sa-vings to extend t h i s further. The C/QPP provided retirement, d i s a b i l i t y , and survivor's pensions, and a lump-sum death benefit within one s o c i a l insurance package. Moreover, the federal government announced that the q u a l i f y i n g age f o r OAS would be lowered by one year annually from 70 i n 1966 to 65 by 1970, and i n 1966 amended the OAS Act to provide a monthly Guaranteed Income Supplement (GIS) that was means-tested. F i n a l l y , the Canada Assistance Plan (CAP) Act (1966) empowered the federal government (on p r o v i n c i a l application) to pay 50% of p r o v i n c i a l and municipal costs of s o c i a l assistance and s o c i a l services to persons i n need, thereby a s s i s t i n g many of the e l d e r l y who remained indigent despite the e x i s t i n g pension programs. During the 1970's provisions were made f o r OAS and C/QPP benefits to be escalated according to the increase i n the cost of l i v i n g , but there was again broad agreement that the entire pension system was i n need of change i f the incomes of older Canadians were to withstand the ravages of apparently chronic i n f l a t i o n . The problems posed to pension funds by i n f l a t i o n , and the r i s i n g number of e l d e r l y people, prompted a series of federally-sponsored reports i n 1979 that explored the va-rious options f o r reform of the retirement income system.16 The Depart-ment of National Health and Welfare submission to a national conference on pensions i n 1981 spe l l e d out Ottawa's objectives for reform as: uni-v e r s a l i t y , p o r t a b i l i t y and e a r l i e r vesting, indexation, and equity f o r women.17 These federal p o l i c y goals indicate a commitment, to adequate income support f o r a l l those over age 65 (univ e r s a l i t y ) through benefits from a v a r i e t y of pension plans that can follow a worker who changes employers(portability) a f t e r a shorter q u a l i f y i n g period of employment ( e a r l i e r v e s t i n g ) . Adequacy i s to be safeguarded through the indexation of pension benefits to the c o s t - o f - l i v i n g so that payments w i l l keep 14 pace with i n f l a t i o n . The goal of equity f o r women i n pension income i s an important one since i n many cases today t h e i r lack of regular p a r t i -c i p a t i o n i n the labour force, and the general inadequacy of spouses' be-n e f i t s , combine with the longevity women experience to impoverish them once t h e i r husbands die (and t h e i r pensions cease). While these objec-ti v e s are worthy ones, t h e i r achievement i n the current cold economic climate promises to be a major challenge f o r policy-makers. 2.1.2.3 Housing Generally the federal government has viewed the housing needs of the e l d e r l y with less concern than those of younger Canadians, and a l l have been subject to market forces since shelter has been considered not so much part of Canada's s o c i a l sector as the proper concern of i t s manufacturing and investment i n t e r e s t s . The Dominion Housing Act (1935) allowed the government to loan up to 25% of the funds f o r home construc-t i o n provided through lending i n s t i t u t i o n s and l o c a l a u t h o r i t i e s . In 1944 the the National Housing Act (NHA) used the j o i n t lending technique to address the problems of low-rental accommodation, slum clearance, and r u r a l housing. The Central Mortgage and Housing Corporation (CMHC) was set up a year l a t e r to make and administer loans under the NHA, and revi s i o n s i n 1954 replaced the j o i n t lending scheme with a system of loan insurance f o r pri v a t e lenders. The f i r s t s p e c i f i c program f o r the e l d e r l y came with 1964 amendments that made funds available to provinces, m u n i c i p a l i t i e s and non-profit groups to b u i l d senior c i t i z e n s ' housing along with general p u b l i c housing, and provided loans and subsidies f o r various forms of group use of new and e x i s t i n g accommodation. A number of changes introduced during the 1970's have focused CMHC programs much more on meeting the housing needs of lower income Canadians through t r a -15 d i t i o n a l types of accommodation as well as various innovative a l t e r n a -t i v e s such as housing co-operatives. 2.1.3 B r i t i s h Columbia Program Developments Program developments a f f e c t i n g the e l d e r l y at the p r o v i n c i a l l e v e l w i l l be reviewed i n t h i s section i n the three areas of health, income, and housing. 2.1.3.1 Health The main health concerns i n B r i t i s h Columbia at the turn of the century were general s a n i t a t i o n and the control of communicable diseases. A p r o v i n c i a l p u b l i c health system was set up by the Public Eealth Act (1893) with a Medical Health O f f i c e r and Sanitary Inspectors i n each Health D i s t r i c t who were to ensure adherence to regulations under the publ i c health code. Hospitals and some homes f o r the aged where pa-ti e n t s could be treated by priv a t e physicians were also i n existence at the beginning of the century financed'by m u n i c i p a l i t i e s and voluntary donations. In 1919 a L e g i s l a t i v e Commission that had been appointed to inves-t i g a t e health insurance i n the province developed a plan to e s t a b l i s h a health care system. Though t h i s was not implemented, ten years l a t e r , i n response to continuing p u b l i c i n t e r e s t i n such a scheme, the govern-ment appointed a Royal Commission on Health Insurance and Maternity Benefits. The Commission's report fared better than i t s predecessor, and led to the passage of the Eealth Insurance Act of 1936. But, des-p i t e wide pu b l i c support, the opposition of physicians and insurance companies prevented t h i s Act's implementation.18 Meanwhile one group of the aged received s p e c i a l attention when i n 1935 e l d e r l y mental patients were separated from the r e s t of the patient population at Essondale. As a r e s u l t of the Provincial Rome for the Aged Act (1935) these patients were relocated i n f a c i l i t i e s that l a t e r became Valleyview, Dellview, and Skeenaview Hospitals f o r the aged mentally i l l . Beginning i n 1943 there was a pub l i c medical services plan f o r o l d age pension and s o c i a l assistance r e c i p i e n t s but uneven coverage, incomplete municipal p a r t i c i -pation, and physician discontent with the scheme made a more comprehen-sive approach necessary. F i n a l l y i n 1949 the province i n i t i a t e d a Hospi-t a l Insurance Program (partly to a l l e v i a t e chronic h o s p i t a l d e f i c i t s ) 1 9 that covered acute care and diagnostic services provided on an in-patient or out-patient basis. By 1950 there was a recognition among p r o v i n c i a l p u b l i c health o f f i -c i a l s that the increasing proportion of older people i n B r i t i s h Columbia would require a new health strategy i n future, but continued heavy de-mand f o r c h i l d - o r i e n t e d services precluded the development of spec i a l programs for the e l d e r l y (except as l o c a l or p i l o t programs) f o r some time. In 1960 a program covering h o s p i t a l r e h a b i l i t a t i o n , chronic t r e a t -ment, and convalescent care was introduced i n the province that interpre-ted r e h a b i l i t a t i o n broadly enough to include the r e - a c t i v a t i o n of e l d e r l y people, but shortages of space and trained personnel i n t e r f e r e d with i t s e f f i c i e n t operation. The B r i t i s h Columbia Medical Plan was set up in 1965 to provide medical care insurance to in d i v i d u a l s of a l l ages, and was followed by the creation of the Medical Services Commission under the Medical Services Act £1967) i n compliance with federal health insu-rance l e g i s l a t i o n . The extended h o s p i t a l care program began slowly i n 1965 with the redesignation of ex i s t i n g units and the planning of others to provide continuous nursing care and medical supervision to non-ambula-tory aged patients. Since by t h i s time the philosophy of treatment f o r 17 the e l d e r l y mentally i l l had changed from custodial care to active t r e a t -ment and r e h a b i l i t a t i o n , with the emphasis on returning to the community, l o c a l h o s p i t a l f a c i l i t i e s were soon under even greater pressure to pro-vide care f o r the aged. A number of Greater Vancouver Regional Hospital D i s t r i c t (GVRHD) and p r o v i n c i a l reports i n the 1970's recommended an increase i n bed f a c i -l i t i e s f o r the e l d e r l y at various care l e v e l s , an expansion of home care services, and better co-ordination of health and s o c i a l services as a whole.20 Thorough reform of the province's health care system was one of the p r i o r i t i e s of the New Democratic government i n i t s term i n o f f i c e from 1972 to 1975. Under the chairmanship of Dr. Richard Foulkes an ambitious review of health services was conducted throughout the province and the findings published i n Health Security for British Columbians (1973).21 Advocating major changes i n the organization and d e l i v e r y of health care through r e g i o n a l i z a t i o n and integration of health and s o c i a l services, t h i s report would l i k e l y have had a tremendous impact on health services to a l l c i t i z e n s including seniors i f i t had been implemented. But when the S o c i a l Credit party returned to power in 1975 t h i s report, along with one recommending a p r o v i n c i a l dental care plan^2 was shelved i n d e f i n i t e l y . However, the greatest impact on health services f o r older people i n the province was made by the introduction i n 1978 of the Long-Term Care (LTC) Program of the Ministry of Health. Attracted by favourable new financing under the federal Extended Health Care Program (part of the agreement embodied i n the EPFA Act) the p r o v i n c i a l S o c i a l Credit government introduced t h i s innovative program a year before the most recent e l e c t i o n i n B r i t i s h Columbia. Long-Term Care i s said to o f f e r the e l d e r l y i n need of health care a system of suppor-t i v e services designed to enable them to remain i n t h e i r own or t h e i r 18 family's homes as long as possible. Health needs are p r o f e s s i o n a l l y assessed at l e v e l s ranging from personal care through intermediate care to extended care. A number of home support services and programs (home-makers, home care nursing, adult day care etc.) may then be u t i l i z e d or d i f f e r e n t forms of r e s i d e n t i a l care (family-care homes, group homes, and i n s t i t u t i o n a l f a c i l i t i e s ) arranged as need and a v a i l a b i l i t y d i c t a t e s . The program i s universal with means-tested subsidies f o r homemaker ser-vices and adult day care, and i s co-ordinated by'.interdisciplinary assess-ment s t a f f operating out of the province's many Public Health Units. Now i n operation f o r over four years, the program has proven popular with older people who generally f e e l i t has improved access to high q u a l i t y health and s o c i a l services. However Long-Term Care has so f a r : been un-able to meet one of i t s o r i g i n a l goals -to reduce the number of acute-care beds occupied by the c h r o n i c a l l y i l l i n B r i t i s h Columbia. Beyond t h i s , i t now appears l i k e l y that continuing pressures f o r f i s c a l r e s t r a i n t may well jeopardize the program's a b i l i t y to provide adequately for the growing number of older people i n the years ahead. The most recent addition to the p r o v i n c i a l health system came when the re-elected So c i a l Credit government f u l f i l l e d a campaign promise by e s t a b l i s h i n g a Dental Care Plan i n 1981.., This scheme covered completely the cost of basic dental services and dentures f o r low-income groups, and h a l f of these expenses f o r a l l senior c i t i z e n s , and children under the age of 15. 2:1.3.2 Income In the nineteenth century, the maintenance of the e l d e r l y i n this province was considered the r e s p o n s i b i l i t y of t h e i r children or r e l a t i v e s , and i f these were lacking, the concern of r e l i g i o u s or charitable groups, 19 with p u b l i c r e s p o n s i b i l i t y a s i t u a t i o n of l a s t r e s o r t . A few homes f o r the aged were established before the turn of the century by the municipa-l i t i e s of Vancouver and V i c t o r i a , and by the province i n Kamloops to pro-vide f o r the i s o l a t e d , indigent e l d e r l y . But other than these few pro-v i s i o n s , there was l i t t l e consideration of spe c i a l programs for the assistance of older people at the p r o v i n c i a l l e v e l u n t i l a f t e r World War 1. B r i t i s h Columbia was the f i r s t province to pass l e g i s l a t i o n under the federal Old Age Pensions Act (1927) providing cost-shared monthly pensions to the needy over age 70, and supplemented t h i s i n c r e a s i n g l y a f t e r 1942. The Social Assistance Act (1942) empowered the p r o v i n c i a l Department of Welfare to make grants to m u n i c i p a l i t i e s f o r f i n a n c i a l , r e s i d e n t i a l , and other assistance to those i n need including the supple-mentation of pensions f o r those r e q u i r i n g s p e c i a l care. The Soci a l Ser-vice D i v i s i o n of the Old Age Pension Board completed a number of studies throughout the 1940's on various aspects of l i f e f o r the aged i n B r i t i s h Columbia, i n t e r p r e t i n g i t s r o l e as including a r e s p o n s i b i l i t y f o r the welfare of a l l e l d e r l y people, and providing a f o c a l point f o r information relevant to them. The Provx-ncxal Inf%rmaries Act (1948) allowed f o r the establishment of i n s t i t u t i o n a l care f a c i l i t i e s f o r those with chronic i l l n e s s who did not require h o s p i t a l i z a t i o n , and these and other r e s i -d e n t i a l settings were licensed and inspected under the Welfare Institu-tions Licensing Act (1948), eventually replaced by the Community Care Facilities Licensing Act (1969). With the passage of the Old Age Assistance Act (1951) introducing f e d e r a l l y cost-shared universal pensions to those 70 and over, and means-tested assistance f o r those 65 to 69, pensions became p r i m a r i l y a federal concern, and attention to the problems of the e l d e r l y on the part of p r o v i n c i a l a u t h o r i t i e s waned noticeably.24 i n 1957 a D i v i s i o n on Aging 20 was set up within the Department of Re h a b i l i t a t i o n and So c i a l Improve-ment to administer f i n a n c i a l assistance programs, provide a p r o v i n c i a l information service, and develop community resources to benefit the aged. Municipal bus passes were issued to a l l those over age 65, and i n 1968 the Senior C i t i z e n s ' Counsellor program began to operate through the re-named Department of So c i a l Welfare. In 1971 the Department began to en-courage the development of senior c i t i z e n s ' day centres through i t s com-munity grant program, and several centres opened i n the next few years. The Guaranteed 'Minimum Income Assistance Act (1972) supplemented the i n -come of those 65 and over from a l l sources to $200 monthly, to be increas-ed with r i s e s i n OAS/GIS, and i n 1973 t h i s "Mincome" program was extend-ed to those aged 60 to 64. In 1976 the Guaranteed-Available Income for Need (GAIN) Act expanded the means tes t f o r Mincome (now c a l l e d GAIN f o r Seniors) to include assets as well as incomes of e l d e r l y applicants. No new income assistance programs f o r the aged have been introduced i n the province since the GAIN program began, although payments are now increas-ed with the c o s t - o f - l i v i n g along with the federal income programs. 2.1.3.3 Housing There was l i t t l e s p e c i a l attention paid to the housing needs of e l -derl y people i n B r i t i s h Columbia u n t i l well a f t e r World War 2, and even then i t was not considered as much of a problem as that of assuring an adequate supply of housing f o r the general population. In 1955, however, the province passed the British Columbia Elderly Citizens ' Housing Aid Act, one of the e a r l i e s t of i t s kind i n Canada, allowing p r o v i n c i a l con-t r i b u t i o n s of up to one-third of the t o t a l cost of new or renovated r e s i -d e n t i a l units f o r the low-income e l d e r l y sponsored by regional d i s t r i c t s , m u n i c i p a l i t i e s , or non-profit s o c i e t i e s . Aid to non-profit s o c i e t i e s qua-l i f i e d f o r a 10% forgiveable federal grant, and was therefore preferred over d i r e c t p u b l i c housing pr o j e c t s . Units f o r the aged b u i l t i n B r i -t i s h Columbia per c a p i t a over 65 have r i s e n over the past few decades and are now co n s i s t e n t l y above the national average, due p a r t l y to the rapid expansion of large h i g h - r i s e f a c i l i t i e s i n the 1960's and early 1970's.25 Although a B r i t i s h Columbia Housing Management Commission (BCHMC) had been created i n 1967, i t was only made responsible f o r ad-ministering the few e x i s t i n g f e d e r a l / p r o v i n c i a l housing projects u n t i l the e l e c t i o n of a new government i n 1972. In 1973 the province set up the f i r s t Department of Housing i n Cana-da to administer various Acts and funds r e l a t i n g to housing with powers to supervise, acquire, develop, maintain, improve, and dispose of hous-ing i n the province. S o c i a l housing programs of a l l kinds were gr e a t l y expanded i n the years following, and a number of measures approved to ease the burden on e l d e r l y tenants and home owners through tax d e f e r r a l s and exemptions. The BCHMC and the federal government j o i n t l y subsidized provincially-owned r e n t a l u n i t s to ensure that tenants would pay no more than 25% of t h e i r income as rent. When the government changed again i n 1976 the impetus to p u b l i c housing programs, including those f o r the e l d e r l y , diminished greatly. A major study of housing problems i n the province prepared by Karl J a f f a r y was shelved, 2? and r e s p o n s i b i l i t y f o r housing was assigned to the Minister f o r Municipal A f f a i r s as the pro-vince gave higher p r i o r i t y to programs encouraging home ownership among moderate income f a m i l i e s . 22 2.1.4 Roles of the Municipal and Voluntary Sectors While the two senior l e v e l s of government have h i s t o r i c a l l y introdu-ced and funded broad programs f o r the e l d e r l y , such developments were very often preceded by substantial e f f o r t s at the l o c a l l e v e l to f i l l the per-ceived service gap through either voluntary or municipal action. The Panel on Aging of the Community Chest and Council ( l a t e r United Community Services) of Vancouver was active throughout the 1950's and 1960's i n lobbying f o r increased health and s o c i a l services to older peo-ple i n the c i t y . Their focus on the need f o r a " t o t a l concept of care" f o r the aged, and the expansion of community al t e r n a t i v e s to acute hospi-t a l care a n t i c i p a t e d by over a decade the f e d e r a l / p r o v i n c i a l Long-Term Care Program. The Committee on Aging of the S o c i a l Planning and Review Council (SPARC) of B r i t i s h Columbia c a r r i e d on t h i s concern f o r services f o r the aged i n the context of the province as a whole. SPARC published a number of guides and reports f o r senior c i t i z e n s i n the early 1970's, 2^ and since 1978 i t s Long Term Care Committee has published a guide to the LTC Program f o r p o t e n t i a l service users.^0 Some voluntary service agen-cies have also focused t h e i r e f f o r t s on the e l d e r l y , most notably the Canadian A r t h r i t i s and Rheumatism Society (CARS). Older people themselves have become in c r e a s i n g l y a c t i v e i n voluntary organizations, and have formed a v a r i e t y of groups to represent t h e i r many inte r e s t s at various l e v e l s . The many Local Old Age Pensioners' Organizations, and Senior C i t i z e n s ' Associations concern themselves mainly with s o c i a l a f f a i r s , while the Council of Senior C i t i z e n s ' Organizations of B r i t i s h Columbia makes annual formal presentations to the p r o v i n c i a l government, and, through i t s national counterpart, to the federal government as well. The m u n i c i p a l i t i e s of Vancouver and V i c t o r i a were the f i r s t to esta-b l i s h homes f o r the indigent e l d e r l y , and t h e i r f r o n t - l i n e r o l e i n the 23 d e l i v e r y of public health and welfare programs has made municipal authori-t i e s acutely aware of the problems of the aged i n an urban s e t t i n g . Chan-ges i n municipal bylaws have made many pub l i c buildings more accessible to the f r a i l e l d e r l y , and the handicapped, and a number of s p e c i a l p r o v i -sions and services have made transportation less d i f f i c u l t and expensive f o r the aged. 2.2 CURRENT STATUS OF PROGRAMS FOR THE ELDERLY IN BRITISH COLUMBIA Having traced the gradual development of health, income, and hous-ing programs f o r older people at both the federal and p r o v i n c i a l l e v e l s , i t i s natural to consider next the actual present s i t u a t i o n of those 65 and over i n B r i t i s h Columbia today with respect to these p u b l i c services. In addition to the services outlined below, e l d e r l y c i t i z e n s may also take advantage of a wide range of programs designed f o r low income adults of any age, or the general p u b l i c . Benefits a v a i l a b l e i n each of the three basic categories are outlined, t h e i r u t i l i z a t i o n by the e l d e r l y re-ported, and some consideration given to the adequacy of the current pro-grams . 2.2.1 Health E l d e r l y residents of t h i s province are e l i g i b l e f o r medical insurance under the Medical Services Plan (MSP), which covers a l l medically required services rendered by medical p r a c t i t i o n e r s , including osteopathic physi-cians, i n B r i t i s h Columbia, and c e r t a i n s u r g i c a l procedures of dental surgeons where n e c e s s a r i l y performed i n a h o s p i t a l . Additional b e n e f i t s under the plan include the following services when rendered i n the pro-vince : C h i r o p r a c t i c - payment f o r up to f i f t e e n v i s i t s per year f o r the 24 services of a registered chiropractor. Naturopathic - payment of up to $100 per year f o r the services of a naturopathic physician. Orthoptic - payment of up to $50 per year ($100 per family) f o r orthoptic treatment on the r e f e r r a l of a medical p r a c t i t i o n e r . Physiotherapy - payment of up to $125 per year f o r the services of a registered physiotherapist on the r e f e r r a l of a medical p r a c t i t i o n e r . Podiatry - payment of up to $75 per year f o r the services of a reg i s t e r e d p o d i a t r i s t when rendered within the year unless r e f e r r e d by a medical p r a c t i t i o n e r . Optometry - payment f o r required diagnostic services of r e g i s -tered optometrists to determine the presence of any observed abnormality i n the v i s u a l system. Monthly premiums f o r the MSP as of A p r i l 1, 1982 were $15 f o r single per-sons and $28 f o r couples. Permanent residents (at least a year's duration) are e l i g i b l e f o r a subsidy of 90% of the f u l l premium rate i f t h e i r income in 1981 was less than $2,810. Under the British Columbia Hospital Insurance Act e l d e r l y people (and a l l other residents) are also covered f o r medically authorized in-patient and out-patient h o s p i t a l care f o r acute i l l n e s s or inj u r y , active conva-lescent, r e h a b i l i t a t i v e , and extended h o s p i t a l care. As of A p r i l 1, 1982 the d a i l y co-insurance charges f o r which patients are themselves responsi-ble were $7.50 f o r in-patient acute care, $10.50 for extended care, and $4 for out-patient care. The Home Care/Long-Term Care Program o f f e r s a u n i v e r s a l l y a v a i l a b l e service to e l d e r l y p r o v i n c i a l residents (at least a year's duration) who 25 can no longer function independently'as a r e s u l t of a health-related pro-blem. The community and r e s i d e n t i a l programs included are: Home Care - required services at home of q u a l i f i e d nurses as well as physiotherapists, occupational and speech therapists where a v a i l a b l e , on the re-f e r r a l of a medical p r a c t i t i o n e r (no d i r e c t charge to p a t i e n t s ) . Homemaker Services - services as required following LTC assessment including routine housekeeping, laundry, meal planning and preparation, shopping, physician v i s i t s , simple home nursing, minor home main-tenance (fees geared to income from n i l to $8 per hour). Adult Day Care - where a v a i l a b l e these centres provide an i n f o r -mal program of s o c i a l and health services f o r those who require assistance '-: (fees $1 to $3 d a i l y ) . Residential Care F a c i l i t i e s - (excluding acute and extended) r e s i d e n t i a l care as required following LTC assessment as person-a l care (minimum assistance necessary), or i n -termediate care (general nursing support neces-sary) ($11.50 per day). The Dental Care Plan of B r i t i s h Columbia i s ava i l a b l e to those 65 and over, as well as children under 15, and those with lower incomes. The program pays 75% of the cost of basic dentisty, dentures and re-pa i r s f o r adults i n need, and h a l f these expenses f o r a l l children and senior c i t i z e n s . . ' * . • The B r i t i s h Columbia Pharmacare Program provides most p r e s c r i p t i o n drugs free of charge to those over 65 who have resided i n the province f o r at least three months. .2.2 Income Under the Old Age Security (OAS) Act (1951) persons aged 65 and over may q u a l i f y f o r e i t h e r the f u l l pension or a p a r t i a l amount depending on t h e i r residence i n Canada a f t e r reaching age 18. The monthly rate foV OAS payments as of January 1982 was $228.73. OAS pensioners .with no i n -come or only a l i m i t e d amount of addit i o n a l income may, upon a p p l i c a t i o n , receive a f u l l or p a r t i a l supplement, the Guaranteed Income Supplement (GIS). GIS monthly benefits as of January 1982 were $228.63. The spouse of an OAS pensioner may be e l i g i b l e f o r f u l l or p a r t i a l benefits (depen-ding on h i s t o r y of residence i n Canada) under a Spouse's Allowance (SPA) i program i f that spouse i s between 60 and 65 years of age and meets OAS residence requirements. The maximum SPA monthly payment as of January 1982 was $404. OAS, GIS, and SPA benefits are adjusted quarterly i n accordance with changes i n the Consumer Price Index (CPI). See Appendix 1 for d e t a i l s of program conditions f o r OAS, GIS and SPA. Under the Canada and Quebec Pension Plans (1965) retirement pensions are payable at age 65 based on the pensionable earnings record of the re-ci p i e n t f o r h i s contributory period. The maximum retirement benefit, $272.31 per month i n 1981, equals 25% of the average adjusted contributo-ry career earnings. C/QPP benefits are increased annually once paid out to f u l l y r e f l e c t increases i n the CPI. See Appendix 2 f o r d e t a i l s of program conditions f o r C/QPP. B r i t i s h Columbians of the age of 65 or more who are Canadian c i t i -zens or landed immigrants with f i v e years' consecutive residence i n Cana-da may q u a l i f y f o r a d d i t i o n a l benefits under the p r o v i n c i a l GAIN program. 27 The GAIN Seniors' Supplement i s an add i t i o n a l payment by the B r i t i s h Columbia government to residents i n rec e i p t of OAS/GIS whose income i s less than the current GAIN rate to r a i s e t h e i r income to t h i s l e v e l , $495.24 as of January 1982 f o r single i n d i v i d u a l s , and $907.66 f o r mar-r i e d couples. The GAIN rate i s adjusted upward i n tandem with the OAS/ GIS/SPA on a quarterly b a s i s . The federal and p r o v i n c i a l governments also provide income assistance to those over 65 through the Income Tax Act (1972) which i n 1981 provides f o r an age exemption of $1,980, a s i m i l a r deduction f o r those b l i n d or bed-ridden, and a maximum deduction of $1,000 from pr i v a t e pension or retirement income. See Appendix 3 f o r d e t a i l s of these tax programs. 2.2.3 Housing Many non-profit s o c i e t i e s i n B r i t i s h Columbia operate housing projects o f f e r i n g bachelor and one-bedroom apartments to p r o v i n c i a l residents of at least one year's duration who are over the age of 60, with limited income, and capable of caring f or themselves and t h e i r apartment. Anyone 65 or over, l i v i n g i n t h e i r own home may apply to have property taxes payable to the municipality deferred u n t i l the property i s transferred or sold (unless they exceed the assessed value). They also receive a home-owner grant of $630 i n 1981 to be applied against yearly property taxes payable. Under the Shelter Aid f o r E l d e r l y Renters (SAFER) program per-sons 65 or over who pay more than 30% of t h e i r income f o r rent may be e l i g i b l e f o r d i r e c t cash assistance equal to 75% of the amount by which the applicant's rent exceeds 30% of his/her income. The maximum payments under SAFER are $97.50 per month f o r single persons (for whom the maxi-mum re n t a l allowed i s $265 monthly) and $58.12 per month f o r married i n -d i v i d u a l s (rental maximum i s $295 monthly) as of June 1981. 28 2.2.4 U t i l i z a t i o n U t i l i z a t i o n s t a t i s t i c s f o r the programs mentioned i n the preceding sections give some i n d i c a t i o n of t h e i r acceptance, popularity, and need. The most recent figures are l i s t e d f o r a l l programs f o r which data i s avai l a b l e i n Appendix 4, and highlighted i n the remainder of t h i s section. It i s noteworthy that the e l d e r l y form about 11% of a l l MSP subscrib-ers: (see Appendix 4.A.1) yet accounted f o r 18.4% of. t o t a l plan b i l l i n g s ( f e e - f o r - s e r v i c e payments only) i n 1979-80.^ E l d e r l y males formed 26.4% of t o t a l male h o s p i t a l cases i n 1980/81, and e l d e r l y women comprised 26.0% of t o t a l female cases (see Appendix 4.A.2.a). These figures contrast sharply with the percentage of the e l d e r l y i n the population as a whole in that year, about 10%. Even more dramatic are comparisons of the num-ber of days of acute h o s p i t a l care used by older men and women - 39.8% and 42.5% of the t o t a l s f o r each sex re s p e c t i v e l y (see Appendix 4.A.2.a). In fact the average length of stay f o r those over 70 i n 1980/81 i n acute care h o s p i t a l s was 14.7 days, almost double the p r o v i n c i a l average of 8.2 days (see Appendix 4.A.2.b). Understandably, the e l d e r l y accounted for most extended care h o s p i t a l cases (82.0%) and days (85.1%) i n 1981 (see Appendix 4.A.2.c). Long-Term Care services are used by a small proportion of the aged as a whole (6.-8%) but a substantial proportion of the oldest subgroup (20-30% of those over 85) as shown i n Appendix 4.A.3, parts (a), (b), and ( c ) . In addition, most u t i l i z a t i o n rates f o r LTC services have been r i s i n g over the past few years, as Appendix 4.A.3 parts (d) and (e) show, with those f o r homemaker services increasing more quick-l y than others ( u n t i l r e s t r i c t i o n s on budget growth were announced i n June 1981). In the area of pharmaceuticals, the e l d e r l y received 22% of a l l drug p r e s c r i p t i o n s , and accounted f o r over 28% of a l l drug expenditures i n 1980.32 Seniors claiming under the Pharmacare Plan "A" accounted f o r 63% of a l l Pharmacare payments despite a u t i l i z a t i o n rate of less than 11% of the t o t a l e l d e r l y population (see Appendix 4.A.4.a). In 1979/ 80 t h i s group received 82% of a l l cardiovasculars and 53% of a l l tran-q u i l i z e r s , the two therapeutic classes most heavily u t i l i z e d under the Pharmacare program (see Appendix 4.A.4.b) In 1978 about 94% of those 65 and over in B r i t i s h Columbia were re c e i v i n g some element of OAS/GIS/SPA (see Appendix 4.B.1.a). Of these 48$ received OAS alone, 16% the maximum GIS/SPA as well,and 36% p a r t i a l GIS/SPA payments (see Appendix 4.B.l.b). The average payment to bene-f i c i a r i e s of CPP retirement pensions i n September 1980 was $128.92, c a l culated from data reported i n Appendix 4.B.2.a. In 1977 about 37% of the province's e l d e r l y received CPP retirement pensions, up from about 13% i n 1971 (see Appendix 4.B.2.b). Almost a quarter (23.4%) of the aged received the GAIN Seniors' Supplement i n 1980, down from almost 40% i n 1976, although average per c a p i t a payments, $381.55 and $384.01 re s p e c t i v e l y , have varied l i t t l e over t h i s period (see Appendix 4.B.3). U t i l i z a t i o n of the GAIN f o r Seniors program has been f a l l i n g s t e a d i l y i n recent years due to the increasing take-up of CPP ben e f i t s rendering more e l d e r l y people i n e l i g i b l e each year. In 1980 12,500 SAFER r e c i -pients, only 4.3% of the province's e l d e r l y , applied f o r rent supple-ments that averaged $50 per month.33 In summary, u t i l i z a t i o n by the e l d e r l y varies with the program areas being considered: from near-total p a r t i c i p a t i o n (90-100%) i n the universal programs of OAS, Pharmacare, and Dental Care, through substantial but minor usage (15-35%) of medical, h o s p i t a l , and selec-t i v e income supplementation programs (GIS, SPA, and GAIN), to minor u t i l i z a t i o n (5-10%) of the Long-Term Care program, and even less p a r t i -c i p a t i o n i n housing programs such as SAFER. While t h i s general picture conforms to the t r a d i t i o n a l rule-of-thumb that most older people (say 85%) do function independently, with r e l a t i v e l y few (10%) p a r t i a l l y dependent, and very few (5%) f u l l y dependent on others f or d a i l y care, these figures do not address the important question of which r e a l needs of the aged s t i l l remain unmet despite e x i s t i n g programs. .2.5 Adequacy Many are r i g h t l y concerned about the adequacy of programs av a i l a b l e f o r e l d e r l y people i n B r i t i s h Columbia. Concern has been expressed about the l e v e l of services i n each of the three program areas, and some have pointed out that the need f o r each i s intimately r e l a t e d to the adequacy of the other two. For example, an older person l i v i n g i n sub-standard housing i s more l i k e l y to become i l l , e s p e c i a l l y without an income adequate f o r a proper di e t and r e c r e a t i o n a l a c t i v i t i e s . It i s generally agreed, however, that the basic element i n the program sup-port system f o r the aged i s that of income. According to recent federal c a l c u l a t i o n s , the incomes of e l d e r l y c i t i z e n s on average are s u b s t a n t i a l l y below those of other Canadians (see Figure 2.1), as many s u f f e r a sharp drop i n t h e i r standard of l i v -ing a f t e r retirement, p a r t i c u l a r l y those i n the middle-income range (see Figure 2.2). Almost h a l f the e l d e r l y i n B r i t i s h Columbia have incomes so low they are e l i g i b l e f o r the GIS, although t h i s i s true for an even higher proportion i n most other provinces (see Figure 2.3), and (as pointed out e a r l i e r ) almost a quarter of these s t i l l receive less than the p r o v i n c i a l GAIN guarantees ($5,942.88 per year f o r s i n -gle persons, and $10,891.92 f o r couples i n January 1982). Even at these l a t t e r income l e v e l s , the incomes of single e l d e r l y i n d i v i d u a l s (mainly women) remain below the s t a t i s t i c a l poverty l i n e s (see Figure 31. FIGURE 2.1 Median income off the elderly and of all Canadians, 1980 All Canadians $19,463 11111 Elderly 11111 l l l l l $9,019 l l l l l From: Department of National Health and Welfare, Pensions In Canada (Ottawa: Health and Welfare Canada, 1981), p. l . Reproduced by permission of the publisher. FIGURE :2.2 Department of National Health and Welfare, Pensions in Canada (Ottawa Health and Welfare Canada, 1981), p. 2. Reproduced by permission of the publisher. 33 FIGURE 2.3 Percent of Old Age Security recipient* Iri each province also receiving Guaranteed Income Supplement August 1981 Canada Average 0% , 53.0% 100% From: Department of National Health and Welfare, Pensions in Canada- (Ottawa: Health and Welfare Canada, 1981), p. 3. Reproduced by permission of the publisher. 2.4), while those of e l d e r l y couples just exceed the lowest poverty l i n e (see Appendix 5). These t e l l i n g f igures surely indicate that the income s e c u r i t y system f o r the aged i n B r i t i s h Columbia (and Canada) i s currently inadequate by any reasonable standard. The extraordinary escalation i n housing costs i n B r i t i s h Columbia i n the past few years has resu l t e d i n a larger proportion of many peo-ple's income going to basic shelter. Although no figures are a v a i l a b l e i t seems i n e v i t a b l e that a number of older people, affected by t h i s general i n f l a t i o n a r y increase (through higher taxes, rents etc.) would be forced to spend r e l a t i v e l y more on housing than before. The quarter l y CPI adjustments to OAS/GIS/SPA and CPP. would s t i l l f a l l short of the le v e l s of i n f l a t i o n experienced i n t h i s province which have been con-s i s t e n t l y higher than the national average f o r some time. There can be l i t t l e doubt that the squeeze on older people (and t h e i r f a m i l i e s ) caused by income shortages and r i s i n g costs of housing, food, and other basic items has led many whose health has deteriorated to seek r e s i d e n t i a l care under the p r o v i n c i a l Long-Term Care program e a r l i e r than they might have otherwise. An i n s u f f i c i e n t number of f a -c i l i t y beds under t h i s program has apparently exacerbated the problem of the blocking of acute care beds by long-stay patients which the pro-gram was p a r t l y designed to a l l e v i a t e . While t h i s phenomenon i s one that i s being experienced i n many c o u n t r i e s , t h e increasing number of such "bed-blockers" recorded i n the province over the past few years has led many to conclude that the problem extends beyond that of ina-dequate LTC bed supply (although t h i s i s part of the story to be sure) to the lack of affordable community a l t e r n a t i v e s a v a i l a b l e to the f r a i l e l d e r l y today. This i n e v i t a b l e combining of factors a f f e c t i n g the e l d e r l y w i l l be FIGURE 2.4 Old Age Security/Guaranteed Income Supplement, 1981 $9015 Old Age Security Old Age Security Sing le pens ioner T w o pens ioner fami ly Guaranteed Income === Supplement = $2542 From: Department of National Health and Welfare, Pensions in Canada (Ottawa: Health and Welfare Canada, 1981), p. 4. Reproduced by permission of the publisher. considered again i n the following section examining the shape of things to come f o r B r i t i s h Columbia's aging population. 3 FUTURE TRENDS AFFECTING PROGRAMS FOR THE ELDERLY In t h i s section the impact of a v a r i e t y of relevant trends on pro-grams f o r the e l d e r l y i n the future are assessed. It i s asserted that such forecasts are e s s e n t i a l despite the acknowledged d i f f i c u l t i e s with predictions off.this kind. 3.1. Limitations It must be emphasized at the outset that since forecasting i s neces-s a r i l y beset by a host of u n c e r t a i n t i e s , i t i s prudent to be e s p e c i a l l y cautious i n drawing conclusions from such exercises. It i s equally clear that the margin of error i n predictions of any kind increases r a p i d l y with the time span involved, and may indeed be so great i n some cases that an informed guess would fare as well. Of course planning would be a great deal simpler i f such uncertainties did not e x i s t , but t h e i r per-sistence cannot be allowed to discourage the planning enterprise. In-deed i t i s important to r e a l i z e that the very acceleration of change that has come to characterize much of modern society makes caref u l planning a l l the more imperative i f policy-makers are not to f i n d them-selves hobbled by outmoded structures i n attempting to solve p u b l i c pro-blems. Thus i t i s anticipated that planners must increasingly address the s t r u c t u r a l aspects of t h e i r concerns to improve the a b i l i t y of govern-ment (or business) to adapt quickly to new conditions i n the turbulence of today's organizational:.world. ... '• ~ T ;• Having made t h i s general qualification';, i t is,, import ant rto: d i s t i n g u i s h the p a r t i c u l a r l i m i t a t i o n s imposed on„this study by the nature of the task at hand. Projections considered i n t h i s section w i l l include those of an economic and p o l i t i c a l nature, based upon expected demographic changes. The po t e n t i a l impact of the former trends on programs f o r the el d e r l y i s seen as s u f f i c i e n t l y great to j u s t i f y t h e i r i n c l u s i o n despite r e l a t i v e l y larger error margins i n forecasting. The basic and most per-suasive trends emerge from demographic projections. Although demographers are not exempt from the r i s k s of forecasting mentioned e a r l i e r (the ex-tended post-war baby boonr i t s e l f eluded most forecasters of the dayj,35. predictions about the e l d e r l y enjoy a d i s t i n c t advantage., Since those who w i l l be over 65 i n the year 2031 are now a l i v e (and i n fact over 15), f e r t i l i t y projections can be disregarded i n forecasting the number of el d e r l y people. Migration i s of course a fac t o r subject to considerable f l u c t u a t i o n , but mor t a l i t y patterns are r e l a t i v e l y well known, and ad-vances i n health technology can only add to the number of the old. How-ever, i f forecasting the number of the e l d e r l y i s r e l a t i v e l y uncomplica-ted, the same cannot be said of pr e d i c t i n g what proportion of the t o t a l population they can be expected to form. F e r t i l i t y rates, once thought to be e a s i l y predictable, have surprised demographers again and again - up in the 1950's (not down as expected), down i n the 1960's (when r i s e s were forecast) and so on. Since the importance of the aged dependency r a t i o (the number of those aged 65 and over divided by the number aged 20 to 64) f o r determining pension funding makes i t necessary to engage i n f e r -t i l i t y p r e d i c t i o n s , a range of scenarios w i l l be considered. As a r u l e , the gloomiest p i c t u r e w i l l be drawn i n the hope that policy-makers w i l l plan f o r t h i s , and use ameliorating developments ( i f any) to allow more room f o r other p u b l i c p r i o r i t i e s . It i s assumed that major depopulating catastrophes such as global war can never be adequately planned f o r . .3.2. Demographic Trends The demographic p i c t u r e presented below w i l l focus both on Canada and B r i t i s h Columbia, although the national s i t u a t i o n may receive r e l a t i v e l y more emphasis since more work has been done at t h i s l e v e l to date. In 1851 there were only 65,000 Canadians (2.7%) of the t o t a l popu-l a t i o n of 2.4 m i l l i o n who had reached the age of 65. Today almost 10% of Canada's population of about 24 m i l l i o n are e l d e r l y , roughly the num-ber i n the t o t a l population 130 years ago-^. For B r i t i s h Columbia the h i s t o r i c a l p i c t u r e i s even more dramatic. From about 1,000 e l d e r l y (approximately 3%) i n a p r o v i n c i a l t o t a l of j u s t over 36,000 in 1871, the aged have grown to comprise today almost 11% of the province's t o t a l population of about 2.7 m i l l i o n . This increase i n the number of the e l d e r l y has been a r e s u l t of general population growth, extended s u r v i -v a l through improved health care and l i v i n g standards, and increased net migration, p a r t i c u l a r l y since World War 2. But the gradual aging of a gradually increasing population i s not "the major element i n demographic projections of the e l d e r l y i n Canada. I f t h i s were the complete p i c t u r e the implications f o r s o c i a l programs would c e r t a i n l y be serious, and merit care f u l attention. But a trend that few expected to occur, yet that lasted f o r over a decade from i t s early post-war beginnings has r a d i c a l l y changed a l l that-^7. The baby boom i n Canada produced more than 400,000 children each year from 1952 to 1965, and created a bulge i n the nation's population p r o f i l e that has been c a r r i e d along since as the "big generation""^ ages (see Figure ?~.5). This abnormally large b i r t h cohort has combined i t s influence with other modern s o c i e t a l forces to produce dramatic change i n the s o c i a l i n s t i t u t i o n s and structures through which i t has passed. From schools and education i n the 1960's, through jobs and the workplace in the 1970' and now into homes and r e s i d e n t i a l accommodation i n the 1980's, t h i s 39 FIGURE 2.5 Birth Rates and Total Fertility Rates, Canada, 1901 to 2031"' ^  Taux de natalite et taux de fecondite totale, Canada, 1901 a 2031 32 — 28 • 24 20 • 16 • 12 — 8 — Birth rates — Taux de natalite (Per 1,000 population Donnees chronologlques Projected — Projections Projection II ' \ * * Projection I **••••« — 32 — 28 24 — 20 — .16 • i 12 i 4 — I 1901 1911 1921 1931 1941 1951 1961 1971 ; 1981 1991 2001 2011 2021 2031 • 1976 „ From: Canada, S t a t i s t i c s Canada, Social Security National Programs 1978 (Ottawa: Queen's Print e r , 1978), p. 10. Reproduced by permission of the Minister of Supply and Services Canada. boom generation has revolutionized society through sheer force of num-.'..' bers. It i s t h i s group that poses the greatest challenge to those planning services f o r the e l d e r l y i n the years ahead. There can be l i t t l e doubt that they w i l l t e s t the health services, pension plans, hou-sing developments, and other public programs upon which they w i l l depend in future j u s t as severely as the systems they w i l l have then l e f t be-hind. This generation also presents planners with a unique opportunity to a n t i c i p a t e s o c i a l needs since t h e i r e f f e c t s on programs f o r the elder-l y w i l l not be f e l t u n t i l about 2011, t h i r t y years from now, and increa-ses i n the proportion of those over 65 u n t i l then, while sizeable, w i l l be comparatively steady and moderate. The s i z e and composition of Canada's.;future population w i l l depend on the rates of f e r t i l i t y , mortality, and immigration that p r e v a i l . Be-cause of the uncertainty i n pr e d i c t i n g future l e v e l s of'-"these v a r i a b l e s , i t i s customary f o r demographic projections to be made on a range Of a l -ternative l e v e l s , encompassing high, medium, and low estimates f o r each one. Appendix 6 describes the various le v e l s f o r each of these variables considered i n a recent background study f o r the Economic Council of Cana-d a - ^ a n c [ ^ he range of projections produced as a r e s u l t . The v a r i a t i o n s i n these estimates well i l l u s t r a t e the s e n s i t i v i t y of demographic struc-ture to changes i n underlying r e s u l t s that was ref e r r e d to e a r l i e r . For t h i s paper the S t a t i s t i c s Canada Projection Number 3, based on the follow ing assumptions, w i l l be used: 1. low f e r t i l i t y - de c l i n i n g from 1.9 children per woman of c h i l d -bearing age i n 1976 to 1.7 i n 1991 and constant thereafter. 2. low l i f e expectancy - r i s i n g u n t i l 1986 to reach 70.2 years f o r men and 78.3 years f o r women, and constant thereafter. 3. medium net immigration - 75,000 persons per year. This population pro j e c t i o n i s de t a i l e d i n Table 2:.,!,,graphed i n Figure 2.6, TABLE 2.1 ! Canadian P o p u l a t i o n P r o j e c t i o n s by Age ! ( S t a t i s t i c s Canada P r o j e c t i o n No. 3) i ( p o p u l a t i o n i n thousands) ! T o t a l Year P o p u l a t i o n 0-17 % 18-59 i 60-64 % 65+ 3 1976 22,993 7,312 • 31. 8 12,774 ,55. 6 905 3.9 2,002 8. 7 1961 24 ,330 :| 6,933 , 28. 5 14,134 58 . 1 963 4.0 2,310 9. 5 1986 25,713 6,833 26. 6 15,159 58 . 9 1,110 4.3 2,615 10. 2 1991 26,975 6,966 :25. 8 15,918 , 59. 0 1,11.4 .4.1 2,980 11. 0 1996 27,993 6,993 25. 0 16,640 59. 4 1,115 4.0 3,24 8 11. 6 2001 2 8,794 6,805 23. 6 . 17,4 01 60. 4 1,165 4.0 3,425 11. 9 2011 30,068 6,411 .21. 3 17,968 59. 8 1,764 5.9 3, 924 13. i : 2021 30,877 6,378 20. 7 17,255 55 . 9 2,151 7.0 5,093 16. 5 2031 30,935 6,162 19. 9 16,715 54 . 0 1,817 5.9 6,240 20. 2i From: B.J. Powell, J.K. Martin,"Economic Implications of an Aging Society i n Canada", a paper prepared f o r the National Symposium on Aging, Ottawa, October 25-27, 1978, p. 6. Reproduced by permission of J.K. Martin. 42 FIGURE 2.6 CANADIAN POPULATION PROJECTIONS BY AGE 0-/7 • • 1 1 1 i 1 1 1 i / m 8/ 86 1/ 16 Zt>o/ 2.0 U ZoZI 2o3l From: Powell and Martin, "Economic Implications", p. 6. ".: 43 and gives r i s e to the dependency r a t i o s forecast i n Table 2.2 and shown gr a p h i c a l l y i n Figure 2.1. In order to err i n the d i r e c t i o n of the worst-case scenario, t h i s r e l a t i v e l y low-growth pro j e c t i o n w i l l be used i n the remainder of the paper to consider the impact of various p o l i c y changes. The most s t r i k i n g feature of the proj e c t i o n i s c e r t a i n l y the dramatic increase i n the number (and proportion) of the e l d e r l y beginning i n about 2011. The slower growth u n t i l that time ( a c t u a l l y slackening be-tween 1991 and 2001) i s also noteworthy, as i s the continuous decline i n the proportion of those aged 0 to 17 during the ent i r e period. . . , sIn B r i t i s h Columbia population projections conform reasonably well with t h i s o v e r a l l p i c t u r e . The l a t e s t a v a i l a b l e p r o j e c t i o n from the Central S t a t i s t i c s Bureau (see Table 2.3 and Figure 2.8) shows c l e a r l y the "wave" created by the baby boom as i t moves into the higher age groups, and the smaller following "baby-echo" created by the children of those born during the baby boom. As a r e s u l t of the aging of t h i s domi-nant cohort, B r i t i s h Columbia too w i l l experience declines i n the r e l a -t i v e proportion of some of the younger age groups. Dependency r a t i o s are forecast to change as shown i n Figure 2.9. The assumptions underly-ing the Central S t a t i s t i c s Bureau (CSB) proj e c t i o n are explained i n Appen-dix 7. It i s worth noting that the S t a t i s t i c s Canada, Projection Number 3 figures f o r B r i t i s h Columbia are considerably lower o v e r a l l than those from the CSB pr o j e c t i o n (see Table 2.4). While the same patterns are evident (see Figure 2.10), the more conservative growth assumptions used by S t a t i s t i c s Canada produce a less o p t i m i s t i c picture than t h e i r CSB counterparts, as can be seen from the somewhat higher e l d e r l y dependen-cy r a t i o s forecast (see Table 2.5). This point should be kept i n mind when implications f o r the programs are considered i n a l a t e r section. TABLE -21.2 PROJECTED DEPENDENCY RATIOS IN CANADA Youth (0-17) E l d e r l y (65 ) Year Dependency Dependency 1976 .53 .15 1981 .46 .15 86 .42 .16 91 .41 .17 96 .39 .18 2001 .37 .18 11 .32 .20 21 .33 .26 31 .33 .34 Powell and Martin, "Economic Implications", p. 6. FIGURE 2.7 PROJECTED DEPENDENCY RATIOS IN CANADA 45 >1l .4-(0-1-7) 1 i 1 1 1 1 1 1— Si 86 <?/ % ZOO/ 201 i 202/ Z03/ From:. Powell and Martin, "Economic Implications", p. 6. TABLE -2.3 PROJECTED BRITISH COLUMBIA POPULATION Br AGE 1980-2001 O000) ! TEAR 0-4 5-9 10-14 15-19 20-24 25-29 AGE GROUP 30-34 35-39 40-44 1(5-1)9 50-54 55-59 60-64 65+ TOTAL I960 1981 1982 1983 1984 1985 11966 11987 '1988 11989 11990 |1991 .1992 1993 19914 1995 |1996 11997 1998 1993 12000 12001 187.5 197. 4 206.9 217.0 226.7 235.2 21*1.3 216.6 251.0 251.6 257.5 259.6 261.Q 261.8 262.0 261.8 261.3 260.8 260.5 260.5 261.1 262.2 186.8 186.6 190.2 19M.i» 200.7 208.3 217.8 227.1 237.0 216.6 254.8 260.8 266.1 270.5 274.1 276.9 279.1 280.5 281.2 281.4 281.2 280.7 202.8 205.1 205.6 206.8 205.5 204.it 203.8 207.2 211.3 217.5 224.8 234.3 243.5 253.4 263.0 271.2 277.2 282.4 286.8 290.4 293.2 295.4 243.5 238.0 232.3 224.3 219.2 218.0 220.0 220.4 221.5 220.1 218.8 218.1 221.5 225.5 231.8 239.1 248.5 257.7 267.5 277.1 285.3 291.3 248.3 257.7 265.2 271.0 273.6 271.1 265.2 259.3 251.1 245.9 244.4 246.3 246.6 247.7 246.3 245.1 244.4 247.7 251.7 257.9 265.2 274.6 235.8 245.5 254.1 263.1 272. 282. 291. 298. 304. 306.8 303.9 297.7 291.8 283.6 278.4 277.0 278.8 279.1 280.2 278.9 277.6 276.9 220.5 231.8 235.9 241.7 249.3 257.7 267.0 275.3 284.2 293.6 303.5 312.0 319.0 324.5 327.0 324.0 318.0 312.0 303.9 298.7 297.3 239.1 174.5 182.5 197.8 210.1 219.8 231.8 242.9 246.7 252.4 260.0 268.2 277.3 285.4 294.3 303.7 313.4 321.9 328.8 334.3 336.8 333.9 327.8 143.0 148.8 155.5 164.3 174.0 182.4 190.0 205.0 217.1 226.7 238.4 249.3 253.1 258.7 266.2 274.3 283.4 291.4 300.2 309.5 319.1 327.5 137.3 138.2 139.7 141.6 144.8 149.1 154.6 161.1 169.6 179.1 187.2 194.6 209.4 221.3 230.8 242.3 253.0 256.7 262.3 269.7 277.7 286.6 134.4 136.5 138.0 140.2 141.0 141.6 142.3 143.6 145.3 148.4 152.5 157.8 164.1 172.4 181.7 189.6 196.9 211.3 223.0 232.3 243.5 253.9 133.1 134.1 133.9 134.3 134.7 136.1 137.9 139.3 141.3 142.0 142.4 143.1 144.4 146.0 149.0 153.0 158.1 164.2 172.2 181.1 188.8 195.7 111.8 116.1 121.4 126.5 131.4 132.6 133.4 133.1 133.4 133.8 135.0 136.6 137.9 139.8 140.5 140.8 141.5 142.7 144.3 147.2 150.9 155.7 280.7 289.6 298.1 305.5 313.2 324.0 334.8 346.0 356.1 366.3 375.7 384.6 392.9 400.7 408.6 416.5 424.4 431.3 438.4 444.4 450.1 456.1 2640.1 2707.8 ' 2774.5 2840.7 2906.4 2975.2 3042.8 3109.5 3175.6 3241.6 . 3307.1 3372.2 1 3436.6 3500.3 3563.1 ! 3625.1 3686.3 ; 3746.8 3806.6 ; 3865.9 j 3924.9 '• 3983.6 ; From: B r i t i s h Columbia, Ministry of Industry and Small Business Development, Central S t a t i s t i c s Bureau, British Columbia Population Projection 10/80 1980-2001 ( V i c t o r i a : Central S t a t i s t i c s Bureau, 1981), Table 2. Reproduced by permission of the publisher. ON 47 TABLE 2.4 PROJECTED POPULATION 65 AND OVER, AND TOTAL POPULATION, BRITISH COLUMBIA, 1981-2031 'POPULATION TOTAL YEAR 65 AND OVER 'POPULATION (in thousands) 1981 283.9 2,649.7 1986 324.5 2,867.9 1991 369.9 3,072.9 1996 404.0 3,251.3 2001 428.7 3,405.4 2007 461.4 3,570.6 2012 521.5 3,695.3 2017 605.0 3,801.6 2022 698.2 3,882.5 2027 795.3 3,935.2 2031 848.9 3,958.4 From: Canada, S t a t i s t i c s Canada, Population Projections for Canada and the Provinces 1976-2001 (Ottawa: Minister of Industry, Trade and Commerce, 1979); and (for 2007-2031) M.B. Ismaily, Demography D i v i s i o n , S o c i a l S t a t i s t i c s F i e l d , S t a t i s -t i c s Canada, Ottawa i n a personal communication 13 January 1982. Projection No. 3 used throughout. 48 TABLE 2.5 PROJECTED ELDERLY DEPENDENCY RATIOS, BRITISH COLUMBIA, 1981-2001 YEAR CENTRAL STATISTICS BUREAU PROJECTION 10/80 STATISTICS CANADA PROJECTION NO. 3 1981 16 17 1986 ,16 1991 17 19 1996 17 ,20 2001 ,17 19 From: Central S t a t i s t i c s Bureau, Projection 10/80; S t a t i s t i c s Canada, Population Projections. '549 FIGURE .2.8 POPULATION AGE DISTRIBUTION FOR BRITISH COLUMBIA ESTIMATED AND PROJECTED: 1951-2001 From: B r i t i s h Columbia, Min i s t r y of Industry and Small Business Development, Central S t a t i s t i c s Bureau, Demographic Impact Summary of British Columbia Population Projection 10/80 1980-2001 ( V i c t o r i a : Central S t a t i s t i c s Bu-. . reau, 1981), p. 2. iReproduced by permission of the publisher. 50 FIGURE 2.9 COMPARISON OF BRITISH COLUMBIA DEPENDENCY RATIOS ESTIMATED AND PROJECTED: 1951-2001 From: Central S t a t i s t i c s Bureau, Demographic Impact Summary, p. 18. Reproduced by permission of the publisher. 51 FIGURE 2.10 c/l C O •H 6 o • H 3 o PROJECTED POPULATION 65 AND OVER, AND TOTAL POPULATION, BRITISH COLUMBIA, 1981-2031 4 A Total 65 + i i 1 i 1 i 1 — 1981 1986 1991 1996 2001 2006 2011 2016 — i 1 ' — 2021 2026 2031 From: Canada, S t a t i s t i c s Canada, Population Projections for Canada and the Provinces 1976-2001 (Ottawa: Minister of Industry, Trade, and Commerce, 1979); and M.B. Ismaily, Demography D i v i s i o n , S o c i a l S t a t i s t i c s F i e l d , S t a t i s t i c s Canada, Ottawa i n a personal communication 13 January 1982. 52 2.3.3. Economic Trends Based on premises, s i m i l a r to those of S t a t i s t i c s Canada Projec-t i o n Number 3, the Economic Council of Canada's Medium (L-01) demogra-phic p r o j e c t i o n has been used to produce the labour force forecast shown i n Table 21.6 using the assumptions on p a r t i c i p a t i o n rates describ-ed i n Table 2.7. B a s i c a l l y t h i s p r edicts a continuation of current trends i n labour force p a r t i c i p a t i o n such as those f o r e a r l i e r retirement, and increasing rates for women between the ages of 20 and 54. There seems no reason to believe that these trends would not also occur i n B r i t i s h Columbia. Forecasting future growth i n p r o d u c t i v i t y and the rate of i n f l a -tion-moves one into the realm of speculation. The technique employed here i s to use middle-range predictions over the long term that would tend to worsen the general p i c t u r e insofar as programs f o r the e l d e r l y are concerned - a sort of moderate worst-case scenario. Consequently a return to the high rates of growth i n p r o d u c t i v i t y of the 1950's ./ and 1960's are not foreseen f o r Canada, and an average increase of about 2% i n Gross National Product (GNP) w i l l be used. B r i t i s h Columbia i s expected to contribute more to national p r o d u c t i v i t y than most other provinces, with a long-term average 4% yearly increase i n Gross Provin-c i a l Product (GPP). Likewise, the rate ofyyear-to-year i n f l a t i o n i s not expected to return to the low l e v e l s of the 1950's and 1960's, and an average rate of 10% i s assumed through 1991, dropping thereafter to 5%. I n f l a t i o n i n t h i s province i s expected to continue to outpace most of the r e s t of the country, with rates of 12% and 7% r e s p e c t i v e l y . Generally, then, t h i s admittedly speculative long-range economic fore-cast c a l l s f o r continued slow r e a l growth, with high to moderate rates of i n f l a t i o n during the p r o j e c t i o n period. TABLE 2.6 , ASSUMPTIONS OF LABOUR FORCE PARTICIPATION RATES, BY AGE GROUP AND BY SEX, CANADA," , 1981 AND 1991 ! Men Women 1976 1981 1991 1976 1981 1991 Actual Medium Medium Actual Medium Medium (Per cent) Age group 15-16 33.2 30.1 30.1 27.7 24.0 24.0 17-19 66.6 63.3 63.3 60.2 59.0 59.0 20-24 85.2 85.2 85.2 67.3 72.0 78.0 25-34 95.5 95.3 95.0 53.9 60.0 68.0 35-44 96.0 96.0 96.0 53.3 58.9 70.0 45-54 92.5 92.0 92.0 48.3 51.1 55.1 55-64 76.8 74.5 70.0 32.0 32.7 34.0 65-69 25.4 21.9 15.0 7.9 6.0 5.0 70 and over 9.7 8.5 6.0 2.1 2.0 1.4 j Note The participation rates are annual averages based on Statistics Canada Labour Force Survey definitions, modified to include the armed forces and residents of the Yukon and Northwest Territories. For years between 1976 and 1981, and between 1981 and 1991, rates are calculated by linear inter-1 polation; for years after 1991, they are assumed constant at their 1991 levels. I SOURCE F. Denton, C. Feaver, and B. Spencer, "The Future Population and Labour Force of Canada: Projections to the Year 2051," a background study prepared for the Economic Council of Canada, 1979. From: Economic Council of Canada, One in Three,;]?. 128. Reproduced by permission of the author. 54 •TABLE 2.7 PROJECTED LABOUR FORCE, CANADA, 1976 TO 2051 Demographic growth projections Medium High Low (L-OI) (L-08) (L-09) (Thousands) 1976 10,411 10,411 10,411 1981 11,723 11,771 11,668 1986 12,803 13,040 12,559 1991 13,655 14,101 13,201 1996 14.299 15,141 13,510 2001 15,099 16,771 13,689 2006 15,861 18,628 13,673 2011 16,380 20,244 13,428 2016 16,610 21,589 12,922 2021 16,771 23,088 12,291 2026 16,982 25,007 11,613 2031 17,296 27,347 10,960 2036 17,689 29,862 10,409 2041 18,060 32,389 9,900 2046 18,331 34,908 9,383 2051 18,557 37,593 8,888 Source F. Denton, C. Fcavcr, and B. Spencer. "The Future Population and Labour Force of Canada: Projections to the Year 2051," a background study prepared for the Economic Council of Canada, 1979. From: Economic Council of Canada, One in Three, p. 128. Reproduced by per-mission of the author. 55 2.3.4 P o l i t i c a l / B u r e a u c r a t i c Trends It was noted early i n t h i s chapter that Canada, o r i g i n a l l y conceiv-ed as a c e n t r a l i z e d state, has evolved into a highly decentralized one with powerful p r o v i n c i a l governments taking a larger and larger r o l e i n national policy-making. At the same time, the federal government's i n -creasingly c o l l e c t i v i s t humanitarian i n i t i a t i v e s i n the s o c i a l p o l i c y sphere have evoked cautious reaction i n B r i t i s h Columbia as a r e s u l t of the u s u a l l y conservative u t i l i t a r i a n but always d i s t i n c t i v e l y p o p u l i s t so-c i a l p o l i t i c a l approach that holds sway here. As w i l l be elaborated later (see Section 3.1.2), the Canadian government appears to have addressed i t s e l f more co n s i s t e n t l y to the issues of equality i n society than has that i n t h i s province (where the commitment to planning has been tenta-t i v e at best as Section 2.1.3 points out). This may be p a r t l y due to the p r o v i n c i a l government's focus on regional economic development based on the entrepreneurial ethic. This trend of p r o v i n c i a l governments hav-ing a greater share i n shaping national policy, has been challenged and p a r t i a l l y reversed i n the l a s t decade as a r e s u l t of the i n t e r p l a y of p e r s o n a l i t i e s , together with the r e a l i t i e s of administration and econo-mics i n the p o l i t i c a l arena. The recommendations of the federal Glassco Report of 1962^0 to en-courage a massive d e c e n t r a l i z a t i o n of authority i n the operation of i t s departments and agencies were followed during that decade by both seni-or l e v e l s of government i n Canada. The r e s u l t s i n the 1970's were deepen-ing f i n a n c i a l d e f i c i t s on every hand as the many r e l a t i v e l y autonomous program managers made s i m i l a r decisions to increase spending with insuf-f i c i e n t regard f o r the aggregate p i c t u r e . In B r i t i s h Columbia, where de c e n t r a l i z a t i o n began l a t e r than i n most provinces due to Premier W.A.C. Bennett's personal s t y l e of administration, the NDP government compress-ed into three years (1972-75) the l i b e r a l i z a t i o n of p u b l i c administration 1 that had taken a decade i n many other j u r i s d i c t i o n s . The consequent f i -nancial squeeze experienced when the p r o v i n c i a l economy entered one of i t s c y c l i c a l downturns i n 1975 (reducing resource and other p u b l i c reve-nues) has been credited with the downfall of the province's only s o c i a l democratic administration.41 Not s u r p r i s i n g l y , a number of government studies i n the 1970's, most recently the federal Lambert Report (1979) 4 2 recommended a r e c e n t r a l i z a t i o n of authority i n the pub l i c sector and con-siderable strengthening of c o n t r o l l i n g central agencies to ensure more prudent administration of the p u b l i c purse. In B r i t i s h Columbia the new-l y re-elected S o c i a l Credit government moved d e c i s i v e l y i n 1976 to i n s t i -tute s t r u c t u r a l reforms aimed at upgrading Cabinet's capacity f o r review of m i n i s t e r i a l program requests, and a number of changes since have greatly strengthened the hand of the province's f i s c a l managers i n deal-ing with p u b l i c finances. The federal government has also taken steps to= increasethe power of the Treasury Board and Finance Mini s t r y at the expense of the various l i n e departments i n order to slow the rate of f e -deral budgetary d e f i c i t s . It i s also important to acknowledge the r o l e of c y c l i c a l economic f a c t o r s , many of int e r n a t i o n a l o r i g i n , i n p r e c i p i -t a t i n g the f i s c a l squeeze now f e l t by most Canadian governments, in c l u d -ing that i n "balanced-budget" B r i t i s h Columbia. The rapid e s c a l a t i o n i n energy p r i c e s since the Organization of Pe-troleum Exporting Countries (OPEC) c a r t e l made i t s presence f e l t world-wide i n 1973-74 has changed the ground rules f o r in t e r n a t i o n a l commerce. Intensifying e x i s t i n g i n f l a t i o n a r y pressures, energy increases have af-fected a l l aspects of the Canada economy, and made the ordinary person aware that i t i s no longer possible to ignore i n t e r n a t i o n a l economic r e a l i t i e s even i n a country as resource-rich as t h i s . Canadian products 57 must in c r e a s i n g l y compete with those from other developed and developing nations as m u l t i l a t e r a l trade agreements under the General Agreement on T a r i f f s and Trade (GATT) r e s t r i c t the imposition of protective commercial b a r r i e r s i n the i n t e r e s t s of expending the world economy. The national and p r o v i n c i a l economies i n Canada, always dependent on larger foreign markets f o r much of t h e i r revenue, are having to r e l y ever more heavily on export sales to a v a r i e t y of trading partners, p a r t i c u l a r l y the U.S.A., the European Economic Community (EEC), and Japan. During the 1970's i n -f l a t i o n and low growth strained domestic finances here, and the eventual world-wide recession of 1980-82 has made i t d i f f i c u l t f o r governments everywhere to match high p u b l i c expectations with diminished p u b l i c mo-nies. At the federal l e v e l there has been a re-ordering of p r i o r i t i e s to encourage investment i n new i n d u s t r i a l ventures, and i t i s apparent now that s o c i a l programs may well s u f f e r i n the process of reducing the fede-r a l d e f i c i t . B r i t i s h Columbia, with an economy long dependent on resour-ce revenues t i e d to export markets, has been h i t hard by the slump i n sales to i t s major customers (the U.S.A. and Japan) as a r e s u l t of reces-sionary impacts they are f e e l i n g , and even the present conservative ad-m i n i s t r a t i o n may end the 1982 f i s c a l year i n a d e f i c i t position. As might be expected, those d i f f i c u l t times have lead to pressures f o r more cen-t r a l i z e d economic management, and b i t t e r confrontations between federal and p r o v i n c i a l leaders over revenue-sharing and i n d u s t r i a l development. Combined with in t e r a c t i o n s between the key players i n the Canadian p o l i t y these economic pressures have accelerated change i n the nature of the p o l i t i c a l system i t s e l f . It cannot be denied that, as Prime Minister f o r most of the past f i f t e e n years, Pierre Trudeau has exercised considerable influence over the evolving Canadian p o l i t i c a l / b u r e a u c r a t i c scene. With a s p e c i a l con-58 cern for the province of Quebec and French speaking people i n Canada, Tru-deau has attempted to impose his v i s i o n of a strong federal government on usually antagonistic p r o v i n c i a l premiers i n an attempt to consolidate national unity by more v i s i b l e federal p o l i c i e s and programs. The r e p a t r i -ation of the BNA Act i n 1982 with an amending formula and a charter of r i g h t s and freedoms i s the culmination of the e f f o r t s of the various Tru-deau administrations since 1968 to renew the Canadian nation i n a form that w i l l enhance the country's a b i l i t y to meet the challenges of the next century. Regardless of whether or not one agrees with M. Trudeau's p o l i -t i c a l philosophy, i t i s a fact that, despite Quebec's objections, the new Canadian Constitution w i l l help the federation grapple with national pro-blems of long-standing while guaranteeing basic elements of the country's make-up. The aspect of the c o n s t i t u t i o n a l package that i s l i k e l y to have the greatest impact on s o c i a l p o l i c y i n general, and programs f o r the e l d e r l y i n p a r t i c u l a r , i s the section of equality r i g h t s (see Appendix 8). This section guarantees equality before and under the law, and the r i g h t to the equal protection and benefit of the law without discrimination based on age or mental or physical d i s a b i l i t y (among other t h i n g s ) . When t h i s p r o v i s i o n comes into force i n 1985 i t w i l l provide e l d e r l y i n d i v i d u -a l s with le g a l recourse f o r unwanted compulsory retirement schemes, inade-quate and inequitable p u b l i c programs, and a host of other grievances as yet unforeseen. In t h i s way the federal i n i t i a t i v e s to improve equality r i g h t s w i l l i n e v i t a b l y a f f e c t the r e a l i t y of r e d i s t r i b u t i o n to the e l d e r l y through the enhancement of programs f o r them administered by CMHC as well as National Health and Welfare, and t h e i r p r o v i n c i a l counterparts. These r e c e n t r a l i z i h g trends show no sign of abating at the present time and, given that the contributing influence of economics promises to remain conservative f o r the foreseeable future, may well lead to f u r -59 ther retrenchment i n the p o l i t i c a l and bureaucratic spheres. In my opinio on t h i s would mean a continued heightening of the federal p r o f i l e i n na-t i o n a l s o c i a l p o l i c y , and a l e v e l l i n g of benefits across the provinces, combined with a determined program of f i s c a l conservatism. 2.3.5 Implications f o r the Programs The impact of expected demographic changes has been estimated to have the e f f e c t s on federal program expenditures indicated i n Table 2.8.43 This expenditure pro j e c t i o n assumes no changes i n current programs, the demographic forecast mentioned e a r l i e r ( S t a t i s t i c s Canada Projection Number 3), p r o d u c t i v i t y growth of 2% a year, and no r a d i c a l changes i n labour force p a r t i c i p a t i o n . The proje c t i o n methodology i s described i n some de-t a i l i n Appendix 9. If these assumptions hold,then the increased tax bur-den implied, according to the authors, i s " s i g n i f i c a n t but c e r t a i n l y not r e v o l u t i o n a r y " ^ since less than 1% w i l l be added to the percent of GNP allo c a t e d to the e l d e r l y by 2011 (a r i s e of 15%), and the following two decades w i l l add only an ad d i t i o n a l 2.5% (a t o t a l r i s e of 67%). Powell and Martin hasten to add, however, that i f the retirement income system i s improved i n order to clear up the problems as seen from the i n d i v i d u a l perspective, then the proportion of GNP going to the e l d e r l y population w i l l increase a good deal further. That s i g n i f i c a n t pension reform i s already underway can be seen i n the federal proposals outlined i n Appendix 10, and for good reason as that submission points out. The e l d e r l y i n Canada are shown as heavily de-pendent on pub l i c programs f o r t h e i r income, since fewer have p r i v a t e pensions than i n most other western i n d u s t r i a l i z e d countries, leaving them much worse o f f than those who do. The pr i v a t e sector has a much . poorer record of employee pension plan coverage, and survivor benefits than the p u b l i c sector, but the r e a l value of non-indexed benefits from TABLE 'X. 8 1976 1981 1986 1991 1996 2001 2011 20 21 2031 P r o j e c t e d Expenditures, on Current Programs I m p l i c a t i o n s of the Changing Age S t r u c t u r e (1976 $) OAS (1) GIS (1) General A l l i e d Other CPP/OPP CAP WVA H o s p i t a l H o s p i t a l M e d i c a l T o t a l GNP Total/GNP 3,268 1,016 3,768 1,006 4 ,266 4 ,862 5,299 5,590 978 957 992 996 6,405 1,031 584 • 670 637 1,769 853 738 2,665 1,066 757 3,831 1,340 664 5,020 1,614 506 6,783 1,880 340 8,721 2,626 77 10 8,310 1,209 12,946 4,153 10,185 1,341 17,500 6,204 1,869 422 306 8,722 190,027 4.6% 2,379 537 389 11,434 231,554 4.9 2,974 671 487 13,863 275,501 5.0 3,742 844 613 16,853 318,410 5.3 4, 503: 1,016 739 19 , 687 366,467 . 5 .4 5,244 ,1,183 863 22,373 423,086 5.3 7,324 1,652 • 1,203 29,034 548,176 5.3 11,584 2,613 1,895 42,721 657,192 6.5 17,306 3, 904 2, 844 59, 2.77 765, 044 7.7' Note: (1) (2) I t must be emphasized t h a t i t i s assumed t h a t OAS/GIS payments are not e s c a l a t e d i n l i n e w i t h average v/ages and s a l a r i e s but o n l y w i t h the c ? r . Furthermore no c o s t r e d u c t i o n i n h e a l t h c a r e i s assumed a l t h o u g h cheaper methods of c h r o n i c care are p o s s i b l e . The t o t a l GNP a l l o c a t e d to the aged i s 7.2% i n c l u d i n g earned income and investment. T2") From: B.J. Powell and J.K. Martin, "Economic Implications of an Aging Society i n Canada", a paper prepared f o r the National Symposium on Aging, Ottawa 25-27, 1978. Reproduced by permission of J.K. Martin. o 61 a l l plans has been s e r i o u s l y eroded b y ' i n f l a t i o n . The roles of the two sectors i n the retirement income f i e l d are also being reconsidered as a r e s u l t of the importance that such vast funds as that of the CPP have acquired i n the past decade as ready sources of cheap c a p i t a l f o r pu b l i c development projects. In addition to these pressures f o r change, Monique Begin and Judy Erola among others continue to lobby within the federal L i b e r a l Cabinet f o r new pension programs to benefit the many single elder-l y women guaranteed only poverty-level incomes at present. So reform of the pension system seems i n e v i t a b l e , probably with dramatic cost implica-tions f o r the future. While increases i n the e l d e r l y dependency r a t i o are expected to be l a r g e l y o f f s e t by decreases i n the youth dependency r a t i o (see Table 2.2 and Figure 2.7), leading some researchers'^' to mini-mize the problem of the "rentenberg" or "pension mountain",47 the r e d i -r e c t i o n by governments of large budget sums from, say, education to health care i n l i n e with s h i f t i n g r a t i o s can hardly be expected to pro-ceed without great pressure from those who stand to lose to simply add on the required expenditures. For B r i t i s h Columbia's GAIN f o r Seniors pro-r gram the future i s one of increasing i n d i v i d u a l payments to fewer r e c i p i -ents as less e l d e r l y people q u a l i f y f o r benefits due to the increasing take-up of CPP b e n e f i t s . Without further change i n the program conditions, i t has been estimated that very few w i l l q u a l i f y f o r benefits i n 1996.48 Of course, without increases i n retirement income f o r those i n need, i t would be expected that the number of the aged currently i n receipt of p r o v i n c i a l welfare assistance would have increased s u b s t a n t i a l l y by that time. Although the province pays l i t t l e toward the cost of pension pro-grams, i t does foot a large share of the b i l l f o r health care services for the e l d e r l y . Some have estimated that those over 65 accounted f o r 34% of the t o t a l budgetary expenditures of the Ministry of Health i n 1980-81.^9 When one considers the heavy u t i l i z a t i o n of expensive medical, h o s p i t a l , and Long-Term Care services by the aged i t i s easy to understand why t h i s i s so. I f those over 65 i n t h i s province continue to consume health care at current rates, t h e i r care may take up over h a l f (of the health budget i n 2001, before the r e a l l y dramatic r i s e i n t h e i r numbers i s forecast. The LTC program has made projections of p r o v i n c i a l u t i l i z a -t i o n to 2001 based on CSB Population Projection of 10/80, and u t i l i z a t i o n rates of A p r i l 1981. This p r o j e c t i o n , shown i n Tables 2.9 and 2.10, and Figures 2.11 and 2.12, predicts that f o r those over 65 the number of f a c i -l i t y c l i e n t s w i l l increase by almost 82% by 2001, and the number of home-maker/adult day care c l i e n t s w i l l r i s e by about 73%. In each case the most dramatic increases are expected among those 85 and over, with those aged 75 to 84 next. Stone has pointed out that those e l d e r l y people over the age of 75 require s i g n i f i c a n t l y more health and s o c i a l services than the "young-old" (65-74), while those over the age of 80 are more i n need of personal care programs, including nursing home care.50 This implies then that increases i n health care expenditures i n the province over even the next twenty years can be expected to be s u b s t a n t i a l . But increases i n health care costs and u t i l i z a t i o n to 2001 w i l l pale beside those expec-ted i n the following three decades, as the baby boom children f i n a l l y reach t h e i r senior years and make t h e i r peak demands on the health care system. In a study of health care costs f o r the e l d e r l y i n Ontario to 2026, Gross and Schwenger found that expenditures on i n s t i t u t i o n a l services to the aged would l i k e l y double by 2001, and t r i p l e by 2026, r a i s i n g the t o t a l i n s t i t u t i o n a l budget by 25%, 62%, and 116% by 1986, 2001, and 2026 r e s p e c t i v e l y . 5 1 They also calculated that physician care costs. TABLE 2.9 PROJECTED NUMBER OF FACILITY' CLIENTS OVER AGE 65 BASED ON PROVINCIAL U T I L I Z A T I O N RATES OF A P R I L , 1981 (E.C.U.'S INCLUDED) 1981 65-74 2,879 75-84 6,215 8 5+ 7,774 ' 6 5+ .16,86 8 1986 1991 3,274 3,638 7,491 9,127 8,770 10,307 19,535 23,072 1996 2001 3,900 4,008 10,339 11,505 12,405 15,139 26,644 30,652 B a s e d on u t i l i z a t i o n r a t e s o f 1.6% (65-74), 7.5% ( 7 5 - 8 4 ) , 29.0% (85+), and 5.8% (65+). P r o j e c t e d numbers o f c l i e n t s d e r i v e d f r o m p o p u l a t i o n p r o j e c t i o n s o f t h e C e n t r a l S t a t i s t i c s B u r e a u , P r o j e c t i o n 10/80, 1981. From: R. Penner, "A Review and Update of U t i l i z a t i o n of Long-Term Care Services", Reference Paper 1, prepared f o r the Ministry of Health, V i c t o r i a , B.C., November, 1981, p. 1. (Mimeographed). Reproduced by permission of the author. ON TABLE 2710 PROJECTED NUMBER OF HOMEMAKER AND ADULT DAY CARE CLIENTS" OVER AGE 65 BASED ON " PROVINCIAL UTILIZATION RATES OF APRIL, 19 81 19 81 "19 86 * 1991 1996 2001 65-74 7,199 8,186 9,095 9 , 750 10,019 75-84 10,027 12,086 14,725 16 , 861 18,562 85 + 5, 201 5 , 867 6,895 8,298 1 0 , 1 2 8 ; 6 5+ 22,427 26,139 30,715 34,909 38,709 Based on u t i l i z a t i o n r a t e s of 4.0% (65-74), 12.1% (75-84), 19.4% (85+),! |and 7.7% (65+). P r o j e c t e d numbers of c l i e n t s d e r i v e d from p o p u l a t i o n • p r o j e c t i o n s of the C e n t r a l S t a t i s t i c s Bureau, P r o j e c t i o n 10/80, 'June, 1981. From: R. Penner, "Review and Update";; Reference Paper 1? p. 1. Reproduced by permission of the author. ON FIGURE 2.11 PROJECTED NUMBER OF FACILITY CLIENTS OVER AGE 65 BASED ON PROVINCIAL UTILIZATION RATES OF APRIL, 1981 (ECU'S included) PROJECTED NUMBER OF CLIENTS (000's) 30 -+-25 - 4 -20 15 10 -4-Based on utilization rates ol 1.6% (65-74), 7.5% (75-84), 20.0% (85-(-), and 5.8% (65+). Projected numbers of clients derived from population projections of the Central Statistics Bureau, Projection 10/80, June, 1981. 65+ 65-74 1981 1986 1991 1996 2001 From: R. Penner, "Review'and Update'', Reference Paper 1, p. 2. Reproduced by permission of the author. FIGURE 2.12 PROJECTED NUMBER OF HOMEMAKER AND ADULT DAY CARE CLIENTS OVER AGE 65 BASED ON PROVINCIAL UTILIZATION RATES OF APRIL, 1981 R. Penner, "Review and Update", Reference Paper 1, p. 3. f o r the e l d e r l y would increase less dramatically over 1976 values, by 20% i n 1986, 77% i n 2001, and 192% by 2026, r a i s i n g the budget f o r t h i s item by 18%, 39%, and 63% i n those years r e s p e c t i v e l y . 5 2 The experi-ence i n B r i t i s h Columbia can be expected to p a r a l l e l the Ontario projec-tions on the high side, due to i t s s l i g h t l y "older" age structure shown in Table 2.11. It almost goes without saying that the g e r i a t r i c boom can also be expected to place housing programs f o r the e l d e r l y under great s t r a i n , and with such units at a premium today the implications f o r the future are ominous. 2.4 THE INTERNATIONAL CONTEXT Canada i s a middle-old n a t i o n 5 ^ compared with those of Europe which have l e v e l s of the e l d e r l y i n t h e i r current populations not expected here u n t i l the next century (see Table 2.12). There i s much to be gain-ed from examining these "elder" nations to f i n d out how they have coped with t h e i r aging populations. Other countries are near the same "age" as Canada and face s i m i l a r demographic prospects i n the next several decades. These countries are i n the process of planning f o r t h e i r growing e l d e r l y population, and can o f f e r valuable ins i g h t s into the ways i n which d i f f e r e n t p o l i t i e s react to s i m i l a r s o c i a l problems. In t h i s section two of Canada's elders (the United Kingdom (U.K.), and the Federal Republic of Germany (FRG)),and two of i t s peers {the United States (U.S.), and Yugoslavia) are considered. 2.4.1 Canada's Elders The UK and FRG are both i n the old-old category of nations mention-ed e a r l i e r . With a population of about 56 m i l l i o n i n 1981, the UK i s TABLE 2.11 THE ELDERLY AS A PERCENT OF TOTAL POPULATION IN ONTARIO, B.C., AND CANADA: 1986 and 2001 1986 2001 Ontario 9.5 10.5 B.C. 11.0 11.4 Canada 9.8 10.9 Gross and Schwenger, Health Cave Costs for the Elderly in Ontario: 1976-2026, Table 39, p. 66, and B.C. Central S t a t i s t i c s Bureau, Population Projection 10/80 1980-2001, Table 2. TABLE 2.12: PERCENTAGE OF POPULATION AGED 65 YEARS AND OVER, SELECTED COUNTRIES, 1980 Percentage of Population Country (exact percentage) 65 Years and Over East Germany (16.3), Sweden (16.2) 16 Au s t r i a (15.5), West Germany (15.1) 15 United Kingdom/(14,9), Norway (14.6), Denmark (14.3), 14 Belgium (14.1) Luxembourg (13.9), Switzerland (13.7), France (13.7), 13 I t a l y (13.5), Hungary (13.4), Greece (13.3) Czechoslovakia (12.7), Bulgaria (12.0) 12 Finland (11.7), Netherlands (11.4), United States (11.2) 11 Ireland (11.1) Spain (10.9), Malta (10.8), Romania (10.4) 10 Uruguay (10.3), Portugal (10.3), Cyprus (10.0), Poland (10.0), USSR (10.0) Iceland (9.5), A u s t r a l i a (9.3), Barbados (9.2), New 9 Zealand (9.2), Yugoslavia (9.2), Canada (9.0\s? Japan (8.8), Argentina (8.6), Israel (8.3) 8 From: United Nations, Department of International Economic and Soc i a l A f f a i r s , Selected Demographic Indicators by Country, 1950-2000: Demographic Estimates and Projections as Assessed in 1980 (New York,: United Nations, 1981). expected to experience a slow r i s e i n i t s percentage of e l d e r l y people from the current l e v e l of around 15% to almost 17% by the middle of the next century (see Table 2.13). In the FRG about 15% of i t s 61 m i l l i o n people were over the age of 65 i n 1981. The proportion of the e l d e r l y i n the FRG has now peaked and w i l l decline s l i g h t l y before r i s i n g again i n about 18% i n the t h i r d decade of the next century (see Table 2.13). Both these countries provide current case-studies i n methods for coping with e l d e r l y populations not expected here u n t i l the 21st century. .4.1.1 The United Kingdom Once the leading c a p i t a l i s t nation with f a r - f l u n g possessions, the UK since World War 2 e s p e c i a l l y has been reduced to a minor economic power, struggling to renew i t s obsolete manufacturing plants, improve p r o d u c t i v i t y , and lower costs. Yet t h i s "prototypical Western l i b e r a l democracy" 5^ i s s t i l l viewed as a model welfare state with s o c i a l p h i -losophy and programs changing l i t t l e since the inaugurating post-war reforms despite the several s h i f t s i n government between the Labour and Conservative p a r t i e s . Even Mrs. Thatcher's d o c t r i n a i r e Conserva-t i v e government has moved slowly to reduce p u b l i c programs, and has l a t e l y encountered s t i f f opposition from within and without the party. B r i t i s h s o c i a l p o l i c y continues to be marked by the goals of u n i v e r s a l i -ty, comprehensiveness, and equality as i t s various programs demonstrates A unitary state with only two l e v e l s of government (central and l o c a l ) the UK has emphasized d i r e c t government administration of services with l o c a l a u t h o r i t i e s funded by central block grants and l o c a l l y c o l l e c t e d " r a t e s " f o r programs f o r which they are responsible. A ser i e s of laws passed a f t e r World War 2 i n the UK provide benefits covering health, income secu r i t y , housing and s o c i a l services. TABLE" 2 .13 PERCENTAGE OF POPULATION. AGED 65 AND OVER, SELECTED COUNTRIES, 1950-2050 YEAR FRG UK • ' US ' YUGOSLAVIA CANADA 1950 9.4 10.7 8.1 5.7 7.7 1955 10.1 11.3 8.8 6.0 7.7 1960 10.8 11.7 9.2 6.3 7.5 1965 11.9 12.0 9.5 6.7 7.7 1970 13.2 12.9 9.8 7.8 7.9 1975 14.3 13.9 10.5 8.6 8.5 1980 15.1 14.9 11.2 9.2 9.0 1985 13.8 14.9 11.7 8.4 9.4 1990 14.4 15.4 12.2 9.4 10.2 1995 15.0 15.3 12.4 11.1 10.7 2000 15.5 14.9 12.2 12.9 11.0 2025 18.1 15.8 15.8 18.4 16.7 2050 17.9 16.9 17'.4' From: United States, Department of Health, Education and Welfare, So c i a l Security Administration, Social Security in a Changing World (Washington, D.C: Health, Education, and Welfare, 1979), p. 91; United Nations, Department of International Economic and Social A f f a i r s , Selected Demographic Indicators by Country, 1950-2000: Demographic Estimates and Projections as Assessed in 1980 (New York: United Nations, 1981). There are three types of income-maintenance programs av a i l a b l e f o r older people. The basic national insurance scheme provides a cost-of-l i v i n g indexed f l a t - r a t e benefit financed by earnings-related contribu-tions to those r e t i r i n g at age 65 f o r men and 60 f o r women. Another benefit comes from a contributory wage-related plan sponsored by either p u b l i c or p r i v a t e employers. F i n a l l y , a means-tested s o c i a l a s s i s t a n -ce supplement guarantees a c e r t a i n income to a l l the e l d e r l y including cash benefits f o r reasonable r e n t a l costs and allowances f o r special needs. Almost a l l older people receive the basic pension, but about a quarter require the supplement since few are .covered by occupational plans, and t h e i r benefits remain r e l a t i v e l y low. The B r i t i s h National Health Service (NHS) o f f e r s health care with-out charge to a l l permanent residents, exempts a l l the e l d e r l y from drug user charges, and those r e c e i v i n g pension supplements from simi-l a r fees f o r dental care and p r o s t h e t i c devices. Health service to the aged i s comprehensive, with a stated community focus co-ordinated by general p r a c t i t i o n e r s under a c a p i t a t i o n arrangement. Important programs used include home nursing, health v i s i t i n g , meals-on-wheels, and chiropody (podiatry), although s t a t i s t i c s indicate that only a small proportion of the aged are a c t u a l l y served by community care ser-vices (see Table 2.14). Although the UK has also emphasized s e l f -help programs f o r many years, substantial numbers of older people re-main i n various forms of i n s t i t u t i o n a l care (see Table 2.15). Only a small proportion of B r i t i s h housing i s p r i v a t e l y rented (13% i n 1972) while h a l f i s owner-occupied and the remainder rented through l o c a l government and housing associations.^5 Buildings are often designed s p e c i f i c a l l y f o r the e l d e r l y , and the poor aged are given higher p r i o r i t y i n some cases. Housing and s o c i a l service de-! TABLE 2.J4 SOME ASPECTS OF COMMUNITY-BASED PROVISION, U.K., 1973 and 1976 Some aspects of community-based provision I Social Services0 A. Home Help Services Total persons over 65 attended Percentage of over 65 population served B. Meals Provided England 1973 1976 448,700 570,400 8.7% England 1973 1976 Total meals provided at home 18,147 24,346 Total meals provided in luncheon clubs etc. 10,406 16,198 Total persons served with meals in own home 158,000 171,500 Percentage of over 65 population served at home 2.6% cDepartment of Health and Social Security. Health and personal Social Services Statistics 1977. Some aspects of community-based provision II (Health) A. District Nurse Services to people in their own homes England 1973 1976 Total persons over 65 attended0 1,028,100 1,294,400 Percentage of over 65 population served0 16.7% Elderly patients as percentage of total workload^ 50% (approx.) B. Health Visiting Services England 1973 1976 Total persons over 65 attended0 660,100 674,200 Percentage of over 65 population served0 8.7% Elderly as percentage of total workload 15% (approx.) ; 'Department of Health and Social Security. A Happier Old Age. 1978. From: Caroline Godlbve: and Anthony Mann, "Thirty Years of the Welfare State: Current Issues i n B r i t i s h S o c i a l P o l i c y f o r the Aged", Aged Cave and Sevvioes Review 2 (January 1980), p. 12. Reproduced by permission of the authors. TABLE 2.15 s A Summary of The Main Forms of Long Term* Institutional Care Persons over 65 accommodated 1976-ENGLAND Hospital beds — Geriatric0 Hospital beds - Psychiatric' 51,300 41,742 99,027 21,320 23,788 20,000 (1975) Local Authority Homes0 Private residential Homes' Voluntary residential homes0 Private and Voluntary Nursing homese TOTAL 257,177 Over-65 population of England3 6,641,000 % of over-65 population in all forms of institutional care 3.9% •Since "long-term care" is not a categorisation used in the collection of official statistics, these figures are necessarily a rough approximation. aAge Concern Research Unit. Profiles of the Elderly. Age Concern Publications, 1977. department of Health and Social Security. Health and personal Social Services Statistics 1977. department of Health and Social Security. In-patient statistics from the mental health enquiry for England 1975. ^Estimate - from Registered Nursing Homes Association - D.H.S.S. does not collect this data. Godlove and Mann, p. 13. Reproduced by permission of the authors. partments co-operate to ensure warden services, necessary equipment and adaptations f o r older residents. Despite an impressive array of services f o r the e l d e r l y i n the UK i n the categories mentioned above, and a national focus on the problem of aging i n recent years, programs are widely considered inadequate. Many f e e l that pensions are too low, ( e s p e c i a l l y with continuing i n -f l a t i o n ) and that health, housing, and s o c i a l services f o r the aged are inadequate. .4.1.2 The Federal Republic of Germany Structured much l i k e Canada governmentally, the Federal Republic of Germany (FRG) i s a federation of ten states (plus West Berlin) which are i n turn composed of self-governing communes. Each l e v e l of government has s i g n i f i c a n t powers of taxation and corresponding res-p o n s i b i l i t i e s i n the s o c i a l p o l i c y f i e l d . The federal government . may pass permissive l e g i s l a t i o n intthe health and p u b l i c welfare f i e l d s , and grant cash benefits but the states share l e g i s l a t i v e res-p o n s i b i l i t y and fund in-kind benefits,and the communes administer these services at the l o c a l l e v e l . German s o c i a l p o l i c y h i s t o r i c a l l y developed from a p a t e r n a l i s t i c base to the present s o c i a l state model i n which the equalization of burdens i n the i n t e r e s t s of s o c i a l jus-t i c e has become the dominant goal. The FRG has made services for the aged, e s p e c i a l l y i n the health f i e l d , the major target f o r i t s s o c i a l budget f o r the l a s t several years. The country's a b i l i t y to finance growing s o c i a l programs has been helped by rapid growth following post war reconstruction and modernization that has made the German economy the strongest i n Europe. The FRG has also benefitted from the a v a i l a -b i l i t y of a large number of migrant workers from neighbouring countries who are i n e l i g i b l e f o r many s o c i a l b e n e f i t s . Only i n the past year or two, under the influence of the current world-wide recession, has the FRG f a l l e n prey to the increasing rates of i n f l a t i o n and unemployment that most other nations have experienced f o r almost a decade. The So c i a l Democratic party which has dominated German p o l i t i c s since World War 2 has c o n s i s t e n t l y avoided d i r e c t government provisions of services where possible and protected marketplace incentives, while b u i l d i n g a widely-praised s o c i a l insurance system and a health insurance system that r i v a l s that of the UK. The FRG maintains a compulsory, f u l l y - i n d e x e d 5 ^ s o c i a l insurance scheme that provides generous pensions on retirement based on a contribu-tory, wage-related plan administered by quasi-public insurance funds,, as v W e l l as a means-tested s o c i a l assistance b e n e f i t . Most older Germans receive pensions which comprise the bulk of their'income, but the small portion (6%) dependent on s o c i a l assistance i s r a p i d l y dominating that program's r e c i p i e n t group. 5^ Additional cash benefits and services may also be provided to needy e l d e r l y c i t i z e n s . Almost the en t i r e population, including a l l aged people, are i n -sured f o r medical, dental, h o s p i t a l , pharmaceutical, and pros t h e t i c services under a large number of independent sickness funds which con-t r a c t f o r services required. Needy older people may also receive cash benefits f o r home-help and home nursing services mostly provided by vo-luntary agencies funded l a r g e l y by user fees. Community support ser-v i c e s , however, are d i f f i c u l t to obtain i n many areas as coverage and manpower remains inadequate. Comprehensive s o c i a l service centres are being established to co-ordinate the work of l o c a l voluntary agencies, which also run s o c i a l centres f o r the aged providing personal care, counselling, and l e i s u r e a c t i v i t i e s . '!.'.'•' Although the FRG has devoted considerable e f f o r t to increasing the supply of housing f o r the e l d e r l y over the past twenty years, i t i s s t i l l considered inadequate. Rent subsidies are provided on a means-tested basis and assistance to the aged i n l o c a t i n g , adapting, and maintaining housing i s guaranteed by law. About 5% of the e l d e r l y are i n s t i t u t i o n a -l i z e d (most under pu b l i c auspices) and the number of beds i n such f a c i -l i t i e s i s s t i l l thought too few despite an ongoing emphasis on community support services to prolong own-home residence as much as pos s i b l e . A v a r i e t y of sheltered housing i s planned to be greatly expanded i n future, but so f a r such u n i t s have proven too expensive even with r e n t a l subsi-dies, and coverage (about 1%) and a v a i l a b i l i t y are very poor.-^ It i s c l e a r that the German emphasis on insurance systems i n the income and health f i e l d s has paid dividends to the aged i n high q u a l i t y service i n these programs, but l e f t the important areas of housing and s o c i a l services i n serious disarray. This contrasts sharply with the B r i t i s h emphasis on the l a t t e r areas as part of a generally more c o l l e c -t i v i s t approach to s o c i a l p o l i c y . .4.2 Canada's Peers The United States (US) and Yugoslavia are close to Canada's "age" in demographic terms f a l l i n g into the middle-old and young-old catego-r i e s r e s p e c t i v e l y . Those aged 65 and over comprised about 11% of the t o t a l US population of 226 m i l l i o n i n 1981, but t h i s proportion i s ex-pected to r i s e to about 16% by 2025 (see Table 2.13). About 9% of the Yugoslavian population of around 22 m i l l i o n were at least 65 i n 1981, with t h i s proportion expected to r i s e to about 13% by the turn of the century, and pass 18% by 2025 (see Table 2.13). These nations, l i k e Canada, are beginning to plan f o r the e l d e r l y boom to come i n the next century. Their strategies can serve as a l t e r n a t i v e models f o r planners i n t h i s country to consider. .4.2.1 The United States The US s t i l l boasts massive domination of the world economy and, while presently reasserting i t s t r a d i t i o n a l free enterprise e t h i c under President Reagan, i t s tremendous wealth has permitted the development of a welfare state system, i f less well developed than elsewhere, since Roosevelt's New Deal of the 1930's. The US i s a very p l u r a l i s t i c and c u l t u r a l l y diverse l i b e r a l democracy that has evolved into a highly cen-t r a l i z e d p o l i t i c a l bureaucracy with f e d e r a l , state, and l o c a l municipal l e v e l s of government bound together through c o n s t i t u t i o n a l l y separated powers. Federal i n i t i a t i v e and superior f i n a n c i a l means have made that l e v e l dominant in s o c i a l f i e l d s over the past few decades with a multi-p l i c i t y of programs o r i g i n a t i n g from ei t h e r the executive or l e g i s l a t i v e branch of government now administered under the gigantic Department of Health, Education, and Welfare. With many s o c i a l programs funded through federal grants to state agencies and delivered through municipal systems, a lack of nation-wide planning has often led to services that are f r a g -mented and vary widely in q u a l i t y and a v a i l a b i l i t y . The Older Americans Act (1965) provided funds for planning and co-ordinating services f o r the aged at the state l e v e l and below, but so f a r t h i s has not resolved the o v e r a l l planning problem. This disorganization has resulted from continuing reluctance concerning greater federal intervention, and a CO general ambivalent a t t i t u d e toward the r o l e of government i n society. In general, as has been noted e a r l i e r i n the German federal system, the senior government provides cash benefits through permissive l e g i s l a t i o n while r e s p o n s i b i l i t y f o r services and in-kind benefits are l e f t to the state and municipal governments. The federal government administers the standard s o c i a l s e c u r i t y be-n e f i t s under the Old Age Survivors D i s a b i l i t y Insurance (OASDI) program provided f o r i n the Social Security Act (1935) and i t s amendments. This i s a contributory retirement benefit to about 90% of the aged beginning at age 65 f o r men and 62 f o r women, or at age 72 regardless of employ-ment status. A means-tested supplementary benefit, Supplementary Secu-r i t y Income (SSI), i s also a v a i l a b l e f o r those not covered by OASDI or rece i v i n g only the minimum be n e f i t . Occupational pensions are increas-i n g l y a v a i l a b l e but s t i l l represent a minor source of income f o r the e l d e r l y as a group. The pu b l i c programs have been credited with the drop i n poverty rates among the e l d e r l y from 35% to 14% between 1959 and 1978, although t h i s rebounded i n 1979 to 15%, and continuing high i n f l a t i o n promises to further erode the income status of the aged. Mea-sures currently before the US Congress, i f approved, would have the ef f e c t of reducing the adequacy of future OASDI payments.^ The US has had a universal health insurance program f o r the e l d e r l y , Medicare, since 1965 which pays about h a l f the t o t a l medical expenses of the aged. The program i s funded by a p a y r o l l tax shared by employers and employees, and the revenue from a supplementary voluntary medical insurance program whose premiums are shared between the i n d i v i d u a l and general federal revenue. Medicare covers acute h o s p i t a l care and r e l a -ted physician services, but not nursing home care, home care, drugs, den^ t a l or o p t i c a l services. About h a l f the e l d e r l y i n the US have private health insurance to supplement Medicare, and a j o i n t f e d e r a l / s t a t e pro-gram, Medicaid, supplements Medicare f o r the low-income e l d e r l y and pro-vides f o r t h e i r long-term care. With health expenditures i n the US s t i l l increasing r a p i d l y , a number of cost-containment strategies are being tested, and home health services are rec e i v i n g more attention as a lower cost a l t e r n a t i v e to i n s t i t u t i o n a l i z a t i o n f o r some of the aged. These economizing e f f o r t s notwithstanding, some have predicted a doubling of the federal budget f o r long-term care i n the next f i v e y e a r s . ^ There has been some federal l e g i s l a t i o n i n the US to expand the sup-pl y of housing f o r the aged, but the r e s u l t s to date are very inadequate. The congregate housing that has been developed includes both personal care f a c i l i t i e s and s p e c i a l l y designed multiple-unit housing and r e t i r e -ment communities. But most e l d e r l y people l i v e i n ordinary single dwel-li n g s or apartments, many of which are considered substandard, and there are long waiting l i s t s f o r scarce s p e c i a l housing f o r the aged. These l a t t e r u n i t s are usu a l l y b u i l t with l i t t l e or no co-ordinated planning at the fede r a l or state l e v e l . The American income, health, and housing programs f or the aged suf-f e r from a lack-of national and state commitment that i s perhaps a re-f l e c t i o n of the pervasive US i d e a l of the rugged i n d i v i d u a l i s t , and a general d i s t r u s t of government intervention. Though demographically somewhat older than Canada at present, the country s t i l l appears i l l -prepared to cope with the huge numbers of e l d e r l y people expected i n the years ahead. .4.2.2 Yugoslavia Unlike the other countries surveyed so f a r , Yugoslavia i s a s o c i -a l i s t state now described as pursuing a course of "market soc i a l i s m " i n i n which a m u l t i p l i c i t y of diverse i n t e r e s t groups p a r t i c i p a t e i n a highly decentralized system of p o l i t i c a l decision-making.^ Created a f t e r World War 1 and reestablished a f t e r World War 2, Yugoslavia i s comprised of one republic f o r each of the f i v e national groups, plus a "mixed" republic, and two lesser developed provinces attached to the Ser T bian re p u b l i c . There i s a central (federal), republic, and commune l e v e l of government i n the country through which p o l i c y concerns percolate i n an e f f o r t to ensure that the nation's c u l t u r a l and r e l i g i o u s groups, as well as other i n t e r e s t groups have a say in most decisions. This p a r t i -cipatory process i s c a r e f u l l y circumscribed by formal and informal struc-tures at the -federal l e v e l designed to control foreign p o l i c y , s e c u r i t y , large-scale i n d u s t r i a l development and so on, with the S o c i a l i s t A l l i a n c e and i t s vanguard, the Communist Party, enjoying formal c o n s t i t u t i o n a l r i g h t s N e v e r t h e l e s s the nation has been able to maintain i t s unity i n the face of formidable d i v e r s i t y l a r g e l y as a r e s u l t of an e f f e c t i v e p a r t i c i p a t o r y p o l i t i c a l system. Despite t h i s , wide v a r i a t i o n s i n s o c i a l conditions p e r s i s t between republics and regions within the country. In terms of s o c i a l p o l i c y the Federation and the several republics share r e s p o n s i b i l i t y f o r formulation of standards while implementation and ser-v i c e d e l i v e r y i s l e f t to the communes or t h e i r sub-units. An underdevelop-ed country a f t e r World War 2, Yugoslavia has achieved great economic growth since, coupled with rapid i n d u s t r i a l i z a t i o n and urbanization. S t i l l i t remains a r e l a t i v e l y poor r u r a l nation, dependent on other indus-t r i a l i z e d European countries f o r the employment of a sizeable part of i t s labour force as migrant workers. The current recession has led to lay-o f f s of these workers i n the FRG and elsewhere, and t h e i r return to Yugo-s l a v i a has created an instant unemployment c r i s i s . Yugoslavia has a system of s o c i a l insurance benefits administered by self-governing associations f o r i n v a l i d i t y and pensions, organized by the republic s , and co-ordinated by national unions. The pensionable age i s 65 f o r men and 60 for women but the varying coverage i s very l i -mited and benefits low (though linked to the cost of l i v i n g ) . S o c i a l assistance i s also a v a i l a b l e f o r the needy aged with means-tested cash benefits which are again quite low. In 1972 only 22% of the e l d e r l y i n Serbia had a regular income from a pension or s o c i a l a s s i s t a n c e . ^ As a r e s u l t the main source of income support f o r the aged i s s t i l l the f a -mily, and the p r i n c i p l e of r e l a t i v e r e s p o n s i b i l i t y remains i n Yugoslavian law to compel children to provide f o r needy parents. Yugoslavia also has numerous tax benefits and exemptions for the low-income e l d e r l y . The country's s o c i a l insurance system includes cash sickness and maternity benefits administered by health insurance associations organi-zed on a regional basis, and again coordinated by a national union. Ser-b i a provides free medical care f o r the e l d e r l y covering treatment, drugs, and transportation, but benefits vary i n the other republics as with most s o c i a l programs. Long-term care f a c i l i t i e s are very inadequate with space f o r less than 1% of the aged i n i n s t i t u t i o n s i n Serbia, the most advanced of the republics i n t h i s regard. Home care i s almost non-exis-tent and congregate housing i s extremely l i m i t e d increasing the demand fo r i n s t i t u t i o n a l care.64 Community support services are also very scar-ce, comprised of senior centres, a mobile variant of a homemaker-home-health aid c a l l e d a "gerontomaid", and l o c a l general s o c i a l work centers with wide l a t i t u d e but l i m i t e d means. Yugoslavia i s hampered i n i t s planning f o r the e l d e r l y by economic problems, and great regional d i s p a r i t i e s . So f a r the country has been unable to mount adequate programs i n any of the categories considered despite wide recognition of t h e i r need. Without substantial economic growth i t appears l i k e l y that e x i s t i n g services w i l l be overwhelmed by the increasing number of older people forecast i n the years ahead. 83 2.4.3 Understanding S o c i a l Development Richard Rose has put the extreme case most s u c c i n t l y : "votes count, resources decide".65 The example of Yugoslavia shows that without a cer-t a i n l e v e l of s o c i e t a l wealth, even the most people-oriented governmental system w i l l be unable to d e l i v e r needed s o c i a l programs f o r i t s older people. But, given t h i s minimum prosperity, enjoyed by a l l the other countries surveyed, the influence of culture, h i s t o r y , and ideology i n shaping the p a r t i c u l a r programs offered to the aged can be s u b s t a n t i a l . The wealthiest nation examined, the US, has programs that can cha-r i t a b l y be described as unco-ordinated and inadequate, whereas the UK's superior package of income, health, and housing programs are financed out of the smallest GNP i n the group aside from Yugoslavia. Though the preponderance of welfare states among the elder European countries sug-gests strongly that the demographic t r a n s i t i o n may i t s e l f propel a na-t i o n toward greater s o c i a l i z a t i o n of services for the aged (among others), notable differences already mentioned point to other underlying factors as well. It i s sometimes suggested that the lengthier national h i s t o -r i e s of the UK and FRG (heir to German and Prussian t r a d i t i o n s ) may have moved t h e i r populations to the point of acceptance of c o l l e c t i v e res-p o n s i b i l i t y f o r s o c i a l problems chronologically e a r l i e r than younger na-tions l i k e the US and Canada. Since Germany i n s t i t u t e d p u b l i c pensions i n 1889, and the UK i n 1908 t h i s theory at f i r s t seems p l a u s i b l e , but A u s t r a l i a and New Zealand provide counterexamples (1898 and 1901 respec-t i v e l y ) , and i t seems probable ( i n t u i t i v e l y ) that a search f o r any s i n -gle causal element i n the development of programs f o r the e l d e r l y i s destined to s i m i l a r f a i l u r e . In f a c t a host of influences are most l i k e -l y responsible f o r such a complex s o c i a l process, although many of them might u s e f u l l y be grouped under the r u b r i c of national ideology. A good case can be.made f o r the importance of h i s t o r y i n the deve-lopment of a nation's ideology, by considering the impact on several na-tions of the catastrophic events of the 1930's and 1940's. C e r t a i n l y Lord Beveridge's s o c i a l insurance scheme i n the UK was an attempt to s o l i d i f y a sense of national commitment following the s a c r i f i c e s made by most Britons during the Depression and War years. Hard economic times also made President Roosevelt's New Deal acceptable to US voters, and the FRG's emphasis on equality i n s o c i a l p o l i c y may well r e f l e c t some national response to the horrors of the Nazi holocaust. In Canada, too, the wartime experience produced widespread support f o r s o c i a l programs of a l l types to guarantee standards of l i v i n g that everyone had helped to make possible through the war e f f o r t . In seeking to understand the influences underlying n a t i o n a l pro-grams f o r the e l d e r l y one can learn from the model of the crime inves-t i g a t o r , who attempts to i d e n t i f y suspects with the capacity, motivation, and opportunity to act. A reasonable l e v e l of economic prosperity i n a country give i t the capacity to enact s o c i a l programs, i t s p e c u l i a r c u l -ture and h i s t o r y combine somehow through a national ideology to produce a c e r t a i n l e v e l of motivation, and a set of events (including elections) and p e r s o n a l i t i e s l i n e d up i n conjunction may create the opportunity to act. Later i n t h i s paper the processes of s o c i a l change w i l l be consi-dered i n more d e t a i l as part of an examination of planning s t r a t e g i e s . THE PROBLEM OF DATA The challenge of coping with the demand f o r programs f o r the e l d e r l y i n B r i t i s h Columbia as the population ages over the next several decades should be obvious from the information presented above. Previous sec-tions have sketched the outlines of the dilemma by using data c o l l e c t e d i n d i f f e r e n t ways at a number of times, and at various le v e l s of analy-s i s . For a general portrayal of the s i t u a t i o n as a whole i n order to examine t h e o r e t i c a l models, and consider planning strategies (the tasks of Chapters 3 and 4 r e s p e c t i v e l y ) , t h i s sort of data analysis w i l l suf-f i c e . For the d e t a i l e d program planning which i t i s suggested should soon proceed, however, i t most c e r t a i n l y w i l l not do. Careful studies of u t i l i z a t i o n , cost, and r e s u l t s of programs f o r the e l d e r l y are essen-t i a l i f decision-makers are to plan e f f e c t i v e l y f o r an aging population, but these research endeavours are greatly complicated by the inadequacy of e x i s t i n g data on senior c i t i z e n s i n B r i t i s h Columbia. In an e f f o r t to address the problem of data t h i s poses, the various primary sources of data on the aged i n t h i s province have been tabulated i n Appendix 11, and suggestions f o r improving the q u a l i t y of t h i s information w i l l be " included i n the recommendations of the concluding chapter of t h i s re-port . 86 3. PARADIGMS The analysis of t h i s chapter l i n k s the information presented i n the l a s t with strategies for action to be developed i n the next. It begins by exploring the p h i l o s o p h i c a l and i d e o l o g i c a l values that per-vade s o c i a l theory and have t h e i r i n e v i t a b l e e f f e c t s upon s o c i a l p b l i c y making ;as'.demonstrated by the examples of the foreign countries describ-ed" above. In h i g h l i g h t i n g important influences underlying s o c i a l theo-r i z i n g t h i s f i r s t section makes e x p l i c i t conceptual b a r r i e r s to be surmounted i n the analysis to follow. A method of analyzing competing s o c i o l o g i c a l paradigms i s then described, and used to c l a s s i f y a v a r i e t y of approaches i n s o c i a l gerontology that attempt to explain the experi-ence of e l d e r l y people in society today. The r e s u l t i n g t h e o r e t i c a l groupings are next evaluated in terms of t h e i r a b i l i t y to describe the information presented i n Chapter 2, and to prescribe useful p o l i c y a l t e r -natives f o r those responsible f o r planning for the aging population. This leads to the elaboration of that paradigm seen as most appropriate to the planning task, and sets the stage for the p r a c t i c a l s t r a t e g i c con-siderations of Chapter 4. 3.1 VALUES, PHILOSOPHIES, AND IDEOLOGIES In Section 2.4 a number of d i f f e r i n g state responses to the f a m i l i a r s o c i a l problems posed by an aging population were described i n the con-text of p a r t i c u l a r national philosophies and ideologies seen as providing the motivation f o r p o l i c y development. This section examines these impor-tant underlying influences more c l o s e l y to reveal the ways i n which they exercise t h e i r e f f e c t s and to s e n s i t i z e the reader to conceptual b a r r i e r s i n the analysis to follow. It i s necessary f i r s t to c l a r i f y the terms of the discussion by defining what i s meant by values, philosophies and ideologies, and how these concepts have been viewed by s o c i a l t h e o r i s t s . 87 The development of p o l i t i c a l and s o c i a l ideologies i n Western democracies i s then discussed with reference to the foreign examples c i t e d above, and the si t u a t i o n s i n Canada and B r i t i s h Columbia are considered. The section concludes with a statement of the i d e o l o g i c a l obstacles to be overcome i n the subsequent analysis. 3.1.1 D e f i n i t i o n s and Concepts The following d e f i n i t i o n s , suggested by Oxford, w i l l be used here: Value: that which i s worthy of esteem f o r i t s own sake; that which has i n t r i n s i c worth Philosophy: a p h i l o s o p h i c a l system or theory, the system which a person forms f o r the conduct of l i f e Ideology: a system of ideas concerning phenomena, e s p e c i a l l y those of s o c i a l life1 Crichton has pointed out how s o c i a l philosophies, underpinned by p a r t i c u l a r values, are t r a n s l a t e d through various stages i n t o s o c i a l ser-vices, as shown i n Figure 3.1. 2 In her view, ideologies are r e l a t i v e l y s p e c i f i c ways of implementing broad ph i l o s o p h i c a l goals (e.g. equality, l i b e r t y , j u s t i c e e t c . ) , but both depend on t h e i r respective i n d i v i d u a l ' and c o l l e c t i v e valuations by the members of society. For Geertz, ideo-logies are better explained as part of a continuing e f f o r t to correct psycho-sociological d i s e q u i l i b r i u m i n society (the s t r a i n theory), than weapons i n the struggle f o r advantage (the in t e r e s t theory).3 He also suggests that ideologies are important mechanisms f o r dealing with c u l -t u r a l s t r a i n , by acting as "maps of problematic s o c i a l r e a l i t y " . 4 Crichton adds that such maps may vary greatly i n scope and content, and depend on exposure, i n t e l l i g e n c e , and motivation f o r t h e i r p r a c t i c a l use.5 She suggests that ideologies act as guides to p a r t i c i p a n t s i n FIGURE 3.1 PARADIGM SHOWING STAGES IN THE PROCESS OF TRANSLATING SOCIAL PHILOSOPHIES INTO SOCIAL SERVICES Ideologies re: e.g.. Resources development and distribution Science Human rights Economic elites and subeliies Delegation back Government Policy Planning— selection of broad ideological goals determination of priorities on ideological grounds consideration of the general will-legitimizing decisions development of definitions, categories and classes-determining feasibility development of legislation and regulations development of standing plans Administrative Planning-(unhtr considerations of legitimacy-specific support ' further considerations of feasibility-specific planning further negotiations relating to structures, processes, resource allocation development of structures and process through resource allocations (rationing finances) & management (coordination 4 control) development of contracts of service Program Planning-furihcr development, as above Political Negotiation -consideration of levels of legitimacy considerations of feasibility-structures, processes of giving service, resource allocation short <& long term considerations-priorities, tradeoffs, analyzing specific and diffuse support, pursuit of positional policies consideration of central & local government jurisdictions consideration of political, economic & other jurisdictions Political negotiation-as above Political negotiation -as above Structures and Processes Service Delivery-receiving individual demands —rationing these demands on time of professionals diagnosing and labelling gatekeeping & allocating treatment services (rationing services) regulating deviance from social norms Feedback loail levels From: Anne Crichton, Health Policy Making: Fundamental Issues in the United States, Canada, Great Britain, Australia (Ann Arbor, Mich.: Health Administration Press, 1981), p. 279. Reproduced by permission of the author and publisher. the unending negotiation process i n the p o l i t i c a l , socio-economic, and c u l t u r a l spheres i n which s o c i e t a l change mainly takes place.^ While one i s accustomed to the idea of ideology as i t pertains to the p o l i t i c a l realm, the notion of r e l a t e d s o c i a l ideologies i s less well understood, perhaps because the b e l i e f s themselves are so commonly accepted. In f a c t , many s o c i a l t h e o r i s t s have asserted the p o s s i b i l i t y of a value-free approach i n the study of s o c i a l organization, though Myrdal and others have since argued strongly against t h i s and i n favour of a c l e a r state-ment of one's own value o r i e n t a t i o n . ^ Following the l a t t e r p o s i t i o n , my own bias i n approaching s o c i a l theory w i l l be discussed at the end of t h i s section. .1.2 P o l i t i c a l and S o c i a l Ideologies Crichton has described the evolution i n the s o c i o - p o l i t i c a l order of Western l i b e r a l democracies from a r i s t o c r a t i c dominance, through l a i s s e z - f a i r e c apitalism, to modern capitalism, or what i s often termed the welfare s t a t e . ^ The two strongest influences i n the l a t t e r s h i f t have been the philosophies of u t i l i t a r i a n i s m and humanitarianism, U t i -l i t a r i a n s ( l i k e Jeremy Bentham and John Stuart M i l l ) persuaded entre-preneurs that s o c i a l reforms would improve the supply and q u a l i t y of l a -bour and hence act i n t h e i r own best i n t e r e s t s , whereas humanitarians ( l i k e William Booth and B. Seebohm Rowntree) appealed f o r change on mo-r a l or r e l i g i o u s grounds alone. A simple scheme f o r analyzing the modern p o l i t i c a l ideological des-cendants of these philosophies can be constructed by l a b e l l i n g that ad-hering to the o r i g i n a l l a i s s e z - f a i r e tenets as conservative, the u t i l i -t a r i a n o f f - s p r i n g as l i b e r a l , and the humanitarian counterpart as s o c i a -l i s t ( s o c i a l democratic). These broad categories can be adequately d i s -tinguished by t h e i r r e s o l u t i o n of the c l a s s i c tension between l i b e r t y and e q uality i n any society. As Figure 3.2 shows, conservatives are seen as those who believe i n l i b e r t y above a l l else, s o c i a l i s t s as those valuing equality of condition? most highly, while l i b e r a l s attempt to resolve the dilemma by tempering l i b e r t y with equality of opportunity. Of course, l i k e most simple schemes, t h i s one ignores much of the com-plex r e a l i t y that l i n k s ideologies and phil o s o p h i c a l goals, but i t w i l l serve well enough to f a c i l i t a t e the discussion to follow. Though the u t i l i t a r i a n and humanitarian philosophies appear i n d i f -ferent mixtures i n the Western democracies, Marchak has pointed out that l i b e r a l ( u t i l i t a r i a n ) ideas are generally dominant, with s o c i a l i s t s (hu-manitarians) i n a free society u s u a l l y providing the counter ideology.10 In f a c t , since she wrote, p o l i t i c a l and s o c i a l developments i n several Western countries have indicated a s h i f t to the conservative r i g h t with t h i s p o l i t i c a l force i n some cases overcoming the l i b e r a l (US) or socia-l i s t (UK) incumbent to assume again a p o s i t i o n of i d e o l o g i c a l dominance. 1 1 Marchak explains the s u r v i v a l of l i b e r a l i s m by i t s pragmatic willingness to adopt ideas and p o l i c i e s from the r i g h t or l e f t when t h i s appears expedient,12 and the pendulum swings of l i b e r a l i s m on t h i s continent at least amply attest to that. The conservative, l i b e r a l , and s o c i a l i s t p o l i t i c a l ideologies have each given r i s e to a s o c i a l ideology that acts as a map or guide to those involved i n negotiating the s o c i a l order. Titmuss suggested that three s o c i a l p o l i c y models can be d i s t i n g u i -shed i n Western democratic nations: the res i d u a l welfare model, the i n d u s t r i a l achievement performance model, and the i n s t i t u t i o n a l r e d i s -t r i b u t i v e model.13 Th e strongest connections between the various p h i l o -sophies, p o l i t i c a l and s o c i a l ideologies are i l l u s t r a t e d i n Table 3.1. This table shows the US as the nation best exemplifying a r e s i d u a l wel-FIGURE 3.2 DISTINGUISHING FEATURES OF POLITICAL IDEOLOGIES TABLE 3.1 PHILOSOPHY AND IDEOLOGY IN SOCIAL THEORY IDEOLOGIES PHILOSOPHIES EXAMPLE POLITICAL SOCIAL l a i s s e z - f a i r e conservative r e s i d u a l welfare US u t i l i t a r i a n l i b e r a l i n d u s t r i a l achievement performance FRG humanitarian s o c i a l i s t i n s t i t u t i o n a l r e d i s t r i b u t i v e UK fare s o c i a l ideology corresponding to conservative l a i s s e z - f a i r e p r i n c i -p l e s , the FRG's i n d u s t r i a l achievement performance model i s seen as the s o c i a l embodiment of i t s dominant u t i l i t a r i a n l i b e r a l ideology, and the i n s t i t u t i o n a l r e d i s t r i b u t i v e s o c i a l ideology i n the UK i s linked to i t s humanitarian s o c i a l i s t emphasis. This c l a s s i f i c a t i o n i s supported by the descriptions of services f o r the e l d e r l y i n these countries i n Section 2.4 above, and begs the question of how one would c l a s s i f y Canada and B r i t i s h Columbia accordingly. Canadian s o c i a l ideology generally follows the achievement model, although some re s i d u a l and r e d i s t r i b u t i v e elements are incorporated i n t h i s as w e l l . This wide-ranging s o c i a l model r e f l e c t s the breadth of an adaptive l i b e r a l ideology i n Canada that has dominated f o r most of t h i s century by a r t f u l borrowing of p o l i c i e s from those on i t s p o l i t i -c a l l e f t and right.14 i n B r i t i s h Columbia the u t i l i t a r i a n l i b e r a l ideology has also dominated f o r many years, withstanding increased .... challenges from the humanitarian s o c i a l i s t s by adopting variants of t h e i r p o l i c i e s , and coalescing with elements from the conservative r i g h t . With respect to programs f o r the e l d e r l y , both le v e l s of govern-ment have opted f o r the r e d i s t r i b u t i v e model i n health care (medical and h o s p i t a l s e r v i c e s , Long-Term Care, Pharmacare, and the Dental Care Plan), but r e t a i n the r e s i d u a l model f o r some income programs (GIS/SPA, GAIN), and the r e d i s t r i b u t i v e f o r others (OAS), while attempting to develop further the achievement model through the C/QPP. Housing pro-grams (e.g. SAFER) at both levels have us u a l l y been re s i d u a l i n nature. 1.3 B a r r i e r s to S o c i a l Analysis Marchak has put the problem t h i s way: I f society i s judged within i t s own terms, and those terms a r i s e e a s i l y from the kind of s o c i a l organization i t supports, i t s members do not seek r a d i c a l solutions to organizational problems. Many, indeed, w i l l not perceive any problem, a t r i -bute to the success of the ideology i n appearing to account f o r events and to r e a l i z e i t s own values.15 It has been suggested i n Chapter 2 that society faces a formidable chal lenge i n planning f o r i t s aging population i n the years ahead. A serious b a r r i e r to analysis of t h i s and other s o c i a l problems must then be recognized i n the comfortable l i b e r a l ideology that p r e v a i l s i n t h i s province and the nation as a whole, spawning an uncoordinated s o c i a l p o l i c y whose only consistent r e d i s t r i b u t i v e emphasis appears i n the health system. Meeting the challenges of an aging s o c i e t y requires considering a l l a l t e r n a t i v e s f o r future programs, including those that deviate from the accepted s o c i a l ideology. For my own part I s h a l l t r y to check my own bias toward i n s t i t u t i o n a l r e d i s t r i b u t i o n which flows from a humanitarian s o c i a l i s t o r i e n t a t i o n , and consider approache that o r i g i n a t e from a l l parts of the i d e o l o g i c a l spectrum. The reader can judge how well t h i s e f f o r t succeeds i n the analysis to follow. 2 A META-PARADIGM FOR SOCIAL THEORY Accepting the d e f i n i t i o n of a paradigm at t r i b u t e d to Thomas Kuhn as a framework of basic concepts and postulates within which research proceeds,16 a meta-paradigm ( l i t e r a l l y , a paradigm of paradigms) can be understood as a way of c l a s s i f y i n g a number of such frameworks, i n t h i s case r e l a t i n g to s o c i a l theory. The m u l t i p l i c i t y and d i v e r s i t y of s o c i o l o g i c a l theories make i t imperative to have a method of orga-n i z i n g them along key dimensions to produce a workable number of theo-r e t i c a l groupings with which to proceed. Gibson B u r r e l l and Gareth Morgan have developed just such a method, which i s described i n t h i s section, and applied i n the next to bring order to the confusing f i e l d of s o c i a l gerontology.17 They suggest that s o c i a l theory can u s e f u l l y be conceived i n terms of four key paradigms based upon d i f f e r e n t sets of meta-theoretical assumptions about the nature of s o c i a l science and the nature of society. These assumptions are seen as occupying po-l a r p o s i t i o n s along a subjective-objective dimension ( r e l a t i n g to so-c i a l science), and a r e g u l a t i o n - r a d i c a l change dimension ( r e l a t i n g to s o c i e t y ) . The combination of these two dimensions produces a matrix of four key paradigms f o r the analysis of s o c i a l theory. Each dimen-sion w i l l be described below before the four s o c i o l o g i c a l paradigms ; are considered. .2.1 The Subjective-Objective Dimension This dimension provides a scheme f o r analyzing assumptions about the nature of s o c i a l science that are seen as addressing four basic issues about the nature of the s o c i a l world and the way i n which i t may be investigated. Figure 3.3 shows that these four sets of assump-tio n s , addressing the issues of ontology, epistemology, human nature, and methodology can be seen to resolve themselves i n the polar p o s i t i o n s indicated. Each of these polar sets then defines the subjective and objective extremes of the dimension. Assumptions of an o n t o l o g i c a l nature are those "which govern the very essence of the phenomena under investigation".18 The basic onto-l o g i c a l question i s whether the ' r e a l i t y ' to be investigated i s exter-nal or the product of i n t e r n a l cognitive processes. The nominalist p o s i t i o n i s that the 'external' s o c i a l world has no ' r e a l ' structure and consists only of names, concepts, and labels a r t i f i c i a l l y created 96 FIGURE 3.3 The subjective-objective dimension The subjectivist approach to social science Nominalism ontology The objectivist approach to social science Realism Anti-positivism -epistemology- Positivism Voluntarism -human nature- Deterrninism Ideographic -methodology- Nomothetic From: Gibson B u r r e l l and Gareth Morgan, Sociological. Paradigms and Organi-sational Analysis (London: Heinemann, 1979), p. 3. Reproduced by-permission of the authors. by the i n d i v i d u a l to organize and negotiate the external world. In i t s most extreme form nominalism does not accept the existence of any world outside the realm of i n d i v i d u a l consciousness. Realism, i n con-t r a s t , views the s o c i a l world beyond the i n d i v i d u a l as composed of hard, tangible, and r e l a t i v e l y immutable structures. These s o c i a l r e a l i t i e s e x i s t whether or not they are recognized, perceived, l a b e l l e d , and des-cribed, i n the same way as elements of the natural world e x i s t p r i o r to t h e i r s c i e n t i f i c 'discovery'. For the r e a l i s t the s o c i a l world i s 'out there', while f o r the nominalist i t i s created i n the mind of each i n d i -v i d u al . A second set of assumptions revolve around the issue of epistemolo-gy, the grounds of knowledge. They are concerned with how one can know something, what forms knowledge takes, how (and whether) truth can be separated from falsehood, and how acquired knowledge may be passed on. On t h i s issue the extreme po s i t i o n s are defended by the p o s i t i v i s t and h i s opposite. The p o s i t i v i s t t r i e s "to explain and predict what hap-pens i n the s o c i a l world by searching f o r regulations and causal r e l a -tionships between i t s constituent elements."19 While there are v a r i a t i o n s within t h i s p o s i t i o n , no p o s i t i v i s t disputes the notion that knowledge grows over time by the addition of new theories, and the d e l e t i o n of hypotheses shown to be f a l s e . The a n t i - p o s i t i v i s t r e j e c t s t h i s quest f o r patterns and r e g u l a r i t y , viewing the s o c i a l world as b a s i c a l l y re-l a t i v e and capable of comprehension only from the point of view of those d i r e c t l y involved i n the events under study. While the p o s i t i v i s t stresses the observations of s o c i a l phenomena, h i s opposite number be-lie v e s understanding can only come from p a r t i c i p a t i o n , or being 'on the i n s i d e ' , and generally discards the idea that s o c i a l s c i e n t i f i c knowled-ge can ever be objective. Related to these two issues i s a t h i r d concerning human nature, spe-c i f i c a l l y the r e l a t i o n s h i p between man and h i s environment. Essential to any s o c i a l s c i e n t i f i c inquiry, the set of assumptions clustered around t h i s question i d e n t i f y the extreme posi t i o n s of determinism on the one hand, and voluntarism on the other. Determinists view man as condition-ed by h i s environment, responding to influences and si t u a t i o n s i n a me-ch a n i s t i c fashion, h i s l i f e ' s course determined from without. Volunta-r i s t s b e l i e v e that human beings have 'free w i l l ' , c r e a t i v e l y shape t h e i r environments rather than the reverse, and are i n every sense autonomous and s e l f - c o n t r o l l e d . The assumptions of many s o c i a l s c i e n t i f i c theories f a l l between these two p o s i t i o n s , but are us u a l l y closer to one extreme or the other. These three sets of assumptions have important implications f o r the issue of methodology i n s o c i a l science, some of which have already been mentioned. D i f f e r i n g p o s i t i o n s on the questions of ontology, epistemology, and human nature w i l l lead to varying methodological choices. The polar p o s i t i o n s on methodology i n s o c i a l science have been termed ideographic and nomothetic.20 The ideographic method i n v o l -ves proximity to the subject of the inquiry, with the stress on ' f i r s t -hand' knowledge gained from subjective reports and d i r e c t involvement in'i.the phenomena under study. The nomothetic approach i n s o c i a l science emphasizes systematic research techniques s i m i l a r to those employed i n the natural sciences. Hypotheses are constructed and tested using quan-t i t i v e data analysis, and standardized research tools such as surveys, questionnaires, and pe r s o n a l i t y t e s t s are employed. Taken as a group, the extreme posi t i o n s on each of the above four issues are rela t e d to the two great schools of s o c i a l s c i e n t i f i c thought since the eighteenth century, ' s o c i o l o g i c a l p o s i t i v i s m ' and 'German 99 idealism'. The f i r s t of these defines the objective extreme of t h i s d i -mension by taking a r e a l i s t view of ontology, a p o s i t i v i s t epistemology, a d e t e r m i n i s t i c o r i e n t a t i o n toward human nature, and a nomothetic metho-do l o g i c a l stance. In general, t h i s school of thought approaches the so-c i a l sciences as i f they were natural sciences, employing concepts and approaches derived from the l a t t e r . The second t r a d i t i o n i s i n complete opposition to the f i r s t . E s s e n t i a l l y i t assumes that "the ultimate r e a l i -ty of the universe l i e s i n ' s p i r i t ' or 'idea' rather than i n the data of sense perception".21 i t i s therefore nominalist with respect to ontology, a n t i - p o s i t i v i s t i n epistemology, v o l u n t a r i s t regarding human nature, and ideographic i n i t s s o c i a l s c i e n t i f i c methodology. This school r e j e c t s the natural science analogy and emphasizes the basic r e l a t i v e nature of s o c i a l l i f e i n defining the subjective extreme of the continuum. While many s o c i a l t h e o r i s t s today have been schooled i n the t r a d i t i o n of socio-l o g i c a l p o s i t i v i s m , there are indi c a t i o n s that German idealism i s having an increasing influence i n the development of perspectives intermediate between the subjective and objective extremes. The subjective-objective dimension, then, f a c i l i t a t e s the compari-son of t h e o r e t i c a l viewpoints of the basis of t h e i r assumptions about issues c e n t r a l to the nature of s o c i a l science. I t comprises the f i r s t dimension of the meta-paradigm f o r s o c i a l theory. 3.2.2 The Regulation-Radical Change Dimension This second dimension draws attention to s o c i a l t h e o r e t i c a l assump-tions about the nature of society. The debate as to whether society i s characterized by order or c o n f l i c t has been continuing f o r a very long time, as can be seen from the following view of Thomas Hobbes i n 1651: Hereby i t . i s manifest that during the time men l i v e without a common power to keep them a l l i n awe, they are i n that con-100 d i t i o n which i s c a l l e d war; and such a war as i s of every man, against every man.22 Theorists who focus upon the nature of s o c i a l order and equilibrium are interested i n understanding those s o c i e t a l forces which prevent Hobbes' v i s i o n of a war of a l l against a l l from becoming a r e a l i t y . On the other hand, those who concern themselves with the issues of change, c o n f l i c t , and coercion i n s o c i a l structures see such a 'war' as i n e v i t a b l e without r a d i c a l s o c i a l change. The o r d e r - c o n f l i c t debate among s o c i a l analysts was p a r t i a l l y s t i l l e d i n the middle of t h i s century by those l i k e Coser who argued that s o c i a l c o n f l i c t serves a purpose i n society, thereby sub-suming i t as a v a r i a b l e into an o v e r a l l s o c i a l order theory.23 i t has also been argued, however, that reports of the death of t h i s debate have been much exaggerated, and the work of Dahrendorf24 to restore Marxist thought to an i n f l u e n t i a l p o s i t i o n i n s o c i o l o g i c a l theory has been joined by others who share a r a d i c a l change outlook. These t h e o r i s t s contend that to t r y to incorporate c o n f l i c t within an order perspective i s to ignore the very fundamental differences between them, as demonstrated by the f a c t that extreme s i t u a t i o n s of c o n f l i c t such as revolution or war defy any reasonable integrating explanation. Recently some have sugges-ted that a more r a d i c a l d e s c r i p t i o n of the c o n f l i c t point of view i s necessary to prevent misinterpretation and confusion by i n t e g r a t i o n i s t order t h e o r i s t s , and i t i s i n l i n e with t h i s approach that B u r r e l l and Morgan o f f e r t h e i r modification of the terms of the debate i n de f i n i n g the second a n a l y t i c a l dimension of the meta-paradigm. They suggest that the problematic terms 'order' and ' c o n f l i c t ' be replaced r e s p e c t i v e l y by 'regulation' and 'r a d i c a l change' to sharpen the d i s t i n c t i o n they believe e x i s t s between the two concepts. Issues that describe the extreme points of view along t h i s continuum are l i s t -ed i n Table 3.2. The term 'sociology of regulation' i s used to describe 101 TABLE 3.2 The regulation—radical change dimension The sociology of REGULATION The sociology of RADICAL CHANGE is concerned with: is concerned with: (a) The status quo (a) Radical change (b) Social order (b) Structural conflict (c) Consensus* (0 Modes of domination (d) Social integration and (d) Contradiction cohesion (e) Solidarity (e) Emancipation (0 Need satisfactiont (f) Deprivation (g) Actuality (e) Potentiality Notes * By 'consensus' we mean voluntary and 'spontaneous' agree-ment of opinion. t The term 'need satisfaction' is used to refer to the focus upon satisfaction of individual or system 'needs'. The sociology of regulation tends to presume that various social characteristics can be explained in relation to these needs. It presumes that it is possible to identify and satisfy human needs within the context of existing social systems, and that society reflects these needs. The concept of 'deprivation', on the other 'hand, is rooted in the notion that the social 'system' prevents human fulfilment; indeed that 'deprivation' is created as the result of the Mains quo. The social 'system' is not seen as satisfying needs but as eroding the possibilities for human fulfilment. It is rooted in the notion that society has resulted in deprivation rather than in gain. From: B u r r e l l and Morgan, Sociological Paradigms, p. 18. Reproduced by permission of the authors. 102 attempts to explain the nature of society by r e f e r r i n g to i t s basic order and cohesion. Such t h e o r i s t s see a need f o r regulation i n the s o c i a l sphere, to maintain consensus, s o l i d a r i t y , and the status quo. The 'so-ciology of r a d i c a l change', i n contrast, seeks "explanations f o r the r a -d i c a l change, deep-seated s t r u c t u r a l c o n f l i c t , modes of domination, and s t r u c t u r a l contradiction which i t s t h e o r i s t s see as characterizing mo-dern society".25 i t i s concerned with the p o t e n t i a l of society as much as i t s current state, and perceives a need to l i b e r a t e man from confining s o c i e t a l structures which presently perpetuate h i s deprivation. Charac-t e r i z e d i n these ways the two polar concepts can be seen as b a s i c a l l y opposed, and capable of in t e g r a t i o n only by d i l u t i o n of t h e i r r e a l mean-ings. The function of s o c i a l c o n f l i c t approach i s thus viewed as part of the sociology of regulation, even i f some distance from i t s pole. Viewed i n t h i s way any s o c i a l theory can be seen to belong to one side of t h i s spectrum or the other. The subjective-objective dimension, together with the regulation-r a d i c a l change dimension defines four basic s o c i o l o g i c a l paradigms that can be used to c l a s s i f y or map various t h e o r e t i c a l approaches. 3.2.3 Four S o c i o l o g i c a l Paradigms The two dimensions described i n the preceding sections can be combi-ned to produce a matrix f o r the analysis of s o c i a l theory, comprised of four key paradigms as shown i n Figure 3.4. Used i n t h i s sense, the term paradigm i s intended to indicate a degree of commonality among t h e o r e t i c a l viewpoints within each quadrant, but not complete agreement. Theorists located within any one paradigm n e c e s s a r i l y share a basic view of the na-ture of society and of s o c i a l science, but may well diverge on countless other points. Nevertheless the acceptance of s i m i l a r meta-theoretical FIGURE 3.4 FOUR PARADIGMS FOR THE ANALYSIS OF SOCIAL THEORY THE SOCIOLOGY OF RADICAL CHANGE SUBJECTIVE 'Radical humanist' 'Interpretive' 'Radical structuralist' 'Functionalist' OBJECTIVE THE SOCIOLOGY OF REGULATION From: B u r r e l l and Morgan, Sociological Paradigms, p. 22. Reproduced by permission of the authors. assumptions i n each of the four areas both draws together t h e o r i s t s so located, and separates them from those with d i f f e r i n g views of s o c i a l r e a l i t y . By using the four paradigms to locate various viewpoints one i s able to construct a map of s o c i a l theory that can help to organize the wealth of diverse ideas concerning the s o c i a l world. It w i l l be used i n the next section to negotiate the confusing realm of s o c i a l ge-rontology by reducing the many t h e o r e t i c a l approaches to these basic four i n order to f a c i l i t a t e t h e i r evaluation. Here, however, the focus i s on understanding the meta-paradigm as i t r e l a t e s to s o c i a l theory i n the broadest sense, and each paradigm w i l l be explored within the con-text of general s o c i o l o g i c a l theory. The f u n c t i o n a l i s t paradigm has dominated s o c i a l theory since the Age of Reason i n the seventeeth century. Rooted i n a view of society that emphasizes regulation, and an objective approach to s o c i a l science, t h i s framework has spawned much of what i s commonly regarded as modern s o c i a l research. F u n c t i o n a l i s t s generally accept the set of assumptions referred to e a r l i e r as defining the t r a d i t i o n of s o c i o l o g i c a l p o s i t i v i s m , characterized by the r e a l i s t , p o s i t i v i s t , determinist, and nomothetic points of view regarding s o c i a l s c i e n t i f i c issues. From t h i s vantage point they seek explanations f o r the status quo, s o c i a l order, consen-sus, s o c i a l i n t e g r a t i o n , s o l i d a r i t y , need s a t i s f a c t i o n , and a c t u a l i t y . The f u n c t i o n a l approach i s often concerned with f i n d i n g p r a c t i c a l solu-tions to p a r t i c u l a r s o c i a l problems, i s u s u a l l y f i r m l y committed to a philosophy of s o c i a l engi-neering as a basis of s o c i a l change and emphasizes the im-portance of understanding order, equilibrium, and s t a b i l i t y i n society and the way i n which these can be maintained. 2^ The foundations of the f u n c t i o n a l i s t approach were l a i d with the work of such t h e o r i s t s as Auguste Comte, Herbert Spencer, Emile Durkheim, and V i l f r e d o Pareto, a l l of whom viewed the s o c i a l world i n much the same 105 way as i t s natural counterpart, emphasizing methods of study derived from the l a t t e r . In t h i s century, however, the f u n c t i o n a l i s t paradigm has shown the influence of German idealism through the work of Max Weber, Georg Simmel, and George Herbert Mead who rejected the use of mechanical and b i o l o g i c a l analogies i n s o c i a l science and advocated understanding s o c i a l phenomena from the point of view of the i n d i v i d u a l s involved in them. Since the 1940's f u n c t i o n a l i s t s have also incorporated some Mar-x i s t influences, as discussed e a r l i e r i n r e l a t i o n to the o r d e r - c o n f l i c t debate, i n an attempt to show that the paradigm i s able to account f o r s o c i a l change. Figure 3.5 shows the ways i n which competing i n t e l l e c t u - " a l p o s i t i o n s have been incorporated into the dominant framework of socio-l o g i c a l p o s i t i v i s m giving r i s e to a number of d i s t i n c t i v e t h e o r e t i c a l perspectives within the f u n c t i o n a l i s t paradigm. Figure 3.6 shows the four paradigms together with the major t h e o r e t i c a l schools of which they are composed. For the sake of b r e v i t y and s i m p l i c i t y the i n d i v i d u a l theories w i l l only be l i s t e d below, and the reader i s referred to Bur-r e l l and Morgan's work 27 f o r d e t a i l e d explanations. For the functiona-l i s t paradigm component t h e o r e t i c a l perspectives range from most to least objective as follows: 1. Objectivism - comprising behaviourism and abstracted empiricism 2. S o c i a l system theory - including s t r u c t u r a l functionalism and systems theory 3. Integrative theory - including c o n f l i c t functionalism, morpho-genic systems theory, Blau's theory of exchange and power, and Mertonian theory of s o c i a l and c u l t u r a l structure 4. Interactionism and s o c i a l action theory It i s also worth noting that systems theory, included i n t h i s paradigm 106 FIGURE 3.5 INTELLECTUAL INFLUENCES UPON THE FUNCTIONALIST PARADIGM From: B u r r e l l and Morgan, Sociological Paradigms, p. 27. Reproduced by permission of the authors. FIGURE 3.6 THE FOUR SOCIOLOGICAL PARADIGMS THE SOCIOLOGY OF RADICAL CHANGE Radiol humanism^ SUBJECTIVE French existentialism Anarchistic ndividuahsm Critical theory Marxism f 1 Phenomenology Mcfrneroutic;? Phennmano-lo (3 ica I sociology •>' i 'Interpretive sociology : ^Radical structuralismf-v *, Russian social theory Conflict theory W -j OBJECTIVE ! Integrative Social theory system theory Objectivism Interactionlsm and social action theory - Functionalist soctoiogy'^jj^^ THE SOCIOLOGY OF REGULATION F-r-om: B u r r e l l and Morgan, Sociological Paradigms, p. 29. Reproduced by permission of the authors. o 108 due to i t s t y p i c a l use of mechanical, organismic, or morphogenic analo-gies, i s , i n p r i n c i p l e , not t i e d to any s p e c i f i c view of the s o c i a l world beyond that implied by i t s general p o s i t i v i s t o r i e n t a t i o n . The use of f a c t i o n a l or catastrophic analogies within systems theory (^repre-senting tendencies toward turbulent d i v i s i o n and complete reorganization respectively) would place a systems t h e o r e t i c a l approach within the r a -d i c a l s t r u c t u r a l i s t paradigm. The range of models possible within sys-tems theory i s shown i n Figure 3.7. The i n t e r p r e t i v e paradigm i s the descendant of the German i d e a l i s t school of s o c i a l theory founded by Immanuel Kant that emphasizes the s p i r i t u a l nature 6f the s o c i a l world. Theorists within t h i s paradigm in accept the s o c i e t a l view of the sociology of regulation along with func-t i o n a l i s t s , but approach s o c i a l science i n a b a s i c a l l y subjective f a s h i -on, tending to hold nominalist, a n t i - p o s i t i v i s t , v o l u n t a r i s t , and ideo-graphic p o s i t i o n s . Interpretive sociology considers that s o c i a l r e a l i t y i s created by those who experience i t , and i s external to them only i n -sofar as t h e i r i n d i v i d u a l meanings are shared. Theorists adhering to t h i s view are concerned with understanding the essence of s o c i a l l i f e as an i n d i v i d u a l process, and though t h e i r acceptance of r e g u l a r i t y and order places them on the regulation side of the map, they are d i s i n t e r e s -ted i n debating t h i s issue as a r e s u l t of t h e i r nominalist o r i e n t a t i o n . The i n t e r p r e t i v e paradigm has been explored l a r g e l y i n t h i s century through the work of Wilhelm Dilthey, Max Weber, and Edmund Husserl, and can be seen to include approaches varying from the most to least subjec-t i v e as follows (see Figure 3.6): 1. Solipsism 2. Phenomenology - including transcendental (JOT pure phenomenology, and e x i s t e n t i a l phenomenology -FIGURE 3.7 SOME POSSIBLE TYPES OF SYSTEM MODELS TYPE OF Mechanical Organismic Morphogenic Factional Catastrophic I SYSTEM I ANALOGY i . . i PRINCIPAL Equilibrium Homeostasis Structure Turbulent Complete TENDENCY . elaboration division reorganisation ORDER AND CONFLICT AND : CHANGE From: B u r r e l l and Morgan, Sociological Paradigms, p. 67. Reproduced by permission of the authors. o 110 3. Phenomenological sociology - including ethno-methodology, and phenomenological symbolic inter-actionism 4. Hermeneutics The r a d i c a l humanist paradigm shares the subjective o r i e n t a t i o n of i n t e r p r e t i v e sociology, but views the nature of society from a r a d i c a l change perspective. A basic assumption of the r a d i c a l humanist i s that a "wedge of 'alienation' or 'false consciousness'"2& has been driven i n the human mind by normative s o c i a l philosophies that are r e f l e c t e d i n e x i s t i n g s o c i a l arrangements, preventing people from experiencing complete f u l f i l m e n t . Derived again from German idealism t h i s paradigm has been influenced by the young Marx, as well as Habermas, Marcuse, Sartre, and a wide v a r i e t y of contemporary s o c i a l t h e o r i s t s such as I l l i c h , Castaneda, and Laing. Despite the obvious differences between these thinkers, A l l i n t h e i r various ways share a common concern for the release of consciousness and experience from domination by various aspects of the i d e o l o g i c a l super-structure of the s o c i a l world within which men l i v e out t h e i r l i v e s . They seek to change the s o c i a l world through a change i n modes of cognition and consciousness.29 S o c i a l theories within t h i s paradigm vary from the most to least subjec-t i v e as follows (see Figure 3.6): 1. Solipsism 2. French e x i s t e n t i a l i s m 3. A n a r c h i s t i c individualism 4. C r i t i c a l theory-including Lukacsian sociology, Gramsci's socio-logy, and that of the Frankfurt School Since r a d i c a l humanists, along with i n t e r p r e t i v e s o c i o l o g i s t s , believe s o c i a l r e a l i t y to be an i n d i v i d u a l l y - c r e a t e d subjective experience they are only concerned with r a d i c a l change insofar as human consciousness i s involved. Radical s t r u c t u r a l i s t s , however, apply the sociology of I l l r a d i c a l change to the f a b r i c of society i t s e l f . Theorists within the r a d i c a l s t r u c t u r a l i s t paradigm share with f u n c t i o n a l i s t s an objective view of s o c i a l science, but believe that the nature of society i s better understood from the point of view of r a d i c a l change than from that of regulation. The main i n t e l l e c t u a l influence within t h i s paradigm has come from the work of Marx following the "epistemological break"30 noticed a f t e r h i s involvement i n p o l i t i c s and studies of evolution and p o l i t i c a l economy. While some t h e o r i s t s seek to explain s o c i a l change by examining society's i n t e r n a l contra-d i c t i o n s , and others by analyzing i t s power structure, a l l those within t h i s perspective concur that "contemporary society i s characterised by fundamental c o n f l i c t s which generate r a d i c a l change through p o l i t i c a l and economic crises",31 and see such change as l i b e r a t i n g man from oppressive s o c i a l structures. The paradigm i s viewed as comprised of the following s o c i a l theories, from the least to most objective (see Figure 3.6): 1. Contemporary Mediterranean Marxism - including Althusser's sociology and C o l e t t i ' s sociology 2. C o n f l i c t theory - including that of Rex and Dahrendorf 3. Russian s o c i a l theory - including Bukharin's h i s t o r i c a l mater-r i a l i s m and Kropotkin's a n a r c h i s t i c communism Whereas functionalism attempts to account f o r the persistence of exis-ti n g s o c i a l formations, r a d i c a l structuralism takes a fundamental change perspective emphasizing contradiction and c r i s i s . S o c i a l change i s seen to involve i n e v i t a b l e s t r u c t u r a l transformations that are catas-trophic i n nature. These four s o c i o l o g i c a l paradigms can be used to make sense of the v a r i e t y of theories that currently comprise s o c i a l gerontology by redu-112 cing them to a few basic groups that can more e a s i l y be evaluated f o r t h e i r usefulness i n understanding the problems of B r i t i s h Columbia's aging population. The next section uses the meta-paradigm j u s t des-cribed to develop a s o c i a l gerontological map. 3.3 MAPPING SOCIAL GERONTOLOGICAL THEORY As a r e l a t i v e l y recent f i e l d of s o c i a l s c i e n t i f i c study s o c i a l gerontology has not yet experienced the consolidation of t h e o r e t i c a l viewpoints that s i m p l i f i e s analysis to some extent i n the more esta-b l i s h e d d i s c i p l i n e s of sociology and psychology. The range and diver-s i t y of i t s many perspectives t e s t i f i e s to the i n t e r d i s c i p l i n a r y nature of i t s o r i g i n s as well as i t s continued hybrid development. For the planner seeking to make sense of a v a i l a b l e information about p o l i c y f o r the e l d e r l y (Chapter 2), the problem i s to f i n d ways to reduce the many theories to a basic few f o r p r a c t i c a l consideration. This section uses the meta-paradigm outlined above to produce a map of s o c i a l geron-t o l o g i c a l theory that w i l l achieve t h i s purpose. The map i s presented i n Figure 3.8, and described under the headings of each of i t s four quadrants below. 3.3.1 F u n c t i o n a l i s t S o c i a l Gerontology As was the case i n discussing s o c i o l o g i c a l theory, most of the t h e o r e t i c a l approaches i n s o c i a l gerontology can be seen to f a l l within a basic f u n c t i o n a l i s t paradigm. These perspectives share an objective approach to the s o c i a l s c i e n t i f i c enterprise, and a basic commitment to the status quo of society that often focuses on ways i n which aging i n d i v i d u a l s can adapt to s o c i a l r e a l i t i e s . This most popular of the four paradigms has witnessed a continuing debate between exponents of SUBJECTIVE FIGURE 3.8 A MAP OF SOCIAL GERONTOLOGICAL THEORY THE SOCIAL- GERONTOLOGY OF RADICAL. CHANGE RADICAL HUMANISM minority'group theory r o l e theory s o c i a l r e c o n s t r u c t i o n theory developmental theory INTERPRETIVE GERONTOLOGY^ RADICAL STRUCTURALISM g e n e r a t i o n a l - c o n f l i c t ' theory a g e - s t r a t i f i c a t i o n theory exchange environmental theory: theory A c t i v i t y disengagement theory theory FUNCTIONALIST GERONTOLOGY OBJECTIVE THE SOCIAL GERONTOLOGY OF REGULATION two older perspectives, a c t i v i t y theory and disengagement theory, and an elaboration of more recent s o c i a l science concepts into environmen-t a l theory, exchange theory, and a g e - s t r a t i f i c a t i o n theory. Each of these approaches are examined b r i e f l y now i n turn. Activity theory (also c a l l e d i m p l i c i t or continuity theory) empha-sizes the s t a b i l i t y of the personal coping systems developed by i n d i v i -duals over the course of t h e i r l i v e s . , In a manner reminiscent of the American rugged i n d i v i d u a l i s t i d e a l the older person, according to t h i s perspective, s h i f t s the focus but maintains a comparable l e v e l of a c t i -v i t y with retirement and subsequent aging. This i s the popular p u b l i c stereotype of a successful senior c i t i z e n : independent, busy, healthy and happy, with continuing a c t i v i t y the key. The emphasis i s on deve-loping a number of personal role-options to ease the transition., from middle to old age. Lemon, Bengtson, and Peterson have stated the two main propositions of a c t i v i t y theory as follows: 1. S o c i a l a c t i v i t y and l i f e s a t i s f a c t i o n i n old age are p o s i t i v e -l y r e l a t e d 2. The loss of important rol e s i s inversely r e l a t e d to l i f e sa-t i s f a c t i o n ^ Using data from a sample of older people moving into a retirement commu n i t y , these researchers were unable to v a l i d a t e the propositions, cast-ing doubt on the theory i t s e l f . 3 3 In d i r e c t opposition to t r a d i t i o n a l a c t i v i t y theory, Cumming and Henry developed the f i r s t major systematic theory of aging i n 1961 ca l l e d disengagement theory.34 They suggested that a process of d i s -engagement of the i n d i v i d u a l from society with advancing age i s normal and functional when viewed from either perspective. As Rose puts i t : The socie t y and the i n d i v i d u a l prepare i n advance f o r the ultimate 'disengagement' of incurable, incapacitating d i -sease and death by an i n e v i t a b l e , gradual and mutually s a t i s f y i n g process of disengagement from s o c i e t y . 3 5 According to t h i s theory, disengagement maintains a necessary balance between the wishes of an i n d i v i d u a l and society f o r or against i n v o l -vement, with society's w i l l p r e v a i l i n g shoud a c o n f l i c t e x i s t . Taking a somewhat more objective approach to the'problem of aging than a c t i -v i t y t h e o r i s t s , those using t h i s model also emphasize the need f o r s o c i e t a l regulation and personal adaptation c h a r a c t e r i s t i c of the func-t i o n a l i s t school. The subject of much discussion and research over the years, disengagement theory has been attacked on both empirical and conceptual grounds by a v a r i e t y of scholars. Some have found that con-tinued a c t i v i t y 3 ^ or re-engagement 3? i s more s a t i s f y i n g f o r the older person, while others have c r i t i c i z e d the theory's u n c r i t i c a l acceptance of the status quo.38 As a r e s u l t of the activity-disengagement contro-versy a number of other d i s t i n c t t h e o r e t i c a l perspectives have emerged within the f u n c t i o n a l i s t paradigm. Some analysts have emphasized the pre-eminence of the s o c i a l en-vironmental context of the aging process i n a highly objective view that downgrades the older person's a b i l i t y to a l t e r h i s s i t u a t i o n ex-39 cept within r e s t r i c t i v e s o c i a l / c u l t u r a l boundaries. Gubrium has suggested that there are three important elements to social environ-mental theory: an emphasis on normative expectations derived from p a r t i c u l a r contexts, attention to i n d i v i d u a l capacities f o r i n t e r a c t i o n , and a focus on the sub j e c t i v e l y evaluated correspondence between a b i l i t y and what i s expected i n a p a r t i c u l a r s i t u a t i o n . 4 ^ These elements should i d e a l l y work together to produce s a t i s f a c t i o n i n the e l d e r l y person, but since i n f a c t they proceed at d i f f e r e n t rates continual adjustment and support i s required to maintain a reasonable balance. 116 Exchange theory, p r i m a r i l y associated with Blau,41 holds that i n -d i v i d u a l s w i l l p a r t i c i p a t e i n s o c i a l i n t e r a c t i o n only as long as the benefits derived outweigh the cost incurred. These valuations change over time as the aging process occurs and the s o c i a l network of the e l d e r l y shrinks as the r e s u l t of a realignment of t h e i r personal r e l a t i o n s h i p brought about by a debasing of the influence that they are able to exercise over t h e i r environments.42 Lacking s o c i a l l y marketable s k i l l s or resources, older people trade t h e i r compliance to gain the acceptance and support of others, and c u l t i v a t e a 'nice' or 'sweet' image i n t h i s e f f o r t . Postulating a mechanism to explain the adjustment process of the e l d e r l y i n society, exchange theory l i e s c l e a r l y within the f u n c t i o n a l i s t paradigm. Age-stratification theory views age s t r a t a as composed of people s i m i l a r i n age or l i f e stage, who tend to share c a p a c i t i e s , a b i l i t i e s , and motivations r e l a t e d to age. Age i s also a c r i t e r i o n f o r entering or leaving r o l e s , and f o r the d i f f e r e n t rewards and obligations associated with these r o l e s . In short, age i s a basis of 'structured s o c i a l inequality'.43 This theory r e l i e s on the concept of cohort flow (the aging of succes-sive strata) which i s seen as p r o p e l l i n g the various age groups through changing s o c i a l r o l e s depending on t h e i r age-related c a p a c i t i e s and expectations.44 Rile y and others have emphasized the importance of s o c i a l i z a t i o n i n ensuring a smooth t r a n s i t i o n of i n d i v i d u a l s from one age status to the next,45 i n d i c a t i n g the theory's basic f u n c t i o n a l i s t o r i e n t a t i o n . 117 3.3.2 Interpretive So c i a l Gerontology There has been renewed i n t e r e s t i n the i n t e r p r e t i v e paradigm over the past few years as gerontologists have renewed e f f o r t s to understand the aging process from the point of view of older people themselves. While p a r t l y growing out of reactions against the detachment of func-tionalism, these subjective perspectives have continued the regulation approach to society that characterizes f u n c t i o n a l i s t theories, but focused on the e l d e r l y i n d i v i d u a l i n his adaptation to a changing s o c i -a l r e a l i t y . As approaches belonging to the i n t e r p r e t i v e paradigm, developmental theory, s o c i a l reconstruction theory, and r o l e theory are each described b r i e f l y below. Developmental theorists l i k e E r i k s o n , 4 ^ basing t h e i r work on psy-chological and b i o l o g i c a l research, have viewed the aging process as a series of linked i n d i v i d u a l l i f e challenges which must be success-f u l l y overcome i f ego s a t i s f a c t i o n i s to r e s u l t . For l a t e r l i f e E r i k -son suggests the challenge i s f o r older people to achieve consummation through r e a l i z i n g ego i n t e g r i t y , or, f a i l i n g t h i s , to give way to des-p a i r . Elaborating Erikson's model, Peck 4 7 has suggested that i f adaptation i s to be maintained i n the years following retirement...new sources of g r a t i f i c a t i o n must be elabora-ted along with an a b i l i t y to transcend not only bodily func-tio n i n g but personal s k i l l s i n order to contribute to the l i v e s of others.48 Further extending the developmental scheme, Neugarten and Lowenthal 5^ have reported s i g n i f i c a n t sex differences i n the developmental tasks faced i n l a t e r l i f e . Men are forced to adjust to retirement and the loss of income, while women must adapt to t h e i r diminishing family o b l i g a t i o n s . Neugarten has also developed a typology of personality types of older people which describes them as integrated, armored-defended, passive-dependent, or un-integrated,51 and has concluded 118 on the basis of subject self-evaluations that these are "most often merely the extensions of middle age coping s t y l e s into l a t e r y e a r s . " 5 2 The developmental theory appears, then, as the c l a s s i c subjective, regulative s o c i a l gerontological approach. Social reconstruction theory draws upon l a b e l l i n g theory i n com-munity psychiatry which i s rela t e d to the symbolic i n t e r a c t i o n i s f . t r a d i t i o n i n s o c i o l o g y . 5 ^ The theory acknowledges that the v i c i o u s cycle of increasing incompetence known as the s o c i a l breakdown syndrome can be used to describe the experience of many aging i n d i v i d u a l s . The breakdown syndrome consists of four main steps which are linked together i n a c i r c u l a r fashion: 1. Precondition or s u s c e p t i b i l i t y to psychological breakdown 2. So c i a l l a b e l l i n g as d e f i c i e n t or incompetent 3. Induction into a sick or dependent r o l e and atrophy of pre-vious s k i l l s 4. S e l f - i d e n t i f i c a t i o n as sick or inadequate 5"* The s o c i a l reconstruction model then describes the breaking of t h i s v i c i o u s cycle, and i t s replacementby-a benign One of increasing competence through s o c i a l system inputs. The main steps linked together i n t h i s cycle are: 1. Reduced s u s c e p t i b i l i t y and increased self-confidence 2. Reduced dependence and increased s e l f - r e l i a n c e 3. S e l f - l a b e l l i n g as able 4. Build-up and maintenance of coping s k i l l s 5. I n t e r n a l i z a t i o n of self-view as e f f e c t i v e These steps are f a c i l i t a t e d by inputs from .a supportive s o c i a l system that help t o : l i b e r a t e the i n d i v i d u a l from the f u n c t i o n a l i s t ethic and evolve alternate evaluations (at step 1); improve maintenance con-d i t i o n s such as housing, health, n u t r i t i o n , and transportation (at step 2); encourage i n t e r n a l locus of control and b u i l d adaptive probl solving (at step 4 ) . 5 5 This perspective stresses the importance of i n d i v i d u a l s ' perceptions of themselves and t h e i r s i t u a t i o n s , and i s oriented to helping them adapt to s o c i e t a l r e a l i t i e s through various s o c i a l support systems. S o c i a l reconstruction theory suggests that some s o c i a l change i s necessary, but may be accommodated within the realm of e x i s t i n g s o c i e t a l arrangements. Role theory i n s o c i a l gerontology considers the career of an ind vidual as he moves through l i f e ' s various status passages. Hughes puts i t t h i s way: In a highly and r i g i d l y structured society, a career co n s i s t s , o b j e c t i v e l y , of a series of status (sic) and c l e a r l y defined o f f i c e s . In a f r e e r one, the i n d i v i d u a l has more l a t i t u d e f o r creating h i s own p o s i t i o n or choosing from a number of e x i s t i n g ones...but unless complete disorder reigns, there w i l l be t y p i c a l sequences of p o s i t i o n , achieve-ment, r e s p o n s i b i l i t y , and even of adventure. 5^ But the older person faces a status passage unlike any other (school, marriage, work, etc.) i n that there i s no exit:, but death, and t h i s cannot be avoided. The t y p i c a l e f f o r t by i n d i v i d u a l s changing role s to take control over t h e i r status passage i s seen as c r u c i a l f o r the e l d e r l y who must t r y to maximize personal control despite the struc-tures of i n s t i t u t i o n s (e.g. old age homes) and diminishing resources of a l l kinds. This process can often be enhanced through s o c i a l i n -t e r a c t i o n and the development of community, as Hochschild found i n a study of an apartment b u i l d i n g , 5 7 but remains fundamentally a subjec-t i v e experience by which older people "attempt to c o n t r o l , through symbolic i n t e r a c t i o n , s i t u a t i o n s i n keeping with b i o g r a p h i c a l l y mean-i n g f u l i n t e n t i o n s " 5 ^ as they maintain t h e i r i d e n t i t y and prepare for death. Role theory, then, continues the i n t e r p r e t i v e focus on the 120 subjective experience within the context of a regu l a t i v e approach to society. 3.3.3 Radical Humanism The r a d i c a l humanist paradigm includes those approaches to the phenomenon of aging that share the subjective o r i e n t a t i o n of inter p r e -t i v e theories, but are oriented toward r a d i c a l change i n society as the means of resolving perceived problems. Emphasizing consciousness i n general and al i e n a t i o n i n p a r t i c u l a r , r a d i c a l humanists seek revo-lutionary change i n society through s i m i l a r change i n the i n d i v i d u a l s of which i t i s composed. Their aim i s to r a i s e the consciousness of a l l people, and e s p e c i a l l y that of the e l d e r l y , i n order to promote a r e j e c t i o n of the stereotype of the aged and a determination to e l i -minate a l l r e s t r i c t i v e attitudes toward aging. Since t h i s paradigm runs counter to the nature of society as a r e s u l t of the denial of so-c i e t a l norms upon which i t r e s t s , i t i s not s u r p r i s i n g that i t should be chosen as a t h e o r e t i c a l framework by few s o c i a l gerontologists. The best example of a r a d i c a l humanist approach i s that of minority group theory. Minority group theory asserts that older people constitute a mi-no r i t y group i n society whose members are victims of ageism, the wide-spread negative stereotyping of the e l d e r l y that involves references to t h e i r supposed " i n t e l l e c t u a l decline, conservatism, sexual decline, lack of pr o d u c t i v i t y , and preference f o r d i s e n g a g e m e n t . P r e j u d i c e against the e l d e r l y i s seen to derive from a number of s o c i a l , econo-" mic and c u l t u r a l factors that combine to devalue the aged i n society on the basis of unsubstantiated normative views of t h e i r c a p a c i t i e s . E l d e r l y people react to t h e i r assigned s o c i e t a l r o l e of 'senior c i t i -121 zen' i n a v a r i e t y of ways that include acceptance, avoidance, and aggression.60 One of the aggressive responses i n recent, years has been the emergence of 'senior power' groups, such as the Gray Panther movement i n the US, which attempt to organize older people to promote the m i l i t a n t r e j e c t i o n of negative norms as well as the patronizing and inadequate p o l i c i e s to which they give r i s e . The influence of the women's movement on the growing consciousness of older people has also been considerable. Female a c t i v i s t s i n the l i b e r a t i o n movements of the 1960's have moved into i n s t i t u t i o n a l lobby groups (such as the Ca-nadian Advisory Council on the Status of Women) during the past decade and used them to promote a greater awareness of the problems of women, and e s p e c i a l l y those of e l d e r l y women. Since most of the aged ave wo-men, and many of them lack adequate pension incomes as a r e s u l t of the inconsistent, low-level employment which family, r e s p o n s i b l i t i e s and systematic d i s c r i m i n a t i o n have forced upon them, the problems of the e l d e r l y often h i g h l i g h t important issues of equity f o r women as a whole. The minority group model suggests that any changes i n s o c i e t a l systems a f f e c t i n g the aged must:be initiated: by older people themselves who recognize t h e i r common problems and unite to seek r e a l s o c i a l equa-l i t y . The f i r s t p r i o r i t y t h i s theory outlines i s the r a i s i n g of the consciousness of e l d e r l y people through promotion of the recognition of: 1. The common status conferred by old age 2. The presence of ageism generally and age discrimination i n t h e i r personal l i v e s 3. Old age as a normal, desirable stage of l i f e ^ l The accomplishment of t h i s primary objective i s expected to lead to necessary s o c i a l and p o l i t i c a l s t r u c t u r a l changes throughout society. 122 3.3.4 Radical Structuralism The r a d i c a l s t r u c t u r a l i s t paradigm, l i k e i t s humanist counterpart, includes t h e o r e t i c a l perspectives which see the s o c i a l problems, re-lated to aging as symptoms of a deep s t r u c t u r a l malaise i n society that can only be cured through r a d i c a l change of the system i t s e l f . Theorists within t h i s school share the objective view of s o c i a l r e a l i -ty of f u n c t i o n a l i s t s , but see within the t o t a l s o c i a l s t r u c t u r a l f o r -mation contradictory i n t e r n a l forces that are viewed as moving society toward an in e v i t a b l e c r i s i s that w i l l make possible a necessary trans-formation of the p o l i t i c a l , economic, and s o c i a l order. While c o n f l i c t theory i s exceptional i n t h i s respect, most r a d i c a l s t r u c t u r a l i s t pers-pectives envision a v i o l e n t revolutionary transformation that d i f f e r s sharply from the humanist i d e a l of a non-violent revolution through consciousness. The emphasis within t h i s paradigm on the need f o r fun-damental system change d i f f e r e n t i a t e s i t c l e a r l y from the most change oriented f u n c t i o n a l i s t theories which accept the current s o c i e t a l framework as normative. The best example of a r a d i c a l s t r u c t u r a l i s t approach to aging i s ge n e r a t i o n a l - c o n f l i c t theory. Generationdl-^oonfViot theory b u i l d s upon the notions discussed under a g e - s t r a t i f i c a t i o n theory (see Section 3.3.1), but considers consciousness of stratum p o s i t i o n as nascent class consciousness, a necessary p r e r e q u i s i t e of revolutionary class action. This theory defines a generation as "a cohort, large proportions of whose mem-bers have experienced s i g n i f i c a n t s o c i o - h i s t o r i c a l changes",62 such as wars, depressions, and innovations l i k e the b i r t h - c o n t r o l p i l l . An understanding of the concept of class i s found i n the action of c o n f l i c t i n g i n t e r e s t groups, who, because of t h e i r r e l a t i o n to property, possession of status, and consciousness of t h e i r r e l a t i v e p o s i t i o n , exercise power i n a h i s t o r i c a l and d i a l e c t i c a l fashion to impose t h e i r i n t e r e s t s on each o t h e r . ^ The development of a generational consciousness among large numbers of members of a cohort, combined with coinciding class i n t e r e s t s i s seen as a potent combination f o r g e n e r a t i o n a l - c o n f l i c t and r a d i c a l action. The basis f o r class c o n f l i c t involving the aged i s found in t h e i r a l i e n a t i o n from labour and the i n e q u a l i t y of income status which, with notable exceptions,^4 i s the l o t of e l d e r l y people. T.ihdale and Marshall point to increasing tension ahead as the baby-boom genera-t i o n , with i t s well developed group consciousness, ages and exerts i t s formidable influence on s o c i a l and p o l i t i c a l structures to benefit the e l d e r l y at the expense of younger workers, since: The bases f o r c o n f l i c t l i e with the tensions and d e p r i -vations of economic and c u l t u r a l l i f e which i n cases of re-l a t i v e s c a r c i t y sometimes p i t various cohorts of people against each other i n generational c o n f l i c t . ^ 5 Generational-conflict theory, then, foresees increasing c o n f l i c t (based on class and generational consciousness) between older and younger c i t i z e n s that may well reach c r i t i c a l proportions and force far-reaching s t r u c t u r a l changes in society. DEVELOPING A PARADIGM FOR PLANNING The v a r i e t y of s o c i a l gerontological theories reviewed i n the preceding section according to four basic paradigms can now be analy-zed f o r t h e i r a b i l i t y to describe accurately the s i t u a t i o n of the e l -derly i n society, and to prescribe useful planning options for p o l i c y makers concerned with :the adequacy of future programs f o r the aged. In t h i s way the paradigms can be p l o t t e d on a d e s c r i p t i v e - p r e s c r i p -t i v e a b i l i t y g r i d as shown i n Figure 3.9. Following t h i s analysis, what are seen as the necessary elements of a paradigm for planning for B r i t i s h Columbia's aging population w i l l be described. The planning paradigm so developed w i l l serve as the t h e o r e t i c a l basis f o r s t r a t e -124 FIGURE 3.9 SOCIAL GERONTOLOGICAL PARADIGMS BY THEIR ABILITY TO DESCRIBE AND PRESCRIBE HIGH a b i l i t y to describe r a d i c a l humanist paradigm LOW «*-mterp parak petive igm a b i l i t y to prescribe r a d i c a l s t r u c t u r a l i s t paradigm HIGH f u n c t i o n a l i s t paradigm LOW gies to be considered i n the next chapter. . 1 The Four Paradigms Evaluated Most of the programs f o r the e l d e r l y i n existence now i n B r i t i s h Columbia have come about through responses to the needs of the aged i m p l i c i t l y based on f u n c t i o n a l i s t theory. As noted e a r l i e r , f u n c t i o -n a l i s t s are highly problem-oriented, aiming to ease the adjustment of the older person to his. perception of s o c i a l r e a l i t i e s . In many respects t h i s approach has served society well, developing an ever increasing number of supportive services that have helped to some ex-tent to mitigate the d i f f i c u l t s i t u a t i o n of the e l d e r l y i n t h i s pro-vince. But the basic problems remain despite, and even i n some cases r as a r e s u l t of such e f f o r t s (e.g. inadequacy of income f o r the aged and e a r l y retirement p o l i c i e s ) . Marshall and Tindale describe t r a d i -t i o n a l f u n c t i o n a l i s t gerontology as a "t i n k e r i n g trade" engaged i n r e p a i r work. It focuses on i n d i v i d u a l s , and on how they might adjust (be adjusted?) to the on-going system. It seldom considers the necessity f o r serious change i n the system i t s e l f . 6 6 F u n c t i o n a l i s t theory, then, i s high i n p r e s c r i p t i v e a b i l i t y , suggest-ing any number of addit i o n a l programs to planners f o r the e l d e r l y , but always within the context of the current s o c i a l s t r u c t u r a l frame-work. Radical change i s not considered an option. While such conser-vative approaches may have been workable when the e l d e r l y represented a very small proportion of the population, and informal supportive structures (the family, church etc.) remained stable, powerful i n f l u -ences that could be counted on to pick up the slack i n program p r o v i -sion, the shape of future B r i t i s h Columbian and Canadian society sug-gests that these t r a d i t i o n a l solutions w i l l become less and less re-levant over the next twenty to t h i r t y years and beyond. Future pro-126 jec t i o n s describe nothing l e s s than a revol u t i o n i n the s o c i a l compo-s i t i o n of society, and a simultaneous narrowing of the range of a l t e r -natives f o r p u b l i c p o l i c y as a r e s u l t of diminishing economic resour-ces. The f u n c t i o n a l i s t paradigm i s unable to account f o r such dramatic changes over a r e l a t i v e l y short time-span, and i s therefore located on the low side with respect to d e s c r i p t i v e a b i l i t y i n Figure 3.9. The i n t e r p r e t i v e paradigm i s s i m i l a r l y hobbled by i t s basic accep-tance of the status quo, but makes a valuable contribution by focusing on the i n d i v i d u a l ' s experience of aging, and h i s a b i l i t y to redefine s o c i a l r e a l i t y i n p o s i t i v e , h e l p f u l ways. The subjective aspect of the world of the e l d e r l y cannot be ignored i n comprehensive p r e s c r i p -tions f o r the problems of the aged, but at the same time i t co n s t i t u -tes only part of the broader s o c i a l r e a l i t y of older people. Inter-p r e t i v e theories are located near the midpoint of each of the descrip-t i v e and p r e s c r i p t i v e a b i l i t y ranges to indic a t e that, while they o f f e r useful and v a l i d i n s i g h t s into aging, t h e i r u t i l i t y i s dimini - i shed by the omission of an objective, s t r u c t u r a l perspective. Radical humanism maintains the subjective view but i n a r a d i c a l form that c a l l s f o r a personal r e v o l u t i o n within society. Its i n s i s -tence on the p r i o r i t y of increased i n d i v i d u a l consciousness underlines an important precondition f o r the success of any strategy f o r s o c i a l change. The r a d i c a l change perspective enables t h i s paradigm to des-cribe more f u l l y than i t s regulative counterparts the past, present, and future s i t u a t i o n s of e l d e r l y people, but humanists are less i n -terested i n drawing the implications f o r corresponding s t r u c t u r a l change that must follow i n a responsible society. As Figure 3.9 shows, t h i s paradigm i s therefore considered low i n p r e s c r i p t i v e a b i l i t y , but high i n d e s c r i p t i v e a b i l i t y . The r a d i c a l s t r u c t u r a l i s t paradigm combines a powerful structu-r a l analysis of society with a r a d i c a l perspective better able to account f o r the complete d e s c r i p t i o n of the s i t u a t i o n of the e l d e r l y presented i n Chapter 2. For the period of the h i s t o r i c a l development of services to the e l d e r l y , when the aged comprised a small group with l i t t l e awareness of t h e i r own separate i d e n t i t y , the r a d i c a l structu-r a l i s t view suggests that the preconditions f o r c o n f l i c t d i d not e x i s t and that the p r o l i f e r a t i o n of functional adaptive approaches which emerged during t h i s time was made possible by the lack of a basic chal lenge to the system i t s e l f . The current period, however, has witnessed a slowly growing 'gray consciousness' that, combined with d i f f i c u l t economic times, has has-tened the heightening of tension that i s forecast to accompany the dramatic r i s e i n the r e l a t i v e proportion of those over 65 i n the pe-r i o d following 2011. This tension has already begun to be f e l t with-i n governments a l l o c a t i n g scarce resources among competing programs that benefit various age groups i n society (e.g. health care f o r the aged versus education f o r the young). The r a d i c a l s t r u c t u r a l para-digm understands t h i s increasing c o n f l i c t as the build-up of forces of i n t e r n a l contradiction that w i l l lead eventually to a c r i s i s of confrontation, perhaps along class and generational l i n e s , i n the next century f o r c i n g r a d i c a l s o c i a l change. C e r t a i n l y the baby-boom generation has the necessary features ( r e l a t i v e s i z e , consciousness) to f u l f i l l t h i s gloomy scenario when i t s members reach t h e i r senior years. Radical s t r u c t u r a l i s t s , then, o f f e r what appears to be a high-l y accurate d e s c r i p t i o n of the s i t u a t i o n of the e l d e r l y over the en-t i r e span of time under consideration. The sources of the i n e v i t a b l e c o n f l i c t and c r i s i s predicted give r i s e to powerful p r e s c r i p t i o n s f o r s o c i a l change. Tensions are seen as derived from basic i n e q u i t i e s i n society perpetuated by a s o c i a l , economic, and p o l i t i c a l order that denigrated the e l d e r l y by a l i e n a t i n g them from the workplace, and providing u s u a l l y inadequate l e v e l s of needed health, income, and hou-sing programs often i n a patronizing way. To defuse c o n f l i c t , accord-ing to t h i s paradigm, r a d i c a l changes must soon be undertaken. Com>-pulsory retirement, i t follows, should be abolished. Adequate income must be guaranteed to a l l older people so that they can order t h e i r own a f f a i r s as they choose as much as possible. Health care and hous-ing programs i n age-integrated settings must provide adequate service to those unable to l i v e without assistance, i n f a c i l i t i e s that are at l e a s t p a r t l y governed by the patients and residents themselves. No possible strategy to accomplish these objectives should be ruled out a p r i o r i , regardless of i t s lack of conventionality, or associat-ed s o c i a l and p o l i t i c a l ideologies. The r a d i c a l s t r u c t u r a l i s t para-digm has a high a b i l i t y to prescribe future a l t e r n a t i v e s f o r older people, although most of these p r e s c r i p t i o n s w i l l c e r t a i n l y be seen as extremely c o n t r o v e r s i a l . It i s consequently located i n the most favourable quadrant of the g r i d of Figure 3.9. .2 Elements of a Planned Paradigm As w i l l be obvious from the foregoing, my own judgement i s that the paradigm f o r planning f o r B r i t i s h Columbia's aging population should most c l o s e l y resemble the r a d i c a l s t r u c t u r a l i s t version j u s t discussed. Its high d e s c r i p t i v e and p r e s c r i p t i v e a b i l i t i e s make t h i s approach most l i k e l y to generate successful s t r a t e g i e s f o r planning, and i t s r a d i c a l departure from conventional a l t e r n a t i v e s appears wel-come i n view of the apparent chronic i n a b i l i t y of t r a d i t i o n a l approa-129 ches. to o f f e r genuine solutions to the problems of the aged. With, some--modifications, to be discussed below, then, the r a d i c a l s t r u c t u -r a l i s t paradigm i s seen as the best upon which to base future plan-ning e f f o r t s . The most c r u c i a l element of t h i s paradigm f o r planning i s the notion that s o c i a l problems such as those a f f e c t i n g the e l d e r l y are the r e s u l t of deep-seated contradictions i n society, r e f l e c t i n g an i n t e r a c t i o n between personal values and the i d e o l o g i c a l superstruc-ture, that are evident i n basic p o l i t i c a l and economic i n s t i t u t i o n s and p o l i c i e s . The s o l u t i o n i s seen to l i e therefore not so much i n the adaptation of the i n d i v i d u a l , as i n fundamental reform of the system i t s e l f to eliminate these contradictions. Although the para-digm must be capable of an objective s t r u c t u r a l c r i t i q u e of e x i s t -ing s o c i a l arrangements, t h i s should be balanced by an appreciation of the subjective experience of aging, and a r e a l "commitment to the 'constituency' of the aged."6? In p a r t i c u l a r the framework must " emphasize the p r i o r i t y of schemes to increase the awareness of the problems of an aging population, e s p e c i a l l y among the e l d e r l y , and encourage the p a r t i c i p a t i o n of the aged themselves i n the planning process. A revolution i n attitudes i s indeed required to make need-ed reforms succeed. Although the paradigm predicts eventual c r i s i s , t h i s i s considered avoidable through the elimination of i n e q u i t i e s perpetuated by the current system. Anything less than genuine re-form, however, amounts to further t i n k e r i n g and can be expected to deepen the contradictions, hastening a damaging confrontation. The planning paradigm can also be described within a systems t h e o r e t i -cal framework that makes use of a catastrophic analogy which repre-sents a tendency toward complete reorganization Cas mentioned i n Section 3.2.3). This systems approach lends i t s e l f to a consideration of the implications f o r planning s t r a t e g i e s of the various theories of s o c i a l change with which Chapter 4 i s concerned. STRATEGIES In t h i s chapter the r e s u l t s of Chapter 3's analysis of the problems of an aging population outlined i n Chapter 2 are used to generate a cor-responding strategy for e f f e c t i v e planning action. The term strategy i s used here to denote a broad approach to p o l i c y making, comprised of nume-rous i n d i v i d u a l plans, and the s p e c i f i c programs these bring about. The background f o r t h i s consideration of strategies f o r planning f o r the el d e r l y i s f i r s t described through a review of the theory and p r a c t i c e of s o c i a l change. CHANGE THEORY AND PRACTICE This section examines s o c i a l change from both an academic and admi-n i s t r a t i v e perspective i n order to set the stage f o r the consideration of planning strategies to follow. After a general discussion of planning and change, p u b l i c p o l i c y making i s described from a systems perspective. • 1 Planning and Change Smith defines change as "a succession of events which produce over time a modification or replacement of p a r t i c u l a r patterns or units by other novel ones".l He.suggests one can u s e f u l l y d i s t i n g u i s h the tempo-r a l change sequence of "calendar events, medium term 'processes' and long-term 'trends'",2 i n which i n d i v i d u a l influence i s most noticeable at the micro-analytical l e v e l . Comprehensive change studies, then, must take account of the d e t a i l of s p e c i f i c happenings, unfolding i n days, weeks, or months, sequences and cl u s t e r s of events that indicate processes occurring on the order of a decade, and the trends to which they give r i s e over the course of centuries or more. In t h i s way the int e r p l a y of s o c i e t a l forces of many kinds proceeding at d i f f e r e n t rates y i e l d s most 132 r e a d i l y to analysis. Since p h i l o s o p h i c a l and i d e o l o g i c a l developments r e f l e c t i n g s o c i a l trends were discussed i n the l a s t chapter (see Sec-tio n 3.1), the present one w i l l concern i t s e l f with events and processes only. This approach s t i l l encompasses a wide range of p o t e n t i a l s o c i a l change as a r e s u l t of the accelerating pace of change that has characte-r i z e d the twentieth century. The r e g u l a t i o n - r a d i c a l change dimension of the meta-paradigm describ-ed i n the l a s t chapter encapsulates a basic dichotomy i n the imagery of change. Smith describes the pervasive images of "flow",3 r e f e r r i n g to the smooth, continuous, incremental change process corresponding to the sociology of regulation, and "rupture", 4 denoting the uneven, d i s c o n t i -nuous, i n t r u s i v e mechanisms corresponding to the sociology of r a d i c a l change. While neither of these approaches i s s u f f i c i e n t to explain a l l s o c i a l change, i t has been argued above that the r a d i c a l change model i s best suited to the task facing those charged with planning f o r B r i t i s h Columbia's aging population (see Section 3.4). H a l l et a l 5 have attempt-ed to synthesize the flow and rupture ideas by postulating that the establishment of legitimacy and f e a s i b i l i t y , each with s u f f i c i e n t support, are preconditions f o r issues to bring about p o l i c y changes. In t h e i r view, the flow model f i t s the period of build-up of support i n each case, but the rupture model more accurately describes the subsequent point of d i s j u n c t i o n . Using the terms of t h i s model, i t i s suggested that planners should now be b u i l d i n g support f o r d i s j u n c t i v e (radical) change i n pro-grams f o r the e l d e r l y , as the l a t e r discussion of strategies makes clea r . A fundamental d i s t i n c t i o n i n s o c i a l change theory, deriving from the t r a n s i t i v e and i n t r a n s i t i v e constructions of the verb 'to change115, i s that between active and passive modes of change. Active change, also c a l l e d purposive 6 or planned 7 change, i s simply that i n which people 133 intervene, while passive (or c r e s c i v e 8 ) change occurs independently of i t s own accord.. Each mode of change has i t s own c h a r a c t e r i s t i c sources, channels, and forms so that changes can be d i f f e r e n t i a t e d according to whether or not human beings a c t i v e l y intervene i n i n i t i a t i n g the events, i n providing the channels of t h e i r impact, and i n furnishing novel forms f o r embodying the changes.9 The exploration of s t r a t e g i e s here i s concerned with active change i n which planners may intervene i n a l l these areas to produce changes i n p u b l i c p o l i c y concerning the aged. Public p o l i c y making is: a s p e c i a l i -zed variant of active s o c i a l change which finds i t s source i n govern-mental responses to pressing s o c i a l problems, uses the p o l i t i c a l - b u r e a u -c r a t i c process as a'channel, and takes the eventual form of new p o l i c y and program i n i t i a t i v e s . The next section explores t h i s p o l i c y making process from a systems a n a l y t i c perspective. 4.1.2 Public P o l i c y Making: A Systems Perspective Dye's d e f i n i t i o n of p u b l i c p o l i c y as "whatever governments choose to do or not to do"10 captures the basic notion, but obscures important process elements. While action by governments i s c e r t a i n l y involved, the 'choosing' of p o l i c y a l t e r n a t i v e s i s a much more complicated pheno-menon than the use of that word implies, and requires c a r e f u l systema-t i c a n a l y s i s . E a r l y systems models of the p o l i c y process followed Easton's input-output approach,H showing the conversion as taking p l a -ce within the 'black box' of the p o l i t i c a l system (see Figure 4.1). According to t h i s view, shared by Sharkansky, Dye and others,12 input demands, re l a t e d support, and resources are transformed into p o l i c y outputs, whose impacts feed back to new inputs, a l l within the context of an i n t e r a c t i v e environment. Subsequently, some analysts have explor-ed what happens within the 'black box', and have i d e n t i f i e d v a r i a b l e s 134 FIGURE 4.1 SYSTEMS MODEL OF THE POLICY PROCESS The Political System inputs Demands Supports Resources Conversion/ Decision processes etc. Policy output Policy outcome Environment: includes social, economic and political influences on inputs, systems variables, policy outputs and policy outcomes. From: W.I. Jenkins, Policy Analysis: A Political and Organizational Pers-pective (London: Martin Robertson, 1978), p. 18. Reproduced by per-mission of the publisher. that mediate i t s inputs. Figure 4.2 shows such an amended systems mo-del depicting the p o l i t i c a l system as the i n t e r a c t i o n of decision-making and organizational elements, with groups, p a r t i e s , and other organizations as mediating v a r i a b l e s . Despite the obvious over-simpli f i c a t i o n s and other short comings of such a systems model, Jenkins argues that i t "can serve at least as a useful h e u r i s t i c map"13 i n the study of p o l i c y development. As has been pointed out above, the sys-tems approach can encompass the whole range of views on the nature of society, from re g u l a t i v e to r a d i c a l change, depending on the type of analogy employed (see Figure 3.7). Given the r a d i c a l change approach embodied i n the selected planning paradigm, the systems analogy appro-p r i a t e here i s e i t h e r f a c t i o n a l or catastrophic (depending on one's optimism about eventual outcomes), s t r e s s i n g the power structure and basic c o n f l i c t s inherent i n the p o l i c y making process. One p a r t i c u l a r l y useful model that incorporates these elements with an important fo-cus on underlying values that has been associated with "the new p u b l i c a d m i n i s t r a t i o n " ^ i n the US, and s o c i a l administration i n the UK,15 i s the "public p o l i c y flow model" of Simmons et al.1° This model, shown i n Figure 4.3, attempts to r e l a t e values to pu-b l i c p o l i c y by i d e n t i f y i n g actors ( s i g n i f i c a n t i n d i v i d u a l s ) , groups, and agencies ( i n s t i t u t i o n a l and administrative), and describing "the c r i t i c a l i n t e r a c t i v e processes that blend power and value i n determi-ning p o l i c y choices".17 The model i s d i s t i n c t i v e i n i t s appreciation of the "random, multi-channeled nature of p o l i c y coalescence"-'-0' as a v a r i e t y of influences are seen to r e s u l t i n linkages and/or blockages along the p o l i c y t r a i l that may eventually lead to a new p u b l i c p o l i c y Two important elements of the p o l i c y flow model are p o l i c y s t y l e and p o l i c y environment. P o l i c y s t y l e r e f e r s to that d i s t i n c t i v e manner FIGURE 4.2 AMENDED SYSTEMS MODEL OF THE POLICY PROCESS (a) Inputs Mediating variables Demands/ Groups/ Resources/ Parties/ Supports/ Organisations etc. etc. (a) Environmental variables: Socio-economic Physical Political N.B. Environmental vatiables vary with time. Organisational "j network • J Environment From: Jenkins, Policy Analysis, p. 22. Reproduced by permission of the publisher. O l •FIGURE 4.3 PUBLIC POLICY FLOW MODEL Interaction Milieu i>wci!k Policy Issue) From: Robert H. Simmons, Bruce W. Davis, Ralph J.K. Chapman, and Daniel D. Sager, " P o l i c y Flow Analysis: A Con-ceptual Model for Comparative Public Policy Research", Western Political Quarterly 27 (Summer 1974): 467. Reproduced by permission of Robert H. Simmons. 138 which the behaviour of actors and groups involved i n the process may acquire over the course of time, and which can be analyzed according to i t s communication, commitment; leadership, and group dynamics. Im-portant actors often have preferred access to communication networks through connections established i n a v a r i e t y of ways, and w i l l use these to influence p o l i c y development. The l e v e l of commitment of actors to p a r t i c u l a r p o l i c y choices may a f f e c t the decisions taken at d i f f e r e n t points depending on the r o l e such persons play. Heads of agencies and those i n formal leadership r o l e s form a s p e c i a l set of actors who may profoundly a f f e c t p o l i c y choice through t h e i r personal a t t r i b u t e s (including charisma) and interpersonal s t y l e . Individual perceptions of others' c r e d i b i l i t y and i n t e n t i o n form the basis f o r formal and informal c o a l i t i o n s whose group dynamics and changing s t a -tus h i e r a r c h i e s w i l l impinge upon the p o l i c y making process. Two of the most important factors within the p o l i c y environment are those of power and resources. Power considerations concern the structure and dynamics of authority within the p o l i c y f i e l d , and de-f i n e a continuum along which involved agencies can be located as auto-nomous from or dependent upon the p o l i t i c a l system for bureaucratic appointment, tenure, and budgetary supervision. Other aspects of the power configuration are the nature of the a f f i l i a t i o n s agencies make with r e l a t e d i n t e r e s t groups, the existence and nature of a core pro-f e s s i o n a l s t a f f , the f i n a n c i a l arrangements f o r departmental a c t i v i t y , and the h i s t o r i c a l t r a d i t i o n of agency operations. A l l of these power , arrangements may have substantial impact on the determination of values and thus the emergence of p o l i c y . A number of d i f f e r e n t environmental inputs a f f e c t the a v a i l a b i l i t y and nature of resources involved i n the development of p o l i c y . I n t e r s o c i e t a l inputs and technological advances 139 may a l t e r perceptions of the possib l e , while c o n f l i c t a r i s i n g from the generational d i a l e c t i c (the struggle among the generations) may change wide-spread values and r e d i r e c t p o l i c y . The quantity and q u a l i -ty of t e c h n i c a l , p h y s i c a l , and f i s c a l resources at hand w i l l also have an obvious e f f e c t on the a b i l i t y of actors to ;shape p u b l i c p o l i c y . Both power and resources can be affected by the conditions that p r e v a i l (or are thought to pr e v a i l ) i n the p o l i c y f i e l d , ranging from s t a b i l i t y to c r i s i s . In the words of.Simmons et a l . : The capacity of a minister, governor, p r o f e s s i o n a l s t a f f , or any involved actor to introduce c r i s e s into the f i e l d may a l t e r s i g n i f i c a n t l y the nature of the p o l i c y options a v a i l a b l e . The degree of c r i t i c a l i t y of c r i s i s , the capacity to generate c r i s i s , the kinds of responses to bring s t a b i l i t y , the nature of s t a b i l i t y , the in t e g r a t i v e or destructive nature of the i n t e r a c t i o n processes, the success or f a i l u r e of these i n t e -grative or destructive f a c t o r s , w i l l a l l have profound e f f e c t s on p o l i c y choices.19 The incidence of the modern p o l i t i c a l - b u r e a u c r a t i c Machiavellianism to which t h i s r e f e r s may well be expected to increase i n the current era of progressive f i s c a l r e s t r a i n t . The challenge facing those planning f o r B r i t i s h Columbia's aging population, then, i s to communicate the sense of r e a l and impending c r i s i s that looms over the various pro-grams f o r the e l d e r l y when projected into the next century. No f a l s e c r i s i s , t h i s scenario seems reasonably assured (see Section 2.3.5), but there i s a danger that i t s apparent remoteness may l u l l d e c i s ion-makers into a f a l s e sense of s e c u r i t y that w i l l i n h i b i t e f f e c t i v e planning action. To prevent the ina c t i o n that w i l l indeed lead to a r e a l c r i s i s i n twenty or t h i r t y years, strong v i s i o n a r y leadership i s required at both the p o l i t i c a l and bureaucratic l e v e l s . Hartle points out that the r o l e of government extends beyond that of r e s o l v i n g c o n f l i c t i n g i n t e r e s t s i n so c i e t y " i n such a way as to avoid the open use of force: 'the war of a l l against a l l ' , to use 140 Hobbes' phrase"20 to that of Leadership by which we mean the adoption of p o l i c i e s that are unpopular i n prospect but come to be accepted perhaps even with enthusiasm and pride, a f t e r they have proven themselves.21 Despite the r e a l i t y of partisan and e l e c t o r a l concerns, Hartle makes a convincing case f o r the p o s s i b i l i t y of true p o l i t i c a l leadership where-by the rare p o l i t i c i a n i s able to discern i n the discoveries of a few others an i n s i g h t " j u s t s l i g h t l y ahead of i t s time", and through a mixture of persuasion and demonstration bring i t to bear on p o l i c y decisions before i t has been widely recognized by voters22. Bureaucratic planners and p o l i c y makers play an e s s e n t i a l r o l e i n t h i s process by developing sound p o l i c y a l t e r n a t i v e s and bringing them to the attention of government p o l i t i c a l leaders. I f support f o r needed p o l i c i e s can then be gained on a non-partisan b a s i s , as Bainbridge has reported was the case f o r Long-Term Care i n t h i s province i n 1975,23 t h i s i s much to be preferred since i t eases the process of p o l i c y adop-t i o n and implementation. The next section considers strategies f o r planning f o r an aging population i n order to suggest a d i r e c t i o n f o r the development of future p o l i c y i n t h i s regard. 4.2 PLANNING STRATEGIES FOR AN AGING POPULATION Against the background of change theory and i t s s p e c i a l i z e d prac-t i c e i n p u b l i c p o l i c y making, t h i s section reviews conventional planning approaches employed i n the past to design programs f o r the e l d e r l y and suggests a s h i f t to a strategy of r a d i c a l change f o r the future. 141. 4.2.1 Strategies f o r the E l d e r l y i n Retrospect Planning strategies f o r the e l d e r l y i n B r i t i s h Columbia i n the past have usually been based i m p l i c i t l y on s o c i a l gerontological theories that emphasize a regulation o r i e n t a t i o n to society, and l a r g e l y on those taking an objective approach to s o c i a l science which f a l l i nto c the functionalist paradigm. F u n c t i o n a l i s t planning strategies have spawned such programs as senior c i t i z e n s ' centres and counsellors, SAr" FER, GIS/SPA, GAIN, and CPP. Although e f f e c t i n g some r e d i s t r i b u t i o n , the older health programs of h o s p i t a l and medical care insurance are also included i n the f u n c t i o n a l i s t group due to t h e i r basic adaptive o r i e n t a t i o n . These strategies are indicated i n Figure 4.4 as those of 'adaptation'. Interpretive strategies have taken a subjective regu-l a t i v e approach that can be characterized as st r e s s i n g 'personal deve-lopment' . Examples of programs i n t h i s category are the hospice pro-grams now getting underway, and various retirement education courses that are offered. A few strategies i n the past have arisen from para-digms, taking a r a d i c a l change o r i e n t a t i o n to society. Those derived from an objective approach to s o c i a l science that have been termed r a -d i c a l s t r u c t u r a l i s t have brought about the development of programs e f f e c t i n g d e l i b e r a t e t r a n s f e r s of resources i n cash or kind to the e l -derly. Examples of programs a r i s i n g through such strategies of 'redis-t r i b u t i o n ' are OAS, Pharmacare (Plan A), Dental Care (Plan 3), and Long-Term Care;/Home Care f o r those 65 and over. There are few examples of programs i n t h i s province that have come about through r a d i c a l huma-n i s t strategies designed to increase the 'consciousness* of older people, although a few of the more active and r a d i c a l pensioners' groups may q u a l i f y i n t h i s regard, as well as some information services set up by seniors such as those funded under the fede r a l New Horizons program FIGURE 4.4 PLANNING STRATEGIES FOR THE ELDERLY IN RETROSPECT SUBJECTIVE STRATEGIES OF RADICAL CHANGE RADICAL HUMANIST CONSCIOUSNESS Hospice PERSONAL DEVELOPMENT Retirement Education INTERPRETIVE RADICAL STRUCTURALIST REDISTRIBUTION OAS Pharmacare, Dental Plan LTC/HC Hospital and Medical Care Insurance CPP ADAPTATION GIS/SPA, GAIN, SAFER Senior's centres, counsellors FUNCTIONALIST OBJECTIVE STRATEGIES OF REGULATION 4*. 143 (which provides community grants to q u a l i f y i n g projects by groups of e l d e r l y c i t i z e n s ) . As has been discussed i n Section 2.3.5, even those programs that can now be considered adequate (and these are few indeed as Section 2.2.5 points out) have l i t t l e hope of meeting the needs of the swollen ranks of the e l d e r l y expected a f t e r 2011 without r a d i c a l changes being effected. It seems an opportune time i n 1982 to begin taking steps to ensure that the dramatic program reforms required w i l l indeed be i n place when the f i r s t group of the baby boom children enter t h e i r senior years about t h i r t y years from now.. Moreover, the current economic rece-ssion has created a climate within the p u b l i c sector that i s more recep-t i v e to r a d i c a l change. In B r i t i s h Columbia the perceived f i s c a l c r i s i s has c e r t a i n l y changed the a v a i l a b i l i t y of power and resources to various government agencies as the p o l i c y flow model predicted. Simmons et a l . also suggest that It may be hypothesized that the access of p o l i t i c a l actors i s greater at times of severe c r i s i s than at times of r e l a t i v e and prolonged s t a b i l i t y . In t h i s instance the influence of the p r ofessional s t a f f or the expert may be f a r greater i n shaping policy.24 I f t h i s i s so, then the current set of circumstances presents an oppor-t u n i t y f o r planners f o r the aging population to lobby f o r p o l i c y chan-ges that are compatible with t h e i r longer term goals. The main elements of a plan to accomplish t h i s are described i n the next section. 4.2.2 The Elements of a Radical Plan The development of an adequate s o c i a l p o l i c y f o r the e l d e r l y would be g r e a t l y f a c i l i t a t e d by the i n t e g r a t i o n of the several services i n various government departments that presently have some r e s p o n s i b i l i t y f o r health, income, and housing programs f o r the province's senior c i t i -zens. An interdepartmental co-ordinating agency should therefore be established as soon as po/ssible to work toward t h i s end, and to act as the information nexus and monitor f o r ongoing research and data c o l l e c t i o n . This agency could eventually become a separate department, i f and when t h i s seemed p r a c t i c a l , responsible for the provision and monitoring of integrated services through l o c a l community service cen-tres which would group programs and personnel now dispersed throughout government. In t h i s way the linkages between the health, income, and housing needs of older people could be more r e a d i l y i d e n t i f i e d , and more appropriate services provided as a r e s u l t . This 'one-stop-shopp-i n g 1 arrangement would also greatly reduce the confusion many e l d e r l y people experience when attempting to access needed services. Within t h i s organizational framework, however, each of the three basic pro-gram areas must work toward s p e c i f i c p o l i c y goals. The health program area must work c l o s e l y with other health agents and i n s t i t u t i o n s i n the community to ensure continuous, high q u a l i t y care when needed by an e l d e r l y person. As a f i r s t step, e x i s t i n g 'blocked beds' i n acute care h o s p i t a l s should be redesignated as long-term care beds (with no compensating acute care bed development) to mitigate the current shortage of i n s t i t u t i o n a l beds f o r the e l d e r l y , and accelerate the process of r e d i s t r i b u t i n g i n s t i t u t i o n a l resources from acute to long-term care. These beds should come under the j u r i s -d i c t i o n of a Director of Health Care f o r the E l d e r l y i n each region of the province who would s i t on the regional h o s p i t a l ' s executive commit-tee as well as managing community health care resources f o r the aged. In addition.; a formula based on the changing population age structure should be developed to r e d i r e c t budget monies to health care f o r older people (from general health care and education programs) with p r i o r i t y 145 a l l o c a t i o n f o r home and other community support services. Whenever possible assessments and other health services should be provided' by nurses and other a n c i l l a r y personnel, i n the older person's home set-ting or day ho s p i t a l s with physicians paid a ca p i t a t i o n allowance f o r medical supervision of a c e r t a i n number of e l d e r l y people. I t may also be p r a c t i c a l to employ some physicians on salary i n the l o c a l service centres f o r those lacking t h e i r own private doctors. The young-old (aged 65-74) in general, and other seniors i n good health should be encouraged to become involved i n a s s i s t i n g those i n need i n p r a c t i c a l ways that stress s e l f - h e l p and disease prevention through the acceptan-ce of personal r e s p o n s i b i l i t y f o r one's health. In addition to further humanizing health services to the e l d e r l y , these arrangements might help to put a l i d on the alarming e s c a l a t i o n i n health expenditures that has occurred i n the past few decades, driven, as Evans points out, not by extreme s h i f t s i n demography, but by the "numbers and types of per-sonnel and gadgetry produced and reimbursed".^ 5 In turn, t h i s cost-containment should permit resources to be redirected f o r use i n innova-t i v e preventive health programs f o r the growing aging population. The basic goal f o r the income program area i s the assurance of adequate income to all e l d e r l y people, e s p e c i a l l y those who are sing l e , and p a r t i c u l a r l y single women. Although the replacement of mandatory retirement by job competence appraisals i s recommended, l a t e r r e t i r e -ment does not diminish the need f o r a major reform of the'income sup-port system. The federal and p r o v i n c i a l governments must work together to implement a u n i f i e d retirement income program out of the threadbare patchwork of CPP, OAS, GIS/SPA, and GAIN programs, to include housewi-ves along with those r e t i r i n g from employment t r a d i t i o n a l l y considered 'productive', and to address the needs of spouses i n the neglected 60 to 65 year age range. The income such a scheme would provide should be at least equal to the highest appropriate poverty l i n e (see Appendix 5), and might most e f f i c i e n t l y be d i s t r i b u t e d through a tax c r e d i t system' that'resulted i n 'negative income tax' payments to e l d e r l y peo-pl e . While private retirement pension plans with early vesting, porta-b i l i t y , and spouse's benefits are to be encouraged, p u b l i c pension income programs should be viewed as providing a basic income f l o o r f o r older people, with extra funds required coming from general government revenues. In addition, retirement education courses and t r a n s i t i o n a l employment schemes should be expanded to play a more s i g n i f i c a n t r o l e as status diminution support programs for those a n t i c i p a t i n g retirement The goal f o r the housing program area i s to ensure access to a range of a l t e r n a t i v e s from independent u n i t s i n regular housing develop ments through various types of congregate or sheltered housing (see the d e s c r i p t i o n quoted below) f o r those who can no longer manage i n t h e i r own homes, but are not i n need of resident nursing care. Since congregate housing i s such an obvious gap i n current housing for the e l d e r l y i n t h i s province, i t i s worth quoting here the d e s c r i p t i o n of the many forms i t may take offered by Kahn and Kamerman: Such housing arrangements may be s p e c i a l l y planned r e t i r e -ment communities or housing, or multiservice f a c i l i t i e s ; they may be c l u s t e r s of detached homes with shared sp e c i a l services and f a c i l i t i e s or a'multidwellirig, high or low-rise apartment house complex, f o r the aged alone or i n part, with s i m i l a r services and f a c i l i t i e s . They are characterized by the presence of a special p h y s i c a l layout and design (wide hallways and elevators and low-level kitchen equipment to permit use by people i n wheelchairs ; a buzzer system to ensure constant a v a i l a b i l i t y of emergency help); and suppor-t i v e services (warden or house manager, homemaker-home-health, meals, s o c i a l i z a t i o n , and recreation).26 Such housing could be" constructed" by p u b l i c or'private.'enterprise de-pending on t h e i r r e l a t i v e cost-effectiveness, and made accessible to e l d e r l y c i t i z e n s through sp e c i a l subsidies or shelter allowances which would reduce the monthly cost to i n d i v i d u a l s to a s p e c i f i e d percentage of t h e i r income regardless of the t o t a l unit cost. The major b u i l d i n g programs f o r the e l d e r l y that must be undertaken i n the future could be stimulated by spe c i a l investment arrangements that reduce or remove taxes on p r o f i t s i n exchange f o r lowered rates of i n t e r e s t on invest-ment c a p i t a l (that i n turn could lead to lower unit b u i l d i n g costs). Another promising a l t e r n a t i v e would be to encourage the expansion of non-profit housing co-operatives to b u i l d and maintain integrated hous-ing developments f o r seniors. In each of these program areas i t i s important to recognize the necessity of s o c i a l supports f o r the e l d e r l y as bridging mechanisms f o r the resource supports that have emphasized above. There w i l l a l -ways be a need f o r s o c i a l support programs, but they perform a c r u c i a l r o l e i n taking up the slack u n t i l resource support programs are made more adequate. The p r i o r i t y of increasing the awareness of older peo-ple and others about the problems and prospects of aging through the various information media must also be stressed. Informed awareness i s a precondition f o r i n t e l l i g e n t action, and the f i r s t step to i n -creasing the self-esteem of many of the aged who now f e e l unnecessary and impotent. The act i v e p a r t i c i p a t i o n by e l d e r l y people i n planning f o r the aging population i s e s s e n t i a l to the eventual success of any programs developed. Only seniors themselves can bring to the planning process the s e n s i v i t y to issues such as inte g r a t i o n versus segregation of services, and the s p e c i a l needs of c u l t u r a l m i n o r i t i e s , that w i l l ensure a new pub l i c program has a human face and heart. It must also be stressed that p u b l i c programs themselves cannot hope to meet a l l the needs of a l l older people, and that most seniors w i l l continue to require the involvement of f a m i l i e s , churches, and a number of other 148 helping agents i n innovative ways (e.g. f o s t e r grand-parenting). The system of supportive programs f o r the aged j u s t described would go a long way toward e f f e c t i n g the r e d i s t r i b u t i o n of resources to the e l d e r l y that has been argued here i s required to prevent the eventual generational c o n f l i c t and confrontation that would threaten the very nature of B r i t i s h Columbian society. Since the plan involves genuine r e d i s t r i b u t i o n , however, i t s implementation can be expected to generate determined opposition from groups now b e n e f i t t i n g from the status quo who would stand to lose s i g n i f i c a n t l y as a r e s u l t of the changes proposed. It i s j u s t as important to develop a strategy for the implementation of such programs as i t i s to have the plan i t s e l f . The f i n a l section examines the r o l e of various planning strategies i n the development of new p o l i c y ' i n i t i a t i v e s , and suggests a timetable f o r implementation of the plan described here. 4,2.3 A Strategy f o r Implementation The process of implementing a plan such as that proposed i n the l a s t section requires car e f u l s t r a t e g i c consideration. A strategy f o r implementation must s u c c e s s f u l l y deal with resistance from groups which perceive adverse e f f e c t s from proposed changes, while develop-ing strong broad-based popular, p o l i t i c a l , and bureaucratic support. The objective i s to enact the plan i n such a manner that the e n t i r e package i s i n place by the time the proportion of e l d e r l y people i n the population begins i t s dramatic climb early i n the next century. It i s h e l p f u l to i d e n t i f y a sequence of planning strategies involved i n p o l i c y development and apply t h i s to the plan f o r B r i t i s h Columbia's aging population i n order to develop a workable timetable f o r imple-mentation. Warren has divided planning strategies into those of co-operation, campaign or contest r e f l e c t i n g low, medium and high resistance respec-t i v e l y . 27 Other analysts have suggested that strategies may be r e -educative, f a c i l i t a t i v e or persuasive depending upon both the length of time a v a i l a b l e f o r pursuit of s t r a t e g i c objectives, and the ease of t h e i r accomplishment.28 i n f a c t a combination of these s t r a t e g i e s could be employed at various phases of the development of new p u b l i c p o l i c y f o r the aged based on the l e g i t i m a c y - f e a s i b i l i t y c r i t e r i a that H a l l et a l . have described.29 As Figure 4.5 shows, during the f i r s t (introduction) phase the time-frame i s longest and resistance r e l a t i -vely low, allowing re-educative/co-operative approaches to be used. During t h i s phase s u f f i c i e n t support must be garnered from those ame-nable to change f o r the new approaches to acquire s o c i a l legitimacy. The l e v e l of resistance offered by dissenters, however, and decreas-ing time a v a i l a b l e necessitates a s h i f t to faci l i t a t i v e / c a m p a i g n strategies i n the second (formulation) phase. The ad d i t i o n a l support evoked through these strategies moves the developing p o l i c i e s to the point of f e a s i b i l i t y , and the process s h i f t s to the power/contest strategies of the t h i r d and f i n a l (implementation) phase during which intense resistance from those most adversely affected must be overcome. At each stage p o l i c y support i s increased, those remaining as non-supporters pose a more formidable obstacle to p o l i c y adoption, and the time a v a i l a b l e to continue negotiations decreases. In the f i n a l a n a l y s i s , compliance with the new i n i t i a t i v e must be assured by the imposition of appropriate binding regulations. It i s hoped that the support developed during p o l i c y introduction and formulation w i l l make the f i n a l implementation phase less contentious. The r a d i c a l s t r u c t u r a l strategy recommended here f o r the develop-FIGURE 4.5 THE SEQUENCE OF PLANNING STRATEGIES IN POLICY DEVELOPMENT TIME-FRAME SHORT MEDIUM LONG threshold o: f e a s i b i l i t y ^ ^ ^ ^ PHASE 3 power/ contest IMPLEMENTATION PHASE 2 f a c i l i t a t i v e / campaign FORMULATION PHASE 1 re-educative/ co-operative INTRODUCTION X ^ threshold o f legitimacy LOW MEDIUM RESISTANCE HIGH 151 ment of p o l i c y f o r the e l d e r l y can be described according to the three-phase model j u s t discussed. During the introduction phase the emphasis would be on developing a data base upon which to b u i l d future programs through research into current service u t i l i z a t i o n and effectiveness, and the p r o j e c t i o n of future needs on the basis of demographic trends. It i s hoped that t h i s paper w i l l contribute to t h i s process by stimula-t i n g and encouraging work of t h i s nature i n the various relevant agen-c i e s . It must be stressed that planning and research should involve the e l d e r l y and t h e i r representatives as much as possible i n order to develop support and consensus, and ensure that ideas advanced have a sound basis i n everyday experience. A number of other provinces such as Ontario, Saskatchewan, and Quebec-^ are further along than B r i t i s h Colum-b i a , having already completed preliminary reports of t h i s nature. The introduction phase might be accelerated, and c e r t a i n l y the q u a l i t y of i t s process improved by the development of a co-ordinating structure within government to act as a f o c a l point f o r information exchange and planning i n the ongoing p o l i c y process. It i s noteworthy i n t h i s re-gard that Ontario has j u s t appointed a P r o v i n c i a l Co-ordinator f o r Se-n i o r C i t i z e n s , i n response to a recommendation of the report mentioned above, who i s to e s t a b l i s h a Seniors Secretariat designed to improve information d e l i v e r y to seniors, to encourage research into issues r e l a t i n g to aging, and to support e f f e c t i v e p o l i c y co-ordination on aging across m i n i s t r i e s . ^ 1 The timing of planning strategies i s shown;.in conjunction with the i n -creasing proportion of the e l d e r l y i n B r i t i s h Columbia i n Figure 4.6. The f i r s t phase of p o l i c y development could be well underway i n t h i s province by 1987 with enough support generated f o r the process to cross the threshold of legitimacy (see Figure 4.5) and begin the formulation of s p e c i f i c program options involved i n the r e d i s t r i b u t i o n of resources FIGURE 4,6 A STRATEGIC TIMETABLE FOR PLANNING FOR B.C.'S AGING POPULATION* 30-1 Percentage of E l d e r l y i n Total Population'' Zo.Z 16.0 10.1 10 196/ I I I I 113 12.0 IZ.+ /Z.6 I*. I nit 1986 1996 1 I I I i ZOO/ I _introduction jphase — ( I formulation phase Z006 Z0I1 ZOt6 ZOZt ZOZ6 2.0BI limplementation phase *Data from Table "2.4 153 to the e l d e r l y i n the key health, income, and housing areas that w i l l guarantee the adequacy of these services i n the years to come. This formulation phase might continue into the early 1990's, and involve the t e s t i n g of p i l o t programs with federal co-operation i n various regions of the province. By the mid-1990's enough information on the e f f e c t i v e -ness of various program options should be a v a i l a b l e f o r province-wide (nation-wide?) p o l i c i e s to be implemented to ensure that the e l d e r l y are adequately served i n the three basic areas mentioned. The increased support developed during the second phase should enable the p o l i c y deve-lopment process to cross the threshold of f e a s i b i l i t y (see Figure 4.5) and enter the f i n a l implementation stage. At t h i s point e s s e n t i a l l y po-l i t i c a l decisions must be taken to overcome remaining resistance and embark on new program i n i t i a t i v e s . These i n i t i a t i v e s could s t i l l be phased i n over the course of a decade or more since the eldest baby-boom chil d r e n w i l l not reach the age of 65 u n t i l about 2011, but i t i s cru-c i a l that action begin by 1996 with f u l l implementation scheduled f o r 2006. Adherence to t h i s timetable w i l l guarantee the adoption of re-forms necessary to avoid the severe s o c i a l stress that can otherwise be expected to develop as the population ages r a p i d l y i n the second and t h i r d decades of the twenty-first century. In a p o s i t i v e sense, the implementation of such a plan would a s s i s t g r e a t l y i n "adding l i f e to years"32 f o r older people who now enjoy only the sometimes dubious bene-f i t s of added years of l i f e . 154 5. CONCLUSION This chapter' draws together the main points of the study as a whole, and l i s t s a number of important recommendations f o r action by the appropriate a u t h o r i t i e s . 5.1 SUMMARY Conservative estimates of B r i t i s h Columbia's aging population sug-gest that the percentage of those 65 and over i n the province w i l l a l -most double over the next f i f t y years, from about 11% to more than 21% of the t o t a l population. Although the most dramatic r i s e i n the propor-ti o n of the e l d e r l y w i l l take place a f t e r 2011 as the baby-boom c h i l d -ren reach t h e i r senior years, the largest increase among the e l d e r l y over the next twenty years i s forecast to occur i n those older sub-groups (75-84, and e s p e c i a l l y 85 +) which are known to be the heaviest users, of c o s t l y i n s t i t u t i o n a l health care services. At the same time as fi x e d pensions are being s e r i o u s l y eroded by apparently chronic i n f l a t i o n , r a p i d l y escalating costs of basic commodities l i k e food and housing are making l i f e e s p e c i a l l y d i f f i c u l t f o r e l d e r l y people l i v i n g alone, par-t i c u l a r l y the many women who have not been a regular part of the labour force. The l i n k s between an older person's health, income, and housing needs are becoming inc r e a s i n g l y obvious amid concern that r e s i d e n t i a l health care settings may face even greater demand as a re s u l t of serious inadequacies i n other supportive programs. With health, income, and housing programs f o r the aged hard-pressed to meet current demands, the prospect of intense demographic pressures i n the years to come increases the unwelcome p o s s i b i l i t y of increasing inter-generational c o n f l i c t un-less appropriate reforms are i n s t i t u t e d to meet society's obligations to i t s senior c i t i z e n s . The example of 'older' countries l i k e the UK that have had to cope with an aging population despite economic d i f f i c u l t i e s shows that some success i s possible with long-range s t r u c t u r a l reforms i n the s o c i a l sector even i f these are i n i t i a l l y at variance with established p o l i t i -c a l and s o c i a l ideologies. The l i b e r a l u t i l i t a r i a n ideology that per-vades Canada should not preclude the use of a r a d i c a l s t r u c t u r a l approach to the problems posed by an aging population e s p e c i a l l y since past and future experience appears better explained by t h i s paradigm than by other subjective and conventional a l t e r n a t i v e s . Such an analysis has clear implications f o r planning strategies that aim to achieve change through a p u b l i c p o l i c y process' conceived of as a comprehensive systems flow model incorporating a f a c t i o n a l or catastrophic dynamic. In place of the previous stress on adaptation and personal development i n s t r a -tegies f o r the e l d e r l y , a r a d i c a l plan to e f f e c t genuine r e d i s t r i b u t i o n i s offered, along with a strategy to ensure i t s ^implementation over the next twenty years. The elements of t h i s plan, and the implementation process form the basis f o r most of the recommendations to follow. RECOMMENDATIONS The implications of the aging of B r i t i s h Columbia's population are p o t e n t i a l l y explosive. It i s es s e n t i a l that government begin now to work toward a coherent p o l i c y f o r the e l d e r l y that w i l l ensure the ade-quacy of accessible supportive programs i n the future. Unless a l l p o l i -t i c i a n s accept t h i s task as a high s o c i a l p r i o r i t y , programs f or the aged i n t h i s province are l i k e l y to continue to be the sometime product of partisan p o p u l i s t appeals, with the f a m i l i a r r e s u l t that seniors must negotiate a confused and confusing p o l i c y maze only to f i n d that i n many cases i t s eventual provisions f a l l short of t h e i r actual needs. Since 156 j u r i s d i c t i o n . f o r d i f f e r e n t program elements i s s p l i t among various governmental l e v e l s , there i s an obvious need f o r co-operative action on the part of f e d e r a l , p r o v i n c i a l , and municipal o f f i c i a l s to develop and implement workable proposals for reform. Although action on the recommendations to follow i s indicated to proceed from those p r o v i n c i a l and federal agencies most c l o s e l y involved, i t i s expected that the con-s u l t a t i v e and co-operative process should extend to other departments of these governments, as well as the various m u n i c i p a l i t i e s and regional d i s t r i c t s where appropriate. Inevitably, some important areas such as •fc transportation and recreation have been omitted i n an e f f o r t to focus attention on what are seen as the c r u c i a l supportive program areas of health, income, and housing. F i n a l l y , the reader should keep i n mind that not a l l older people w i l l need a l l p u b l i c programs recommended, so that the plan i s not so completely i n t e r v e n t i o n i s t as i t at f i r s t may seem to be. In f a c t , while most (.90-100%) 0 f rhe e l d e r l y would i n -deed b e n e f i t from reforms to pension and general health care programs, f a r fewer (about 50%) would be affected by changes i n labour l e g i s l a -t i o n , and only a small minority (5-15%) would l i k e l y be involved i n housing and Long-Term Care programs. The recommendations l i s t e d below indicate steps t h a t , i n my judgement, should be taken over the next two decades to meet the challenge of planning f o r our aging population. In doing so we s h a l l i n e v i t a b l y be planning f o r ourselves as w e l l . POLICY AREA RECOMMENDATION. INFORMATION AND 1. B r i t i s h Columbia should e s t a b l i s h an inter-departmental PLANNING agency on aging at the e a r l i e s t possible date with i n i -t i a l r e s p o n s i b i l i t y f o r co-ordinating information and planning f o r the e l d e r l y . 2. Data on the e l d e r l y should be upgraded and co-ordinated, and related research at the p o l i c y and program l e v e l encouraged. (See Appendix 11). 3. The integration of major public services to e l d e r l y peo-ple i n comprehensive l o c a l service d e l i v e r y centres should be considered. HEALTH 4. To mitigate the current shortage of long-term care beds and begin i n s t i t u t i o n a l resource r e d i s t r i b u t i o n e x i s t -ing 'blocked beds' i n acute care hospitals should be redesignated long-term care with no compensating acute bed development. 5. A formula r e f l e c t i n g changing demographic r e a l i t i e s should be developed f o r the r e d i r e c t i o n of budget monies to health care f o r the e l d e r l y from general health and education revenues, with p r i o r i t y a l l o c a t i o n for preventive, long-term care, and community support services delivered by a n c i l l a r y health personnel. ACTION(provincial / f edera l ) Health Human Resources Lands, Parks, and Housing Education Labour P r o v i n c i a l Secretary and Government Services Health Human Resources Lands, Parks, and Housing Finance U n i v e r s i t i e s , Science, and Commu-nications Health and Welfare Central Mortgage and Housing Health Human Resources Lands, Parks and Housing Health and Welfare Health Health Education Finance Health and Welfare INCOME A capitation arrangement f or private physicians provid-ing care to the e l d e r l y should be considered, with some salaried doctors available i n the integrated l o c a l service centres.. Le g i s l a t i o n and regulations supporting mandatory retirement at age 65 should be replaced by a system of regular job competence appraisals. The Province should work with the federal government to e s t a b l i s h a u n i f i e d retirement income system pro-viding an adequate pension f l o o r f o r a l l the aged, including single women and regardless of work h i s t o r y , to replace the many current income support programs for the e l d e r l y (CPP, OAS, GIS, SPA, GAIN). Private employers should be encouraged to e s t a b l i s h or expand pension programs f or workers with improved provisions f o r early vesting, p o r t a b i l i t y , and spouse's benefits. HOUSING 10. The Province should encourage the construction of a wide range of independent and congregate housing a l t e r -natives f o r the e l d e r l y through the public or pri v a t e sector depending on r e l a t i v e cost-effectiveness i n r e l a t i o n to program goals. 11. Senior c i t i z e n s should receive housing subsidies to reduce monthly costs to a sp e c i f i e d percentage of th e i r income. 12. Innovative housing alternatives such as non-profit co-operatives should be encouraged, and programs to a s s i s t the independent e l d e r l y or the fam i l i e s of those depen-dent should be expanded. Health Finance Health and Welfare Labour Manpower, Employment and Immigration Human Resources Labour Finance Health and Welfare Labour Health and Welfare Lands, Parks, and Housing Finance Health Human Resources Central Mortgage and Housing Lands, Parks, and Housing Fihah'ce Lands, Parks, and Housing Finance Central Mortgage and'Housing NOTES CHAPTER 1 1. Throughout the paper the terms 'the e l d e r l y ' , 'the aged', and'senior citizens',, and 'older people' are used interchangeably to r e f e r to those aged 65 or over, p r i m a r i l y to allow some l i t e r a r y v a r i e t y . 2. While i t i s f a r from clear that the needs of e l d e r l y people i n the f u -ture w i l l be s i m i l a r to those of today's aged, i t seems safe to assume that they w i l l continue to require health care, income, and shelter in some form. CHAPTER 2 1. This review of h i s t o r i c a l development draws l a r g e l y on Margaret McPhee's comprehensive planning t h e s i s , "Health Care or Health: The Development of the Elements of a Plan to Address the Health Needs of the E l d e r l y i n B r i t i s h Columbia" (M.Sc. t h e s i s , University of B r i t i s h Columbia, 1977). 2. Garth Stevenson, Unfulfilled Union (Toronto: Macmillan 1979). 3. Canada, Department of J u s t i c e , A Consolidation of the British North America Acts 1967 to 1975 (Hull, Quebec: Supply and Services Canada, 1978), pp. 24-29. 4. Canada, Parliamentary Task Force on Federal - Pr o v i n c i a l F i s c a l Arrange-ments, Fiscal Federalism in Canada (Ottawa: Supply and Services Canada, 1981), p. 46. 5. Malcolm Taylor, "The Canadian Health Insurance Program", Public Adminis-tration Review 33 (Jan.-Feb. 1973), p. 31. 6. Canada (Heagerty), Advisory Committee on Health Insurance, Eealth Insu-rance (Ottawa: King's P r i n t e r , 1943). 7. Canada ( H a l l ) , Royal Commission on Health Services, Report (Ottawa; Queen's P r i n t e r , 1964). 8. McPhee, Eealth Care or Eealth, p. 22. 9. Canada, Department of National Health and Welfare Task Force on the Costs of Health Care, Report (Ottawa: Queen's P r i n t e r , 1969). 10. Canada (Hastings), Department of National Health and Welfare, The Com-munity Eealth Centre in Canada, 3 vo l s . (Ottawa: Information Canada, 1972-73). 11. Canada (Lalonde), Department of National Health and Welfare, A New Perspective on the Eealth of Canadians (Ottawa: Information Canada, 1974). 160 12. Canada ( H a l l ) , Department of National Health and Welfare, Canada's National-Provincial Health Program for the 1980 's (Ottawa: Queen's Pr i n t e r , 1980). 13. Canada, Fiscal Federalism in Canada. 14. Dennis Guest, The Emergence of Social Security in Canada (Vancouver: University of B r i t i s h Columbia Press, 1980), p. 34. 15. Great B r i t a i n (Beveridge), Social Insurance and Allied Services (London: H.M.S.O., 1942). 16. Canada, Economic Council of Canada, One in Three: Pensions for Cana-dians to 2030 (Ottawa: Queen's P r i n t e r , 1979); Canada, Senate, Special Senate Committee on Retirement Age P o l i c i e s , Retirement Without Tears (Ottawa: Queen's Pr i n t e r , 1979); Canada, Task Force on Retirement In-come Po l i c y , The Retirement Income System in Canada: Problems and Alternative Policies for Reform (Ottawa: Queen's Pr i n t e r , 1979). 17. Canada, Department of National Health and Welfare, Pensions in Canada (Ottawa: Queen's Pr i n t e r , 1981). 18. Guest, Emergence of Social Security,^. 99-100. 19. McPhee,. Health Care or Health, p. 4. 20. Ibid., p. 6. 21. B r i t i s h Columbia (Foulkes), Health Security Program Project, Health Security for British Columbians ( V i c t o r i a : Queen's Pr i n t e r , 1973). 22. B r i t i s h Columbia (Evans), Children's Dental Health Research Project, Report ( V i c t o r i a : Queen's Pr i n t e r , 1975). 23. McPhee, Health Care or Health, p. 13. 24. Ibid., p. 13. 25. Ibid., p. 18. 26. Albert Rose, Canadian Housing Policies 1935-1980 (Scarborough, Ont: Butterworth, 1980), p. 83. 27. B r i t i s h Columbia ( J a f f a r y ) , Interdepartmental Study Team on Housing and Rents, Housing and Rent Control in British Columbia (Vancouver, 1975). 28. Rose, Canadian Housing Policies p. 84. 29. S o c i a l Planning and Review Council of B r i t i s h Columbia: Community Care for Seniors (Vancouver: SPARC, 1972); The Quality of Living in Housing for the Elderly (Vancouver: SPARC, 1974); The Health Needs of the In-dependent Elderly (Vancouver: SPARC, 1976). 30. So c i a l Planning and Review Council of B r i t i s h Columbia, A Citizen's Guide to Long Term Care in B.C. (Vancouver: SPARC, 1978). 161 31. Personal communication with B i l l Lawrence, Director of Research and Evaluation, Planning Po l i c y and L e g i s l a t i o n , Ministry of Health, V i c t o r i a , B.C., January 12, 1982. i 32. B r i t i s h Columbia, Mini s t r y of Human Resources, Annual Report 1980 (Vic-t o r i a : Queen's Print e r , 1981), p. 50. 33. Ibid., p. 46. 34. "Blocked Beds", e d i t o r i a l i n The Lancet, November 8, 1980, p. 1013. 35. Landon Y. Jones, Great Expectations (Toronto: Random House, 1981), pp. 18-19. 36. C.B. Walker, "The Emerging P r o f i l e of the Aged i n Canada", a paper pre-sented to The Research Symposium on Canada's Changing Age Structure: Implications f o r the Future, Vancouver, B.C., August 23, 1981. 37. Demographers expected ..a., s h o r t - l i v e d increase i n b i r t h - r a t e following World War 2 as a r e s u l t of deferred pregnancies, but few foresaw the sustained baby boom that subsequently occurred i n Canada, the U.S.A., A u s t r a l i a , and New Zealand. See Jones, Great Expectations. 38. John Kettle, The Big Generation (Toronto: McClelland and Stewart, 1980), p. 215. 39. Economic Council, One in Three, pp. 125-127. 40. Canada (Glassco), Royal Commission on Government Organization, Report (Ottawa: Queen's Pr i n t e r , 1963). 41. Paul Tennant, "The NDP Government of B r i t i s h Columbia: Unaided P o l i t i -cians i n an Unaided Cabinet", Canadian Public Policy 3 (Autumn 1977) : pp. 489-503. 42. Canada (Lambert, Royal Commission on Fi n a n c i a l Management and Accounta-b i l i t y , Report (Hull, Quebec: Canadian Government Publishing Centre, 1979). 43. Brian J . Powell and James K. Martin, "Economic Implications of An Aging Society i n Canada", a paper prepared f o r The National Symposium on Aging", Ottawa, October 25-27, 1978. 44. Powell and Martin, "Implications of an Aging Society", p. 31. 45. Ibid. 46. See Leroy 0. Stone, "Employment Opportunity and the Achievement of Adequate Income f o r the Baby Boom Generation", i n Blossom T. Wigdor (ed.), Canadian Gerontological Collection Volume 1 (Calgary: Canadian Asso-c i a t i o n of Gerontology, 1977); also Frank T. Denton and Byron G. Spencer, "Canada's Population and Labour Force: Past, Present, and Future", i n Vic t o r W. Marshall (ed.), Aging in Canada: Social Perspectives (Don M i l l s , Ont.: Fitzhenry and Whiteside, 1980). 16 47. Harry Weitz, The Foveign Experience with Income Maintenance for tlte Elder.ly, a study prepared f o r the Economic Council of Canada (Ottawa: Queen's Pri n t e r , 1979), p. 4. 48. Personal communication with B i l l Galbraith, Co-ordinator, Gain f o r Seni-or Program, Mini s t r y of Human Resources, V i c t o r i a , B.C., January 12, 1982. 49. Ministry of Health estimate, 1982. 50. Leroy 0. Stone, "Research Issues i n the F i e l d of Population Aging", pa-per presented to the Graduate Seminar i n Gerontology, University of B r i t i s h Columbia, Vancouver, B.C., September 22, 1981. 51. M. John Gross and Cope W. Schwenger, Health Care Costs for the Elderly in Ontario: 1976-2026, Ontario Economic Council, Occasional Paper 11 (Toronto: Ontario Economic Council, 1981), p. 101. 52. Ibid., p. 103. 53. According to c r i t e r i a established by the United Nations, a country i s "young" i f i t s aging population constitutes 4% or less of t o t a l popula-t i o n , "adult" when they represent between 4% and 7% of the t o t a l , and " o l d " when the aged comprise 7% or more of the population. Within the " e l d e r l y " nations, however, one can u s e f u l l y d i s t i n g u i s h between the young-old (7-9%), the middle-old (10-12%), and the old-old (13% or more). See A l f r e d J . Kahn and Shei l a B. Kamerman, Social Services in International Perspective: The Emergence of the Sixth System, a study f o r the U.S. Department of Health, Education, and Welfare, S o c i a l and R e h a b i l i t a t i o n Service, O f f i c e of Planning, Research and Evaluation (Washington, D.C.: U.S. Government Pr i n t i n g O f f i c e , 1977), p. 235. 54. Ibid., p. 33. 55. Ibid., p. 260. 56. " F u l l y indexed" here means indexed not only to increases i n the cost-of l i v i n g , but also to gains i n national p r o d u c t i v i t y . 57. Kahn and Kamerman, Social Services, p. 261. 58. Ibid., p. 295. 59. Ibid., p. 52. 60. Eric'R. Kingson and Richard M. S c h e f f l e r , "Aging:: Issues and Economic Trends f o r the 1980's", Inquiry 18 ( F a l l , 1981), p. 201. 61. : Ibid., p. 211. 62. Kahn and Kamerman, Social Services, p. 55. 63. Ibid., p. 255. 64. Ibid., p. 279. 65. Richard Rose, Do Parties Make A Difference? (London: Chatham House, 1980). CHAPTER 3 1. W. L i t t l e , H.W. Fowler, and J . Coulson, The Shorter Oxford English Dic-tionary 3rd e d i t i o n (London: Oxford University Press, 1973). 2. Anne Crichton, Health Policy Making: Fundamental Issues in the United States, Canada, Great Britain, Australia (Ann Arbor, Mich.: Health Ad-m i n i s t r a t i o n Press, 1981), pp. 278-9. 3. C l i f f o r d Geertz, "Ideology as a C u l t u r a l System", i n David E. Apter ed., Ideology and Discontent (New York: Free Press, 1964) pp. 47-76. 4. Ibid., p. 64. 5. Crichton, Health Policy Making, p. 213. 6. Ibid., p 4 214. 7. Gunnar Myrdal, An American Dilemma: The Negro Problem and Modern Demo-cracy (London: Harper and Row, 1962); see also Richard Titmuss, Social Policy: An Introduction (London: George A l l e n and Unwin, 1974), p. 27. 8. Crichton, Health Policy Making, p. 216. 9. Joyce Warham, "The Concept of Equality i n S o c i a l P o l i c y " , Department of Health Care and Epidemiology, University of B r i t i s h Columbia, Vancouver, 1974. (Mimeographed.) 10. M. P a t r i c i a Marchak, Ideological Perspectives on Canada (Toronto: McGraw H i l l Ryerson, 1975), p. 2. 11. It i s important to d i s t i n g u i s h between i d e o l o g i c a l or e l e c t o r a l dominance and the general character of the s o c i a l sector i n a nation as a whole. In p a r t i c u l a r , Mrs. Thatcher's Conservative government i n the UK, while making some important changes, and threatening more, has so f a r l e f t the B r i t i s h s o c i a l welfare state i n t a c t . 12. Marchak, Ideological Perspectives, p. 5 2 . 13. Titmuss, Social Policy, pp. 30-31. 14. Gad Horowitz, "Conservatism, Liberalism, and Socialism i n Canada: An Interpretation, Canadian Journal of Economics and P o l i t i c a l Science 22 (May 1966), reprinted i n Hugh G. Thorburn ed., Party P o l i t i c s in Canada 4th e d i t i o n (Scarborough, Ont.: Prentice-Hall, 1979), pp. 64-70. 15. Marchak, Ideological Perspectives, p. 3., 16. Dictionary of the Social Sciences (Reading, 1977), quoted i n Crichton, Health Policy Making,,^. 371. 164 17. Gibson Burrell:and Gareth Morgan, Sociological Paradigms and Organisa-tional Analysis: Elements of the Sociology of Corporate Life (London: Heineman, 1979). 18. Ibid., p. 1. 19. Ibid., p. 5. 20. Ibid., p. 6. 21. Ibid., p. 7. 22. Thomas Hobbes, Leviathan or The Matter, Form, and Power of a Commonwealth Ecclesiastical and Civil (1651), quoted i n Crane Brinton ed., The Port-able Age of Reason Reader (New York: Viking Press, 1956), pp. 140-141. 23. Lewis A. Coser, The Functions of Social Conflict (London: Routledge and Kegan Paul, 1956). 24. Ralf. Dahrendorf, Class and Class 'Conflictin Industrial Society (London: Routledge and Kegan Paul, 1959). 25. B u r r e l l and Morgan, Sociological Paradigms, p. 17. 26. Ibid., p. 26. 27. Ibid., pp. 104-106. 28. Ibid., p. 32. 29. Ibid., p. 33. 30. Ibid., p. 34. 31. Ibid. 32. Vern L. Bengtson, The Social Psychology of Aging (Indianapolis: Bobbs-M e r r i l l , 1973), p. 43. 33. B.W. Lemon, V.L. Bengtson, and J.A. Peterson, " A c t i v i t y Types and L i f e S a t i s f a c t i o n i n a Retirement Community", Journal of Gerontology 27 (Ap r i l 1972): 511-23. 34. ElaineCumming and William E. Henry, Growing OZcifNew York: Basic Books, 1961). 35. Arnold M. Rose "A Current Issue i n Social Gerontology", Gerontologist 4 (1964): 46,' quoted in Jack Levin and William C. Levin, Ageism: Prejudice and Discrimination Against the Elderly (Belmont, C a l i f . : Wadsworth, -•",1980), p. 44. 36. Robert J . Havighurst, "Personality and Patterns of Aging", Gerontologist 8 (1968): 20-23. 37. Ruth H. Jacobs and Barbara H. Vinick, Re-Engagement in Later Life (Stam-ford, Conn.: Greylock, 1977). 38. Rose, "A Current Issue". 165 39. Jaber F. Gubrium, The Myth of the Golden Years: A Socio-Environmental Theory of Aging ( S p r i n g f i e l d , 111.: Charles C. Thomas, 1973). 40. Jon Hendricks and C. Davis Hendricks, Aging in Mass. Society: Myths and Realities (Cambridge, Mass.: Winthrop, 1977), p. 117. 41. Zena S. Blau, Old Age in a Changing Society (New York: New Viewpoints, 1973). 42. Hendricks and Hendricks, Aging in Mass Society, p. 117. 43. Anne Foner, "Age S t r a t i f i c a t i o n and Age C o n f l i c t i n P o l i t i c a l L i f e " , American Sociological Review 39 ( A p r i l 1974): 187-96. 44. Hendricks and Hendricks, Aging in Mass Society, p. 120. 45. Matilda W. R i l e y , "Age Strata i n S o c i a l Systems", i n Robert Binstock and Ethel Shanas eds., Handbook of Aging and the Social Sciences (New York: Van Nostrand Reinhold, 1976), pp. 189-217. 46. E r i k H. Erikson, Childhood and Society 2nd e d i t i o n (New York: W.W. Norton, 1963). 47. R.C. Peck, "Psychological Developments i n the Second Half of L i f e " , i n Bernice L. Neugarten ed., Middle Age and Aging (Chicago: University of Chicago Press, 1968), pp. 88-92. 48. Hendricks and Hendricks, Aging in Mass Society, p. 149. 49. Bernice L. Neugarten, "The Awareness of Middle Age", i n Neugarten ed., Middle Age, pp. 93-98. 50. M.F. Lowenthal, "Psychosocial Variations Across the Adult L i f e Course: Frontiers f o r Research and P o l i c y " , The Gerontologist 15 (January 1975): 6-12. 51. Bernice L. Neugarten, "Personality and the Aging Process", The Geronto-logist 12 (January 1972): 9-15. 52. Hendricks and Hendricks, Aging in Mass Society, p. 116. 53. Bengtson, Social Psychology, p. 46. 54. Ibid., p. 47. 55. Ibid., p. 48. 56. Everett C. Hughes, The Sociological Eye: Selected Papers (Chicago: Aldine, Atherton, 1971), p. 137, quoted i n V i c t o r W. Marshall, "No E x i t : An Interpretive Perspective on Aging", i n V i c t o r W. Marshall ed., Aging in Canada: Social Perspectives (Don M i l l s , Ont.: Fitzhenry and White-side, 1980), p. 55. 57. A r l i e R. Hochschild, The Unexpected Community CEnglewood C l i f f s , N.J.: Pr e n t i c e - H a l l , 1973). 58. Marshall, "No E x i t " , p. 59. 59. Levin and Levin, Ageism, p. 95. 60. Ibid., p. 113. 61. Ibid., p. 127. 62. Joseph A. Tindale and V i c t o r W. Marshall, "A Generational-Conflict Perspective f o r Gerontology", i n Marshall ed., Aging in Canada, p. 45. 63. Ibid. 64. Although the old are disproportionately poor, i t i s also the case that the wealthy are disproportionately old. See Gordon F. S t r e i b , " S o c i a l S t r a t i f i c a t i o n and Aging", i n Binstock and Shanas, Handbook of Aging, p. 171. 65. Tindale and Marshall, "Generational-Conflict", p. 47. 66. V i c t o r W. Marshall and Joseph A. Tindale, "Notes f o r a Radical Geronto-logy", International Journal of Aging and Human Development 9 (1978-79) 165. 67. Ibid., p. 167. CHAPTER 4 1. Anthony D. Smith, Social Change (London: Longman, 1976), p. 13. 2. Ibid., p. 17. 3. Ibid., p. 29. 4. Ibid., p. 39. 5. Phoebe H a l l , H i l a r y Land, Roy Parker and Adrian Webb, Change, Choice~ and'.. Conflict in. Social Policy (London: Heinemann, 1975). 6. Roland L. Warren, Social Change and Human Purpose: Toward Understanding and Action (Chicago: Rand McNally, 1977), p. 5. 7. Warren G. Bennis, Kenneth D. Benne, and Robert Chin, The Planning of Change 2nd e d i t i o n (New York: Holt, Rinehart and Winston, 1969), p. 4 8. Warren, Social Change and Human Purpose, p. 9. 9. Smith, Social Change, p. 23. 10. Thomas R. Dye, Policy Analysis (University, Alabama: University of Alabama Press, 1976), p. 1. 11. David Easton, A Framework for Political Analysis (Englewood C l i f f s , N.J. Prent i c e - H a l l , 1965). 16.7 12. Ira Sharkansky, Public Administration: Policy Making in Government Agencies (Chicago: Markham, 1970); Thomas Dye, Understanding Public Policy (Englewood C l i f f s , N.J.: Prentice-Hall, 1972). 13. W.I. Jenkins, Policy Analysis: A Political and Organisational Perspec-tive (London: Martin Robertson, 1978), p. 25. 14. Frank Marini ed., Toward a New Public Administration:- The Minnowbrook Perspective (San Francisco: Chandler, 1979); H. George Frederickson, New Public Administration (University, Alabama: University of Alabama Press, 1980). 15. Martin Bulmer, "The B r i t i s h T r a d i t i o n of So c i a l Administration: Moral Concerns at the Expense of S c i e n t i f i c Rigour", Eastings Centre Report ( A p r i l 1981) : 35-42. 16. Robert H. Simmons, Bruce W. Davis, Ralph J.K. Chapman, and Daniel D. Sager, " P o l i c y Flow Analysis: A Conceptual Model f o r Comparative Public P o l i c y Research", Western Political Quarterly 27 (Summer 1974): 457-68. 17. Ibid., p. 457. 18. Ibid., p. 461. 19. Ibid., p. 464. 20. Douglas G. Hartle, Public Policy Decision Making and Regulation (Mont-r e a l : I n s t i t u t e f o r Research on Public P o l i c y , 1979):, p. 34. 21. Ibid. 22. Ibid., p. 35. 23. Jack Bainbridge, " B r i t i s h Columbia's Long-Term Care Program: The F i r s t Two Years", Health Management Forum Summer 1980) : 30. 24. Simmonset a l . , " P o l i c y Flow Analysis", p. 461. 25. Robert G. Evans, "Review of 'Health Expenditures i n Canada and the Im-pact of Demographic Changes on Future Government Health Insurance Pro-gram Expenditures'", Canadian Public Policy 6 (Winter 1980): 133. 26. Kahn and Kamerman, Social Services, p. 272. 27. Warren, Social Change and Human Purpose, p. 125. 28. Gerald Zaltman and Robert Duncan, Strategies for Planned Change (New York: Wiley-Interscience, 1977), pp. 166-67. 29. H a l l et a l . , Change, Choice and Conflict. 30. Ontario, Secretariat f o r S o c i a l Development, Task Force on Aging, The Elderly in Ontario: An Agenda for the '80's (Toronto: Queen's Pr i n t e r , 1981); Saskatchewan, M i n i s t r y of Health., G e r i a t r i c Services Review Com-mittee, Saskatchewan's Geriatric Services: Directions for the Eighties and Beyond (Regina: Saskatchewan Health, 1981); Gouvernement du Quebec, Ministre des A f f a i r e s Sociales, Growing Old Grace fully in Quebec (Que-bec: A f f a i r e s Sociales, 1980). Ontario, Secretariat f o r S o c i a l Development, Communications Branch, "Province Announces Appointment of P r o v i n c i a l Co-ordinator f o r Senior C i t i z e n s " . News release issued i n Toronto, Ontario, 18 January, 1982. Lord Amulree, Adding Life to Years (London: National Council of Soci a l Services, 1951). APPENDIX 1 DETAILS OF PROGRAM CONDITIONS FOR OAS/GIS/SPA OLD AGE SECURITY (OAS) Coverage Persons aged 65 or over may qualify for either the full pension or a partial amount, depending on their residence in Canada after reaching age 18. The full pension is payable to everyone who has resided in Canada for a total of 40 years after age 18. There are also two alternative methods of fulfilling the residence requirements for full pension. These are available only to persons who were 25 years of age or over on July 1, 1977, and resident in Canada on that date or with some prior residence after age 18, and are as follows: a) residence in Canada for the 10 years immediately prior to approval of the application for pension; or b) presence in Canada, after reaching age 18 and prior to the 10 years mentioned in (a), for periods equal to three times the length of absences in the 10-year period and, in addition, residence in Canada for at least one year immediately prior to approval of the application. Persons aged 65 or over who cannot qualify for the full pension may receive a partial pension based on the number of completed years of residence in Canada after the 18th birthday, subject to a minimum of 10 years for payment in Canada and 20 years for payment abroad. A partial monthly pension is calculated at the rate of l/40th of the full pension for each complete year of residence in Canada after reaching age 18. In addition to meeting the residence requirements an applicant for full or partial pension must be a Canadian citizen or legally resident in Canada on the day preceding approval of the application; an applicant who is no longer residing in Canada must have been a Canadian citizen or legally resident in Canada on the day before he ceased to reside in Canada. Once the pension (full or partial) has been approved, it may be paid indefinitely outside of Canada if the pensioner has resided in Canada for at least 20 years after attaining age 18. Otherwise, payment may be made only for the month of departure from Canada and for six additional months, and is then suspended. If the pensioner's absence is a temporary one, payment may be resumed on his return to Canada. If, however, he has ceased to reside in Canada, payment may be resumed only when he again takes up residence. Canada, Department of National Health and Welfare, Basic Facts on Social Security Programs (Ottawa: Health and Welfare Canada, 1981), pp. 18-22. Reproduced by permission of the publisher. GUARANTEED INCOME SUPPLEMENT (GIS) OAS pensioners with no income or only a limited amount of income apart from OAS may, upon application, receive a full or partial supplement. Entitlement is normally based on the pensioner's income in the preceding year, calculated in accordance with the Income Tax Act. The maximum GIS is reduced by $1 a month for every $2 a month of other income. In the case of a married couple, each is considered to have one half of their combined income. The GIS is added to the pensioner's OAS cheque. GIS is payable abroad for only 6 months following the month of departure from Canada. In the case of a pensioner residing in Canada who is temporarily absent from the country payment may be resumed when he returns to Canada if the other conditions of eligibility are met. Where a pensioner has ceased to reside in Canada payment may be resumed only when he again takes up residence in Canada. SPOUSE'S ALLOWANCE (SPA) The spouse of an OAS pensioner may be eligible for a Spouse's Allowance if that spouse is between 60 and 65 years of age and meets the OAS residence requirements. The Spouse's Allowance may be full or partial, depending on the spouse's history of residence in Canada. Once the amount based on residence has been established, it is subject to an income test on the basis of the couple's combined yearly income. As of January 1981, the maximum income level under which a Spouse's Allowance may be paid is $10,800. Where there is entitlement only to a partial allowance on the basis of residence, the maximum income level would be lower. The maximum full monthly allowance is equal in amount to the OAS pension plus maximum GIS at the married rate. A partial allowance is made up of an amount equal to l/40th of the OAS pension for each year of residence in Canada after age 18 (minimum 10 years) plus maximum GIS at the married rate. The Spouse's Allowance (full or partial) is reduced by $3 for every $4 of the couple's combined monthly income until the OAS equivalent or partial OAS equivalent is eliminated. After that, the GIS equivalent and the GIS of the pensioner are each reduced by $1 for every additional $4 of combined monthly income. Spouse's Allowance is payable outside of Canada for a period of six months following the month of departure of either the recipient or the pensioner spouse and payment must then be suspended. In the case of a temporary absence, it may be resumed when the Spouse's Allowance recipient and the pensioner spouse return to Canada, provided the other conditions of eligibil-ity are met. Where residence in Canada has ceased, payment of Spouse's Allowance may be resumed only when the couple again takes up residence in Canada. Extension of Spouse's Allowance Following Death of Pensioner Effective November 1979, a spouse who is eligible for a Spouse's Allowance for the month of the pensioner's death retains eligibil-ity for the allowance until age 65, or until remarriage. Entitle-ment from the month following the pensioner's death is recalcu-lated on the basis of the surviving spouse's income only. The maximum amount is reduced by $3 a month for.every $4 of the surviving spouse's monthly income until the OAS equivalent (full or partial) is eliminated; then the GIS equivalent is reduced by $1 for every additional $2 of monthly income. Annual reapplication is required as for GIS and regular Spouse's Allowance. APPENDIX 2 QETAILS OF PROGRAM CONDITIONS FOR CPP/QPP Benefits 1. Retirement Pension The retirement pension payable is 25% of average adjusted contributory career earnings. When calculating benefits, there are provisions which allow a person to drop out a certain number of months of low or zero earnings. 2. Disability Pension This consists of a flat rate portion and an earnings-related portion of 75% of the imputed Retirement Pension. It is payable in the case of a severe and prolonged disability, as a result of which the person is incapable regularly of pursuing any substantially gainful occupation. 3. Disabled Contributor's Child Benefit This consists of a fixed monthly amount and is payable on behalf of an unmarried child up to the age of 18, or up to the age of 25 in the case of a student. However, in order that he be eligible, the student must attend school without interruption. If schooling is interrupted for reasons beyond his control, the benefits may continue to be paid under certain conditions. 4. Survivor's Pension This is paid to the surviving spouse of a contributor. A benefit consisting of a flat rate portion and 37.5% of the contributor's actual or imputed Retirement Pension is payable to: a) a surviving spouse aged 45 - 64; b) a surviving spouse under 45 who is disabled or has dependent children. There is a pro-rated reduction in this benefit when the surviving spouse is between the ages of 35 and 45, is not disabled and has no dependent children. If the spouse is over 65, the benefit is equal to 60% of the contributor's Retirement Pension. This off-setting reduction is made because of the availability of the Old Age Security Pension payable at age 65. 5. Orphan's Benefits Same as item 3. 6. Death Benefit This is paid to the estate of the deceased contributor. It consists of a lump-sum payment equal to 6 months' Retirement Pension up to a maximum of 10% of the YMPE for the year of death. 7. Combined Pension Refers to a surviving spouse's pension and a retirement or disability pension paid simultaneously to the same person. N.B. a) Eligibility for benefits other than the Retirement Pension is subject to the contributor having made contributions to the Plan for specified minimum quali-fying periods. b) Applications must be mode for all bonefits and approved before entitlement to the benefits exists. From: Canada, Department of National Health and Welfare, Basic Facts on Social Security Programs (Ottawa: Health and Welfare Canada, 1981), pp. 6-10. Reproduced by permission of the publisher. 172 Coverage Generally speaking, the Plans are an integral part of Canada's social security system, serving as the vehicle whereby millions of members of the Canadian labour force acquire and retain, during their productive years, protection for themselves and their families against loss of income due to retirement, disability or death, regardless of where their employment may take them in Canada, and under certain circumstances, outside Canada. The Canada Pension Plan (C.P.P.) does not operate in Quebec because this province exercised its constitutional prerogative to establish a similar provincial pension plan to operate in lieu of C.P.P. Contributions Employees pay 1.8% of contributory earnings. In 1981, this excludes the first $1 400 of earnings and the maximum earnings on which contributions can be made is $14 700. These con-tributions are matched by the employer. Self-employed persons contribute 3.6% on the same earnings range. The lower limit is known as the Year's Basic Exemption (YBE), the upper limit is the Year's Maximum Pensionable Earnings (YMPE). Effective January 1976, and at the beginning of each subsequent year, the YMPE will be increased by 12.5% until it catches up to the average earnings of Canadian workers as represented by the Industrial Composite of weekly wages and salaries published by Statistics Canada. Thereafter, the YMPE will increase annually in line with the Industrial Composite average. The YBE is fixed at 10% of the YMPE. Division of Pension Credits Pension credits earned by one or both spouses during their years of marriage may be divided equally between them upon marriage dissolution, that is, upon divorce or legal annulment. The spouses must have cohabited for at least three consecutive years during the marriage, and application must be made within three years of marriage dissolution. This provision applies to marriages dissolved on or after January 1, 1977, for the Quebec Pension Plan (Q.P.P.) and on or after January 1, 1978, for the Canada Pension Plan. :173 APPENDIX 3 'DETAILS OF TAX EXEMPTIONS AND DEDUCTIONS Age exemption If you were born before 1917, claim the age exemption of $1,980, regardless of your income. If you did not receive the Old Age Security Pension in 1981, attach a note telling why. Pension income deduction Claim either $1,000 or the total amount received from all of the following, whichever is less: (a) payments from a pension fund including lump sum payments, whatever your age, (b) payments from a registered retirement income fund, annuity payments from a registered retirement savings plan or deferred profit sharing plan and the taxable portion of other annuities, if you were born before 1917, and (c) payments listed in (b), if received due to the death of your spouse, whatever your age. These amounts do not qualify: • Old Age Security Pension, Guaranteed Income Supplement and Spouse's Allowance • Payments from the Canada or Quebec Pension Plan • Retiring allowances such as severance pay • Annuity income you choose to report as interest income • Income-averaging annuity contract payments • Death benefits • Pension payments transferred into a registered retirement savings plan, a registered pension plan, or an income-averaging annuity contract, and • Lump sum withdrawals from a registered retirement savings plan. Deduction for blind persons or those confined to a bed or wheelchair Claim this deduction of $1,980 if you were blind at any time in 1981. You may also claim if you were confined to a bed or wheelchair for a substantial period of time each day for at least 12 consecutive months ending in 1981. Factors such as inability to work, or receiving disability payments are not looked on as reasons for claiming this deduction. You may not need all of this amount to reduce your taxable income to zero. In this case, your spouse or supporting person may claim the unused part. Your supporting person is someone who claimed an "equivalent to married" or "child" exemption for you, or would have if your net income had not been over $3,270. You may not claim this deduction if expenses for an attendant or nursing home were claimed as medical expenses. Eligible deductions transferred from spouse If your spouse has no taxable income, you may claim the unused part of these deductions on your return: • Age exemption (for persons 65 or over) • Interest, Dividends and Capital Gains Deduction • Pension Income Deduction • Deduction for blind persons or persons confined to a bed or wheelchair • Education Deduction. From: Canada, Department of National Revenue, 1981 General Tax Guide -For Residents of British Columbia (Ottawa: Revenue Canada, 1980), pp. 25, 29-30. Reproduced by permission of the publisher. 174 APPENDIX 4 CURRENT UTILIZATION OF PROGRAMS FOR THE ELDERLY IN B.C. A. Health 1. Medical Services Plan COVERAGE BY AGE GROUP AT MARCH 31, 1981 791,553 ,From: B r i t i s h Columbia, Mini s t r y of Health, V i c t o r i a , B.C., 1982. (Mimeo-graphed). Reproduced by permission of the publisher. 175 A., Health (cont.) 2. Hospital Insurance Program a. Fr,om: B r i t i s h Columbia, Mini s t r y of Health, V i c t o r i a , B.C., 1982. (Mimeo-graphed) . Reproduced by permission of the publisher. A. Health (cont.) 2. Hospital Insurance Program (cont.) b. AVERAGE LENGTH OF STAY BY AGE. GROUP AND- REGIONAL HOSPITAL DISTRICT APRIL 1 , 1 9 8 0 - t o MARCH 3 1 , 1 9 8 1 ( i n days) Regional Hospital Under- 1 - 1 4 1 5 - 4 4 - 4 5 - 6 9 7 0 + District 1 Year Years Year s Years Years Total Alberni-Clayoquot 6 . 2 4 . 6 - 6 . 3 - 9 . 8 1 4 . 9 7 . 8 -Bulkley-Nechako 6 . 9 - - 4 . 8 4 . 9 - 8 . 3 : 1 2 . 9 - 6 . 3 , Capital 6 . 8 ; " 5 ' . 4 n 6 . 5 9 . 8 . 1 5 . 7 9 . 7 ' ; Cariboo 8 . 0 : , 4 . 9 5 . 5 . 8 . 6 12.2: 6 - . 8 r Central Coast 6 . 4 . : 4 . 3 . 4 . 8 r 1 0 . 6 • 8 ' . 9 - 6 . 5 : Central Fraser' Valley 7 ' . 9^ •• 4 . 2 ' . 5 : . , 7 - 8 . 9 - ' 1 3 . T 7 . 7 ' Central Kootenay 4 . 8 : 3 . 3 5 . 2 ; . 8 . 1 . . 1 2 . 3 . 7 . 2 : ' ' Central Okanagan. . 6 . 9 - 4 . 0 - 6 . 4 8 . 9 1 2 . 5 - 8 . 3 Columbia-Shuswap . 5 . 2 - 3 . 4 5 ' . 3 ' 8 . 6 1 2 . 2 . 7 . 1 Comox-Strathcona 6 . 1 • 5 . 1 5 . 5 8 . 7 1 3 . 3 , 7 . 4 .. Cowichan Valley 7". .7 4 . 4 - 5 . 8 - 8 . 6 : 1 4 . 0 - 7 . 8 Dewdney-Alouette 7 . 3 , 4 . 0 5 . 9 - 9 . 5 1 3 . 4 7 . 8 • East Kootenay 4 . 6 3 . 4 . 4 " . 9 8 . 8 : 1 6 . 1 . 7 . 0 Fraser-Cheani: 6 . 6 . 4 . 2 5 ' . 3 9 . 0 1 3 . 2 7 . 7 ' Fraser-Fort George- 6 . 6 . 4 . 7 5 . 5 ' - 9 . 8 - 1 3 . 4 : 6 . 8 ' Greater Vancouver 8 . 4 4 . 8 6 . 1 - . 1 0 . 3 1 6 . 1 ' 9 . 1 Kitimat-Stikine- 7 . 1 4 . 4 . 5 . 4 ; . 8 . 3 - 1 4 . 3 6 . 4 . - . Kootenay Boundary 5 . 0 5 . 3 5 . 6 - 9 . 4 - 1 4 . 1 . 8 . 3 . Mount Waddington 9 . 2 4 . 4 • 4 . i. • 9 - . 1 1 3 . 8 5 . 9 ' Nanaimo 6 . 7 - 4 . 6 ; . 5 . 4 - 8 . 8 : 1 1 . 9 7 : 5 ' North Okanagan 5 . 8 - 3 . 9 6 . 3 , 8 . 8 1 4 . 2 . 8 . 3 r Okanagan-S imilkameen 6 . 3 4 . 4 5 . 8 8 . 4 1 1 . 8 8 . 1 . Peace River-Liard 7 . 1 4 . 2 5 . 2 ' 8 . 0 1 2 . 7 6 . 2 . Powell River 5 . 6 4 . 1 5 . 4 - 9 . 7 1 5 . 2 8 . 1 . Skeena-Queen Charlotte 7 . 3 4 . 3 : 4 . 8 1 0 . 2 1 6 . 2 6 . 7'j Squamish-Lillooet 9 . 5 4 . 9 6 . 3 9 . 4 1 5 . 0 T . 8 Stikine 4 . 0 6 . 0 - 5 . 1 6 . 2 1 2 . 5 - 5 . 8 I Sunshine Coast 6 . 1 3 . 7 4 . 9 8 . 7 1 2 . 0 7 . 5 : Thompson-Nicola 7 . 5 - 4 . 3 6 . 7 1 0 . 2 1 3 . 9 8 . 2 TOTAL ACUTE . 7 . 3 4 . 5 5 . 8 9 . 5 1 4 . 7 8 . 2 Does not. include Long Term Care in Acute Beds Includes Acute and Free Standing Rehabilitation. From: B r i t i s h Columbia, Mini s t r y of Health, Hospital Programs, Hospital Indicators 1980/81 ( V i c t o r i a : Ministry of Health, 1982), p. 26. Reproduced by permission of the publisher. 177' A. Health (cont.) 2. Hospital Insurance Program (concl.) c. EXTENDED CARE HOSPITAL SEPARATIONS, 1981 # # age cases (%) days (%) 0-14 64 (2.0) 22,404 C1.4) 15-18 35 (1.1) 8,898 (0.5) 19-24 40 (1.2) 13,468 (0.8) 25-64 445 (13.8) 197,130 (12.1) 65 2652 (82.0) 1,382,163 (85.1) t o t a l 3236 1,624,063 From: B r i t i s h Columbia, M i n i s t r y of Health, Hospital Programs, Research D i v i s i o n , V i c t o r i a , B.C., 1982. A. Health (cont.) 3. Long-Term Care Program UTILIZATION OF LONG-TERM CARE SERVICES  BY THE 65 & OVER POPULATION ONGOING DATA U t i l i z a t i o n Rate = Percentage of the g e n e r a l p o p u l a t i o n f o r a given age t h a t i s r e c e i v i n g t h e s p e c i f i e d k i n d o f c a r e . Rates are based on p o p u l a t i o n e s t i m a t e s a d j u s t e d t o t h e p a r t i c u l a r month (by i n t e r p o l a t i n g b e t w e e n y e a r l y e s t i m a t e s ) . F a c i l i t y Data i n c l u d e c l i e n t s i n H o s p i t a l Programs Extended Care U n i t s (E.C.U.s). About 2,000 c a s e s u s u a l l y a r e m i s s i n g from the E.C.U. data due to a r t i f a c t s i n coding and r e p o r t i n g the i n f o r m a t i o n . T h e r e f o r e u t i l i z a t i o n i s somewhat underestimated, p a r t i c u l a r l y f o r the 85 and over group which has the g r e a t e s t p o r t i o n of E.C.U. c l i e n t s . Homemaker Data i n c l u d e A d u l t Day Care. Home Care i s not i n c l u d e d i n any of the d a t a . F i g u r e s r e f l e c t the number of persons " c u r r e n t l y approved f o r s e r v i c e " , which v a r i e s from about 10-15% h i g h e r than f i g u r e s f o r persons a c t u a l l y r e c e i v i n g s e r v i c e . From: R. Penner, A. Review and Update of Utilization of Long-Term Care Services, Reference Paper 7 prepared f o r the Ministry of Health, V i c t o r i a , B.C., November, 1981. Reproduced by permission of the author. Health (cont.) Long-Term Care Program (cont.) HOMEMAKER UTILIZATION RATES 1980 1981 July 31 Oct.31 Dec.31 .March 31 j June 30 Sept.30 B.C. 3 66 3.87 3 87 4 07 4 16 3 98 C.R.D. 2 27 2.20 2 30 2 37 2 41 2 37 65 - 74 VAN 3 67 3.95 4 01 4 08 4 20 4 05 REST 4 10 4.33 4 48 4 61 4 68 4 42 B.C. 10 64 11 28 11 58 12 02 12 36 12.27 C.R.D. 7 27 7. 45 7 81 8 38 8 45 8.57 75 - 84 VAN 10 01 10. 81 11 03 11 45 11 93 11.90 REST 13 14 13. 74 14 11 14 47 14 72 14. 42 B.C. 16 44 17 39 17 78 18 65 18 73 18 05 C.R.D. 15 49 16 18 16 41 18 14 18 60 18 10 85 + VAN 14 91 16 21 16 72 17 24 17 49 16 91 REST 19 63 20 14 20 45 21 40 20 94 20 00 B.C. 6 92 7 33 7 52 7 79 7 95 7 75 C.R.D. 5 42 5 53 5 72 6 15 6 26 6 22 65 + VAN 6 76 7 31 7 46 7 69 7 93 7 77 REST 7 69 8 05 8 27 8 53 8 62 8 30 Health (cont.) Long-Term Care Program (cont.) FACILITY UTILIZATION RATES 1980 J u l y 31 I Oct.31 Dec.31 iMarch 31 I June 30 SeDt.30 B.C. 1 55 1 56 1 57 | 1 58 1 59 1 63 C.R.D. 1 24 1 23 1 24 i 1 28 I 25 1 34 65 - 74 VAN 1 82 1 83 1 83 1 86 1 87 1 90 REST 1. 35 1 35 1 36 1 37 1 39 1 42 B.C. 7 27 7 35 7 43 • 7 47 7 66 7 68 C.R.D. 5 96 5 90 6 04 6 11 6 44 6 41 75 - 84 VAN 7 68 7 81 7 87 7 83 7 94 8 01 REST 7 28 7 34 7 44 7 56 7 80 7 80 B.C. 27 13 27.54 27 50 27 87 28 56 29 44 C.R.D. 25 55 25.65 25 92 26 17 26 87 27 66 85 + VAN 26 91 27.55 27 18 27 53 28 13 29 12 REST 28 44 28.65 29 01 29 46 30 29 31 05 B.C. 5 68 5 75 5 78 5 84 5 97 6 09 C.R.D. 5 61 5 61 5 68 5 77 5 95 6 10 65 + VAN 6 23 6 34 6 32 6 37 6 47 6 62 REST 5 02 5 05 5 12 5 19 5 33 5 42 A. Health (cont.) 3. Long-Term Care Program (cont.) c. AGE-SPECIFIC UTILIZATION RATES BY SOURCE OF CARE (MARCH 31, 1981) . FAC • HMKR 65-69 70-74 75-79 80-84 85-89 90+ A. Health (cont.) 3. Long-Term Care Program (cont.) d. UTILIZATION RATE{%) HOMEMAKER UTILIZATION RATES OVER TIME FOR 65 & OVER AGE GROUP 9.0 8.5 8.0 7.5-7.0 6.5 6.0 5.5 5.0 Ralera lo client! "approved" (or lervlce. VAN = Health District* 9, 10, 20, 30, 40, 50 CRD = Henllh District 60 REST = Ths Rail ol B.C. Utilization Ratal ara baied on aallmalai ol the general population ad|uilad to aach month. REST. C R D ' ' OCT. 31 DEC: 31 1980 MAR. 31 1981 JUNE 30 1 SEPT. 30 DEC. A. Health (cont.) 3. Long-Term Care Program (concl.) e. FACILITY UTILIZATION RATES OVER TIME FOR 65 & OVER AGE GROUP UTILIZATION RATE (%) 8.75-8.504 VAN = Health District! 9, 10, 20, 30, 40, 50 CHD = Health District 80 RE9T = The Rest ol B.C. Utilliatlon Rates are basod on esllrrtBlet ol the general population adjusted to each month. 6.25-6.00 -I 5.75 5.50 5.25-VAN • 5.00 RES! -+- -t- 1 SEPT. 30 OCT. 31 DEC. 31 MAR. 31 19B1 JUNE 30 DEC. 3" A. Health (cont.) 4. Pharmacare a. B . C . PHARMACARE E X P E R I E N C E 1974-1980 PLAU "A" P L A N "3" FISCAL . AVERAGE UTILIZATION * » ! U A L COST T O T A L NO. T O T A L YEAR Rx COST RATE P E R 7EES0N E L I G I B L E ( O O O ' S ) COST ( s n n n - * i 1974/75 4 .75 10 8 51 .30 239 12291 1975/76 5 .22 12 0 62 .64 255 15959 1976/77 5 .90 10 9 64 .35 249 16025 1977/78 6 .60 11 2 « .90 260 19734 1978/79 7 .22 10 8 77 .98 270 21136 1979/80 8 .41 12 2 102 .98 280 . 28836 1980/81 10 .73" 10. 8 116 81 292 34111 | 1976/77 5 90 52 0 306 80 1 ! 17 5215 1S77/78 6 6JL 49 0 323 40 1 17 5497 1978/79 6 18 37 4 231 44 1 17 3834 1979/80 6 79 40 0 276 19 1 " 4695 1980/81 8 11 37 5 303 94 17 5167 PLAN " C " 1974/75 4.75 8.2 38.95 i 100 3895 1975/76 5.22 8.5 44.37 i 100 44 37 1976/77 5 .90 9 . 3 55.16 |. 100 5516 1977/78 6.60 7.4 49.32 | 100 4932 1978/79 1979/SO 7.22 8.0 57.58 1 100 5758 8.41 7.9 66.73 j 100 6673 1980/81 9 .06 8.9 80.38 | 100 8038 SUB TOTAL 1 5-ULLY P A I D 1974/75 4 .75 10.3 49.04 399 16626 1975/76 5.22 11.3 59.11 355 20987 1976/77 5.90 12.8 76 . 10 366 27356 1977/78 6.60 10.6 70.41 377 26548 1978/79 6.52 12.2 79 .66 387 30829 1979/80 8.10 12.4 101.20 397 40204 1980/81 10. 15 11.3 115.68 409 47316 ?LAU 1227/78 6 . 60 18 9 1 20 00 •100 2000 1978/79 7 . 22 13. _ 0 _ _ i 24 J>2 * i S9 J . 6 i 3 1979/80 8 .10 17 8 T 3 5 .14 *175 6150 1opo/81 11. 90 18. 6 | 36. 47 * 185 6785 * r.o. o f c l a i m a n t s From: B r i t i s h Columbia, M i n i s t r y of Human Resources, Pharmacare, Vancouver, B.C., 1982. (Mimeographed).. Reproduced by permission of P. T i d b a l l , Director. Health (concl.) Pharmacare (concl.) P e r c e n t U t i l i z a t i o n b y P l a n a n d T h e r a p e u t i c C l a s s BY A B C C L A S S 04 A n t i h i s t a m i n e s 67 , ,0 17, .0 16 . 0 1 . 1 08 A n t i b i o t i c s 58 , .0 6, .0 36 . 0 8 . 2 12 A u t o n o m i c s 67 , .0 13 , .0 20 . 0 3 .3 24 C a r d i o v a s c u l a r s 82, .0 12, .0 6 . 0 16 .8 28 T r a n q u i l l i z e r s 53 , .0 16. .0 31 . 0 17 . 1 40 D i u r e t i c s 75, .0 18 , .0 7 . 0 9 . 7 48 Cough P r e p a r a t i o n s 76, ,0 1, .0 23 .0 1 . 3 52 E . N . T . 79, .0 9, .0 12 . 0 3 . 5 56 6 . 1 . P r e p a r a t i o n s 46 . .0 42, .0 12 . 0 3 . 0 68 Hormones 70 . ,0 10, .0 20 .0 6 .1 84 S k i n P r e p a r a t i o n s 69 . .0 9 .0 22 .0 4 . 2 86 S p a s m o l y t i c s 76 , .0 8 , .0 16 . 0 0 . 3 88 V i t a m i n s 49 . .0 42 , .0 9 . 0 1 . 5 92 U n c l a s s i f i e d 78 . .0 1 0 . .0 12 . 0 6 .6 93 S e d a t i v e s 66 . .0 14, .0 20 .0 5 .9 94 A n a l g e s i c s 6 5 , ,0 12 . .0 23 . 0 8 .9 99 N o n - D r u g 75 . .0 8. .0 17 . 0 1 .1 A v e r a g e % Rx 6 7 . .0 14. .0 19 . 0 100 . 0 By P o p u l a t i o n 70 , .0 4 , 0 26 .0 U t i l i z a t i o n b y p l a n 1 2 . .2 40, ,0 7 .9 12 .4 B. Income 1. OAS/GIS/SPA a. NUMBER OF OAS/GIS/SPA BENEFICIARIES BY PROVINCE AND ACCOUNT TYPE JUNE 1978 PROVINCE OAS ONLY GIS/SPA MAXIMUM GIS/SPA PARTIAL TOTAL Nf I d . 7 255 19 403 15 077 41 735 P.E.I . 3 863 4 200 6 455 14 518 N.S. 28 774 22 857 36 260 87 891 N.B . 20 794 18 510 27 096 66 400 Que. 194 024 136 314 201 145 531 483 On t . 406 372 95 809 261 427 763 608 Man. 46 877 19 403 46 617 112 897 S a s k . 47 225 19 204 41 873 108 302 A l t a . 61 620 26 712 57 000 145 332 B.C. 119 923 40 877 90 902 251 702 N.W.T.' 257 774 164 1 195 Yukon 285 233 127 645 TOTAL 937 269 404 296 784 143 2 125 708 From: Canada, Department of National Health and Welfare, A Profile of OAS/ GIS/SPA Benefiaoiaries. for June 1978 (Ottawa: Health and Welfare Canada, pp. 24-26. Reproduced by permission of the publisher. 187 B. Income (cont.) 1. OAS/GIS/SPA (cont.) b. PERCENTAGE DISTRIBUTION OF OAS/GIS/SPA BENEFICIARIES BY ACCOUNT TYPE WITHIN EACH PROVINCE JUNE 1978 PROVINCE OAS ONLY GIS/SPA MAXIMUM GIS/SPA PARTIAL TOTAL PERCENTAGE (%) (%) (%) (%) Nf I d . 17 .38 46 .49 36 .13 100 .00 P . E . I . 26 .61 28 .93 44 .46 100 .00 N.S. 32.74 26 .01 41.26 100 .00 N.B. 31.32 27.88 40 .81 100.00 Que. 36 .51 25 .65 37 .85 100 .00 Ont. 53 .22 12 .55 34.24 100 .00 Man. 41.52 17.19 41.29 100 .00 S a s k . 43 .60 17 .73 38 .66 100 .00 A l t a . 42.40 18 .38 39 .22 100 .00 B.C. 47 .64 16 .24 36 .11 100 .00 N.W.T. 21.51 64.77 13 .72 100.00 Yukon 44 .19 36.12 19.69 10 0.0 0 TOTAL 44 .09 19.02 36 .89 100 .00 188 B. Income (cont.) i 2. CPP./QPP a. Contributors and Contributions CPP QPP (1978) (1977) Contributors 7 778 929 2 658 174 Source: CPP Contributors 1978, Health and Welfare Canada. QPP Statistical Bulletin, October 1980. Revenues CPP QPP Jan.-March 1979/80 1979/80 (million dollars) Contributions 2 367.5 1 002.3 Interest 1 220.7 686.5 Other 68.3 0.8 Total ' 3 656.5 1 689.6 Source: ,CPP Statistical Bulletin, March 1980. QPP Annual Report, 1979-80 Beneficiaries and Benefits For the month of September 1980 CPP QPP Benefi- Benefi-Type ciaries Benefits ciaries Benefits ($000's) ($000's) Retirement 807 823 104 142.4 232 281 30 870.9 Disability 84 435 18 626.7 21 725 6 994.2 Disabled Contributor's Child Benefit 35 248 2 472.0 9 496 336.4 Orphans' 105 730 6 399.9 44 698 1 384.5 Surviving Spouse 242 022, 26 746.9 92 749 15 567.2 Death 3 562 . 3 551.7 1 382 , 1 409.4 Combined Pensions (37 757T (6 612.0) (7 528/ — ^ Recipients of combined pensions are counted for each type of benefit received; thus there is some double-counting. 2 The actual amount of the components of combined pensions has already been shown in the appropriate columns (i.e., in "the Retirement, Disability and Surviving Spouse Pensions columns). Number of lump sum payments to the estate. Source: CPP and QPP Statistical Bulletins, September 1980. From: Canada, Department of National Health and Welfare, Basic Facts on Social Security Programs CQttawa: Health and Welfare Canada. 1981). p. 10. Reproduced by permission of the publisher. B. 2. b. Income (cont.) CPP/QPP (concl.) Retirement Pensioners of Canada and Quebec Pension Plans as Percentage of Population 65 and Over. Canada and Provinces, 1971 and 1977 Beneficiaires deipensions de retraite des Regimes de pensions du Canada et de rentes du Quebec en pourcentage de la population agee de 65 ans et plus, Canada et provinces, 1971 et 1977 Canada Nfld. - T.-N. P.E.I.-l.-P.-E. N.S. - N.E. Que. - Que. Ont. Man. Saik. N.W.T. 1 T. N.O. 40\ 40% From: Canada, S t a t i s t i c s Canada, Societal Security National Programs 1978 (Ottawa: S t a t i s t i c s Canada, 1978), p. 402. Reproduced by permission of the Minister of Supply and Services Canada. B. Income (concl:,) 3. GAIN Seniors Supplement GAIN SENIORS SUPPLEMENT UTILIZATION Recipients as of Total Annual Year "r. December Program Cost $ 1980 67,830 25,880,740 79 75,253 28,723,195 78 81,996 31,877,781 77 92,506 35,962,866 76 97,198 37,324,860 From: B r i t i s h Columbia, Mini s t r y of Human Resources, Annual Report 1 ( V i c t o r i a : Queen's Print e r , 1981), pp. 41-42. '\APPENDIX 5 COMPARISON OF STATISTICS CANADA, CCSD AND SENATE COMMITTEE POVERTY LINES, 1981 ESTIMATES Family S t a t i s t i c s Canada Size range mid-range CCSD Senate Committee 1 $ 4,739- 6,521 $ 5,928 $ 6,214 $ 6,960 2 6,811- 9,451 8,595 10,357 11,600 3 8,773-12,059 11,295 12,429 13,920 4 10,429-14,344 .. 13,037 14,500 16,240 5 11,663-16,034 14,576 16,571 18,560 6 12,799-17,602 : 16,001 18,643 20,880 7 or 14,034-19,300 17,544 20,714 23,200 more From: Canada, -Department of National Health and Welfare, National Council of Welfare, Measuring Poverty: 1981 Poverty Lines (Ottawa: National Council of Welfare, 1981), p. 4. Reproduced by permission of the publisher. APPENDIX 6 Alternative Population and Labour Force Projections: / The Underlying Assumptions The size and composition of Canada's future popu-lation will depend on the rates of fertility, mortality, and immigration. Tne higher the birth rate, life expectancy, and net immigration, the larger the population will be. Because it is impossible to pre-dict with certainty the future levels of these vari-ables, demographers often base their population and labour force projections on a variety of assumed levels. For each variable, usually three levels are assumed: the high, medium, and low. This is the procedure followed in the projections that have been prepared for the Council.1 (_The demographic and labour participation assumptions used are presented in Table C-l. The levels assumed are based on past experience and/or likely trends. Thus, the high fertility level assumes a return to the high birth rates of the postwar baby boom. The medium level postulates that the birth rates of the early seventies would prevail, while the low level assumes a further decline in birth rates from the present level. As for life expectancy, no drastic changes are expected as the decline in death rates has recently leveled off. Thus, the assumed increases in life expectancy vary from a slight rise in the low projection to a moderate improvement in the high one. In the case of immigration, it is assumed that there would be 140,000 net immigrants annually in the high projection, 80,000 in the medium, and 20,000 in the low. Some twenty population projections have been-prepared on the basis of these assumptions about future fertility and net immigration rates, and life expectancy. Eleven of these, identified as P-01 to P-ll, are shown below in Table C-2. The assump-tions underlying them are as follows: P-01: "Medium" projection: medium fertility, medium life expectancy, and medium net immigration. P-02: High fertility; otherwise the same as P-01. P-03: Low life expectancy; otherwise the same as P-01. P-04: High net immigration; otherwise the same as P-01. P-05: Low fertility; otherwise the same as P-01. P-06: High life expectancy; otherwise the same as P-01. P-07: Low net immigration; otherwise the same as P-01. P-08: "High growth" projection: high fertility, high life expectancy, and high net immigration. P-09: "Low growth" projection: low fertility, low life expectancy, and low net immigration. P-10: "Old population" projection: low fertility, high life expectancy, and medium net immigration. P-ll: "Young population" projection: high fertility,. low life expectancy, and medium net immigra- j tion. Table C-2 indicates a population of just over 38 million in the year 2031 under the "medium" • projection (P-01). Under certain extreme assump-tions, the population might reach 63 million in that year as in the "high" projection (P-08), or only 24 million as in the "low" projection (P-09). Table C-3 shows that the proportion of persons 65 and over in the total population will double under the "medium" projection (P-01), from about 9 per j cent to 18 per cent by 2031. On the other hand, it will go to almost 25 per cent under the "low popula-tion" projection (P-09). The proportion of old ' people would rise slightly to 13 per cent under the "high population" projection (P-08). The labour force participation assumptions (Table C-4) are specified separately for men and From: Economic Council of Canada, One In Three: Pensions for Canadians to 2030, (Ottawa: "Queen's Print e r , 1979), pp. 125-127. Reproduced by permission of the author. women, and 1981 and 1991 are chosen as target years in which the assumed changes would be achieved. The 1991 participation rates are similar to the 1981 rates for men under 55, but lower for those 55 and over, to allow for the continuation of the trend towards earlier retirement. For men aged between 25 and 44 the assumed rates are virtually the same as the actual 1976 rates. For other age groups, the assumed changes are rather small. Much larger changes are assumed for women. This is especially true of women aged 20 to 54, for whom higher participation rates are specified in 1981 and with further increases occurring by 1991. For women under 20 and over 65, a slight decline in participation is expected. Combining each of three alternative levels of labour force participation rates with various popula: tion projections produces a large number of labour force projections. Three of these — referred to in this report as high, medium, and low — are shown in Table C-5 (there are twelve more in the back-ground study). The underlying assumptions are the following: L-01: "Medium" projection: medium fertility, medium life expectancy, medium net immi-gration, and medium labour force participa-tion rates. L-08: "High" projection: high fertility, high life expectancy, high net immigration, and medium labour force participation rates. L-09: "Low" projection: low fertility, low life expectancy, low net immigration, and medium labour force participation rates. Under the "medium" projection, Canada would have a labour force of just over 17 million by 2031. Over 39 million people would be in the labour force under the "high" projection, but only just under 11 million by that time under the "low" projection. TABLE C-l DEMOGRAPHIC ASSUMPTIONS OF ALTERNATIVE POPULATION GROWTH PROJECTIONS, CANADA,' 1976 TO 2051 Population growth projections High Medium Low Life Life Life expectancy Immigration2 expectancy Immigration2 expectancy Immigration2 Fertility1 Men Women Gross Net Fertility1 Men Women Gross Net Fertility1 Men Women Gross Net (Years) (Thousands) (Years) (Thousands) (Years) (Thousands) 1976 2,102 70.1 77.9 172 131 1,923 69.8 77.4 172 131 1,803 69.6 76.9 172 131 1981 2,650 70.8 79.5 171 131 2,024 70.3 78.4 120 80 1,607 69.8 77.4 69 29 1986 2,979 71.5 81.3 180 140 2,085 70.8 79.5 120 80 1,489 70.1 77.9 60 20 1991 2,979 72.3 83.3 180 140 2,085 71.3 80.7 120 80 1,489 70.3 78.4 60 20 2001 2,979 72.7 84.3 180 140 2,085 71.6 81.5 120 80 1,489 70.5 78.9 60 20 2011 2,979 73.0 85.3 180 140 2,085 71.9 82.3 120 80 1,489 70.7 79.3 60 20 2021 2,979 73.0 85.3 180 140 2,085 71.9 82.3 120 80 1,489 70.7 79.3 60 20 2031 2,979 73.0 85.3 180 140 2,085 71.9 82.3 120 80 1,489 70.7 79.3 60 20 2041 2,979 73.0 85.3 180 140 2,085 71.9 82.3 120 80 1,489 70.7 79.3 60 20 2051 2,979 73.0 85.3 180 140 2,085 71.9 82.3 120 80 1,489 70.7 79.3 60 20 'Total fertility rate per 1,000 women of child-bearing age. 2The difference (about 4 0 , 0 0 0 ) between gross and net immigration represents emigration. S O U R C E F. Denton^ C. Feaver, and B. Spencer, "The Future Population and Labour Force of Canada: Projections to the Year 2 0 5 1 ,"a background study prepared for the Economic Council of Canada, 1979. PROJECTED POPULATION, CANADA, 1976 TO 2051 Population growth projections P-01 P-02 P-03 P-04 P-05 P-06 P-07 P-08 P-09 P-10 P - l l (Thousands) 1976 22,993 22,993 22,993 22,993 22,993 22,993 22,993 22,993 22,993 22,993 22,993 1981 24,561 24,929 24,536 24,681 24,314 24,586 24,441 25,076 24,171 24,338 24,904 1986 26,351 27,624 26,278 26,810 25,499 26,426 25,892 28,181 24,982 25,572 27,546 1991 28,099 30,367 27,955 28,933 26,582 28,248 27,265 31,415 25,648 26,724 30,213 1996 29,626 32,841 29,399 30,858 27,478 29,861 28,393 34,433 26,103 " 27,702 32,597 2001 30,966 35,222 30,655 32,616 28,169 31,288 29,317 37,389 26,341 28,4.73 34,884 2006 32,289 37,980 31,887 34,374 28,698 32,699 30,203 40,768 26,406 29,083 37,536 2011 33,662 41,298 33,163 36,207 29,086 34,165 31,118 44,774 26,319 29,553 40,731 2016 34,992 44,892 ' 34,394 38,019 29,314 35,588 31,966 49,121 26,071 29,859 44,192 2021 36,162 48,452 35,466 39,683 29,350 36,848 32,640 53,487 25,640 29,969 47,614 2026 37,152 52,013 36,355 41,175 29,185 37,933 33,129 57,906 25,015 29,879 51,025 2031 38,014 55,848 37,109 42,541 28,819 38,896 33,487 62,661 24.204 29,592 54,690 2036 38,796 60,143 37,784 43,828 28,269 39,782 33,763 67,949 23,233 29,116 58,796 2041 39,510 64,831 38,402 45,048 27,570 40,592 33,973 73,697 22,153 28,478 63,285 2046 40,156 69,753 38,970 46,195 26,778 41,312 34,116 79,735 21,027 27,719 68,006 2051 40,758 74,908 39,512 47,295 25,955 41,967 34,221 86,059 19,915 26,900 72,955 SOURCE F. Denton, C. Fcaver, and B. Spencer, "The Future Population and Labour Force of Canada: Projections to the Year 2051,"a background study prepared for the Economic Council of Canada, 1979. PROJECTED PERCENTAGES OF POPULATION AGED 65 AND OVER, CANADA, 1976 TO 2051 Population growth projections P-01 P-02 P-03 P-04 P-05 P-06 P-07 P-08 P-09 P-10 P-ll 1976 8.7 8.7 1981 9.4 9.3 1986 10.0 9.5 1991 10.7 9.9 1996 11.2 10.1 2001 11.5 10.1 2006 11.7 9.9 2011 12.4 10.1 2016 13.9 10.8 2021 15.4 11.5 2026 17.2 12.3 2031 18.3 12.4 2036 18.2 11.7 2041 17.5 10.7 2046 17.3 10.4 2051 17.6 10.9 8.7 8.7 8.7 9.4 9.4 9.5 9.8 9.8 10.3 10.5 10.5 11.3 10.9 10.9 12.1 11.1 11.1 12.7 11.2 11.2 13.2 11.8 11.9 14.4 13.2 13.2 16.6 14.7 14.7 19.1 16.4 16.4 21.9 17.4 17.5 24.2 17.2 17.4 25.0 16.5 16.9 25.2 16.3 16.7 25.2 16.6 17.0 25.2 (Per cent) 8.7 8.7 8.7 9.5 9.4 9.3 10.1 10.1 9.5 11.0 10.9 9.9 11.6 11.6 10.2 12.0 11.9 10.2 12.3 12.2 10.0 13.1 13.1 10.2 14.6 14.7 10.9 16.2 16.4 11.6 18.0 18.2 12.4 19.2 19.3 12.7 19.2 19.2 12.1 18.6 18.4 11.2 18.4 18.2 11.0 18.7 18.5 11.4 8.7 8.7 8.7 9.5 9.6 9.2 10.3 10.4 9.4 11.3 11.6 9.7 12.1 12.5 9.8 12.6 13.2 9.7 13.2 13.8 9.5 14.5 15.2 9.6 16.8 17.4 10.2 19.5 20.0 10.9 22.4 22.9 11.6 24.8 25.3 11.8 25.7 26.3 11.0 25.8 26.6 10.0 25.8 26.7 9.8 25.8 26.7 10.3 SOURCE F. Denton, C. Feavcr, and B. Spencer, "The Future Population and Labour Force of Canada: Projections to (he Year 2051,"a background study prepared for the Economic Council of Canada, 1979. 196 APPENDIX 7 ASSUMPTIONS UNDERLYING BRITISH COLUMBIA POPULATION PROJECTION 10/80 I . I n t r o d u c t i o n B r i t i s h C o l u m b i a P o p u l a t i o n P r o j e c t i o n 1 0 / 8 0 p r o v i d e s an i n f o r m a t i v e d e s c r i p t i o n o f t h e l i k e l y a g e - s e x p o p u l a t i o n , s t r u c t u r e f o r t h e p r o v i n c e o f B r i t i s h C o l u m b i a t o t h e y e a r 2 0 0 1 . i The p r o j e c t i o n r e s u l t s f rom t h e a p p l i c a t i o n o f a Component  C o h o r t - S u r v i v a l p o p u l a t i o n m o d e l t o a s s u m p t i o n s d e a l i n g w i t h f e r t i l i t y , m o r t a l i t y and m i g r a t i o n s e l e c t e d by t h e B u r e a u as t h e | most l i k e l y f u t u r e c o u r s e o f e v e n t s f o r t he P r o v i n c e . 1 1 i A s n o t e d a b o v e , t h e m e t h o d o l o g y u n d e r l y i n g P r o j e c t i o n 1 0 / 8 0 < i s a Component C o h o r t - S u r v i v a l a p p r o a c h . T h i s method r a q u i r e s ' I s e p a r a t e p r o j e c t i o n s o f e a c h o f t h e componen t s o f p o p u l a t i o n j c h a n g e , n a m e l y f e r t i l i t y , m o r t a l i t y and n e t m i g r a t i o n . W i t h t h i s 1 i n f o r m a t i o n , and w i t h a b a s e y e a r age s p e c i f i c e s t i m a t e o f j p o p u l a t i o n , a p r o j e c t i o n f o r e a c h s u b s e q u e n t y e a r i s made b y p r o m o t i n g e a c h age g r o u p i n t h e p r e c e e d i n g y e a r t o t h e n e x t | h i g h e r age g r o u p , w h i l e a t t h e same t i m e t a k i n g i n t o a c c o u n t t h e I e f f e c t s o f n e t - m i g r a t i o n , d e a t h s a n d / o r b i r t h s . T a b l e s 1 t h r o u g h 4 o n t h e p r o c e e d i n g p a c e s c o n t a i n t h e I p r o j e c t e d a g e - s e x s p e c i f i c p o p u l a t i o n s f o r B r i t i s h C o l u m b i a . ] T h i s i s f o l l o w e d by a b r i e f d e s c r i p t i o n o f t h e p r i n c i p a l 1 a s s u m p t i o n s u n d e r l y i n g P r o j e c t i o n 1 0 / 9 0 . A l s o a v a i l a b l e i s e p a r a t e l y i s ' a - b r i e f summary o f some o f t h e ma jo r d e m o g r a p h i c j i m p l i c a t i o n s r e s u l t i n g f rom t h e p r o j e c t i o n . From: Central S t a t i s t i c s Bureau, Population Projection 10/80, pp. i - v . Reproduced by permission of the publisher. 197 II. Projection Assumptions To follow is a brief overview of the procedures and assumptions underlying Projection 10/80. I BASE POPULATION: The base population adopted by the projection was Statistics Canada's preliminary estimated provincial population by sex and single year of age for June 1, 1979. FERTILITY PROJECTIONS: The projections of births for the Province are based on the prior projections of three f e r t i l i t y indices. -Total F e r t i l i t y Rate (TFR) This is the sum of the age-specific f e r t i l i t y rates for females aged 15 to 49. The TFR represents the average number of births that would occur to a woman during her reproductive years, and is computed from data at a given point in time. The current Total F e r t i l i t y Rate for British Columbia is in the neighbourhood of 1.7, down from over 2.25 in 1970 and over 3.5 in 1960. -Mean and Modal Ages of F e r t i l i t y These are summary measures of the mothers' age at the time, of birth. The three indices are combined using Romaniuk's three parameter model to produce a set of age specific f e r t i l i t y rates. These rates in turn are used to compute the total number of projected births (for details of Romaniuk's model see; Technical Report on Population Projections for Canada and the  province, Statistics Canada, July 1975, Catalogue 91-516: p. 39-48). The historical and projected TFR for British Columbia is given in Figure 1. The projected values for the years 1979 through to 2001 result from averaging the high and low f e r t i l i t y assumptions (I and II) used by Statistics Canada (see; Population Projections for Canada and the Province, 1976-2001, Statistics Canada, February 1979, Catalogue 91-520: p. 15-18). The mean and modal ages of f e r t i l i t y are assumed to be constant at the 1976 level of 26.2 and 25 years respectively. As can be seen in Figure 1 the total f e r t i l i t y rate is assumed to arrest its decline of the 60's and early 70's, and to rise gradually toward a level of 1.82 births per woman by 1991, remaining stable thereafter. Once projections of the age specific f e r t i l i t y rates are made through the Romaniuk model, projections of total births result from applying these rates to the projected female population aged 15-49. MORTALITY PROJECTIONS: The projected number of deaths for British Columbia is based on the 1981 estimated age-sex specific death rates for the province. These projected age-sex specific death rates are converted into l i f e table survival ratios, which are shown in Figure 2. It is assumed that the l i f e expectancy at birth (a summary of the age-specific death rates) w i l l remain constant at the 1981 level throughout the projection years. This corresponds to an expected l i f e span from birth of 71.13 years for males (1971: 69.85, 1976: 70.01) and 79.12 year for females (1971: 76.69, 1976: 77.50). MIGRATION PROJECTIONS: i Separate projections were made for British Columbia net interprovincial migration, emmigration and immigration. It should be noted that the migration projections adopted are intended to capture only the general trends expected over the next 20 years, and consequently may not fully reflect any "local" fluctuations that may occur from year to year. (i) Net interprovincial migration The historical and projected net movement to/from the Province from/to the rest of Canada is shower in Figure 3. The net inflow of persons to British Columbia from the rest of Canada is expected to decline gradually from the 1979/80 level of almost 40,000 to the historically high level of 27,000 persons annually by 1987/88, remain constant thereafter. ( i i ) Immigration Immigration to British Columbia, as seen in Figure 4, is projected to remain constant at a 1979/80 level of 21,000 persons annually until 1983/84, then increasing to a level of 24,500 thereafter. Because immigration is largely determined by government policy, only general levels over spans of several years have been identified. ( i i i ) Emmigration Emmigration has fluctuated within fa i r l y narrow limits over the past decade, with only a slight upwards trend. Emmigration from British Columbia, as seen in Figure 4, is projected to-remain constant at a 1979/80 level of 10,500 persons annually until 1985/86, then increasing slightly to 11,000 thereafter. Age-sex specific migration projections were made by applying the estimated 1978/79 age/sex structure of net interprovincial migrants, immigrants and emmigrants to the projected total net interprovincial migration, immigration and emmigration. The age/sex distributions of migrants assumed throughout the projection years are shown in Figures 6, 7 and 8. 201 APPENDIX 8 THE CANADIAN CHARTER OF RIGHTS AND FREEDOMS For the first time, the basic rights and freedoms of Canadians are entrenched in a Canadian Charter of Rights and Free-doms, which applies to all federal, provincial and territorial authorities. Equality Rights \ Equality Rights protect citizens from discrimination by gov-ernments, particularly on the basis of race, national or ethnic origin, colour, religion, age, sex, or mental or physical disa-bility. This provision does not rule out "affirmative action" programs or activities aimed at improving the situation of disadvantaged individuals or groups. It will come into effect three years after patriation to enable the federal and provin-cial governments to make any necessary adjustments to their-laws. ; Under the agreement that broke the constitutional deadlock,-i both parliament and provincial legislatures retain the power to 1 pass laws that may conflict with the Charter in these areas. In order to do so, Parliament or a legislature must insert a '. clause stating specifically that it is passing the law notwith-standing the relevant provisions of the Charter of Rights. In other words, when governments propose laws that may limit the rights and freedoms set out in the Charter, they must say clearly that this is what they are doing and accept full responsibility for the political consequences. Furthermore, any federal or provincial law containing this "notwithstanding" or override clause will have to be reviewed and renewed at least , every five years or it cannot remain in force. Equality Rights for Men and Women Notwithstanding anything in this Charter, the rights and freedoms referred to in it are guaranteed equally to men and women. From: Canada, Mini s t r y of Supply and Services, The Canadian Constitution 1981: Highlights (Ottawa: Supply and Services, 1981), pp. 2-4. Reproduced by permission of the publisher. 202 APPENDIX 9 ELDERLY PROGRAM EXPENDITURE PROJECTION METHODOLOGY I n t h i s p a p e r t h e e x p e n d i t u r e s of. s e v e r a l p r o g r a m s f o r t h e a g e d h a v e been p r o j e c t e d f o r w a r d , i n c l u d i n g : O l d Age S e c u r i t y , t h e G u a r a n t e e d Income S u p p l e m e n t , CPP/QPP, War V e t e r a n s A l l o w a n c e s / P e n s i o n s , C a n a d a A s s i s t a n c e P l a n , and H o s p i t a l and M e d i c a l c a r e . I n a d d i t i o n , t h e p o p u l a t i o n a n d GNP h a d t o be p r o j e c t e d . A l l e x p e n d i t u r e s a r e p r e -s e n t e d i n t e r m s o f 1976 d o l l a r s . The m e t h o d o l o g y f o l l o w s m u c h . a l o n g t h e l i n e s o f p r e v i o u s w o r k s s u c h a s t h e ?. D e n t o n and D. S p e n c e r p a p e r , "Some G o v e r n m e n t 3 u d g e t C o n s e q u e n c e s o f P o p u l a t i o n C h a n g e " ( D e p a r t m e n t o f E c o n o m i c s , M c M a s t e r U n i v e r s i t y , 1974) o r L. M c D o n a l d ' s " C h a n g i n g P o p u l a t i o n and t h e I m p a c t on G o v e r n m e n t A g e - S p e c i f i c S x p e n d i t u r e s " ( T r e a s u r y B o a r d S e c r e t a r i a t , O t t a w a , 1977) .. P e r c a p i t a e x p e n d i t u r e s b y ag e g r o u p a r e a d j u s t e d t h r o u g h t i m e a n d t h e n a p p l i e d t o p o p u l a t i o n p r o j e c t i o n s t o d e v e l o p t h e c o s t i m p l i c a t i o n s . i P o p u l a t i o n i I n o r d e r t o i l l u s t r a t e t h e more s e r i o u s r a m i f i c a - - • c i o n s o f t h e d e m o g r a p h i c s h i f t , o n e o f t h e .lower g r o w t h ; s t a n d a r d S t a t i s t i c s C a n a d a p o p u l a t i o n p r o j e c t i o n s was s e l e c t e d (number 3 ) . : GNP ' GNP was assumed t o be p r o p o r t i o n a l t o t h e number '• o f man h o u r s o f employment w h i c h was, i n t u r n , assumed t o be p r o p o r t i o n a l t o t h e s i z e o f t h e age g r o u p 18-64 . I n a d d i t i o n , i t was assumed t h a t r e a l p r o d u c t p e r man h o u r w o u l d grow a t 2% p e r y e a r . GNP f o r 197 6 a c t s a s t h e b a s e f o r t h e p r o j e c t i o n . From: Powell and Martin, "Implications of an Aging Society", pp. 36-39. Reproduced by permission of J.K. Martin. OAS • Annual expenditure on OAS to 2031 i s p r o j e c t e d by m u l t i p l y i n g the OAS r o c i p i e n t ' p o p u l a t i o n f o r each year by the .197C annual b e n e f i t l e v e l . The r e c i p i e n t p o p u l a t i o n i s o b t a i n e d by m u l t i p l y i n g the t o t a l number o f persons 63 years and over obtained from p r o j e c t i o n Mo. 3 of S t a t i s t i c s Canada by 0.5985. GIS Annual expenditure on GIS i s projected! as f o l l o w s : i) the p r o p o r t i o n of r e c i p i e n t s i s assumed to decrease by 1.6% per year u n t i l 1991. No d e c l i n e t h e r e a f t e r , i i ) the average b e n e f i t per r e c i p i e n i s assumed to decrease i n r e a l terms by- 1.4;% per year u n t i l 1991, and by 1.% per year t h e r e a f t e r . The assumption i s t h a t CPP/QP? w i l l '.have "matured." by 1991 with most of those aged 65 and over x e c e i v i n g s o — e b e n e f i t s . The assumptions of i.5%/1.4% d e c l i n e are based on program data f o r the p e r i o d 1973 to 1973. CP?/QPP P r o j e c t i o n s of the p r o p o r t i o n o f thos--a aged 55 a n d over r e c e i v i n g retirement b e n e f i t s and s u r v i v o r ' s b e n e f i t s were obtained from the Department of I n s u r a n c e . These were a p p l i e d to the p o p u l a t i o n p r o j e c t i o n . A n n u a l expenditures were obtained by a s s i g n i n g to e a c h r e c i p i e n t , of these two type of b e n e f i t s 12 times the-average b e n e f i t of a new r e c i p i e n t i n June 1975 e s c a l a t e d by 2%. per year.. CAP CAP e x p e n d i t u r e o n the a g e d i s p r o j e c t e d an f o l l o w s : 21.7% o f t o t a l CA? e x p e n d i t u r e f o r 1976 i s s p e n t o n t h i s g r o u p . 3y d i v i d i n g . ' t h i s e x p e n d i t u r e by t h e number a g e d 63 and o v e r , p e r c a p i t a CAP e x p e n d i t u r e on e l d e r l y p e r s o n s . w a s o b t a i n e d . T h i s p e r c a p i t a e x p e n d i t u r e i s e s c a l a t e d a t 2% p e r y e a r s i n c e m o s t c o s t s w i l l b e r e l a t e d t o wages a n d s a l a r i e s . D e t a i l s o f CAP e x p e n d i t u r e on e l d e r l y p e r s o n s i n 1 9 7 6 , as o b t a i n e d f r o m t h e T r e a s u r y 3 o a r d S e c r e t a r i a t , P l a n n i n g B r a n c h , a r e : G e n e r a l A s s i s t a n c e 1.7% o f t o t a l CAP A d u l t I n s t i t u t i o n a l -Care 17 .1% o f t o t a l CAP H e a l t h C a r e 2.0% o f t o t a l CAP W e l f a r e S e r v i c e s 0.9% o f t o t a l CA? T o t a l 21.7% o f t o t a l e x p e n d i t u r e s WVA P r o j e c t i o n s o f ' W a r V e t e r a n ' s A l l o w a n c e / P e n s i o n s w e r e s u p p l i e d by t h e D e p a r t m e n t o f V e t e r a n ' s A f f a i r s ( R e p o r t e d i r . t h e T r e a s u r y 3 o a r d p a p e r " C h a n g i n g P o p u l a t i o n a n d t h e I - p a c t on G o v e r n m e n t A g e - S p e c i f i c E x p e n d i t u r e s " , 1977 ) . P h y s i c i a n s S e r v i c e s a n d H o s p i t a l C o s t P r o j e c t i o n s 1974 p e r c a p i t a c o s t s o f p h y s i c i a r s s e r v i c e s b y a g e a n d se:'. w e r e o b t a i n e d f r o m t h e E c o n o m i c C o u n c i l o f C a n a d a . They w e r e m u l t i p l i e d by 1 .21 t o o b t a i n t h e c o r . t c i n 197G p i ' i c e s . T h e s e c o s t s were f u r t h e r e s c a l a t e d by 2% p e r y e a r t o r e f l e c t t h e d i s c u s s e d i n c r e a s e i n wages a n d s a l a r i e s . To o b t a i n t o t a l c o s t s o f p h y s i c i a n s s e r v i c e s , t h e e s c a l a t e d p e r c a p i t a c o s e s were m u l t i p l i e d b y the. number o f e l d e r l y p e r s o n s . The 197G c o s t s o f h o s p i t a l s , b y t y p e , w e r e e s t i m a t e d by t h e H e a l t h E c o n o m i c s a n d S t a t i s t i c s D i r e c t o r a t e , N a t i o n a l H e a l t h and W e l f a r e a n d c a n be o b t a i n e d f r o m t h e m . T h e i m p l i e d p e r c a p i t a c o s t '..'as e s c a l a t e d by 2% p e r y e a r a s a b o v e , and a n n u a l e x p e n d i t u r e s were o b t a i n e d b y m u l t i p l y i n g , t h e p e r c a p i t a e x p e n d i t u r e s by t h e number o f e l c e r l y p e r s o n s 206 APPENDIX 10 PENSIONS IN CANADA The Federal Government's objectives for pension reform J . s '* * • UNIVERSAL COVERAGE: (*•'•'••'to guarantee all Canadian workers and their families decent pension protection. • PORTABILITY AND EARLIER VESTING P> to ensure that those who change employment.keep.their pension protection, '.s, r • SOME FORM OF INDEXATION .... to protect the value of pensions against inflation ' . ^ „ „ t . . . . i i . , . , , , . . ^ . . , ^ . . .^„ . . ; , :v.. ;-j ,...,.j„™-, r.... I,-., ,..,.„ . . . . . , • EQUITY FOR WOMEN 4 , W-\6 improve pension protection for women and to ensure that they are treated equally. From: Canada, Department of National Health and Welfare, Pensions In Canada, pp. i , i i , 5-11. Reproduced by permission of the publisher. x 207 T h e three- t iered pens ion s y s t e m 80 H 70 A 60 H 08 3 •g • >'" c U « QL (D to CD c o •JS tO E 5 tO S |i O c a . CO -•*-.-• c g i P C **** 100-i lis 90-1 50 30 20 o. 10 0 GOOD PRIVATE PENSION CPP/QPP OAS 4/, ' > • A " ? * " 1 i ^3rd T ie r W$-r2nd Tier! 'Miff 4? m 1 st T ie r With Pr ivate P e n s i o n ! W.thout Pr ivate P e n s i o n ,CRR:,Canada Pension|r|Ja|p^^^S QPP: Qi PL> C P^nsioriiPlan OAS Old Age Security I i *C GIS Guaranteed Income Supplement Only about $1 of every $10 of the income of the elderly comes from private pension plans. More than $4 out of every $10 come from public programs — OAS, GIS, CPP and QPP Composition of tho income of tho elderly 66 year* or over, 197S Other .4% Pensions -11% Government Programs (OAS, GIS, CPP, QPP) 45% Earned Income 17% Investment Income 23% Source: 1980 Survey of Consumer Rnancss, 1979 Incomes for Census Families Seven out of 10 persons 66 and over have no private pension, but those who do are far better off Proportion of the elderly below the poverty lines in 1979 % 45-i Average family income of the elderly in 1979 $ 1 0 , 0 0 0 -H 12,723 7,409 with without pension pension income income 40 3 5 -3 0 -2 5 -2 0 -1 5 -10 5H 39% 7% with without pension pension income income The majority of the work force is not covered by private (employer-sponsored) pension plans. Coverage is particularly poor for women. Source: Stanstcs Canada Pension Plans in Canada, 1980 Pubicaten pending There are major differences in coverage between the . public and the private sector. While almost all employees . in the public sector belong to pension plans, only about ; one employee in three in the private sector belongs to such plans. Without pension plans With pension plans o o Public sector , / 2% Private sector Source: Statutes Canada Pension Plans m Canada. 1980 Purification pending The coverage of the work force in Canada by private pension plans lags behind most other western industrialized countries. Proportion of paid workers in Canada and ••van othar countries covered by employer-sponsored pension plans, 1976 Sweden France Netherlands Switzerland West Germany United Kingdom Canada United States Approximate 0 i r 50 T — r 100 Source: The Retirement Income System in Canada. Volume 1. Page 41. 213 Leaf 213 missed in numbering. 214 : The real value of many employer-sponsored pension plans has been seriously eroded by inflation. Purchasing power of fixed pension : of $ 1000 starting in 1971 with no adjustment for inflation $1000 $750 CD s cn c °U) CO JC o V-3 0 . $500 $250 $1000 $697 1971 1976 1981 1986 (estimate) Source: NHW estimaies. More than half of all members of pension plans do not have automatic provisions in their plans for pensions to surviving spouses when the pensioner dies after retirement. This is particularly a problem in the private sector. Private Sector Public Sector Source: Statistcs Canada Penson Plans in Canada 1980 Pubi cation pending 216 APPENDIX 11 DATA ON THE ELDERLY IN BRITISH COLUMBIA Studies of u t i l i z a t i o n , cost, and effectiveness of programs for the elder-l y i n B r i t i s h Columbia must soon take place i f decision-makers are to plan adequately f o r the province's aging population. These research e f f o r t s continue to be hampered by inadequate, and unco-ordinated data i n the key program areas of health, income, and housing. Section A below l i s t s the p r i n c i p a l current sources of information, and b r i e f l y describes the relevant data reported. Sec-ti o n B indicates some avenues f o r change to upgrade and co-ordinate data on the province's aging population. A l l references are to the population of B r i -t i s h Columbia aged 65 or over, unless otherwise indicated. A. CURRENT DATA DESCRIPTION I PERSONAL DATA 1. Population Numbers, percentages, r a t i o s by sex. SOURCE COVERAGE 1966 Census of Canada, Population Age Groups. ( S t a t i s t i c s 1961, 1966 Canada 92-610) 1976 Census of Canada, Population: Demographic Characteris- 1971, 1976 tics, Five Year Age Groups ( S t a t i s t i c s Canada 92-823) Population by Sex and Age, 1921-1971. ( S t a t i s t i c s Canada 1921-1971 91-512). Population, Revised Annual Estimates of Population, by Sex 1971-1976 and Age for Canada and the Provinces, 1971-1976. (Sta-t i s t i c s Canada 91-518). Population Projections for Canada and the Provinces, 1976- 1976-2001 2001. ( S t a t i s t i c s Canada 91-520). British Columbia Population Projection 10/80 1980-2001. 1980-2001 (B.C. Central S t a t i s t i c s Bureau). Health General Mortality 1950-1972 ( S t a t i s t i c s Canada 84-531). Deaths, death rates by sex. Vital S t a t i s t i c s , Volume I, Births and Deaths. ( S t a t i s -t i c s Canada 84-204). Vital Statistics, Volume 3, Mortality: Summary List of Causes. ( S t a t i s t i c s Canada 84-206) . Separations, separation rates Hospital Morbidity. ( S t a t i s t i c s Canada 82-206) . by sex, ICDA-8 l i s t , average length of stay. Separations, separation rates Hospital Morbidity, Canadian Diagnostic List. ( S t a t i s -by sex, Canadian Diagnostic ticsCanada 82-209). 1950-1972 Annual Annual Annual Annual ro i—« DESCRIPTION SOURCE COVERAGE L i s t , average length of stay. AVerage length of stay by Hospital Indicators. (B.C. Minis t r y of Health). Annual Regional Hospital D i s t r i c t . Number of cases, days per .. Statistics of Hospital Cases Discharged. (B.C. Minis t r y Annual 1,000 population by Region- of Health), a l Hospital D i s t r i c t . Income Percentages by sex, income groups. Numbers by sex, l e v e l of schooling, 1970 income groups. Income Distributions by Size in Canada. ( S t a t i s t i c s Canada 13-207). 1971 Census of Canada, Income of Individuals. ( S t a t i s t i c s Canada 94-763). Annual 1971 Housing Dwelling c h a r a c t e r i s t i c s by household head sex, income groups, urban and r u r a l etc. Dwelling c h a r a c t e r i s t i c s by sex of household head. Household F a c i l i t i e s by Income and Other Characteristics, 1972 1972. ( S t a t i s t i c s Canada 13-560). 1971 Census of Canada, Housing, Dwelling Characteristics by Age and Sex of Household Head. " ( S t a t i s t i c s Canada 93-739) . 1971 II. PROGRAM DATA 1. Health Programs Federal program expenditure Federal Government Finance. ( S t a t i s t i c s Canada 68-211). Annual and u t i l i z a t i o n by l e g i s l a -ted program areas (e.g. Hos-p i t a l Insurance and Diagnos-t i c Services, Medical Care, etc. r o f—' OO DESCRIPTION SOURCE COVERAGE Pr o v i n c i a l program expenditure and u t i l i z a t i o n by service program areas (e.g. Hospital Programs, Medical Services Plan, Long-Term Care Program, etc.) Ministry, of. Health Annual Report. (B.C. M i n i s t r y of Health) Annual 2. Income Programs CPP u t i l i z a t i o n and expendi-ture by program category. OAS/GIS/SPA u t i l i z a t i o n and expenditure by program category. P r o v i n c i a l program u t i l i z a -t i o n and expenditure by program areas (e.g. GAIN, SAFER, Pharmacare, etc.) Canada Pension Plan: Report for the Year Ending March 31. (Health and Welfare Canada). Old Age Security: Report for the Year Ending March 31. (Health and Welfare Canada). Ministry of Human Resources Annual Report (B.C. M i n i s t r y of Human Resources). Annual Annual Annual 3. Housing Programs Housing s t a r t s , completions, and loans approved by CMHC under l e g i s l a t e d pro-grams . P r o v i n c i a l program expendi-ture by region, project, u n i t . Canadian Housing Statistics (Central Mortgage and Housing Cor- Annual poration). Ministry of Lands, Parks, and Housing Annual Report (B.C. Mi n i s - Annual t r y of Lands, Parks, and Housing). f—' FUTURE DATA To f a c i l i t a t e future research a central bank of data pertaining to the e l d e r l y i n B r i t i s h Columbia should be set up and maintained by a sepa-. rate co-ordinating agency. This data bank would hold current information on program u t i l i z a t i o n and expenditure from a l l p r o v i n c i a l and federal sources, upgraded to show breakdowns at least by e l d e r l y age groups (65-74, 75-84, 85-*), and cross-tabulated with personal data including popu-l a t i o n , health, income, and housing status. Central S t a t i s t i c s Bureau population projections should be extended to take i n the years of major increase in numbers of the aged through 2031, using a number of d i f f e r e n t sets of assumptions concerning rates of f e r t i l i t y , m o r t a l ity, and net migration. It should be possible to develop health service u t i l i z a t i o n summaries f o r the e l d e r l y as rough ind i c a t o r s of o v e r a l l morbidity by integr a t i n g data cu r r e n t l y generated and maintained separately by ( p r i n -c i p a l l y ) the Medical Services Plan, Hospital Programs, the Long-Term Care Program, Pharmacare, and the Dental Care Plan. The Survey of Consumer Finances conducted annually by S t a t i s t i c s Canada should take into account the value of non-money income such as subsidized services, imputed rent, and employer contributions. F i n a l l y , the Ministry of Lands, Parks, and Housing data on p r o v i n c i a l senior c i t i z e n housing should be linked with that maintained on federal projects by the Central Mortgage and Housing Corporation to give a more complete p i c t u r e of subsidized housing f o r the aged i n B r i t i s h Columbia. In summary, i t i s suggested that the province develop a central data c a p a b i l i t y concerning the e l d e r l y that would enable linkage between com-prehensive p r o f i l e s of t h e i r status with respect to health, income, and housing and the u t i l i z a t i o n of and expenditure on p u b l i c service programs i n these areas. 221 BIBLIOGRAPHY Amulree, Lord. Adding Life to Years. London: National Council of Social Service, 1951. Anderson, Digby C. The Ignorance of Social Intervention. London: Croon Helm, 1980. Asimakapulos, A. The Nature of Public Pension Plans: Intergenerational Equity, Funding and Saving. Ottawa: Economic Council of Canada, 1979. Aucoin, Peter. "Public P o l i c y Analysis and the Canadian Health Care Sys-tem". Canadian Public Administration 23 (Spring 1980): 166-74. Bailey, Joe. Social Theory in Planning. London: Routledge and Kegan Paul, 1975. Bainbridge, Jack. " B r i t i s h Columbia's Long-Term Care Program: The F i r s t Two Years". Health Management Forum (Summer 1980): 28-36. Bellamy, David J . , Pammett, Jon H., and Rowat, Donald C. eds. The Provin-cial P o l i t i c a l Systems: Comparative Essays. Agincourt, Ont.: Methuen, 1976. Bengtson, Vern L. The Social Psychology of Aging. Indianapolis: Bobbs-M e r r i l l , 1973. Bennis, Warren G., Benne, Kenneth D., and Chin, Robert. The Planning of Change 2nd e d i t i o n . New York: Holt, Rinehart,and Winston, 1969. Berkley, George E. The Craft of Public Administration 2nd e d i t i o n . Toron-to: A l l y n and Bacon, 1980. Bernstein, Samuel J . , and O'Hara, Patrick. Public Administration: Orga-nizations, People, and Public Policy. New York: Harper and Row, 1979. Birch, R.C. The Shaping of the Welfare State. London: Longman, 1976. Blau, Zena S. Old Age in a Changing Society. New York: New Viewpoints, 1973. B r i t i s h Columbia. (Foulkes) Health Security Program Project. Health Security for British Columbians. V i c t o r i a : Queen's Pr i n t e r , 1973. B r i t i s h Columbia. (Evans) Children's Dental Health Research Project. Report. V i c t o r i a : Queen's Pr i n t e r , 1975. B r i t i s h Columbia. (Jaffary) Interdepartmental Study Team on Housing and Rents. Housing and Rent Control in British Columbia. V i c t o r i a : Queen's Pr i n t e r , 1975. 222' B r i t i s h Columbia. Mini s t r y of Health. Annual Report, 1980. V i c t o r i a : Queen's Print e r , 1981. B r i t i s h Columbia: Mini s t r y of Health. Hospital Programs. Research D i v i -sion. Statistics of Hospital Cases Discharged during 1979/80. V i c t o r i a : M i n i s t r y of Health, 1981. B r i t i s h Columbia. Ministry of Health. Hospital Programs. Research D i v i -sion. Hospital Indicators 1980/81. V i c t o r i a : M i n i s t r y of Health, 1982. B r i t i s h Columbia.. Ministry of Human Resources. Annual Report 1980. V i c -t o r i a : Queen's Pr i n t e r , 1981. B r i t i s h Columbia. Ministry of Industry and Small Business Development. Central S t a t i s t i c s Bureau. British Columbia Population Projection 10/80 1980-2001. V i c t o r i a : Central S t a t i s t i c s Bureau, 1981. B r i t i s h Columbia. Mini s t r y of Industry and Small Business Development. Central S t a t i s t i c s Bureau. Demographic Impact Summary of British Columbia Population Projection 10/80 1980-2001. V i c t o r i a : Central S t a t i s t i c s Bureau, 1981. B r i t i s h Columbia. Mini s t r y of Lands, Parks and Housing. Annual Report, 1980. V i c t o r i a : Queen's Print e r , 1981. Bulmer, Martin. "The B r i t i s h T r a d i t i o n of Soci a l Administration: Moral Concerns at the Expense of S c i e n t i f i c Rigour"."',' Hastings Center Report ( A p r i l 1981) : 35-42 B u r r e l l , Gibson, and Morgan, Gareth. Sociological Paradigms and Organisa-tional Analysis: Elements of the Sociology of Corporate Life. London: Heinemann, 1979. Canada. (Heagerty) Advisory Committee on Health Insurance. Health Insu-rance. Ottawa: King's P r i n t e r , 1943. Canada. Canadian Advisory Council on the Status of Women. Pension Reform With Women in Mind. Ottawa: Canadian Advisory Council on the Status of Women, 1981. Canada. Central Mortgage and Housing Corporation. Canadian Housing Sta-t i s t i c s , 1979. Central Mortgage and Housing Corporation, 1980. Canada. Department of Ju s t i c e . A Consolidation of the British North America Acts 1867 to 1975. H u l l , Quebec: Supply and Services Canada, 1981. Canada. Department of National Health and Welfare. Task Force on the Costs of Health Care. Report. Ottawa: Queen's Pr i n t e r , 1969. Canada. (Hastings) Department of National Health and Welfare. The Commu-nity Health Centre in Canada. 3 v o l s . Ottawa: Information Canada, 1972-73. Canada. (Lalonde) Department of National Health and Welfare. A New Pers-223 " pective on the Eealth of Canadians. Ottawa: Information Canada, 1974. Canada. Department of National Health and Welfare. A Profile of OAS/GIS/ SPA Beneficiaries for June 1978. Ottawa: Health and Welfare Canada, 1979. Canada. Department of National Health and Welfare. Canada Pension Plan: Report for the Year Ending March 31, 1978. Ottawa: Health and Welfare Canada, 1979. Canada. Department of National Health and Welfare. Old Age Security: Report for the Year Ending March 31, 1978. Ottawa: Health and Welfare Canada, 1979. Canada. (Hall) Department of National Health and Welfare. Canada's National-Provincial Health Program for the 1980 's. Ottawa: Queen's Pr i n t e r , 1980. Canada. Department of National Health and Welfare. Basic Facts on Social Security Programs. Ottawa: Health and Welfare Canada, 1981. Canada. Department of National Health and Welfare. National Council of Welfare. Measuring Poverty: 1981 Poverty Lines. Ottawa: Nation-a l Council of Welfare, 1981. Canada. Department of National Health and Welfare. Pensions in Canada. Ottawa: Queen.:';s Pr i n t e r , 1981. Canada. Department of National Revenue. 1981 General Tax Guide - For Residents of British Columbia. Ottawa: Revenue Canada, 1981. Canada. Dominion Bureau of S t a t i s t i c s ; 1966 Census of Canada: Popula-tion Age Groups. Cat. No. 92-610. Ottawa: Queen's Pr i n t e r , 1968. Canada. Economic Council of Canada. One in Three: Pensions for Cana-dians to 2030. Ottawa: Queen's P r i n t e r , 1979. Canada. National Advisory Council on Aging. P r i o r i t i e s for Action. Ottawa: Queen's Printer,. 1981. Canada. Parliamentary Task Force on Federal-Provincial F i s c a l Arrangements. Fiscal Federalism in Canada. Ottawa: Supply and Services Canada, 1981. Canada. Publications Canada. The Canadian Constitution 1981. Ottawa; Publications Canada, 1981. Canada. Publications Canada. The Canadian Constitution 1981: Highlights. Ottawa: Publications Canada, 1981. Canada: (Lambert) Royal Commission on F i n a n c i a l Management and Accounta-b i l i t y . Report. H u l l , Quebec: Canadian Government Publishing Centre, 1979. 224 Canada. (Glassco) Royal Commission on Government Organization. Report. Ottawa: Queen's Print e r , 1963. Canada. (Hall) Royal Commission on Health Services. Report. Ottawa: Queen's Print e r , 1964. Canada. Science Council of Canada. Perceptions 2: Implications of the Changing Age Structure of the Canadian Population. Ottawa: Sup-p l y and Services Canada, 1976. Canada. Senate. Special Senate Committee on Retirement Age P o l i c i e s . Retirement Without Tears. Ottawa: Queen's Print e r , 1979. Canada. S t a t i s t i c s Canada. Population by Sex and Age3 1921-1971. Cat. No. 91-512. Ottawa: Information Canada, 1973. Canada. S t a t i s t i c s Canada. Household F a c i l i t i e s by Income and Other Characteristics, 1972. Cat. No. 13-560. Ottawa: Information Canada, 1974. Canada. S t a t i s t i c s Canada. 1971 Census of Canada. Housing Dwelling Characteristics by Age and Sex of Household Head. Cat. No. 93-739. Ottawa: Information Canada, 1975. Canada. S t a t i s t i c s Canada. 1971 Census of Canada. Income of Individuals. Cat. No. 94-763. Ottawa: Information Canada, 1975. Canada. S t a t i s t i c s Canada. General Mortality 1950-1972. Cat. No. 84-531. Ottawa: Information Canada, 1976. Canada. S t a t i s t i c s Canada. 1976 Census of Canada. Population: Five-Year Age Groups. Cat. No. 92-823. Ottawa: Minister of Industry, Trade and Commerce, 1978. Canada. S t a t i s t i c s Canada. Social Security National Programs 1978. Ottawa: Queen's P r i n t e r , 1978. Canada. S t a t i s t i c s Canada. Population Projections for Canada and the Provinces, 1976-2001. Cat. No. 91-520. Ottawa: Minister of ". Industry, Trade and Commerce, 1979. Canada. S t a t i s t i c s Canada. Population: Revised Annual Estimates of Population, by Sex and Age for Canada and the Provinces, 1971-1976. Cat. No. 91-518. Ottawa: Minister of Industry, Trade and Commerce, 1979. Canada. S t a t i s t i c s Canada. Federal Government Finance, 1979. Cat. No. 68-211. Ottawa: Minister of Industry, Trade and Commerce, 1981. Canada. S t a t i s t i c s Canada. Hospital Morbidity, 1978. Cat. No. 82-206. Ottawa: Minister of Industry, Trade and Commerce, 1981. Canada. S t a t i s t i c s Canada. Hospital Morbidity, Canadian Diagnostic List, 1978. Cat. No. 82-209. Ottawa: Minister of Industry, Trade and Commerce, 1981. 225 Canada. S t a t i s t i c s Canada. Income Distributions by Size in Canada, 1979. Cat. No. 13-207. Ottawa: Minister of Industry, Trade and Com-merce, 1981. Canada. S t a t i s t i c s Canada. Vital Statistics. Volume I: Births and Deaths, 1979. Cat. No. 84-204. Ottawa: Minister of Industry, Trade and Commerce, 1981. Canada. S t a t i s t i c s Canada. Vital Statistics. Volume 3: Mortality, Sum-mary List of Causes, 1979. Cat. No. 84-206. Ottawa: Minister of Industry, Trade and Commerce, 1981. Canada. Task Force on Retirement Income Po l i c y . The Retirement Income System in Canada: Problems and Alternative Policies for Reform. Ottawa: Queen's Pr i n t e r , 1979. Chandler, Marsha A., and Chandler, William M. Public Policy and Provin-cial P o l i t i c s . Toronto: McGraw-Hill Ryerson, 1979. Coser, Lewis, A. The Functions of Social Conflict. London: Routledge and Kegan Paul, 1956. Crichton, Anne. Eealth Policy Making: Fundamental Issues in the United States, Canada, Great Britain, Australia. Ann Arbor, Mich.: Health Administration Press, 1981. Crozier, M., and Friedberg, E. Actors and Systems: The P o l i t i c s of Col-lective Action. Chicago: University of Chicago Press, 1980. Cumming, Elaine, and Henry, William E. Growing Old. New York: Basic Books, 1961. Dahrendorf, Ralf. Class and Class Conflict in Industrial Society. Lon-don: Routledge and Kegan Paul, 1959. Denton, F.T., Robb, A.L., and Spencer, B.G. The Future Financing of the CPP and QPP: Some Alternative P o s s i b i l i t i e s . Ottawa::. Economic Council of Canada, 1979. Denton, Frank T., and Spencer, Byron G. "Canada's Population and Labour Force: Past, Present, and Future." In Aging in Canada: Social Perspectives, pp. 10-26. Edited by V i c t o r W. Marshall. Don M i l l s , Ont.: Fitzhenry. :and . Whiteside, 1980. Doern, G. Bruce ed. Eow Ottawa Spends Your Tax Dollars: Federal Priori-ties 1981. Toronto: James Lorimer, 1981. Dye, Thomas R. Policy Analysis: What Governments Do, Why They Do It, and What Difference It Makes. University, Alabama: University of Alabama Press, 1976. Dye, Thomas, R. Understanding Public Policy. Englewood C l i f f s , N.J.: Prentice-Hall, 1972. Easton, David. A Framework for P o l i t i c a l Analysis. Englewood C l i f f s , N.J.: Pr e n t i c e - H a l l , 1965. E l k i n s , D., and Simeon, R. Small Worlds: Provinces and Parties in Canadi an Political'--Life. Toronto: Methuen, 1980. Emery, F.E., and T r i s t , E.L. "The Causal Texture of Organizational Envi-ronments." In. Resource- Book in Macro-Organizational Behaviour, pp. 227-241. Edited by Robert H. Miles. Santa Monica, C a l i f . : Goodyear, 1980. Erikson, Erik H. Childhood and Society 2nd e d i t i o n . New York: W.W. Nor-ton, 1963. Evans, Robert G. "Review of 'Health Expenditures i n Canada and the Impact of Demographic Changes on Future Government Health Insurance Program Expenditures'". Canadian Public Policy 6 (Winter 1980) 132-33. Foley, John W. A Comparative Study of the Determinants of Public Policy. Program i n Urban and Regional Studies, Occasional Paper 9. Itha ca, N.Y.: Cornell U n i v e r s i t y Press, 1978. Foner, Anne. "Age S t r a t i f i c a t i o n and Age C o n f l i c t i n P o l i t i c a l L i f e " . American Sociological Review 39 ( A p r i l 1974): 187-96. Forder, Anthony. Concepts in Social Administration: A Framework for Ana l y s i s . London: Routledge and KeganPaul, 1974. Frederickson, H. George. New Public Administration. University,J.Alabama U n i v e r s i t y of Alabama Press, 1980. Fry, John A. ed. Economy, Class and Social Reality. Toronto: Butter-worths, 1979. Furniss, Norman, and T i l t o n , Timothy. The Case for the Welfare State: From Social Security to Social Equality. Don M i l l s , Ont.: F i t z henry and Whiteside, 1977. Geertz, C l i f f o r d . "Ideology as a C u l t u r a l System". In Ideology and Dis-content, pp. 47-76. Edited by David E. Apter. New York: Free Press, 1964. Godlove, Caroline, and Mann, Anthony. " T h i r t y Years of the Welfare State Current Issues i n B r i t i s h S o c i a l P o l i c y f o r the Aged." Aged Care and Services Review 2 (January 1980): 1-13. Gouvernement du Quebec, Ministere des A f f a i r e s S o c i a l e s . Growing Old Gracefully in Quebec. Quebec: A f f a i r e s Sociales, 1980. Grayson, J . Paul. Class, State, Ideology, and Change: Marxist Perspec-tives on Canada. Toronto: Holt, Rinehart and Winston, 1980. Great B r i t a i n . (Beveridge) Social Insurance and Allied Services. Lon-don: H.M.S.O., 1942. Gross, M. John, and Schwenger, Cope W. Health Care Costs for the Elderly in. Ontario: 1976-2026. Ontario Economic Council, Occasional Paper 11. Toronto: Ontario Economic Council, 1981. 227 Gubrium, Jaber F. The Myth of the Golden Years: A Socio-Environmental Theory of Aging. S p r i n g f i e l d , 111.: Charles C. Thomas, 1973. Guest, Dennis. The Emergence of Social Security in Canada. Vancouver: University of B r i t i s h Columbia Press, 1980. H a l l , Phoebe, Land, H i l a r y , Parker, Roy, and Webb, Adrian. Change, Choice and Conflict in Social Policy. London: Heinemann, 1975. Hartle, D.G. Public Policy Decision Making and Regulation. Montreal: I n s t i t u t e f o r Research on Public P o l i c y , 1979. Havighurst, Robert J . "Personality and Patterns of Aging." Gerontolo-gist 8 (1968): 20-23. Hendricks, Jon, and Hendricks, C. Davis. Aging in Mass Society: Myths, and Realities. Cambridge, Mass.: Winthrop, 1977. Hess, Beth B. ed. Growing Old in America 2nd e d i t i o n . New Brunswick, N.J.: Transaction, 1980. Hiebert, Gerald P., Schurman, Donald S., and A l l e n , Janina. "Long-Term Care: Perspectives f o r the 80s". Eealth Management Forum (Summer 1980): 55-69. Hobbes, Thomas. Leviathan or The Matter, Form and Power of a Commonwealth Ecclesiastical and Civil (1651) . Excerpted i n The Portable Age of Reason Reader, pp. 137-141. Edited by Crane Brinton. New York: Viking Press, 1956. Hobman, David. The Social Challenge of Ageing. London: CroomHelm, 1978. Hochschild, A r l i e R. The Unexpected Community. Englewood C l i f f s , N.J.: P r e n t i c e - H a l l , 1973. Horowitz, Gad. "Conservatism, Liberalism, and Socialism i n Canada: An Interpretation". Canadian Journal of Economics and P o l i t i c a l Science 22 (May 1966). In Party P o l i t i c s in Canada 4th e d i t i o n , pp. 64-70. Edited by Hugh G. Thorburn. Scarborough, Ont.: P r e n t i c e - H a l l , 1979. Hughes, Everett C. The Sociological Eye: Selected Papers. Chicago: Aldine, Atherton, 1971. Quoted i n V i c t o r W. Marshall, "No E x i t : An Interpretive Perspective on Aging". In Aging in Canada: Social Perspectives, pp. 51-60. Edited by V i c t o r W. Marshall. Don M i l l s , Ont.: Fitzhenry and Whiteside, 1980. Jacobs, Ruth H., and Vinick, Barbara H. Re-Engagement in Later Life. Stamford, Conn.: Greylock, 1977. Janowitz, Morris. Social Control of the Welfare State. New. York: Else-v i e r , 1976. Jenkins, W.I. Policy Analysis: A P o l i t i c a l and Organisational Perspec-tive. London: Martin Robertson, 1978. 228 Jones, Landon Y. Great Expectations. Toronto: Random House, 1981. Kahn, A l f r e d J . , and Kamerman, Sheila B. Social Services in International Perspective: The Emergence of the Sixth System. Report to the U.S. Department of Health, Education, and Welfare, So c i a l and R e h a b i l i t a t i o n Service, O f f i c e of Planning, Research, and Evalua-t i o n . Washington, D.C.: U.S. Government Pr i n t i n g O f f i c e , 1977. Kane, Robert L., and Kane, Rosalie A. "Long-Term Care: Can Our Society-Meet the Needs of i t s E l d e r l y ? " Annual Review of Public Health. (1980): 227-53. Kettle, John. The Big Generation. Toronto: McClelland and Stewart, 1980. King, Alexander. "Change and Uncertainty: The Challenge to Administration". Canadian Public Administration 22 (Spring 1979): 2-22. Kingson, E r i c R., and S c h e f f l e r , Richard M. "Aging: Issues and Economic Trends f o r the 1980's". Inquiry 18 ( F a l l , 1981): 197-213. Kirby, M.J.L., Kroeker, H.V., and Teshke, W.R. "The Impact of Public P o l i c y -Making Structures and Processes i n Canada". Canadian Public Administration 21 ( F a l l 1978): 407-17. Lancet. ( E d i t o r i a l ) Blocked Beds. 8 November 1980, p. 1013. Lemon, B.W., Bengtson, V.L., and Peterson, J.A. " A c t i v i t y Types and L i f e S a t i s f a c t i o n i n a Retirement Community". Journal of Gerontology 27 ( A p r i l 1972): 511-23. Levin, Jack, and Levin, William C. Ageism: Prejudice and Discrimination Against the Elderly. Belmont, C a l i f . : Wadsworth, 1980. L i t t l e , W., Fowler, H.W., and Coulson, J . The Shorter Oxford English Dic-tionary 3rd e d i t i o n . London: Oxford University Press, 1973. Lowenthal, M.F. "Psychosocial Variations Across the Adult L i f e Course: Frontiers f o r Research and P o l i c y " . Gerontblogist 15 (January 1975): 6-12. Marchak, M. P a t r i c i a . Ideological Perspectives on Canada. Toronto: Mc-Graw-Hill Ryerson, 1975. Marini, Frank ed. Toward a New Public Administration: The Minnowbrook Perspective. San Francisco: Chandler, 1971. Markson, Eliz a b e t h W., and Batra, Gretchen R. Public Policies for an Aging Population. Toronto: D.C. Heath, 1980. Marshall, V i c t o r W. "No E x i t : An Interpretive Perspective on Aging". In Aging in Canada: Social Perspectives, pp. 51-60. Edited by V i c t o r W. Marshall. Don M i l l s , Ont.: Fitzhenry and White-side, 1980. Marshall, V i c t o r W., and Tindale, Joseph A. "Notes f o r a Radical Geronto-logy". International Journal of Aging and Human Development 9 (1978-79): 163-75. McPhee, Margaret. "Health Care or Health: The Development of the Ele-ments of a Plan to Address the Health Needs of the E l d e r l y i n B r i t i s h Columbia". M.Sc. Thesis, University of B r i t i s h Columbia 1977. (Mimeographed). Meilecke, Carl A. "Canadian Health Services Administration i n the 1980s" Health Management Forum (Spring 1981): 7-12. Meilecke, Carl A., and Storch, Janet L. eds. Perspectives on Canadian Eealth and Social Services Policy: Eistory and Emerging Trends. Ann Arbor, Mich.: Health Administration Press, 1980. Myles, J.F. "The Aged, the State and the Structure of Inequality". In Structured Inequality in Canada, pp. 317-42. Edited by J. Harp and J.R. Hofley. Scarborough, Ont.: Prentice-Hall, 1980. Myrdal, Gunnar. An American Dilemma: the Negro Problem and Modern Demo-cracy. London: Harper and Row, 1962. Navarro, Vincente. Medicine Under Capitalism. New York: Prodist, 1977. Neugarten, Bernice L. "The Awareness of Middle Age". In Middle Age and Aging, pp. 93-98. Edited by Bernice L. Neugarten. Chicago: University of Chicago Press, 1968. Neugarten, Bernice L. "Personality and the Aging Process". Gerontolo-gist 12 (January 1972): 9-15. O'Connor, James. The Fiscal Crisis of the State. New York: St. Martin' Press, 1973. Ontario. M i n i s t r y of Health. Ontario Council of Health. Eealth Care for the Aged. Toronto: Ontario Council of Health, 1978. Ontario. Secretariat f o r S o c i a l Development. Task Force on Aging. The Elderly in Ontario: Agenda for the '80s. Toronto: Queen's P r i n t e r , 1981. O r i o l , William E. "'Modern' Old Age and Public P o l i c y " . Gerontologist 21 (January 1981): 35-45. Ossenberg, Richard J . Power and Change in Canada. Toronto: McClelland and Stewart, 1980. Osterbind, Carter C. ed. Social Goals, Social Programs and the Aging. G a i n e s v i l l e , F l o r i d a : U niversity Presses of F l o r i d a , 1975. Panitch, Leo ed. The Canadian State: P o l i t i c a l Economy and P o l i t i c a l Power. Toronto: University of Toronto Press, 1977. Peck, R.C. "Psychological Developments i n the Second Half of L i f e " . In Middle Age and Aging, pp. 88-92. Edited by Bernice L. Neugarten Chicago: University of Chicago Press, 1968. Penner, Ronald. "A Review and Update of U t i l i z a t i o n of Long-Term Care Services". Report prepared f o r the M i n i s t r y of Health, V i c t o r i a B.C., November 1981. (Mimeographed.) 230 Pesando, James E. Private Pensions in an Inflationary Climate: Limita-tions and Policy Alternatives. Ottawa: Economic Council of Canada, 1979. Pesando, James E. The Elimination of Mandatory Retirement: An Economic Perspective. Toronto: Ontario Economic Council, 1979. Pinker, Robert. The Idea of Welfare. London: Heinemann, 1979. Pinker, Robert. Social Theory and Social Policy. London: Heinemann, 1971. Powell, Brian J . , and Martin, James K. "Economic Implications of an Aging Society i n Canada". Paper presented at The National Sympo-sium on Aging, Ottawa, 25-27 October 1978. Quinney, Richard. Capitalist Society: Readings for a Critical Sociology. Georgetown, Ont.: Dorsey Press, 1979. Redekop, John H. Approaches to Canadian P o l i t i c s . Scarborough, Ont.: Prentice-Hall, 1978. Riley, Matilda W. "Age Strata i n Soc i a l Systems". In Handbook of Aging and the Social Sciences, pp. 189-217. Edited by Robert Binstock, and Ethel Shanas. New York: Van Nostrand Reinhold, 1976. Robson, William,A. Welfare State and Welfare Society: Illusion and Reality. London: George A l l e n and Unwin, 1977. Rose, Albe r t . Canadian Housing Policies 1935-1980. Scarborough, Ont.: Butterworth, 1980. Rose, Arnold M. "A Current Issue i n S o c i a l Gerontology". Gerontologist 4 (1964). Quoted i n Jack Levin, and William C. Levin, Ageism: Prejudice and Discrimination Against the Elderly, p. 44. Belmont, C a l i f . : Wadsworth, 1980. Rose, Richard. Do Parties Make a Difference? London: Chatham ,House, 1980. Saskatchewan. Mini s t r y of Health. G e r i a t r i c Services Review Committee. Saskatchewan's Geriatric Services: Directions for the Eighties and Beyond. Regina: Saskatchewan Health, 1981. Schneider, Louis. Classical Theories of Social Change. Morristown, N.J.: General Learning Press, 1976. Schon, Donald A. Beyond the Stable State: Public and Private Learning in a Changing Society. New York: IV.W. Norton, 1973. S c u l l , Andrew T. Decarceration - Community Treatment and the Deviant: A Radical View. Englewood C l i f f s , N.J.: Prentice-Hall, 1977. Shapiro, Evelyn, Roos, Noralou P., and Kavanagh, Steve. "Long-Term Pa-t i e n t s i n Acute Care Beds: Is There a Cure?" Gerontologist 20 (March 1980) : 342-9.. 231 Sharkansky, Ira. Public Administration: Policy Making in Government Agencies 4 th e d i t i o n . Chicago: Rand McNally, 1978. Sherman, H.J., and Wood, J.L. Sociology: Traditional and Radical Perspec-tives. New York: Harper and Row, 1979. Simmons, Robert H., Davis, Bruce W., Chapman, Ralph J.K., and Sager, Daniel D. " P o l i c y Flow Analysis: A Conceptual Model f o r Compa-r a t i v e Public P o l i c y Research". Western P o l i t i c a l Quarterly 27 (Summer 1974): 457-68. Smith, Anthony. The Concept of Social Change. London: Routledge and Kegan Paul, 1973. Smith, Anthony D. Social Change. London: Longman, 1976. Soci a l Planning and Review Council of B r i t i s h Columbia. Community Care for Seniors. Vancouver: SPARC, 1972. Soci a l Planning and Review Council of B r i t i s h Columbia. The Quality of Living in Bousing for the Elderly. Vancouver, SPARC, 1974. So c i a l Planning and Review Council of B r i t i s h Columbia. The Eealth Needs of the Independent Elderly. Vancouver: SPARC, 1976. So c i a l Planning and Review Council of B r i t i s h Columbia. A Citizen's Guide to Long Term Care in B.C. Vancouver: SPARC, 1978. Stammen, Theo. P o l i t i c a l Parties in Europe. London: John Martin, 1980. S t e i n f e l s , Peter. The Neoconservatives. New York: Simon and Schuster, 1979. Stevenson, Garth: Unfulfilled Union. Toronto: MacMillan, 1979. Stoesz, David. "A Wake f o r the Welfare State: S o c i a l Welfare and the Neoconservative Challenge". Social Service Review (September 1981): 398-410. Stone, Leroy 0. "Employment Opportunity and the Achievement of Adequate Income f o r the Baby Boom Generation". In Canadian Gerontological Collection, Vol. 1 Edited by Blossom T. Wigdor. Calgary: Cana-dian Association of Gerontology, 1977. Stone, Leroy 0. "Research Issues i n the F i e l d of Population Aging". Paper presented at the Graduate Seminar i n Gerontology, University of B r i t i s h Columbia, Vancouver, B.C., 22 September 1981. Stone, Leroy 0., and Fletcher, Susan. A Profile of Canada's Older Popu-lation. Montreal: I n s t i t u t e f o r Research on Public P o l i c y , 1980. Stone, Leroy 0., and MacLean, M.J. Future Income Prospects for Canada's Senior Citizens. Montreal: I n s t i t u t e f o r Research on Public P o l i c y , 1979. 232 Stone, L.O., and Marceau, C. Canadian Population Trends and Public Policy Through the 1980 's. Montreal: I n s t i t u t e f o r Research on Public P o l i c y , 1978. St r e i b , Gordon F. " S o c i a l S t r a t i f i c a t i o n and Aging"'.1 In Handbook of Aging and the Social Sciences, pp. 160-185. Edited by Robert Binstock, and Ethel Shanas. New York: Van Nostrand Reinhold, 1976. Taylor, Malcolm. "The Canadian Health Insurance Program". Public Adminis-tration Review 33 (Jan.-Feb. 1973): 31-39. Tennant, Paul. "The NDP Government of B r i t i s h Columbia: Unaided P o l i t i -cians i n an Unaided Cabinet". Canadian Public Policy 3 (Autumn 1977): 489-503. Tihdale, Joseph A., and Marshall, V i c t o r W. "A Generational-Conflict Perspective f o r Gerontology". In Aging in Canada: Social Pers-pectives, pp. 43-50. Edited by V i c t o r W. Marshall. Don M i l l s , Ont.: Fitzhenry and Whiteside, 1980. Titmuss, Richard M. Essays on the Welfare State 2nd e d i t i o n . Boston: Beacon, 1969. Titmuss, Richard. Social Policy: An Introduction. London: George A l l e n and Unwin, 1974. Tupper, A l l a n . "The State i n Business". Canadian Public Administration 22 (Spring 1979) : 124-50. Turner, Jonathan H. The Structure of Sociological Theory. Georgetown, Ont.: Dorsey, 1978. United Nations. Department of International Economic and So c i a l A f f a i r s . Selected Demographic Indicators by Country, 1950-2000: Demogra-phic Estimates and Projections as Assessed in 1980. New York: United Nations, 1981. United States. Department of Health, Education, and Welfare. S o c i a l Security Administration. Social Security in a Changing World. Washington, D.C.: Health, Education, and Welfare, 1979. Walker, C.B. "The Emerging P r o f i l e of the Aged i n Canada". Paper pre-sented at The Research Symposium on Canada's Changing Age Struc-ture: Implications f o r the Future, Vancouver, B.C. 23 August, 1981. Warham, Joyce. "The Concept of Equality i n So c i a l P o l i c y " . Department of Health Care and Epidemiology, University of B r i t i s h Columbia, Vancouver, B.C., 1974. (Mimeographed.) Warren, Roland L. Social Change and Human Purpose: Toward Understanding and Action. Chicago: Rand McNally, 1977. Warshay, Leon H. The Current State of Sociological Theory. New York: D. McKay, 1975. 233 Weitz, Harry. The Foreign Experience with Income Maintenance for the Elderly. Background study f o r the Economic Council of Canada. Ottawa: Queen's Pr i n t e r , 1979. Wiatr,.. J . J . , and Rose, R. eds. Comparing Public Policies. Warsaw: Ossolineum, 1977. Yelaja, S.A. "The E l d e r l y and S o c i a l P o l i c y " . In Canadian Social Policy, pp. 147-65. Edited by S.A. Yelaja. Waterloo, Ont.: Wilfred Laurier University Press, 1978. Zaltman, Gerald, and Duncan, Robert. Strategies for Planned Change. Nfew York: Wiley-Interscience, 1977. 

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