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How old people live: a descriptive case-study of a sample group of old age pensioners; their living conditions… Cuthbert, Eyvolle Pearl 1961

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HOW OLD PEOPLE LIVE A Descriptive Case-Study of a Sample Group of Old Age Pensionersj their Living Conditions and Welfare Needs.  by EYVOLLE PEARL OJTHBERT  Thesis Submitted i n Partial Fulfilment of the Requirements for the Degree of MASTER OF SOCIAL WORK in the School of Social Work  Accepted as conforming to the standard required for the degree of Master of Social Vfork  School of Social Work  1961 The University of British Columbia  iii  ABSTRACT  This study examines the major difficulties experienced by a small sample of Old Age Pensioners i n their daily living, and the manner i n which these problems are resolved. The method was to interview these persons personally, and to draw from the facts obtained, a word picture of their situations and needs. The f i r s t section (Chapter I ) , describes generally, the major exigencies of elderly people i n modern urban society, as known from current writing on the subject. The middle sections (Chapters II and III) depict (a) the housing situation, l i v i n g conditions and health circumstances, (b) the personal l i f e and social contacts of the persons interviewed. On the basis of these "case histories," conclusions are drawn as to existing needs for certain services for the aged, which are not sufficiently recognized at present, or would enhance those already provided, in significant ways.  ii  TABLE OF CONTENTS Chapter 1. The Aged i n Industrial Society Growing problems of the aged. Increase i n the l i f e span. Economic insecurity. Health. Living accommodation. Recreational a c t i v i t i e s . Studies of the aged today. Scope and method of present study •  Page  1  Chapter 2. Housing, Living Conditions, and Health Heating. Toilet and bathing f a c i l i t i e s . Laundry f a c i l i t i e s . Food storage. Reasons for l i v i n g where they do. Income, rent and budget problems. Health. Case examples  15  Chapter 3. Personal Life and Social Contacts Friends and relatives. Social contacts and isolation. Loss of friends by death. Recreation. Clubs, organizations, churches  35  Chapter 4. Opportunities for Improved Services (a) Community Resources. Meals on wheels. Housekeeper service. Telephone. Medical care. The V.O.N. Social and recreational a c t i v i t i e s . Implications for the agency. Implications for the community. (b) Personal Services. Information Service. Friendly v i s i t i n g . Counselling service  44  CHARTS IN THE TEXT Figure 1. City of Vancouver Social Service Department, Unit Boundaries  63  iv  ACKNOWLEDGEMENTS  I should like to express my sincere appreciation to a l l those who have given generously of their time, and who have made suggestions regarding the content of this paper. My greatest debt of gratitude goes to Mr. Michael Wheeler (supplemented i n his absence by Dr. Leonard Marsh), whose patient guidance and astute criticisms have been invaluable i n the completion of this study. Particular mention should be made of Mr. Frank McDaniel, Assistant Administrator of the City Social Service Department, and the staff of Center Unit. Finally, I wish to thank the persons who willingly consented to the interviews, without whose co-operation this study would not have been possible.  HOW OLD PEOPLE LIVE A Descriptive Case-Study of a Sample Group of Old Age Pensionersj their Living Conditions and Welfare Needs.  CHAPTER 1  THE AGED IN INDUSTRIAL SOCIETY  An increasedly aging population i s an unpleasant, unexpected and tragic result of the struggle for social and economic progress in industrial society. Certain marked features can be discerned in the development of this situation —  the lengthening of the l i f e span; eco-  nomic insecurity} poor health; inadequate living arrangementj improper use of leisure time, and so forth. Increase in the l i f e span over the last half-century in modern industrial society, has been due to the advance in medical techniques and the discovery of antibiotics, the growth of environmental health measures, and the rise of nutritional standards.  In their recent  book, The Economic Status of the Aged, Steiner and Dorfman have pointed out that in the United States, infant mortality has decreased to the extent that more than two-thirds of a l l persons who survive infancy w i l l attain the age of 65, and many w i l l live beyond."^ If this trend derives from the advances in medical and other techniques outlined above, there is no doubt that Canada w i l l also experience similar increases in the aged population. Economic insecurity among the aged i s , at least in part, a result of industrialization. Most modern industrial societies now  accept  the principle of compulsory retirement at 65. This situation creates economic insecurity for many aged people, especially those who have not 1.  Steiner, P., and Dorfman, R., The Economic Status of the Aged; University of California Press; Berkeleyj 1957, p. 1.  ,2  been able to establish some savings during their earlier years. In a recent book on the public welfare aspects of this subject, Elizabeth Wickenden states that: With the s h i f t . . . . to a heavy preponderance of wage employment in larger-scale industrial distributive and service enterprises, the opportunities for continued employment and economic participation of older people (have been) greatly narrowed.^  -  Economic insecurity of the aged with i t s concomitant evils i s handled in a variety of ways in industrial societies, but particularly by social insurance. In England, every employed person makes a monthly contribution from his wages towards the National Insurance scheme, which provides economic protection in old age, as well as other benefits. In the United States, employees and their employers contribute to the Old Age and Survivors Insurance program, which ensure protection for the individual against the economic hazards of old age. Canada also makes economic provision for i t s aged population, though on a non-contributive basis. By the end of the 19th Century on this continent, the need for specific services for the aged population became apparent, and the provinces therefore enacted legislation to provide homes for the aged and infirm, hospitals for the indigent, and so forth. In 1927, the Old Age Pensions Act came into effect. This was a Dominion-Provincial act in which the federal government provided f i f t y percent of costs as a subsidy to provinces, for needy people over seventy years of age. This system did not take into account those destitute persons who were no longer in the labour force, either through physical disability, poor health or compulsory retirement, and who no 1.  Wickenden, E., The Needs of Older People; American Public Association; Chicagoj 1953. pp. 4 & 5.  3  longer had a source of income. Fortunately, a growing number of reports on social security needs prepared by L.C. Marsh and others i n 1943 proved effective, and legislation was later enacted to make provision for these people. So far as old people were concerned, legislative action was not taken t i l l 1952, when the Old Age Pensions Act was changed to the Old Age Security (OAS) Act. This provided, without a means test, a pension for a l l persons over the age of 70. Unlike the Old Age Pensions Act,  this new one was a federal program, a l l costs being the responsi-  b i l i t y of the federal government. In addition, the Old Age Assistance (OAA) Act was enacted to provide, on a means basis, assistance on a sliding scale for needy persons between 65- and 69- years of age. Fifty percent of the costs here were provided by the federal government, and the other f i f t y percent was provided jointly by the provincial and municipal governments. At the present time, some provinces also provide supplementary assistance or Bonus as a means test, and this ranges from |10.00 per month i n some provinces to $24.00 per month i n British Columbia. For persons who may be described as prematurely aged, there are also Blind Persons' and Disabled persons Allowances which are simi1  l a r l y available. These two programs are the joint responsibility of the federal and provincial governments, and function on a means-test basis. Other financial assistance includes War Veterans' Allowances, a federal program for needy veterans, or veterans over 60 years of age j and Social Assistance. Employee pension plans and retirement savings plans i n some firms also enable people to make provision for old agej but these naturally  4  vary i n coverage adequacy, and are of no use to people who have not worked long i n one company or industry. Health. Another fact which aged persons face, and which i s perhaps the most c r i t i c a l change in the health picture, i s their heightened proneness to the degenerative diseases. These diseases are expensive to treat and are quite beyond the budget of elderly people with limited means. As the l i f e expectancy increases and as the population is augmented, the degree of ill-health among the aged becomes more acute. In a recent Canadian survey, Dr. Sydney Friedman, of the University of British Columbia has indicated that, of any 1000 persons between the ages of 50 and 60 from the general population: "we shall find that approximately 619 w i l l die .from diseases of the cardiovascular system, 146 from cancer, 44 from accidents, 33 from pneumonia and influenza, 20 from tuberculosis, 21 from diabetes, and a l l other causes w i l l account for the remaining 117". He further pointed out that i f cardiovascular diseases as an entity could be conquered, this alone would increase the l i f e expectancy by ten or twelve years. But since the indigent aged person cannot afford the necessary medical treatment to effect prevention or cure of these diseases, i t w i l l rest with society whether this provision i s made now or in the future. In Canada there are a variety of public and voluntary services designed to meet some of the costs of illnesses. Some provinces provide prepaid medical public hospital care programs, in which the provincial or municipal government bears the major costs, with the individual making a small contribution. In some of the provinces older people receiving 1.  Friedman, S. "Biological Changes". First B.C. Conference on the Needs and Problems of the Aging; Sponsored by the Community Chest and Councils and U.B.C.j 1957, p. 6.  5  specific types of public assistance may benefit from programs of health care, administered and largely financed by the provincial governments. In British Columbia, the provincial government provides medical care and prepaid hospitalization for a l l recipients of Old Age Assistance (OAA) and Old Age Security and Bonus (OASB). This permits the recipient to secure the services of a private doctor of his choice, and also includes the coverage of most medical prescriptions Geriatric services for the aged are provided in veterans' hospitals, and i n a few institutions. Nursing services in the home are made possible by voluntary agencies and public authorities. The Victorian Order of Nurses has given some attention to geriatric nursing, and now includes rehabilitative nursing procedures in their staff training program. Some local public health authorities provide home nursing care, especially in the smaller centres and rural areas where voluntary services are not available. The federal government provides a series of grants to assist in the development of medical rehabilitation f a c i l i t i e s . The Department of Veterans' Affairs has established a service for the assessment, treatment and rehabilitation of older veterans. Some national voluntary health organizations such as the Canadian National Institute for the Blind, and the Canadian Arthritis and Rheumatism Society, offer treatment and rehabilitation services which benefit many of the older population. Living accommodation. Getting decent housing at rents they can afford to pay, i s a serious difficulty which elderly people encounter in many modern urban societies. The trend is now towards building homes to 1.  c f . p. 2 9 .  6  accommodate the " n u c l e a r f a m i l y " o n l y , i . e . , making no p r o v i s i o n f o r o l d e r r e l a t i v e s . I n many i n s t a n c e s aged p e o p l e a r e f o r c e d t o s e l l own homes and move t o s m a l l e r q u a r t e r s ,  their  because they have n e i t h e r t h e  s t r e n g t h n o r t h e money t o m a i n t a i n a l a r g e house o r pay a h i g h  rent.  N e e d l e s s t o say, needy p e o p l e a r e under compulsion t o seek cheap accommodation, because t h e i r s m a l l incomes w i l l a l l o w n o t h i n g  better. I t i s  s m a l l wonder, t h a t s u c h a l a r g e p e r c e n t a g e o f t h e I n d i g e n t  o l d e r people  r e s i d e i n downtown " s k i d r o a d " , a b l i g h t e d a r e a o f l a r g e c i t i e s where r e n t i s r e l a t i v e l y low.  I n v a r i a b l y , s u c h accommodation p r o v i d e s  inade-  quate housekeeping f a c i l i t i e s w i t h p o o r v e n t i l a t i o n , l i g h t and h e a t . V e r y o f t e n t h e r e a r e many f l i g h t s o f s t a i r s , t h e u s e o f w h i c h o n l y adds t o the d i s c o m f o r t  o f these o l d e r persons.  A l l t h i s creates  f o r modern urban s o c i e t i e s t h e r e s p o n s i b i l i t y  o f p r o v i d i n g h o u s i n g f a c i l i t i e s a t low r e n t a l r a t e s , geared t o meet t h e s p e c i f i c needs o f t h e aged, e . g . modem household f a c i l i t i e s , few o r no s t a i r s , e l e v a t o r s e r v i c e where n e c e s s a r y , adequate h e a t , l i g h t and v e n t i l a t i o n . Questions a l s o a r i s e regarding  t h e l o c a t i o n o f such h o u s i n g  f a c i l i t i e s . S h o u l d t h e y be l o c a t e d i n suburban a r e a s , where  conditions  a r e " p e a c e f u l a n d q u i e t " , S h o u l d t h e y be b u i l t i n r e s i d e n t i a l a r e a s where s e n i o r c i t i z e n s may r e t a i n t h e i r c o n t a c t w i t h a l l age groups, S h o u l d t h e y be e r e c t e d i n t h e c i t y c e n t r e amidst a l l t h e e x c i t e m e n t a n d a c t i v i t y , where shopping c e n t r e s a n d r e c r e a t i o n a l s o u r c e s a r e e a s i l y a c c e s s i b l e , Undoubtedly, t h e answers a r e n o t c l e a r - c u t , f o r o l d e r p e o p l e , l i k e a l l o t h e r s , v a r y i n t h e i r needs and p r e f e r e n c e s  and p r o v i s i o n s h o u l d  be made  t o meet v a r y i n g n e e d s . I n Canada, through t h e e f f o r t s o f v o l u n t a r y  groups, a l o n g w i t h  p r o v i n c i a l g r a n t s and f e d e r a l l o a n s , h o u s i n g p r o j e c t s hare been  erected  7  in many of the larger cities, to provide housing accommodation at low rental rates. A number of provinces have made provision through legislation, for capital grants to organizations building approved accommodation for the elderly. In most cases, however, the supply of such accommodation does not nearly meet the demand. In Vancouver and surrounding districts, there are a number of housing projects which are a l l occupied, and for each of these there are waiting l i s t s of three to four years' Standing. Institutional care for senior citizens in Canada i s made possible through various forms of arrangements. There are "homes" which offer congregate care to the needy and incapacitated, as well as units supplying nursing care to elderly people who are not sufficiently i l l to be hospitalized. Other institutions accommodate elderly persons who are ambulatory and need l i t t l e or no supervision or assistance. A few provinces promote active programs for the provision of supervised care of old people who are able-bodied, in small proprietary boarding homes. Recreational a c t i v i t i e s . It i s a well accepted fact that, for the elderly person, leisure time has increased considerably in modern urban so cieties. This i s perhaps due to compulsory retirement at 65 which leaves an individual with a considerable amount of spare time. Many students of gerontology have defended the right of elderly persons to creative activity, the opportunity for self-expression, and the choice to maintain a meaningful role in the society in which they l i v e . These can be achieved in a number of ways, but i t i s a popular opinion that group activity provides a good medium for such expression. In Vancouver a number of organizations are concerned with the welfare of the aged. These organizations are sponsored by various groups; although they have  8  different emphases, they share a common objective. — the welfare of the aged. There are about five different types of groups which may be distinguished. 1. Provincial organizations. There are two major bodies in British Columbia. The Old Age Pensioners* Association i s a provincial organization which works i n the interest of older people. Its main emphasis i s the struggle for higher pensions and improved services for elderly people, but the programs also include concerts, films, teas and other social act i v i t i e s . The Senior Citizens' Association of B.C. i s similarly a provincial organization whose purpose i s to promote the welfare of senior citizens. This organization also includes a social program i n addition to Its main objective. A number of special groups of retired employees include the Government Retired Employees Association, the C.N.R. Veterans Association, the C.P. Pioneers' Association and the Superannuated Federal Civil Servants. 2.  Church-sponsored groups primarily emphasize a devotional period,  followed by a social event. Although these groups support specific religious beliefs, they nevertheless make their programs available to aged men and women of a l l denominations. 3. Social groups are mainly concerned with social activities and exist in such places as the Alexandra and Gordon Neighbourhood houses, community centers, the Jewish Golden Age Club, the Vancouver Second Mile Society and many others. 4.  Camping opportunities are also available through the First United  Church i n Vancouver. Unfortunately these f a c i l i t i e s are limited so the number of elderly persons who can take advantage of this program i s  9  f a i r l y small. 5.  Educational opportunities are available through the Vancouver Public  Library, the Department of Adult Education and so forth. Some enquiry has been made as to the methods employed i n recruiting new members in these various groups, but unfortunately this aspect of the programs seems to be grossly neglected. The two provincial organizations (mentioned under 1. above) distribute news letters and other information to i t s members, but no attempt i s made to advertise the programs for the benefit of prospective members e.g. persons who have just started receiving O.A.A. or O.A.S. Generally speaking, i t would appear that, although these f a c i l i t i e s exist, they f a i l to attract the attention of those whom they intend to serve, due to a lack of adequate advertisement. Although the OASB and OAA programs are the responsibility of the federal and provincial governments, the administration of these programs comes under the jurisdiction of municipal governments. In Vancouver, the agency concerned with administering these programs i s the City Social Service Department (C.S.S.B.), whose responsibility i t i s to establish e l i g i b i l i t y , complete annual investigations and make any enquiries which may be pertinent to the client's receipt of assistance. The area which the C.S.S.iD. serves i s divided into four units East, West, Centre and South Units. (See chart 1). In 1956, the department carried out a survey in an attempt to identify some of the unmet needs of recipients of O.A.A. and O.A.S.B. Out of this study i t was discovered that the greatest number of single aged recipients lived in the Centre Unit areaj that poor health bore a higher percentage here than i n any other unit; that social isolation was much in evidence. Some discus-  10  sion of the Centre Unit area with pension workers (social workers working with pensioners) revealed interesting information concerning the area. Residents of this district had a variety of backgrounds. Some of them had been separated from their spouses as a result of death. Many of the single men had worked i n logging camps and mines a l l their lives, and in their twilight years had moved to Vancouver skidroad, where they could l i v e cheaply on their limited resources. By moving to this location, most of them had l e f t relatives and friends behind i n the districts where once they lived, and some of their friends and acquaintances had passed away. In many instances, these persons had relatives who lived in other sections of the city, but they seldom or never came into contact with them. Many of the elderly people find i t d i f f i c u l t to understand and accept the anonymity of modern city l i f e , where crowds surge past without taking notice of a "stranger", especiall y an old man or woman. In Vancouver, as in other western societies where financial security i s often regarded as an index of success and status, the i n digent aged person i s forced into feeling he i s of l i t t l e import in the community. This serves to create in him feelings of inferiority and worthlessness, and drives him into being more withdrawn from social contacts. A l l this, of course, indicates a need for counselling of these aged persons, in order to help them understand and accept the "new society" in which they now l i v e , and to enable them to maintain a more productive role i n the community. A few of the pension workers consulted in the C.S.S.D. recognized the need for such counselling services, but admitted their inability to meet these needs because of heavy caseloads.  11  Other Studies. Over the last two decades, various studies have been undertaken in connection with problems of the aged in modern urban societies. Some of these studies have been very extensive while others have been simpler. Among the large-scale studies i s Kutner's Five Hundred over Sixty, a study carried out to determine, among other things, whether services already existing in the community really met the needs of the indigent aged. One of his major findings was that resources for older people are geared, not to the large ambulatory segment of the population, but to the most severely i l l , most dependent, most disturbed. Furthermore, he f e l t that services should include preventive work with elderly people.  1  In 1956, Elizabeth Talker undertook a set of interviews  on Services for Married Couples on Assistance and Pension. She attempted to obtain first-hand knowledge of their circumstances and to note any indication of services needed, by analyzing those already available. She concluded that some existing services needed to be expanded and new services introduced. In particular, she thought that recreational act i v i t i e s should be planned according to the particular interests of i n p  dividuals i n groups, in order to stimulate and encourage participation. Dennis Guest, another Social Worker researcher, completed a thesis, four years earlier, on the f a c i l i t i e s of Vancouver's Home for the Aged, and evaluated the extent to which i t met the needs of i t s residents. Among the recommendations he made was the need for a reconsideration of the overall policy of the program; and the introduction of a Women's Auxiliary to provide the more personal touch to the program.' 1. 2. 3.  Kutner, B., Fanshel, D.; Tag, A.j and Langner, T.: Five Hundred Over Sixty; A Survey on Aging. Russel Sage Foundation, Hew York, 1956. Talker, E.: Services for Married Couples on Assistance and Pension. Master of Social Work Thesis, U.B.C, 195b. Quest, D.s Taylor Manor — A Survey of the f a c i l i t i e s of Vancouver's Home for the Aged. Master or social Work Thesis; U.B.C, 1952.  12  There are other studies which do not deal specifically with problems of the aged population, but which nevertheless bear some relation to them. Such a study i s Maureen Evans' thesis, Living on a Marginal Budget, which has a bearing on the present s t u d y I n a recent report on Needed Research i n Welfare in British Columbia, Michael Wheeler includes consideration of the situation of the aged population in this province. The need for research in this f i e l d to stimulate better and more effective services for this group, i s made apparent from several sources ?• Scope and Method. The present study i s an exploratory one, concentrating on the single indigent and aged persons in Vancouver. Many questions come to mind. What kind of living arrangements can such people afford from their limited income, and what i s the nature of the household f a c i l i t i e s provided, What kind of family relationships exist, and what contribution do relatives make towards the well-being of their aged kinfolk, To what extent do they participate i n community l i f e , recreationa l activities, organizational'.membership, etcetera, What personal problems do they encounter from day to day, and how are these resolved, To what extent does the social worker prove helpful i n the lives of these needy old people, Neither time nor f a c i l i t i e s permitted a thorough study of these questions on a city-wide basis, but enlightenment on such questions as the above can prepare the way for further definitive research. It was logical to secure the assistance of the City Social Service Department, which could provide the best resource for this purpose. After considerable preliminary consultation, i t was decided that 1. 2.  Evans, M.: Living on a Marginal Budget. Master of Social Work Thesis j U.B.C, 1953. Wheeler, M.: "A Report on Needed Research in Welfare in British Columbia", Community Chest and Council, Vancouver, March, 1961.  13  the Centre Unit would be most suitable for the purpose of this study, since the greatest number of single clients resided in that area. Following further consultation, the pension worker indicated 20 single recipients whom she knew to be mentally and emotionally equipped to be able to respond to such a study. Of these, seven men and five women were chosen at random. A l l but one responded well to the interviews. A l l the subjects chosen were single, over 65, l i v i n g alone, and a l l had a maximum income of 179.00 per month from OAA or OASB. They were a l l white, but were of various national backgrounds. Identifying information was obtained from f i l e s at the C.S.S.D., but the more substantial information was secured through personal interviews with the respondents. Each respondent was sent a letter which explained the nature and purpose of the study, with a request for the respondent's participation. Interviews were unstructured and lasted for one hour. During this period, an attempt was made to obtain i n d i vidual profiles of those studied covering (a) l i v i n g arrangements, (b) family relationships, (c) social l i f e , (d) kind of problems being faced and (e) methods of resolving these problems. In dealing with these people's "problems" i t was evident that what constituted a problem for one person could be insignificant for another. For the purpose of this study, therefore, i t was assumed that any experience or handicap which debarred the elderly person from r e a l i zing maximum satisfaction i n l i f e , must be accepted as "a problem". In such small dimensions, this study cannot pretend to be representative of a l l the pros and cons of the needy aged in Vancouver, or to present a complete picture. It i s reasonable, however, to compare this small local sample with many of the "pen pictures" which now appear in  14  contemporary literature. I t seeks to portray some experiences of the daily lives of old people, and the manner in which they cope with economic and social limitations. In particular, i t seeks to indicate whether counselling services are a medium of assistance to people i n need, and i f so, of what kind.  'CHAPTER II  HOUSING, LIVING CONDITIONS AND HEALTH  How or where a person lives i s largely dependent upon his economic status, and for the old person subsisting on a marginal income the range of choice i s severely limited. The elderly persons who  are  the subject of this study l i v e in the "skid road" area of Vancouver, which i s close to the city centre and flanked on the north by water front and wharves. Day and night one can hear the noisy sound of traff i c and the warning horns of approaching trains or ships. On the busy sidewalks men and women, shabbily dressed, walk about aimlessly, or simply stand around. Occasionally, a drunken man i s to be seen tottering alone to find the nearest beer parlour. The residents of this district live in cheap hotels and rooming houses, which are squeezed between warehouses and wholesale houses, or over cheap cafes, beer parlours, gambling and sports clubs. Brug stores and small grocery stores abound in the area. Generally speaking, the rooms in these dwelling places are dirty, old and shabby. The rent is cheap and the accommodation provides the minimum of comfort. In this area well-maintained and attractive buildings are the exception. Sometimes the only entrance to the building l i e s through a cafe or beer-parlour on the main floor and, in order to get to the rooms above, one has to thread one's way through a throng of patrons. Stairways and corridors are often poorly l i t and this in i t s e l f i s a hazard for old people whose vision i s deteriorating. In only one of the rooming  16  houses visited by the writer was the floor of the corridor adorned with a rugj for the most part corridors were bare and unpainted, though some effort was made to keep floors clean. The majority of the people interviewed were fortunate to be l i v i n g on the f i r s t floor but i n these cheap hotels many old people live on upper floors which can be reached only after climbing several flights of stairs. Only four of the buildings visited provided elevator service, with the result that many of the elderly persons who were a f f l i c t e d with arthritis, heart disease and other ailments, preferred to endure the tedium and isolation of their room rather than face the prospect of having to climb stairs on their return from an outing. The average size of the eleven rooms visited was approvimately 12' by 14'. The walls were mostly wooden and covered with wall-paper which was usually torn and brown with age. Some of the walls were decorated with family portraits and pictures, but in most cases they remained starkly bare. Although these hotel rooms were not originally equipped for housekeeping purposes, i t would appear that, as more low-income groups seek them out for permanent accommodation, the managers adopt a more lenient attitude toward the preparation of meals in the rooms. Most of the managers permitted the use of a hot plate, but would not allow more substantial cooking equipment requiring more power. The furnishing of a typical room included a wash basin with running water, a bed, a dresser, a table and two chairs. Of the eleven rooms, two were sleeping rooms without cooking f a c i l i t i e s , but the house-keeping rooms were a l l equipped with a hot plate. Heating represented a serious problem for those pensioners whose only source of heat was a one- or two-burner hot plate. Such a  17  method of heating cannot be considered satisfactory for even the average room occupied by these elderly persons. In one instance the landlord provided central heating, but because he turned i t off during most of the day, the pensioner was forced to v i s i t her neighbour i n the adjoining building in cold weather. Hot water was not always available and pensioners were constantly faced with the problem of heating water for dish washing, laundering and personal use. As a result of his lessened physical activity and poor blood circulation the older person i s inclined to feel the cold more easily, so that this whold problem of heating i s perhaps more serious for older persons than for those of a younger age group. Toilet and bathing f a c i l i t i e s were also inadequate. A l l of the persons visited shared toilet and bathing f a c i l i t i e s with at least four other residents. Most pensioners did not mind sharing f a c i l i t i e s , either because they f e l t these were clean and well-kept, or because they had become so resigned to this situation that they no longer cared. One woman resented sharing because her fellow residents did not use the f a c i l i t i e s assigned to their own sex. Two others thought this sharing was infringing on their privacy and a few of the pensioners described the f a c i l i t i e s as being f i l t h y . In two instances the bathrooms were located close to the room, but the convenience this afforded was offset by the unbearable odour that emanated every time the bathroom door was opened. Moreover, the walls of the room were so poorly constructed that they were no barr i e r to the sound of flushing toilets, running bath-water, and squeaking doors. Laundry f a c i l i t i e s were available to seven of the pensioners, and were located in the basement of their buildings. The elderly persons,  18  however failed to use them for various reasons. Many found i t too t i r e some to go down to the basement to launder a small quantity of clothing, and preferred to do the laundering in their own rooms. Others, especiall y the men, laundered only their undergarments in their rooms and sent other clothing to the cleaners. Fortunately, a l l but one of the pensioners were provided with bed linen, and, i n some cases, towels, so they avoided the expense of laundering these articles. Food storage f a c i l i t i e s were found to be inadequate for a l l but one of the pensioners. A few of them tried to overcome this by storing non-perishables neatly i n a box or in an old cabinet, but a few who were not quite so resourceful, strewed them in every vacant space they could find - on a table, i n a corner, beside the bed. The only woman who had a refrigerator was also the only one who could store milk, green vegetables and meat. During the winter months, the problem of food storage^ i s less acute, since the temperature on the window s i l l i s usually cold enough.to preserve milk and other perishable foods. This, however i s impossible in summer or even i n a mild winter. Needless to say, this lack of storage f a c i l i t i e s forces these old people into buying only enough meat and milk for one day which in turn, presents two major problems. First, they have to shop almost every day, which i s often d i f f i c u l t due to their f a i l i n g strength. Second, they are unable to budget their expenses i n the most economical way. Some pensioners found that they could purchase goods at a cheaper rate on certain days, but were forced to neglect these opportunities to avoid loss from spoiling. As a result of these handicaps some pensioners did not bother to prepare themselves a substantial meal for days at a time and consequently their nutrition was affected. They could hardly afford much variety  19  so that eating afforded l i t t l e pleasure. If they opened a can of baked beans one day, they would have to eat the remainder on the following day. They could not even break the monotony by baking occasionally, nor could they afford to purchase food from the bakery. A few of them treated themselves, at least once every month to f u l l course meals at low cost in some of the neighbouring restaurants. Reasons for living in the area. The principal reasons advanced for their choice of accommodation were (a) low rents, and (b) the convenient location of the area in relation to down-town shopping f a c i l i t i e s . One of the elderly persons had lived in that area for almost thirty years and therefore f e l t she belonged there. A few others, however, had lived in the West End and other parts of the city, and had moved to their present location only because there was cheap accommodation here. Two of them had sold their houses and lived off the proceeds for a while. When this was gone and their only income was Old Age Assistance, they moved down into this area. Another man who had lived in the northern part of B.C. for several years, decided to move to Vancouver for a change, and settled in the skid-road area because his friends lived there. But there were other factors besides financial ones which i n fluenced their selection of accommodation. In one instance, a female pensioner was invited to l i v e in the hotel which was being managed by a friend of long standing. Since she had no relatives nearby, this arrangement provided some degree of companionship for her. Another woman who had a serious back ailment chose her accommodation because i t provided maid service and an elevator without any extra charge. One man had a shack in a suburb of Vancouver; but, because i t was not adequately protected against cold weather, he moved into the city i n the winter.  20  A l l the persons in the study were dissatisfied with their l i v i n g arrangements although some of them were becoming resigned to their fate. Two of them had attempted to secure accommodation in some of the Vancouver Housing Projects, but without success. One woman had spent a short period in a boarding house situated away from the city centre, but she moved back again where there was more activity, and where shopping f a c i l i t i e s were more accessible. She and a few others f e l t that boarding houses should be more centrally located because transportation was too costly for them. One man was appalled by the types of people he encountered in the vicinity, and was alarmed at the noises and many fights in the neighbouring hotels. A woman who lived i n the same hotel as he did was also a l i t t l e fearful, but f e l t relatively safe since she did not go outdoors at night. There was one man who was so disgusted with his living arrangements that he wanted to move out immediately. Unfortunately, he did not know how or where to look for boarding house accommodation which would be more to his l i k i n g . An 83-year-old woman had heard of less expensive l i v i n g accommodation, but she did not have the physical energy to go house-hunting, and had no one to help her move even i f she did locate a place. A l l this would indicate that although most of these e l derly people were not happy with their l i v i n g arrangements they were unable to do otherwise because of a number of barriers. Income, Rent and Budget Problems. Only two of the eleven person's were not receiving the f u l l pension of 179.00 per month. Of the two, one was receiving $71.13 because she had an income from her former estate; the other was receiving |68.10 because she had a pension from the Workmen's Compensation Board. Almost a l l of them regarded the amount of  21  assistance they were receiving to be inadequate for their needs, and most of them f e l t that the federal government should do something about i t . But i n spite of the alleged inadequacy of these funds, some of the pensioners who were more economical were able to sustain themselves from one month to another. Others, of course, were always out of everything by the middle of the month, and one man in particular was constantly in debt either for rent, groceries, or dry cleaning. In general, their opinion of the adequacy of the pension seemed to be directly related to their previous standards of l i v i n g . One woman who thought i t was adequate had worked as a waitress i n earlier l i f e , and had been on Social Assistance for a long period before receiving Old Age Pension. On the other hand, a man who had worked as a dental mechanic found i t extremely d i f f i c u l t to make ends meet. Rent for these pensioners ranged between $26.00 per month for a sleeping room at the Salvation Army Shelter for men, and $50.00 per month for the only two-room suite occupied by one of the persons i n this study. One other sleeping room, rented at $45.00 per month, was located in the hotel which provided the best quality of f a c i l i t i e s . Housekeeping rooms ranged from $28.00 to $35.00 per month. After the rent was paid the remaining money had to provide the pensioners with food, clothing, incidentals and other comforts. Needless to say, they could not afford new clothing and were therefore always forced to resort to second hand stores, or charitable donations. One 84 year old man complained that many of these second hand goods were not durable, so he was constantly faced with the problem of buying a "new" set of used clothing. A woman of 84, who i s particularly sensitive to cold, found i t very d i f f i c u l t to obtain warm  22  undergarments which were n e c e s s a r y f o r h e r comfort. One  o t h e r man  was  unhappy because he n e v e r had any money l e f t o v e r f o r comforts and i n c i d e n t a l s - r a z o r b l a d e s , n e e d l e s and t h r e a d , a s p i r i n s , t o o t h p a s t e . A few o f them would have l i k e d an o c c a s i o n a l g l a s s o f beer, but o f t e n  had  t o depend on t h e g e n e r o s i t y o f f r i e n d s and a c q u a i n t a n c e s .  also  a d e a r t h o f c i g a r e t t e s and t o b a c c o , and c o n s e q u e n t l y ,  There was  some o f them had  r e s o r t e d to the p r a c t i c e o f c o l l e c t i n g s i z e a b l e c i g a r e t t e b u t t s . Some o f the women were q u i t e i n t e r e s t e d i n t h e i r appearance and found i t i m p o s s i b l e to buy  c o s m e t i c s , shampoos and f o u n d a t i o n  ments. As a r e s u l t , a few o f them had given up  gar-  t h e u n e q u a l s t r u g g l e and  became c a r e l e s s o f good grooming. One woman o f 69 whose h a i r hung l i k e a weeping w i l l o w , a c t u a l l y seemed i n t e r e s t e d i n making i t l o o k more a t t r a c t i v e , f o r she was  e n q u i r i n g about t h e p o s s i b i l i t y o f o b t a i n i n g  a h a i r c u t and shampoo, f o r w h i c h she c o u l d a f f o r d  750.  Three case examples. The p r e c e d i n g s e c t i o n has l i v i n g arrangements o f e i g h t o f the p e n s i o n e r s  s t u d i e d , i n the o t h e r  t h r e e c a s e s , the accommodation and mariner o f l i v i n g were d i f f e r e n t , each i n t h e i r own  way,  d e s c r i b e d the  sufficiently  t o m e r i t s e p a r a t e c o n s i d e r a t i o n . The  f i r s t r e p r e s e n t s t h e most modern, most c o m f o r t a b l e and most a t t r a c t i v e accommodation o f a l l the rooms v i s i t e d . The  second d e s c r i b e s the  d i r t i e s t and most n e g l e c t e d room, whose occupant seemed as i f he  no  l o n g e r c a r e d about p e r s o n a l h y g i e n e . The  t h i r d case i s t h a t o f a woman  who,  s t i l l a b l e to m a i n t a i n a home-  i n s p i t e o f h e r l i m i t e d income, was  l i k e atmosphere w i t h many f a m i l i a r o b j e c t s o f h e r e a r l i e r  life.  The h o t e l which p r o v i d e d the b e s t q u a l i t y o f accommodation was  slightly  removed from the n o i s e and t r a f f i c o f the c i t y c e n t r e . On  the main f l o o r t h e r e was  a l a r g e q u i e t lounge,  equipped w i t h  comfortable  23  chairs and a television set. A large window offered a good view of act i v i t y in the street. There was a self operated elevator which afforded quick transportation to the f i r s t floor, which was covered with a rug that muffled the sound of footsteps. Remarkably enough, no other hotel visited in the course of this study, enjoyed this luxury. The pensioner's room i t s e l f was clean, well-kept and attractively arranged. A focal point was a window which was a source of light and overlooked the street below. The drapes were of the same material which covered her clothes closet and the bed spread and partial rug matched the walls of the room. The furnishings in the 14' x 12' room comprised a bed, a dresser with a large mirror, a corner table with a reading lamp, a comfortably cushioned rocking chair, and another small table on which was a portable radio. There were various other comforts about the room - figurines, two paintings and so forth. Hot and cold water were available in the room, but toilet f a c i l i t i e s which were shared, were located about f i f t y feet down the h a l l . No cooking was a l lowed in the room although cooked food could be brought i n . Maid service and bed linen were included in the rent of $45.00 per month. The 68-yearold woman who lived here was the only pensioner in this study who enjoyed this kind of accommodation. She had been a housewife a l l her l i f e and had been on 0.A .A. for only three years. In marked contrast with this situation were the living conditions of an 84-year-old man who had been on pension for at least thirteen years. He lived in an old and worn rooming house situated above a row of second hand stores. A door from the sidewalk opened directly on a flight of stairs, which led to the second floor where this pensioner resided. The hallway i t s e l f was rather dismal, except at the other end where the  24  light from a window afforded an easier and more comfortable journeyalong the unfamiliar corridor. There were no rugs on the floor, and the sound of the interviewer's feminine footsteps called forth surprised and curious glances from half-opened doors. The walls were worn and smutty, and their only adornment were cobweb and fingerprints. As the pensioner's door opened a foul odour came from within the room. The window in his room did not permit much light, since the adjoining building was only a few feet away. The bed did not have a spread, but two tattered blankets covered the bare mattress. Beside the bed was a wash basin which was heavily specked with grease and dirt. This man (like many of the other pensioners i n the study) used the sink for a three fold purpose: personal cleanliness, dishwashing and laundering. Next to the wash basin was a blackish mildewed table with pots and pans which seemed as i f they had not been washed for several days. Also on this table were the remains of food and a few groceries. In one corner of the room was a garbage can of a kind usually seen outdoors. Beside that stood an old rugged and dusty wooden cabinet which contained a few dishes. The floor was caked with dirt, and the ceiling hung with cobwebs. There were three chairs - a wooden straight backed one, and two cushioned ones which were so torn and dirty i n appearance that they seemed a perfect breeding ground for vermin. There was also a two-burner hot plate which was dotted with grease spots, bits of food and rust. An old shredded curtain failed to cover his tattered and worn clothing which hung i n a corner. The "T" shirt which he wore was so soiled, i t could hardly regain i t s whiteness even i f i t were bleached for a week. His personal appearance, as well as that of his room gave the impression that he had  25  long given up his hold on l i f e . He was dirty and unkept and neither enjoyed cooking for himself, nor keeping himself or his environment clean and attractive. In comparing this man's circumstances with those of the woman previously described, i t i s perhaps worthwhile to speculate what factors may have contributed to the significant differences between them. One cannot overlook the fact that the two buildings were themselves quite different in appearance and in the f a c i l i t i e s they provided. But i t is quite possible that past experience of the two people played a part in this. The woman had been a housewife a l l her l i f e and had developed some s k i l l in housekeeping. The man, on the other hand, had been a farmer and later, a labourer, during which time he had boarded with families. But this does not fully explain the filthiness of his room. Perhaps his health and environment were neglected because of his f a i l i n g energy, or because of a loss of morale, or both. Age, too, must be taken into account in this comparison. The woman had been on Old Age Assistance for only three years, and had owned a home with a l l i t s furnishings only five years before. She s t i l l had many friends who showed some interest in her, and she enjoyed f a i r l y good health. The old man, on the other hand, had been on Old Age Pension for over thirteen years and had lived in this same room for about seven years. His friends had a l l died and his health was now very poor. A l l these had perhaps contributed to his loss of morale and consequent neglect of himself and his immediate environment. The third pensioner, a woman, occupied a two-room suite in an apartment block. An old fashioned elevator, manned by an equally old gentleman, afforded slow but certain transport to the f i r s t floor where  26  she lived. The only source of light in the corridor came from a window about seventy feet down the h a l l . The door from the corridor opened into Mrs. B's kitchenette, which contained a four burner stove with an oven, a large frigidaire, cupboards f i l l e d with dishes, and more cupboards which presumably contained groceries. There was a dinette set i n the corner and a large kitchen sink. A very narrow passage led to the l i v i n g room, which was furnished with cushioned chairs and two single chesterfield chairs. A small table stood i n a corner with a reading lamp on i t , and on the lower shelf a number of books were neatly arranged. There was a large old model radio which u t i l i z e d more space than i t deserved for she s e l dom used i t . On either side of a well polished coffee table stood a cigaret stand from which green shrubs draped. Several pictures decked the walls which, though not freshly painted, maintained good colour. The floor was adorned with a well kept though worn, Indian rug. There were a number of hand-made cushions and chair-tops, which probably served as a reminder of her hand work done in earlier l i f e . Various l i t t l e indoor plants and figurines also helped to enhance the suite. A bright window opened over a moderately busy street. Indeed, the suite which measured approximately 20' x 36' altogether, was rather crowded with a l l i t s contents, but i t was most satisfying to the pensioner that she was living among familiar things and in a "homey" atmosphere. Health problems. The health picture presented by the persons interviewed in the present study i s in accord with the findings of a survey carried out by the Vancouver City Social Service Department in 1956. The purpose of this earlier study, was to ascertain the nature and  27  prevalence of specific problems experienced-.by elderly persons i n receipt of public assistance, and poor health was discovered to be the greatest problem among those studied. The incidence of poor health among recipients was significantly higher in the district served by Centre unit of the City Social Service Department, the actual percentages of recipients suffering poor health in the different units being as follows: East Unit  West Unit  Centre Unit  South Unit One of the pensioners interviewed, a 67-year-old woman, had suffered a serious f a l l several months prior to the interview, and was s t i l l suffering considerable pain and discomfort. She had consulted her private doctor at the time of the accident, but claimed the doctor had merely given her a few p i l l s and sent her on her way. After using several of these p i l l s , she failed to get any relief and therefore decided to terminate her contact with the physician. Subsequently she attended a chiropractor whose treatment gave her considerable r e l i e f . Unfortunately, however, she learned from her social worker that chiropractic services were not covered by her Medical Card and as a result, she was faced with the responsibility of a b i l l for $50.00.^ Because of the high cost of this service, she was forced to discontinue treatment. Another woman complained that her doctor merely prescribed aspirins when she sought his advice so that she no longer consults him even when she i s very i l l . One of the men interviewed liked to have an annual check -up including X-rays and so forth. On his last v i s i t he had been 1.  Persons in receipt of Old Age Assistance or Old Age Pension and Supplementary Assistance (Bonus) are eligible for free Medical care, when they present their Health Service Identity Card, c f . p.  28  required by his doctor to pay flO.OO for this service, because i t was not provided for under this medical scheme. Two other pensioners complained that they were required by their doctors to contribute out of their own pocket towards the cost of the service provided. They did not feel they could afford to pay doctor's fees from their meagre i n come and consequently avoided doctors and neglected their health. One woman suffering from a heart condition and diabetes, i n addition to having crippled hands and feet, no longer visited her doctor because she was unable to board the bus and could not afford a taxi. Six months previously she had suffered a fractured skull when she collapsed on her way to buy groceries. One 84-year-old man consulted his doctor two years ago concerning severe pains and swelling in his legs. At that time, he expressed a wish to be hospitalized, but was advised by the physician that hospitalization would be useless. He returned home and has since suffered intensely from these pains. As a result he i s forced to remain indoors most of the time and has no visitors. On two occasions during the past four months he collapsed on the sidewalk. At the time of the interview his condition was poor, his room and person f i l t h y , and he had neither the energy nor the desire to prepare meals for himself. One woman who has had multiple illnesses, experienced a "spell" sometime ago. She lived on the second floor and her only friend lived on the main floor of the apartment block. Since she did not have a telephone she sought the assistance of the couple in the adjoining suite, but they abruptly reported that they could not help and l e f t her helpless i n the corridor. An 84-year-old woman i n the group studied, had lived with her  29  sister for almost twenty years. Last year her sister had to be taken to hospital by ambulance shortly before she died, and the pensioner was faced with a b i l l for $16.00 from the ambulance company. One month later, she herself had to be taken to hospital by ambulance, and was presented with another b i l l for $16.00. The pensioner found i t very distressing to have to cover these b i l l s from her meagre income. This same woman was labouring under another difficulty of a kind frequently experienced by older people living alone. She wished to move to less expensive quarters, but was not physically capable of going "house hunting", and even i f she were capable, she would need help in moving her belongings. Because there was no help forthcoming she was forced to remain i n a room where she was not particularly happy. In view of the variety of medical problems which this group has experienced, i t seems appropriate at this juncture, to examine the nature of medical services which are provided for the needy aged. An agreement between the British Columbia Medical Association (B.C.M.A.)* and the department of Social Welfare, sets out a plan by which costs of doctor's care are shared. There i s also an arrangement with the Health Insurance Service of the Department of Health Services and Hospital Insurance, to pay for hospital benefits, and an agreement with the Pharmaceutical Association to supply prescribed drugs set down in the B.C.  Formulary. The Department of Social Welfare issues an Health Services  Identity card (H.S.I.) to recipients of financial assistance, who are eligible for health services, and pays a premium for each registrant and each dependent to the B.C.M.A. This card i s the client's authority -*Taken from the Policy Manual, Department of Social Welfare; Province of B.C. pp. 1, 2, 49.  30  to receive certain health services. Also, i t i s the authority to the doctor, hospital or druggist to provide the service and to submit accounts to the department for payment. The Medical Services Division of the Department of Social Welfare directs the health services programme. The division has an administrative office and a provincial pharmacy. The pharmacy provides special drugs (drugs not included in the B.C. Formulary) to clients, and drugs on a continuing monthly basis to clients with chronic conditions, who l i v e in private hospitals and boarding homes. By direct referral to his medical doctor, hospital or druggist, the patient may receive (a) medical benefits, (b) hospital benefits or (c) drugs. These may be further explained as follows.  Services provided  by doctors include f u l l medical, surgical and obstetrical care in home, hospital and doctor's office, in accordance with recognized medical practices. The arrangement for admission to acute hospitals, prescription of drugs and medications, and examination by an occulist or opthalmologist are also included. The hospital insurance services provide for the payment of the co-insurance and general hospital services available under the Hospital Insurance Act. Such hospital services include public ward f a c i l i t i e s , necessary operating and case room f a c i l i t i e s , X-ray and laboratory diagnostic and therapeutic procedures, anaesthetics and other services, dressings and drugs as are prescribed by regulations. Drugs prescribed by the client's physician may be provided by local druggists, according to the terms and regulations of the B.C. Formulary. A l l H.S.I, cards for O.A.A. clients are prepared and sent directly to the client by the O.A.A. Board. A l l O.A.A. recipients and their dependents are eligible to receive health services, providing  31  they have resided in B.C. for at least one year continuously immediatel y prior to the date of commencement of O.A.A. A l l H.S.I, cards for O.A.S. cases in receipt of Supplementary Assistance (bonus) are prepared and sent directly to the client by the O.A.A. Board. On the surface, such provisions appear to meet a l l medical needs of the indigent aged, but many drawbacks to these arrangements have emerged from the present study. Many of the elderly persons fear that they may be charged an additional fee for medical services received. This fear i s well-founded on the actual experience which some of them have had in this regard. It i s unfortunate that there i s no clause in the agreement to protect pensioners against exploitation by dissatisfied medical practitioners. There i s another aspect of this subject which must not be treated l i g h t l y . A few medical practitioners pointed out to the writer that, according to the agreement, the provincial government would pay 75 per cent of the cost while the B.C.M.A. would contribute 25 per cent. At the present time, however the B.C.M.A. i s contributing almost 50 per cent of the cost. These doctors claimed that the B.C.M.A. has raised this issue with the provincial government but to no avail. Since some medical practitioners find i t necessary to charge pensioners contrary to the terms of the agreement, i t i s perhaps an indication that they are dissatisfied with their terms as they now exist. It seems imperative then, that the two parties of this agreement should review this situation and arrive at terms which are more acceptable to the B.C.M.A. Unless this i s done soon, the effectiveness of this service to the aged w i l l continue to deteriorate. There i s perhaps a need for an extension of the range of services outlined above. The agreement provides for examination by an  32  occulist or an ophthamologist. Perhaps the services of chiropractors and similar well-recognized practitioners should also be made available to the needy aged. The B.C.M.A. does not regard chiropractors as professiona l medical practitioners, hence their services cannot be covered under this agreement. One cannot overlook the fact, however, that chiropractors enjoy considerable recognition in B.C. and elsewhere, nor the fact that their services do produce untold r e l i e f to many people. The B.C.M.A. has every right to reserve membership for whom i t w i l l , but the problem should not be dismissed here. Some provision should be made whereby pensioners could be permitted to use those services which w i l l relieve their distresses. It i s rather to be regretted that some of those interviewed could not u t i l i z e available medical services either because they could not afford transportation or because they could not travel by bus for physical reasons. One woman claimed that her doctor visited her at home once every month, but home calls should not be expected except in cases of real emergency. On the other hand, the pensioner should not have to neglect his health because of lack of transportation, so some provision should be made within the community to meet this need. Also evident from this study i s the need for better coordination of services in the community. When the doctor realized that the 84-year-old man could not profit from hospitalization, he should have brought this to the attention of the C.S.S.D. so that a Boarding or Nursing Home placement could have been arranged. Such co-operation i s necessary between groups and agencies serving the aged population, in order that these people might receive maximum benefit from available resources. Many a time, senior citizens have grown too irrational and con-  33  fused to judge what i s best for them, and even more often, they are unaware of community resources. It i s important, then that those who work with, and for them, be alert to their needs, and inform the persons who can help satisfy them. Also connected with this, was the expression by some pensioners of a loss of confidence in the ability or interest of the doctor to be of real help. I t i s indeed possible that many of the problems of the elderly people are non-medical in nature. I t i s also possible that medical men, already frustrated by the fee loss they suffer by serving the indigent aged, may quickly dispatch these patients by prescribing aspirins without an examination. I f community resources are well coordinated, these people can be directed to a social worker or psychiatrist, whenever social emotional or psychiatric problems are indicated. There were two occasions when i t became quite evident that accessibility to a telephone was an essential commodity rather than a luxury. The possible threat of isolation during serious illness, or untimely death due to the inability to secure help speedily, pointed up the need for elderly people to have easy access to a telephone. Most of the indigent ones cannot afford this out of their limited income, and one wonders whether some arrangement could not be made between the provincial government and the B.C. Telephone Company, to provide this service for needy pensioners. Needless to say, the tlephone could have the added advantage of enabling the pensioner to maintain contact with friends and relatives in the community without having to travel. Those who are shut i n , can order groceries or make further contacts with doctor, minister and so forth as the need may arise. The Policy Manual points up quite clearly that " a l l H.S.I, cards  34  for O.A.A. and O.A.S. clients in receipt of Supplementary Assistance are prepared and sent directly to the client by the Old Age Assistance Board" ?• Indeed the 0 .A .A. Board f u l f i l s i t s duty by explaining in a covering letter that the medical card i s enclosed, but no explanation i s given concerning the various services which are available through the medical card. It i s the duty of the visiting C.S.S.D. worker to point out the uses that can be made of the medical card, but this i s often neglected because the worker i s overwhelmed with an oversized case load. A verbal explanation i s often necessary, because the client may be either poor-sighted, i l l i t e r a t e or too overwhelmed about receiving his pension, to take notice of the information regarding medical care. Very often the letter and card are carefully preserved in a dresser drawer and forgotten . It is possible, that a l l these drawbacks hinder these elderly persons from taking greater advantage of the medical and hospital services which the Provincial government and B.C.M.A. have made available to them.  1.  Policy Manual, Department of Social Welfare; Province of British 'Columbia; p. 49-  CHAPTER III  PERSONAL LIFE AND SOCIAL CONTACTS  Generally speaking the social l i f e of the group studied was very limited, dull and uneventful. In most instances, relatives were either in other parts of 'Canada or in distant countries, and their friends had passed away. Recreational activities were curtailled either because of a lack of funds or a loss of interest. A l l the women but only one of the men in this study had been married. This one man had had no children, and his wife had died six years after the union. The other married persons had lived for at least twenty years with their spouses before either death or separation had intervened. With one exception, the women had given birth to at least one child, and four of them stated they s t i l l had children alive. One woman had children l i v i n g in this city, with whom she maintained occasional contact. Although they did not offer her any financial assistance, she bore no grudge against them, because they could not afford i t , and because she did not think they were indebted to her. Another woman, whose daughter also lived in Vancouver refused to continue contact with her, because of a disagreement between them. One woman had a son and several grand children, but did not know of their whereabouts. There was one other woman who had a son i n this province and another on the East Coast. She had maintained constant contact with the boy in British Columbia, but was rather disappointed when he did not v i s i t " her last Christmas. She claimed that she had received financial assistance from her children in the past, and would be willing to do so again i f they  56  could afford i t . She thought, however, that she could never live with her children since she preferred to be independent. One unmarried man claimed he had relatives on the East Coast of Canada, with whom he corresponded frequently. He spoke fondly of them, and longed to move closer to them, but could not do this since the province of Quebec does not offer a bonus. Friends. Friendship represented one of the rarest possessions of these elderly persons. Five of them reported that they s t i l l had at least one friend alive, but i n most cases these friends did not live sufficiently close-by to f a c i l i t a t e v i s i t i n g . The only friend of one of the elderly persons lived about 30 miles from Vancouver, but was nevertheless quite willing to render any assistance to the pensioner whenever necessary. Unfortunately, the pensioner had no means of contacting her friend in the event of an emergency, for she did not have a telephone nor did she have the telephone number of her friend. Most of the pensioners claimed they had many acquaintances i n the hotel where they lived, or in other parts of the city, but these were not people with whom they f e l t free to share their intimate thoughts. One 83-year-old woman was appalled by the lack of warmth that was evident among persons occupying rooms in the same hotel. She failed to understand why people were no longer interested i n their fellows as they had done several years ago, in more rural d i s t r i c t s . A few of them reported that they were very lonely, and one woman in particular indicated that although she had several friends and acquaintances whom she saw from time to time, she s t i l l longed for warm and constant companionship. Another woman, who was extremely lonely, f e l t that i t was decidedly too risky to attempt to be friendly i n a city as large as  37  Vancouver. She had one friend in the apartment block where she lived a woman to whom she was able to turn for help when she was sick - and was quite content to l e t a l l her eggs l i e in this one basket. Actually, this woman had had several friends i n earlier l i f e , and had taken great pride in entertaining for she felt that this was one way to be popular. Unfortunately, an income of $79.00 per month did not allow for much entertaining, so her one-time mascot cruelly l e f t her to the mercy of solitude and loneliness. Strangely enough, there were two women who did not experience any loneliness, not because they had many friends or did a great deal of visiting, for the opposite was more correct. They simply wanted to be l e f t alone. One of them, a woman of 67, had worked most of her l i f e as a waitress during which time she had seen many people and had made many friends and acquaintances. Now two years after retiring, she was quite satisfied and relieved to be alone. Although she s t i l l had a few acquaintances in the city, she neither visited nor expected to be visited. The other woman in this category had never had many friends in earlier l i f e , so she never cared for companionship, since she found people rather t i r e some at times. The death of friends - Their reaction. A l l the pensioners agreed that many of their friends had died over the last decade or so. In most cases, their concern about death had heightened during this period, but their attitude to i t varied with their faith and philosophy of l i f e . Two of the men who were devout Roman Catholics, nestled comfortably in the thought that after death, they would go to Purgatory where they would prepare to enjoy the bliss of heaven. Over the years a few of them had drifted away from their original faith, and their purpose i n l i f e had long grown  38  hazy. These demonstrated more fear, perhaps because of the uncertainty of the future. An exception was one man of 84 who was "too busy living", to be distracted by thoughts of death. He argued that man continued to l i v e on in spite of death, because his remains were conserved in the universe, which in i t s e l f i s eternal. Death, then does not introduce an "after l i f e " or a "better l i f e " as some people perceive i t , but merely marks the transition between l i f e on this planet, and another in the universe. With such a belief this man was not afraid of the frightful "spectre" which so many of his fellows dread. For those who s t i l l retained their faith or some belief, there was evidently less anxiety about death, than there was among the others. In most cases, fear was more often connected with what happened after death than with the actual event of death. Recreation. There was a real dearth of recreational participation among this group of pensioners. This was not surprising, for their energy and v i t a l i t y had ebbed away with the passing years. Two of them, a woman of 69 and a man of 84, were perhaps more vigorous than the others, and were s t i l l interested in ballroom dancing. The woman expressed dissatisfaction with the new trend in which old and young no longer attend the same dances, as was practised in rural communities in her younger days. In the majority of cases, the persons in this study engaged in activity which did not c a l l for too much physical exertion. Most of them listened to the radio, but two of them confined their interest to the news casts only. There was one man who truly enjoyed listening to radio programs, but his radio was out of order, and he could not afford to have i t repaired. Actually there are service clubs in this city which would  39  have had that radio repaired i f the pensioner had sought their assistance. But because he was not aware of these resources, he sat i n his room deprived of the entertainment from which he once derived so much pleasure. Only one woman owned a television set. Three others had access to television in the lounge of their hotel, but only one of them took advantage of this luxury. Only one man continued to attend the movies, and this he did in the forenoon, since prices were cheapest at that time. Most of the women had done one or a l l of sewing, knitting and crocheting in earlier years, but only one of them continued to pursue these hobbies. One man had owned a budgie for several years and spent a great deal of time caring for this pet. The pensioners were a l l able to get out for a walk once in a while, although their physical endurance determined how f a r and how often they could enjoy this pastime. dubs, Organizations, Churches, d u b membership among the group studied was very rare. Only two of them claimed membership in any organization, and their attendance was by no means regular. Two others had belonged to organizations at some period in earlier l i f e . Most of them were aware of the existence of clubs for senior citizens within the city, but were not interested in attending or seeking membership i n any of these groups. One man explained that he had visited one of these organizations a few times, but once he discovered that some of i t s members indulged in the vice of back-biting, he quickly severed his contact with this group. Some of the pensioners complained that the time of meeting did not f i t their schedule, for i t was either too early i n the day or too late at night. Only four of the pensioners continued to attend church services. One 83-year-old woman regarded herself as an active member, even though  40  in October she had not yet been able to attend a single service for the year. One other -woman maintained some degree of interest through the medium of radio and television. She had lost faith in the church and i n ministers whom she thought were not sure of the things they themselves preached. Most of the pensioners had not attended a church service for at least 20 years. One woman in this category claimed she had a Bible which she sometimes read, but wished she could be favoured with a v i s i t from the minister. Incidentally, she had no idea where the nearest church of her denomination was located, even though she had lived in that vicinity for over 25 years. One 80-year-old woman who had not been able to attend church for over a year, claimed that she belonged to a group connected with the church. The purpose of this organization was to promote the interest of senior citizens within the church. Yet no representative from the group had visited or attempted to contact her during her absence. One exception to a l l this was an 84-year-old man who led such an extraordinary existence as to merit special consideration. Mr. S. was an 84-year-old single man who appeared to be about 15 years younger than his stated age. He was well-groomed, and unlike some of the other pensioners in the study, he seemed to have retained interest in his personal appearance. This old man was vibrant and simply oozing with v i t a l i t y . His bluegrey, eyes twinkled gaily and he seemed unruffled by worry or care. Except for a l i t t l e anaemia, he enjoyed good health. He was bom in England, and since coming to Canada in 1909, he worked in various parts of this country, as a machinist, a cook in logging camps, a fisherman and as a fisheries inspector. He had supported himself adequately over the years, but became dependent on Old Age Assistance shortly before his 70th birth-  41  day. This was necessary because he was unable to find employment at his age, and because he was not eligible for Old Age Security. At the time of the interview he was occupying a sleeping room at the Salvation Army Shelter for Men. This man had never married or had any children. He had had several brothers and sisters, but only a sister, now 74 years old had survived. She lived in Australia, and corresponded with him quite frequently. Many of his friends had died over the years, but a number of them whom he s t i l l visited occasionally lived within the limits of Vancouver. A few of them from Victoria s t i l l called on him from time to time. He enjoyed social intercourse, but found most of his acquaintances (and even some of his friends) rather dull and apathetic to world affairs and l i f e around them. Indeed, his scope of interest was by no means limited or narrowed, for he was as much interested in the situation in Laos or Africa as he was in local problems. He could not do much reading due to his  f a i l i n g sight, but listened to radio programs, and favoured those  which dealt with scientific, economic or p o l i t i c a l information. He f e l t that most commodities i n present-day markets in Western society, were too synthetic. I f he went to a beer parlour, he found that a glass of alcoholic beverage was diluted or concocted for commercial gain, so he was no longer inclined to procure himself an occasional drink. He recalled the days in England when he could buy a good "mug of ale", but those days were now forever in the past. He neither attended the movies nor viewed television, but sometimes went down to the large recreation room on the main floor of the "Shelter" to engage i n a game of pool, with some of his fellow residents.  42  However, this occurred only occasionally, for he thought that the recreation room often looked like a miniature public f a i r with men busily participating or moving around to look at various a c t i v i t i e s . He did at one time belong to a lodge i n the city, but terminated his membership when he found that their principles did not coincide with his own. Later on, he joined one of the clubs for Senior citizens, but found their program rather dull and childish, with a barrage of singsongs. He thought the program leaders were too condescending, showed a lack of respect for the intelligence of older citizens and for their ability to maintain a mature level of interest and participation in the community. one of his great hobbies was window shopping. This however, was not the steriotyped aimless journey from one window to another, gazing with frustration at the things he could not purchas. Rather, i t i n volved a more organized and purposeful occupation. He chose several stores of a kind e.g. department {stores or jewellers shops or clothiers, and compared the prices of similar merchandise from one shop to another. Unlike the other pensioners, his l i f e routine did not follow the same pattern a l l year round. He spent the spring and summer months in a two-room shack which he owned on property in a suburb of Vancouver. His time here was spent making and nurturing a flower garden and a vegetable garden for himself, and he did similar jobs for residents in the d i s t r i c t . Indeed, he derived a great deal of satisfaction from his experience, for in addition to the monetary gains which accrued from his gardening, the products gave him a feeling of achievement and creativity. He was fascinated by l i f e in every form - in people, in blooming flowers, in verdant  43  grass, in chirping birds and busy chipmunks. He could s i t for hours just looking at l i f e as revealed in these elements of nature. But because his shack was not furnished with heat or hot water, he returned to the city iji the Fall of the year, to a way of living that was  dif-  ferent but nevertheless, equally interesting. Undoubtedly, there i s a striking difference between this man's pattern of l i f e and that of the others in this study. Although he was one of the two oldest persons in the group, he had more v i t a l i t y , was more agile and alert than any of the others. Although he could no longer read, he did not give up his interest in current affairs, but maintained contact with the world around through the medium of wireless. He displayed a considerable degree of resourcefulness, for when he found he did not enjoy programs that organized groups offered, he sought alternative interests e.g. window shopping. The pattern of l i f e which this pensioner pursues certainly raises many questions: what are the factors which help the aged person to maintain a l i v e l y interest in l i f e and the world around him, Can this v i t a l i t y be assumed in old age, or i s i t merely a reflection of the person's behaviour in earlier l i f e , Are inactivity, lack of interest and isolation necessarily concomittants of old age, or can one use his own i n i t i a t i v e and inner resources to spend his l i f e to the best advantage, These questions cannot be answered here from this limited study, but they should certainly be examined more closely in further research.  CHAPTER IV  OPPORTUNITIES FOR IMPROVED SERVICES  Most elderly people experience one or more of such exigencies as financial d i f f i c u l t i e s , inadequate housing, poor physical or emotional health, which, i n turn, create further complications i n their daily l i v e s . But i f they are given some assistance i n their particular area of distress, i t seems l i k e l y that many of these elderly people would be capable of l i v i n g independently i n the community. The present study indicates the need for a number of aids and services, which would enable the indigent aged to lead an independent existence i n the community, as long as this i s humanly possible. Some of these resources include household aids, medical care, housing f a c i l i t i e s , social and recreational activities, and an adequate program for the integration of these services. It w i l l help to distinguish the services i n question under two headings, (a) Community Resources and (b) Personal Servicesj and the exposition i n this chapter thus f a l l s into two parts. It w i l l be apparent, however, that they are closely interrelated. (a) Community Resources Meals on Wheels. During the second world war, i n England, the Women's Voluntary Service, headed by Lady Redding, started the program commonly called "meals on wheels"• The Program, which s t i l l exists, consists of the daily provision of a hot, full-course meal, for persons who are unable to prepare meals for themselves. The food i s taken to the homes of those who have ordered i t , and i s obtained either at a minimal cost, or  45  free of charge, depending on the individual's a b i l i t y to pay. The mealson-wheels program i s a voluntary service, the cost of which i s covered through philanthropic contributions. A program of this kind seems necessary i n Vancouver, to meet the need of many old people l i v i n g alone. Such a program would make i t possible for elderly persons to have at least one nourishing meal per day, which would lessen the possibility of i l l health due to malnutrition. It would also solve at least part of the problem of inadequate food storage f a c i l i t i e s , which so many of them experience. Housekeeper service i s another need which i s quite evident from the present study. In Vancouver, this service i s now provided for elderly couples i n receipt of public assistance, who are no longer able to carry on with housekeeping chores. The C.S.S.D. restricts the service to couples only, since i t maintains that every effort should be made to keep the spouses together, as long as possible. In the case of the single person, however, the principle f a l l s by the way. Except i n a few isolated instances, arrangements are usually made for admission to nursing or boarding homes, whenever the elderly person becomes incapable of managing on his own. This action i s taken because the department regards i t as uneconomical to provide housekeeper service for only one person. Such a practice takes into consideration only one dimension of this situation, namely, the cost to the public i n providing housekeeper service for one person. It i s important, however, that those responsible for making decisions on this issue, should consider what i t means to elderly persons to be removed from a familiar neighbourhood, room or house, which bears precious memories of the past; or how devastating i t i s to separate them from household objects, furniture, portraits and so forth, which, though worn and tattered, s t i l l serve as a link with their past. Like drowning men, these elderly people often clutch at these last  46  few "straws", which alone give some meaning to their existence. It i s therefore important that every effort be made to enable them to carry on i n their familiar surroundings, whenever this i s feasible. In many instances, housekeeper service for about two or three hours per day would be adequate to keep the pensioner out of nursing or boarding home, for a period of time. To the writer's best knowledge, there i s no policy regulation at the C.S.S.D. which restricts housekeeper service to elderly couples only, so this matter should be taken up by administration to expand the service to single persons, wherever possible. A telephone i s an aid which could be invaluable to single e l derly persons l i v i n g alone. Many of them are forced to remain indoors due to inclement weather, or physical ailments of some kind. I f they had easy access to a telephone, they could contact a physician i n an emergency; such action might well prevent an untimely death. With a telephone readily available, these elderly persons could also maintain contact with relatives and friends without the expense, and possible inconvenience, of making personal v i s i t s . Those who are temporarily shut i n would also be able to order meals, drugs and groceries whenever necessary. It i s conceivable that some special form of telephone service could be arranged between the Department of Social Welfare and the B.C. Telephone Company, to meet this need of the indigent aged in Vancouver. Medical care, as provided i n British Columbia, doubtless furnishes a scheme which theoretically makes generous provision for the e l derly person on public assistance. But, as was pointed out earlier, many elderly people neglect their health because of the doctor's apparent i n difference to their welfare, and also because of the growing trend towards extra fee-charging. These conditions need revision, i n order that aged  47  people can seek and obtain medical care whenever needed. In addition, i t seems necessary that the present medical plan make provision for preventive medical care. Existing f a c i l i t i e s allow for medical consultation i f the aged person i s i l l , but he or she* is not permitted to see the doctor for a periodical check-up. As a result, many old folk v i s i t the doctor only after their ailments have progressed to a stage beyond repair. The Victorian Order of Nurses (V.O.N.) furnishes bedside care to senior citizens, under the direction of the family doctor. This service i s offered as long as needed, and i s often supplemented by health instructions. Referrals can be made to the V.O.N, by anyone who may be aware of the old person's need for nursing care. This program should be utilized more extensively, and similar services be made available by public health nurses, i n an attempt to arrest illness and keep old people out of nursing homes as long as possible. Since the V.O.N, i s already heavily pressed however, this program may require subsidy. Housing f a c i l i t i e s continue to leave much to be desired. It was pointed out i n an earlier chapter that since the needs and preferences of senior citizens are numerous, housing f a c i l i t i e s should also be varied to meet these needs. Low-rent units are needed i n the city as well as i n suburban areas\ they should be built at ground level, or else elevators should be installed to avoid the discomfort of stair-climbing, which i s often so tedious for old people. With a l l the efforts that have been made by voluntary groups of various kinds to provide old people's units, the supply i s far behind the existing and future demand. The services of the Central Housing Registry are most valuable  48  and commendable; they need to be expanded, and this cannot happen without more public support, financial and otherwise. The registry now provides a centrally located place, at which elderly people can obtain i n formation about low-rental housing projects, and can make application for accommodation. There are five non-profit projects for senior citizens, which the registry now represents. It i s obviously too few. As a further aid to senior citizens who are waiting to secure low-rental accommodation i n the projects, the registry has compiled a l i s t of house-keeping rooms, sleeping rooms, homes offering room and board, and so forth. This service i s invaluable to many old people, and i t should be more widely publicized, so that those i n need might be made aware of this f a c i l i t y . There i s another associated need which the present study underlines, the need for assistance to old people in moving when they secure better housing accommodation. Both male and female volunteers could be of service i n this area. The need for social and recreational activities for the elderly became evident at various points i n the course of this study. Many studies of old people have shown that a large number of elderly persons have f a l len into isolation and loneliness, as their health has declined, and as relatives and friends have died or moved elsewhere. In earlier l i f e , these people have often been so busy working to make ends meet, that they had l i t t l e time to cultivate hobbies and social a c t i v i t i e s . Such persons undoubtedly have difficulty i n becoming involved i n groups and active recreations i n later l i f e . As an earlier chapter has accounted, a number of groups and associations i n Vancouver have concerned themselves with the social l i f e of senior citizens i n one way or another; but this study and  49  other observations, make i t clear that these programs are not too widely utilized by elderly people. Most of the people interviewed demonstrated l i t t l e or no knowledge of existing organizations i n the community, and this probably holds true for a large percentage of the needy aged i n Vancouver. The Community Information Service i n Vancouver was consulted to find out how the various organizations publicized their programs. Some of the larger organizations, such as the B.C. Old Age Pensioners Association and the Senior Citizens Association of B.C., do this through their own news letters. Neighbourhood houses advertise by means of their local community papers. The Information service i t s e l f has compiled a Directory of Social and Educational Activities for older people, a copy of which has been sent to a l l agencies working with senior citizens. These a l l appear to be excellent media of communication, but the fact remains that they reach only a very small proportion of the aged population. The news letters usually reach people who are already members, and, due to staff shortages i n the C.S.S.D., only a limited few of the pensioners receive information about these organizations. From a l l this, i t would appear that the new recipient of O.A.A. or O.A.S.B. has only a slim chance of learning about these programs. It has been suggested that organizations neglect publicity because some of them do not regard i t as being important, but also because they cannot afford the costs involved. Whatever the cause, i t i s necessary and important that knowledge of these programs come to the notice of elderly people, otherwise the programs w i l l f a i l to serve their purpose. Care should be taken in the various groups, to ensure that members are given the opportunity to participate i n a c t i v i t i e s . It i s not enough that they be entertained to movies, teas, and other more passive  50  activities. They should be encouraged to plan their programs in keeping with their own tastes and interests. The services of well-trained social group workers should be made available to group leaders and those responsible for organizing various programs. This does not imply that social workers should take charge of these groups. Tn fact, i t would not be the group worker's responsibility to change the form of any program, or the criteria for membership, etcetera, which originally may have been set up. The group worker's function should be that of a consultant to those leaders and organizers, who might need some expert assistance in planning programs, that would effectively meet the needs of the elderly persons. Implications for Agencies. The suggestions mentioned above, have certain implications for agency as well as community planning, that must be taken into account i f improvements are to be made in serving the aged in Vancouver. The agency administrator needs to be aware of the wide range of service needs among the aging population in Vancouver today. He should be convinced of the right of old people to be regarded as human beings and as citizens, and should have the integrity and enthusiasm to face the community and enlist its support in promoting better services for them. Furthermore, he should recognize the imbalance of casework services among different age groups in the agency, and should identify the needs of public assistance recipients, which require most intensive casework services, and those which require less. Tasks should be assigned in relation to qualification and degree of s k i l l , to allow for maximum production on the part of personnel. For example, jobs can be divided into those involving (1) establishment of eligibility for public assistance, and so  51  forth, and (2) those requiring casework services. Of course, the administrator would need to be supplied with additional staff i n order to make this a workable plan, but i t i s the responsibility of the community to provide these. '  The regulations with respect to Old Age Security stipulate  that a recipient of O.A.S.B. w i l l be visited at least once in every five years, while the recipient of O.A.A. w i l l be visited once every year, for a review of his circumstances. The reason for these v i s i t s i s mainly to ensure that these pensioners have not acquired any money, which would make them ineligible for further benefits. The differential rate of required v i s i t s for O.A.A. and O.A.S.B. recipients, seems associated with the fact that persons over 70 are less l i k e l y to acquire money through employment or other sources, than those between 65 and 69. Strict adherence to these regulations satisfy the requirements for establishing e l i g i b i l i t y , but this i s by no means enough. The person on O.A.A. (age 65 - 69) i s more l i k e l y s t i l l to have a few friends and social contacts such as clubs, church and informal groups or cliques. He i s likely to be more vivacious, and more aware of, and interested i n his  environment. Having had (presumably) to fend for himself u n t i l this  time, he i s more l i k e l y to know of resources i n the community, which he might u t i l i z e i n time of need. The person over 70, however, often has retired completely from social activities, because of physical incapacity. His  friends have more or less died out. He i s often restricted to his  solitary room, and his l i t t l e world becomes sadly centered around himself. His  infrequent contact with the outside world (both l i t e r a l l y and figura-  tively) rather blunts his memory and sensitivity to l i f e . It would seem,  52  then, that he needs to have frequent v i s i t s —  v i s i t s that would keep  hi m i n touch with the community, v i s i t s from people who would show some interest i n hjm as a human being, v i s i t s from people who would give him an opportunity to t e l l of his troubles, and who would give him some help with them. It i s therefore the agency's responsibility to. see to i t that the number of v i s i t s be increased to meet needs which may arise. The agency should promote in-service programs for those working with aged clients. Although social work assistants (those establishing e l i g i b i l i t y ) would not be doing case-work under the suggested plan, they should nevertheless be sufficiently knowledgeable of the needs of the aged to note any indication of social problems, and bring them to the attention of the caseworker. On the other hand, the caseworker would need, in addition to basic social work training, some knowledge of the physical changes common to the aging body, and the concomitant emotional, psychological and social effects which evolve as a result. The agency should ensure that this knowledge i s supplied to those who need i t . When such a plan i s effected, the C.S.S.D. should be prepared to study and analyse i t s experience i n serving older clients, i n an attempt to improve i t s program. It should also work co-operatively with other agencies and service groups i n the community, to promote the interest of senior citizens. Finally, the agency needs to make the public aware of the exigencies of i t s aged clients, and the handicaps i t encounters i n providing solutions to resolve them, for unless the community i s acquainted with these d i f f i c u l t i e s , i t cannot be expected to take necessary action to remedy the present situation.  53  Implications for the Community. In spite of beliefs to the contrary, the Vancouver community, in general, i s too apathetic to the needs of i t s older population. And there i s also no question, that, i n view of the rapidly increasing number of d i f f i c u l t i e s arising for this group, immediate action i s needed to remedy existing conditions. Assuming that the community i s made sufficiently acquainted with conditions at the present time, i t should be prepared to review and increase public assistance rates, augment lowrental housing, correct deficiencies i n medical care, and so forth. Bat there i s one requirement which stands out predominantly from this survey the need for the integration of services, both existing and newly planned for the future. Throughout the city of Vancouver, there are a variety of publ i c and private services for senior citizens. The people responsible for these programs are anxious to serve this segment of the population, but admit, i n many instances, that they do not really know how they can best be of help. The writer knows of a service group i n Vancouver, which assumes the responsibility of providing entertainment, treats, and so forth for a small number of elderly women. For about three months, this service group was unable to get i t s f u l l complement of elderly people, because i t did not know how to go about finding replacements. Most agencies, clubs, etcetera, which are connected with senior citizens, tend to operate as i f only their program mattered. Persons i n volved i n these programs seem oblivious of the fact that the old person, like any other individual, cannot be partialized, and that every aspect  54  of h i s l i f e and s i t u a t i o n , bears some r e l a t i o n t o t h e o t h e r s . I t seems o n l y l o g i c a l t h a t a g e n c i e s and so f o r t h , seek t o I n t e g r a t e lities,  their  faci-  so t h a t a more complete a n d s a t i s f a c t o r y s e r v i c e would be g i v e n  e l d e r l y p e o p l e . I n o r d e r t o a c h i e v e t h i s , t h e w r i t e r sees t h e n e c e s s i t y for  e s t a b l i s h i n g an o r g a n i z a t i o n , w h i c h might be c a l l e d t h e  Senior  C i t i z e n s Agencies» S e r v i c e  Bureau.  Such a S e r v i c e Bureau would i n v i t e membership f r o m a l l p u b l i c and v o l u n t a r y a g e n c i e s and i n s t i t u t i o n s j r e c r e a t i o n a l , c h u r c h and o t h e r groupsj programs promoted by s e r v i c e c l u b s ; v o l u n t e e r s ;  associations;  m e d i c a l and p s y c h i a t r i c s e r v i c e s j h o u s i n g a n d any o t h e r s e r v i c e s d e a l i n g v W M s e n i o r c i t i z e n s . E a c h o f t h e s e b o d i e s w o u l d be r e g i s t e r e d w i t h t h e Bureau, but r e g i s t r a t i o n would n o t a f f e c t t h e program c o n t e n t o f a n y member group, i.e.,  a p r i v a t e group would be f r e e t o c o n t i n u e i t s program a l o n g  pre-  v i o u s l y e s t a b l i s h e d l i n e s , w i t h i t s own c r i t e r i a f o r membership, a n d so forth. The Bureau would be a f f i l i a t e d w i t h t h e Community Chest and Councils  o f g r e a t e r Vancouver and would c o n s i s t o f r e p r e s e n t a t i v e s o f  member groups, w i t h t h e s e r e p r e s e n t a t i v e s  a c t i n g as l i a i s o n between t h e  community and t h e i r r e s p e c t i v e a g e n c i e s . E a c h member group would have a department o r s e c t i o n i n t h e bureau, f o r example, m e d i c a l , h o u s i n g , and so o n . An i n f o r m a t i o n n i s h b r i e f information,  public health,  s e r v i c e w i t h i n t h e Bureau would f u r -  but would r e f e r c a l l e r s , f o r more s p e c i f i c de-  t a i l s , t o whatever department i s i n d i c a t e d . The i n f o r m a t i o n  desk would  a l s o s e r v e a s a r e f e r r a l a g e n t . I f , f o r example, a c a l l e r a d v i s e s her e l d e r l y n e i g h b o u r has been s i c k i n b e d f o r two days, t h i s  that  caller  55  would not need to know who  i s involved i n such a s i t u a t i o n . The i n f o r -  mation desk, however, would promptly relay the matter to the p u b l i c health section, which i n turn would arrange with the appropriate Metr o p o l i t a n Health unit to v i s i t , and take any necessary a c t i o n . Another function of the Bureau would be that o f promoting i n t e r d i s c i p l i n a r y co-operation. This implies that each member would recognize that i t s service represents only a part of the t o t a l needs of e l d e r l y c i t i z e n s , and that co-operation with a l l others would help i n c l a r i f y i n g each member's r o l e i n the o v e r - a l l scheme. This i n t e r a c t i o n should s t i mulate the desire to share knowledge, d i f f i c u l t i e s ^ successes and f a i l u r e s , and thus serve to strengthen the body as a whole. F i n a l l y , the Bureau should provide highly s p e c i a l i z e d casework counselling services f o r a l l aged persons i n Vancouver. The service would be s p e c i a l i z e d i n the sense that, those o f f e r i n g these services would be professional s o c i a l workers with g e r i a t r i c t r a i n i n g . S o c i a l group work service should a l s o be available f o r any r e c r e a t i o n a l , church or other a c t i v i t y groups, which might require consultation with regard to program planning. Once organized, i t would be the Bureau's r e s p o n s i b i l i t y to publ i c i z e i t s program, i t s function, and services to the aged population i n t h i s c i t y . In a d d i t i o n , i t should assume r e s p o n s i b i l i t y f o r ensuring that e l d e r l y people are made aware of the program. From time to time, i t should seek to evaluate the effectiveness of i t s services, and seek to f i n d ways of developing i t s f a c i l i t i e s . (b) Personal Services The second major area f o r development c l e a r l y indicated i n t h i s  56  study,  i n c l u d e s t h e need f o r i n f o r m a t i o n s e r v i c e s ,  casework c o u n s e l l i n g  f r i e n d l y v i s i t i n g and  services.  I n f o r m a t i o n s e r v i c e t o s e n i o r c i t i z e n s i n Vancouver c o u l d be g r e a t l y f a c i l i t a t e d through the Senior C i t i z e n s  Bureau d e s c r i b e d a b o v e .  I f t h e e l d e r l y p e r s o n , o r h i s r e l a t i v e s , w i s h t o know how t h e y might o b t a i n n u r s i n g home c a r e , r e c r e a t i o n a l a c t i v i t i e s  or whatever,  n o t w a i t u n t i l t h e s o c i a l worker comes around n e x t y e a r ,  t h e y need  but they might  s e c u r e t h e n e c e s s a r y i n f o r m a t i o n by c a l l i n g the B u r e a u . The need f o r f r i e n d l y v i s i t i n g was c o n s p i c u o u s l y f e l t the course of t h i s p r o j e c t . f r i e n d s and r e l a t i v e s ,  during  Many o f the p e o p l e v i s i t e d were i s o l a t e d from  and f e l l o w occupants i n the h o t e l s were o f t e n  "too  b u s y " , o r t o o d i s i n t e r e s t e d t o engage i n c o n v e r s a t i o n . I t would seem t h a t v o l u n t e e r s and c h u r c h groups s h o u l d t a k e up t h e c h a l l e n g e t h e s e l o n e l y p e o p l e on a r e g u l a r b a s i s . Such v i s i t s  of v i s i t i n g  s h o u l d be geared t o  keep e l d e r l y p e r s o n s i n t o u c h w i t h the community and w i t h c u r r e n t V o l u n t e e r s can o f t e n be h e l p f u l i n w r i t i n g l e t t e r s f o r t h e s e people,  o r by r e a d i n g t o t h o s e whose s i g h t i s Counselling services  affairs.  elderly  failing.  i s another p e r s o n a l need w h i c h was  clearly  u n d e r l i n e d d u r i n g t h e s t u d y . S i n c e t h i s need i s o f p a r t i c u l a r i n t e r e s t t h i s study,  i t w i l l be g i v e n d e t a i l e d c o n s i d e r a t i o n . Of the  in  group i n t e r -  v i e w e d , a few were almost f r i g h t e n e d by t h e p h y s i c a l changes w h i c h had taken p l a c e i n t h e i r bodies, to the extent t h a t they e i t h e r denied or r e b e l l e d against  the f a c t  o f a g i n g . Others were v e r y b i t t e r a g a i n s t  "young  p e o p l e " , whom they f e l t were r e s p o n s i b l e f o r t h e s o c i a l c o n d i t i o n s w h i c h now p r e v a i l , namely,  gross n e g l e c t o f s e n i o r c i t i z e n s . Others c o n t i n u e d to  57  d w e l l on p a s t memories o f t h e " g o o d o l d d a y s " , because t h e y were t o o c o n f u s e d by the s o c i a l changes w h i c h have o c c u r r e d w i t h i n t h e i r  lifetime.  Needless t o s a y , t h e s e e l d e r l y p e o p l e need h e l p from t h o s e who understand t h e i r  d i f f i c u l t i e s , and t h e meaning t h e y may h o l d f o r  old  p e o p l e . F u r t h e r m o r e , t h e y need t h e a s s i s t a n c e o f s k i l l e d caseworkers  to  h e l p them t o r e s o l v e some o f t h e i r f e e l i n g s , and t o a c c e p t p h y s i c a l and s o c i a l changes, w h i c h have o c c u r r e d t h r o u g h the  years.  Casework c o u n s e l l i n g t o t h e aged cannot be s u c c e s s f u l l y by v i r t u e  effected  o f o n e s l e n g t h y e x p e r i e n c e i n w o r k i n g w i t h p e o p l e , o r by a 1  n a t u r a l t a l e n t f o r h a n d l i n g p e o p l e . Such a s e r v i c e needs t o be a d m i n i s t e r e d by a p r o f e s s i o n a l s o c i a l worker who has a c q u i r e d s p e c i a l knowledge and e x p e r i e n c e , w h i c h would enable him t o make sound p s y c h o - s o c i a l d i a g n o s t i c e v a l u a t i o n s o f t h e o l d p e r s o n ' s s i t u a t i o n . Once t h e worker has made h i s d i a g n o s i s , he needs t o be s u f f i c i e n t l y s k i l l e d t o determine what f o r m o f treatment i s a p p r o p r i a t e to the p a r t i c u l a r c a s e . I t at t h i s  i s perhaps  suitable  j u n c t u r e , t o o u t l i n e some o f the s p e c i a l s k i l l s needed by t h e  p e r s o n o f f e r i n g casework c o u n s e l l i n g s e r v i c e s t o t h e e l d e r l y p e r s o n . The casework c o u n s e l l o r s h o u l d have knowledge o f t h e characteristics  special  and needs o f t h e o l d e r c l i e n t , and an u n d e r s t a n d i n g of  the  changes brought about by t h e p r o c e s s o f a g i n g . As a p e r s o n grows o l d , a . number o f o r g a n i c changes i n e v i t a b l y t h e r e f o r e l i k e l y to a f f l i c t  o c c u r , and many common a i l m e n t s  t h e a g i n g p e r s o n . In a d d i t i o n t o t h i s ,  are  there  i s a d e c l i n e i n p h y s i c a l and mental c a p a c i t i e s w h i c h , i n t u r n , c r e a t e a number o f e m o t i o n a l and p s y c h o l o g i c a l c h a n g e s . The worker needs t o be aware o f t h e s e f a c t s i n o r d e r t h a t he might empathize w i t h h i s  elderly  58  client, and understand the problems that are involved. Another factor which the caseworker needs to bear i n mind, i s the part that cultural influences play i n the lives of his clients. The aging client views his situation i n the light of the cores and norms of his own background. If, i n his original culture, i t was socially unacceptable to receive public assistance, i t i s almost inevitable that he would feel some apprehension and resistance to accepting such help i n later l i f e . Many a time, the client who was born i n a foreign country, demonstrates behavior or mannerisms which seem different or even unacceptable i n North-western society. The alert worker would not affix a label to this client, without f i r s t exploring the cultural significance which such behavior might hold for the client. It i s also important for the worker to discern what resources exist within the client himself, and those offered i n the community, i n order to f a c i l i t a t e effective resolution of problems. Recognition of the client's physical capacities, emotional strength, mental alertness and motivation, i s essential for making a r e a l i s t i c treatment plan for the old person with problems, and s k i l l i n doing this i s not achieved by experience only, but through professional training. Very often, the e l derly person i s ignorant of services available to him, or i s sometimes to inarticulate or confused to know how to intercede i n his own behalf. The caseworker's knowledge of these f a c i l i t i e s enables him to guide the client i n using f a c i l i t i e s to his best advantage. The caseworker needs to employ s k i l f u l interviewing techniques, i n order to encourage communication, and to further the client's p a r t i c i -  59  pation i n the casework process. Many a time, the aging client experiences d i f f i c u l t y i n communicating, either because of language d i f f i c u l ties, i l l i t e r a c y or physical disability. In such cases, the worker needs to exercise a great deal of patience, demonstrate genuine interest i n the client's welfare, and encourage the use of gestures and so forth, to f a c i l i t a t e communication. These aids often serve to release the client's inhibitions and permit him to express himself with greater ease. It i s of v i t a l importance that the caseworker recognize his own, and the client's feelings and attitudes, which might influence the caseworker-client relationship. It i s indeed possible, that some personal prejudice can develop between the worker and client, but the s k i l f u l worker should be sensitive to such feelings, and handle them i n such a manner as to avoid jeopardizing the relationship. Always present i n the worker's mind, whould be the goal — to help the elderly client. Finally, the worker should be reliable, resourceful, empathic, a source of strength, and professional i n the finest sense. He should be steady and honest i n his dealings with the older client, and be able to set limits whenever this i s necessary. Being resourceful implies that he should possess inner resources, which would enable him to exercise good judgement in dealing with his elderly clients. When he can truly empathize with his aging clients, they discern this, and are then assured of his desire to be of real help. This i s an important requirement i n the casework process. I f the client i s suspicious and dubious of the worker's intent, he thus creates a barrier, which prevents the development of a healthy atmosphere for the solution of problems. When the worker retains profes-  60  sional poise, he i s thus able to keep the focus of his relationship and reach his objective. A l l these are s k i l l s and attitudes which a caseworker needs i n order to give counselling services to the aging clients. Needless to say, such s k i l l s are not attainable through experience only, but are developed through professional training provided i n courses i n Social Work. While employed by a public agency, this writer encountered a number of elderly persons, seeking casework counselling. Unfortunately, these persons were not eligible for help, because they were not clients of the agency, i.e., they were not i n receipt of public assistance. Of course, this does not imply that the C.S.S.D. should provide services for persons other than i t s own clientele, but i t does indicate the need for counselling services as an adjunct of the public assistance program. Casework counselling should be a special service available to a l l aged persons, not only those i n receipt of public assistance. If these services are available only to the latter group, i t suggests that only the needy aged have psycho-social problems, which i s not the case. Special casework counselling services should therefore be organized, to provide such help for a l l elderly people i n Vancouver, and should be a part of the earlier suggested Senior Citizens' Bureau. It i s important that such a service be physically divorced from the public assistance program, which bears the stigma of a charitable institution. This stigma often inhibits some people from seeking help, that i t would be advisable to avoid any apparent connection of the two, at least for the present time. The provision of casework counselling services would not  61  automatically meet the psychosocial needs of elderly people i n Vancouver. In fact, i t needs to be said that many elderly people have l i t t l e confidence i n social workers, and regard them as persons akin to policemen,  1  rather than professionals wanting to he of help. Old folk s t i l l  harbour memories of the depression years, when they came into contact with "social Workers" who were severe and punitive i n their attitudes to the needy. Of course, many changes have been effected since that time. The term " r e l i e f " has been eliminated i n favor of the more acceptable one "social assistance". The Old Age Pensions Act has been changed to the Old Age Security Act, and thereby ruled out the means test program for people aged 70 and over. Certainly, drastic changes have been made i n the approach which professional social work commands serving for and dealing with the indigent. The needy i s no longer regarded as someone who i s culpable, but rather, as an individual i n his own right, who needs to be respected and helped to attain maximum satisfaction i n l i f e . Great strides have been made to improve the curricula of schools of Social Work throughout Canada, and particular efforts are being made to provide information pertinent to work with the aged. In the last analysis however, caseworkers dealing with aging people, have the responsibility to reveal these changing attitudes by how they work with elderly clients. Through word and deed, the "welfare task" today i s not only to lend a helping hand to those i n need, but also to raise the morale and, i f possible, the degree of participation, of those who are helped. 1.  Even at present, workers at C.S.S.D. are called "investigators" by many clients.  62  Appendix A.  BIBLIOGRAPHY  (a) General References  1.  Cassidy, Harry M., Social Security and Re-construction In Canada. The Ryerson Press; Toronto; 1943.  2.  Corson, John J. "The Aged and Society." March 1951.  3.  Evans, Maureen, Living on a Marginal Budget. Master of Social Work Thesis, University of British Columbia, 1953.  4.  Garrett, Annette, Interviewing - Its Principles and Methods. Family Services Association of America; New York; 1942.  5.  Govan, Elizabeth, Ottawa; 1951.  6.  Guest, Dennis T., Taylor Manor; A Survey of the F a c i l i t i e s of Vancouver's Home for the Aged. Master of Social Work Thesis, University of British Columbia, 1952.  7.  Havighurst, R.J., Albrecht, R., Older People. Longmans, Green and Co.; New York; 1953.  8.  Koos, Earl Loman, Families i n Trouble. York; 1946.  9.  Kutner, B.; Fanshel, D.j Tag, A.; and Langner, T., Five Hundred . Over Sixty; A Survey on,Aging. Russell Sage Foundation; New York; 1956.  Survey. Volume 87,  The Needs of the Aged.  Canadian Welfare Council;  King's Crown Press; New  10.  MacEachem, R., Fourteen Days as an Old Age Pensioner. Reprinted from the Toronto Daily Star.  11.  O'Reilly, Charles and Pembrooke, Margaret, O.A.A. Profile - The Old Age Assistance Client i n Chicago; A Student Research Report. School of Social Work, Loyola University; Loyola University Press; Chicago; 1961.  12.  Strunk, William, and White, E.B., The Elements of Style. Macmillan Company; New York; 195IH  The  63  Appendix A* c o n t i n u e d .  13.  T a l k e r , E l i z a b e t h , S e r v i c e s f o r M a r r i e d Couples on A s s i s t a n c e and P e n s i o n . Master o f S o c i a l Work T h e s i s , U n i v e r s i t y o f B r i t i s h Columbia, 1956.  14.  Wheeler, M i c h a e l , A R e p o r t on Needed R e s e a r c h i n W e l f a r e i n B r i t i s h Columbia" Community Chest a n d C o u n c i l s o f t h e G r e a t e r Vancouver area} Vancouver, B r i t i s h Columbiaj 1961.  15.  W i l e n s k y , H a r o l d and Lebeaux, C h a r l e s , I n d u s t r i a l S o c i e t y and S o c i a l W e l f a r e . R u s s e l l Sage Foundation} New York; 1958.  16.  — A n n u a l R e p o r t . B r i t i s h Columbia Housing F o u n d a t i o n , Admissions Committeej 1959.  17.  O l d Age i n t h e Modern W o r l d - R e p o r t o f t h e T h i r d Congress o f t h e I n t e r n a t i o n a l A s s o c i a t i o n o f G e r o n t o l o g y . E.S. L i v i n g s t o n e L t d . j Londonj 1955.  18.  M e e t i n g t h e C h a l l e n g e . R e p o r t o f Proceedings} The Second B r i t i s h Columbia Conference on A g i n g ; I960.  19.  " T a k i n g t h e O l d o u t o f O l d Age." A l t r u s a n . . V o l u m e 3 8 j Number 6 j 1961.  20.  — R e - o r i e n t a t i o n f o r Treatment a n d C o n t r o l - An Experiment i n P u b l i c W e l f a r e A d m i n i s t r a t i o n . The Minnesota Department o f P u b l i c W e l f a r e ; Community R e s e a r c h A s s o c i a t e s , I n c . (no d a t e ) .  The I n t e r n a t i o n a l  (b) S p e c i f i c R e f e r e n c e s  1.  Burgess, E.W.; Cavan, R.S.j H a v i g h u r s t , R . J . Your A c t i v i t i e s and . A t t i t u d e s . S c i e n c e R e s e a r c h A s s o c i a t e s } U n i v e r s i t y o f Chicago} I l l i n o i s } 1948.  2.  Minton, E u n i c e , " I m p l i c a t i o n s o f the;Seminar f o r Agency P l a n n i n g . " S o c i a l Casework} Volume XL, Number 4; A p r i l ; 1959.  3.  Rosenburg, J e a n e t t e , " I m p l i c a t i o n s o f t h e Seminar f o r S t a f f Development." S o c i a l Casework; Volume XL, Number 4} A p r i l } 1959.  4.  S i b u l k i n , L i l i a n , " S p e c i a l S k i l l s i n Working w i t h O l d e r P e o p l e . " S o c i a l Casework}^Volume XL, Number 4} A p r i l } 1959.  5.  S t e i n e r , P. a n d Dorfman, R., The Economic S t a t u s o f t h e Aged. U n i v e r s i t y o f C a l i f o r n i a Press} Berkley} 1957.  64  Appendix A. continued.  6. Sytz, Florence, "Implications of the Seminar for Casework Practices." Social Casework; Volume XL, Number 4; April; 1959. 7. Wickenden, Elizabeth, The Needs of Older People. American Public Welfare Association; Chicago; 1953. 8.  Background Paper on Social Services for the Aging. White House Conference on Aging. Prepared under the direction of the Planning Committee; Social Services; March I960.  9.  Directory of Social and Educational Activities for Older People. Community Chest and Councils of Greater Vancouver, September; I960.  10.  Report on the Operations of the Central Housing Registry between September 1958 and December 1959. Community Chest and Councils of Greater Vancouver; February; I960.  11.  Report of Unmet Needs - A Survey of Persons Receiving Old Age Assistance, or Old Age Security with Supplementary Allowance. Vancouver; 1956.  12.  The Needs and Problems of the Aging. Report of Proceedings. The First British Columbia Conference; University of British Columbia; 1957.  13.  Services for the Aged i n Canada. Department of National Health and Welfare, Research Division; 1957.  65  Appendix B.  SOCIAL SERVICE DEPARTMENT  Dear A student from the University of British Columbia, Mrs. E. Cuthbert, i s making a study of services which are provided for aged persons i n Vancouver. The purpose of the study i s to help us to learn whether we are giving you the best possible service, and to enable us to improve our services wherever possible. The only way we can obtain the necessary information i s through your assistance. We would like to ask you, therefore, to take part i n this study through an interview with the student. Any information you give w i l l be treated as confidential, lour name w i l l not be revealed to anyone. Mrs. Cuthbert would like to meet with you at your home on . If you cannot be at home at that time, would you kindly telephone Mrs. S t l l at the City Social Service Department RE. 1-5727. She w i l l also be glad to answer any questions you may have about this. We certainly appreciate your co-operation in this matter. Yours truly,  T. T. H i l l , ADMINISTRATOR.  66  Appendix C.  INTERVIEW GUIDE  A. (i) (ii) (iii)  How do they live  Are there cooking f a c i l i t i e s (private, shared)? Are t o i l e t f a c i l i t i e s on same floor?  Shared?  Did they choose type of accommodation of their own accord, or because of a limited income?  (iv) Would higher incomes affect type of housing they now occupy? (v) Are they satisfied with present arrangements (type of housing, f a c i l i t i e s , location, etc.)?  B. Family Relationships (I) (ii) (iii) (iv)  Have they ever been married? Where i s the spouse at present? Have they had children? Where do they now reside? Do they s t i l l maintain contact with relatives?  (v) Do relatives contribute to their maintenance? about this?  How often? How do they feel  C. Social Activities (a) Friends (I) (ii) (iii) (iv)  How many friends do they have? Where do they live? they exchange visits?  How often do  Are these friends sufficiently close to permit pensioner to share his intimate feelings with them? Have many of their friends died? Do they make friends easily?  How does this experience affect them?  Do they long to have new friends?  67 Appendix C. continued.  C. Social Activities (b) Church A f f i l i a t i o n (i)  What i s their religion?  (ii)  Do they attend services?  (.Iii)  If not, why not?  Do they know their minister? Do they have friends i n the church?  (c) Recreational Activities (i) (ii)  What do they do i n their free time? Do they have any hobbies or favorite pastimes?  (d) Clubs and Organizations (i) (ii)  Do they belong to any of these? What i s the extent of their participation i n these?  D. Experience of Personal Problems (i)  What are their major problems?  E. (i) (ii) (iii) (iv) (v)  How Are Problems Handled?  Help of friends and relatives? Social Worker? Doctor? Own inner resources? Other resources i n the community?  CHART I  CITY OF VANCOUVER The  SOCIAL SERVICE DEPARTMENT  Unit  Boundaries  of Center  Unit  Boundaries  UNIT OFFICES CENTER  CENTER 1530 W.  8 t h Ave.  RE 1-5727 EAST  SOUTH  49th a n d K n i g h t FA 1-3441 EAST 2610 V i c t o r i a  Dr  TR 2-2515 WEST  1530 W. 8th Ave. RE 1-5727  CTi 03  


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