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Residential milieu and locational suitability : a study of selected elderly residents in non-profit care… Fallick, Arthur Laurence 1980

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RESIDENTIAL MILIEU AND LOCATIONAL SUITABILITY; A STUDY OF SELECTED ELDERLY RESIDENTS IN NON-PROFIT CARE FACILITIES WITHIN GREATER VANCOUVER M.A., The University of Dundee, 1977 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department of Geography) We accept this thesis as coriforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA May 1980 c Arthur Laurence Fallick, 1980 by ARTHUR LAURENCE FALLICK In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f the r e q u i r e m e n t s f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h Columbia, I agree t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s t u d y . I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f 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 g r a n t e d by the Head o f my Department o r by h i s r e p r e s e n t a t i v e s . I t i s unders t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . Department n f SEOftiA-PvAV The U n i v e r s i t y o f B r i t i s h Columbia 2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5 DE-6 BP 75-5 1 1 E ABSTRACT As the age structure of Canadian society changes i n the ensuing decades, housing and caring f o r the e l d e r l y w i l l undoubtedly take on increased significance, and consequently, i t i s c r u c i a l that our s o c i a l i n s t i t u t i o n s begin to prepare now f o r t h i s change. This thesis focuses upon the opinions of a selected number of residents of f i f t e e n Personal and Intermediate Care F a c i l i t i e s operated by non-profit organisations w i t h i n the Greater Vancouver Regional D i s t r i c t , which are now an i n t e g r a l part of the recently inaugurated Long Term Care Program i n B r i t i s h Columbia. An i n i t i a l fundamental premise of the research was that a poor location, one which serves to physi c a l l y i s o l a t e residents and reduce t h e i r i n t e r a c t i o n with the wider coimiunity, would l i k e l y engender s o c i a l i s o l a t i o n with a concomittant reduction i n i n d i v i d u a l well-being. While geographers and others have developed location - a l l o c a t i o n algorithms for determining the optimal location of e.g. health f a c i l i t i e s , a notable deficiency of such a n a l y t i c a l methods i s t h e i r lack of attention to the needs and opinions of those whom the f a c i l i t i e s are designed to serve. In an attempt to r e c t i f y t h i s s i t u a t i o n a survey of f i f t e e n per cent of the residents i n each of the selected i n s t i t u t i o n s was conducted to improve our understanding of how w e l l the f a c i l i t i e s were serving the occupants, and i n p a r t i c u l a r , whether or not they are w e l l situated with respect to the l o c a t i o n a l preferences of the elderly. I t has been argued that the space - occupancy behaviour of the e l d e r l y i s extremely sensitive to t h e i r surroundings and that the location of structures and spaces assumes greater significance especially when the constraints on mobility i i . ' . Abstract Contd. are taken into account. These and associated questions are addressed through the analysis of the responses to the questionnaire which was administered. In evaluating a person's degree of residential satisfaction, i t is unrealistic to separate the dwelling unit from its surroundings or its locality. Both are an integral part of what has here been termed "residential milieu" which includes both the institutional milieu and those parts of the surrounding area which the individual uses to satisfy his or her physical and psycho-social needs. The results generally confirm the notion that l i f e satisfaction is positively related to the level of residential satisfaction and mobility. While the respondents' assessment of the surrounding area is less centrally related to their sense of well-being we are reluctant to conclude that the location of a care facility is unimportant. i i i TABLE OF CONTENTS Page Abstract i i L i s t of Tables v L i s t of Figures v i i i L i s t of Appendices i x Acknowledgements x Chapter 1 INTRODUCTION 1 Chapter 2 METHODOLOGY 18 Chapter 3 ANALYSIS AND,RESULTS 30 Chapter 4 DISCUSSION AND INTERPRETATION 77 OF FINDINGS Chapter 5 CONCLUSION 108 APPENDICES 114 BIBLIOGRAPHY I 5 0 i v LIST OF TABLES Institutions under study by sponsorship type and municipality Age composition of the sample Sex composition of the sample Marital status Number of living children Care type Place of birth Previous address Reasons for satisfaction with residence Reasons for preferring to live in present residence or elsewhere Most frequently stated reasons for residential satisfaction Most frequently stated reasons for residential dissatisfaction Suggested improvements to the institutional milieu Reasons for leaving previous residence Reasons for choosing present residence Number of hours spent in own room Problems faced in,daily living Life satisfaction scores Perceived changes since moving into residence Percentage of respondents in contact once a month or more often with 0-9 offspring, other relatives and friends v Number of t r i p s outside residence per week Frequency of a c t i v i t i e s outside (average month) Frequency of public transport t r i p s S a t i s f a c t i o n with landscaping around buil d i n g Perceived a c c e s s i b i l i t y to community f a c i l i t i e s Canonical analysis of r e s i d e n t i a l s a t i s f a c t i o n versus l i f e s a t i s f a c t i o n Canonical analysis of r e s i d e n t i a l s a t i s f a c t i o n versus mobil i t y Canonical analysis of r e s i d e n t i a l s a t i s f a c t i o n versus environmental evaluation Canonical analysis of r e s i d e n t i a l s a t i s f a c t i o n versus the presence of f a c i l i t i e s w i t h i n the residence Canonical analysis of mobilit y versus l i f e s a t i s f a c t i o n Canonical analysis of mobility versus proximity of comnurrity services Canonical analysis of l i f e s a t i s f a c t i o n versus contact with children, r e l a t i v e s and friends Canonical analysis of contact with children, r e l a t i v e s and friends versus contact with those who l i v e i n the GV.R.D. Regression analysis of l i f e s a t i s f a c t i o n versus "ROOMHR" Regression analysis of the proximity to community services versus "TIMEOUT" Pearson product moment cor r e l a t i o n analyses v i Discriminant analysis of residential satisfaction by care type Discriminant analysis of l i f e satisfaction by care type Discriminant analysis of mobility by care type Discriminant analysis of residential satisfaction by each residence Discriminant analysis of l i f e satisfaction by each residence Discriminant analysis of mobility by each residence Discriminant analysis of environmental evaluation by each residence Discriminant analysis of proximity to community facilities by each residence v i i LIST OF FIGURES C r i t i c a l distance measures to selected f a c i l i t i e s Non-profit Personal and Intermediate care i n s t i t u t i o n s i n the Greater Vancouver Regional D i s t r i c t Past and future growth of Canada's t o t a l population and persons 65 years and older, 1851-2001 v i i i LIST OF APPENDICES Page Appendix 1 Sample Selection Data Form I I 3 2 Letter Contacting Residents I l 6 3 Residents 1 Interview Schedule U S 4 Age D i s t r i b u t i o n by Residence 128 5 Sex D i s t r i b u t i o n by Residence 130 6 Reasons for Satisfaction.. with 132 Each Residence 7 Reasons for D i s s a t i s f a c t i o n with 134 Each Residence 8 Number of Hours per Day Spent 136 i n the Room by Residence 9 Perceived Presence of Services 1 3 ® w i t h i n Each Building 10 Frequency of Journeys Outside 1 4 0 Each Residence 11 S a t i s f a c t i o n with Surrounding 142 12 Perceived Proximity and Access 1 4 4 to Local Services by Residence 13 Acronyms and Variables by 1 4 ^ Substantive Theme i x ACKNOWIIilJGEMENIS In acknowledging those who assisted in the conduct of this study thanks go first to the management, staff and residents of. the fifteen participating institutions. This study could not have taken place without their generous co-operation and patience. I would also like to sincerely thank Dr. John Mercer in the Depart-ment of Geography and Dr. Gloria Gutman in the Department of Psychology at U.B.C. for their support, advice and encouragement throughout the course of my M.A. programme. Special thanks also go to the staff and graduate students in the Department of Geography for their support and friendship. Others I would like to thank are Cindy Constable, Dorothy Hyslop, Wendy Moffat, Yasmin Jiwani, Ruth Mclsaac and Hanifa Mangali a l l of whom conducted residents' interviews, John Lawman and Howard Greenstein who advised me on the various drafts, and especially Maureen Quaid who assisted greatly as a statistical consultant and constant source of support. Finally, I wish to thank the Canada Mortgage and Housing Corporation for their financial support and for the co-operation of their regional staff throughout the project and to Christine Wakefield for typing the manuscript. Arthur L. Fallick x CHAPTER ONE INTRODUCTION Age, l i k e woman, requires f i t surroundings. Emerson (1886) Purpose There i s a growing body of gerontological l i t e r a t u r e which focuses upon the complex interactions between man and his environment (Pastalan and Carson, 1970), a theme which has long been central to geographical analysis (White, 1974). The concept of home range (Stea, 1970), or what w i l l be defined here as the r e s i d e n t i a l milieu, has been used to describe the extent and d i f f e r e n t i a t i o n of behaviour i n terms of o r i g i n and destinations, patterns of movement, occupancy, and usage of various places: (Home range) i s also a cognitive entity, a conceptual gestalt b u i l t up of i n t e r s t i c e s i n the behavioral pattern ( " i n v i s i b l e landscapes"), of knowledge of places once v i s i t e d or l i v e d i n , and of l o c a t i o n a l goals r e a l i z a b l e within the scope of the individual's plans. The conceptual extensity or d i f f e r e n t i a t i o n of home range may vary from time to time within a developmental stage. (Stea, pp. 139-14) 1 2 In essence, r e s i d e n t i a l m i l i e u i n c l u d e s the d w e l l i n g u n i t and those p a r t s of the surrounding area which the i n d i v i d u a l uses to s a t i s f y h i s p h y s i c a l and s o c i a l needs. In the case of those who l a c k the a b i l i t y to i n t e r a c t w i t h t h e i r surroundings, the concept can be used to apply to those p o r t i o n s o f the e n v i r o n -ment which the i n d i v i d u a l p e r c e i v e s as having r e s o u r c e s which are at l e a s t p o t e n t i a l l y able to s a t i s f y h i s needs. With the onset of advancing years, there i s a tendency f o r the home range to c o n t r a c t as the i n d i v i d u a l ' s mastery over the wider environment d i m i n i s h e s . An o l d e r person thus o f t e n comes to r e l y much more upon h i s immediate surroundings to c a t e r to h i s housing and p s y c h o - s o c i a l needs. Moreover, f o r those who r e q u i r e some form of i n s t i t u t i o n a l care, the dependence upon the r e s i d e n c e and the immediate surroundings can be even more marked, p a r t i c u l a r l y when m o b i l i t y i s reduced through poor h e a l t h . I t i s t h e r e f o r e extremely important that the r e s i d e n t i a l m i l i e u o f i n s t i t u t i o n s be as s u p p o r t i v e and r e s p o n s i v e to the t o t a l needs of the e l d e r l y r e s i d e n t s as p o s s i b l e (Kahana, 1971). In t h i s t h e s i s , a t t e n t i o n w i l l be f o c u s s e d upon i n s t i -t u t i o n a l s e t t i n g s through a study of a r e p r e s e n t a t i v e sample of n o n - p r o f i t P e r s o n a l and Intermediate Care F a c i l i t i e s w i t h i n the Greater Vancouver Regio n a l D i s t r i c t . Two reasons d i c t a t e d the c h o i c e of n o n - p r o f i t i n s t i t u t i o n s f o r study. F i r s t l y , the sheer number of p r i v a t e n u r s i n g care homes p r e c l u d e d r e p r e -s e n t a t i v e a n a l y s i s and i n t e r v i e w s i n the time a v a i l a b l e . Secondly, C e n t r a l Mortgage and Housing C o r p o r a t i o n (C.M.H.C.), the f e d e r a l housing agency, has expressed i n t e r e s t i n r e s e a r c h 3 on care f a c i l i t i e s i n B r i t i s h Columbia. Given a new d i r e c t i o n i n p r o v i n c i a l p o l i c i e s , there i s currently a diminished i n t e r -est i n housing the e l d e r l y through the construction of new self-contained housing, e s p e c i a l l y i n the larger metropolitan centres. Greater attention i s now being given to the pro-v i s i o n of an integrated range of care f a c i l i t i e s for those e l d e r l y no longer able or w i l l i n g to maintain an independent residence. Since C.M.H.C. provides f i n a n c i a l assistance to non-profit organizations to construct care f a c i l i t i e s , the pot e n t i a l to make a contribution to federal policy-making exists by investigating non-profit i n s t i t u t i o n s . These i n s t i t u t i o n s (care f a c i l i t i e s ) are now part of the recently inaugurated (January 1, 1978) Long Term Care Pro-gram i n B r i t i s h Columbia. This program i s intended to pro-vide a continuum of care for those who cannot l i v e indepen-dently without help, because of health-related problems which do not warrant admission to an acute care h o s p i t a l . The Pro-v i n c i a l Department of Health and the Department of Human Re-sources define Personal Care as care required by persons whose physical d i s a b i l i t i e s are such that th e i r primary need i s for room and board, limited lay-supervision, assistance with, some of the a c t i v i t i e s of d a i l y l i v i n g and a planned programme of s o c i a l and recreational a c t i v i t i e s . Persons i n need of Inter-mediate Care require d a i l y nursing supervision i n addition to the services offered to Personal Care residents. They are generally less independent and have more health-related prob-lems, often exhibiting greater problems with mobility than those at the Personal Care l e v e l . 4 The former head of the Long Term Care Program for the c i t y of Vancouver estimated that there were over 65,000 people over the age of 65 i n the c i t y , of whom about 8% would be expected to need care services (approximately 4,500 to 5,000). The projected figure for 1978 was 7,500 and i t was expected that t h i s would r i s e to around 10,000 by the end of the decade. More generally, there are now approximately 87 non-profit i n s t i t u t i o n s involved i n the programme throughout the province. But, there appears to be a lack of detailed s p e c i f i c a t i o n s concerning what types of locations would be most suitable for the residents, nor are the l o c a t i o n a l c r i t e r i a used to deter-mine the appropriateness of a s i t e r e a d i l y available. This lack of knowledge i s p a r t l y o f f s e t by the reliance on the non-profit approach, as the sponsors are viewed as being more sensitive to t h e i r c l i e n t s ' needs and l o c a l conditions (Mercer, 1978). At present, most aspects of the r e s i d e n t i a l milieux of the i n s t i t u t i o n s within the Greater Vancouver area remain largely unexplored. Few guidelines ex i s t for determining what constitutes a suitable milieu, and although a number of l o c a t i o n a l factors appear to be at work, one of the most important determinants for the s i t i n g of the i n s t i t u t i o n s would seem to be the a v a i l a b i l i t y of land at r e l a t i v e l y low cost. The p r i n c i p a l aims of this research are to c o l l e c t and interpret information on the c h a r a c t e r i s t i c s and behaviours of the residents within certain of the institutions,;, and to assess the l o c a t i o n a l s u i t a b i l i t y of t h e i r dwelling units through an analysis of measures of r e s i d e n t i a l and l i f e 5 s a t i s f a c t i o n , mobility and the residents' evaluation of the l o c a l environment. The primary methodological emphasis of this work i s oriented to incorporate the views and opinions of the residents themselves, and as a r e s u l t , these various measures were administered i n the context of interviews with samples of the residents drawn from the selected i n s t i t u t i o n s . A basic i n i t i a l premise was that an appropriate m i l i e u i s one i n which the diverse needs of the residents can be met either within the residence or else i n the surrounding neigh-bourhood. An i n a b i l i t y on the part of the residents to interact with the l o c a l environment and to maintain or develop s o c i a l contacts outside of the residence (as well as i n s i d e ) , i s assumed to be detrimental to their s o c i a l well-being, which could possibly accentuate or reinforce physical and s o c i a l i s o l a t i o n . This assumption has been discussed by Lawton and Simon (1968), who argue that space-occupancy behaviour of older people i s very sensitive to the nature of the physical surroundings, suggesting that the location of spaces and struc-tures assumes heightened importance when the frequent l i m i t a -tions on mobility of the aged are considered. In discussing the older person's s e n s i t i v i t y to environmental v a r i a t i o n , they develop the "environmental d o c i l i t y " hypothesis which states that: The greater the degree of competence of the organism, the less w i l l be the proportion of variance i n behav-iour due to environmental factors. Conversely, l i m i t a -tions i n health, cognitive s k i l l s , ego strength, status, s o c i a l r ole performance, or degree of c u l t u r a l evolution w i l l tend to heighten the d o c i l i t y of the person i n the face of environmental constraints and influences. (Lawton and Simon, p. 108) 6 Lawton (1970) suggests t h a t the o l d e r person i s thus more s e n s i t i v e to change i n the environment than people i n m i d - l i f e because he i s l i k e l y to have experienced some k i n d of reduc-t i o n i n competence. However, there i s l i t t l e evidence i n the l i t e r a t u r e to i n d i c a t e t h a t the nature of the i n t e r a c t i o n s w i t h the environment are the same f o r the i n s t i t u t i o n a l i z e d e l d e r l y as f o r the n o n - i n s t i t u t i o n a l i z e d . The p r i n c i p a l focus of a t t e n t i o n having been upon the housing and psycho-s o c i a l needs of the independent e l d e r l y , l i t t l e i s known about the p a r t i c u l a r needs and p r e f e r e n c e s of those who are no longer a b l e to f u l l y look a f t e r themselves. Because of the nature of t h e i r i n f i r m i t i e s , the a b i l i t y of many of the r e s i -dents i n i n s t i t u t i o n s to r e t a i n mastery o f t h e i r environment d i m i n i s h e s , o f t e n w i t h a concomittant c o n s t r i c t i o n of t h e i r home range. Thus, i t i s expected that where the r e s i d e n t i a l m i l i e u i s congruent w i t h the needs of the r e s i d e n t s , t h e i r m o b i l i t y and p e r c e i v e d l e v e l s of s a t i s f a c t i o n ( r e s i d e n t i a l and p s y c h o - s o c i a l ) w i l l be h i g h , whereas m a r g i n a l m i l i e u x w i l l be r a t e d l e s s f a v o u r a b l y . The a v a i l a b i l i t y of, and prox-i m i t y to d e s i r e d community s e r v i c e s i s t h e r e f o r e regarded as e s s e n t i a l f o r the continued w e l l - b e i n g of the r e s i d e n t s , and i t i s suggested t h a t , f o r those who cannot make use of the l o c a l environment because of t h e i r i n f i r m i t i e s , the d w e l l i n g u n i t should have the r e s o u r c e s to compensate f o r t h i s l o s s . Thus, the c e n t r a l o b j e c t i v e of t h i s study i s to determine whether or not the n o n - p r o f i t i n s t i t u t i o n s are s u i t a b l y s i t u -ated w i t h r e s p e c t to the r e s i d e n t i a l and s o c i a l needs of t h e i r r e s i d e n t s . 7 The Psycho-Social Needs of the Aged:  Neighbourhood and Community Settings Within the l a s t two and a h a l f decades, dramatic changes have occurred which have modified the s o c i a l , econo-mic and p o l i t i c a l ways of l i f e i n western i n d u s t r i a l i z e d s o c i e t i e s , and these i n turn have affected the physical envi-ronment within which the changes have taken place. Unfortun-ately, i n many instances, the well-being of older people has lagged behind the general improvements i n the r i s i n g standards of l i v i n g , to the extent that many aspects of the present environment are not i d e a l l y suited to the patterns of l i f e i n l a t e r maturity and old age. Since the e l d e r l y exhibit diverse l i f e s t y l e s and have d i f f e r i n g amounts of resources to s a t i s f y t h e i r needs and goals, there i s , as Golant (1976) suggests, considerable v a r i a t i o n i n the community f a c i l i t i e s and services that are both required and preferred by d i f f e r e n t sub-groups. He advocates that the r e s i d e n t i a l setting which, i t i s argued here, i s analogous to the concept of milieu, should be able to accommodate the changing effectiveness and competency of the older person to r e a l i z e his needs: The successful adaptation to old age may require him to cope with declining physical energy, poorer health, smaller f i n a n c i a l funds, lower s o c i a l status, a sudden loss of spouse or good friends, or a general decline i n his a b i l i t y to deal with complex situations. The physical attributes and s o c i a l environment of the r e s i d e n t i a l setting should help f a c i l i t a t e the older person's adjust-ment to those c r i t i c a l events. (Golant, p. 387) The question of the importance of the l o c a l environment i n providing support for the e l d e r l y has also been discussed by 8 V i v r e t t (1966), who argues that the psycho-social needs of the older person pertain f i r s t l y to his i n d i v i d u a l i z e d and habitualized patterns of d a i l y l i v i n g , and secondly, to his relationship to s i g n i f i c a n t others i n the community. As a r e s u l t , there i s a marked tendency for the person to wish to remain amid f a m i l i a r surroundings to compensate for the lone-li n e s s caused by the narrowing c i r c l e of friends which often accompanies old age. The p a r t i c u l a r needs of the e l d e r l y remain largely i l l - d e f i n e d however, and there seems to be l i t t l e agreement as to the d e f i n i t i o n and scope of s o c i a l services; although Beattie (1976) offers one useful d e f i n i t i o n : . . . organized s o c i e t a l approaches to the amelioration or eradication of those conditions which are viewed at any h i s t o r i c a l point of time as unacceptable . . . (and) which can be applied to improve the s o c i a l functioning and s e l f - a c t u a l i z a t i o n of the older i n d i v i d u a l , his family, or community. (Beattie, p. 619) Beattie also r e l a t e s , i n an e a r l i e r context, s p e c i f i c levels of services for the aged to the p a r t i c u l a r problems that con-front old people, d i f f e r e n t i a t i n g (a) basic services, (b) adjust-ment and integration services, (c) support services, (d) con-gregate and shelter care services and (e) protective services, (Beattie, 1965). Two somewhat si m i l a r typologies have been developed, based on the concept of "human needs." For example, Cohen (1965) c l a s s i f i e s services on the basis of f i n a n c i a l assistance; medical orientation; enhancement of s o c i a l contact and p a r t i c i p a t i o n , and s o c i a l l y supportive. Lowy (1969) employs a c l a s s i f i c a t i o n based on "need areas," such as food, 9 clothing, shelter, sexual, psychological-emotional-spiritual, health, economic, s o c i a l , c u l t u r a l and p o l i t i c a l . The consensus of the relevant l i t e r a t u r e i s that a wide range of services must be available when people need them; they ought to be accessible, preferably i n geographical proxi-mity to the place of residence, and they should be acceptable to the users. Whenever possible, i t i s suggested that the services should be designed for use by the whole community, thereby enhancing the opportunity for the continued integra-tion of the e l d e r l y . As Lowy (1969) suggests: Continuity, comprehensiveness and co-ordination . . . are the c r i t e r i a i n the development and evaluation of a network of services answering to the needs of a "whole person" and through an h o l i s t i c approach w i l l counteract a p r e v a i l i n g practice of fragmentation and discontinuity. (Lowy, p. 29) In summary, i t may be suggested that the s u i t a b i l i t y of the r e s i d e n t i a l m i l i e u for the aged, outside of the residence, i s contingent upon the a v i l a b i l i t y and a c e s s i b i l i t y of l i f e - s u s t a i n i n g and l i f e - e n r i c h i n g s o c i a l services, designed to support the e l d e r l y i n comfort and dignity wherever they l i v e . As Brophy (1961) points out, the fears of loneliness and change which many older people face can be minimized. For instance, environments y i e l d i n g adequate transportation and a c c e s s i b i l i t y to shops, hospitals and c l i n i c s , to i n s t i -tutions such as churches, community centres, l e i s u r e centres and s i m i l a r supportive services, can compensate for the con-tr a c t i o n of the home range. 10 The Housing Needs of the E l d e r l y What does housing mean to the elderly? Aside from his spouse, housing i s probably the single most important element i n the l i f e of an older person. (Proceedings of the 1971 White House Conference on Aging, 1973) The issue of the housing needs of the e l d e r l y has received considerable attention within s o c i a l gerontology since the early 1960's, and to a lesser extent, more recently, i n socia geography. International meetings have brought together planners, researchers, architects and service providers, with the intent of working out solutions to the housing problems facing the elderly.(Byerts, 1973, 1974). Attention has however, been focused lar g e l y upon the independent, mobile e l d e r l y person, not recognising the p a r t i c u l a r s i t u a t i o n of the i n f i r m and i n s t i t u t i o n a l i z e d . The problem of i d e n t i f y i n g the housing needs i s com-plex. Golant (1976) recognizes seven categories of needs or problems: s p a t i a l a c c e s s i b i l i t y , a r c h i t e c t u r a l design and quality, the maintenance and cost of the residence, the a v a i l b i l i t y of f a c i l i t i e s and services (including s p e c i a l i z e d services), s o c i a l support and the general c h a r a c t e r i s t i c s of the neighbourhood setting. S i m i l a r l y , Carp's (1976) essay on the housing and l i v i n g environments of older people r e i n -forces the notion that the effects of housing upon the s o c i a l well-being of the e l d e r l y are i n e x t r i c a b l y linked to the other aspects of the r e s i d e n t i a l milieu. As Turano further observes: 11 . . . The location of a s i t e i s not the most important thing. As long as i t i s near public transportation, near younger r e s i d e n t i a l groups, and a l l the other necessary recreational, health and s o c i a l f a c i l i t i e s are conveniently near, the cost i s the main deciding factor. But, what you DO with the s i t e once you have it--how you develop i t , how you make i t into a L i v i n g Site--that i s the most important thing. He argues that although the issue of where to b u i l d i s fraught with a number of problems, such as zoning regulations, design standards and s o c i a l phenomena such as s t r a t i f i c a t i o n by age and economic status, s i t e s e l ection often ignores the types of future occupants, being determined rather by cost. This however, can have deleterious effects on the well-being of the aged i f they are placed i n settings which are incon-gruous with th e i r needs or resources. Nonetheless, despite the inte r e s t which has been shown on the topic of housing, r e l a t i v e l y l i t t l e i s known about the impact of the r e s i d e n t i a l m i l i e u upon the well-being of the majority of older people, although the home, being tangible evidence of a person's home range, can be instrumental i n achieving many of the mi l i e u requirements. Golant suggests that four of the more important requirements are (a) independence, (b) security, (c) environ-mental mastery, and (d) the maintenance of a p o s i t i v e s e l f -image (Golant, 1976). Housing i s an equally important element i n the formu-l a t i o n of s o c i a l p o l i c y , yet the objectives of such p o l i c i e s are very often no more than vague experessions of sentiment and hope. "Improving the quality of l i f e " and "providing stimulation, meaningful i n t e r a c t i o n and dignity" are limited 12 i n v a l u e as st a t e m e n t s o f i n t e n t w i t h o u t s p e c i f i c implementa-b l e g u i d e l i n e s . A l t h o u g h r e s i d e n t s o f i n s t i t u t i o n s f o r t h e e l d e r l y make up o n l y 7% o f Canada's e l d e r l y p o p u l a t i o n , they a r e a group w h i c h e x e m p l i f y t h e problems o f v u l n e r a b i l i t y f a c i n g many p e o p l e i n t h e i r l a t e r y e a r s . T r a d i t i o n a l l y , t h e i n s t i t u t i o n has been the f i n a l r e s i d e n c e f o r p e o p l e no l o n g e r a b l e to f u n c t i o n i n the community, because o f economic, s o c i a l , p h y s i c a l o r p s y c h o l o g i c a l i n f i r m i t i e s . However, r e s e a r c h f i n d i n g s on the e f f e c t s o f i n s t i t u t i o n a l i z a t i o n r e m a i n i n c o n c l u s i v e , d e s p i t e the f a c t t h a t m a tching i n d i v i d u a l c h a r a c t e r i s t i c s and e n v i r o n -m e n t a l s e t t i n g s i s e s p e c i a l l y a c u t e f o r t h e i n s t i t u t i o n a l i z e d e l d e r l y i n d i v i d u a l . As Kahana (1971) o b s e r v e s : The o p t i m a l type o f i n s t i t u t i o n a l c a r e may (then) be seen as t h a t r e s p o n d i n g t o t h e needs o f t h e a g i n g i n d i v -i d u a l . S i n c e the needs o f the i n d i v i d u a l may undergo many changes i n the c o u r s e o f i n s t i t u t i o n a l l i v i n g , such environments must be f l e x i b l e by d e f i n i t i o n . H ousing Needs i n ah I n s t i t u t i o n a l M i l i e u I n Canada, t h e b u i l d i n g o f s p e c i a l i z e d a ccomodation f o r s e n i o r s i s a r e l a t i v e l y r e c e n t phenomenon w h i c h has come about i n r e s p o n s e to cha n g i n g demographic p a t t e r n s , l i f e s t y l e s and s o c i a l l e g i s l a t i o n , and as a r e s u l t o f the g r e a t e r a c c e p t a n c e o f community r e s p o n s i b i l i t y f o r the w e l f a r e on t h e aged. A t t e m p t s a r e b e i n g made to move away from t h e t r a d i t i o n a l l y c u s t o d i a l o r i e n t a t i o n o f the i n s t i t u t i o n s towards a more r e h a b i l i t a t i v e r e s i d e n t i a l emphasis. U n t i l now, however, t h e s e e f f o r t s have been confounded by i n s t i t u t i o n a l c o n s t r a i n t s . 13 Aulinger (1979) considers that there are e s s e n t i a l l y three major problems with which residents have to contend. F i r s t l y , there i s an abrupt change i n routine as the sty l e of l i v i n g i s r a d i c a l l y d i f f e r e n t from that to which the i n d i v i d u a l was previously accustomed. Secondly, residents must cope with the fact that t h e i r active role i n society has greatly decreased, often with an accompanying loss of s o c i a l i n t e r -action. The t h i r d problem, which i s perhaps the most d i f f i c u l t to resolve, i s that the resident must cope with the i n d i v i d u a l and/or c u l t u r a l stigma attached to i n s t i t u t i o n a l l i v i n g - - a stigma that to many connotes defeat i n the struggle to main-tai n an independent residence, lack of f i n a n c i a l independence, and/or, r e j e c t i o n by family and friends. To many the word " i n s t i t u t i o n " carries negative overtones, p a r t i c u l a r l y i n a society which promotes i n d i v i d u a l i t y . The need to turn to others for care and to surrender the d i r e c t i o n of one's per-sonal l i f e are, according to Marcovitz (1969), the most pro-found negative effects of i n s t i t u t i o n a l i z a t i o n . As Brody (1969) points out, other detrimental factors are depersonali-zation, the intermixing of the mentally impaired with the mentally sound, and geographical and s o c i a l distancing from s i g n i f i c a n t others. I f the i n s t i t u t i o n s are not to end up as mere dumping grounds, the importance of planning appro-priate milieux must be recognized. The implications of pro-viding "the right services to the right person at the ri g h t time" implies the development of a range of opportunities and a knowledge of the needs and p a r t i c u l a r s of the population being served. 14 In planning environments for the eld e r l y , i t makes no sense to dichotomize between the r e s i d e n t i a l and community settings. In comparison to any other s o c i a l group, the el d e r l y are as sensitive, i f not more so, to th e i r s o c i a l environment. They can be victimized by uncongenial environ-ments when they are rendered vulnerable by poor physical con-d i t i o n , prejudice or s i t u a t i o n a l i s o l a t i o n . Recent research e f f o r t s have attempted to measure the s u i t a b i l i t y of environmental settings by determining the extent to which they obviate or minimize the need for services a n d . f a c i l i t a t e the development, maintenance and delivery of those that are required. The needs however, re-main i l l - d e f i n e d , as do the guidelines for the e f f e c t i v e provision and use of services. Furthermore, research and dis-cussion has tended to centre on those a r c h i t e c t u r a l and design sp e c i f i c a t i o n s considered important i n the adjustment of r e s i -dents to th e i r i n f i r m i t i e s . I f the s i t e of an i n s t i t u t i o n i s chosen c a r e f u l l y , independence may well be increased (Gutman, 1975b). However, few guidelines exist i n B r i t i s h Columbia for determining what constitutes a suitable i n s t i t u t i o n a l setting for e l d e r l y people. For example, i t i s assumed that an appro-priate s i t e w i l l have access to shops, parks, senior centres, public t r a n s i t routes and s o c i a l contacts. The services should also be within close proximity to the i n s t i t u t i o n to accomo-date the infirm. Niebanck (1965) has argued that the housing unit should not be discussed i n isolation,.but should be related to i t s s i t u a t i o n within the neighbourhood. In the analysis of location as a determinant of the qua l i t y of l i f e 15 of the e l d e r l y , he proposed a series of " c r i t i c a l distance" measures (Figure 1) for selected services considered to be important to the e l d e r l y . Although this approach represents what l i t t l e research there i s on the topic, i t s u t i l i t y i s li m i t e d i f distance or location i s studied i n i s o l a t i o n from the other s o c i a l , p o l i t i c a l and economic conditions which exi s t . In short, a number of defic i e n c i e s characterize the l i t e r a t u r e which deals with the s u i t a b i l i t y of r e s i d e n t i a l milieux for the aged. L i t t l e emphasis has been placed on the importance of s p a t i a l and s o c i a l factors involved i n the s i t e s e l e c t i o n process. Design considerations have preoccupied much of the research which i n turn i s heavily biased toward consideration of the independent, n o n - i n s t i t u t i o n a l i z e d . There i s a tendency for researchers and p r a c t i t i o n e r s to overlook the valuable insights which residents can provide. The r e s u l t i s that analyses tend to be limited and often do not r e f l e c t the complex needs and preferences of this hetero-geneous group. Consequently, the government agencies have few guidelines upon which to base t h e i r decisions. Yet, environmental aspects do not appear to be given a high p r i o r i t y , and as was stated by an administrator of the Long Term Care Program: Our major p r i o r i t y i s providing care and then we worry about appropriate placement. (Sorochan, 1979) The lack of detailed knowledge about the most effec-t i v e ways of supporting residents of i n s t i t u t i o n s , and what should be done to make the f i n a l years as s a t i s f y i n g as FIGURE 1 CRITICAL DISTANCE MEASURES TO SELECTED FACILITIES Rank o f C r i t i c a l Recommended F a c i l i t y I m p o r t a n c e ^ D i s t a n c e ^ D i s t a n c e -G r o c e r y S t o r e 1 2T3 b l o c k s 1 b l o c k Bus s t o p House o f w o r s h i p 2 1-2 b l o c k s a d j a c e n t t o s i t e 3 1/4 - 1/2 m i l e 1/2 m i l e Drug s t o r e 4 3 b l o c k s 1 b l o c k C l i n i c o r h o s p i t a l 5 1/4 - 1 2 m i l e 1 m i l e Bank 6 1/4 m i l e 1/4 m i l e S o c i a l c e n t r e 7 i n d e t e r m i n a t e on s i t e i f f e a s i b l e L i b r a r y 8 1 m i l e 1/2 m i l e News-c i g a r - s t o r e 9 1/4 m i l e 1/4 m i l e R e s t a u r a n t 10 1/4 - 1/2 m i l e ho concensus Movie house 11 1 m i l e 1 m i l e Bar 12 i n d e t e r m i n a t e no i m p o r t a n c e Notes: 1. Based on the number o f time f a c i l i t y mentioned as " i m p o r t a n t " i n t h e l o c a t i o n o f a h o u s i n g development f o r t h e e l d e r l y . 2. Based on the a c t u a l d i s t a n c e from a g i v e n f a c i l i t y i n cases where d i s s a t i s f a c t i o n had been e x p r e s s e d by t h e r e s i d e n t s . 3! Based on t h e a p p a r e n t consensus o f the r e s p o n d e n t s as to the p r o p e r d i s t a n c e to each f a c i l i t y . Source: P a u l Niebanck and John B. Pope The E l d e r l y i n O l d e r Urban A r e a s ( P h i l a d e l p h i a : U n i v e r s i t y o f P e n n s y l v a n i a , I n s t i t u t e f o r E n v i r o n m e n t a l S t u d i e s , 1965) p. 64 16 17 p o s s i b l e i s - a sad commentary upon.contemporary s o c i e t y . Con-s i d e r i n g the c u r r e n t undervalued s t a t u s of the e l d e r l y , and the stigma at t a c h e d to growing o l d , i t i s hard to r e c o n c i l e the f a c t t h a t the m a j o r i t y of the people who took p a r t i n the study were the pioneers of t h i s n a t i o n . The i m p l i c i t v a l u e o r i e n t a t i o n adopted i n t h i s study, r e v o l v e s around the q u e s t i o n of whether we are f u l f i l l i n g our moral o b l i g a t i o n to support and m a i n t a i n a meaningful e x i s t e n c e f o r those e l d e r l y people i n the community who have to r e l y upon the s o c i a l s t r u c t u r e f o r t h e i r needs. O r g a n i z a t i o n of the T h e s i s In Chapter Two, the r e s e a r c h design employed i n the study w i l l be d i s c u s s e d . Some of the more s a l i e n t method-o l o g i c a l i s s u e s which have a r i s e n w i l l a l s o be addressed. The r e s u l t s of the i n t e r v i e w s w i t h the r e s i d e n t s from the f i f t e e n i n s t i t u t i o n s w i l l be p r e s e n t e d i n Chapter Three, and the c o n t e x t u a l data gathered from the f i e l d work w i l l be analyzed. An e v a l u a t i o n of the s u i t a b i l i t y of the v a r i o u s r e s i d e n t i a l m i l i e u x w i l l be undertaken i n Chapter Four, based on the r e s u l t s of the data a n a l y s e s . Where a p p l i c a b l e , the r e s u l t s of other r e s e a r c h i n s o c i a l gerontology and geography w i l l be i n c o r p o r a t e d . The f i n a l chapter w i l l d i s c u s s the c o n c l u s i o n s from the r e s e a r c h , and where p o s s i b l e , w i l l pro-pose m o d i f i c a t i o n s or changes to the e x i s t i n g s i t u a t i o n . CHAPTER TWO METHODOLOGY Des p i t e the f a c t t h a t there i s a growing awareness of the s p e c i a l needs of e l d e r l y people i n modern i n d u s t r i a l -i z e d s o c i e t i e s , r e s e a r c h e f f o r t s l a g behind p r a c t i c a l every-day attempts to improve the c u r r e n t s i t u a t i o n . In geography, there has yet to be developed t h e o r i e s and me t h o d o l o g i c a l g u i d e l i n e s which can be used to study the nature and e f f e c t s of the aging p r o c e s s . T h i s l a c k i s p a r t i c u l a r l y e v i d e n t i n r e s e a r c h p e r t a i n i n g to the r e s i d e n t i a l and s o c i a l needs and pre f e r e n c e s o f e l d e r l y r e s i d e n t s of care i n s t i t u t i o n s . Although questions have been r a i s e d i n the l i t e r a t u r e concerning the u t i l i t y o f i n v o l v i n g the r e s i d e n t s ' responses i n s o c i a l g e r o n t o l o g i c a l r e s e a r c h (Fowler, 1970), i t was decided f o r t h i s r e s e a r c h t h a t t h e i r o p i n i o n s should be a major p a r t of the e v a l u a t i v e p r o c e s s . A q u e s t i o n n a i r e f o r r e s i d e n t s was t h e r e f o r e designed and administered. In a d d i t i o n , data and o p i n i o n s were c o l l e c t e d from the a d m i n i s t r a t o r s o f the i n s t i t u t i o n s , a r e s p o n s i b l e o f f i c i a l o f each of the sponsor-i n g o r g a n i z a t i o n s , and the c o - o r d i n a t o r s o f the new Long Term Care Program i n Vancouver. 18 19 Selection of Care F a c i l i t i e s to be Studied From information supplied by the Community Care Fac-i l i t i e s Licensing Board, a master l i s t of a l l non-profit Personal and Intermediate Care F a c i l i t i e s i n the G.V.R.D. was created; for the location of these residences see Figure 2. Of the t o t a l number of f a c i l i t i e s (n = 27), seventeen were i n i t i a l l y i n v i t e d to pa r t i c i p a t e i n the study. These seven-teen were selected so as to r e f l e c t the s p a t i a l d i s t r i b u t i o n of non-profit i n s t i t u t i o n s throughout the G.V.R.D., and to r e f l e c t variations i n size and i n sponsorship a f f i l i a t i o n . It transpired that some of the o r i g i n a l information concern-ing the type and size of resident population was inaccurate, and thus, substitutions had to be made i n the o r i g i n a l sample. Also, two i n s t i t u t i o n s declined to p a r t i c i p a t e . Since they could not be replaced with i n s t i t u t i o n s of comparable loca-tion, size and sponsorship, the f i n a l sample consisted of f i f t e e n i n s t i t u t i o n s . Seven were a f f i l i a t e d with r e l i g i o u s groups (e.g., Catholic, Baptist and Salvation Army), four were sponsored by ethnic organizations (e.g., Chinese, Jewish, French Canadian and German Canadian), and the remaining four were linked to community so c i e t i e s (Action Line Housing Society, Kiwanis Senior C i t i z e n s ' Housing Society and the Dogwood Lodge Society (2)). The locations of the selected i n s t i t u t i o n s are shown i n Figure 2, and Table 1 l i s t s t h e i r names and sponsorship a f f i l i a t i o n s , together with an alpha-b e t i c a l i d e n t i f i e r . 19a FIGURE 2 Non-profit Personal and Intermediate care institutions in the Greater Vancouver Regional District. TABLE 1 I n s t i t u t i o n s under study by s p o n s o r s h i p t ype and m u n i c i p a l i t y (,a) R e l i g i o u s s p o n s o r s h i p , A l p h a b e t i c I d e n t i f i e r Y o u v i l l e R e s i d e n c e , Vancouver (R.C.) A Ev e r g r e e n B a p t i s t Home, White Rock ( B a p t ) ) B Grandview Towers, No. 2, Vancouver (Bapt.) G Ble n h e i m Lodge, Vancouver ( C h r i s t . B r e t h r e n ) H Duke R e s i d e n c e , Vancouver (R.C.) P Buchanan Memorial Sunset Lodge, New Westminster ( S a l . Arm.) R S a l v a t i o n Army Home f o r S e n i o r C i t i z e n s , Vancouver ( S a l . Arm.) J (b) E t h n i c s p o n s o r s h i p L o u i s B r i e r Home, Vancouver ( J e w i s h ) 1 3 N V i l l a Cathay, Vancouver ( C h i n e s e ) K German Canadian B e n e v o l e n t S o c i e t y , Vancouver (German) E Foyer M a i l l a r d , C o q u i t l a m (French-Cdn.) F (c) Independent s p o n s o r s h i p Dogwood Lodge, Vancouver C Dogwood Lodge, Burnaby D Seton V i l l a , Burnaby L K i w a n i s R e s i d e n c e , West Vancouver M Notes : a. The a l p h a b e t i c i d e n t i f i e r i s used throughout t h i s study when r e f e r r i n g t o a p a r t i c u l a r i n s t i t u t i o n . b. S t a t i s t i c s Canada uses J e w i s h t o denote b o t h a r e l i g i o u s d e n o m i n a t i o n and an e t h n i c group; f o r . t h i s s t u d y , i t i s a s s i g n e d the e t h n i c d e n o t a t i o n . 2 1 .22 Selection of Respondents In the i n i t i a l stages of the research design, i t was determined that upon receiving permission from the administra-tion to conduct the survey, a 25% random sample was to be drawn from each i n s t i t u t i o n . The mental and physical condi-tion of the individuals selected were then to be checked with the supervisory s t a f f using a s p e c i a l l y designed form (see Appendix 1) which contained some questions extracted from the Long Term Care Program assessment form. Anyone who was considered confused or whose knowledge and use of the surround-ing neighbourhood was impeded by t h e i r i n f i r m i t i e s was to be excluded from the sample. The next step of the respondent selection process c a l l e d for a l e t t e r of introduction (Appen-dix 2) to be mailed to s i x t y - percent." of the residents i n each institution's, sample. In the l e t t e r the purpose of the study and the content areas of the questionnaire were explained, and also, that i f the resident agreed to p a r t i c i p a t e , an interview was to be conducted shortly thereafter. I f the resident decided to decline, a substitute from the back-up 4.0% was to be contacted. This procedure quickly proved to be impractical as too much of the s t a f f ' s time was being taken up generating the samples, and also, because a s i g n i f i c a n t proportion of the residents seemed worried that t h e i r names were known to the researchers p r i o r to any personal contact. In order to overcome these d i f f i c u l t i e s the selection c r i t e r i a were modified and a new procedure adopted. A l i s t of those 23 residents who met the selection requirements was obtained from the administrator and the interviewers went to each of the rooms with a senior s t a f f member. The nature of the study was explained and the interviewer's credentials v e r i -f i e d . Thus, should the resident decline, they did not have to f e e l intimidated by the presence of an unknown person at their door. A considerable amount of time was saved using this procedure and the s t a f f were a l l extremely co-operative i n providing as varied a cross-section of respondents as they could, recognizing that they knew the residents' i d i o -syncracies more intimately and could divert the interviewers from any i n d i v i d u a l whom they thought might be perturbed by the i n t r u s i o n . I t i s f e l t that there was no undue bias i n the selection process and that every e f f o r t was made to supply the v a r i e t y of residents requested. This procedure yielded a respondent set of 238 persons. Administration of the Residents' Questionnaire The questionnaires were completed i n a private place of the resident's choice within the i n s t i t u t i o n , i n the presence of an interviewer and anyone else desired by the respondent. Seven interviewers p a r t i c i p a t e d i n the study a l l of whom underwent an i n i t i a l t r a i n i n g period to f a m i l i a r i z e them with the questionnaire content, and to est a b l i s h a stan-dardized interviewing technique. As p r i n c i p a l researcher, the author conducted interviews i n a l l of the i n s t i t u t i o n s . A research assistant was involved i n a t h i r d of the interviews 2 4 i n f i v e o f the i n s t i t u t i o n s , and f i v e women s t u d e n t s , whose ages ranged from twenty to ; f i " f t y , , i n t e r v i e w e d i n f o u r i n s t i -t u t i o n s . The i n t e r v i e w s were d e s i g n e d t o be a p p r o x i m a t e l y f o r t y minutes i n d u r a t i o n , and c o u l d be t e r m i n a t e d a t any time by the r e s p o n d e n t s , who were f r e e t o r e f u s e t o answer any o f the q u e s t i o n s they c o n s i d e r e d i n a p p r o p r i a t e . Content and S t r u c t u r e o f the  R e s i d e n t s ' Q u e s t i o n n a i r e ! I n a d d i t i o n t o s e c u r i n g s t a n d a r d demographic d e s c r i p -t i v e i n f o r m a t i o n on t h e r e s i d e n t s ' age, sex, e t h n i c i t y and m a r i t a l s t a t u s , the q u e s t i o n n a i r e was d e s i g n e d t o y i e l d d a t a on f o u r s u b s t a n t i v e t o p i c s . Two o f t h e s e r e l a t e d t o the p r i m a r i l y g e o g r a p h i c a l themes o f m o b i l i t y and e n v i r o n m e n t a l e v a l u a t i o n , w h i l e the o t h e r two d e a l t w i t h r e s i d e n t i a l and l i f e s a t i s f a c t i o n (Appendix 3 ) . Under the g e n e r a l theme o f r e s i d e n t i a l s a t i s f a c t i o n were q u e s t i o n s d e a l i n g w i t h the m o t i v a t i o n s and pathways i n t o the p a r t i c u l a r i n s t i t u t i o n s . R e s i d e n t s were asked to i n d i c a t e the p r i m a r y r e a s o n s f o r l e a v i n g t h e i r p r e v i o u s r e s i d e n c e , and why they chose the s p e c i f i c i n s t i t u t i o n . They were a l s o asked to i n d i c a t e t h e i r awareness o f the programmes and a c t i v i t i e s w h i c h were a v a i l -a b l e t o them w i t h i n the i n s t i t u t i o n . I n a d d i t i o n t o q u e s t i o n s r e l a t i n g t o v a r i o u s a s p e c t s o f l i f e s a t i s f a c t i o n , n i n e o f Resources employed i n the d e s i g n o f the q u e s t i o n -n a i r e i n c l u d e d the work of A u d a i n (1973}, Gutman (1975a) and C l e l a n d e t . a i . ( 1 9 7 7 ) . 2 5 the twelve items of wood et. al. rs (,1969')' index of l i f e s a t i s -f a c t i o n were used to derive a crude index which was more appropriate for residents i n i n s t i t u t i o n s (see Appendix 3 ) . The questions related to mobility were designed to determine both the incidence and types of a c t i v i t y carried on outside the building. These were interspersed with questions about the respondents' awareness of and s a t i s f a c t i o n with the neighbourhood immediately surrounding the building, thus per-mitting an environmental evaluation for each of the i n s t i t u t i o n s . Throughout the questionnaire there was a combination of open-ended and multiple-choice items, and the emphasis was on allowing the respondents as much opportunity as possible to express th e i r opinions. Other Sources of Data In an attempt to gain as detailed an insight into the lo c a t i o n a l s u i t a b i l i t y of the i n s t i t u t i o n s as possible, three additional sets of interviews were conducted. The adminis-trators, of a l l but four of the i n s t i t u t i o n s responded to a request to provide information about the d e s i r a b i l i t y of the s i t e s ; to v e r i f y that the residents' perceptions of the a v a i l a b i l i t y and proximity of the community services were i n fact accurate; and, to outline what some of the major admin-i s t r a t i v e problems were i n running a non-profit i n s t i t u t i o n . They were also questioned as to how important they f e l t the location of the residence was, and to determine what i n the i r judgement, was the approximate proportion of the residents 26 a c t u a l l y making use of the surrounding neighbourhood. Data were also obtained on the demographic c h a r a c t e r i s t i c s of the residents i n each i n s t i t u t i o n , and what preference, i f any, was given to p a r t i c u l a r types of el d e r l y people such as individuals who were i n some way s o c i a l l y a f f i l i a t e d with the sponsoring organization. The question of how to provide a home-like atmosphere rather than an i n s t i t u t i o n a l or hos p i t a l environment was also discussed. It was primarily through these r e l a t i v e l y lengthy discussions with the administrators and by subjective observations, that a " f e e l " for the i n s t i t u t i o n s was developed. Gaining an appreciation of the constraints under which the various places had to operate f a c i l i t a t e d a greater understanding of the question-naire responses. A b r i e f questionnaire was mailed to a member of the sponsoring organization who held a responsible p o s i t i o n at the time the i n i t i a l s i t e selection process was undertaken. One of the central questions asked the person to explain, as far as possible, the development process whereby the i n s t i -tution was established, the s i t e selected, and the s i g n i f i -cance of any other factors which had an influence upon the location of the i n s t i t u t i o n . As a corol l a r y , they were requested to explain what c r i t e r i a they thought should be employed were a new f a c i l i t y to be b u i l t by the i r organiza-tion. Attempts were also made to discover both from the spon-sors and the administrators what degree of l i a i s o n existed between the various non-profit organizations and what, i n 27 th e i r opinions, were the most prevalent problems confronting th e i r residents at the present time. Informal interviews were also conducted with o f f i c i a l s of the Central Mortgage and Housing Corporation and the Long Term Care Program to try to est a b l i s h what guide-lines were used to approve or rej e c t proposed s i t e s , and to determine the government's assessment of the ex i s t i n g r e s i -dences . The remaining data co l l e c t e d f or the evaluation i n -volved a geographical reconnaissance of the s i t u a t i o n of each of the i n s t i t u t i o n s . A considerable amount of time was spent walking around the neighbourhoods trying to determine i f there were s i g n i f i c a n t environmental b a r r i e r s which could impede the residents' mobility, and to ascertain from observation and by questioning shopkeepers and l o c a l employees, whether or not there was much contact between the residents and the l o c a l community. This information was augmented where pos-s i b l e by data from the l o c a l planning o f f i c e s . Methodological Issues As many of the problems a f f e c t i n g older people originate not only i n changes i n mental and physical capaci-t i e s , but also i n changes i n s o c i a l opportunity, both i n d i v i -dual and s o c i a l factors which a f f e c t t h e i r life-chances need to be i d e n t i f i e d . The most s i g n i f i c a n t implications for methodology i n this respect involve defining the issues under consideration and producing e f f e c t i v e and r e l i a b l e measurements. 28 Establishing a precise research design proved to be one of the most d i f f i c u l t aspects because of the lack of any detailed information on the nature of r e s i d e n t i a l care i n s t i t u t i o n s for the e l d e r l y . The pre-theoretical assumptions adopted at the outset of the study were by necessity loosely defined, and i n e f f e c t , one of the primary reasons for the work was to attempt to organize and interpret r e l a t i v e l y large amount of diffuse information concerning those who l i v e i n such i n s t i t u t i o n s . The r e l a t i v e advantages of having a sample. selected?, from a number of d i s t i n c t locations must be balanced against the lack of detailed information and description afforded an in-depth analysis i n one location. However, as the aim of the study was to undertake an evaluation of the s u i t a b i l i t y of the r e s i d e n t i a l milieux of groups of residents l i v i n g i n di f f e r e n t locations, i t was f e l t that the former approach would be more appropriate, despite i t s lim i t a t i o n s i n terms of a deep understanding of s p e c i f i c places and th e i r residents. An issue of methodological import which i s relevant to the current study i s the use of i n t e r d i s c i p l i n a r y approaches to the study of the aging process. At present, the f i e l d of s o c i a l gerontology i s t h e o r e t i c a l l y underdeveloped, and as Archae (1976) suggests, research i s generally characterized by: . . . a s i t u a t i o n where discrete packages of knowledge and d i s t i n c t rules for proper s c i e n t i f i c conduct have been inherited from such diverse parent d i s c i p l i n e s that no p o s i t i o n or family of positions on what to look for or how to look at i t can a t t r a c t enough advocates to enforce th e i r own standards for s c i e n t i f i c content or conduct. 29 He goes on to argue that there are fundamental d i f -ferences i n the ontological commitments of the various d i s c i -p l i n e s, and that these differences determine the appropriate models of knowledge and the methodological procedures employed in a given piece of research. Thus, there are important motivational differences which arise because the d i s c i p l i n e s have d i f f e r i n g views of the e l d e r l y , and consequently, d i f -f e r i n g methods for defining the problem areas, and the tools for t h e i r analysis (Baltes, 1977). The r e s u l t i s that much of the research i s m u l t i - d i s c i p l i n a r y and discrete, rather than being t r u l y i n t e r - d i s c i p l i n a r y . This problem i s p a r t i c u -l a r l y evident i n the current geographical analyses of the e l d e r l y . Although research into the s p a t i a l aspects of aging has been produced i n the l a s t f i v e years (e.g. Golant, 1976, 1977, 1979, Peet and Rowles, 1974, Rowles, 1978, Wiseman, 1979), i t has been characterized by a lack of conceptual c l a r i t y and i n t e r d i s c i p l i n a r y communication. As a r e s u l t , there appears to be l i t t l e complementarity or comparability among the studies, and as yet, no clear statements have been made delimiting the areas where geographers would be most appropriately q u a l i f i e d to conduct gerontological research. Although i t i s d i f f i c u l t to place the current study within s t r i c t d i s c i p l i n a r y parameters, i t i s argued that the evaluation i s concerned with s o c i a l -gerontological issues, the fieldwork was conducted using a geographical perspective, and has incorporated l i t e r a t u r e from both multi- and i n t e r - d i s c i p l i n a r y gerontological research. CHAPTER THREE ANALYSIS AND RESULTS The presentation of the results begins with a description of the sociodemographic c h a r a c t e r i s t i c s of the sample as a whole - t h e i r age, sex, marital status, number of l i v i n g children, l e v e l of care and place of b i r t h . This i s followed by a description of findings from each of the four substantive topic areas of the questionnaire -r e s i d e n t i a l s a t i s f a c t i o n , l i f e s a t i s f a c t i o n , mobility and environmental evaluation. The f i n a l portion of the chapter presents the results of s t a t i s t i c a l analyses performed on the data i n order to ascertain the relationships between the four topic areas, whether there were s i g n i f i c a n t differences between the responses of those i n Personal as compared to Intermediate care, or between the f i f t e e n different i n s t i t -utions included i n the study. Tables showing responses for each of the in d i v i d u a l i n s t i t u t i o n s are included i n Appendices 4 to 8 . 50 31 Sociodemographic Data T h i s s e c t i o n w i l l d e s c r i b e t h e s o c i o d e m o g r a p h i c c h a r a c t e r i s t i c s o f the sample as a whole t o c l e a r l y i d e n t i f y the n a t u r e o f t h i s p a r t i c u l a r i s t i c p o p u l a t i o n . Age A p p r o x i m a t e l y t h r e e q u a r t e r s o f t h e r e s i d e n t s sampled a r e 75 y e a r s o f age o r o l d e r ( T a b l e 2 ) , a l t h o u g h t h e r e i s c o n s i d e r a b l e v a r i a t i o n i n t h e age d i s t r i b u t i o n o f t h e sub-samples drawn from each o f t h e f i f t e e n i n s t i t u t i o n s (Appendix 4 ) . The s e l e c t i o n p r o c e d u r e s y i e l d e d a number o f r e s i d e n t s under 65 y e a r s o f age (5 per c e n t ) . Though a m i n o r i t y group as a r e s u l t o f l i v i n g i n homes w h i c h c a t e r p r i m a r i l y t o t h e needs o f the e l d e r l y (commonly d e f i n e d as aged 65 or o l d e r ) , t h e s e r e s p o n d e n t s were i n c l u d e d i n the subsequent a n a l y s e s . Sex The sex c o m p o s i t i o n o f t h e r e s p o n d e n t s r e v e a l s a male-female r a t i o o f about 1 t o 3 ( T a b l e 3) w h i c h i s t y p i c a l i n r e t i r e m e n t h o u s i n g (Gutman, 1975a); a g a i n t h e r e a r e n o t i c e -a b l e d i f f e r e n c e s i n t h e c o m p o s i t i o n o f t h e sub-samples drawn from t h e f i f t e e n i n s t i t u t i o n s (Appendix 5 ) . Two o f the i n s t i t u t i o n s a r e f o r women o n l y (P and R) and as i n d i c a t e d i n t h e appendix, i n two cases (B and N), the samples s e l e c t e d i n v o l v e d o n l y women. M a r i t a l S t a t u s As might be e x p e c t e d g i v e n t h e age d i s t r i b u t i o n and d i f f e r e n c e s i n male and female l i f e e x p e c t a n c y , a l a r g e p r o p o r t i o n 70% ..of the r e s i d e n t s a r e widowed ( T a b l e 4) o f the TABLE 2 Age c o m p o s i t i o n o f the sample 5-0-54 1.2% 55-59 0 .8 6 0 - 6 4 2 . 8 65-69 5 .0 70-74 1 0 . 6 75-79 1 4 . 3 8 0 - 8 4 2 6 . 5 85-89 2 2 . 7 90-94 1 0 . 9 95-99 1.2 100- 0 .4 • no answer 3 . 4 Age /"Range;. ;.5 0 - 1 0 0 l y r Mean Age 8 0 . 6 9 y r s s.d. 8'.:47 y r s TABLE 3 Sex c o m p o s i t i o n o f the sample Male 27.7% Female 7 2 . 3 TABLE 4 M a r i t a l s t a t u s M a r r i e d Widowed D i v o r c e d Never M a r r i e d 8.0% 7 1 . 0 1 1 . 8 9 . 2 TABLE 5 Number o f l i v i n g c h i l d r e n None 3 4 $ 1- 1 9 . 3 2 1 8 . 1 3 1 0 . 9 4 1 0 . 5 5 2 . 5 6 4 . 2 7 0 . 4 32 33 r e m a i n i n g 30 p e r c e n t , r o u g h l y a t h i r d a r e p r e s e n t l y m a r r i e d , a t h i r d have never been m a r r i e d and a t h i r d a r e d i v o r c e d . As w i t h the age and sex c o m p o s i t i o n , t h e r e i s some v a r i a t i o n between each o f t h e samples, but t h e o v e r a l l d a t a would seem to be c o n s i s t e n t w i t h o t h e r s t u d i e s o f t h e i n s t i t u t i o n a l i s e d e l d e r l y (Townsend 1962,Lieberman, 1969). Number o f L i v i n g C h i l d r e n A s i g n i f i c a n t p r o p o r t i o n o f t h e r e s p o n d e n t s , over one t h i r d , have no l i v i n g c h i l d r e n ( T a b l e 5 ) , and a p p r o x i m a t e l y 20 p e r c e n t have one c h i l d . The r e m a i n i n g 50 p e r c e n t have two o r more c h i l d r e n . I n 70 p e r c e n t o f t h e c a s e s , i n o t h e r words, t h e r e i s p o t e n t i a l f o r p a r e n t - c h i l d i n t e r a c t i o n , a l t h o u g h as w i l l be shown s u b s e q u e n t l y , t h i s p o t e n t i a l i s not always r e a l i s e d . L e v e l o f Care Of t h e f i f t e e n i n s t i t u t i o n s s u r v e y e d , seven p r o v i d e o n l y P e r s o n a l c a r e and two p r o v i d e only- I n t e r m e d i a t e care.''" The o t h e r s i x i n s t i t u t i o n s p r o v i d e b o t h l e v e l s o f c a r e . As i n d i c a t e d i n T a b l e 6, two t h i r d s o f t h e r e s p o n d e n t s r e c e i v e P e r s o n a l c a r e (n=157) and t h e remainder (n=81) I n t e r m e d i a t e c a r e . Note 1: T h i s i s a t t r i b u t a b l e t o t h e a d m i s s i o n s p o l i c y i n the i n s t i t u t i o n s . However, the t r e n d would seem t o be toward p r o v i d i n g b o t h l e v e l s o f c a r e i n the f u t u r e , as a r e s u l t o f the r e c o g n i t i o n t h a t i n d i v i d u a l s f l u c t u a t e between th e l e v e l s thus a v o i d i n g major r e l o c a t i o n . 34 P l a c e o f B i r t h and L o c a t i o n o f P r e v i o u s R e s i d e n c e The sample r e f l e c t s a wide range o f e t h n i c backgrounds, w h i c h i s c h a r a c t e r i s t i c o f t h e n a t i o n as a whole. However, as the d a t a on t h e l o c a t i o n o f t h e i r p r e v i o u s r e s i d e n c e show, most o f t h e r e s p o n d e n t s have been l i v i n g i n Canada f o r a c o n s i d e r a b l e number o f y e a r s . Only 40 p e r c e n t o f the r e s p o n d e n t s i n t h e o v e r a l l sample i n d i c a t e d t h a t they were born i n Canada ( T a b l e 7 ) , e i t h e r w i t h i n B r i t i s h Columbia (7.6 p e r c e n t ) o r i n the o t h e r p r o v i n c e s (32.8 p e r c e n t ) , whereas a p p r o x i m a t e l y one t h i r d were b o r n i n t h e U n i t e d Kingdom. Of t h e remainder, 15.5 p e r c e n t were European and 6.3 p e r c e n t were o f A s i a n o r i g i n . As shown i n T a b l e 8, when asked t o s t a t e where t h e y had l i v e d f o r the p a s t f i v e y e a r s , l e s s t h a n one per c e n t i n d i c a t e d t h a t they had l i v e d o u t s i d e o f Canada d u r i n g t h a t p e r i o d . L e s s t h a n 2 p e r c e n t o f t h e sample (1.2 p e r c e n t ) l i v e d o u t s i d e o f B r i t i s h Columbia over t h e f i v e y e a r s , and i t would appear t h a t the overwhelming m a j o r i t y (95 per c e n t ) had been l i v i n g w i t h i n t h e G r e a t e r Vancouver R e g i o n a l D i s t r i c t . Moreover, a l m o s t t h r e e q u a r t e r s o f t h e r e s p o n d e n t s a c t u a l l y l i v e d i n t h e same m u n i c i p a l i t y as t h e i n s t i t u t i o n i n which they a r e now l i v i n g . Thus, t h e r e s p o n d e n t s a r e c o n s i d e r a b l y more " l o c a l " t h a n t h e d a t a on n a t i v i t y would seem to suggest. I t i s w o r t h n o t i n g h e r e t h a t a p p r o x i m a t e l y one f i f t h o f the r e s p o n d e n t s had p r e v i o u s l y l i v e d i n a n o t h e r c a r e home b e f o r e e n t e r i n g t h e i r p r e s e n t r e s i d e n c e , s u g g e s t i n g t h a t t h e r e i s a c e r t a i n degree o f f l e x i b i l i t y w i t h i n t h e system t o a l l o w f o r c h anging p r e f e r e n c e s and r e l o c a t i o n i f d e s i r e d . TABLE 6 Care -type A b s o l u t e f r e q u e n c y P e r c e n t P e r s o n a l c a r e 157 6 6 . 0 I n t e r m e d i a t e c a r e 8 l 3 4 . 0 TABLE 7 P l a c e o f b i r t h B r i t i s h Columbia 7 .6% Elsewhere i n Canada 32 . 8 U n i t e d Kingdom 30 • 7 Western Europe 8 .4 E a s t e r n Europe 7 .1 A s i a 6 . 3 Other 6 .7 No answer 0 .4 TABLE 8 P r e v i o u s address Same p l a n n i n g a r e a 18.9% Same m u n i c i p a l i t y 5 3 . 4 Elsewhere w i t h i n GVRD 2 3 . 1 Elsewhere i n B.C. 1.7 Elsewhere i n Canada 0 . 8 U n i t e d Kingdom 0 .4 No- answer 1 . 7 35 56 F i n d i n g s R e l a t e d to t h e Four T o p i c Areas o f t h e Q u e s t i o n n a i r e I n an attempt t o a s c e r t a i n whether o r n o t t h e r e s p o n d e n t s i n t h e f i f t e e n i n s t i t u t i o n s were s a t i s f i e d w i t h t h e l o c a t i o n and s i t u a t i o n o f t h e i r r e s p e c t i v e homes, q u e s t i o n s r e l a t i n g t o l e v e l s o f r e s i d e n t i a l and l i f e s a t i s f a c t i o n w i t h i n t h e b u i l d i n g s were d e v i s e d . S i m i l a r l y , q u e s t i o n s r e l a t i n g t o t h e s u i t a b i l i t y o f t h e n eighborhoods s u r r o u n d i n g t h e i n s t i t u t i o n s were d e s i g n e d , and w i l l be subsumed under the g e n e r a l headings o f m o b i l i t y and e n v i r o n m e n t a l e v a l u a t i o n . Thus, thr o u g h o u t the q u e s t i o n n a i r e , the q u e s t i o n s r e l a t e t o t h e f o u r major themes, and a l t h o u g h t h e s e have been o r g a n i s e d on an i n t u i t i v e b a s i s , they a l l address t h e q u e s t i o n o f the s a t i s f a c t i o n w i t h , and s u i t a b i l i t y o f t h e r e s i d e n t i a l m i l i e u x . The q u e s t i o n s i n each o f the f o u r t h e m a t i c a r e a s and t h e d e s c r i p t i o n o f the r e s p o n s e s g i v e n t o them w i l l be a d d r e s s e d s y s t e m a t i c a l l y . R e s i d e n t i a l S a t i s f a c t i o n One o f the i n i t i a l q u e s t i o n s asked o f t h e r e s p o n d e n t s was how s a t i s f i e d t h e y were g e n e r a l l y w i t h l i v i n g i n t h e p a r t i c u l a r i n s t i t u t i o n (Appendix 3, Q . l l ) . Over t h r e e q u a r t e r s o f the sample i n d i c a t e d t h a t t h e y were v e r y s a t i s f i e d (79. 4 p e r c e n t ) under a f i f t h were m o d e r a t e l y s a t i s f i e d (17.6 p e r c e n t ) and o n l y a v e r y few were v e r y d i s s a t i s f i e d (1.3 p e r c e n t ) . When asked how w e l l t h e needs o f the e l d e r l y , p e o p l e were l o o k e d a f t e r i n t h e i n s t i t u t i o n (Q.52), 83.2 p e r c e n t r e p l i e d , " v e r y w e l l " and 16 p e r c e n t , " a d e q u a t e l y . " These d a t a a r e r e i n f o r c e d by the r e s p o n s e s t o a q u e s t i o n (Q.13) w h i c h asked t h e r e s p o n d e n t s t o i n d i c a t e whether they would choose to l i v e i n t h e i r p r e s e n t r e s i d e n c e o r move e l s e -where were they g i v e n the o p p o r t u n i t y . E i g h t y - t w o per c e n t i n d i c a t e d t h a t they would p r e f e r to r e m a i n where they were, and o n l y 16 per c e n t p r e f e r r e d to l i v e e l s e w h e r e , a l t h o u g h i t s h o u l d be n o t e d t h a t t h e q u e s t i o n i s s l i g h t l y ambiguous. I t does not appear c l e a r whether " e l s e w h e r e " r e f e r s to a n o t h e r i n s t i t u t i o n o r whether i t r e f e r s to a d i f f e r e n t type o f r e s i d e n t i a l s e t t i n g . W h i l e one s h o u l d be c a u t i o u s i n i n t e r p r e t i n g t h e s e d a t a t h e y suggest t h a t r e s i d e n t i a l s a t i s -f a c t i o n was r e l a t i v e l y h i g h a c r o s s t h e i n s t i t u t i o n s . The most f r e q u e n t l y r e p o r t e d r e a s o n s why t h e r e s p o n d e n t s were s a t i s f i e d w i t h t h e i r p r e s e n t r e s i d e n c e i l l u s t r a t e the o v e r a l l s a t i s f a c t i o n w i t h the p h y s i c a l p l a n t and w i t h the s t a f f and t h e a d m i n i s t r a t i o n ( T a b l e 9 ) . I n an open-ended q u e s t i o n (Q.12) i n w h i c h r e s p o n d e n t s were asked to say why they were s a t i s f i e d w i t h l i v i n g where they were, over h a l f alludedj.i.to the p l e a s a n t atmosphere i n t h e b u i l d i n g . The i m p o r t a n c e o f t h e atmosphere was a l s o r e p o r t e d i n the r e a s o n s why p e o p l e p r e f e r r e d t o l i v e i n t h e i r p r e s e n t r e s i d e n c e r a t h e r t h a n moving e l s e w h e r e ( T a b l e 10, Q.13). The d a t a would, seem to i n d i c a t e t h a t the r e s p o n d e n t s a r e most happy w i t h the h e a l t h - c a r e component o f the i n s t i t -u t i o n s . I n a s e r i e s o f open-ended questions(Q.44-46) the r e s p o n d e n t s were asked to s t a t e what they l i k e d most and l e a s t about the i n s t i t u t i o n and what they thought c o u l d be done to TABLE 9 Reasons for s a t i s f a c t i o n with residence Staff good 11% Everything provided 10 High quality of physical plant 10 Well run 10 Good atmosphere 9 Good location for seniors 7 Perfect for an i n s t i t u t i o n 5 It's home 5 Very clean 4 Religious place 3 Would prefer independence 3 Feel happy here 3 Organisation good 3 Note: A maximum of fi v e reasons were coded for each respondent. The percentages are number of times a reason was mentioned i n propor-t i o n to the t o t a l number of rea-sons given. Only reasons which represent 3 percent or more of the t o t a l responses given are tabled. In t h i s instance, these account for 80 percent of a l l responses. TABLE 10 Reasons for preferring to l i v e i n present residence or elsewhere Place has everything 21% Happy here 16 Staff good 13 People f r i e n d l y 11 Would prefer independence 6 Wish to be near family 4 Residence i s close to family 4 Good location for seniors 4 Want to be i n own home 4 Note: A maximum of three reasons were coded for each respondent. The procedure for calcu l a t i n g per-centages was similar to that noted .in Table 9. In thi s case, these responses account for 83 percent of a l l responses given. 38 Most f r e q u e n t l y TABLE 11 s t a t e d r e a s o n s f o r r e s i d e n t i a l s a t i s f a c t i o n S t a f f . 2 0 $ Atmosphere 15 E v e r y t h i n g , 14 L e v e l o f car e 11 R e l i g i o u s a s p e c t s 7 C l e a n l i n e s s 6 Q u a l i t y o f rooms 5 A c t i v i t i e s w i t h i n b u i l d i n g 5 Pood 4 L o c a t i o n 3 Freedom t o do what I want 3 Note: A maximum o f t h r e e r e a s o n s were coded f o r each r e s p o n d e n t . The proce d u r e f o r c a l c u l a t i n g p e r c e n t a g e s was s i m i l a r t o t h a t noted i n Ta b l e 9 . I n t h i s c a s e , t h e s e r e s p o n s e s account f o r 9 3 p e r c e n t o f a l l r e s p o n s e s g i v e n . TABLE 1 2 Most f r e q u e n t l y s t a t e d r e a s o n s f o r r e s i d e n t i a l d i s s a t i s f a c t i o n M i x i n g s e n i l e w i t h a l e r t 18% Having t o be l o o k e d a f t e r 1 6 N o t h i n g t o do 1 1 B e i n g i n an i n s t i t u t i o n 8 Too much o r g a n i s a t i o n 7 Food 6 Change p h y s i c a l l a y o u t o f b l d g . 5 Bad l o c a t i o n 3 Poor t r a n s p o r t a t i o n , i s o l a t i o n 3 No p r i v a c y 3 S h a r i n g a room 3 D i s s a t i s f i e d w i t h LTC Program 3 Problems w i t h s t a f f 3 I n s u f f i c i e n t i n t e r a c t i o n w i t h r e s i d e n t s 3 Note: A maximum o f t h r e e reasons were coded f o r each r e s p o n d e n t . The proce d u r e f o r c a l c u l a t i n g p e r c e n t a g e s was s i m i l a r t o t h a t n o t e d i n Ta b l e 9 . I n t h i s c a s e , t h e s e r e s p o n s e s account f o r 9 2 p e r c e n t of a l l r e a s o n s g i v e n . 39 4* make t h e p l a c e more s a t i s f y i n g t o l i v e i n . Of t h e re a s o n s g i v e n f o r s a t i s f a c t i o n , t h e s t a f f , t he o v e r a l l atmosphere and the l e v e l o f c a r e were most f r e q u e n t l y mentioned (Table 11) and o f t h e reaso n s g i v e n f o r b e i n g d i s s a t i s f i e d , t h e m i x i n g o f s e n i l e and a l e r t r e s i d e n t s , h a v i n g t o be l o o k e d a f t e r , h a v i n g n o t h i n g t o do and b e i n g i n an i n s t i t u t i o n were most f r e q u e n t l y mentioned (Table 12). When s u g g e s t i o n s were made c o n c e r n i n g improvements to t h e i n s t i t u t i o n a l m i l i e u x ( T a b l e 13) th e y were d i v i d e d between improvements i n t h e b u i l d i n g and t h e organ-i s a t i o n and improvements t o t h e l o c a l n e i g h b o r h o o d s . I t s h o u l d be n o t e d t h a t t h e r e were r e l a t i v e l y few re s p o n s e s t o t h i s q u e s t i o n ( o f a p o s s i b l e 714 r e s p o n s e s , o n l y 147 were a c t u a l l y r e c o r d e d ) . As mentioned, t h e h e a l t h - c a r e component was g i v e n as an i m p o r t a n t p o s i t i v e f a c t o r i n r e s i d e n t i a l s a t i s f a c t i o n and as can be seen i n T a b l e s 14 and 15, i t was h e a l t h - r e l a t e d problems and t h e a v a i l a b i l i t y o f n u r s i n g s u p e r v i s i o n w h i c h l e d a h i g h p r o p o r t i o n o f the re s p o n d e n t s t o l e a v e t h e i r p r e v i o u s r e s i d e n c e and t o choose the p a r t i c u l a r i n s t i t u t i o n s . The res p o n d e n t s were shown two s e t s o f statements (Q. 16 and 17) and were asked t o i n d i c a t e t h e t h r e e most i m p o r t a n t r e a s o n s f o r l e a v i n g where they l i v e d b e f o r e and t h e t h r e e most i m p o r t a n t r e a s o n s f o r c h o o s i n g t h e i r p r e s e n t r e s i d e n c e . The d i f f i c u l t y o f l o o k i n g a f t e r t h e i r p r e v i o u s r e s i d e n c e , a change i n t h e i r h e a l t h o r p h y s i c a l s t a t u s and as a r e s u l t o f m e d i c a l a d v i c e were the most f r e q u e n t r e s p o n s e s t o Q u e s t i o n 16 ( T a b l e 14). The q u a l i t y o f TABLE 13 Suggested Improvements to i n s t i t u t i o n a l milieu More l o c a l services 17 .1% Separate senile and al e r t 16 .3 Changes i n physical plant 13 .6 More inside a c t i v i t i e s 10 .2 Better public transportation 9 .5 More outside a c t i v i t i e s 6 .8 More s t a f f 6 .1 More personal freedom i n bldg. 5 .4 More friends 5 .4 More privacy 4 .8 Change structure of s t a f f 4 .1 Note: A maximum of three reasons were coded for each respondent. The procedure for cal c u l a t i n g per-centages was similar to that noted i n Table 9- In thi s instance these responses account for a l l the responses given. TABLE 14 Reasons for leaving previous residence D i f f i c u l t y : in:" looking \after'°previous residence 26 .1$ Change i n health of physical status 24 .8 Medical advice 1 9 . 1 Possible future need for medical help 7 .0 Loneliness 6 .0 D i s s a t i s f a c t i o n with previous residence 3 .3 Note: A maximum of three reasons were coded for each respondent. The procedure for calcula t i n g per-centages was similar to that noted i n Table 9-In t h i s case, these responses account for 8 6 . 3 percent of a l l the responses given. 41 42 the dwelling unit, the fact that they were recommended to go to the i n s t i t u t i o n and the a v a i l a b i l i t y of medical services and meals on the premises were the reasons given for choosing the p a r t i c u l a r place (Table 15). Examination of the data r e l a t i n g to r e s i d e n t i a l s a t i s -f a c t i o n would seem to suggest that the necessity of being i n an i n s t i t u t i o n because of either physical or psycho-social problems i s more prevalent than the desire to choose the i n s t i t u t i o n as a retirement setting. As a r e s u l t , s a t i s f a c t i o n seems to be measured i n terms of the supervision and care provided. This assumption i s backed up by the results to Question 48, i n which the respondents were asked to state how many hours they spent i n t h e i r own room i n an average day (Table 16) and what they did there; the time spent i n the room was based on a 12 hour period which did not include meals or sleeping time. Almost two thirds of the respondents spent between six and twelve hours i n t h e i r room i n an average day, and i n fact, less than one f i f t h spent more than three hours outside t h e i r door. Resting, reading, watching t e l e v i s i o n and l i s t e n i n g to the radio were the most frequently stated a c t i v i t i e s c a r r i e d on i n the rooms and as w i l l be discussed subsequently, having nothing to do was a common complaint among many. Thus, i t i s not absolutely clear how to interpret the r e l a t i v e l y high levels of r e s i d e n t i a l s a t i s f a c t i o n based on the responses to a number of questions ostensibly r e l a t i n g to the same theme. The question of how much the quality of l i f e TABLE 1 5 Reasons f o r c h o o s i n g p r e s e n t r e s i d e n c e Q u a l i t y of d w e l l i n g u n i t 1 8 , .3% Recommended 1 1 . . 8 M e d i c a l f a c i l i t i e s t h e r e 1 0 . . 6 A v a i l a b i l i t y o f meals 1 0 . . 5 R e l i g i o u s r e a s o n s 6 . . 5 F a m i l i a r neighbourhood 6 . . 3 C h i l d r e n t h e r e 5 . . 6 Cost 5 . , 0 Housekeeping f a c i l i t i e s t h e r e 5 , . 0 F r i e n d s or r e l a t i v e s t h e r e 4 , . 8 F a m i l y made c h o i c e 4 . • 3 E t h n i c r e a s o n s 3 . . 2 Note: A maximum o f t h r e e r e a s o n s were coded f o r each r e s p o n d e n t . The pr o c e d u r e f o r c a l c u l a t i n g p e r c e n t a g e s was s i m i l a r t o t h a t n o t e d i n T a b l e 9 . I n t h i s c a s e , t h e i r r e s p o n s e s account f o r 9 1 . 9 p e r c e n t o f a l l r e s p o n s e s g i v e n . TABLE 1 6 Number o f hours per day spent i n own room Hours P r o p o r t i o n Hours P r o p o r t i o n 1 2.9% 7 7 - 6 $ 2 6 . 7 8 1 1 . 3 3 2 . 9 9 3 . 8 4 1 3 - 9 1 0 1 1 . 8 5 9 . 2 1 1 2 . 1 6 2 2 . 3 1 2 1 . 7 no answer 3 • 8 Note: Number o f hours were based on a 1 2 hour p e r i o d w hich d i d not i n c l u d e meals or s l e e p i n g t i m e . TABLE 1 7 Problems f a c e d i n d a i l y l i v i n g M e d i c a l 5 0 . 1 $ L o n e l i n e s s 1 0 . 4 I m m o b i l i t y 8 . 1 No p l a c e t o go 7 - 8 N o t h i n g t o do 7 - 5 Note: A maximum of t h r e e problems were coded f o r each r e s p o n d e n t . The pr o c e d u r e f o r c a l c u l a t i n g p e r c e n t a g e s was s i m i l a r t o t h a t n o t e d i n T a b l e 9 . I n t h i s c a s e , t h e s e r e s p o n s e s account f o r 8 3 . 9 p e r c e n t mentioned. ,43 44 i s determined by the quality of care provided i s open to debate and w i l l be addressed i n the discussion. L i f e S a t i s f a c t i o n The s u i t a b i l i t y of the r e s i d e n t i a l m i l i e u i s governed not only by the residents' s a t i s f a c t i o n with the i n s t i t u t i o n , the quality of the physical plant and the f a c i l i t i e s on hand, but also by the s a t i s f a c t i o n within the building. In thi s context, an attempt was made to ascertain the general quality of l i f e of the respondents by asking a series of questions about th e i r l i f e s a t i s f a c t i o n l e v e l s . The f i r s t of these (Q. 8) asked them to rate t h e i r r e l a t i o n s h i p with t h e i r family. 45.8 per cent indicated that the relat i o n s h i p was excellent, 28.6 per cent said i t was on the whole good, and 8.4 per cent admitted to either a f a i r (5.9 per cent) or a poor one (2.5 per cent) -a sizeable proportion (17.2 per cent) did not respond and r e f l e c t s the fact that some respondents now have no family. When asked how s a t i s f i e d they f e l t at the present time (Q. 42), over three quarters reported that they were very s a t i s f i e d (23.1 per cent) or s a t i s f i e d (54.6 per cent), and one f i f t h stated that they were d i s s a t i s f i e d . The remaining 2 per cent were very d i s s a t i s f i e d . The respondents were asked to evaluate t h e i r own health status at the present time (Q. 49) and i n an open-ended question (Q. 40), were asked to rel a t e what kinds of problems they faced i n th e i r d a i l y l i v e s . It was assumed that a general impression of l i f e s a t i s f a c t i o n could be ascertained from these data. Again almost two thirds of the o v e r a l l sample f e l t that t h e i r health status was excellent or good, 28.6 per cent 45 c o n s i d e r e d themselves t o be " f a i r , " and l e s s t h a n one t e n t h r e p o r t e d t h e i r h e a l t h was poor. I t s h o u l d however be borne i n mind t h a t a l l o f t h e r e s p o n d e n t s were i n need o f a t l e a s t some form o f m e d i c a l c a r e and s u p e r v i s i o n , and thus t h e i r r e s p o n s e s t o t h i s q u e s t i o n s h o u l d be i n t e r p r e t e d c o n t e x t u a l l y . The problems w h i c h the r e s p o n d e n t s i n d i c a t e d t h e y f a c e d i n t h e i r d a i l y l i v e s a r e r e p o r t e d i n T a b l e 17. M e d i c a l l y r e l a t e d problems and l o n e l i n e s s were th e two most f r e q u e n t l y s t a t e d problems (59.1 per c e n t and 10.4 p e r c e n t r e s p e c t i v e l y ) but i m m o b i l i t y and h a v i n g e i t h e r no p l a c e t o go, o r n o t h i n g to do, f i g u r e d p r o m i n e n t l y (18.9 per c e n t ) . The r e s p o n s e s t o Q u e s t i o n 39, w h i c h asked, " I n g e n e r a l , would you say t h a t most days you have p l e n t y t o do " was answered n e g a t i v e l y by about a f i f t h o f the r e s p o n d e n t s . The main c o m p l a i n t s were t h a t t h e r e was no p l a c e f o r them t o go, o r e l s e t h e y f e l t t h a t t h e r e was n o t h i n g t o do, and so t h e y s i m p l y d i d n o t go o u t . A s e r i e s o f s t a t e m e n t s drawn from t h e L i f e S a t i s f a c t i o n Index (Wood et a l . , 1969) was shown t o the r e s p o n d e n t s (Q. 41) and t h e y were asked t o i n d i c a t e whether t h e y agreed o r d i s a g r e e d w i t h the i t e m s . The i n t e r v i e w e r r e a d each o f t h e statements and r e c o r d e d t h e p r e f e r e n c e g i v e n . Responses i n d i c a t i v e o f s a t i s -f a c t i o n were s c o r e d 1 (items 1, 2, 3, 5 and 6 ) , and t h o s e i n d i c a t i n g d i s s a t i s f a c t i o n were s c o r e d 2. Thus, t h e c u m u l a t i v e s c o r e s ranged from 9 ( i n d i c a t i v e o f a h i g h l e v e l o f l i f e s a t i s f a c t i o n ) t o 18. As r e p o r t e d i n T a b l e 18, 71 p e r cent o f the r e s p o n d e n t s had s c o r e s i n t h e 9 t o 13 range, s u g g e s t i n g t h a t TABLE 1 8 L i f e s a t i s f a c t i o n s c o r e s 9 High s a t i s f a c t i o n 1 2 . 6 ; 1 0 2 0 . 6 1 1 ' 1 5 . 5 1 2 1 2 . 2 1 3 ' 1 0 . 1 14 1 2 . 2 1 5 1 1 . 3 1 6 0 . 8 1 7 0 . 8 1 8 Low s a t i s f a c t i o n 0 . 0 no answer 3 . 8 TABLE 1 9 P e r c e i v e d changes s i n c e moving i n t o r e s i d e n c e More Same Less No answer P e e l s a f e 6 6 . 8 2 9 . 4 2 . 9 0 . 8 • Worry 3 9 . 1 3 9 . 5 1 9 . 3 2 . 1 Energy 1 8 . 5 2 6 . 5 54 . 6 0 . 4 H e a l t h 2 8 . 6 42 . 9 2 7 . 7 0 . 8 A c t i v e 14 • 7 2 2 • 3 6 1 . 8 1 . 3 F r i e n d s 2 9 . 4 2 9 . 8 3 7 . 0 3 ..8 Eat See c h i l d r e n 48 . 7 3 1 . 9 1 7 . 6 1 • 7 2 1 . 0 5 4 . 8 24 . 2 0 . 0 See r e l a t i v e s 14 . 3 64 . 1 2 1 . 4 0 . 0 S l e e p 3 0 . 3 5 0 . 8 1 6 . 4 2 . 5 Go o u t s i d e 14 . 7 3 0 . 7 5 3 . 4 1 . 3 Happiness 3 7 . 8 4 7 . 1 1 3 . 0 2 . 1 Dress up 1 8 . 9 6 9 . 7 8 . 4 2 . 9 Notes: a. • T h e s e . p r o p o r t i o n s are based on n = 1 5 7 ; t h a t i s the number o f r e s p o n d e n t s w i t h l i v i n g c h i l d r e n . 46 47 l i f e s a t i s f a c t i o n levels were r e l a t i v e l y high i n the i n s t i t u t i o n s . Also included i n the theme of l i f e s a t i s f a c t i o n was a question designed to f i n d out whether the respondents f e l t that they had changed i n s i g n i f i c a n t ways since moving into the i n s t i t u t i o n (Q. 43). The respondents were asked to indicate whether they f e l t more safe, less safe or the same since moving into the i n s t i t u t i o n . 66.8 per cent reported that they f e l t more safe (Table 19); 48.7 f e l t that they ate better; 37.8 per cent were more happy and 30.3 per cent slept better. On the other hand, 54.6 per cent f e l t that they had less energy; 61.8 per cent were less active; 37.per cent had less friends and 53.4 per cent went out le s s . Over h a l f of the respondents saw t h e i r children and t h e i r r e l a t i v e s the same amout of time they did p r i o r to moving i n , and 42.9 per cent stated that th e i r health had remained about the same. It i s somewhat d i f f i c u l t to draw conclusions from the data except to point out that overall, health-related items show up less favourably as exemplified i n the fact that 61.8 per cent of the respondents f e l t less active. As mentioned i n Table 19, over h a l f of the respondents f e l t that they had the same amount of contact with t h e i r r e l a t i v e s and children as they had p r i o r to moving into the i n s t i t u t i o n . It i s assumed for the purposes of argument here, that contact with r e l a t i v e s , family and friends has a po s i t i v e effect upon l i f e s a t i s f a c t i o n , and as a r e s u l t , analysis of Table 20 indicates that there i s s i g n i f i c a n t v a r i a t i o n i n the amount of 48 contact among the f i f t e e n sub-samples. The respondents were i n i t i a l l y asked i f they had any l i v i n g c h i l d r e n , and i f so, the amount of contact they had per month w i t h them. They were als o asked to i n d i c a t e where t h e i r c h i l d r e n l i v e d , to a s c e r t a i n the p r o p o r t i o n of c h i l d r e n l i v i n g w i t h i n the Greater Vancouver Regional D i s t r i c t (Q. 4 and 5). The respondents were a l s o asked to i n d i c a t e which of t h e i r r e l a t i v e s or f r i e n d s they were i n contact w i t h once per month or more o f t e n , and of them, how many r e s i d e d w i t h i n the G.V.R.D. (0. 6 and 7). As i n d i c a t e d i n the s e c t i o n d e s c r i b i n g sociodemographic c h a r a c t e r i s t i c s of respondents, 66 per cent had one or more l i v i n g c h i l d r e n . Of those w i t h c h i l d r e n , almost a l l (98 per cent) reported that they were i n contact w i t h one or more of them once a month or more f r e q u e n t l y . There was a l s o evidence of a considerable degree of contact w i t h other r e l a t i v e s and f r i e n d s . As shown i n Table 20, approximately two t h i r d s of the respondents were i n contact w i t h one or more of t h e i r r e l a t i v e s and two'thirds w i t h one or more of t h e i r f r i e n d s once a month or more f r e q u e n t l y . I t seems, i n other words, that contrary to popular b e l i e f , f o r the m a j o r i t y of respond-ents, movement i n t o an i n s t i t u t i o n d i d not represent divorce from f a m i l y and f r i e n d s . So f a r i n the data, the concern has been to d i s c e r n the appropriateness of the r e s i d e n t i a l m i l i e u x by c o n s i d e r i n g the l e v e l s of s a t i s f a c t i o n w i t h and w i t h i n the i n s t i t u t i o n s . A t t e n t i o n w i l l now be d i r e c t e d towards the respondents' a b i l i t y TABLE 20 Percentage of respondents in contact once a month or more frequently with 0-9 of their offspring, other relatives and friends. Number in contact with Offspring Other Relatives Friends 0 1.9% 37.8% 39.9% 1 32.4 23.1 11.3 2 33.1 16.0 16.8 3 15.3. 6.7 4.6 4 13.4 5.5 2.9 5 1.9 2.9 2.9 6 1.9 3.4 2.5 7 0 0 0.4 8 0 2.1 2.9 9 0 2.5 15.5 Note: 1. Percentages in Column 2 are based on an N of 157, the number of respondents having one or more living children. 49 50 to make use of the surrounding neighborhood, and t h e i r evaluation of the l o c a l environments. Mobil i t y In each of the f i f t e e n i n s t i t u t i o n s involved i n the study, the administration a c t i v e l y encouraged the residents, where possible, to go outside of the buildings from time to time, and to make use of the surrounding neighborhood f a c i l i t i e s . However, as the data to be presented w i l l show patterns of mobility varied considerably throughout the sample, due to age-related and health-related problems, and also i n part, due to the fact that as a number of the respondents mentioned, there was either nothing very much to do or no place f o r them to go to. Each of the respondents was asked whether they could go out into the street by themselves (Q. 23), and whether i n fact they did go out (Q. 24). Over three quarters of the respondents said they were able to go into the street alone (76.1 per cent) but only 61.3 per cent do go out alone. Going some distance i s less easy, as just under h a l f (46.2 per cent) said they were able to go six blocks and back again by themselves for some reason or another (e.g. a purchase or a walk to the park). In response to the question "How many times i n a week do you go outside " (Q. 26), 42.9 per cent indicated that they went out at the most once per week, and only 16.8 per cent indicated that they went out, on average, at least once per day (Table 21). Walking within the grounds of the i n s t i t u t i o n was regarded as going outside i n the present context. Consequently, i n order to gain a more detailed insight into T A B L E 2 1 N u m b e r o f t r i p s o u t s i d e r e s i d e n c e p e r week 0 - 1 4 2 . 9 $ 2 - 3 2 1 . 0 4^5 1 0 . 9 6 - 7 8 . 0 +7 1 6 . 8 n o a n s w e r 0 . 4 T A B L E 2 2 F r e q u e n c y o f a c t i v i t i e s o u t s i d e ( A v e r a g e m o n t h ) N e v e r 1 2 3 4 5 6 7 8 9 D r i v e s w i t h f a m i l y 44 .1 ; 18 .9 1 1 . 8 8 . 0 1 2 . 6 2 . 5 1. 3 0 . 4 .0 0 . 4 Go w i n d o w s h o p p i n g 57 . 6 11 . 8 9 . 7 2 . 9 8 . .8 3 . 4 0 . 8 2 . 1 1 .7 1 . 3 O r g a n i s e d b u s d r i v e s 62 . 2 23 . 1 8 . 4 1. 3 3 . ,8 0 . 4 0 . 4 0 0 . 4 0 V i s i t " f r i e n d s 65 .1 6 .7 9 . 7 5 . 0 9 . 7 1. 3 0 . 4 0 .4 1 . 3 0 . 4 M e d i c a l t r i p s 66 . 8 23 . 1 5 . 5 2 . 1 2 . 1 0 0 0 0 0 .4 E a t o u t s i d e r e s i d e n c e 68 . 1 13 .4 8 . 0 2 . 9 5 . 9 1. 7 0 0 0 0 C l u b / m e e t i n g 77 • 7 5 . 0 6 . 3 1. 3 6 . 7 0 . 4 0 . 4 • o': 1 . 3 0 . 8 B i n g o 84 • 5 0 . 8 3 . 8 0 . 8 8 . 8 0 . 4 0 . 8 0 0 0 Do v o l u n t e e r w o r k 89 . 9 0 . 8 5 . 0 0 . 4 1 . 7 0 . 4 0 0 0 . 8 0 . 8 S p o r t s e v e n t 91 . 2 2 . 9 0 . 8 0 . 8 2 . 1 0 . 8 0 . 8 0 0 . 4 0 A c t i v e s p o r t 95 .4 1 .7 1 . 3 0 0 . 8 0 0 . 4 0 0 . 4 0 Go t o a b a r 95 . 8 0 2 . 1 0 0 . 8 0 0 . 4 0 0 .4 0 .4 T A B L E 2 3 F r e q u e n c y o f p u b l i c t r a n s i t t r i p s N e v e r 6l.3% -1-2 2 5 . 6 3 - 4 5 . 1 5-6 2 . 1 7+ 3 . 8 n o a n s w e r 2 . 1 51 52 t h e t y p e s o f a c t i v i t i e s c a r r i e d on o u t s i d e the i n s t i t u t i o n s , and t h e f r e q u e n c y o f v i s i t s t o l o c a l s e r v i c e s and f a c i l i t i e s , Q u e s t i o n s 37 and 38 were a d m i n i s t e r e d . The r e s p o n d e n t s were asked t o e x p l a i n what t h e y d i d o u t s i d e t h e b u i l d i n g , and t o i n d i c a t e a p p r o x i m a t e l y how many times i n a month they v i s i t e d s p e c i f i c community f a c i l i t i e s , as shown i n T a b l e 22. The d a t a show t h a t 44.1 p e r cen t n e v e r went out f o r a d r i v e w i t h t h e i r f a m i l y ; 57.6 p e r cen t n e v e r went shopping or window sho p p i n g ; 62.2 per c e n t n e v e r went on bus o u t i n g s o r g a n i s e d by the r e s i d e n c e ; 65.1 per c e n t n e v e r v i s i t e d f r i e n d s o u t s i d e ; 66.8 per cen t n e v e r went out on m e d i c a l l y r e l a t e d t r i p s and 68.1 per c e n t n e v e r a t e out a t a r e s t a u r a n t o r c a f e . W e l l over t h r e e q u a r t e r s o f a l l t h e r e s p o n d e n t s never a t t e n d e d c l u b s o r meetings (77.7 per c e n t ) ; p l a y e d b i n g o o u t s i d e (95.8 per c e n t ) o r were i n v o l v e d w i t h any s p o r t i n g a c t i v i t i e s . Thus, t h e o v e r a l l p i c t u r e w h i c h emerges i s t h a t a s i g n i f i c a n t l y h i g h p r o p o r t i o n o f the r e s p o n d e n t s remain w i t h i n t h e i n s t i t u t i o n s f o r the most p a r t (Appendix 1 1 ) . One c o n f u s i n g a s p e c t o f the d a t a i s t h a t 63.4 per c e n t o f t h e r e s p o n d e n t s r e p o r t e d t h a t t h e y f e l t t h a t t h e r e were enough t h i n g s f o r them t o occupy t h e i r day i n the a r e a i m m e d i a t e l y around the i n s t i t u t i o n s . I t i s suggested t h a t t h i s c o u l d be i n t e r p r e t e d t o mean t h a t they f e l t t h e r e was enough t o do i f th e y were a b l e o r w i l l i n g / t o go o u t s i d e . Data were c o l l e c t e d on t h e a v a i l a b i l i t y and use o f b o t h p u b l i c and p r i v a t e modes o f t r a n s p o r t a t i o n i n t h e attempt t o determine p a t t e r n s o f m o b i l i t y . The r e s p o n d e n t s were asked whether t h e y had r e g u l a r h e l p from a f r i e n d o r r e l a t i v e i n 53 g e t t i n g t o t h e p l a c e s t h e y most want t o go (Q. 2 9 ) . 65.1 p e r cent r e p o r t e d t h a t t h e y had h e l p i f t h e y needed i t . A l s o , a t h i r d o f the sample i n d i c a t e d t h a t t h e y had a v a i l a b l e and used a v o l u n t e e r o r p r o f e s s i o n a l l y s t a f f e d t r a n s p o r t a t i o n s e r v i c e a s s o c i a t e d w i t h the i n s t i t u t i o n . Use o f the p u b l i c t r a n s i t system v a r i e d from p l a c e t o p l a c e , but on average, s l i g h t l y o v e r one t h i r d o f the r e s p o n d e n t s used th e bus a t l e a s t once per week ( T a b l e 23), whereas 63.1 n ever used th e bus s e r v i c e d e s p i t e ease o f a c c e s s t o a bus r o u t e . 90 per c e n t i n d i c a t e d t h a t t h e r e was a bus s t o p w i t h i n two b l o c k s o f t h e i n s t i t u t i o n s . Over h a l f o f t h o s e i n t e r v i e w e d i n d i c a t e d t h a t t h e y e x p e r i e n c e d problems u s i n g the buses, e s p e c i a l l y g e t t i n g on and o f f , a l t h o u g h somewhat p a r a d o x i c a l l y i n r e s p o n d i n g t o a q u e s t i o n a s k i n g s p e c i f i c a l l y how good was t h e p u b l i c t r a n s i t i n t h e i r a r e a , 61 per cent v i e w e d the bus s e r v i c e as e x c e l l e n t , (Q.23.) . E n v i r o n m e n t a l E v a l u a t i o n The f i n a l t h e m a t i c s e c t i o n i n v o l v e s the r e s p o n d e n t s ' a t t i t u d e s toward t h e neighborhoods i n w h i c h they were l i v i n g . Q u e s t i o n s were d e s i g n e d t o e l i c i t i n f o r m a t i o n on t h e r e l a t i v e a c c e s s i b i l i t y o f s e l e c t e d community s e r v i c e s and f a c i l i t i e s , as p e r c e i v e d by the r e s p o n d e n t s . There were a l s o a s e r i e s o f q u e s t i o n s w h i c h i n v o l v e d t h e o v e r a l l l e v e l s o f s a t i s f a c t i o n w i t h t h e q u a l i t y o f t h e v a r i o u s n e i g h b o r h o o d s . The r e s p o n d e n t s were asked t o i n d i c a t e i f t hey were g e n e r a l l y s a t i s f i e d w i t h t h e l o c a t i o n o f the i n s t i t u t i o n i n q u e s t i o n . Over t h r e e q u a r t e r s r a t e d t h e a r e a around th e b u i l d i n g s v e r y h i g h l y (Q. 10 and Q.36) TABLE 2 4 S a t i s f a c t i o n with" l a n d s c a p e around b u i l d i n g Don't know S a t i s f i e d D i s s a t i s f i e d & no answer L a n d s c a p i n g 9 2 . 4 1 ' 2 . 5 $ 5 . 0 S i d e w a l k c o n d i t i o n 8 7 . 0 1 . 7 1 1 . 3 T r a f f i c n o i s e 8 0 . 7 1 5 - 5 3 . 8 T r a f f i c h a z a r d . 7 1 . 0 1 4 . 3 1 4 . 7 S a f e t y from crime 6 8 . 9 8 . 4 2 2 . 7 Shopping f a c i l i t i e s 4 6 . 6 2 1 . 0 3 2 . 4 E n t e r t a i n m e n t f a c i l . 3 6 . 5 1 6 . 4 4 7 - 9 Does neighbourhood c a t e r t o your needs? 4 2 . 9 1 2 . 6 4 4 . 6 TABLE 2 5 P e r c e i v e d a c c e s s i b i l i t y t o community f a c i l i t i e s Easy D i f f i c u l t Walk Bus Walk/Bus Not A v a i l Shopping places: 3 1 . 9 $ ' 4 3 . 7 $ 11". 8 $ 4 , . 2 $ V a r i e t y ' / Corner s t o r e 4 5 . 4 2 7 - 3 9 . 7 7 . . 6 M e d i c a l o f f i c e 2 7 . 3 3 0 . 7 1 6 . 4 4 . . 6 Church 3 7 . 0 2 5 . 6 9 . 1 3 . . 5 H o s p i t a l 2 5 . 6 3 0 . 7 1 6 . 8 9 . . 7 L i b r a r y 3 0 . 7 3 0 . 3 7 . 1 7 . . 1 Park 4 5 . 4 1 9 . 3 1 2 . 6 5 , . 5 S e n i o r Centre 1 2 . 2 3 8 . 2 1 2 . 2 4 . . 2 Community • Centre 1 5 . 1 3 6 . 6 1 0 . 1 4 . , 6 Don't know & no answer 8 . 4 $ 1 0 . 1 2 1 . 0 2 6 . 0 1 7 . 2 2 4 . 8 17 . 2 3 3 - 2 3 3 . 6 TABLE 2 6 C a n o n i c a l a n a l y s i s o f l i f e s a t i s f a c t i o n (Set 1 ) v e r s u s r e s i d e n t i a l s a t i s f a c t i o n (Set 2 )  C a n o n i c a l c o r r e l a t i o n 0 : 5,?.6 . • . S i g r i i f i c a n c e , 0 . 0 0 1 _ . C o e f f i c i e n t s f o r c a n o n i c a l v a r i a b l e s Set 1 LOT2D0 - 0 . 5 0 5 S A T 2 D A - 0 . 4 9 2 HEALST - 0 . 3 8 1 Set 2 ROOMHR -O . 7 1 8 PRESRES - 0 . 4 8 9 NEEDOK , - 0 . 3 8 7 Note: C a n o n i c a l c o e f f i c i e n t s a r e r e p o r t e d o n l y f o r those v a r i a b l e s w i t h c o e f f i c i e n t s o f + 0 . 3 i n Tab l e s 2 6 t o 3 3 . 54 55 i n d i c a t i n g , h i g h l e v e l s o f s a t i s f a c t i o n w i t h t h e l a n d s c a p i n g , paths and s e a t i n g a r e a s around the b u i l d i n g s , the s a f e t y from c r i m e and t r a f f i c and the l a c k o f t r a f f i c n o i s e ( T a b l e 24). 85.3 p e r c e n t i n d i c a t e d t h a t they were s a t i s f i e d w i t h t h e l o c a t i o n i n terms o f the a v a i l a b i l i t y o f s e r v i c e s and f a c i l i t i e s i n the l o c a l a r e a (Q.28) b u t as shown i n T a b l e 25 p e r c e i v e d a c c e s s i b i l i t y v a r i e d depending on the type o f f a c i l i t y and a l s o on t h e l o c a t i o n o f the i n s t i t u t i o n ' . <: > (Appendix 12) . The g e n e r a l i m p r e s s i o n o f the r e s p o n d e n t s ' e v a l u a t i o n o f t h e l o c a l environment i s t h a t a l t h o u g h they a r e r e l a t i v e l y f a m i l i a r and s a t i s f i e d w i t h the. l o c a t i o n o f t h e i n s t i t u t i o n s , t h e r e appears to be l i t t l e i n t e r a c t i o n w i t h t h e s u r r o u n d i n g n e i g h b o r h o o d f o r many. Because t h e p a t t e r n s o f m o b i l i t y r e f l e c t e d a tendency toward r e m a i n i n g w i t h i n t h e i n s t i t u t i o n , i t would appear t h a t t h e e n v i r o n m e n t a l components o f the r e s i d e n t i a l m i l i e u x a r e n o t b e i n g used to t h e i r c a p a c i t y . As w i l l be d i s c u s s e d , t h i s may have d e l e t e r i o u s e f f e c t s on the p s y c h o s o c i a l w e l l - b e i n g o f some o f t h e r e s p o n d e n t s . S t a t i s t i c a l A n a l y s e s The remainder o f the c h a p t e r d e s c r i b e s the s t a t i s t i c a l a n a l y s e s w h i c h were performed. These i n c l u d e d c a n o n i c a l c o r r e l a t i o n s , m u l t i p l e r e g r e s s i o n a n a l y s e s and P e a r s o n p r o d u c t moment c o r r e l a t i o n s . I n a d d i t i o n , d i s c r i m i n a n t a n a l y s e s were performed on the p r i n c i p a l themes to e s t a b l i s h i f t h e r e were s i g n i f i c a n t d i f f e r e n c e s i n t h e res p o n s e s o f i n d i v i d u a l s 56 receiving d i f f e r e n t types of care and i f there were s i g n i f i c a n t l y d i f f e r e n t responses to questions i n the various i n s t i t u t i o n s . Canonical Correlations^ A t o t a l of fourteen canonical correlations were performed using data from the four substantive themes, and also, using data on the presence of f a c i l i t i e s w i t h i n the building (Q. 47), the proximity to community services (Q. 15) and the amount of contact per month with children, family and friends. (Qs. 5 - 7). Note 1: Canonical c o r r e l a t i o n analysis takes as i t s basic input two sets of variables which can be given theoretical meaning as sets, and derives a l i n e a r combination from each of the sets of variables i n such a way that the corre l a t i o n between the two l i n e a r combinations i s maximised (Nie et a l . , 1970). There are two d i f f e r i n g approaches i n the l i t e r a t u r e concerning the interpretation of the canonical variates. The interpretation of the weights associated with the variates i s c r i t i c a l f o r the selection of variables f o r the regression and corre l a t i o n analyses i n the present study, and although i t i s recognised that there i s one school of thought which cautions against interpreting d i r e c t l y the canonical weights (e.g. Levine, 1977 and Draper, 1966), i n the present context a p a r t i c u l a r strategy has been followed which i s recommended by ce r t a i n texts (e.g. Harris, 1975) and which has been used i n Geography (e.g. Berry's work i n L.J. King, 1975). 57 Table 26 shows the r e s u l t s of the canonical c o r r e l a t i o n analysis of the respondents 1 s a t i s f a c t i o n with t h e i r residence and measures of l i f e s a t i s f a c t i o n . The variables i n the r e s i d e n t i a l s a t i s f a c t i o n set included questions on the respondents' perceived s a t i s f a c t i o n with t h e i r residence, t h e i r preference for l i v i n g where they were or elsewhere, how w e l l they f e l t the needs of older people were being looked a f t e r and the amount of time they spent i n t h e i r room (Qs. 11, 13, 48 and 52; see also Appendix 13) . The l i f e s a t i s f a c t i o n measures included questions on the respondents' relationship with t h e i r family, the score on the l i f e s a t i s f a c t i o n index, the perceived health status and s a t i s f a c t i o n at the time of the interview, and f i n a l l y , whether they f e l t they had plenty to do most days (Qs. 8, 42, 49 and 39). The n u l l hypothesis stated that there would be no s i g n i f i c a n t r e l a t i o n s M p between r e s i d e n t i a l and l i f e -s a t i s f a c t i o n , and t h i s was rejected at the 0.001 l e v e l of significance. The canonical variates would seem to be i d e n t i f y i n g a tendency for those residents who stated that they had plenty to do most days, were s a t i s f i e d with t h e i r l i f e a t the present time and who perceived t h e i r health status to be good, to spend less hours i n t h e i r rooms, to prefer to remain i n t h e i r present residence and to f e e l that the needs of e l d e r l y residents i n the i n s t i t u t i o n s were being looked a f t e r . In the relationship between r e s i d e n t i a l s a t i s f a c t i o n and mobility (Table 27), there would appear to be a s i g n i f i c a n t c o r r e l a t i o n between the amount of time spent outside, the a b i l i t y to go outside and the number of sports events attended and the hours respondents spent i n t h e i r rooms, as w e l l as the degree of r e s i d e n t i a l s a t i s f a c t i o n . There are also a series of correlations i n the Table which make no sense to the researcher, but i t should be noted that the function of the canonical TABLE 2 7 C a n o n i c a l a n a l y s i s o f r e s i d e n t i a l s a t i s f a c t i o n ( s e t 1 ) v e r s u s m o b i l i t y ( s e t 2 ) C a n o n i c a l c o r r e l a t i o n s F i r s t 0 . 4 9 8 Second 0 . 4 1 6 C o e f f i c i e n t s f o r c a n o n i c a l v a r i a b l e s . Set 1 F i r s t c o r r e l a t i o n ROOMHR RESSAT • - 0 . 7 4 4 - 0 . 5 5 4 Set 2 F i r s t c o r r e l a t i o n TIMEOUT 0 . 6 3 4 ACTIVE - O . 5 4 9 DOOUT - 0 . 5 3 7 CANOUT - 0 . 4 1 9 SPORT 0 . 3 9 4 -S i g n i f i c a n c e 0 . 0 0 1 0 . 0 2 9 Second c o r r e l a t i o n RESSAT ROOMHR 0 . 9 0 8 0 . 7 3 7 Second c o r r e l a t i o n DO OUT-CLUB' •' -0.644 -O . 5 6 3 Note: S i n c e t h e r e a r e two s i g n i f i c a n t c a n o n i c a l c o r r e l a t i o n s r e p o r t e d , t h e r e a r e two groups o f c o e f f i c i e n t s , one f o r each a n a l y s i s . TABLE 2 8 C a n o n i c a l a n a l y s i s o f r e s i d e n t i a l s a t i s f a c t i o n ( s e t 1 ) v e r s u s e n v i r o n m e n t a l e v a l u a t i o n ( s e t 2 )  C a n o n i c a l c o r r e l a t i o n O . 6 5 6 S i g n i f i c a n c e 0 . 0 0 3 C o e f f i c i e n t s f o r c a n o n i c a l v a r i a b l e s Set 1 Set 2 \ RESSAT -0.658 •ROOMHR -C.593 SIDWAL . - 0 . 4 1 0 CRIME : > 0 . 3 2 1 LANSCA - . - 0 . 2 9 6 58 59 c o r r e l a t i o n analysis i s to manipulate inter/correlations among variables to see i f a p a r t i c u l a r type of patterning e x i s t s . These may not always lend themselves to meaningful interpretations. A s i g n i f i c a n t set of r e s u l t s were obtained i n the c o r r e l a t i o n analysis between r e s i d e n t i a l s a t i s f a c t i o n and environmental evaluation (p<0.05). There appears to be a c o r r e l a t i o n between the s a t i s f a c t i o n with the condition of the sidewalks around the building; the f e e l i n g that there was a problem with crime i n the area; and a general d i s s a t i s f a c t i o n with the landscaping, paths and seating i n the outdoor area and the respondents' d i s s a t i s f a c t i o n with the i n s t i t u t i o n and the greater number of hours spent i n t h e i r rooms (Table 28). The f i n a l canonical c o r r e l a t i o n which involved the variables i n the r e s i d e n t i a l s a t i s f a c t i o n theme was only s i g n i f i c a n t at the 0.07 l e v e l , but w i l l be described since i t suggests some interesting trends (Table 29). The n u l l hypothesis stated that there was no s i g n i f i c a n t relationship between r e s i d e n t i a l s a t i s f a c t i o n and the presence of selected f a c i l i t i e s w i t h i n the buildings. The data seem to indicate that there i s a tendency for respondents to spend more hours i n t h e i r room and to prefer to l i v e elsewhere, especially i n i n s t i t u t i o n s i n which there .is an absence of a c t i v i t i e s w i t h i n the building such as a c r a f t s room, a games room, a coffee shop or a volunteer transportation service. A s i g n i f i c a n t c o r r e l a t i o n was produced i n the canonical analysis of the m o b i l i t y variables and the measures of l i f e s a t i s f a c t i o n (Table 30). There appears to be a relationship between an a b i l i t y to go outside, having enough to do to occupy the day; going for drives with the family; playing less bingo and having help from r e l a t i v e s and friends with trans-portation. There i s also a tendency to f e e l more s a t i s f i e d with l i f e at the present time and to perceive that one's health status i s good (p?<0.05). TABLE 2 9 C a n o n i c a l a n a l y s i s o f r e s i d e n t i a l s a t i s f a c t i o n ( s e t -.1) v e r s u s the:.presence o f f a c i l i t i e s w i t h i n the r e s i d e n c e ( s e t 2) C a n o n i c a l c o r r e l a t i o n 0.491 S i g n i f i c a n c e 0.07 C o e f f i c i e n t s f o r c a n o n i c a l v a r i a b l e s Set 1 :. Set 2 ROOMHR - 0 . 8 9 8 NEEDOK 0 . 5 9 1 PRESRES -O . 3 6 3 PRITEL 0 . 6 2 7 VOLVTS 0 . 5 1 5 CRAFTS - 0 . 3 3 9 CARDS . . - 0 . 3 3 7 COFFEER - O . 3 0 3 VOLTRA . - 0 . 3 0 2 TABLE 3 0 C a n o n i c a l a n a l y s i s o f m o b i l i t y ( s e t 1) v e r s u s l i f e s a t i s f a c t i o n ( s e t 2 )  C a n o n i c a l c o r r e l a t i o n 0 . 4 9 6 S i g n i f i c a n c e 0 . 0 2 3 C o e f f i c i e n t s f o r c a n o n i c a l v a r i a b l e s Set 1 Set 2 CANOUT 0 . 5 7 6 SAT2DA 0.502 ENU2DO 0 . 4 3 5 HEALST 0 . 4 4 5 FAMDRI -0.412 BINGO 0 . 3 5 6 MOBAID 0.300 TABLE 31 C a n o n i c a l a n a l y s i s o f m o b i l i t y ( s e t 1) v e r s u s p r o x i m i t y o f community s e r v i c e s ( s e t 2) C a n o n i c a l c o r r e l a t i o n 0.640 S i g n i f i c a n c e 0.001 C o e f f i c i e n t s f o r c a n o n i c a l v a r i a b l e s Set 1 Set 2 CANOUT 0.665 PROSHO -0.902 VISITFR -0.541 LIBRAR 0.886 DOOUT -0.516 VARSTO 0.469 ACTIVE 0.502 MEDOFF .-0.444 SIXBLS 0 . 3 2 1 CHURCH 0.407 SEMCEN • • "0.342 60 61 The mobility variables were also correlated with questions r e l a t i n g to the proximity to coimiunity services (p : < 0.001). There seems to be a tendency for respondents who stated that they could go out as f a r as s i x blocks and back, but who i n fact did not go out much and did not v i s i t t h e i r friends often, to perceive that shops, medical o f f i c e s and senior centres were not e a s i l y accessible; although l i b r a r i e s , corner stores and churches were wit h i n r e l a t i v e l y easy access (Table 31). The remaining canonical analyses which produced s i g n i f i c a n t r e s u l t s involved the degree of contact which the respondents had with t h e i r children, r e l a t i v e s and friends. Those who indicated that they had a good relationship with t h e i r family, and who were s a t i s f i e d at the time tended to have a greater amount of contact with t h e i r children and r e l a t i v e s (Table 32). S i m i l a r l y , three c o e f f i c i e n t s of canonical corre l a t i o n were s t a t i s t i c a l l y s i g n i f i c a n t at the 0.001 l e v e l i n the relationship between the number of children, r e l a t i v e s and friends who were i n contact once per month with the respondents, and of those, the number who l i v e d w i t h i n the Greater Vancouver D i s t r i c t (Table 33). I t would appear from the Table that the more the residents were i n contact with t h e i r s i g n i f i c a n t others, the more l i k e l y i t was that the children, r e l a t i v e s and friends resided i n the G.V.R.D. Six canonical analyses did not produce s i g n i f i c a n t r e s u l t s . . These involved the l i f e s a t i s f a c t i o n variables and t h e i r i n t e r c o r r e l a t i o n with the variables addressing mobility, environmental evaluation, the presence of f a c i l i t i e s w i t h i n the building and ccnrnunity services i n the l o c a l neighborhood; the correlations of the environmental evaluation set with mobility and the presence of community services and the correlates of r e s i d e n t i a l s a t i s f a c t i o n with the a v a i l a b i l i t y of comiunity services. TABLE 3 2 C a n o n i c a l a n a l y s i s o f l i f e s a t i s f a c t i o n ( s e t 1) v e r s u s c o n t a c t w i t h c h i l d r e n , r e l a t i v e s and f r i e n d s ( s e t 2)  F i r s t c a n o n i c a l c o r r e l a t i o n O.36O C o e f f i c i e n t s f o r c a n o n i c a l v a r i a b l e s Set 1 S i g n i f i c a n c e 0 .001 Set 2 FAMREL - 0 . 8 7 9 SAT2DA - 0 . 3 3 2 L0T2D0 - 0 . 3 1 8 KIDCONT 0 .848 RELATS 0 .478 Second c a n o n i c a l c o r r e l a t i o n 0 .272 S i g n i f i c a n c e 0 .036 C o e f f i c i e n t s f o r c a n o n i c a l v a r i a b l e s Set 1 Set 2 LISAT 0 .779 SAT2DA - 0 . 7 1 6 CHUGVD 0 .871 KIDGVD - 0 . 5 5 9 TABLE 33 C a n o n i c a l a n a l y s i s o f c o n t a c t w i t h c h i l d r e n , r e l a t i v e s and f r i e n d s ( s e t 1) v e r s u s c o n t a c t and l i v i n g i n G.V.R.D. ( s e t 2) C a n o n i c a l c o r r e l a t i o n F i r s t 0 .904 Second 0 .651 T h i r d 0 .590 C o e f f i c i e n t s f o r c a n o n i c a l v a r i a b l e s S i g n i f i c a n c e 0 . 0 0 1 0 . 0 0 1 0 . 0 0 1 F i r s t c o r r e l a t i o n Set 1 Second c o r r e l a t i o n Set 1 T h i r d c o r r e l a t i o n Set 1 CHUMS 0.876 Set 2 CHUGVD 0 .901 RELATS - 0 . 8 8 9 KIDCONT 0 .589 CHUMS 0 .441 Set 2 RELGVD - 0 . 9 2 9 CHUGVD 0 . 4 6 6 KIDGVD 0 . 4 6 4 KIDCONT 0 .816 RELATS 0 .557 CHUMS 0 .451 Set 2 KIDGVD 0 .894 RELGVD 0 .443 CHUGVD - 0 . 3 1 0 6.2 63 Multiple Regression Analyses Having analysed correlations between sets of variables using the canonical corre l a t i o n procedure, a number of in d i v i d u a l variables which were weighted highly were used i n a series of seven multiple regression analyses, of which s i x were s i g n i f i c a n t . The re s u l t s of the analyses have been summarised i n Tables 34 and 35. The number of hours which respondents spent i n t h e i r rooms was considered to be an important variable as i t gave insight into the respondents' r e l a t i v e s a t i s f a c t i o n ( r e s i d e n t i a l and l i f e ) and patterns of mobility. As a r e s u l t , the variable ''ROOMHR'1 (Appendix 14), was used i n two analyses as the dependent variable. No s i g n i f i c a n t relationship ' emerged between. ;the- respondents '-relationship with t h e i r - family "and- the score "obtained on the variables derived from the l i f e s a t i s f a c t i o n index. Sig n i f i c a n t r e s u l t s were obtained f o r the other three l i f e s a t i s f a c t i o n variables "LOT2D0," "HEALTST" and "SAT2DA" (P< 0.001). The variable "L0T2D0" was weighted twice as highly as the other two variables, predicting the s i t u a t i o n that the more time the respondents spent i n t h e i r rooms, the more they f e l t that they did not have enough to do to occupy t h e i r day. The re s u l t s of the analysis would suggest that the more time the respondents spend i n t h e i r rooms i s predicted by the less they have to do, the more d i s s a t i s f i e d they are with t h e i r l i f e at the present time, and the poorer they perceive t h e i r health status to be. Of the f i f t e e n variables which dealt with the presence or absence of f a c i l i t i e s w i t h i n the building, eleven s i g n i f i c a n t l y predicted the amount of time the residents spent i n t h e i r own room (p<0.05). The absence of laundry f a c i l i t i e s (Table 34), a c r a f t s or sewing room and a greenhouse TABLE 34 R e g r e s s i o n a n a l y s i s o f l i f e s a t i s f a c t i o n v e r s u s "ROOMHR" S t a n d a r d i s e d c o e f f i c i e n t s o f independent v a r i a b l e s ( B e t a w e i g h t s ) ' HEALST 0.171 S i g n i f i c a n c e p 0.0001 L0T2D0 0.234 F 13.376 SAT2DA 0.126 M u l t i p l e R O.383 Stepwise r e g r e s s i o n a n a l y s i s o f p e r c e i v e d presence o f f a c i l i t i e s i n s i d e the r e s i d e n c e v e r s u s "ROOMHR" Be t a w e i g h t s PRITEL 0. 260 CRAFTS -0:. 166 GHOUSE -0. 189 S i g n i f i c a n c e P 0 . 041 INFIRM 0. 110 F 2 .032 COFFEER 0. 067 M u l t i p l e R 0 • 354 LAUNDRY -0. 073 GUESTR 0. 062 VOLVIS -0. 063 CARDS 0. 061 Note: Only v a r i a b l e s w hich c o n t r i b u t e d s i g n i f i c a n t l y t o the r e g r e s s i o n e q u a t i o n are i n c l u d e d . 64 65 strongly predicted more time spent i n the room. The absence of an a u d i t o r i u m and a v o l u n t e e r v i s i t i n g s e r v i c e were w e i g h t e d l e s s h i g h l y b u t i n t h e same d i r e c t i o n . The pr e s e n c e o f a room f o r playing cards or games predicted less time i n the room, as did the presence of a private telephone. Although weighted less than the previous variables, the presence of an infirmary on the s i t e , a coffee shop and a room where guests could sleep over i f they needed were s i g n i f i c a n t . As a check on the previous analyses, the variable ''TJlMDUT1' was used i n a series of three multiple regressions involving two measures of mobility, one of r e s i d e n t i a l s a t i s f a c t i o n and one of l i f e s a t i s f a c t i o n (Table 35). The variable "CANOUT" and "DOOUT" s i g n i f i c a n t l y predicted the amount of time spent outside the building (p<0.001), with ''DOOUT" having a weighting nine times greater than "CANOUT". Although the r e s i d e n t i a l s a t i s f a c t i o n variable ''ROOMHR" and the l i f e s a t i s f a c t i o n variable "USAT" were s i g n i f i c a n t at the 0.001 l e v e l , neither attained a c o e f f i c i e n t of 0.3 which has been used tliroughout as the c r i t i c a l l e v e l for reporting. However i t should be noted that the c o e f f i c i e n t for the variable "ROOMER" was weighted seven times greater than "LISAT" i n predicting "TIMFDUT". Variables r e l a t i n g to the proximinity of corrriunity services were used to predict the amount of time spent outside (p< 0.05). The presence of a community centre and a v a r i e t y store s i g n i f i c a n t l y predicted more time spent outside, whereas the d i f f i c u l t y i n getting to a senior c i t i z e n ' s centre and a medical o f f i c e predicted less time spent outside. Pearson Correlations Having analysed how pa r t i c u l a r variables were predicted by sets of variables using the multiple regression analyses, i t was decided to compute TABLE 3 5 R e g r e s s i o n a n a l y s i s o f the p r o x i m i t y t o community s e r v i c e s v e r s u s "TIMEOUT" S t a n d a r d i s e d c o e f f i c i e n t s o f x - v a r i a b l e s ( B e t a w e i g h t s ) PROSHO 0. 0 7 4 VARSTO - 0 . 2 5 2 MEDOFF 0.243 P 0. 019 CHURCH -0.046 F 2. 3 1 3 HOSP -0.090 M u l t i p l e R 0. 3 6 8 LIBRAR - 0 . 0 9 1 PARK 0.026 SENCEN 0.381 COMCEN 0.481 R e g r e s s i o n a n a l y s i s o f ( 1 ) "CANOUT, DO OUT" and ( 2 ) "ROOMHR, LISAT" v e r s u s "TIMEOUT"  B e t a w e i g h t s CANOUT 0 . 0 6 4 p 0 . 0 0 0 1 DO OUT - 0 . 6 0 2 F 5 2 . 8 3 ' M u l t i p l e R 0 . 5 5 7 LISAT 0 . 0 2 5 P 0 . 0 0 0 1 ROOMHR - 0.146 F 1 3 . 9 5 4 M u l t i p l e R 0 . 3 2 6 66 67 Pearson correlations to establish what relationships i f any existed between individual variables. "TIMEOUT" was correlated with respondents' perceived health status, the level of care they were receiving and the amount of time they spent in their rooms (Table 36). Each of the results were significant suggesting potentially important implications for future planning of institutions of this type. The variable "SIZE" was added to the l i s t of variables used in the questionnaire as i t was one of the i n i t i a l selection criteria. Three correlation analyses were computed and yielded significant results (p<0.01) in two cases ("RESSAT" and "PRESRES"). It would appear that there was a higher level of residential satisfaction in the smaller institutions, but paradoxically, respondents who lived in the smaller places preferred t live elsewhere. There was no significant correlation between the length of time spent in their room and the respondents' perception of how well the needs of older people are looked after, when they were correlated with the variable "SIZE". Similarly, the age of the respondents did not produce significant results with the amount of time spent outside, nor did the l i f e satisfaction score correlate with the cimount of time spent in their rooms. The level of satisfaction with the residence seems to be related to the amount of time spent in the room (p <0.001), and as shown in the Table,, higher satisfaction was expressed by respondents spending fewer hours in their rooms. There was also a significant correlation between the level of residential satisfaction and the level of care provided, and as the final significant correlation in Table 36 shows, the level of care was related to the number of hours spent in the room (p<0.01). 68 Multiple Discriminant Analyses In the preceedlng analyses an attempt has been made to elucidate patterns of relationships on the basis of a l l the residents' responses. However, important differences which may exist between subgroups are not discernible. Two series of discrirmnant analyses were therefore performed. The first series involved the variables included in the principal themes of mobility, residential and l i f e satisfaction. The aim of the analyses was to test for significant differences between the two levels of care being provided. The second series was designed to test for differences between the fifteen individual institutions. A. Difference Between Levels of Care There would appear to be a tendency for respondents in Personal care to spend more time in their rooms; to be more satisfied with the residence, but to prefer to live elsewhere and to perceive that the needs of older people are being well looked after in the institutions (Table 37). Respondents receiving Intermediate care on the other hand, spend less time in their rooms but appear to be less satisfied with the residences, seeing their needs as not being well looked after; but yet, they express a preference for remaining in their current residence. Using the level of care to differentiate l i f e satisfaction levels (Table 3&0, reveals a tendency for Personal care respondents to perceive that since moving into the institutions they worry less; sleep more; have relatively better health; see their children less often; dress up less often, and in general, feel that they do not have plenty .to do most days. The analysis would seem to suggest that those in Intermediate care appear to worry more; sleep less and be in poorer health; dress up more TABLE 3 6 Pearson p r o d u c t moment c o r r e l a t i o n a n a l y s e s : C o r r e l a t i o n c o e f f i c i e n t s and l e v e l o f s i g n i f i c a n c e V a r i a b l e p a i r V a r i a b l e p a i r V a r i a b l e p a i r TIMEOUT w i t h HEALST SIZE w i t h RESSAT RESSAT w i t h ROOMHR ROOMHR w i t h CARETY -0.140 (0.05) 0.147 (0.001) 0 . 2 2 7 ( 0 . 0 0 1 ) - 0 . 1 0 8 (0.049) TIMEOUT w i t h CARETY SIZE w i t h PRESRES CANOUT w i t h DOOUT -0.284 (0.001) - 0 . 1 2 2 ( 0 . 0 3 0 ) 0 . 7 2 2 ( 0 . 0 0 1 ) TIMEOUT - 0 . 3 1 5 w i t h ( 0 . 0 0 1 ) ROOMHR SIZE w i t h ROOMHR RESSAT w i t h CARETY - 0 . 0 3 1 ( 0 . 3 1 7 ) 0.114 (0.040) TABLE 3 7 D i s c r i m i n a n t a n a l y s i s o f r e s i d e n t i a l s a t i s f a c t i o n by ca r e type S t a n d a r d i s e d d i s c r i m i n a n t F u n c t i o n c o e f f i c i e n t s RESSAT PRESRES ROOMHR NEEDOK 0 . 6 9 2 - 0.486 - 0 . 7 7 5 0 . 3 8 1 E i g e n v a l u e 0.048 W i l k s ' Lambda 0 . 9 5 4 R e l a t i v e p e r c e n t a g e 1 0 0 . 0 C a n o n i c a l c o r r e l a t i o n 0 . 2 1 5 C h i - s q u a r e S i g n i f i c a n c e 1 1 . 0 5 0 . 0 2 6 C e n t r o i d s o f groups PERSONAL INTERMEDIATE 0 . 1 5 4 - 0 . 5 9 5 69 TABLE 3 8 D i s c r i m i n a n t a n a l y s i s o f l i f e s a t i s f a c t i o n by care t ype S t a n d a r d i s e d d i s c r i m i n a n t F u n c t i o n c o e f f i c i e n t s L0T2D0 HEALST CWORRY HEALTH SEEKID SLEEP DRESS 0 . 3 2 8 • 0 . 5 0 3 0 . 6 1 2 0 . 3 8 6 0 . 4 0 4 • 0 . 5 8 8 0 . 3 6 5 E i g e n v a l u e 0 . 1 4 9 R e l a t i v e . per c e n t a g e 1 0 0 . 0 Wi l i e s ' Lambda Chi-Square 0 . 8 7 1 1 8 . 4 8 9 C e n t r o i d s o f groups PERSONAL 0:. 2 1 6 INTERMEDIATE - 0 . 5 9 5 C a n o n i c a l c o r r e l a t i o n 0 . 3 6 0 S i g n i f i c a n c e 0 . 0 1 0 TABLE 3 9 D i s c r i m i n a n t a n a l y s i s o f m o b i l i t y by care t ype S t a n d a r d i s e d d i s c r i m i n a n t F u n c t i o n c o e f f i c i e n t s CANOUT TIMEOUT USEBUS FAMDRI 0 . 3 2 0 - 0 . 4 4 2 - 0 . 5 1 4 0 . 3 3 7 E i g e n v a l u e 0 . 2 2 9 R e l a t i v e p e r c e n t a g e 1 0 0 . 0 W i l k s ' Lambda C h i - s q u a r e 0 . 8 1 4 3 8 . 2 8 8 C a n o n i c a l c o r r e l a t i o n 0 . 4 3 1 S i g n i f i c a n c e 0 . 0 0 1 C e n t r o i d s o f groups PERSONAL .-0'.'340 INTERMEDIATE 0 .545 70 71 often than before and have things to do to occupy t h e i r time. When the l e v e l of care was used to discriminate the variables i n the mobility set, the res u l t s seem to show that Personal care respondents could and i n fact did, go outside more often (Table 39). They also used the public t r a n s i t system more, but went less often f o r drives with t h e i r family than did the Intermediate care respondents. B. Differences Between the Fi f t e e n I n s t i t u t i o n s Two s i g n i f i c a n t discriminant functions were produced when the variables i n the r e s i d e n t i a l s a t i s f a c t i o n set were tested across each of the i n s t i t u t i o n s . In the f i r s t function (p < 0.001), the amount of time the residents spent i n t h e i r room seemed to be an important discriirdnating variable between the f i f t e e n i n s t i t u t i o n s (Table 40). The standardised discriminant function c o e f f i c i e n t s indicate that t h i s variable was weighted almost twice as highly as the other s i g n i f i c a n t discriiriinator, the perceived r e s i d e n t i a l s a t i s f a c t i o n . Ln the second discriminant function (p<0.05), i t was the variables "NEEDOK" and "PRESRES" which s i g n i f i c a n t l y discriminated between the homes (the weighting of the respondents' perception of how w e l l t h e i r needs were being looked a f t e r being twice that of t h e i r preference f o r remaining i n the i n s t i t u t i o n or moving else-where) . Two s i g n i f i c a n t functions were obtained i n the discriniinant analysis of the l i f e s a t i s f a c t i o n variables by each i n s t i t u t i o n (Table 41). The l i f e s a t i s f a c t i o n score . which ••was- adapted from. Wood et. al.'s Z-index was the most highly weighted c o e f f i c i e n t of the f i r s t function, with the perceived health status and reported relationship with the family also being s i g n i f i c a n t discriminators (p<0.001). In the second function, TABLE 40 D i s c r i m i n a n t a n a l y s i s of r e s i d e n t i a l s a t i s f a c t i o n by each r e s i d e n c e S t a n d a r d i s e d d i s c r i m i n a n t F u n c t i o n c o e f f i c i e n t s RESSAT PRESRES ROOMHR NEEDOK Func 1 Func 2 0 . 5 2 2 - 0 . 1 7 7 -0. 980 0. 240 0 . 0 3 3 0 . 4 6 3 - 0 . 1 8 5 - 0 . 9 1 0 E i g e n v a l u e 0 . 3 5 2 0 . 1 3 0 R e l a t i v e C a n o n i c a l p e r c e n t a g e c o r r e l a t i o n 5 6 . 9 2 1 . 1 0 . 5 1 0 0.340 W i l k s ' Lambda C h i - s q u a r e S i g n i f i c a n c e 0 . 5 7 4 0 . 7 7 6 1 2 6 . 2 6 0 5 7 - 7 0 4 0.001 0.027 TABLE 41 D i s c r i m i n a n t a n a l y s i s o f l i f e s a t i s f a c t i o n by each r e s i d e n c e S t a n d a r d i s e d d i s c r i m i n a n t E i g e n F u n c t i o n c o e f f i c i e n t s v a l u e R e l a t i v e C a n o n i c a l p e r c e n t a g e c o r r e l a t i o n FAMREL LISAT SAT2DA HEALST Func 1 Func 2 0 . 3 4 5 0 . 6 5 7 0 . 0 5 7 0 . 5 2 2 - 0 . 5 6 3 0 . 1 3 0 1 . 0 3 2 - 0 . 3 5 0 0 . 246 0 . 1 8 0 42.4 3 1 . 1 0.444 0 . 3 9 1 W i l k s ' Lambda C h i - s q u a r e S i g n i f i c a n c e 0 . 5 8 9 0 . 7 3 2 9 9 . 5 3 9 5 8 . 4 0 7 0.001 0.024 72 73 the variables, "FAMREL" and "HEALST" were s i g n i f i c a n t at the 0.05 l e v e l . The variables included i n the theme of mobi l i t y reveal a number of inte r e s t i n g differences between the f i f t e e n i n s t i t u t i o n s (Table 42). Four s i g n i f i c a n t functions were produced, with the variable "SIXBLS" (Q25) being important i n each function. I t would appear that patterns of mobility are s i g n i f i c a n t l y d i f f e r e n t between the i n s t i t u t i o n s , and as w i l l be discussed i n the next chapter, t h i s has important implications for the evaluation of appropriate r e s i d e n t i a l milieux. The importance of l i v i n g i n the same area as t h e i r children and t h e i r r a t i n g of the surrounding area were the two variables which s i g n i f i c a n t l y discriminated between the•groups i n the f i r s t function when the environmental evaluation set were tested (p < 0.001). In the second function, the s a t i s f a c t i o n with the location i n terms of the services and f a c i l i t i e s available i n the l o c a l area ("LOCSAT") was weighted most highly (p < 0.05) . The preferred neighbours was also a s i g n i f i c a n t discriminator (Table 43). The f i n a l discriminant analyses reveal int e r e s t i n g differences between the f i f t e e n subgroups and the r e l a t i v e presence of services i n the area surrounding the i n s t i t u t i o n s (Table 44) . In terms of the r e l a t i v e ease of access to neighborhood services, h o s p i t a l s and l i b r a r i e s were s i g n i f i c a n t discriminators i n four of the f i v e functions produced (p<0.001); shopping centres, v a r i e t y stores and community centres i n three functions; and medical o f f i c e s , parks and senior c i t i z e n 1 s centres i n two. TABLE 42 D i s c r i m i n a n t a n a l y s i s o f m o b i l i t y by each r e s i d e n c e S t a n d a r d i s e d d i s c r i m i n a n t f u n c t i o n c o e f f i c i e n t s Func 1 Func 2 Func 3 Func 4 DOOUT 0 • 338 -0 .575 0 .093 0 • 3 7 2 SIXBLS -0 • 3 3 1 0 .555 0 . 5 2 2 -0 .680 TIMEOUT -0 . 4 2 5 0 .761 0 .003 0 .271 MOBAID .2.0 .047 -0 .182 -0 .319 -0 .591 VOLBUS -0 . 7 6 2 -0 • 2 7 9 0 .014 0 • 393 USEBUS -0 .211 -0 .541 -0 .155 -0 .556 FAMDRI -0 . 1 9 4 -0 .194 0 . 6 1 8 -0 . 3 0 1 E i g e n v a l u e s R e l a t i v e p e r c e n t a g e C a n o n i c a l c o r r e l a t i o n O . 6 5 6 4 5 . 9 O . 6 3 0 0 . 3 0 3 2 1 . 2 0 . 4 8 3 0 . 1 6 5 1 1 . 5 0 . 3 7 6 0 . 1 5 6 1 0 . 9 0 . 3 6 7 W i l k s ' Lambda 0 . 2 9 8 0 .493 0 . 6 4 3 0 . 7 4 9 C h i - s q u a r e 2 7 3 . 7 4 3 1 5 9 . 6 9 2 9 9 . 7 6 0 6 5 . 2 5 2 S i g n i f i c a n c e 0 . 0 0 1 0 . 0 0 1 0 . 0 0 1 0 . 0 2 0 TABLE 43 D i s c r i m i n a n t a n a l y s i s of e n v i r o n m e n t a l e v a l u a t i o n by each r e s i d e n c e S t a n d a r d i s e d d i s c r i m i n a n t F u n c t i o n c o e f f i c i e n t s SAMLOC RATEHE LOCSAT NEIBPRE Func 1 Func 2 0 . 8 0 9 - 0 . 6 2 7 0 . 1 6 9 0 . 0 7 8 0 . 2 7 7 0 . 3 4 6 0 .449 0 .729 E i g e n -v a l u e s 0 . 2 7 2 0 . 2 0 3 R e l a t i v e p e r c e n t a g e 4 3 3 2 C a n o n i c a l c o r r e l a t i o n 0.462 0 .411 Wilks"' Lambda C h i - s q u a r e S i g n i f i c a n c e 0.570 0 .725 98 .045 56 .126 0 . 0 0 1 0 . 0 3 7 74 TABLE 4 4 D i s c r i m i n a n t a n a l y s i s o f p r o x i m i t y t o community f a c i l i t i e s by each r e s i d e n c e S t a n d a r d i s e d d i s c r i m i n a n t f u n c t i o n c o e f f i c i e n t s Func 1 Func 2 Func 3 Func 4 Func 5 PROSHO 0 . 4 8 1 - 0 . 458 0 . 4 9 0 0 . 1 0 2 - 0 . 1 0 9 VARSTO 0 . 4 8 9 0 . 0 9 8 0 . 4 1 7 0 . 3 6 8 0 . 2 8 4 MEDOFF - 0 . 2 5 3 - 0 . 4 2 7 - 0 . 2 0 5 0 . 2 2 0 - 0 . 6 3 9 HOSP 0 . 6 5 7 0 . 401 - 0 . 7 5 5 - 0 • 7 5 2 - 0 . 0 8 4 LIBRAR - 0 . 4 5 1 0 . 2 2 2 - 0 . 3 9 7 0 . 6 7 7 - 0 . 7 5 9 PARK - 0 . 1 1 7 - 0 . 041 - 0 . 3 0 7 0 .546 . 1 . 1 9 5 SENCEN - 0 . 1 3 7 0 . 2 3 1 0 . 1 7 4 - 0 • 5 1 7 - 0 . 7 0 9 COMCEN - 0 . 1 9 2 - 0 . 8 5 3 - 0 . 0 8 3 - 0 . 6 9 4 0 . 5 1 1 TWOBLS - 0 . 036- 0 . 3 5 2 • 0 . 1 2 1 - 0 . 0 0 5 - 0 . 0 2 7 E i g e n v a l u e s R e l a t i v e p e r c e n t a g e C a n o n i c a l c o r r e l a t i o n 1 . 8 0 5 3 8 . 9 0 . 8 0 2 0 . 7 9 2 1 7 . 1 0 . 6 6 5 0 . 6 4 0 1 3 . 8 0 . 6 2 5 0 . 5 5 7 1 2 . 0 0 . 5 9 8 0 . 3 9 2 8 . 5 0 . 5 3 1 W i l k s ' Lambda C h i - s q u a r e S i g n i f i c a n c e 0 . 0 3 7 3 4 8 . 3 6 8 0 . 0 0 1 0 . 1 0 3 2 3 9 . 5 6 0 0 . 0 0 1 0 . 1 8 5 1 7 8 . 0 0 6 0 . 0 0 1 0 . 3 0 4 1 2 5 . 8 0 1 0 . 0 0 1 0 . 4 7 3 7 9 . 1 0 6 0 . 0 0 1 75 CHAPTER FOUR DISCUSSION AND INTERPRETATION OF FINDINGS: Before f o c u s i n g upon the d i s c u s s i o n of the r e s u l t s r e -p o r t e d i n Chapter Three, the l o c a t i o n a l c h a r a c t e r i s t i c s of the f i f t e e n i n s t i t u t i o n s s t u d i e d w i l l be examined. L o c a t i o n C h a r a c t e r i s t i c s of the  F i f t e e n I n s t i t u t i o n s In d i s c u s s i n g the r e s e a r c h design, i t was noted that a c r i t e r i o n f o r the s e l e c t i o n of an i n s t i t u t i o n was to ensure g e o g r a p h i c a l r e p r e s e n t a t i o n i n the sample of f a c i l i t i e s e q u i v a l e n t to the d i s t r i b u t i o n of n o n - p r o f i t care i n s t i t u t i o n s throughout the Greater Vancouver Region a l D i s t r i c t . Nine of : the i n s t i t u t i o n s s e l e c t e d are l o c a t e d w i t h i n the c i t y of Vancouver ( F i g u r e 2), r a nging from the west end of the down-town core . (P-Table 1), through the downtown e a s t s i d e ~(K) and as f a r as the e a s t end of the c i t y l i m i t s (G).- I n s t i t u t i o n s C, E and J are s i t u a t e d a t the southern l i m i t s of the c i t y ; A and N are l o c a t e d i n the c e n t r a l r e s i d e n t i a l core, and H i s s i t u a t e d i n the west end towards the U n i v e r s i t y Endowment Lands. The remaining s i x i n s t i t u t i o n s are l o c a t e d i n the 76 77 m u n i c i p a l i t i e s of Burnaby (L and D), New Westminster (R), Coquitlam ( F ) , West Vancouver (M) and White Rock (B). The assumption made at the ou t s e t o f the study t h a t one of the major c r i t e r i a f o r s i t e s e l e c t i o n was the a v a i l a -b i l i t y of r e l a t i v e l y cheap lan d seems to have been borne out i n the m a j o r i t y of cases. As was f r e q u e n t l y mentioned i n i n t e r v i e w s conducted w i t h the a d m i n i s t r a t o r s o f the i n s t i t u -t i o n s , o f f i c i a l s of the n o n - p r o f i t sponsoring o r g a n i z a t i o n s , r e p r e s e n t a t i v e s of the Long Term Care Program and the C e n t r a l Mortgage and Housing C o r p o r a t i o n , l a n d c o s t s w i t h i n the G.V.R.D. are extremely h i g h and com p e t i t i o n f o r land i s f i e r c e i n the r e s i d e n t i a l areas. One of the i m p l i c a t i o n s a r i s i n g from t h i s s i t u a t i o n i s th a t pragmatic c o n s i d e r a t i o n s take precedence over the more i d e o l o g i c a l questions of s i t i n g i n the most s u i t a b l e l o c a t i o n s . Budget c o n s t r a i n t s and steep c o m p e t i t i o n f o r a v a i l a b l e space l a r g e l y determine the d e c i s i o n making and p o l i c y c o n s i d e r a t i o n s i n v o l v e d i n the s e l e c t i o n of s i t e s , and t h i s i n t u r n d i r e c t l y a f f e c t s and c o n s t r a i n s the a d m i n i s t r a t i v e o r g a n i z a t i o n o f the i n s t i t u t i o n s . The r e s u l t i s t h a t , i n many i n s t a n c e s , the s i t e s are l e s s than optimal and the problem becomes one of compensating f o r the s i t u a t i o n a l drawbacks, by making the i n s t i t u t i o n s as c o n g e n i a l as i s humanly p o s s i b l e . In the present context, s i t u a t i o n a l drawbacks i n v o l v e c o n s i d e r a t i o n s of both the r e s i d e n t i a l and environmental s e t -t i n g s , such as the l a c k of a c c e s s i b i l i t y by t r a n s p o r t a t i o n ; p r o x i m i t y to community s e r v i c e s and f a c i l i t i e s ; b a r r i e r s to communication ( t o p o g r a p h i c a l and p e r c e p t u a l ) ; p e r s o n a l 78 c h a r a c t e r i s t i c s of the sample p o p u l a t i o n ( e s p e c i a l l y i n f i r m -i t i e s ) ; the q u a l i t y of the d w e l l i n g u n i t s ( i n c l u d i n g design, communal and p r i v a t e spaces, the atmosphere and the adminis-t r a t i v e expediency of the s t a f f ) and the d i f f e r e n t value o r i e n t a t i o n s of the v a r i o u s o r g a n i z a t i o n s i n v o l v e d i n the Long Term Care Program. I t i s by no means the i n t e n t i o n of the p r e s e n t study to c r i t i c i z e or adjudge the q u a l i t y , standards or o r g a n i z a t i o n of the f i f t e e n homes, as i t i s f e l t s t r o n g l y t h a t t h e i r con-t r i b u t i o n to the community and to the r e s i d e n t s i s i n v a l u a b l e ; any such approach would be presumptuous. What w i l l be suggested i s t h a t the s i t u a t i o n a l drawbacks o u t l i n e d a f f e c t the optimal s u i t a b i l i t y of the r e s i d e n t i a l m i l i e u x . However, the i m p l i c i t l y c r i t i c a l overtones of such an approach should be viewed w i t h i n the o v e r a l l context of the s e r v i c e which the i n s t i t u t i o n s p r o v i d e . The evidence of a v e r y r e a l concern f o r enhancing the q u a l i t y of l i f e f o r the r e s i d e n t s was p r e v a l e n t i n the i n t e r v i e w s and d i s c u s s i o n s conducted, and every p o s s i b l e c o - o p e r a t i o n and advice were a f f o r d e d the r e s e a r c h e r s . The c r i t i c a l n a ture of the ensuing d i s c u s s i o n i s intended to h i g h l i g h t areas f o r f u t u r e developments and should not be i n t e r p r e t e d as an a t t a c k on the e f f o r t s of those c u r r e n t l y i n v o l v e d i n c a r i n g f o r the r e s i d e n t s . 79 S i t u a t ional Cohs iderat ion s Affeet ing  Milieux S u i t a b i l i t y Perhaps the single most important requirement i n the provision of care for those eld e r l y people who are no longer able to function independently i n the i r own homes, i s a detailed understanding of the nature of the r e s i d e n t i a l pop-ula t i o n , and what are th e i r s p e c i a l needs i n th e i r new setting. This may appear to be nothing more than a statement of the obvious, but i n fact, as much of the relevant geron-t o l o g i c a l l i t e r a t u r e point out, we do not adequately under-stand the nature of this very heterogeneous sector of the population. In Canada as a whole, those persons over the age of s i x t y - f i v e represent over 87> of the t o t a l population (over two m i l l i o n people in 1976). Although this proportion i s less than i n other western i n d u s t r i a l i z e d countries (U.S.A. 10.77o, France 13.67,, United Kingdom 14.27, and Sweden 15.17.), as shown in Figure 3 the eld e r l y are one of the fastest growing segments of the Canadian population, and thei r problems have important national implications. Within the over s i x t y - f i v e group, the "old o l d " are growing i n number more quickly than the rest, have the greatest p r o b a b i l i t y of i l l n e s s , and are the most l i k e l y to require some form of i n s t i t u t i o n a l i z a t i o n . I t i s suggested therefore, that i n the case of the i n s t i t u t i o n a l i z e d e l d e r l y we are dealing with a very d i s t i n c t i v e subgroup. The average age of the respondents interviewed was 80.7 years, and almost three quarters of them were women. In the nation as a whole, almost half of the eld e r l y women are widowed; Figure 3 Past and Future Growth of Canada's Total Population and Persons 65 years and older, 1851 - 2001. 81 i n the i n s t i t u t i o n s sampled, t h i s f i g u r e i s c o n s i d e r a b l y h i g h e r (almost 75% o f the r e s p o n d e n t s are widowed). The s o c i a l i m p l i -c a t i o n s o f the v e r y uneven sex r a t i o i n each o f the i n s t i t u t i o n s appear t o be compounded by the wide range o f c u l t u r a l backgrounds w h i c h a r e e v i d e n t . T h i s s i t u a t i o n i s p a r t i c u l a r l y s i g n i f i c a n t i n B r i t i s h Columbia because o f the i n f l u x o f r e t i r e d p e o p l e from o t h e r p r o v i n c e s , many o f whom were i n f a c t b o r n o u t s i d e the c o u n t r y (59.5%). A l s o , the r e l a t i v e l y h i g h p r o p o r t i o n o f the e l d e r l y i n the p r o v i n c e (9.8%) a r e c o n c e n t r a t e d i n the c i t i e s o f Vancouver and V i c t o r i a , w h i c h can i n p a r t be a t t r i b u t e d t o t h e i r p r e f e r e n c e f o r a m i l d c o a s t a l c l i m a t e , and the s e r v i c e s a s s o c i a t e d w i t h l a r g e u r b an c e n t r e s . As mentioned i n the i n t r o d u c t i o n , the p r o p o r t i o n o f the e l d e r l y p o p u l a t i o n who a r e i n need o f i n s t i t u t i o n a l c a r e i n the p r o v i n c e i s about 7%, and t h e y t e n d t o be c o n s i d e r a b l y o l d e r and more v u l n e r a b l e because o f t h e i r g r e a t e r p r o p e n s i t y towards i l l n e s s and i n f i r m i t y . As a r e s u l t o f t h e i r d e c r e a s e d a b i l i t y to f u n c t i o n i n d e p e n d e n t l y w i t h i n t h e i r own homes, t h e y seek a c o n d u c i v e environment w h i c h i s i n h e r e n t l y p r o t e c t i v e , b u t w h i c h can f u l f i l l t h e i r p e r c e i v e d unmet needs. K o s t i c k (1961) has s u g g e s t e d t h a t one common denominator t o a l l homes f o r the aged i n v o l v e s the element o f a group l i v i n g e x p e r i e n c e f o r the r e s i -d ents. The i n s t i t u t i o n i s a microcosm w i t h i t s own mores and s t r u c t u r e s ; a w o r l d c r e a t e d t o p r o t e c t the r e s i d e n t s by a team o f s p e c i a l l y t r a i n e d p e r s o n n e l . However, i t s h o u l d be n o t e d t h a t t h e r e i s a tendency f o r the r e s i d e n t s t o become s e p a r a t e d from the community, and o f t e n t h e i r f a m i l i e s . I n the p r e s e n t sample, over one t h i r d o f the r e s p o n d e n t s had no l i v i n g c h i l d r e n , 82 and of those who had c h i l d r e n , a p r o p o r t i o n 'had." l i t t l e or no c o n t a c t w i t h them. A s i m i l a r p a t t e r n was evident i n terms of the l a c k of c o n t a c t w i t h r e l a t i v e s and f r i e n d s . C h a r a c t e r i s t i c s of the Respondents Which  A f f e c t M i l i e u x S u i t a b i l i t y The problems of l o n e l i n e s s and s o c i a l i s o l a t i o n which can pervade i n s t i t u t i o n a l l i v i n g may, i n p a r t , be o f f s e t by a f a m i l i a r i t y w i t h the neighbourhood i n which the i n s t i t u t i o n i s s i t u a t e d . In the c u r r e n t sample, almost one f i f t h of the respondents p r e v i o u s l y l i v e d i n the same l o c a l p l a n n i n g area as the i n s t i t u t i o n i n which they now r e s i d e , which may have reduced the problems of adjustment to u n f a m i l i a r surroundings f o r some. Although data were not c o l l e c t e d on the q u e s t i o n of r e l o c a t i o n s t r e s s and the traumas a s s o c i a t e d w i t h adapting to a r a d i c a l l y d i f f e r e n t way of l i v i n g , i t would seem that many of the respondents had p r i o r knowledge of the g e n e r a l l o c a l e s . Seventy-three percent of those i n t e r v i e w e d p r e v i o u s l y l i v e d i n the same m u n i c i p a l i t y as t h e i r i n s t i t u t i o n ; and 96% had l i v e d w i t h i n the Greater Vancouver Regional D i s t r i c t b e f o r e e n t e r i n g the i n s t i t u t i o n . T h i s may have made the t r a n -s i t i o n s l i g h t l y e a s i e r to cope wit h , although the f a m i l i a r i t y w i t h the surroundings can only p a r t i a l l y o f f s e t the r a d i c a l d i f f e r e n c e s i n l i f e s t y l e which accompany i n s t i t u t i o n a l l i v i n g . I t i s apparent from the responses to the open-ended questions i n the survey, and from o b s e r v a t i o n , that the 8? respondents have to modify a whole pattern of reactions and relationships which they have developed throughout the course of t h e i r l i v e s . In the new l i v i n g s i t u a t i o n they must endeavour to l i v e c l o s e l y with unrelated people. In e f f e c t , i t i s the homogeneity of the i n s t i t u t i o n a l way of l i f e and the medically related physical and psycho-social i n f i r m i t i e s which would seem to characterize s i m i l a r i t i e s among the respondents. For example, the re s u l t s of the discriminant analyses i n Tables 37 to 39 show a tendency for Personal care respondents to share certain c h a r a c t e r i s t i c s which d i f f e r e n t i a t e them from the Intermediate care respondents. However, the question which remains to be answered i s whether or not the s i m i l a r i t i e s i n behavioural patterns can be traced to the expectations of the i n s t i t u t i o n a l regimen. The pattern which seems to emerge from the data i s that the Intermediate Care respondents spend considerably more^time inside the i n s t i t u t i o n s , with a r e l a t i v e l y higher proportion of them stating that they cannot go outside. This i s r e i n -forced by the data c o l l e c t e d on the frequency of t r i p s made outside the i n s t i t u t i o n . They tend not to use the public t r a n s i t often, and r e l y upon t h e i r families to provide trans-portation when they go out. The o v e r a l l levels of l i f e - s a t i s -f a c t i o n are somewhat lower than those of the respondents i n Personal care, but i n t e r e s t i n g l y , they would prefer to remain where they are rather than move elsewhere. They also seem to f e e l that they have plenty to do to occupy th e i r days, which may be attributable to the fact that they are i n closer contact with the nursing s t a f f , and have a tendency to u t i l i z e the 84 the services and f a c i l i t i e s within the building more. This may r e s u l t i n a closer i d e n t i f i c a t i o n with the i n s t i t u t i o n as home. The Personal care respondents are r e l a t i v e l y more mobile and have higher levels of l i f e - s a t i s f a c t i o n , which could account for their tendency to prefer to l i v e elsewhere. The higher degree of r e s i d e n t i a l s a t i s f a c t i o n may be explained by the fact that they see their needs as being well, looked afte r and they have the security of the on-site medical services should they require them, but at the same time, they are s t i l l able to maintain t h e i r independence to an extent. They tend to have closer t i e s with the outside world, being more mobile and i n need of less supervision. Despite the fact that the need for medical care and nursing supervision brings the respondents together and requires their compliance to an i n s t i t u t i o n a l regimen, perhaps the single most sal i e n t c h a r a c t e r i s t i c which pervades the s i t u a t i o n i s the marked heterogeneity of the sample. Even the most cursory examination of the demographic data shows that differences i n personal h i s -t o r i e s far outweigh the s i m i l a r i t i e s , and questions the v a l i d -i t y of trying to impose too many generalizations. To date i n the s o c i a l gerontological l i t e r a t u r e , too l i t t l e emphasis has been placed on the important i n d i v i d u a l differences which exist and which a f f e c t the type of r e s i d e n t i a l m i l i e u which i s suitable. 85 Aspects of the R e s i d e n t i a l M i l i e u x Considered  to be Important by the Respondents" On the s u r f a c e , i t would appear t h a t the m a j o r i t y of the respondents are happy w i t h t h e i r l i v i n g arrangements w i t h i n the i n s t i t u t i o n s . Over e i g h t y percent of a l l those i n t e r v i e w e d expressed moderate to h i g h s a t i s f a c t i o n , i n t i m a t i n g t h a t t h e i r needs were being w e l l looked a f t e r , and t h a t they would r a t h e r l i v e where they were than move elsewhere. As mentioned p r e v i o u s l y , there was a tendency f o r respondents i n P e r s o n a l care to p r e f e r to remain where they were w h i l e p r o p o r t i o n a t e l y more of those r e c e i v i n g Intermediate care suggested t h a t they would p r e f e r to be l i v i n g i n t h e i r own home. There i s a p o s s i b i l i t y however, th a t these r e s i d e n t s may not a c t u a l l y be r e f e r r i n g to a d w e l l i n g u n i t . Rather, i t i s suggested t h a t t h e i r d e s i r e i s f o r the h e a l t h i e r more independent l i f e s t y l e they l e d b e f o r e r e q u i r i n g i n s t i t u t i o n a l support. I t would seem that t h e i r present i n f i r m -i t i e s would p r e c l u d e the p o s s i b i l i t y of t h e i r remaining at home without constant s u p e r v i s i o n , and that the f e e l i n g of b i a s a g a i n s t the i n s t i t u t i o n may i n p a r t be d i r e c t e d towards t h e i r own d i s a b i l i t i e s . The q u a l i t y of the r e s i d e n c e s was given c o n s i s t e n t l y as an important reason f o r choosing to enter the homes, as was the a v a i l a b i l i t y of medical f a c i l i t i e s on the premises. Many of the r e s i d e n t s seem to have entered the homes on the recommend-a t i o n of e i t h e r t h e i r doctor of f a m i l y , or e l s e , the i n s t i t u t i o n was s i t u a t e d i n the neighbourhoods w i t h which some of the respon-dents were f a m i l i a r (as i n the case of i n s t i t u t i o n s H, N, G and 86 P). The proximity to children, r e l a t i v e s and friends was also given as an important reason for moving i n , and i n the case of the ethnic and r e l i g i o u s i n s t i t u t i o n s , the stated reasons empha-sized the affcilaftIon with the sponsoring organizations. An in t e r e s t i n g finding which emerged as an important reason for choosing a p a r t i c u l a r i n s t i t u t i o n was the a v a i l a b i l i t y of meals and housekeeping f a c i l i t i e s . These reasons were es p e c i a l l y important i n i n s t i t u t i o n s P, L, K, G and B, and seemed to be r e l a t i v e l y more important than other, l o c a t i o n a l aspects. Most of the reasons given would seem to r e f l e c t the respondents' i n a b i l i t y to cope with the more taxing domestic chores as well as the desire to have the necessary medical f a c i l i t i e s r e a d i l y available. In conversations with many of the respondents the f e e l i n g of security and of not being an unnecessary burden on the i r children were also expressed as important reasons for deciding to seek i n s t i t u t i o n a l care. The data also illuminate the p r i n c i p a l reasons which re-sulted i n the respondents' decisions to leave t h e i r previous homes (Table 140:. The d i f f i c u l t y of looking after the home as a r e s u l t of changes i n health and physical status seems to be extremely important. Closely associated with this was the fact that medical problems become more acute with advancing years, and, with the increased propensity for serious f a l l s r e s u l t i n g i n broken limbs, many of the respondents were encour-aged to seek a more sheltered environment, or else r e a l i z e d that they were no longer able to manage independently. Loneliness was also given as being an important factor, e s p e c i a l l y after the loss of a spouse. 87 The reasons given f o r l e a v i n g t h e i r p r e v i o u s r e s i d e n c e were remarkably c o n s i s t e n t across the f i f t e e n i n s t i t u t i o n s , as were the reasons why the respondents p r e f e r r e d to remain where they were or move elsewhere (Table 10). Of those who pre-f e r r e d to remain, many mentioned that the i n s t i t u t i o n s con-t a i n e d e v e r y t h i n g they needed. They a l s o s t a t e d t h a t the good r e l a t i o n s h i p s they had w i t h the s t a f f and other r e s i d e n t s were important c o n s i d e r a t i o n s . The d e s i r e to be more independent and to l i v e i n t h e i r own home or nearer to t h e i r f a m i l i e s were f r e q u e n t l y expressed reasons f o r wanting to l i v e elsewhere. A somewhat d i f f e r e n t p i c t u r e emerges however when one examines the reasons which the respondents gave f o r t h e i r s a t i s f a c t i o n w i t h the i n s t i t u t i o n s . The answers do not d i r e c t l y correspond to the reasons given f o r choosing the p a r t i c u l a r p l a c e s . The s t a f f , atmosphere and the l e v e l of care were giv e n as the most important c o n s i d e r a t i o n s (Appendix 6 ) , and although a l a r g e p r o p o r t i o n of the r e s i d e n t s r e p o r t e d that they were s a t i s f i e d w i t h e v e r y t h i n g , i t was extremely d i f f i c u l t i n many cases to o b t a i n more s p e c i f i c answers. A l s o , the reasons given f o r d i s s a t i s f a c t i o n w i t h v a r i o u s aspects seems to c o n t r a -d i c t the n o t i o n that they are i n f a c t s a t i s f i e d w i t h e v e r y t h i n g . The impression which emerges from the data does not seem to r e i n f o r c e the i d e a that the respondents r e g a r d the i n s t i t u -t i o n s as t h e i r p r i v a t e domain. S a t i s f a c t i o n seems to be r e s t r i c t e d to the q u a l i t y o f the p h y s i c a l p l a n t s and to the nature o f t h e i r r e l a t i o n s h i p s w i t h the s t a f f and the a d m i n i s t r a -t i o n . There i s evidence i n the data to support the n o t i o n f r e q u e n t l y expressed i n the l i t e r a t u r e , t h a t the i n s t i t u t i o n s 88 a r e r u n more a l o n g the l i n e s o f a h o s p i t a l than a home, a l t h o u g h a number o f the a d m i n i s t r a t o r s , s t a t e d t h a t t hey t r i e d t o a v o i d t h i s . The r e s p o n d e n t s appear t o h i g h l i g h t t h e s e r v i c e s and r e s o u r c e s a v a i l a b l e t o them, b u t the f e e l i n g o f b e i n g p e r i p h e r a l as a r e s u l t o f the l a c k o f independence and autonomy was e v i d e n t i n more th a n one i n s t i t u t i o n . R a t h e r t h a n t h e r e s p o n d e n t s b e i n g the predominant s o c i a l f o r c e , i t i s f e l t t h a t the i n s t i t u t i o n a l s t r u c t u r e permeates and t o an e x t e n t d i c t a t e s the e x p e c t e d and a c t u a l way o f l i f e . I t would appear as i f the assessment o f s a t i s f a c t i o n i s measured by the degree t o w h i c h the re s p o n d e n t s see themselves as h a v i n g become a s s i m i l a t e d i n t o the e x i s t i n g s t r u c t u r e . The d i s c r i m i n a n t a n a l y s e s i n v o l v i n g r e s i d e n t i a l s a t i s -f a c t i o n v a r i a b l e s show t h a t t h e r e a r e s i g n i f i c a n t d i f f e r e n c e s between the f i f t e e n i n s t i t u t i o n s , and t h e s e would seem t o be r e l a t e d t o the a v a i l a b i l i t y and s a t i s f a c t i o n w i t h the s e r -v i c e s and a c t i v i t i e s w i t h i n the b u i l d i n g s and i n the immediate v i c i n i t y . The tendency i s f o r low l e v e l s o f s a t i s f a c t i o n t o be r e l a t e d t o the l a c k o f a c c e s s i b i l i t y and p r o x i m i t y t o the d e s i r e d s e r v i c e s , and as can be d i s c e r n e d from t h e c a n o n i c a l c o r r e l a t i o n s , t h i s seems t o r e s u l t i n lower l e v e l s o f l i f e s a t i s f a c t i o n , and more n e g a t i v e assessments o f t h e l o c a l e n v i -ronment. A l s o , where m o b i l i t y i s reduced t h r o u g h i n f i r m i t i e s , s a t i s f a c t i o n w i t h the r e s i d e n c e i s l e s s e n e d . One o f the i n d i c a t o r s o f the u n s u i t a b i l i t y o f t h e r e s i d e n t i a l s e t t i n g s i s the i n c r e a s i n g number o f hours the re s p o n d e n t s spend i n t h e i r rooms w a t c h i n g t e l e v i s i o n o r l i s t e n i n g t o the r a d i o . 89 The re s u l t s of the Pearson correlations would seem to reinforce this assumption as i t can be seen that levels of s a t i s f a c t i o n were s i g n i f i c a n t l y lower for those who spent more time i n their rooms. The reasons given for r e s i d e n t i a l d i s s a t i s f a c t i o n tend to be related to personal problems, such as the respondents' i n a b i l i t y to look after themselves. There was also d i s s a t i s -f a ction voiced about the perceived stigma attached to being in an i n s t i t u t i o n . There was evidence of a strong d i s l i k e for mixing senile residents with those who are mentally a l e r t . Some of the respondents remarked that they f e l t i l l at ease with the senile residents, on the basis that what they could see i n the senile residents, they could picture i n themselves at some future point i n time. This i s a p a r t i c u l a r l y complex si t u a t i o n to resolve as there are undoubtedly benefits to be derived from continued int e r a c t i o n for the senile residents, and as has been suggested i n the gerontological l i t e r a t u r e , we are not sure whether or not some aspects of s e n i l i t y are in fact s o c i a l l y produced, the r e s u l t of an i n a b i l i t y to adjust to the i n s t i t u t i o n a l regime. The data and findings discussed i n this section reinforce the notion that the r e s i d e n t i a l milieux are extremely important aspects of the respondents' s a t i s f a c t i o n and psychological well-being. It would appear that the o v e r a l l l e v e l of r e s i d e n t i a l s a t i s f a c t i o n i s high for the majority of the respondents, but at the same time, i t i s f e l t that this i s very c l o s e l y related to the p a r t i c u l a r conditions which necessitate t h e i r being i n 90 an i n s t i t u t i o n . Many o f the r e s p o n d e n t s seem t o have few o p t i o n s open t o them i f t h e r e i s no one t o l o o k a f t e r them when they a r e no l o n g e r a b l e t o remain i n t h e i r own homes. The r e s u l t i s t h a t the i n s t i t u t i o n becomes t h e i r l a s t home, and they have v i r t u a l l y l i t t l e a l t e r n a t i v e but t o be as s a t i s f i e d as t h e y can. However, t h i s does n o t i m p l y t h a t the l i v i n g arrangements a r e the most a p p r o p r i a t e t o f u l f i l l t h e i r s o c i a l as w e l l as t h e i r m e d i c a l needs. To r e v i e w , a number o f p o i g n a n t c r i t i c i s m s were e x p r e s s e d i n the i n t e r v i e w s c o n c e r n i n g the l a c k o f t h i n g s t o do and p l a c e s t o go, and i t was e v i d e n t on a number o f o c c a s s i o n s t h a t l o n e l i -n e ss and a l a c k o f purpose were a f f e c t i n g the w e l l - b e i n g o f some o f t h e r e s p o n d e n t s . L e v e l s o f s a t i s f a c t i o n appeared t o be c l o s e l y r e l a t e d t o the s u p e r v i s o r y and h e a l t h - c a r e components i n the i n s t i t u t i o n s , b u t the f e e l i n g ; o f s e c u r i t y and s a f e t y w h i c h t h i s a f f o r d e d was o f f s e t by the l o s s o f independence and the st i g m a a s s o c i a t e d w i t h b e i n g u n a b l e t o l o o k a f t e r o n e s e l f . However, v e r y few n e g a t i v e remarks were made about the q u a l i t y o f the i n s t i t u t i o n s , and i n f a c t , many re s p o n d e n t s commented upon the h i g h l y e f f i c i e n t o r g a n i z a t i o n and h i g h l i g h t e d the f a c t t h a t the s t a f f were a major p o s i t i v e i n f l u e n c e . I t i s su g g e s t e d however, t h a t an e x a m i n a t i o n o f the rea s o n s g i v e n f o r the r e s p o n d e n t s ' d i s s a t i s f a c t i o n may p r o v i d e u s e f u l i n s i g h t s f o r p l a n n i n g and o r g a n i z a t i o n a l r e c o n s i d e r a t i o n s and c o u l d be v e r y u s e f u l i n h e l p i n g t o f o r m u l a t e more e x p l i c i t s i t e s e l e c t i o n c r i t e r i a . A l t h o u g h none o f the i n s t i t u t i o n s a re i n c o m p l e t e l y i n a p p r o p r i a t e l o c a t i o n s , few o f them seem t o be c l o s e l y i n t e g r a t e d w i t h the s u r r o u n d i n g communities. The p r e s e n c e o f s e r v i c e s and f a c i l i t i e s 91 w i t h i n the b u i l d i n g s do compensate to an extent, but the problem remains t h a t many of the respondents do not seem to have a v a r i e t y o f o p p o r t u n i t i e s f o r meaningful s o c i a l a c t i v i t i e s . There i s an attendant problem f o r the e i g h t y and n i n e t y year o l d r e s i d e n t s i n that they are not p a r t i c u l a r l y o r i e n t e d toward l e i s u r e a c t i v i t i e s . T h e i r working l i v e s were i n a l l l i k e l i h o o d c h a r a c t e r i z e d by the P r o t e s t a n t Work E t h i c , and as a r e s u l t , there appears to be some d i f f i c u l t y i n g e t t i n g them to p a r t i c i -pate i n l e i s u r e p u r s u i t s . T h i s p a t t e r n appears to be changing w i t h subsequent generations but remains a t prese n t one of the most confounding problems f o r a c t i v i t y d i r e c t o r s and t h e r a p i s t s . In the next s e c t i o n the d i s c u s s i o n w i l l focus on the r e l a -t i v e s u i t a b i l i t y of the f i f t e e n i n s t i t u t i o n s i n terms of t h e i r a c c e s s i b i l i t y and p r o x i m i t y to community s e r v i c e s and f a c i l i t i e s . The respondents' m o b i l i t y p a t t e r n s and p e r c e p t i o n s of the l o c a l environments w i l l be examined, and the i m p l i c a t i o n s of s i t u a t i o n a l drawbacks such as t o p o g r a p h i c a l and other b a r r i e r s to communica-t i o n w i l l be o u t l i n e d . The S u i t a b i l i t y of the Environmental M i l i e u x The f i f t e e n i n s t i t u t i o n s have v e r y d i f f e r e n t l o c a t i o n s , r a n g i n g from r e s i d e n t i a l neighbourhoods i n i n n e r c i t y l o c a l e s or o l d e r suburban areas, to predominately i n d u s t r i a l areas to s i t e s which are not p a r t i c u l a r l y a p p r o p r i a t e because of b a r r i e r s or r e l a t i v e i s o l a t i o n . Nonetheless, the m a j o r i t y o f the respon-dents i n d i c a t e d t hat they were g e n e r a l l y s a t i s f i e d w i t h the l o c a l environments, although there may w e l l be a degree of 92 acquiescence e v i d e n t , p a r t i c u l a r l y i n the responses to questions 10 and 28. .A r e l a t i v e l y h i g h degree of p a s s i v i t y among r e s i d e n t s was observed i n each of the i n s t i t u t i o n s surveyed, and i t i s argued that the h i g h l e v e l of s a t i s f a c t i o n does not r e f l e c t h i g h l e v e l s o f i n t e r a c t i o n w i t h the surrounding neighbourhoods. Rather, i n the i n s t i t u t i o n s which have dynamic views, and i n which there i s c o n s i d e r a b l e a c t i v i t y , i t i s suggested t h a t the more i n a c t i v e respondents d e r i v e t h e i r s a t i s f a c t i o n from merely watching what goes on around them. For example, i n s t i t u t i o n s J , K, N and P are s i t u a t e d i n areas where there i s a c o n s i d e r a b l e amount of a c t i v i t y i n the immediate neighbourhoods, and i t i s p o s s i b l e f o r the respondents to be aware of t h i s from the r e l a t i v e s a f e t y of the i n s t i t u t i o n s . On the other hand, i n s t i t u t i o n s A, F, L and M have developed the grounds around the b u i l d i n g s to enable the r e s i d e n t s to get o u t s i d e i f they d e s i r e , but at the same time, they do not have to worry about managing the busy s t r e e t s , steep h i l l s and the t r a f f i c i n the neighbourhoods. In the case of i n s t i t u t i o n s B, H and to an extent G, the l o c a l environments do not appear to prese n t major problems f o r the more mobile r e s i d e n t s , although a c c e s s i b i l i t y to l o c a l s e r v i c e s and f a c i l i t i e s can be p r o b l e m a t i c without t r a n s p o r t a t i o n , par-t i c u l a r l y i n w i n t e r . I n s t i t u t i o n s C and D are i d e n t i c a l b u i l d i n g s but they are s i t u a t e d i n v a s t l y d i f f e r e n t l o c a t i o n s , the Vancouver s i t e (C) b e i n g i n a predominately r e s i d e n t i a l area c l o s e to shops, a park and an extended care u n i t , and i s on a major p u b l i c t r a n s i t r o u t e , whereas the Burnaby l o c a t i o n (D), i s probably the most disadvantaged of a l l . The i n s t i t u t i o n was b u i l t a t the top of a p a r t i c u l a r l y steep i n c l i n e and 93 a c c e s s i b i l i t y and p r o x i m i t y to s e r v i c e s and f a c i l i t i e s are poor. There i s an extremely busy s t r e e t a t the bottom of the h i l l which l i n k s up wi t h one of the major freeways i n the area, and as a r e s u l t , c r o s s i n g the s t r e e t p r e s e n t s major problems f o r many r e s i d e n t s . The s t a f f a l s o i n d i c a t e d t hat there was a problem w i t h those r e s i d e n t s who had a tendency to wander, suggesting t h a t the area around the i n s t i t u t i o n was hazardous at times f o r them. Both i n s t i t u t i o n s were designed t o be i n -wardly o r i e n t e d , the emphasis being on c r e a t i n g s e l f - s u f f i c i e n t communities w i t h i n the c o n f i n e s of the b u i l d i n g s and grounds. There i s t h e r e f o r e l e s s emphasis p l a c e d on encouraging r e s i d e n t s to use the l o c a l neighbourhoods i f t h e i r i n f i r m i t i e s would make t h i s p r o b l e m a t i c . Thus, i t i s d i f f i c u l t to assess what the h i g h l e v e l s of s a t i s f a c t i o n w i t h the l o c a l environments r e f e r t o , and whether i n f a c t the s e t t i n g s do s a t i s f y the needs of the respondents by p r o v i d i n g them w i t h a v a r i e t y o f oppor-t u n i t i e s to enhance t h e i r s o c i a l w e l l - b e i n g . One v e r y c o n s i s t e n t s et of responses which seem to a c c u r a t e l y r e f l e c t the s u i t a b i l i t y of the l o c a l environments concern the respondents' s a t i s f a c t i o n w i t h the grounds of the i n s t i t u t i o n s (Q36). The lan d s c a p i n g , paths, s e a t i n g areas and the c o n d i t i o n of the sidewalks around the i n s t i t u t i o n s were c o n s i s t e n t l y regarded as being s a t i s f a c t o r y . I t would appear t h a t these areas are e x t e n s i v e l y used by r e s i d e n t s when the weather permits, and even those who are not p a r t i c u l a r l y ambula-t o r y have the o p p o r t u n i t y of g e t t i n g o u t s i d e . Few of the respondents f e l t t h a t there was a p a r t i c u l a r problem w i t h t r a f f i c around the i n s t i t u t i o n s (Table 24), e i t h e r i n terms 94 of n o i s e or r i s k . Those whose rooms f a c e d a major road d i d mention t h a t on o c c a s s i o n t r a f f i c n o i s e bothered them, but t h i s was o f t e n q u a l i f i e d a n e c d o t a l l y by some who suggested t h a t a p o s i t i v e consequence of the n o i s e problem was t h a t as long as they c o u l d hear the t r a f f i c , they were not g e t t i n g deaf. There a l s o d i d not appear to be a problem w i t h crime i n the area surrounding the i n s t i t u t i o n s , and the s e c u r i t y and s a f e t y c o n t r o l s seemed to be r e a s s u r i n g to the respondents, although, i t was r e p o r t e d that i n a few cases, problems had a r i s e n w i t h people posing as l e g i t i m a t e tradesmen or salespersons s t e a l i n g from the r e s i d e n t s . As a consequence of t h i s , t here was a very n o t i c e a b l e s u s p i c i o n of o u t s i d e r s , u n t i l t h e i r c r e d e n t i a l s had been v e r i f i e d , a s i t u a t i o n which seemed to p r o v i d e a common bond among the r e s i d e n t s and an i d e n t i f i c a t i o n w i t h the i n s t i -t u t i o n as t h e i r p r o p e r t y to be defended. I t was assumed p r i o r to the i n v e s t i g a t i o n t h a t the impor-tance of l i v i n g i n the same g e n e r a l area as t h e i r c h i l d r e n would be an important aspect of the respondents' p e r c e i v e d s a t i s f a c t i o n w i t h the l o c a t i o n of the i n s t i t u t i o n . I n t e r e s t i n g l y , t h i s d i d not prove to be the case i n n i n e of the f i f t e e n p l a c e s . The respondents i n the e t h n i c i n s t i t u t i o n s E and F (French and German Canadians) f e l t t h a t t h i s was only somewhat important whereas the Jewish and Chinese respondents (K and N) thought t h a t i t was not a t a l l important. I t i s i n t e r e s t i n g to note that each of the f o u r e t h n i c i n s t i t u t i o n s were s i t u a t e d i n areas w i t h s i g n i f i c a n t c o n c e n t r a t i o n s of the p a r t i c u l a r e t h n i c groups, and thus, the r e s u l t s do not appear to be a f u n c t i o n of l o c a t i o n . In the other i n s t i t u t i o n s , the m a j o r i t y of 95 respondents i n A and J d i d not f e e l t h a t l i v i n g i n the same area as t h e i r c h i l d r e n was very important, whereas those i n G, H and R f e l t i t was somewhat important. The responses to t h i s q u e s t i o n (Q9) were compared w i t h the data obtained on the amount of co n t a c t respondents had w i t h those of t h e i r c h i l d r e n who l i v e d i n the Greater Vancouver Regio n a l D i s t r i c t , and i t was sur-p r i s i n g to. note t h a t the respondents who f e l t t h a t i t was only somewhat important to l i v e i n the same area as t h e i r c h i l d r e n had more than the average number of c h i l d r e n l i v i n g i n c l o s e p r o x i m i t y . There e x i s t s w i t h i n the g e r o n t o l o g i c a l l i t e r a t u r e an u n r e s o l v e d debate concerning the type of l i v i n g arrangements (segregated or i n t e g r a t e d ) and hence, the type of neighbours p r e f e r r e d by o l d e r people. T h i s debate has tended not to i n c l u d e r e s i d e n t s of i n s t i t u t i o n s , but as can be d i s c e r n e d from the a n a l y s i s , o p i n i o n s on t h i s i s s u e seem to vary widely. Over one t h i r d of a l l those i n t e r v i e w e d were i n d i f f e r e n t as to the age of t h e i r p r e f e r r e d neighbours, and l e s s than 10% expressed a d e s i r e to have e x c l u s i v e l y younger people. The remaining 60% were d i v i d e d evenly between those who p r e f e r r e d neighbours of the same age and those who p r e f e r r e d people of d i f f e r e n t ages. There were again i n t e r e s t i n g d i f f e r e n c e s i n the responses across the f i f t e e n i n s t i t u t i o n s , w i t h more than the average p r e f e r r i n g neighbours of the same age i n i n s t i t u t i o n s A and C, whereas i n B, and to an extent i n M, there was a d e s i r e f o r younger neighbours, which i n p a r t r e f l e c t s the composition of the host communities. The tendency i n K and L was f o r a p r e -f e r e n c e f o r people of d i f f e r e n t ages whereas respondents i n 96 i n s t i t u t i o n H were d i v i d e d between those who p r e f e r r e d people of the same age and those who p r e f e r r e d a mixture. S i m i l a r l y , i n N, the d i v i s i o n was between neighbours o f d i f f e r e n t ages and those who were i n d i f f e r e n t , and i n M, between younger people and a mixture. The respondents i n the Burnaby l o c a t i o n D were completely d i v i d e d between the range of p o s s i b l e answers, and t h e i r responses were v e r y s i m i l a r to the o v e r a l l averages out-l i n e d above. I t i s suggested on the b a s i s of the f o r e g o i n g d i s c u s s i o n that there i s no one type o f l i v i n g arrangement which w i l l s u i t the needs of a l l of the respondents. I t would appear that there i s a need f o r as much v a r i a t i o n as p o s s i b l e to ensure that the o l d e r people have the cho i c e s to s u i t t h e i r p r e f e r e n c e s . How-ever, at the prese n t time, the demographic composition of areas p r o j e c t e d f o r p o s s i b l e s i t i n g of i n s t i t u t i o n s does not seem to be an important c o n s i d e r a t i o n , although i t c o u l d enhance the p o t e n t i a l f o r s o c i a l i n t e r a c t i o n between r e s i d e n t s and the l o c a l community. The s u i t a b i l i t y o f the environmental m i l i e u x i s a f f e c t e d not o n l y by the q u a l i t y of the ground w i t h i n which the i n s t i t u -t i o n s stand, but a l s o by t h e i r p r o x i m i t y and a c c e s s i b i l i t y to community s e r v i c e s and f a c i l i t i e s , and a l s o by the r e s i d e n t s ' a b i l i t y and d e s i r e to make use of them. As the m a j o r i t y of the r e s i d e n t s are i n need of at l e a s t some form of n u r s i n g s u p e r v i s i o n and medical care, they tend to be l e s s mobile than they were at one time. Many of the people i n t e r v i e w e d expres-sed the i d e a that t h e i r a b i l i t y to move around i n the e n v i r o n -ment p r o v i d e d both s a t i s f a c t i o n and a c h a l l e n g e . Being able 97 t o go o u t s i d e w i t h o u t a s s i s t a n c e was used i n some i n s t a n c e s as a guage o f how w e l l a p e r s o n was m a i n t a i n i n g a t l e a s t some independence. The l o c a l environment can be an e x t r e m e l y impor-t a n t element i n the home range o f the r e s i d e n t s p r o v i d i n g t h a t t h e r e a r e s e r v i c e s and f a c i l i t i e s w i t h i n easy a c c e s s w h i c h they can u t i l i z e . I n an attempt t o e s t a b l i s h how w e l l s u i t e d the l o c a l neighbourhoods were t o the needs and p r e f e r e n c e s o f the e l d e r l y r e s i d e n t s , q u e s t i o n s were i n c l u d e d i n the q u e s t i o n n a i r e c o n c e r n i n g the p r o x i m i t y and a c c e s s i b i l i t y o f a s e r i e s o f s e r -v i c e s w h i c h were f e l t t o be i m p o r t a n t ( T a b l e 25). The d a t a suggest t h a t the m a j o r i t y o f the s e r v i c e s (shops, v a r i e t y o r c o r n e r s t o r e s , m e d i c a l o f f i c e s , c h u r c h e s , h o s p i t a l s and p a r k s ) were r e l a t i v e l y a c c e s s i b l e e i t h e r by w a l k i n g or by p u b l i c t r a n s p o r t a t i o n . Almost 90% o f the r e s p o n d e n t s s t a t e d t h a t t h e r e was a bus sto p w i t h i n two b l o c k s o f the i n s t i t u t i o n , and the g e n e r a l i m p r e s s i o n o f the p u b l i c t r a n s i t system was f a v o u r a b l e . Shopping c e n t r e s and a v a r i e t y o r c o r n e r s t o r e appear t o be the most a c c e s s i b l e t o the m a j o r i t y o f the r e s p o n d e n t s , and a l t h o u g h p a r k s , c h u r c h e s , h o s p i t a l s and l i b r a r i e s were n o t i n c l o s e p r o x i m i t y , t h e y were a c c e s s i b l e by bus. Med i -c a l o f f i c e s , s e n i o r c i t i z e n s ' c e n t r e s and community c e n t r e s were g e n e r a l l y r e g a r d e d as b e i n g d i f f i c u l t t o get t o , and a r e l a t i v e l y h i g h p r o p o r t i o n o f the re s p o n d e n t s d i d n o t know i f th e y were a v a i l a b l e . The r e s u l t s o f the d i s c r i m i n a n t a n a l y s i s o f the presence o f community f a c i l i t i e s ( T a b le 44) r e v e a l t h a t t h e r e were s i g n i f i c a n t d i f f e r e n c e s between each o f the i n s t i t u -t i o n s . A t o t a l o f f i v e s i g n i f i c a n t s t a n d a r d i z e d d i s c r i m i n a n t f u n c t i o n c o e f f i c i e n t s were produced ( r < 0.001) s u g g e s t i n g t h a t 98 some of the l o c a t i o n s were r e l a t i v e l y more advantaged than o t h e r s . S i m i l a r f i n d i n g s were produced from the r e s u l t s of the c a n o n i c a l c o r r e l a t i o n a n a l y s i s shown i n Table 31. The r e s u l t s show a tendency f o r s e n i o r c e n t r e s and medical o f f i c e s to be p e r c e i v e d as not being as a c c e s s i b l e as l i b r a r i e s , churches and corner s t o r e s by those respondents who seldom l e f t the i n s t i t u t i o n s . The n i n e questions which r e f e r d i r e c t l y to the p r o x i -mity and a c c e s s i b i l i t y of l o c a l s e r v i c e s and f a c i l i t i e s (Q15), were used to d e r i v e an o v e r a l l impression of the s u i t a b i l i t y of the l o c a l neighbourhoods. The r e s u l t s show that the respon-dents i n i n s t i t u t i o n s C, D, G, H, K and M regarded the s e l e c t e d s e r v i c e s as being d i f f i c u l t to get to, or e l s e were u n a v a i l a b l e or unknown to them. In terms of s p e c i f i c s e r v i c e s , i n v e s t i g a -t i o n r e v e a l e d that A, J , N and P are s i t u a t e d i n l o c a t i o n s where s e r v i c e s are i n c l o s e s t p r o x i m i t y , although t h i s i s not n e c e s s a r i l y r e f l e c t e d i n the respondents' p e r c e p t i o n s . The r e s u l t s o f the respondents' e v a l u a t i o n of the e n v i r o n -ments surrounding the i n s t i t u t i o n s r e v e a l t h a t they are r e l a -t i v e l y s a t i s f i e d w i t h the l o c a t i o n s . These p e r c e p t i o n s however, do not f u l l y r e f l e c t the a c t u a l p r o x i m i t y and a c c e s s i b i l i t y . The m o b i l i t y p a t t e r n s , which w i l l be d i s c u s s e d s h o r t l y , show that there i s not a h i g h degree of i n t e r a c t i o n w i t h the l o c a l neighbourhoods. T h i s i s a n t i t h e t i c a l to the p e r c e p t i o n s , and i n e f f e c t , questions the i n t e r p r e t a t i o n of the responses at f a c e v a l u e . The apparent c o n t r a d i c t i o n can be a t t r i b u t e d to a v a r i e t y of reasons, and i n the present context i t w i l l be argued that acquiescence and the p e r c e p t i o n s of the r e l a t i v e l y h i g h pro-p o r t i o n of the respondents who do not and cannot leave the 99 p r e m i s e s , mask the f a c t t h a t a number o f t h e i n s t i t u t i o n s have c o m p a r a t i v e l y i n a p p r o p r i a t e l o c a t i o n s because o f t o p o g r a p h i c a l b a r r i e r s and the r e s p o n d e n t s ' i n a b i l i t y t o manage t h e i r e n v i r o n -ments. M o b i l i t y P a t t e r n s as I n d i c a t o r s o f I n t e r a c t i o n I t would appear t h a t i n a l l b u t f o u r o f the i n s t i t u t i o n s (E, H, J and N) a t l e a s t 25% o f a l l the r e s p o n d e n t s s t a t e d t h a t t h ey d i d n o t l e a v e the c o n f i n e s o f the i n s t i t u t i o n s . I n the case o f i n s t i t u t i o n s B, C, D, G, K and M a t l e a s t h a l f o f the r e s p o n d e n t s d i d n o t go o u t s i d e p l a c i n g more of an onus upon the s t a f f t o compensate f o r the l o s s . I n each o f the i n s t i t u -t i o n s , w i t h the e x c e p t i o n o f K, a t l e a s t two t h i r d s o f the r e s p o n d e n t s i n d i c a t e d t h a t t hey c o u l d go out i n t o the s t r e e t s by t h e m s e l v e s , but more than 25% o f those i n i n s t i t u t i o n s B, C, D, G, H, K, L, M and R c o u l d n o t w alk f o r s i x b l o c k s and back i f t h e y had t o do something. T h i s s u g gests t h a t i f s e r v i c e s and f a c i l i t i e s a r e t o b e n e f i t t h e s e p e o p l e , t h e y s h o u l d be w i t h -i n t h i s c r i t i c a l d i s t a n c e , a l t h o u g h t h i s was n o t always the case. The r e s u l t s o f the d i s c r i m i n a n t a n a l y s i s o f m o b i l i t y p a t t e r n s by each r e s i d e n c e (Table 42) i n d i c a t e s t h a t seven v a r i -a b l e s s i g n i f i c a n t l y d i s c r i m i n a t e d between the f i f t e e n i n s t i t u -t i o n s . I n f a c t , f o u r s i g n i f i c a n t f u n c t i o n s were produced. The amount o f time w h i c h r e s p o n d e n t s spent o u t s i d e the i n s t i t u t i o n was s i g n i f i c a n t i n two o f the f o u r f u n c t i o n s , and from the d a t a i t would seem t h a t an average o f 437Q o f t h e t o t a l sample v e r y r a r e l y went o u t s i d e . Only i n i n s t i t u t i o n s A, E, F, H, J , L, N 100 and R, d i d more respondents than average go-outside. .From the c a n o n i c a l c o r r e l a t i o n i n Table 30, i t can be seen that there i s a tendency f o r those who are r e l a t i v e l y more mobile to have h i g h e r l e v e l s of l i f e s a t i s f a c t i o n , and thus, i t can be suggested t h a t the lower morale evident i n almost h a l f the i n s t i t u t i o n s i s i n p a r t a t t r i b u t a b l e to the f a c t t h a t the respondents l e a d more r e s t r i c t e d l i v e s . As they are l e s s able to i n t e r a c t w i t h the o u t s i d e environment, t h e i r r e s i d e n t i a l m i l i e u x are d e f i n e d by the d w e l l i n g u n i t s . As a c o r o l l a r y to t h i s , more respondents i n the i n s t i t u t i o n s w i t h more than average numbers of immobile people s t a t e d t h a t they d i d not have enough to do to occupy t h e i r days i n the l o c a l area. In an e f f o r t to o b t a i n an o v e r a l l impression of the r e l a t i v e p a t t e r n s of m o b i l i t y , f i f t e e n q uestions r e l a t i n g to the theme of m o b i l i t y were grouped f o r a n a l y s i s (Appendix 10). The average responses to the questions were t a b u l a t e d and each of the i n s t i t u t i o n s were compared to the averages. From the r e s u l t s , i t would seem that a h i g h e r p r o p o r t i o n of the r e -spondents i n i n s t i t u t i o n A were more mobile than those i n the other p l a c e s . For example, more respondents than average c o u l d and d i d go out i n t o the s t r e e t s by themselves, and c o u l d walk s i x b l o c k s and back i f necessary. They tended to spend more time o u t s i d e and f e l t t h a t there was enough f o r them to do i n the l o c a l area. More used the p u b l i c t r a n s i t system although more s t a t e d t h a t they had t r o u b l e u s i n g the bus, and a h i g h e r p r o p o r t i o n went on o r g a n i z e d bus o u t i n g s . T h i s can perhaps be a t t r i b u t a b l e to the f a c t t h a t fewer than average s t a t e d that they had a v a i l a b l e and used, a v o l u n t e e r t r a n s p o r t a t i o n s e r v i c e . 101 It was also i n t e r e s t i n g to note that fewer than average numbers went outside either to go shopping or to v i s i t friends, and although 45% went for drives with their families, fewer needed to go on medically related t r i p s . The respondents i n i n s t i t u t i o n C were perhaps the least mobile of the f i f t e e n i n s t i t u t i o n s , but as has been pre-viously pointed out, this may be due i n part to the fact that the orientation was toward creating an enclosed community. Con-siderably fewer than average numbers went outside and this was r e f l e c t e d i n the fact that more of the respondents f e l t that they did not have enough to do to occupy t h e i r time i n the surrounding neighbourhood. Three of the variables which s i g n i f i c a n t l y d i f f e r e n t i a t e d the mobility patterns i n the f i f t e e n i n s t i t u t i o n s are the a v a i l -a b i l i t y of help with transportation by a r e l a t i v e or friend, the number of times the respondents used the public t r a n s i t , and going for drives with th e i r family during a month (Table 42). There would appear to be a tendency for more of the respondents in A, B, D, F, H and M to receive help with transportation, and as a consequence, more of them went on t r i p s with their families. The results of the analyses indicate that there are important relationships between the amount of time the respondents spend outside the i n s t i t u t i o n s and th e i r mobility patterns. From the Pearson correlations (Table 36), i t would appear that e s p e c i a l l y among the Personal care respondents those who perceived t h e i r health status to be good, tended to spend more time outside. The Intermediate care respondents seemed to spend more time i n the i r rooms and stated that t h e i r health status was poorer. 102 I t would a l s o seem to be the case that the p r o x i m i t y and acces-s i b i l i t y of l o c a l s e r v i c e s and f a c i l i t i e s p r e d i c t e d the amount of time the respondents spent o u t s i d e (Table. 35) .. I t can be argued from these data that the v e r y favour-a b l e p e r c e p t i o n s of the environmental s e t t i n g s must be i n t e r -p r e t e d w i t h c a u t i o n . The p a t t e r n s of m o b i l i t y which can be d i s c e r n e d i l l u s t r a t e the p o i n t that i n t e r a c t i o n w i t h the l o c a l neighbourhood pres e n t s major problems f o r a s u b s t a n t i a l propor-t i o n of the respondents. The r e s i d e n t i a l m i l i e u x have c o n t r a c t e d to such an extent that f o r many the m i l i e u i s the i n s t i t u t i o n . I t would seem to be c o n t i n g e n t upon the p l a n n e r s , organ-i z e r s and a d m i n i s t r a t o r s to p r o v i d e environments to help the r e s i d e n t s compensate f o r the l o s s of c o n t a c t w i t h the o u t s i d e . The primary focus should t h e r e f o r e be on f i n d i n g out what types of l o c a t i o n s are best s u i t e d to the needs of the r e l a t i v e l y immobile. T h i s would seem to run c o n t r a r y to the c r i t e r i a cur-r e n t l y being adopted, which have more to do w i t h budget c o n s i d e r -a t i o n s than humanistic concerns. Although i t i s conceded t h a t very few i n s t i t u t i o n s would be b u i l t i f o n l y o p t i m a l s i t e s were chosen, the problem remains that i n c e r t a i n cases the present l o c a t i o n s are i n a p p r o p r i a t e . The s o c i a l i m p l i c a t i o n s of t h i s are t h a t an a l r e a d y v u l n e r a b l e s e c t o r of the community s u f f e r even more. S o c i a l i s o l a t i o n i s perhaps one of the the most d e t r i m e n t a l a t t r i b u t e s of i n s t i t u t i o n a l l i v i n g , as f o r some of the r e s i d e n t s i t may r e s u l t i n a l o s s of purpose and the f e e l i n g t h a t there i s n o t h i n g l e f t f o r them to do. I n d i c a t i o n s of t h i s were evident i n i n t e r v i e w s conducted, and can be d i s c e r n e d from responses to the open-ended q u e s t i o n s . 103 One way i n which the l a c k of meaningful s o c i a l a c t i v i t y i s m a n i f e s t can be seen i n the number of hours per day many respondents spend i n the s o l i t u d e of t h e i r rooms. T h i s does not deny that many r e s i d e n t s p r e f e r and at times need the p r i v a c y of t h e i r own room, and that there are a number of a c t i v i -t i e s which are c a r r i e d on i n the rooms. Rather, the suggestion i s b e i n g made that the unintended consequences of being too p r i v a t e can r e s u l t i n the v i r t u a l estrangement from the r e s t of s o c i e t y and the r e l i a n c e upon the i n s t i t u t i o n a l way of l i f e . The s i t u a t i o n i s made more complex when the p r i v a c y i s enforced because of an i n a b i l i t y to i n t e r a c t w i t h the environment or as a r e s u l t of the l a c k of r e s i d e n t i a l and/or neighbourhood s e r -v i c e s and f a c i l i t i e s . From Table 36 i t can be seen t h a t there i s a h i g h e r degree of r e s i d e n t i a l s a t i s f a c t i o n shown by those who spend l e s s time i n t h e i r room. I n t e r e s t i n g l y , the r e s u l t s of the d i s c r i m i n a n t analyses suggest t h a t there i s a tendency f o r the respondents i n P e r s o n a l care to spend more hours i n t h e i r rooms, but t h i s i s c o n t r a s t e d w i t h the f a c t t h a t they are able to leave the i n s t i t u t i o n more o f t e n then the Intermediate respondents. They a l s o appear to be r e l a t i v e l y more s a t i s f i e d w i t h t h e i r homes, and from the r e s u l t s of the r e g r e s s i o n analyses, i t would seem t h a t the number of hours spent i n the room s i g n i -f i c a n t l y p r e d i c t s l e v e l s of l i f e s a t i s f a c t i o n . More e x a c t l y , the more time the respondents spend i n t h e i r rooms, the more l i k e l y they are to f e e l t h a t they do not have enough to do most days, t h a t t h e i r h e a l t h s t a t u s i s poorer, and as a c o r o l l a r y , they are l e s s s a t i s f i e d w i t h t h e i r l i v e s at the p r e s e n t time. The r e s u l t s of the c a n o n i c a l analyses seem to imply t h a t when 104 there are fewer f a c i l i t i e s w i t h i n the b u i l d i n g s , respondents spend more time i n t h e i r rooms (Table 34). In s h o r t , the argu-ment has been made th a t i n order to prevent s o c i a l i s o l a t i o n and a l i e n a t i o n i t i s e s s e n t i a l to p r o v i d e a p p r o p r i a t e on s i t e f a c i l i t i e s to augment or compensate f o r neighbourhood s e r v i c e s . At p r e s e n t however, th e r e are few g u i d e l i n e s a v a i l a b l e which can be r e a d i l y implemented, and a l s o , there i s l i t t l e consensus as to what c o n s t i t u t e s a p p r o p r i a t e s e r v i c e s and f a c i l i t i e s . The i m p l i c a t i o n s which t h i s s i t u a t i o n have on the morale of the respondents w i l l now be d i s c u s s e d . M i l i e u x S u i t a b i l i t y and Morale Morale v a r i e d c o n s i d e r a b l y between the f i f t e e n i n s t i t u -t i o n s and consequently, an o v e r a l l impression i s d i f f i c u l t to determine. However, one p a r t i c u l a r l y i n t e r e s t i n g r e s u l t to emerge was that lower l e v e l s of s a t i s f a c t i o n were expressed on two of the l i f e s a t i s f a c t i o n v a r i a b l e s (LISAT and SAT2DA) i n the f o u r e t h n i c i n s t i t u t i o n s . T h i s p a t t e r n was not r e c o g n i z a b l e i n any of the other v a r i a b l e s , and does not appear to be a t t r i b u t a b l e to any one i n f l u e n c e o p e r a t i n g i n these p l a c e s . The m a j o r i t y of the respondents i n each of the i n s t i t u -t i o n s appear to have a good r e l a t i o n s h i p w i t h t h e i r f a m i l i e s . From the data i t would appear that d i f f e r e n c e s i n the amount of c o n t a c t w i t h c h i l d r e n , r e l a t i v e s and f r i e n d s v a r y more w i t h i n each of the i n s t i t u t i o n s than between them, although the p r o p o r t i o n of respondents having no c o n t a c t w i t h t h e i r s i g n i f i -cant others i s h i g h . T h i s s i t u a t i o n i s e s p e c i a l l y e v i d e n t i n ICS-i n s t i t u t i o n s E, G, K, N and P, whereas respondents i n F, H, J and M appear to have c o n s i d e r a b l y more than average contact. With the e x c e p t i o n of i n s t i t u t i o n J , t h i s l a t t e r group had more d i r e c t c o n t a c t w i t h c h i l d r e n , r e l a t i v e s and f r i e n d s r e s i d i n g w i t h i n the Greater Vancouver R e g i o n a l D i s t r i c t . One of the most i n t e r e s t i n g paradoxes i n v o l v e d the r e -spondents' p e r c e p t i o n s of whether or not they have enough to do to occupy t h e i r days. Almost 80% s t a t e d that they had enough to do, but on c l o s e r i n s p e c t i o n , t h i s i s confounded by responses to other q u e s t i o n s . When asked to d e s c r i b e the more important d a i l y problems w i t h which they have to contend, over h a l f the responses r e f l e c t e d the f a c t t h a t many respondents had n e i t h e r any p l a c e to go, nor anything to do (Table 17). There were a l s o attendant problems of i m m o b i l i t y and l o n e l i n e s s , and m e d i c a l l y r e l a t e d problems accounted f o r the other h a l f of the responses. I t would appear t h e r e f o r e that a c e r t a i n d i s c r e p a n c y e x i s t s between the p e r c e i v e d l e v e l s of l i f e s a t i s f a c t i o n (or morale), and the nature and scope of the respondents' problems. Although mention must be made of the remarkable r e s i l i e n c e of many of those i n t e r v i e w e d , and b e a r i n g i n mind that p a s s i v i s m may not n e c e s s a r i l y r e s u l t i n lower l e v e l s of l i f e s a t i s f a c t i o n , i t remains u n c l e a r as to how much the c o n f u s i n g nature of the data can be a t t r i b u t e d to the r e l a t i v e i n a p p r o p r i a t e n e s s of the r e s i d e n t i a l m i l i e u x . I t i s perhaps the case that i n d i v i d u a l d i f f e r e n c e s i n l i f e s a t i s f a c t i o n are more important aspects f o r a n a l y s i s than group d i f f e r e n c e s , but t h i s would r e q u i r e con-s i d e r a b l y more d e t a i l e d i n v e s t i g a t i o n of the l i f e - w o r l d s of the i n d i v i d u a l s than are p r e s e n t l y a v a i l a b l e . I 0 6 Summary Analyses of the data r e i n f o r c e s the importance of having a p p r o p r i a t e r e s i d e n t i a l m i l i e u x to ensure p s y c h o s o c i a l w e l l - b e i n g . The r e s u l t s i n d i c a t e t hat both the r e s i d e n t i a l s e t t i n g s and the neighbourhood environments are p e r c e i v e d as being s a t i s f a c t o r y by the respondents, but t h e i r a b i l i t y to u t i l i z e them and to m a i n t a i n meaningful d a i l y a c t i v i t i e s i s c o n s t r a i n e d by s i t u a t i o n a l drawbacks. These are due i n p a r t to the nature of the problems which a f f l i c t the respondents, the problems which are attendant i n a d j u s t i n g to the i n s t i t u t i o n a l regimen, and those which r e s u l t from the u n s u i t a b i l i t y of l o c a t i o n s which are chosen f o r budgetary r a t h e r than humanistic reasons. L e v e l s of s a t i s f a c t i o n v a r y c o n s i d e r a b l y r e f l e c t i n g the r e l a t i v e m e r i t s and disadvan-tages i n each i n s t i t u t i o n , but the evidence suggests t h a t i m m o b i l i t y i s a s e r i o u s problem f o r a l a r g e p r o p o r t i o n of the respondents. The s o c i a l i m p l i c a t i o n s of the unintended conse-quences of p r o v i d i n g i n a p p r o p r i a t e l o c a t i o n s have been broached and i t i s suggested t h a t more i n v e s t i g a t i o n i s needed i n t h i s area i f s o l u t i o n s are to be achieved. CHAPTER FIVE SUMMARY AND CONCLUSIONS Throughout the course of t h i s t h e s i s , two p r i n c i p a l themes have been explo r e d . F i r s t l y , an attempt has been made to gather, s y n t h e s i z e and analyse i n f o r m a t i o n on the charac-t e r i s t i c s of the respondents which d i f f e r e n t i a t e them from other groups of e l d e r l y people. I t has been suggested that the r e s i d e n t s of i n s t i t u t i o n s are a more v u l n e r a b l e s e c t o r of the community and have p a r t i c u l a r needs and c o n t r a s t i n g pre-f e r e n c e s . The Long Term Care Program i s s t i l l i n i t s i n f a n c y , and not much i s known about how w e l l the p s y c h o - s o c i a l and, i n a d d i t i o n , the h e a l t h - c a r e needs of the r e s i d e n t s are being met w i t h i n the i n s t i t u t i o n s . U n t i l , t h i s study, no attempt has been made to assess the s u i t a b i l i t y o f the l o c a t i o n s of the i n s t i t u t i o n s , and there appear to be few c l e a r g u i d e l i n e s as to what c o n s t i t u t e a p p r o p r i a t e s i t e s e l e c t i o n c r i t e r i a . The s o c i a l needs and p r e f e r e n c e s of the r e s i d e n t s are i l l -d e f i n e d , as are the types of r e s i d e n t i a l environments most s u i t e d to these needs. Much of t h i s i n f o r m a t i o n i s a c t u a l l y a v a i l a b l e w i t h i n each of the i n s t i t u t i o n s , but there i s a d i s t i n c t l a c k of i n t e r - i n s t i t u t i o n a l communication at presen t 107 108 which i s h i n d e r i n g the p r o v i s i o n of e f f e c t i v e s o l u t i o n s and the development of improvements f o r the f u t u r e . The second theme to be ex p l o r e d i n v o l v e d the concept of the r e s i d e n t i a l m i l i e u . I t has been argued t h e o r e t i c a l l y , and from the data, that the r e s i d e n t i a l s e t t i n g and the l o c a l environment are p a r t i c u l a r l y important i n the l i v e s o f the respondents as they d e f i n e the s p a t i a l l i m i t s of the home range. In order t h a t the way of l i f e o f the r e s i d e n t s of i n s t i t u t i o n s does not become c h a r a c t e r i z e d by s o c i a l i s o l a t i o n , l o n e l i n e s s and a l a c k of purpose, i t has been suggested that the m i l i e u x must be s e n s i t i v e to t h e i r needs. A number of c h a r a c t e r i s t i c s and p a t t e r n s of behaviour have been i d e n t i f i e d i n the data, and an attempt has been made to a s c e r t a i n how s a t i s f i e d they are i n t h e i r p r e s e n t l o c a t i o n s . The marked h e t e r o g e n e i t y of the p o p u l a t i o n sampled p r e c l u d e s making too many g e n e r a l i z a t i o n s or recommendations although i t has been argued t h a t a v a r i e t y of m i l i e u x are needed, and no s i n g l e s o l u t i o n to the problems encountered w i l l s u f f i c e . I n v e s t i g a t i o n of the ap p r o p r i a t e n e s s of the r e s i d e n -t i a l m i l i e u x should not be separated from i n v e s t i g a t i o n of the w e l l - b e i n g and s a t i s f a c t i o n of the r e s i d e n t s . The psycho-s o c i a l w e l l - b e i n g of the respondents i n the study has been shown to be i n e x t r i c a b l y l i n k e d to t h e i r s o c i a l and p h y s i c a l environments and t h e i r a b i l i t y to i n t e r a c t w i t h i n them. At the present time the o r i e n t a t i o n of the i n s t i t u t i o n s tends h e a v i l y towards the e f f i c i e n t p r o v i s i o n of h e a l t h care f o r the r e s i d e n t s , although t h i s would appear to be, at times, to the e x c l u s i o n of the development and c o - o r d i n a t i o n of s o c i a l 109 o p p o r t u n i t i e s . As a r e s u l t of the pragmatic e f f o r t s o f the decision-makers to secure s i t e s on land which i s a v a i l a b l e and r e l a t i v e l y cheap, c e r t a i n f a c t o r s a f f e c t i n g the s o c i a l w e l l - b e i n g o f the r e s i d e n t s have been overlooked. The need f o r a more d e t a i l e d understanding of those aspects of the e l d e r l y which r e s u l t i n t h e i r r e q u i r i n g s p e c i a l i z e d c o n s i d e r a t i o n was s e t out at the be g i n n i n g of Chapter Four. I t would appear from the data t h a t two ge n e r a l types of respondents can be d i f f e r e n t i a t e d , and that t h e i r p a r t i c u l a r c h a r a c t e r i s t i c s have important i m p l i c a t i o n s f o r the types o f r e s i d e n t i a l m i l i e u x which b e s t s u i t t h e i r needs. These two groups do not n e c e s s a r i l y need t o t a l l y d i f f e r e n t types of r e s i d e n t i a l s e t t i n g s ; w i t h the a p p r o p r i a t e p l a n n i n g and s e r v i c e d e l i v e r y systems, t h e i r needs can be met simul-taneously. The b a s i c assumption u n d e r l y i n g the ensuing d i s -c u s s i o n i s that because of the tendency of e l d e r l y people to become more f r a i l w i t h advancing y e a r s , and more s u s c e p t i b l e to environmental c o n s t r a i n t s , t h e i r home range c o n t r a c t s . In the case of those respondents who were v i r t u a l l y immobile, the c o n t r a c t i o n can be so severe as to reduce the home range to the c o n f i n e s of the d w e l l i n g u n i t . T h i s becomes t h e i r r e s i d e n t i a l m i l i e u , and as a r e s u l t , t h e i r t o t a l needs must be met w i t h i n the b u i l d i n g . However, because o f the emphasis on the p r o v i s i o n of h e a l t h - c a r e , the o v e r a l l q u a l i t y of l i f e may not be as v a r i e d and meaningful f o r these respondents. Attempts are made to p r o v i d e a c t i v i t i e s and s e r v i c e s w i t h i n the b u i l d i n g s , but the responses to questions i n the survey do not r e f l e c t the f a c t t h a t the i n s t i t u t i o n s compensate f o r n o t h i s l o s s to the extent that they might were they l e s s con-s t r a i n e d by l o c a t i o n a l f a c t o r s and budget c o n s i d e r a t i o n s . The r o u t i n e of the i n s t i t u t i o n a l regime to an extent determines the way of l i f e o f those who do not leave the i n s t i t u t i o n s , and i t would not appear at present that the widest p o s s i b l e range of s o c i a l o p p o r t u n i t i e s are p r o v i d e d . T h i s can be a t t r i b u t e d p a r t l y to the f a c t t h at we do not as yet f u l l y understand the complex nature of the r e s i d e n t s i n i n s t i t u t i o n a l s e t t i n g s , nor what s e r v i c e s and f a c i l i t i e s should be p r o v i d e d to enhance the q u a l i t y of t h e i r remaining years. The immobile respondents t y p i f y the problems of many e l d e r l y people s t i l l r e s i d i n g i n t h e i r own homes, and s o l u t i o n s to t h e i r problems can have wider i m p l i c a t i o n s , but u n t i l more evidence i s a v a i l a b l e , the a p p r o p r i a t e r e s i d e n t i a l m i l i e u x f o r them remain u n c l e a r . I t has been suggested i n the presen t context however, that the e x i s t i n g l o c a t i o n s are l e s s than o p t i m a l f o r many. The second broad group which can be d i f f e r e n t i a t e d from the r e s u l t s o f the data are those respondents who are r e l a t i v e l y more mobile. I t i s apparent that they experience many problems i n t h e i r e f f o r t s to remain i n t e g r a t e d w i t h the surrounding community. For t h i s group, the r e s i d e n t i a l m i l i e u x i n v o l v e the d w e l l i n g u n i t and the l o c a l environment, and consequently, the present c r i t e r i a used to s e l e c t s i t e s f o r the i n s t i t u t i o n s have important s o c i a l i m p l i c a t i o n s f o r them. Environmental b a r r i e r s , whether they are p e r c e i v e d or a c t u a l , have an e f f e c t upon the amount and types of meaningful a c t i v i t i e s which the respondents can pursue. T o p o g r a p h i c a l b a r r i e r s and the l a c k of a c c e s s i b i l i t y or p r o x i m i t y to l o c a l s e r v i c e s and f a c i l i t i e s I l l can r e s u l t i n t h e i r v i r t u a l imprisonment i n an environment they are unable to u t i l i z e . The f r u s t r a t i o n a s s o c i a t e d w i t h such a s i t u a t i o n was expressed on more than one o c c a s s i o n , and would appear to be an important source of d i s s a t i s f a c t i o n and concern. The i n s t i t u t i o n s under review are not designed to be t o t a l , and i t i s the p o l i c y of the s t a f f and a d m i n i s t r a t i o n to encourage those who are a b l e , to ma i n t a i n as much con t a c t as p o s s i b l e w i t h the l o c a l community. However, these e f f o r t s are f u t i l e i f the l o c a t i o n s of the i n s t i t u t i o n s are i n a p p r o p r i a t e to the needs and p r e f e r e n c e s of the r e s i d e n t s , or i f the l o c a l s e r v i c e s and f a c i l i t i e s are not pres e n t . In s i t u a t i o n s i n which the mobile respondents cannot, or f a i l to make use of t h e i r surroundings, they are as s o c i a l l y c o n s t r i c t e d as the more immobile, and tend to remain r e l a t i v e l y i n a c t i v e w i t h i n the b u i l d i n g s . As the data show, the problem i s made more compli-cated and f r u s t r a t i n g when l o c a l s e r v i c e s e x i s t but are not a c c e s s i b l e to those who have no t r a n s p o r t a t i o n a v a i l a b l e . I t has been argued from the analyses that c o n s i d e r a b l y more emphasis be p l a c e d on•the development and maintenance of s o c i a l a c t i v i t i e s f o r the respondents, both w i t h i n the i n s t i -t u t i o n s and i n the immediate neighbourhoods. T h i s means t h a t the design s p e c i f i c a t i o n s , s i t e s e l e c t i o n c r i t e r i a , budget con-s i d e r a t i o n s and o r i e n t a t i o n of those concerned w i t h enhancing the q u a l i t y of l i f e and developing L i v i n g S i t e s f o r the e l d e r l y i n the i n s t i t u t i o n s should be as concerned w i t h s o c i a l aspects as w i t h h e a l t h care. One way i n which t h i s may be e f f e c t i v e l y produced i s by the p r o v i s i o n of r e s i d e n t i a l m i l i e u x which are i n t e g r a t e d w i t h i n the l a r g e r communities. 112 There are important c o n t r i b u t i o n s which geographers can make to the study of the s p a t i a l c h a r a c t e r i s t i c s of the e l d e r l y . The p e r s p e c t i v e s c u r r e n t l y being developed i n the f i e l d s of s o c i a l geography and to an extent i n l o c a t i o n a l a n a l y s i s p r o v i d e a u s e f u l medium through which to analyse the complex i n t e r -r e l a t i o n s h i p s between man and h i s p h y s i c a l and s o c i a l e n v i r o n -ment. T h i s i s perhaps even more c r u c i a l when one i s d e a l i n g w i t h the i n s t i t u t i o n a l i z e d e l d e r l y as t h e i r i n t e r a c t i o n w i t h t h e i r c o n s t r i c t e d surroundings i s v i t a l f o r the maintenance of meaningful d a i l y a c t i v i t i e s . I t i s t h e r e f o r e the c o n c l u s i o n of t h i s study t h a t more r e s e a r c h be focused on the study of the i n t e r - r e l a t i o n s h i p s of- the i n d i v i d u a l s w i t h i n the context of t h e i r l i v i n g space and l i f e h i s t o r i e s to a s c e r t a i n t h e i r needs and p r e f e r e n c e s , and how b e s t to accommodate them w i t h i n the l a r g e r s o c i a l s t r u c t u r e . 1 1 3 APPENDIX I SAMPLE SELECTION DATA FORM SAMPLE SELECTION DATA This information i s to be c o l l e c t e d from the Administrator/Manager of the residence. 1. Resident's name: 2. Room Number: 3. Telephone Number: 4. Name of F a c i l i t y : 5. Date of resident's admission For O f f i c e Use Only 1. Subject I.D. _ 2. F a c i l i t y I.D. 6. Resident's l e v e l of care: (1) Personal Care (2) Intermediate Care 7. Date of l a s t assessment: ' 8. Country of o r i g i o n : 9. Date of b i r t h : Health Functioning (compared to normal functioning)? A. COMMUNICATION 10. A b i l i t y to see (with glasses i f worn): (1) Normal (2) Limited V i s i o n Can (3)_ read, watch T.V. (4) D i s t . only ( 5 ) _ T o t a l l y b l i n d l i g h t & dark 11. A b i l i t y to Hear (with hearing a id i f worn): (1) Normal (2) Limited Hearing (3) T o t a l l y deaf (4) Almost t o t a l l y (5) deaf 12. A b i l i t y to speak or understand English: (1) words f u l l y (2) words mostly B. 13. understandable (4) words not (5) unders tandable PERSONAL FUNCTION understandable other language spoken Adequate f o r Personal safety _Adequate f o r Personal safety (3) words p a r t i a l l y understandable Ambulation: (1) Walker Crutches (7) (8) F u l l y ambulatory Independent only with: (2)_ Cane Requires Assistance (6) (3) _ (4) (5) Wheelchair C. MENTAL FUNCTION 1 i 14. Comprehension 15. Memory ' 16. Self d i r e c t i o n _______ 17. R e a l i t y O r i e n t a t i o n ' 18. Emotional S t a b i l i t y on the > l e v e l on s t a i r s immobile 114 D. PROBLEM BEHAVIOURS 19. A n t i s o c i a l 20. Vio l e n t and Destructive 21. Inappropriate Habits/Manners 22. A t t e n t i o n Demanding 23. Withdrawn 24. Hyperactive 25. Wandering 26. .Other, specify E. SOCIAL FACTORY/GENERAL INFORMATION 271 A b i l i t y to shop: (1) Requires no (2) Shops independently (3) Needs to be help small items accompanied (4) Completely unable (5) Mentally unable p h y s i c a l l y to shop to shop 28. A b i l i t y to t r a v e l : ( 1 ) _ Able to t r a v e l (2) U t i l i z e s own tr a v e l (3) Travels i f - t a x i but not bus accompanied (4) P h y s i c a l l y unable to t r a v e l (5) Mentally unable to tr a v e l 29. A b i l i t y to use the telephone: (1) Requires no help (2) Dia l s a few well (3) Answers, phone'-knoxra numbers does not d i a l (4) P h y s i c a l l y unable (5) .Mentally unable to to use telephone use telephone F. SUPPORT FROM FAMILY AND FRIENDS 1. Assistance with d a i l y l i v i n g (A.D.L.) 2. Assistance with Transportation 3. General Encouragement and friendship G. SOCIAL CONTACTS - Describe Applicant's involvement with community groups/ i n d i v i d u a l s . Note degree of s o c i a l i s o l a t i o n . 115 116 APPENDIX 2 -LETTER. CONTACTING RESIDENTS 117 THE UNIVERSITY OF BRITISH COLUMBIA 2075 WESBROOK MALL VANCOUVER, B.C., CANADA V6T 1W5 DEPARTMENT OF PSYCHOLOGY D r . J o h n M e r c e r , o f t h e U . B . C . G e o g r a p h y D e p a r t m e n t a n d I a r e p l a n n i n g t o c o n d u c t a s t u d y i n A u g u s t a n d S e p t e m b e r o f t h e l o c a t i o n a l n e e d s a n d p r e f e r e n c e s o f r e s i d e n t s i n p e r s o n a l a n d i n t e r m e d i a t e c a r e . W h a t w e i n t e n d t o d o i n t h i s s t u d y i s t o i n t e r v i e w a s a m p l e o f r e s i d e n t s o f c a r e f a c i l i t i e s o f v a r i o u s s i z e a n d i n v a r i o u s l o c a t i o n s i n t h e G r e a t e r V a n c o u v e r a r e a . W e w o u l d l i k e v e r y m u c h t o i n c l u d e y o u r o p i n i o n s i n o u r s t u d y . T h e i n t e r v i e w w i l l t a k e a p p r o x i m a t e l y o n e h o u r , a n d w i l l b e c o n d u c t e d i n t h e p r i v a c y o f y o u r r o o m o r s o m e o t h e r p r i v a t e p l a c e i n t h e b u i l d i n g i f y o u d o n o t l i v e a l o n e . I n i t w e w i l l a s k f o r s o m e i n f o r m a t i o n a b o u t y o u p e r s o n a l l y - f o r e x a m p l e , y o u r a g e , s e x a n d m a r i t a l s t a t u s , w h a t a r e a y o u l i v e d i n b e f o r e a n d h o w y o u c a m e t o m o v e i n t o y o u r p r e s e n t r e s i d e n c e . W e w i l l a l s o a s k y o u r o p i n i o n a b o u t f a c i l i t i e s a n d s e r v i c e s o f f e r e d i n y o u r r e s i d e n c e a n d t h e n e i g h b o u r h o o d s u r r o u n d i n g i t a n d w h a t f a c i l i t i e s a n d s e r v i c e s y o u w o u l d l i k e t o h a v e t h a t a r e n o t n o w a v a i l a b l e t o y o u . T h e i n f o r m a t i o n t h a t y o u g i v e u s w i l l b e k e p t s t r i c t l y c o n -f i d e n t i a l . I t i s f o r r e s e a r c h p u r p o s e s o n l y a n d w i l l n o t b e s e e n b y t h e m a n a g e m e n t o f y o u r r e s i d e n c e o r a n y o n e e l s e o t h e r t h a n t h e s t u d y s t a f f . Y o u r n a m e w i l l n e t a p p e a r o n a n y d a t a . Y o u d o n ' t h a v e t o a n s w e r a n y q u e s t i o n s y o u d o n ' t w a n t t o a n s w e r , a n d y o u m a y e n d t h e i n t e r v i e w a t a n y t i m e i f y o u f e e l t i r e d o r f o r a n y o t h e r r e a s o n y o u w o u l d l i k e t o s t o p . W i t h i n t h e n e x t t w o o r t h r e e d a y s o n e o f o u r s t a f f w i l l p h o n e y o u t o a n s w e r a n y q u e s t i o n s t h a t y o u m a y h a v e a b o u t t h e s t u d y a n d t o a r r a n g e a c o n v e n i e n t t i m e f o r a n i n t e r v i e w . T h e i n f o r m a t i o n g a t h e r e d f r o m y o u a n d o t h e r s c o o p e r a t i n g i n t h e s t u d y w i l l b e a n a l y z e d a n d w i l l b e u s e d f o r t h e g u i d a n c e o f g o v e r n m e n t o f f i c i a l s , n o n - p r o f i t s o c i e t i e s a n d o t h e r s c o n c e r n e d w i t h h o u s i n g a n d c a r e f o r o l d e r p e o p l e . I f , w h e n t h e s t u d y i s c o m p l e t e , y o u w o u l d l i k e t o h a v e a c o p y o f t h e s u m m a r y r e p o r t , w e s h o u l d b e p l e a s e d t o s e e t h a t y o u r e c e i v e o n e . Y o u r s s i n c e r e l y , _ _ G l o r i a M.Gutman,Ph.D. Assistant Professor 118 APPENDIX 3 RESIDENTS' I N 1 E F V I E W SCHEDULE 119 I'd l i k e to begin the interview by asking you some questions about yourself and your family. A. DEMOGRAPHIC INFORMATION 1. Are you: (1) Married ( 2 ) _ Widowed (3)__ Divorced'/-Sep.arated • (4) Have you never been married? 2. Where were you born? 3. How o l d were you on your l a s t birthday? B. SOCIAL CONTACTS AND AVAILABILITY OF FAMILY SUPPORT 4. How many l i v i n g c h i l d r e n do you have? (Note: include adopted and stepchildren) 5. Which of your c h i l d r e n do you see or hear from once per month or more-' » (For each c h i l d mentioned asc e r t a i n where l i v i n g ) C h i l d Where L i v i n g 1. 2. 3. 4. 5. 6. 6. Which of your r e l a t i v e s do you see or hear from once per month of more? (For each r e l a t i v e mentioned, a s c e r t a i n where l i v i n g ) Relationship Where L i v i n g 1. _________________^^ 2. ______________ 3. .  4. 5. 6. 7. Which of your friends do you see or hear from once per month or more? (For each f r i e n d mentioned, ascertain where l i v i n g ) Friend Where L i v i n g 120 8. In general, how do you rate your r e l a t i o n s h i p with your family? Would you say i t was (1) Exce l l e n t (2) Good (3) F a i r (4) Poor 9. How important i s i t f o r you to l i v e i n the same area as your c h i l d r e n : (1) Very important (2) Somewhat important (3) Not important? C. NATURE AND LEVELS OF PERSONAL MOVEMENT IN LOCAL AREA a) AWARENESS OF LOCAL SERVICES AND FACILITIES 10. In general, how would you rate the area r i g h t around .(.Name) (-eas a place to l i v e ? (Record a l l comments) (1) Excellent (2) Good (3) F a i r (4) Poor (5) Very 'poor 11. In general, how s a t i s f i e d are you with l i v i n g here? (1) Very S a t i s f i e d (2) Moderately s a t i s f i e d (3) Very ' di s s a t i s f i e d 12. Why do you f e e l that way about (Name)? 13. I f the opportunity was a v a i l a b l e , would you rather l i v e i n (Name,1)., or somewhere else? (Probe f or reasons) Present Residence Elsewhere ' Reasons: 14. I f you could choose to l i v e anywhere within the Lower Mainland, would you prefer that your neighbours were :-1. Mostly the same age as you 2. Mostly younger than you are or 3. Of d i f f e r e n t ages? (4) (Do not read) 4. I n d i f f e r e n t 121 15. We want to f i n d out how close some important services and f a c i l i t i e s are to_ (Name) . I am going to describe some services and f a c i l i t i e s to you, and I would l i k e you to t e l l me how close they are to here; whether i t i s easy f o r you to wald to them; i f you need to take a bus to get to them, or i f they are not provided i n the l o c a l area. Easy Easy Access D i f f i c u l t No such Don't Walk by Public by Publ i c F a c i l i t y Know Transport Transport a v a i l a b l e or Walking Faculty/Service (1) (2) (3) (4) (5) L. Shopping Centre 2. Variety/corner store ' ' 3. Medical O f f i c e / c l i n i c ' ______ 4. Major denominational churches 5. Hospital ' ' ' 6. L i b r a r y ' ' 7. Park 8. Senior c i t i z e n centre ' '  9. Community centre D. MOTIVATIONS AND PATHWAYS INTO PERSONAL/INTERMEDIATE CARE FACILITY AND  BASES OF SITE SELECTION 16. Can you i d e n t i f y (on the card provided) the three most important reasons f o r leaving where you l i v e d before? 1. ' Medical Advice 2. D i s s a t i s f a c t i o n with previous area i n which I was l i v i n g 3. F i n a n c i a l Reasons 4. D i f f i c u l t y i n looking a f t e r my previous residence 5- Possible future need for medical help 6. Change i n my health or physical strength 7 . '__ Loneliness 8. Need f o r more privacy 9. Wish to be with people of my own age 10. Other reasons (specify) 17. Can you now i d e n t i f y the 3 most important reasons for choosing (Name) (show card B) 1. Cost 2. Children or r e l a t i v e s close by 3. Friends or r e l a t i v e s moving i n or already there 4. Famil i a r neighbourhood 5. Nearness to f a c i l i t i e s (shops etc) 6. Quality of dwelling u n i t 7. Recreational f a c i l i t i e s and a c t i v i t i e s a v a i l a b l e on s i t e 8. Medical f a c i l i t i e s on premises 9. A v a i l a b i l i t y of housekeeping f a c i l i t i e s 3 s e r v i c e s 10. A v a i l a b i l i t y of meals on premises II* I t was the only one available Other reasons - specify) 122 E. RESIDENTIAL HISTORY PRIOR TO MOVE INTO PRESENT RESIDENCE 18. Where have you l i v e d f o r the l a s t 5 years? 19. When did you move into (name)? (1) Date (2) Previous Address (street intersection will- s u f f i c e ) 20. Have you previously l i v e d i n a Personal of Intermediate Care F a c i l i t y ? (1) Yes (2) No 21. I f yes, where was this? Location 22. Why did you leave that development? (Specify) F. PERSONAL MOBILITY 23. Can you go out into the stre e t ( s ) by yourself? (1) Yes (2) No 24. Do you go out into the stre e t ( s ) by yourself? (1) Yes (2) No 25. I f you had to wallc for 6 blocks to do something, could you walk there, and back by yourself? (l) Yes (2) No G. USES OF LOCAL SERVICES AND FACILITIES 26. How many times a week do you-leave (Name) and go outside? (1) 0-1 (2) 2-3 (3) 4-5 (4) 6-7 :(5) +7 27. Are there enough things f o r you to occupy-your day i n the area . immediately around (Name). (1) Yes (2) No I f no, probe for reasons. 28. In gereral, are you s a t i s f i e d with the l o c a t i o n of _ (Name' i n terms of the services and f a c i l i t i e s which are provided l o c a l l y - , " (1) Yes (2) No I f no, probe for reasons. 29. Do you have regular help,from a f r i e n d or a r e l a t i v e i n getting to any of the places you most want to get to? (1) Yes (2) No 123 30. How do they help you? (who helps) a) r e l a t i v e : b) c h i l d : c) other 31. Do you r e g u l a r l y have av a i l a b l e and use a volunteer transportation system (or p r o f e s s i o n a l l y s t a f f e d one) - d r i v e r , s p e c i a l bus, etc. -to ger to places you e s p e c i a l l y want to go to? •1. available and use 2. a v a i l a b l e and do not use - (probe for why) 3. not a v a i l a b l e 4. don't dnow 32. . How good i s the public transport i n this area? (1) excellent (2) f a i r (3) poor 33. Is there a bus service close by (within 2 blocks)? (1) yes (2) no 34. How often do you use the bus i n an average week? Do you use i t : (1) never (2) 1-2 times (3) 3-4 times (4) 4?5 times (5) 5-6 times (6) +7 times 35. Do you have any trouble using the bus? (1) yes (2) no (If yes ask: What type of trouble do you have using the bus) 36. There are a few things about t h i s neighbourhood that I would l i k e your ideas on. For each of the things I mention please t e l l me i f you are s a t i s f i e d or d i s s a t i s f i e d , and i f d i s s a t i s f i e d what's wrong with the way i t i s now. Are you s a t i s f i e d or d i s s a t i s f i e d with (read each item below - i f d i s s a t i s f i e d probe for what i s wrong) S. D. K. What's Wrong the landscaping', paths and seatingj i n the outdoor area surrounding the b u i l d i n g . the way the sidewalks are kept up. How good i s the condition of the sidewalks around here? What about the amount of noise from t r a f f i c , t r a i n s , airplanes, industry and things l i k e that? Is the t r a f f i c a hazard around here? How safe i s this area from crime, vandalism, etc. How. s a t i s f i e d are you with the shopping places i n this area? How s a t i s f i e d are you with the entertainment f a c i l i t i e s i n this area? Does the neighbourhood cater to your needs? 124 37. I would l i k e to ask some questions about the way i n which you spend your time. Now, approximately how many times a month do you go outside the residence to: Times a Month 1. attend clubs, lodges, or other meetings (1) 2. attend a sports event (2) 3. swim, bowl or take part i n other indoor or outdoor sports (specify) (3) 4. play bingo (4) 5. v i s i t or entertain friends (specify) (5) 6. do volunteer work (6) 7. eat out at a restaurant or cafe (7) 8. go to a bar or pub/lounge etc. (outside building) (8) '  9. go shopping, whether i t be window shopping or v i s i t s to the nearest store (9) 38. During the past month, how many times did you go: Times a Month 1. outwith your family, f or a v i s i t or a drive etc (1) ' 2. on t r i p s or excursions (bus t r i p s or t r i p s other than with family) (2) ' 3. on medically r e l a t e d t r i p s (e.g. to d e n t i s t , opthalmologist, etc.) (3) '  39. In general, would you say that most days you have plenty to do? (1) Yes (2) No I f no, can you t e l l me why t h i s i s so. (probe) 40. We would l i k e to know what sorts of problems you have to deal with i n your d a i l y l i f e . Can you t e l l me i n your own words what some of the more important problems that you face these days are? (probe) 41. L i f e S a t i s f a c t i o n Index Could you please t e l l me i f you agree or disagree with the following statements. There are no r i g h t or wrong answers, we merely want your opinion. (Ask: Do you think that) Agree Disagree (1) (2) 1. As you grow older, things seem better than you thought they would be? 2. You have had more breaks i n l i f e than other people you know? 3. You are j u s t as happy as when you were younger? 4. Most of the things you do are boring and monotonous? 5. The things you do are as i n t e r e s t i n g to you as they ever were? 6. As you look back on your l i f e you are f a i r l y well s a t i s f i e d ? 125 41 /-42. H. Agree Disagree (1) (2) 7. You have made plans f o r things you w i l l be doing a month or year from now? 8. When you look back over your l i f e , you didn't get most of the important things you wanted 9. Compared to other people, you get down i n the dumps, quite often. How s a t i s f i e d are you with your l i f e today? (1) very s a t i s f i e d (2) - s a t i s f i e d (3) (4) very d i s s a t i s f i e d , somewhat d i s s a t i s f i e d 43. Would you say that you have changed i n any of the following ways since you have moved into (name)? 2 3 1. Do you f e e l . more safe ( ) less safe ( : ) same ( : 2. Do you worry less ( ) more : ) same ( ; 3. Do you have more energy( ) less energy! ' ) same ( : 4. Is your health better ( ) worse ( : ) same ( : 5. Are you more active( ) less active! ' ) same ( : 6. Do you have more friends(- ) less friends! ") same ( ) 7. Do you eat better ( ) worse ( ) same ( ) 8. Do you see your c h i l d r e n more often ( ) less often ( ) same ( ) 9. Do you see your close r e l a t i v e s more often ( ) less often ( ) same ( ) 10. Do you sleep better ( ) less often ( ) same ( ) 11. Do you go out more often ( ) less often ( ) same ( ) 12. Are you generally happier ( ) less happy i ) same ( ) 13. Do you dress up more often ( ) less often ( ) same ( ) AWARENESS AND USE OF PROGRAMMES AND ACTIVITIES SCHEDULES WITHIN (NAME) 44. What do you l i k e most about (name)? 45. What do you think you l i k e l e a s t of a l l i n (name)? 46. What do you think could be done to make (name) better and more s a t i s f y i n g for you? (probe) 126 47. In terms of the services and f a c i l i t i e s provided within the b u i l d i n g , could you t e l l me which of the following e x i s t , and also which services now lacking you f e e l would be useful? S e r v i c e / F a c i l i t y check i f i n check i f not i n don't development but f e e l s would know be-useful  1. crafts/sewing room 2. laundry f a c i l i t y 3. beauty shot 4. l i b r a r y room 5. greenhouse '  6. special garden pl o t s ' '  7. guest room(s) '  8. separate card, chess etc room 9. telephone i n each room ____ 10. coffee shop 11. auditorium 12. does a mobile l i b r a r y v i s i t ? 13. i s there a volunteer transporta-t i o n service? 14. i s there a volunteenr f r i e n d l y v i s i t i n g service available? '•  15. r e l i g i o u s service 16.. infirmary where a person could go for a few days or weeks i f he gets sick and then move back to his own room 48. (a) In an average day, about how much time do you spend i n your room? (b) What do you do there? Before f i n i s h i n g the interview, I would l i k e to ask j u s t a few more questions about you yo u r s e l f . HEALTH STATUS 49. Compared to most people your age, how would you rate your health at the present time? Would you say i t was 1. excellent 2. good _ _ _ _ 3. f a i r 4. poor 5. very poor EMPLOYMENT STATUS 50. At the present time do you do any work for which you get paid? (1) _ Yes (2) No I f Yes, specify type of work '  and whether i t i s (1) f u l l time or (2) part time 127 51. Before retirement, what was your and/or your spouse's occupation? 52. About how well would you say the needs of e l d e r l y people are looked a f t e r i n (Name). Would you say very w e l l , adequately, or not very well? (1) very well (2) adequately (3) not very well 53. F i n a l l y , we are not interested i n how much money you have coming i n each month, but we would l i k e to know what are your sources of f i n a n c i a l support. As I read o f f the following l i s t , can you t e l l me i f any of the items are a source of income? YES NO (1) (2) 1. Canada Pension Plan 2. P r i v a t e Pension 3. Wages 4. Investment Income Sources 5. Annuities '_ 6. Help from your c h i l d r e n 7. Other (specify) INTERVIEWER RATING 54. A f t e r hearing the respondents answers to a l l of these questions, how would you say he or she,feels about l i f e as a whole? 1) completely s a t i s f i e d , no reservations or problems 2) generally s a t i s f i e d and happy but with minor problems 3) f a i r l y s a t i s f i e d but with some f a i r l y major problems 4) neutral 5) somewhat d i s s a t i s f i e d but with a number of good things going 6) generally d i s s a t i s f i e d but happy with a few things 7) completely d i s s a t i s f i e d , could see nothing r i g h t with l i f e 55. O v e r a l l , how great was the respondent's i n t e r e s t i n the interview? (1) very high (2) above average (3) often sincere 57. Ad d i t i o n a l comments: 128 APPENDIX 4 AGE DISTRIBUTION BY RESIDENCE Age d i s t r i b u t i o n by r e s i d e n c e Age Cohort A B C D E • F G U. i i J K L M N P R 50-54 4.8 5.0 7.7 55-59 5.0 6.3 60-65 4.8 10.0 5.0 5.6 6.3 7.7 25.0 65-69 4.8 5.0 15.0 5.6 11.8 12.6 7.7 70-74 18-1 14.4 15.0 10.0 20.0 5.6 5.6 11.8 12.6 15.4 75-79 9.0 14.3 9.6 20.0 15.0 15.0 22.3 22.3 5.9 18.8 7.7 16.6 22.2. 14.3 25.0 80-84 36.3 14.4 23.0 5.0 40.0 25.0 39.0 16.8 23.6 12.6 23.1 41.6 25.0 42.9 25.0 85-89 27.2 52.4 9.5 20.0 10.0 11.2 33.4 29.5 18.8 30.8 16.7 50.0 28.6 25.0 90-94 4.5 4.8 14.4 15.0 10.0 15.0 11.2 22.3 11.8 12.6 14.9 95-99 9.5 4.8 100 3.0 No Answer 4.5 0.0 14.3 5.0 0.0 0.0 0.0 0.0 5.9 0.0 0.0 0.0 11.1 14.3 0.0 150 APPENDIX 5 SEX DISTRIBUTION BY RESIDENCE 131 Sex D i s t r i b u t i o n by Residence F a c i l i t y Male Female Sample Size A 22.7% '. 77.3% 22 B 0 100.0 21 C 33.3 66.7 21 D 35.0 65.0 20 E 40.0 60.0 20 F 30.0 70.0 20 G 22.2 77.8 18 H 33.3 66.7 18 J 41.2 58.8 17 K 43.8 56.3 16 L 53.8 46.2 13 M 16.7 83.3 12 N 0 100.0 9 P 0 100.0 7 R 0 100.0 4 A l l F a c i l i t i e s 27.7 72.3 238 132 APPENDIX 6 REASONS FOR SATISFACTION WITH EACH RESIDENCE 155 Reasons f o r S a t i s f a c t i o n with each residence Residence Reason 1 Reason 2 Reason 3 Reason 4 Reason 5 A B C D G H J K M N P R Staff Care Staff Atmos-phere Religion Care Own Room Staff Religion A l l Clean Atmos-phere A l l Atmos-phere A l l S taff A l l S t a f f Care Staff Staff Atmos-phere A l l A l l Food Atmos-phere Clean A l l R eligion A l l Atmos-phere A c t i v i t i e s A l l i n Bldg. A c t i v i t i e s i n Bldg. Atmos-phere Care Staff Atmos-phere Own Room A l l Care Food Religion Staff A l l Religion Own Room Freedom A c t i v i t i e s i n Bldg. Atmos-phere Care Own Room Care Question asked: What do you l i k e most about (name of Residence)? 134 -APPENDIX 7 REASONS FOR DISSATISFACTION WITH EACH INSTITUTION Reasons f o r d i s s a t i s f a c t i o n with each i n s t i t u t i o n Residence Reason 1 Reason 2 Reason 3 Reason 4 Reason 5 A Organ- Mixing Food No longer i s a t i o n s e n i l e - a l e r t independent B Mixing No longer Nothing to Being i n Organisation s e n i l e - a l e r t independent do i n s t i t u t i o n C " 11 Being i n Nothing to i n s t i t u t i o n do D " " Organisation Food Change Bldg. E " " Nothing to Organisation Food do F No longer Nothing to Mixing Being i n Change Bldg. independent do s e n i l e - a l a r t i n s t i t u t i o n G Mixing " Being i n se n i l e - a l e r t i n s t i t u t i o n H No longer Organisation Nothing to Food Mixing independent do se n i l e - a l e r t J " Mixing " Being i n Food s e n i l e - a l a r t i n s t i t u t i o n K " Being i n i n s t i t u t i o n L Mixing Nothing to Food Change Bldg. s e n i l e - a l e r t M Being i n Organisation No longer Food Nothing to i n s t i t u t i o n independent do N Nothing to Food " Want family Don't get closer out P No longer Noise Bad independent loc a t i o n R Nothing to Change do Bldg. Question asked: What do you l i k e least of a l l i n (name of residence)? 135 136 APPENDIX 8 NUMBER OF HOURS PER DAY SPENT LN THE ROOM BY RESIDENCE Number of hours per day spent i n the room by residence Hours A B C D E F G H J K L M N P R 1- 14.3 15.0 7.7 2. 42.9 20.0 10.0 5.6 3 13.6 10.0 5.6 14.3 4 27.3 14.3 14.3 10.0 15.0 20.0 5.6 22.2 38.5 22.2 5 13.6 4.8 4.8 10.0 10.0 15.0 5.6 31.1 11.8 7.7 11.1 14.3 50.0 6 18.2 23.8 4.8 10.0 50.0 40.0 11.1 27.8 35.3 12.5 7.7 25.0 44.4 7 13.6 9.5 5.0 11.1 17.6 6.3 7.7 25.0 22.2 8 9.1 4.8 4.8 5.0 5.0 15.0 27.8 16.7 23.5 12.5 15.3 8.3 14.3 9 4.8 4.8 5.0 11.1 12.5 8.3 25.0 10 4.5 38.1 5.0 5.0 10.0 11.8 25.0 15.4 33.3 28.6 25.0 11-12 16.7 31.3 14.3 No Answer °-° °'° 9 , 3 1 0'° °-° °' 0 2 2 , 2 °-° °-° °-° °-° °-° °-° 1 4 - 3 °-° Mean 5.4 7.5 3.2 4.0 5.7 6.2 7.9 5.7 7.0 9.3 5.8 8.0 5.7 8.0 7.2 S.D. 1.9 2.3 2.3 2.6 2.0 1.8 2.5 26.1 1.5 1.8 2.7 1.7 1.1 3.4 2.6 00 158 APPENDIX 9 PERCEIVED PRESENCE OF SERVICES WITHIN EACH BUTLDING 159 Perceived presence of services within each building Facility Present Not Present Don't know A 49.4 44.8 5.8 B 74.3 23.2 2.2 C 52.4 37.1 10.2 D 49.0 44.7 6.3 E 53.7 19.7 26.7 F 59.0 26.7 14.3 G 57.4 27.0 15.6 H 49.6 28.1 22.2 J 60.4 30.2 9.4 K 37.5 28.7 33.7 L 68.2 22.1 9.7 M 55.0 23.9 21.1 N 49.6 41.5 8.9 P 43.8 41.0 15.2 R 60.0 28.3 11.7 Note: List of services about which respondents were asked: Crafts Room Laundry Beauty Salon Library Greenhouse Garden Plots Guest Room Card Room Private tele-phone Coffee Room Auditorium Mobile Library Volunteer transportation Volunteer visiting Infirmary 140 APPENDIX 1 0 FREQUENCY OF JOURNEYS OUTSIDE EACH RESIDENCE Frequency of journeys outside each residence CANOUT 76.17, Yes + - - = + DOOUT 61.3 Yes + - - = -H - A SIXBLS 42.0 Yes + - - — -H- + TIMEOUT 42.9 . 0-1 + - - + -H ENU2DO 63.4 Yes + = = - + + MOBAID 65.1 Yes + + - + = + TRUBUS 47.1 Yes + - -H- A - -H USEBUS 61.0 Never + - - • - + + = VOLBUS 72.4 Never = + + • - • —z -H CLUB • 77.0 Never + - + + + — VTSITFR 65.1 Never - + - + -GOSHOP 57.6 Never - -H + A A FAMDRI 44.1 Never A + - ++ - A BUSDRI 62.2 Never + - + - + + MEDDRI 66.8 Never - + — — NOTE : + = Average _ = Average A = Average From USEBUS to MEDDRI: - = Less Use + s More Use - + + - - - + + + -> ++ ++ = A - ++ _ " : :: " -H - + - A + -H - A ++ ++ = + - - H - A + + A + + + + + + -+ A - ..++ - - — + - + - -H - +f + — +T A 4+ + + + = +¥ = +4-— = -H - A •H- - A = -H-= - + - = = — + + + - + ++ = + + = - - • A + A — _ + - ++ - = _ + + + = + = • = + _ + -H - + - - + 142 APPENDIX 11 SATISFACTION WITH SURROUNDING ENVIRONMENT BY RESIDENCE 1 4 3 S a t i s f a c t i o n with surrounding environment by residence F a c i l i t y A B C D E F G H J K L M N P R S a t i s f i e d 77.3 68.5 60.7 63.1 66.9 66.9 56.3 67.4 56.6 70.3 71.2 71.9 66.7 50.0 56.3 D i s s a t i s f i e d 8.5 8.3 11.9 18.1 17.1 8.7 7.6 21.5 7.4 3.9 11.5 3.1 12.5 23.2 18.7 Don't know - No Answer 14.2 23.2 27.4 18.7 15.6 24.3 36.2 11.1 36.1 25.8 17.3 25.1 20.9 26.8 25.0 NOTE: Elements of the environment comprise the following items: Landscaping, paths and seating Condition of sidewalks Noise from t r a f f i c , etc. T r a f f i c as hazard Safety from crime Shopping places Entertainment f a c i l i t i e s Neighbourhood o v e r a l l This i s a composite measure f o r each residence. For each item (8), the number of residents (M) could give one of three responses. Thus, the response set across a l l items i s 8 x M. " S a t i s f i e d " i s coded 1 and the t o t a l number of such responses i s then expressed as a proportion of 8 x M. Sim i l a r l y , for D i s s a t i s f a c t i o n (2) and Don't Know (3). 1 4 4 APPENDIX 12 PERCEIVED PROXIMITY AND ACCESS TO LOCAL SERVICES BY RESIDENCE 1 4 5 Perceived proximity and access to l o c a l services by residence Easy Easy D i f f i c u l t Not Don't Know & F a c i l i t y Walk Bus Walk/Bus~ Available No Answer A 55.1 34.3 2.0 0.5 8.1 B 34.9 49.2 1.6 0.0 14.3 C 26.5 14.3 16.4 6.3 36.5 D 4.4 41.7 16.1 17.2 20.5 E 15.6 50.7 3.3 9.4 21.1 F 10.6 53.9 30.3 0.0 5.6 G 26.5 21.0 10.5 8.6 33.3 H 29.6 15.4 11.1 20.4 23.4 J 72.5 19.6 3.3 0.0 4.6 K 13.9 16.7 20.1 0.0 49.4 L 12.8 40.2 11.1 7.7 28.3 M 25.0 14.8 37.0 2.8 20.3 N 54.3 33.3 0.0 1.2 11.1 P 60.3 15.9 0.0 0.0 23.8 R 50.0 22.2 5.6 0.0 22.2 Local services include the following items: Shopping Centre Variety or corner store Medical o f f i c e / c l i n i c Churches Hospital Library Park Senior C i t i z e n Centre Community Centre This i s a composite measure f o r each residence. For each item (9), the number of residents could give one of f i v e responses. Thus, the response set across a l l items i s 9 x M. "Easy Walk" i s coded 1 and the t o t a l number of such coded responses i s then expressed as a proportion o f 9 x M. Sim i l a r l y , f o r Easy Bus (2), D i f f i c u l t Walk/Bus (3), Not Available (4) , and Don't Know (5). 146 APPENDIX 13 ACRONYMS AND VARIABLES BY SUBSTANTIVE THEME 1 4 7 Acronyms and Variables by Substantive Theme DEMOGRAPHIC DESCRIPTION Acronym Variable Age Age in Years Sex Sex composition Carety Level of Care Bom Place of birth Kids Number of living children Maritst Marital Status PREVADA Previous address Date in Date of moving into institution Reshl-Resh5 Where lived for last 5 years PICFB4 . Have you lived in an institution before? RESIDENTIAL SATISFACTION Acronym RESSAT PRESRES ROOMHR NEEDOK WHYSAT YPRES LEAVF-S-T PREFA-B-C LTKRESF-S-T NOLIKEF-S-T BETTERF-S-T WHATDOA-TO-E CRAFTS LAUNDRY BEAUTY Variable How satisfied with living here? Would you prefer living here or elsewhere? How many hours per day spent in own room How well are the needs of the older people met in the.institution? Reasons for satisfaction with residence Reasons for preferring to live here or elsewhere Reasons for leaving previous residence Reasons for choosing present residence What do you like most about residence? What do you like least about residence? What could be done to make residence better? What do you do in your room? Is there a crafts room in the residence? Are there laundry facilities? Is there a beauty salon? 148 Acronymn Variable Library Is there a library? GHOUSE Is there a greenhouse? GDNPLOT Are there special garden plots? GUESTR Is there a guest sleeping room? CARDS Is there a separate games room? PRITEL Do you have a private telephone? COFFEER Is there a coffee room available? AUDIT Is there an auditorium? MOBLIB Does a mobile library visit? VOLTRA Is there a volunteer transport service? VOLVIS Is there a volunteer visiting service? INFIRM Is there an infirmary in the residence? MOBILITY;' Acronym CANOUT DOOUT SIXBLS TIMEOUT ENU2D0 MOBAID HOWAID VOLBUS USEBUS TRUBUS YTRUB CLUB SPORT ACTIVE BINGO VISITER VOLUNT EATOUT PUB GOSHOP FAMDRI BUSDRI. MEDDRI Variable Can you go outside by yourself? Do you go out? Can you walk six blocks and back? How many times per week do you go out? Are there enough things to occupy your, day outside? Do you get help getting places you want to go? How do you get help? Do you. use the volunteer transport service? Do you use the public transport system Do you have trouble using the bus? What sort of trouble? How many times in a month do you: attend clubs? attend sports? take part in sports play bingo? visit friends? do volunteer work? eat outside? got to a pub-bar? go shopping (window)? go out with family? go for a bus drive? go on medical trips? 149 ENVIRONMENTAL EVALUATION Acronym SAMLOC RATEHE LOCSAT NEIBPRE TWOBLS PUBBUS PROSHO VARSTO MEDOFF CHURCH HOSP LIBRAR PARK SENCEN COMCEN LANSCA SIDWAL TRAFNO TRAFHA CRIME SHOPSA ENTFAC NEBNEED Variable How important i s i t to l i v e i n same area as your children? How do you rate area around residence? How s a t i s f i e d with location re l o c a l services -f a c i l i t i e s ? What age neighbours do you prefer? Is bus service w i t h i n two blocks? How good i s public t r a n s i t ? How close and accessible are the following: Shopping.Centre? Variety-corner store? Medical o f f i c e ? Church? Hospital? Library? Park? Senior c i t i z e n centre? Community Centre? How s a t i s f i e d are you with these features of the neighbourhood? Landscaping, seating around the residence Condition of sidewalks Amount of noise from t r a f f i c etc. T r a f f i c as a hazard Safety of the area Shopping places^ Entertainment Neighbourhood catering to needs 150 LIFE .-SATISFACTION • Acronym FAMREL L0T2D3 LISAT SAT2DA HEALST KLDCONT KIDGVD RELATS RELGVD CHUMS CHUGVD EROBSF-S-T YNODOA-B CSAFE CWORRY CENERGY HEALTH ACTION FRIEND EAT SEEKID SEEREL SLEEP GO OUT HAPPY DRESS Variable How would you rate your relationship with Family' Do you have plenty to do most days? Life satisfaction index score How satisfied are you with l i f e today? How would you vote your health? Children in contact with per month Children in contact living in G.V.R.D. Relatives in contact with per month Relatives in contact living in G.V.R.D. Friends in contact with per month Friends in contact living in G.V.R.D. What sorts of daily problems do you have? Why do you not have plenty to do? Do you leel more safe, less safe or the same since moving in? Do you worry more, less same? Do you have more, less, same energy? Is your health better, worse, same? Are you more active; less, same? Do you have more, less same Friends? Do you eat better, worse, same? Do you see your children, more, less, same? Do you see your relatives more, less, same? Do you sleep better, worse same? Do you go out more, less, same? Are you more, less, same, happy? Do you dress up more, less, same? 151 BIBLIOGRAPHY Arc h a e , J . " A p p l i e d I n t e r d i s c i p l i n a r y R e s e a r c h on Environment and A g i n g : C o n c e p t u a l and M e t h o d o l o g i c a l C o n f l i c t s . " i n Theory Development i n Environment and A g i n g : Report from a c o n f e r e n c e h e l d a t Kansas S t a t e U n i v e r s i t y , A p r i l 1974. G e r o n t o l o g i c a l S o c i e t y , Washington D.C., 1974. A u d a i n , M. Beyond S h e l t e r . A Study o f N a t i o n a l Housing A c t F i n a n c e d H o u s i n g f o r t h e E l d e r l y . 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"An analyses of a shorter s e l f - r e p o r t measure of l i f e s a t i s f a c t i o n : c o r r e l a t i o n with rated judgement." Journal of Gerontology Vol.24 (1969) 465-469. 

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