Open Collections

UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Discharge planning in homes for the aged : an analytical survey of a group of patients hospitalized for… Elmore, Eugene 1959

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
831-UBC_1959_A5 E5 D4.pdf [ 4.46MB ]
Metadata
JSON: 831-1.0106185.json
JSON-LD: 831-1.0106185-ld.json
RDF/XML (Pretty): 831-1.0106185-rdf.xml
RDF/JSON: 831-1.0106185-rdf.json
Turtle: 831-1.0106185-turtle.txt
N-Triples: 831-1.0106185-rdf-ntriples.txt
Original Record: 831-1.0106185-source.json
Full Text
831-1.0106185-fulltext.txt
Citation
831-1.0106185.ris

Full Text

DISCHARGE PLANNING IH HOMES FOR THE AGED An A n a l y t i c a l S u r v e y o f a Group o f Patients h o s p i t a l i z e d f o r Mental I l l n e s s i n the Homes f o r t h e Aged, P o r t C o q u i t l a m , B. C., 1958.  by EUGENE ELMORE  T h e s i s Submitted i n P a r t i a l F u l f i l l m e n t o f t h e Requirements f o r t h e Degree o f MASTER OF SOCIAL WORK i n t h e S c h o o l o f S o c i a l Work  Accepted as c o n f o r m i n g t o t h e s t a n d a r d r e q u i r e d f o r t h e degree o f MASTER OF SOCIAL WORK  S c h o o l o f S o c i a l Work.  1959 The U n i v e r s i t y  ofBritish  Columbia.  ABSTRACT There has been a growing c o n v i c t i o n on the p a r t o f m e d i c a l and n u r s i n g s t a f f i n the Homes f o r the Aged i n B r i t i s h Columbia, which p r o v i d e p s y c h i a t r i c c a r e f o r the aged, t h a t some o f the r e s i d e n t s have s u f f i c i e n t p h y s i c a l and m e n t a l h e a l t h t o be d i s c h a r g e d . T h i s study makes an a n a l y t i c a l s u r v e y o f some o f the needs and r e s o u r c e s o f a group o f p a t i e n t s c o n s i d e r e d t o be r e a d y t o l e a v e one o f these i n s t i t u t i o n s (the P o r t C o q u i t l a m U n i t ) . The purpose o f the s u r v e y was t o determine what k i n d s o f r e s o u r c e s t h e s e people would r e q u i r e t o m a i n t a i n an o p t i m a l l e v e l o f adjustment i n the community, as w e l l as t o d e s c r i b e the p o s s i b l e c o n t r i b u t i o n s o c i a l s e r v i c e s c o u l d make i n f a c i l i t a t i n g t h e i r discharge. The areas s e l e c t e d f o r assessment were grouped i n t o two broad c a t e g o r i e s , (l) the p a t i e n t ' s needs which r e s u l t e d d i r e c t l y from h i s h o s p i t a l i z a t i o n and (2) the p e r s o n a l and s o c i a l r e s o u r c e s which he c o u l d employ upon d i s charge. There a r e two s t e p s i n v o l v e d i n s e l e c t i n g the group f o r study. F i r s t , through the use o f a q u e s t i o n n a i r e submitted t o the m e d i c a l and n u r s i n g s t a f f i n o r d e r t o determine which p a t i e n t s were judged t o be m e n t a l l y and p h y s i c a l l y r e a d y f o r d i s c h a r g e , and second, from t h i s l a r g e r number o f p a t i e n t s , t h r o u g h the use o f r o u t i n e sampling p r o c e d u r e , a s m a l l e r group was s e l e c t e d f o r s t u d y . T h i s f i n a l group was a s s e s s e d by the c l i n i c a l team i n the i n s t i t u t i o n p r i m a r i l y through the use o f r a t i n g s c a l e s . An e x a m i n a t i o n o f the needs and r e s o u r c e s o f t h e s e p a t i e n t s r e v e a l e d t h a t a l l o f these p a t i e n t s c o u l d b e n e f i t from t h e a s s i s t a n c e o f s o c i a l work i n one o r more o f the a r e a s e v a l u a t e d . A l t h o u g h the needs and r e s o u r c e s o f t h e group v a r i e d c o n s i d e r a b l y , t h e r e were some i n d i c a t i o n s t h a t t h e p a t i e n t ' s l e n g t h o f s t a y had a marked e f f e c t upon the type o f s o c i a l work s e r v i c e t h e y c o u l d use. Those r e m a i n i n g i n h o s p i t a l f o r a p e r i o d o f l e s s than two y e a r s had u s u a l l y r e t a i n e d some r e s o u r c e s i n t h e i r former community w h i c h c o u l d be m o b i l i z e d t o a s s i s t them i n d i s c h a r g e . On the o t h e r hand, the i n d i c a t i o n s f o r these p a t i e n t s i s t h a t t h e y would need an e x t e n s i o n o f h o s p i t a l s e r v i c e s a f t e r t h e y were d i s c h a r g e d . The p a t i e n t s who had remained i n h o s p i t a l f o r a l o n g e r p e r i o d o f time, had l e s s need f o r o u t - p a t i e n t h o s p i t a l s e r v i c e s , y e t had l i t t l e i n the way o f s o c i a l r e s o u r c e s o r c o n t a c t s i n t h e i r former community t o a s s i s t them once t h e y had l e f t the h o s p i t a l . T h i s group a l s o e v i d e n c e d l e s s m o t i v a t i o n f o r d i s c h a r g e and seemed t o r e g a r d t h e i r h o s p i t a l i z a t i o n as a permanent l i v i n g arrangement. I n c o n c l u s i o n , the study p o i n t s out the need f o r f u r t h e r d e f i n i t i v e assessments o f the a r e a s o f f u n c t i o n o f a s o c i a l worker I n an i n s t i t u t i o n where the aged, p s y c h i a t r i c a l l y i l l a r e t r e a t e d . A l s o p o i n t e d o u t i s t h e need f o r s o c i a l work programme p l a n n i n g i n the l i g h t o f these assessments, as w e l l as the i n s u r a n c e o f adequate p r o v i s i o n s f o r f u r t h e r r e s e a r c h t o h e l p develope i t . Treatment programmes i n o t h e r p s y c h i a t r i c i n s t i t u t i o n s a r e mentioned, i n d i c a t i n g t h a t w i t h the use o f more advanced t h e r a p i e s , an i n c r e a s i n g number o f g e r i a t r i c p a t i e n t s w i t h m e n t a l i l l n e s s e s a r e r e s p o n d i n g t o treatment and a r e , t h e r e f o r e , e l i g i b l e f o r d i s c h a r g e . Thus, t h e r e i s a growing need f o r s o c i a l work c o n t r i b u t i o n s i n p l a n n i n g w i t h the o l d e r p e r s o n who i s l e a v i n g h o s p i t a l . Some i n d i c a t i o n s o f community c o n c e r n i n p l a n n i n g f o r t h e s e p e o p l e are c i t e d as evidence o f awareness on the p a r t o f both t h e i n s t i t u t i o n s f o r the g e r i a t r i c p a t i e n t and the community t h a t the change f r o m h o s p i t a l l i f e t o community l i f e must be an u n i n t e r r u p t e d p r o c e s s .  In presenting  t h i s thesis i n p a r t i a l fulfilment of  the requirements for an advanced degree at the  University  of B r i t i s h Columbia, I agree that the Library s h a l l make i t freely available for reference  and  study.  I further  agree that permission for extensive copying of t h i s thesis for scholarly purposes may  be granted by the Head of my  Department or by his representatives.  It i s understood  that copying or publication of this thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission.  Department The University of B r i t i s h Columbia Vancouver Canada.  ACKNOWLEDGEMENTS  I w i s h t o e x p r e s s my a p p r e c i a t i o n t o b o t h t h e m e d i c a l and n u r s i n g s t a f f a t t h e P o r t C o q u i t l a m u n i t o f t h e Homes f o r t h e Aged f o r t h e i r i n t e r e s t e d and c o - o p e r a t i v e p a r t i c i p a t i o n i n c a r r y i n g o u t t h i s s t u d y . I p a r t i c u l a r l y want t o thank D r . B.F. Bryson, M e d i c a l S u p e r i n t e n d e n t , Homes f o r the Aged, f o r h i s h e l p .  I a l s o wish t o acknowledge i n d e b t e d n e s s t o D r . L e o n a r d C. Marsh and Miss Dorothy R. Begg f o r t h e i r c o n s t r u c t i v e s u g g e s t i o n s and encouragement.  xxxxxxxx  ii TABLE OF CONTENTS Page  Chapter I .  The I n c r e a s i n g Aged P o p u l a t i o n  The S o c i a l Adjustment o f t h e Aged. The Dependent Aged. P s y c h i a t r i c c a r e f o r t h e Aged. The B r i t i s h Columbia Homes f o r t h e Aged. Focus and method o f t h i s study.  1  C h a p t e r I I . An I n s t i t u t i o n a l Popuj.at i o n The P o r t C o q u i t l a m u n i t o f t h e Homes f o r t h e Aged. S e l e c t i n g t h e group f o r study. The v a l i d i t y o f t h e i n f o r m a t i o n . Who a r e the p a t i e n t s • C h a p t e r III.Needs and Resources  •  22  i n Discharge Planning  The s e l e c t i o n o f a r e a s f o r assessment. Psychiatric casework and m e d i c a l needs. H o u s i n g needs. The need f o r P e r s o n a l S u p e r v i s i o n . P h y s i c a l a b i l i t y . F i n a n c i a l and M a t e r i a l Resources. The i n t e r e s t o f f a m i l y and f r i e n d s . The l e v e l o f motivation f o r discharge  42  C h a p t e r IV. S o c i a l Work f o r t h e I n s t i t u t i o n a l i z e d Aged Summary and assessment. The t r a n s i t i o n p e r i o d o f b o t h t h e i n s t i t u t i o n s and the community. S o c i a l work programming f o r the aged i n p s y c h i a t r i c i n s t i t u t i o n s . Departments i n o t h e r areas  74  Appendices: A.  Bibliography*  85 TABLES IN THE TEXT  T a b l e 1.  The P r o p o r t i o n o f O l d e r People Admitted t o G e n e r a l H o s p i t a l s i n B r i t i s h Columbia  T a b l e 2.  T a b l e 3.  i n 1954  An Assessment o f t h e Amount o f I n f o r m a t i o n A v a i l a b l e on a Group o f Twenty-Four P a t i e n t s a t t h e Homes f o r t h e Aged, P o r t C o q u i t l a m , 1958  *«  8  35  The L e n g t h o f S t a y o f a Group o f Twenty-Four P a t i e n t s a t t h e Homes f o r t h e Aged, P o r t C o q u i t l a m , 1958  38  iii Table A. The. Diagnosis of a Group of Twenty-Four Patients at the Homes for the aged, Port Coquitlam, 1958  • AO  Table 5* The Need for Counselling and Psychotherapy of a Group of Twenty-Four Patients of the Homes for the Aged, Port Coqultlam, 1958  AA  Table 6. The Extent of Medical Needs of a Group of TwentyFour Patients i n the Homes for the Aged, Port Coqultlam, 1958  47  Table 7. An assessment of the Type of Housing Needed by a Group of Twenty-Four Patients i n the Homes f o r the Aged, Port Coquitlam, 1958... •  5j  Table 8. The Amount of Supervision Required by a Group of Twenty*Four Patients i n the Homes for the Aged, Port Coquitlam, 1958 •  54  Table 9- The Physical A b i l i t y of a Group of Twenty-Four Patients i n the Homes f o r the Aged, Port Coquitlam, 1958  56  Table 1 0 . The Financial and Material Resources of a Group of Twenty**Four Patients i n the Homes for the Aged, Port Coquitlam, 1958  60  Table U . The Quantity of Family and Friends of a Group of Twenty-Four Patients i n the Homes for the Aged, Port Coquitlam, 1958 • 65 Table 12. The Interest of the Family and/or Friends of a Group of Twenty-Four Patients i n the Homes for the Aged, Port Coquitlam, 1958.......  67  Table 13. The Level of Motivation of a Group of Twenty-Four Patients i n the Homes f o r the Aged, Port Coquitlam, 1958  70  CHAPTER I THE  GROWTH OF THE AGED POPULATION  Almost any l i t e r a t u r e r e g a r d i n g t h e aged o r t h e i n c r e a s i n g aged p o p u l a t i o n i n c l u d e s s t a t i s t i c a l surveys p r o p o r t i o n o f our p e o p l e  i n d i c a t i n g that the  over s i x t y - f i v e y e a r s o f age, when compared  w i t h the zero t o s i x t y - f i v e y e a r o l d group, i s s t e a d i l y i n c r e a s i n g . These s t u d i e s have had a g r a d u a l impact on t h e community a s a whole and  have g i v e n way t o a v e r y r e a l a n x i e t y on t h e p a r t o f S o c i a l  Welfare  A u t h o r i t i e s occupied with attempting  t o meet t h e problems  of t h i s p a r t i c u l a r group, A b r i e f mention o f some o f the causes f o r t h e i n c r e a s e d p r o p o r t i o n o f aged, and a r e v i e w  o f t h e h i s t o r y o f t h e adjustment  o f t h i s group d u r i n g t h e p a s t t h r e e c e n t u r i e s i s h e l p f u l both i n terms o f g a i n i n g f u r t h e r u n d e r s t a n d i n g day,  o f t h e problem, i n t h e p r e s e n t  and i n s e e i n g i n i t s development some p o s s i b l e , p a r t i a l s o l u t i o n s ,  (1) Most r e c o g n i z e d a u t h o r i t i e s on t h e problem o f t h e aged p o i n t t o two t r e n d s i n t h e e v o l u t i o n o f our Western c u l t u r e t h a t c o n t r i b u t e t o an i n c r e a s i n g number o f aged i n t h e p o p u l a t i o n .  The f i r s t and  p o s s i b l y t h e most r e c o g n i z e d by t h e layman i s t h e f a c t t h a t p e o p l e a r e l i v i n g longer.  Many developments such as more widespread and advanced  (1) Of p a r t i c u l a r i n t e r e s t i n t h i s r e g a r d i s o f Shock Nathan, Trends I n Gerontology, S t a n f o r d U n i v e r s i t y P r e s s , S t a n f o r d , C a l i f o r n i a , 1957.  2  m e d i c a l care, b e t t e r n u t r i t i o n and more ease o f l i v i n g have contributed to a higher longevity. increased  I t should life  standard  o f p h y s i c a l h e a l t h and  a l s o be p o i n t e d  out,  however, t h a t  i n terms o f the  The  second and  increasing population  most s i g n i f i c a n t  the p r o p o r t i o n  the fact  o f aged i s t h a t l e s s c h i l d r e n  p e r f a m i l y are b e i n g produced so t h a t , i n terms o f the o f the aged has  total  s t e a d i l y increased.  T h i s s t e r i l i t y on t h e p a r t of the p o p u l a t i o n has  this  span does not i n i t s e l f c o n t r i b u t e s o l e l y t o  l a r g e r p r o p o r t i o n o f aged.  population,  resultant  as a whole  s e v e r a l i m p l i c a t i o n s which w i l l be b r i e f l y o u t l i n e d l a t e r i n  terms o f w e l f a r e  c o s t s and  s o c i a l workers and  programmes and  working w i t h t h e  resultant a c t i v i t y  aged.  S t a t i t i c i a n s have produced a g r e a t many s u r v e y s population  trends  of  throughout the Western w o r l d .  regarding  F o r example,  the  average number o f c h i l d r e n born i n a m a r r i a g e has dropped from f i v e o r s i x i n the 18th day..  Century t o two  or three  i n our  .  I n terms o f the p o p u l a t i o n  r a t i o , there i s a d e f i n i t e  t r e n d toward s m a l l e r numbers i n the young, economical, age  present  (1)  productive  group assuming r e s p o n s i b i l i t y f o r a l a r g e r p r o p o r t i o n o f  older  persons.  (1) Report o f the t h i r d c o n g r e s s o f the 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 , London, 1954* Old Age and t h e Modern World E, and S. L i v i n g s t o n , L t d . 1955, Page 3.  - 3 The  S o c i a l Adjustment o f t h e Aged Some o f the causes and  I m p l i c a t i o n s behind  the growth i n s i z e  o f the o l d e r segment o f the p o p u l a t i o n have a l r e a d y been d i s c u s s e d . growth c o n s t i t u t e s o n l y one  This  f a c e t o f t h e p r e s e n t problems Western s o c i e t y  e n c o u n t e r s i n d e a l i n g w i t h t h e aged. The  f o l l o w i n g b r i e f h i s t o r i c a l summary t a k e n from the work o f (2)  P a u l E . Sauvey, a f r e n c h s o c i o l o g i s t , o u t l i n e s the development o f aged d u r i n g the p a s t few  the  c e n t u r i e s and p o i n t s out some o f the f a c t o r s  which have c o n t r i b u t e d t o the development o f an " o l d age  problem".  Sauvey breaks man's s o c i a l adjustment i n terms o f the o l d e r p e r s o n i n t o t h r e e main phasess (a)  The F a m i l y Phase -  Many o f the problems which t o d a y are d e s c r i b e d  as s o c i a l were f o r m e r l y r e s o l v e d w i t h i n the o l d p a t r i a r c h a l type T h i s was was  n o t a b l y so w i t h the care o f o l d p e o p l e .  a task delegated  f a m i l y members and and  The  care o f the o l d  t o t h e o l d e r person's o f f s p r i n g o r immediate  i n the average f a m i l y , which was  i n a r u r a l a r e a , such a t a s k was  predominantly l a r g e  no p a r t i c u l a r problem.  be added t h a t a t t h i s time the p r o p o r t i o n o f o l d people was and was  I t should fairly  small  not undergoing any l a r g e s c a l e growth as has been c h a r a c t e r i s t i c  of recent times.  T h i s type o f f a m i l y c a r e has extended i n some o f the  more i s o l a t e d r u r a l communities up t o modern  (1)  family.  I b i d . , P.  35.  times.  - A (b) I n d i v i d u a l i s t i c Phase -  As society became more advanced towards  the end of the 18th Century, d i s l o c a t i o n s became apparent i n the i n s t i t u t i o n of the family.  There followed a geographic d i s p e r s i o n  o f the family into smaller, scattered u n i t s .  Many family members  went to work i n the towns i n f a c t o r i e s . There followed also a decrease i n parental authority which the s o c i o l o g i s t s believe helped to bind the family together as a unit.  At about t h i s time i t became  possible to make f i n a n c i a l investments with a view to providing f o r oneself i n old age so that t h e o r e t i c a l l y i f onewanted carein h i s o l d age one was  responsible f o r providing t h i s care through long term  planning and saving.  Such provision f o r old age f o r the major  portion of the population was  impossible because of poverty at t h i s  time as well as the lack, f o r the most part, of the a b i l i t y to foresee the problems of old (c) S o c i a l Phase -  population's  age.  The growing concern on the part of thepublic  o f various s o c i a l problems brought about t h i s phase i n which government authorities accepted some r e s p o n s i b i l i t y f o r planning and providing f o r the aged. acceptance was  The most notable example of t h i s  i n the passing of numerous old-age pension acts  throughout the nations o f Europe and the Western hemisphere.  This  period might be said to date from about the time of the F i r s t World War  up to and including the  present.  The author goes on to point out that these periods overlapped considerably i n view of the accelerated s o c i a l movement i n some areas and lags i n others.  In addition he mentions d i f f e r e n t  rates of evolution take place within the various socio-economic c l a s s .  - 5 In  terms o f t h e above a n a l y s i s a r e p o r t o f a committee h a v i n g  completed  a r e c e n t s t u d y i n B r i t i s h Columbia sums up the p r e s e n t  l e v e l o f adjustment statistical  o f the aged i n t h i s a r e a .  A f t e r reviewing  i n f o r m a t i o n r e g a r d i n g t h e growth o f the o l d e r p o p u l a t i o n  (1) t h i s groups concluded: of  "At the same t i m e , t h r o u g h the development  Canada's economy, s o c i e t y has become i n c r e a s i n g l y  industrial  and  urban, p e n a l i z i n g t h e e l d e r l y , l i m i t i n g t h e i r o p p o r t u n i t i e s  for  p r o d u c t i v e a c t i v i t y , r e s t r i c t i n g t h e i r share In t h e g e n e r a l  p r o s p e r i t y and c u r t a i l i n g t h e i r p a r t i c i p a t i o n i n community living.  I n c r e a s e d m o b i l i t y and problems o f urban h o u s i n g have  s e r v e d t o s e p a r a t e p a r e n t s and c h i l d r e n and have f r e q u e n t l y d e p r i v e d an o l d e r p e r s o n o f a secure p l a c e and f a m i l y l i f e . The  h i g h e r income o f post-war y e a r s has a l l o w e d f a m i l i e s t o e n t e r t a i n  and be e n t e r t a i n e d - t h e y a r e "out" t o a g r e a t e r e x t e n t than before.  The d e s i r e o f young couples t o be c o n s t a n t l y "on t h e  ever go"  c o n f l i c t s w i t h t h e need f o r e l d e r l y p a r e n t s t o have c o n s t a n t s u p e r v i s i o n and r e s u l t s i n the removal o f p a r e n t s t o i n s t i t u t i o n s o u t s i d e the home.  F u r t h e r , urban h o u s i n g developments c a l l f o r the  s m a l l e r house or c o t t a g e w i t h enough rooms t o accommodate t h e immediate f a m i l y .  A t the same time t h e development o f modern  I n s t i t u t i o n a l f a c i l i t i e s f o r the o l d e r p e r s o n who h i m s e l f o r who  can't l o o k a f t e r  i s i n need o f n u r s i n g c a r e has tended t o l a g . "  (1) From an u n p u b l i s h e d r e p o r t by t h e G r e a t e r Vancouver H e a l t h League, A S t u d y by t h e N u r s i n g Homes Committee. May, 1958. P.l.  - 6 -  Unfortunately, i t is very d i f f i c u l t to obtain any statistics on the actual numbers of aged who are l i v i n g socially or economically independent lives.  This paucity of information Is  especially apparent when one attempts to review the Canadian scene (perhaps because independent citizens seldom find themselves listed on the various roles or records of agencies or organizations.) Some inferences, however, can be drawn from the available figures on the  aged i n Canada. In the Province of British Columbia in the year 1956 there  were 27,028 people listed as receiving financial assistance supplementary (1) to the Federal Old Age Security Pension of #40.00. This figure compared (2) with 96,701. indicates that over 69,000 had maintained some measure of economic independence or have made financial provision for themselves. Similarly a survey of the labour force of the USA completed in 1951 (the author has been unable to find similar figures for Canada) indicates that forty per cent of the male population of the United States sixty-five years of age and over were s t i l l listed as "active . w  This same survey indicates that 9.5 per cent of the women from this same age group were s t i l l listed on the labour force. the  In addition,  breakdown of this sixty-five years and over age group In 1953 for  (1) British Columbia, Annual Report of the Department of Sbcial Welfare, Queens Printer, Victoria, 1956, Pt 61. . (2) Canada, Dominion Bureau of Statistics, Census of Canada, 1956, Population Bulletin* 1-10, Single Years of Age, Queens Printer, Ottawa, 1957. PP 21-5, 21-6. (3) Shock Nathan, Trends in Gerontology, Stanford University Press, Stanford California, 1957, PP 34-35.  the USA  indicates a s i m i l a r proportion i n the various vocational  categories as that found i n the fourteen to sixty-four year old age group.  This would seem to indicate that the aged can carry  on with a l l the various types of work despite the varying physical (1) and mental demands made upon them i n these jobs.. There are many surveys too numerous to mention about the economic adjustment of the aged i n other countries along with studies of housing, r e c r e a t i o n a l medical and other f a c i l i t i e s f o r the aged. The Dependent Aged Although the proceeding paragraphs indicate that there are varying levels of adjustment i n our older age group, the f a c t remains that older age does bring on greaterphysical and mental i n f i r m i t i e s . Hospital and other I n s t i t u t i o n s devoted to the care of the s i c k f o r example, usually record a;proportionately larger number of older (2) people i n residence . than any other age group when compared with the same groups i n the general population.  Published figures (Table l )  also indicate that the g e r i a t r i c s group i n B r i t i s h Columbia tends to remain f o r a longer period i n h o s p i t a l than those i n every other  age  group*  (1) Shock Nathan, Trends i n Gerontology, Stanford U n i v e r s i t y Press, Stanford C a l i f o r n i a , 1957, PP 34-35. (2) births.  These f i g u r e s usually exclude those figures c l a s s i f i e d as  TABLE 1 The P r o p o r t i o n o f O l d e r P e o p l e Admitted t o G e n e r a l H o s p i t a l s i n B r i t i s h Columbia i n 1954. as compared w i t h The Age P e r c e n t a g e D i s t r i b u t i o n o f t h e T o t a l P o p u l a t i o n o f B r i t i s h Columbia and t h e Percentage o f the T o t a l P a t i e n t Days O l d e r P e o p l e were i n H o s p i t a l d u r i n g 195A.  Age  Percentage o f G e n e r a l Population.  Percentage o f P a t i e n t s Admitted During 1954.  Percentage of P a t i e n t Days D u r i n g  1954  65 - 69  4.54  4.4  7.4  70 - 74  5.26  4.3  8.0  75- 79  1.78  3.0  5.8  84 - 89  .84  1.6  3.3  90  .40  .9  2.0  Source*  B r i t i s h Columbia, Report o f t h e H o s p i t a l I n s u r a n c e S e r v i c e s , Department o f H e a l t h & W e l f a r e , Queens P r i n t e r , ¥ictoria, 1955  Similar findings to these have been recorded i n other areas. In Ontario, f o r example, patients i n general h o s p i t a l i n the g e r i a t r i c age group t o t a l only eight per-cent o f the t o t a l hospital population but accounted hospitals.  f o r nineteen per cent of the t o t a l days i n general  In i l l u s t r a t i n g these figures, one author made the following (1)  comments about the longer stay o f older patients, "For a good many among them the i l l n e s s or d i s a b i l i t y which sent them to hospital means the end of a previous l i v i n g arrangement the i m p o s s i b i l i t y of returning home without a period of intermediate care, or a s a t i s f a c t o r y discharge to t h e i r homes only i f follow-up home care i s provided.  These are the basic reasons why a good many  cannot be discharged at the appropriate time even when t h e i r i l l n e s s does not require a transfer to permanent i n s t i t u t i o n a l nursing care.*  1  I t would appear then, that perhaps these figures are somewhat misleading i n terms of the degree of impairment that many of these older patients may have.  Many perhaps could return t o the community  even though they might have to accept a more marginal l e v e l of s o c i a l adjustment than they previously enjoyed.  Miss Bradford went on t o  comment further, "Positive welfare and r e h a b i l i t a t i o n programmes should embrace the long stay i n hospital and a f t e r care i n one c o n t i n u i t y and the planning of these a c t i v i t i e s must take into account the f a c t that many of these older patients do not have the physical homes and immediate families that are generally pre-supposed f o r younger people,"  (1) lBd P22 Bradford Marjorie, A Study of the Need3 of Older and Chronically 111 Persons i n the C i t y o f Ottawa. Council of the Corporation of the C i t y of Ottawa, 1954, P.21,  - 10 A g a i n , the s o c i a l i s o l a t i o n o f t h e o l d e r p e r s o n i s seen t o p l a y an important p a r t i n d e a l i n g w i t h o t h e r h a n d i c a p s ,  i n t h i s case, p h y s i c a l  illness. P s y c h i a t r i c Care f o r the Aged O l d e r p e o p l e , as t h e i r p h y s i c a l and mental powers begin- t o wane, seem t o be more s u s c e p t i b l e t o m e n t a l i l l n e s s .  Unfortunately,  t h e y a l s o tend t o have a g r e a t e r degree o f o r g a n i c and  chronic i l l n e s s .  Thus, t o the layman and even t o many p r o f e s s i o n a l p e o p l e , m e n t a l i n an o l d e r person seems t o be equated  w i t h l o n g term  illness  institutional  c a r e and poor p r o g n o s i s , o r a t b e s t , d i s c h a r g e from a m e n t a l h o s p i t a l w i t h a c r i p p l i n g p s y c h i a t r i c r e s i d u a l and o n l y a m a r g i n a l  adjustment  t o be hoped f o r . Added t o t h i s common f e e l i n g o f a gloomy p r o g n o s i s i n the p s y c h i a t r i c treatment o f t h i s group i s t h e d i f f i c u l t y t h e aged  person  has i n moving back i n t o t h e community a f t e r t h e l e n g t h y p e r i o d i n h o s p i t a l t h a t treatment  usually entails.  O l d age  with s o c i a l r i g i d i t y ~  t h a t the o l d e r person  i s often associated  I s not as s o c i a l l y o r  p s y c h o l o g i c a l l y adept i n making a d i f f e r e n t adjustment, t o p r e s e r v e and extend  h a v i n g a need  thos t h i n g s t h e y know and w i t h which t h e y a r e  comfortable. One  need not l o o k back over f i f t y y e a r s t o f i n d t h a t a l l  m e n t a l i l l n e s s i n any age group was viewed as a r a t h e r h o p e l e s s , i r r e m e d i a l i l l n e s s and t h a t any p a t i e n t ' s r e c o v e r y was as an a c t o f God. p s y c h o l o g i c a l and  viewed  almost  S i n c e the t u r n o f the c e n t u r y , however, b o t h somatic t h e r a p i e s have been used t o such  an  e x t e n t t h a t many types o f p s y c h i a t r i c i l l n e s s have an o p t o m i s t i c p r o g n o s i s ; the layman i s g r a d u a l l y a c c e p t i n g mental i l l n e s s ,  particularly  - 11 i n the younger age groups, as a treatable i l l n e s s involving periods of i n s t i t u t i o n a l l i v i n g and a l o s s of time and money. Somatic therapies, such as coma i n s u l i n , electro-shock therapy and more r e c e n t l y the ataractics ( t r a n q u i l i z e r s ) as w e l l as the use of psycho-analysis and other forms of psychotherapy, to name only a few treatment techniques, have been e f f e c t i v e l y used i n combatting the so-called e f f e c t i v e disorders (e.g. schizophrenia, manic depressive disorders, etc.) as w e l l as modifying some of the i l l n e s s e s with i r r e v e r s i b l e organic changes (e.g., epilepsy, General Paresis of the Insane, etc.) Although there seems to be an awakening optimism regarding the t r e a t a b i l i t y of most aged groups and most types of i l l n e s s , there also seems to be a considerable l a g i n both the layman and p r o f e s s i o n a l groups regarding the t r e a t a b i l i t y of the older age group. i n commenting on the p s y c h i a t r i c treatment  One  author  of the aged, describes the  r e s u l t of a survey performed i n the State of New  York.  "A report of patients on the Books of the New York State Mental Hospitals, 65 years of age and older, as of March 31st, shows 28,250 such p a t i e n t s .  Of these 59.A  1953,  per cent have been  hospitalized f o r a period of from f i v e to over twenty years.  The  diagnostic categories indicate that only 50.3 per cent carried a primary diagnoses which might be said to r e l a t e more or less s p e c i f i c a l l y to the process of aging i n the sense that these diagnosis were*  Psychosis with Cerebral Arteriosclerosis - senile and Involutional Psychosis*  The other 49.7 per cent carried diagnosis that in no  way were specific for that age group, instead 32.7 per cent of the total were diagnosed as Demeatia Praecox.  These figures have  tremendous implications for the evaluation of the problem of the type of psychiatric reaction related specifically to the aged factor".-—-(New knowledge of syndromes) should have an important impact on the attitude toward prognosis and treatment. A f a t a l i s t i c attitude of the inevitability of deterioration has led to a programme of involving custodial care primarily.  This  new insight opens a completely different vista and must involve a totally different programme of active therapy (1)  and research at  a l l echelons. One can only conclude from these and other studies that there i s a growing awareness within the professional disciplines dealing with the psychiatrically i l l that many people are treatable and capable of discharge into the community, yet considerable work w i l l have to be done in this area to intensify our efforts in treatment and l i f t the public level of awareness in this regard.  (1) Gruenberg, Dr. Ernest and Kaufman, Dr. Ralph M., Charter 'for the Aging. Report of the New York State Conference at Albany, New York, 1956. P. 263»  - 13 Treatment i n B r i t i s h  Columbia  B r i t i s h Columbia, d u r i n g the p a s t q u a r t e r o f a c e n t u r y , developed aged.  has  a v a s t programme f o r the s p e c i a l p s y c h i a t r i c c a r e o f the  A comparison i n t h i s r e g a r d w i t h a l l o t h e r p r o v i n c e s i n d i c a t e s  t h a t t h i s p r o v i n c e i s the o n l y one o u t s i d e o f A l b e r t a h a v i n g a s m a l l 300  for  bed  i n s t i t n t i o n , which has made any s p e c i a l p s y c h i a t r i c p r o v i s i o n s  (1)  t h e aged.  .  O f f i c i a l r e c o g n i t i o n o f t h e need and p r o v i s i o n s f o r the of  t h i s group i n t h i s p r o v i n c e d a t e s back t o 1936  the Aged A c t was  passed  when the Homes f o r  by t h e B r i t i s h Columbia government.  p r o v i d e d f o r s e p a r a t e a d m i n i s t r a t i v e o r g a n i z a t i o n and to  care f o r the p s y c h i a t r i c a l l y i l l o f 65  care  y e a r s o f age  This act  facilities and  over.  These f a c i l i t i e s were i n i t i a l l y made an a u x i l i a r y s e r v i c e t o t h e P r o v i n c i a l M e n t a l H o s p i t a l i n t h a t a l l admissions  t o the Homes f o r  t h e Aged, as t h e y l a t e r became known, were screened t h r o u g h  (2)  the P r o v i n c i a l  ^fental H o s p i t a l . F o r s e v e r a l y e a r s p r i o r t o 1936 H e a l t h S e r v i c e s (Dr. A.L.  Crease) had  the D i r e c t o r o f M e n t a l  s t r e s s e d the overcrowded  c o n d i t i o n s and the need f o r more space i n t h e M e n t a l H o s p i t a l .  (1) M e n t a l H e a l t h S e r v i c e s i n Canada. Research D i v i s i o n , Department of N a t i o n a l H e a l t h & W e l f a r e , Ottawa, J u l y 1954, P.P. 102, 103. (2) F o r a f u l l d e s c r i p t i o n o f t h e e a r l y development o f the Homes f o r the Aged see* C l a r k , R i c h a r d James, Care o f t h e M e n t a l l y 111 in B r i t i s h Columbia, 1945. PP 92-94.  - H In response to this need, the Provincial Secretary made two buildings available, which were formerly part of the Industrial School and which were adjacent to the hospital at Essondale.  These buildings  were quickly occupied by a small group of the older patients from various wards in the Mental Hospital*  There were approximately  forty patients transferred at that time. Dr. Crease in his Mental Health Services report for the year 1936 commented that this arrangement was most satisfactory and that the buildings were converted to very pleasant l i v i n g accommodations for this group of patients.  In 1939 two more wards  were converted from a former Boys' Industrial School building in this same area and these were used to house geriatric patients requiring isolation (for contagious diseases such as Tuberculosis, Syphilis, e t c ) This small unit served to illustrate the efficacy of special f a c i l i t i e s for the aged and this experience, coupled with the findings of other institutions of a similar nature throughout the world, created an increasing demand for more units of this kind.  Growth, however,  was very gradual and in 1945 the annual report (Provincial Mental Health Services) recorded only 132 patients in residence at the Homes for the Aged. In 1948,  in response to this need an additional unit was  established at Vernon, B.C. The Vernon unit had formerly been a military hospital and as such was easily converted to house two hundred patients i n i t i a l l y .  The majority of these patients were transferred  from Essondale and the Homes for the Aged i t s e l f , and at that time, these patients were selected on the basis of their stamina for withstanding the long train journey and the fact that they would require long term care as a hospital patient.  - 15 -  In 1951,  the t h i r d unit was established at Terrace, B.C., and  at the end of that f i s c a l year an average of seventy-five patients were in residence.  The Terrace home had also been a former m i l i t a r y h o s p i t a l  converted f o r the use of g e r i a t r i c patients. The three units at Vernon Terrace and Port Coquitlam provided a nucleus f o r the present g e r i a t r i c programme B r i t i s h Columbia has f o r i t s p s y c h i a t r i c a l l y i l l .  Each unit  has expanded throughout the years with the addition of new buildings or converted older buildings up to the present time when the Homes f o r the Aged have an approximate t o t a l of 1,100 patients i n residence (Port Coquitlam - 550, Vernon - 300 and Terrace - 250). Present P o l i c i e s According t o the terms of the Act f o r the establishment o f the Homes f o r the Aged, any person over the age of s i x t y - f i v e years who i s judged to be suffering from changes as a r e s u l t of old age, can be assessed f o r admission to these units.  The Act and the  i n s t i t u t i o n s themselves are administered by a Medical  Superintendent  who i s responsible f o r the admission and care of the patients and f o r s e t t i n g up an administrative organization to provide t h i s care. Requests f o r admission t o the Homes f o r the Aged, are made by the applicant's physician i n the community.  The doctor completes  an application form containing h i s opinion as to the patient's s u i t a b i l i t y for admission as w e l l as e s s e n t i a l medical and p s y c h i a t r i c data, and forwards t h i s to the Medical  Superintendent.  - 16 -  As mentioned e a r l i e r , there has been a s t e a d i l y increasing demand f o r f a c i l i t i e s f o r the Homes f o r the Aged which these services have been unable to f u l f i l l .  (The annual report of the Medical  Superintendent has c o n s i s t e n t l y pointed out the shortage of bed space f o r the past ten years). A l l requests f o r admission are, therefore, c a r e f u l l y screened by the Medical Superintendent and are either admitted or placed on a l i s t f o r admission based upon urgency o f t h e i r committal).  There has been a l i s t of patients  awaiting admission throughout the years and these cases are p e r i o d i c a l l y reviewed and assessed to s ee whether or not there has been any change i n t h e i r p r i o r i t y r a t i n g . 1958,  Boring the year  f o r example, there was a t o t a l 266 applications of men aid  women over s i x t y years of age.  I t was possible t o accept 252  patients f o r admission and of these, 111 or forty-two per cent of  the number received, were considered urgent so that admission  could not be delayed.  The remainder are s t i l l on the waiting  l i s t and hopefully, w i l l be admitted at some l a t e r date. In  addition t o dealing with o f f i c i a l application, the  Medical Superintendent has:  "Spent many hours during the year  interviewing r e l a t i v e s and others by telephone, by mail or i n person, who have been burdened or intimately concerned with the problem of caring f o r disturbed, e l d e r l y r e l a t i v e s .  Wherever  possible, advice and encouragement have been given t o maintain  - 17 these patients i n community as long as possible.  In many cases,  suitable accommodation or medical treatment has been worked out so that admission to the Homes f o r the Aged could be delayed or (1) was no longer required". Insofar as possible, a l l applicants are admitted to the unit which serves the area from which they come, i . e . , those patients i n the Vernon d i s t r i c t are admitted to that unit and s i m i l a r l y with the Port Coquitlam and Terrace units.  This occasionally r e s u l t s  i n vacancies i n the units serving the less populated parts of the Province (Vernon and Terrace) and may create over-crowding i n the Port Coquitlam u n i t .  Thus approximately once yearly, patients  are transferred to the Vernon or Terrace units from the Lower Mainland area i f they can withstand the rigors of a long t r a i n journey and are suitable f o r the type of care that i s given i n these respective units. Treatment Services As previously outlined i n mentioning the h i s t o r y of the development of the Homes f o r the Aged, two of the units (Vernon and Terrace) are converted m i l i t a r y hospitals and some of the buildings i n the Port Coquitlam d i s t r i c t are converted i n d u s t r i a l school b u i l d i n g s .  These f a c i l i t i e s are, f o r the most part, more  suitable f o r providing custodial, medical and nursing care.  Since  (1) B r i t i s h Columbia, Annual Report of the Mental Health Services, Queens P r i n t e r s , V i c t o r i a , 1958. P.L 106.  - 18 -  a g r e a t many g e r i a t r i c p a t i e n t s , because o f t h e p h y s i c a l f r a i l i t i e s o f o l d age and t h e o r g a n i c i t y o f t h e i r i l l n e s s e s r e q u i r e p r i m a r i l y bed  c a r e , t h e s e wards p a r t i c u l a r l y i n t h e Vernon and T e r r a c e u n i t s  a r e kept i n f u l l use. P s y c h i a t r i c treatment  i n the Homes f o r t h e Aged, a t t h e  p r e s e n t time, f e a t u r e s , f o r t h e most p a r t , c u s t o d i a l ,  psychiatric,  m e d i c a l and n u r s i n g c a r e by an e x p e r i e n c e d and u n d e r s t a n d i n g  staff.  Heavy use i s made o f t h e newer t r a n q u i l i z i n g drugs and o t h e r pharmacological therapies i n a l l three units t o maintain the n  p a t i e n t ' s maximum improvement and adjustment i n t h e h o s p i t a l environment, and t o p r o v i d e f o r t h e p a t i e n t ' s g r e a t e s t p o s s i b l e (1) comfort and contentment." Unfortunately, limited  use i s made o f t h e p s y c h i a t r i c  a u x i l i a r y s e r v i c e s ( s u c h as O c c u p a t i o n a l and R e c r e a t i o n a l t h e r a p i e s , physiotherapy, Psychology  and S o c i a l S e r v i c e s ) p a r t i c u l a r l y i n t h e  Vernon and T e r r a c e u n i t s , as t h e r e i s no p r o v i s i o n w i t h establishment f o r these s e r v i c e s . Coquitlam  unit d i f f e r s ,  t o the P r o v i n c i a l Mental Mainland  staff  In t h i s respect the Port  i n t h a t because o f i t s c l o s e p r o x i m i t y H o s p i t a l and t h e h e a v i l y p o p u l a t e d  lower  a r e a , s e r v i c e s a r e more r e a d i l y a v a i l a b l e from t h e i r  s o u r c e s than i n t h e more i s o l a t e d a r e a s o f Vernon and T e r r a c e .  (1) ( E x c e r p t from treatment aims as s e t out i n a memo s e n t from the M e d i c a l S u p e r i n t e n d e n t t o the w r i t e r . )  - 19 -  The P o r t Coquitlam  u n i t i s d e s c r i b e d i n the f o l l o w i n g  chapter, the s e t t i n g f o r the d e t a i l e d study.  The two o t h e r u n i t s  a t Vernon and T e r r a c e have s p a c i o u s grounds s u r r o u n d i n g them, and o f f e r ambulatory p a t i e n t s ample o p p o r t u n i t y f o r e x c e r c i s e o r l i g h t work i n o r d e r t o m a i n t a i n o p t i m a l p h y s i c a l h e a l t h . a l s o a i d p a t i e n t s t o keep o c c u p i e d  i n meaningful  c o n t r i b u t e s t o t h e i r own f e e l i n g o f w e l l - b e i n g .  Such a c t i v i t i e s  a c t i v i t y and These u n i t s a r e  s e r v e d m e d i c a l l y t h r o u g h t h e use o f p r i v a t e p r a c t i t i o n e r s In the community c o n t r a c t e d by the P r o v i n c e ,  They, t h e r e f o r e , o f f e r  c o n s t a n t care and have s u b s t i t u t e p h y s i c i a n s a v a i l a b l e i f n e c e s s a r y . S u r g i c a l and o t h e r more e x t e n s i v e m e d i c a l treatments  are provided  by t r a n s f e r r i n g p a t i e n t s t o the l o c a l g e n e r a l h o s p i t a l s w i t h i n the a r e a . Regarding  The n u r s i n g s t a f f works f u l l  time i n t h e s e  institutions.  o c c u p a t i o n a l and r e c r e a t i o n a l t h e r a p y , as p r e v i o u s l y  mentioned, t h e r e a r e no p r o v i s i o n s f o r t h e s e a c t i v i t i e s ,  although  some nurses have been i n t e r e s t e d I n t h e s e a r e a s and have o b t a i n e d some t r a i n i n g i n h a n d i c r a f t s , hobbies  and r e c r e a t i o n a l o r g a n i z a t i o n ,  so t h a t as p a r t o f t h e i r d u t i e s t h e y can g i v e t h e s e s e r v i c e s t o patients.  I n a d d i t i o n , p a t i e n t s i n t h e s e u n i t s have weekly r e l i g i o u s  s e r v i c e s p r o v i d e d f o r them through t h e e f f o r t s o f l o c a l o r g a n i z a t i o n s i n the r e s p e c t i v e d i s t r i c t s  •  church  Volunteers are also  a c t i v e so t h a t t h e r e i s a m o n t h l y programme u s i n g l o c a l g l e e s clubs, e t c .  - 20 -  Throughout a l l three Homes f o r the Aged units there i s no provision made f o r psychological or s o c i a l services.  The Medical  Superintendent has consistently requested these services i n order to provide better diagnostic evaluations, as w e l l as a c t i v i t y devoted to admission and discharge planning. Services Related to Discharge The present discharge rate from the Homes f o r the Aged i s extremely low:  Out of a population of approximately eleven hundred  patients, only f i f t e e n men and four women could be returned to t h e i r families or t o nursing homes during the year 1958*  In commenting  upon t h i s the Medical Superintndent stated i n his annual report, "It i s f e l t that many more patients could be discharged i f s o c i a l service workers were available on the s t a f f of the g e r i a t r i c d i v i s i o n . " This service would provide better l i a i s o n with community agencies and families of improved patients whereby suitable arrangements could be (1) worked out to f i n d accommodation away from h o s p i t a l . " The Medical Superintendent  i s , i n making these  statenmts,  not only indicating the need f o r s o c i a l workers i n these i n s t i t u t i o n s but also expressing the growing conviction on the part of both medical  (1) B r i t i s h Columbia, Annual Report of Mental Health Services, Queens P r i n t e r , V i c t o r i a , 1958, P.L. 107.  - 21 -  and  n u r s i n g s t a f f t h a t a s i z e a b l e group o f the p a t i e n t s now i n  r e s i d e n c e a r e capable o f l i v i n g i n t h e o u t s i d e community. the treatment and  Although  p r o v i d e d c o n s i s t s o f p r i m a r i l y c u s t o d i a l and m e d i c a l  n u r s i n g c a r e , many o f these p a t i e n t s have responded t o t h e  e x t e n t t h a t t h e symptoms which b r o u g h t them t o h o s p i t a l a r e e i t h e r c l e a r e d up, o r a r e under c o n t r o l . Focus and Method o f T h i s Study A random sample was taken o f a l l p a t i e n t s judged r e a d y f o r d i s c h a r g e , w i t h a view t o d e t e r m i n i n g  t o be  the extent that  they w i l l r e q u i r e s o c i a l service a c t i v i t y i n l e a v i n g the h o s p i t a l and i n m a i n t a i n i n g an o p t i m a l adjustment i n t h e community. An a n a l y t i c a l s u r v e y ( i n v o l v i n g an a d a p t a t i o n o f t h e r a t i n g s c a l e method) was made o f some o f t h e needs t h e s e p a t i e n t s w i l l have i n b e i n g d i s c h a r g e d and p o t e n t i a l r e s o u r c e s t h e y have r e l a t i v e t o t h e i r discharge plans.  The f o c u s o f t h i s s u r v e y i s on a r e a s i n  which a s o c i a l worker c o u l d make a c o n t r i b u t i o n i n both p r e d i s c h a r g e p l a n n i n g and i n f o l l o w - u p  care.  - 22 CHAPTER I I AN INSTITUTIONAL POPULATION  I t h a s been observed  t h a t n o t a l l o f the p a t i e n t s a r e i n r e s i d e n c e  a t t h e Homes f o r t h e Aged because t h e y remain p s y c h i a t r i c a l l y i l l .  Some,  f o r example, who a r e w e l l enough t o l e a v e a r e u n w i l l i n g t o do so because t h e y a r e happy i n h o s p i t a l and a r e r e l u c t a n t t o r e t u r n t o t h e i r f o r m e r community because o f the d i f f i c u l t i e s t h e y may have e x p e r i e n c e d a l o n g p r i o r t o t h e i r admission. and o t h e r reasons  i ngetting  O t h e r s because o f t h e l e n g t h y h o s p i t a l i z a t i o n  f i n d t h e y have l o s t c o n t a c t w i t h t h e i r f a m i l y o r f r i e n d s  and t h e r e f o r e would have no-one t o h e l p them i f t h e y were t o r e t u r n . some p a t i e n t s l a c k t h e f i n a n c i a l r e s o u r c e s t o be a b l e t o a f f o r d h o u s i n g accommodation o r m e d i c a l  suitable  care.  I f there are p a t i e n t s remaining reasons  Possibly  i n h o s p i t a l f o r any o f t h e above  t h e r e would appear t o be a need f o r s o c i a l s e r v i c e s t o a s s i s t them  i n discharge planning.  F o r example, t h e s o c i a l worker c o u l d a s s e s s  with  the p a t i e n t the a v a i l a b i l i t y o f f i n a n c i a l r e s o u r c e s p r o v i d e d u n d e r e x i s t i n g s o c i a l l e g i s l a t i o n , o r could contact r e l a t i v e s o r f r i e n d s i n order t o assess the p o s s i b i l i t y o f h e l p from t h e s e s o u r c e s , t o mention o n l y two p o s s i b l e areas o f a c t i v i t y . I t would f o l l o w , i f a s o c i a l worker were t o a s s i s t any o f t h e s e p a t i e n t s i n d i s c h a r g e p l a n n i n g , t h e f i r s t s t e p would be t o determine which s p e c i f i c patients are dischargeable. f i c a t i o n c o u l d be accomplished  One o f the ways i n which t h i s  i s through  t h e u s e o f an a n a l y t i c a l  identisurvey  o f the p a t i e n t p o p u l a t i o n made i n terms o f c r i t e r i a u n d e r which t h e s e patients are presently i n hospital.  T h a t i s , a s u r v e y t o determine which  p a t i e n t s have responded t o treatment  t o the e x t e n t t h a t t h e y now have  s u f f i c i e n t mental h e a l t h t o be d i s c h a r g e d .  - 23 The  second s t e p would i n v o l v e a more d e f i n i t i v e assessment o f  t h o s e p a t i e n t s who  are judged r e a d y t o l e a v e h o s p i t a l .  Such an a n a l y s i s  would i n c l u d e a s u r v e y o f some o f the p e r s o n a l r e s o u r c e s p o s s e s s and how the h o s p i t a l . surveyed  these r e s o u r c e s  c o u l d be used t o a s s i s t them t o l e a v e  they c o u l d be met  s u c c e s s f u l adjustment i n the  i f t h e y were t o m a i n t a i n  be  a  community.  f o l l o w i n g o u t l i n e s the r e s u l t s o f a s u r v e y o f the p a t i e n t  p o p u l a t i o n o f the P o r t C o q u i t l a m s e t t i n g was  patients  I n addition-, some o f the p a t i e n t ' s needs would have t o  i n terms o f how  The  these  u n i t o f the Homes f o r the Aged.  This  chosen because i t p r o v i d e s a good c r o s s s e c t i o n o f the p a t i e n t  p o p u l a t i o n o f the t h r e e u n i t s ( n e a r l y one  h a l f o f the t o t a l  population  o f a l l the Homes f o r the Aged i s i n r e s i d e n c e i n t h i s area) and  i s easily  a c c e s s i b l e f o r s t u d y as i t i s o n l y a s h o r t d i s t a n c e from Vancouver. An  Institutional The  Population.  Coquitlam  u n i t o f the Homes f o r t h e Aged i s s i t u a t e d about  t w e n t y - f i v e m i l e s e a s t o f Vancouver and P r o v i n c i a l Mental H o s p i t a l . s i d e and  a r e bordered  The  i s immediately a d j a c e n t  the  b u i l d i n g s b o r d e r the main highway on  by f o r e s t l a n d s and mountains on t h e o t h e r .  s e t t i n g f e a t u r e s w e l l - k e p t grounds ( w i t h lawns and roadways, and  to  shrubs) and  g i v e s the e f f e c t o f q u i e t r e s t f u l s p a c i o u s n e s s .  one  The  winding Although  t h e h o s p i t a l seems t o be a c o n s i d e r a b l e d i s t a n c e from the c i t y , i n terms o f p r e s e n t - d a y t r a n s p o r t a t i o n (and an e x c e l l e n t road) one route i n approximately maintained  t h i r t y - f i v e minutes.  g i v i n g v i s i t o r s and  P o r t Coquitlam  schedule  is  o t h e r persons from t h e community ample  o p p o r t u n i t y t o go t o and from the The  A r e g u l a r bus  can t r a v e r s e  hospital.  u n i t , b e i n g l o c a t e d next t o the  Columbia P r o v i n c i a l M e n t a l H o s p i t a l and  British  the Crease C l i n i c , has  the  use  the  - 2U of  t h e e x t e n s i v e f a c i l i t i e s found i n these i n s t i t u t i o n s .  Considerable use  i s made o f these s e r v i c e s i n b o t h d i a g n o s t i c and t r e a t m e n t p l a n n i n g . F o r example, p a t i e n t s a r e n o t admitted d i r e c t l y t o t h e P o r t C o q u i t l a m u n i t , as i s t h e case i n the Vernon and T e r r a c e i n s t i t u t i o n s , b u t a r e a d m i t t e d a s w  guests  w  o f the P r o v i n c i a l Mental H o s p i t a l while they a r e given a f u l l  d i a g n o s t i c work-up.  S i m i l a r l y , i f i n t e n s i v e p s y c h i a t r i c somata t h e r a p y  (such as e l e c t r o - c o n v u l s i v e therapy) o r major s u r g e r y i s r e q u i r e d , a p a t i e n t c a n be t r a n s f e r r e d t o t h e mental h o s p i t a l as a g u e s t . In  a d d i t i o n t o u s i n g d i a g n o s t i c and t r e a t m e n t f a c i l i t i e s i n -  v o l v i n g p a t i e n t t r a n s f e r s , p a t i e n t s themselves c a n use t h e numerous r e c r e a t i o n a l f a c i l i t i e s found a t t h e h o s p i t a l .  Those p a t i e n t s e n j o y i n g  "Grounds P r i v i l e d g e s " , t h a t i s freedom t o go o u t onto t h e grounds d u r i n g s p e c i f i e d hours o f t h e day ( o v e r o n e - h a l f o f those i n r e s i d e n c e a t P o r t Coquitlam) may go b o w l i n g , swimming, p l a y g o l f o r a t t e n d movies and o t h e r a c t i v i t i e s as they are scheduled. Still  a n o t h e r advantage t h i s u n i t e n j o y s i s t h e u s e o f any  a v a i l a b l e a u x i l i a r y s e r v i c e s from the h o s p i t a l o r c l i n i c , w i t h i n the Homes f o r t h e Aged.  As w i l l  be n o t e d from t h e b r i e f d e s c r i p t i o n below,  many o f the treatment p e r s o n n e l , n o t p r o v i d e d f o r i n t h e s t a f f e s t a b l i s h m e n t of  t h e u n i t , a r e "borrowed" from these o t h e r s e r v i c e s t o be u s e d i n the  G e r i a t r i c u n i t on a p a r t - t i m e b a s i s . As p r e v i o u s l y o u t l i n e d  (Chapter I ) t h e b a s i c a i m o f t h e t r e a t m e n t  programme i s t o m a i n t a i n i n each p a t i e n t h i s o p t i m a l l e v e l o f p h y s i c a l m o b i l i t y and p s y c h i a t r i c h e a l t h .  B a s i c a l l y , the Port Coquitlam u n i t , along  with other u n i t s , provides a high l e v e l o f c u s t o d i a l care along with proper m e d i c a l and p s y c h i a t r i c t r e a t m e n t .  R e g a r d i n g m e d i c a l s t a f f , the m e d i c a l  s u p e r i n t e n d e n t and one p h y s i c i a n work f u l l - t i m e i n m e e t i n g  t h e m e d i c a l and  - 25 p s y c h i a t r i c needs o f the p a t i e n t s . seventy-five  I n a d d i t i o n , there a r e approximately  nurses and " a i d e s " employed i n t h i s h o s p i t a l .  R e g a r d i n g a u x i l i a r y s e r v i c e s , t h e r e has o f r e c e n t y e a r s been some p r o v i s i o n made f o r t h e e s t a b l i s h m e n t o f s e v e r a l departments which a r e ex-  (1) e l u s i v e t o the l a r g e r Home f o r t h e Aged u n i t a t P o r t C o q u i t l a m . a f u l l time O c c u p a t i o n a l T h e r a p i s t  There i s  on s t a f f and t h i s worker has a n a c t i v e  t r e a t m e n t programme i n f o r c e a t t h e p r e s e n t and many p a t i e n t s a r e engaged i n hobbies o r h a n d i c r a f t s .  One r e c r e a t i o n a l t h e r a p i s t , on l o a n f r o m t h e  P r o v i n c i a l M e n t a l H o s p i t a l , spends t h e major p a r t o f h i s working day a t t h e Homes f o r the Aged o r g a n i z i n g v a r i o u s  s o c i a l a c t i v i t i e s such as p a r t i e s ,  c a r d games, e t c . and has a marked impact o n the spare time a c t i v i t y o f t h e older patient i n this unit.  The s e r v i c e s o f a p h y s i o - t h e r a p i s t  on l o a n from t h e P r o v i n c i a l M e n t a l H o s p i t a l and c o n s i d e r a b l e  are a l s o  activity i s  b e i n g m a i n t a i n e d i n t h e form o f e x e r c i s i n g and t r a i n i n g v a r i o u s  patients  t o improve t h e i r p h y s i c a l m o b i l i t y and c o n s e q u e n t l y t h e i r m e n t a l o u t l o o k . A psychologist  i s a l s o a v a i l a b l e i f r e q u i r e d t o conduct group t h e r a p y  programmes o r p r o v i d e d i a g n o s t i c  evaluations.  T h e r e i s no e s t a b l i s h m e n t a t the p r e s e n t time f o r a s o c i a l worker. I n c a s e s o f emergency, however, t h e M e d i c a l S u p e r i n t e n d e n t has r e q u e s t e d and  employed t h e s e r v i c e s o f the s t a f f o f the S o c i a l S e r v i c e Department o f  the E s t Lawn B u i l d i n g , one o f the u n i t s o f the P r o v i n c i a l M e n t a l H o s p i t a l . a  However, t h e s e s e r v i c e s a r e n o t f r e q u e n t l y u s e d because o f the demands on t h e s e workers i n t h e i r own u n i t .  (1) B r i t i s h Columbia, A n n u a l R e p o r t o f the M e n t a l H e a l t h Queen's P r i n t e r , V i c t o r i a , 1952 - 1958.  Services,  - 26 -  The Port Coquitlam u n i t , because of i t s close proximity to various areas i n the Lower Mainland area, maintains very e f f e c t i v e t i e s with the (1) community through the use of a Volunteer Programme* of Volunteers  Twice weekly, groups  come to the u n i t , v i s i t i n g i n d i v i d u a l patients who  have no  contact with outside community, conducting sing-songs with patient groups and a s s i s t i n g i n ward s o c i a l s .  One  example of t h i s a c t i v i t y i s to be found  i n the presentation of a Christmas g i f t to each patient, thus contributing to the patient's f e e l i n g s that he i s s t i l l a part of the l a r g e r , outside community.  P e r i o d i c a l l y , bus-loads of patients from the Homes f o r the Aged,  when weather permits, w i l l go on outings and p i c n i c t r i p s to Stanley Park i n Vancouver or on mystery bus t r i p s , a l l of which provides f o r the patient's enjoyment and well being.  Regular ward programmes, as well as s p e c i a l  parties on such holidays as Easter, Valentine's Day,  etc.  In a d d i t i o n the  Audio V i s u a l Department at Essondale presents regular weekly movies. Television sets are also i n evidence on each ward and contribute a great d e a l to the patient's enjoyment of t h e i r l e i s u r e time. Religious services are held weekly on each ward throughout the year, i n addition to the regular Sunday services i n the Chapel.  Both Protestant  and Catholic services are conducted by the regular Chaplain f o r the P r o v i n c i a l Mental H o s p i t a l and pastors of other denominations i n the d i s t r i c t .  A very  welcome a d d i t i o n a l s ervice f o r patients i s that of a beautician assigned the i n s t i t u t i o n .  She i s s t e a d i l y occupied throughout the year doing  s t y l i n g , etc., f o r the female patients.  to  hair  Other services  ( l ) Mr. Robert M. Ross has made an analysis of the use of Volunteers i n the B r i t i s h Columbia Mental Health Services i n h i s A Volunteer Programme f o r the Patients of a Mental H o s p i t a l , 1958. MASTER OF~SOCIAL WORK THESIS, U n i v e r s i t y of B r i t i s h Columbia, 1958.  - 27 s u c h as b a r b e r i n g  and  -  c h i r o p o d y , are a l s o p r o v i d e d  P r o v i n c i a l Mental H o s p i t a l , devoting  by  those employed by  the  p a r t o f t h e i r time t o the Homes f o r  t h e Aged. The Of t h e s e ,  P o r t C o q u i t l a m u n i t i s composed o f a t o t a l o f e i g h t b u i l d i n g s .  seven b u i l d i n g s are u s e d t o house and  c o o k i n g , e t c ) and  one  headquarters s t a f f .  service patients ( i . e .  b u i l d i n g i s u s e d as an a d m i n i s t r a t i v e u n i t , h o u s i n g F i v e o f these b u i l d i n g s were c o n v e r t e d from the  Boys' I n d u s t r i a l S c h o o l which o c c u p i e d e s p e c i a l l y s t r u c t u r e d f o r the  t h i s s i t e , and  geriatric patient.  The  former  t h r e e b u i l d i n g s were older buildings  are  n o t too s u i t a b l e f o r the h o s p i t a l i z a t i o n o f aged p e o p l e because o f the narrow s t a i r w e l l s , narrow c o r r i d o r s and  s m a l l rooms.  The  newer u n i t s ,  however, were s u i t a b l y s t r u c t u r e d w i t h no s t a i r s ( r e p l a c e d by g e n t l e hand r a i l s i n the c o r r i d o r s and and  f l o o r lighting...  steep,  ramps),  i n the wards f o r semi-ambulatory p a t i e n t s ,  I t would seem r a t h e r i r o n i c a l t h a t the most  hopeful  o r a c t i v e cases are t h e r e f o r e housed i n the o l d e r b u i l d i n g s because t h e y a r e a b l e t o a d j u s t t o the shortcomings i n the c o n s t r u c t i o n o f these b u i l d i n g s , whereas, the p a t i e n t s w i t h the poor p r o g n o s i s o r more extreme h a n d i c a p s a r e housed i n b r i g h t , new,  modern b u i l d i n g s .  mentioned t h a t a l l f a c i l i t i e s r e v e a l c o n s i d e r a b l e  I t should  c o n c e r n and  t h e p a r t o f a l l s t a f f i n o r d e r t o m a i n t a i n a c h e e r f u l and and  also  be  activity  on  b r i g h t atmosphere  t o c a t e r t o the needs o f the p a t i e n t p o p u l a t i o n as much as p o s s i b l e .  The  f o l l o w i n g i s a breakdown o f t h e s e wards i n terms o f the t y p e o f p a t i e n t t h e y house: 1  Male I n f i r m a r y Ward  2  Male w»rds Ambulant ( P a r t PMH  1  Female I n f i r m a r y Ward  2  Female Ambulatory P a t i e n t s  Workers)  - 28 2  Female Ambulatory - Older Buildings  1  Female Special  1  Female Semi-Infirm  The patient population a t t h i s time i s 4 8 4 , made up o f 142 men and 342 women.  This imbalance i n sexes i s due i n part t o the f a c t that  Vernon u n i t has a population o f 300 men only so that some o f the men are transferred to that u n i t when the Coquitlam u n i t becomes over-crowded. Of the patient group, 80 to 85 per cent have been diagnosed as showing s e n i l e b r a i n changes with a major p o r t i o n due to cerebral a r t e r i o s c l e r o s i s . Approximately 135 patients are considered non-ambulatory and as such occupy two wards. Unfortunately, l i t t l e information i s available about the s o c i a l , marital and c u l t u r a l backgrounds o f the resident population of the Homes f o r the Aged.  However, an analysis o f new admissions during the past f i v e  years reveals some s i g n i f i c a n t data.  A very high proportion (about 85$)  of the patient group i s e i t h e r Canadian or B r i t i s h born.  A s i m i l a r per-  centage are o f the Protestant f a i t h , attending e i t h e r Anglican, Baptist or United Churches.  The majority o f the patients are either s i n g l e or  widowed and are i n the 70 - 79 year o l d age group.  As mentioned previously  over 85$ of the population have been diagnosed as e i t h e r chronic b r a i n syndromes, senile psychosis o r psychosis with cerebral a r t e r i o s c l e r o s i s . Of the 484 patients i n residence, approximately 245 are s u f f i c i e n t l y well enough to enjoy grounds p r i v i l e g e s . In s e l e c t i n g a suitable representative group o f patients f o r study o f t h e i r p o t e n t i a l s o c i a l need, resources and discharge planning, i t was e s s e n t i a l t o keep several c r i t e r i a i n mind:  These are l i s t e d as follows:  (1) P s y c h i a t r i c Q u a l i f i c a t i o n s : Since a patient i s admitted and treated i n the Homes f o r the Aged f o r h i s or her p s y c h i a t r i c i l l n e s s , the  - 29 f i r s t c r i t e r i o n i n terms o f d i s c h a r g e p l a n n i n g would have t o be t h a t m e n t a l h e a l t h had  improved  r e a d y f o r d i s c h a r g e and  their  t o t h e e x t e n t t h a t t h e y c o u l d be c o n s i d e r e d  t h a t t h e y would m a i n t a i n a s u f f i c i e n t l y h i g h l e v e l  o f mental h e a l t h once t h e y were o u t i n community. (2)  N u r s i n g and M e d i c a l Q u a l i f i c a t i o n s :  Many p a t i e n t s , because  o f the f r a i l t i e s o f o l d age and p h y s i c a l i l l n e s s e s accompanying t h e i r p s y c h i a t r i c problems,  r e q u i r e c o n s t a n t n u r s i n g and m e d i c a l c a r e .  As  p r e v i o u s l y o u t l i n e s , many o f the p a t i e n t s i n the Homes f o r the Aged a r e sufficiently i l l  p h y s i c a l l y t o r e q u i r e c o n s t a n t bed c a r e .  Since discharge  t o community o f the p a t i e n t r e q u i r i n g c o n s t a n t n u r s i n g o r m e d i c a l c a r e would i n v o l v e f i n d i n g a s i t u a t i o n s i m i l a r t o t h a t o f Homes f o r the Aged such as a p r i v a t e h o s p i t a l o r g e n e r a l h o s p i t a l s e t t i n g , i t was  f e l t t h a t t h e y would  be excluded from the group s t u d y , i n t h a t the type o f c a r t h e y c o u l d r e c e i v e i n community would n o t d i f f e r markedly from t h a t which were a l r e a d y r e c e i v i n g . I t was  d e c i d e d t h a t o n l y p a t i e n t s who  were p h y s i c a l l y r o b u s t enough t o be  m a i n t a i n e d i n a normal community ( w i t h some s u p p o r t s such as a  moderately  s h e l t e r e d h o u s i n g o r r e s t r i c t e d r e c r e a t i o n a l r e s o u r c e s ) would be c o n s i d e r e d f o r the study. (3)  Representativeness:  Any group s e l e c t e d f o r t h i s s t u d y would  n e c e s s a r i l y have t o be s u f f i c i e n t l y r e p r e s e n t a t i v e o f the t o t a l p a t i e n t population.  T h i s c o u l d be r e q a r d e d i n terms o f s o c i a l c r i t e r i a such  n a t i o n a l i t y , r a c i a l o r i g i n , r e l i g i o n , sex, e t c . the " t o p group * 1  Thus, r a t h e r than  as  selecting  i n terms o f m e d i c a l , n u r s i n g and p s y c h i a t r i c c r i t e r i a f o r  s t u d y , a random sampling a more r e p r e s e n t a t i v e group would be gathered t h e r e f o r e would p r e s e n t s o c i a l problems more common t o the e n t i r e population  and  hospital  - 30 -  S e l e c t i o n and Assessment P r o c e s s . F o u r b a s i c s t e p s were t a k e n i n s e l e c t i n g the group and i n a s s e s s i n g t h e i r s o c i a l p o t e n t i a l f o r r e h a b i l i t a t i o n t o community:  These a r e  b r i e f l y o u t l i n e s below. (1) was  S c r e e n i n g f o r M e d i c a l and N u r s i n g C r i t e r i a :  This f i r s t  step  taken t o a s c e r t a i n t h a t group o f p a t i e n t s w i t h i n the i n s t i t u t i o n which  p r e s e n t e d the l e a s t problem i n terms o f the need f o r n u r s i n g and care.  Approximately  a memorandum was  s i x weeks b e f o r e the sample group was  medical  f i n a l l y obtained,  s e n t t o the Charge Nurses o f each ward by the M e d i c a l  S u p e r i n t e n d e n t r e q u e s t i n g the names o f p a t i e n t s who  fulfilled  c r i t e r i a w i t h r e s p e c t t o g e n e r a l c a r e and management.  the f o l l o w i n g  (They were asked  d i v i d e the p a t i e n t s i n terms o f group A t o i n c l u d e p a t i e n t s who the c r i t e r i a c o m p l e t e l y and group B t o i n c l u d e those p a t i e n t s who l i n e o r showed c h a r a c t e r i s t i c s which might make c a r e o u t s i d e the  to  fulfilled were b o r d e r institution  difficult.) Physical Factors: 1*  Ambulatory w i t h o u t a s s i s t a n c e .  2.  Regular D i e t .  3»  Able t o d r e s s and g i v e adequate c a r e t o p e r s o n a l appearance w i t h minimal a s s i s t a n c e .  A.  No  I.V.  o r I.M.  medication required.  M e n t a l and. B e h a v i o u r a l F a c t o r s : 1.  C o - o p e r a t i v e and amenable t o d i r e c t i o n and s u p e r v i s i o n .  2.  B e h a v i o r n o t i n f l u e n c e d by d e l u s i o n a l i d e a s , h a l l u c i n a t i o n s , e t c .  3*  M i n i m a l t o moderate c o n f u s i o n , d i s o r i e n t a t i o n , memory l o s s .  A.  M i n i m a l tendency  t o wander.  - 31 The  l i s t s were s u b s e q u e n t l y r e t u r n e d  t o the Medical  and  i n d i c a t e d t h a t throughout t h e i n s t i t u t i o n a t o t a l o f 39 p a t i e n t s  f i l l e d the c r i t e r i a o f Group A c o m p l e t e l y and 158  Superintendent's  office ful-  p a t i e n t s were l i s t e d u n d e r  Group B. A l t h o u g h t h e r e was no a c t u a l m e d i c a l assessment made a t t h i s as w i l l be noted, m e d i c a l f a c t o r s a r e i m p l i c i t w i t h i n t h e q u e s t i o n s the n u r s i n g  s t a f f i n terms o f each p a t i e n t ' s need f o r m e d i c a l c a r e  the nurses when o r d e r e d t o do so b y t h e p a t i e n t ' s d o c t o r . group was o b t a i n e d ,  time,  given t o g i v e n by  When t h e sample  a check was made w i t h each p a t i e n t ' s p h y s i c i a n a s t o  t h e v a l i d i t y o f t h e n u r s e s ' assessment r e g a r d i n g  the d i s c h a r g a b i l i t y o f  each p a t i e n t and i t i s t o be n o t e d t h a t there was no v a r i a t i o n r e g a r d i n g t h e patients*  need f o r m e d i c a l c a r e j i . e . , the n u r s i n g c r i t e r i a as a p p l i e d t o  each p a t i e n t was s u f f i c i e n t l y v a l i d i n terms o f m e d i c a l c r i t e r i a f o r t h e purpose o f t h i s study so t h a t the d o c t o r was o n l y r e q u i r e d t o check on t h e nursing  assessment. (2)  P s y c h i a t r i c Screening:  The group o f 197  p a t i e n t s which were  s c r e e n e d b y t h e n u r s e s were t h e n a s s e s s e d b y t h e p s y c h i a t r i s t s who were a c t i v e in  these p a r t i c u l a r cases.  T h i s assessment i n c l u d e d n o t o n l y a d i a g n o s i s o f  the p a t i e n t ' s m e n t a l and p h y s i c a l h e a l t h , b u t a l s o such c o n d i t i o n s a s t h e p a t i e n t ' s emotional r e a c t i o n t o discharge  planning,  a s w e l l as t h e p a t i e n t ' s  need f o r f u r t h e r p s y c h i a t r i c t h e r a p y unique t o t h i s i n s t i t u t i o n i n o r d e r t o p r e s e r v e treatment g a i n s made o r f o r f u r t h e r improved mental h e a l t h w h i c h c o u l d n o t be p r o v i d e d  i n the outside  community.  As a r e s u l t o f t h i s s c r e e n i n g , a t o t a l o f 74 as b e i n g p o t e n t i a l l y amenable t o d i s c h a r g e  planning.  p a t i e n t s were s e l e c t e d These p a t i e n t s were from  b o t h t h e A and B groups i n terms o f m e d i c a l c r i t e r i a , as i t was t h e d o c t o r ' s o p i n i o n t h a t some o f t h e p a t i e n t s i n group B who had s p e c i a l needs c o u l d have t h e s e needs met i n community  - 32 -  (3)  S e l e c t i n g the Sample Group:  chosen from t h i s group o f s e v e n t y - f o u r  T w e n t y - f i v e p a t i e n t s were  t h r o u g h the p r o c e s s o f t a k i n g e v e r y  (1) t h i r d p a t i e n t from the l i s t a s which was i n i t s e l f i n random form.  After  t h i s s e l e c t i o n was made a p r e l i m i n a r y assessment o f each p a t i e n t was (2) c a r r i e d o u t by examining t h e p a t i e n t ' s c l i n i c a l and correspondence i n order to obtain i d e n t i f y i n g s o c i a l information  files  as w e l l as t o a s s e s s some  o f the a r e a s (such a s t h e p a t i e n t ' s f i n a n c i a l s i t u a t i o n , i n f o r m a t i o n o u t s i d e community s o u r c e s ,  from  correspondence from p a t i e n t ' s r e l a t i v e s , e t c . )  w h i c h was n o t a v a i l a b l e t o t h e c l i n i c a l team i n c o n t a c t w i t h t h e p a t i e n t . (A)  C l i n i c a l Team D i s c u s s i o n :  Each p a t i e n t was d i s c u s s e d  the Charge Nurse on h i s o r h e r ward, a s w e l l a s w i t h the p a t i e n t ' s a f t e r t h e f i l e s were s t u d i e s . formal  interviews  I n a d d i t i o n t o these contacts,  with  doctor  some i n -  were h e l d by the s o c i a l worker w i t h s e v e r a l p a t i e n t s  who were on the ward a t t h e time these meetings were t a k i n g A l t h o u g h these i n t e r v i e w s  place.  were n o t s t r u c t u r e d t h e y were h e l p f u l  i n g i v i n g worker some i d e a o f the t y p e o f p e r s o n b e i n g a s s e s s e d i n terms o f the p a t i e n t ' s a b i l i t y t o r e l a t e . formation motiv/ation  was o b t a i n e d for  O c c a s i o n a l l y , some c o n f i r m i n g  in-  from the study, such as t h e p a t i e n t ' s l e v e l o f  discharge.  (1) A s h o r t time a f t e r t h e group was s e l e c t e d one o f t h e p a t i e n t s s u f f e r e d a severe s t r o k e w i t h t h e r e s u l t t h a t she was c o n f i n e d t o bed. T h i s p a t i e n t was t a k e n o f f the l i s t , so t h a t t w e n t y - f o u r remained. (2) The c o n t e n t s o f the c l i n i c a l f i l e i n c l u d e d t h e a d m i s s i o n p a p e r s , m e d i c a l c h a r t s and t h e notes made by the p a t i e n t ' s d o c t o r . These d o c t o r s ' n o t e s summarize the r e s u l t s o f p e r i o d i c e x a m i n a t i o n s and a r e r e c o r d e d from the time o f t h e p a t i e n t ' s a d m i s s i o n t o h o s p i t a l . The c o r respondence f i l e r e c o r d s a l l incoming and o u t g o i n g correspondence r e g a r d i n g the p a t i e n t .  - 34 -  One  o f the f i r s t problems c o n f r o n t i n g the c l i n i c a l team was  o r not t h e r e was  whether  s u f f i c i e n t i n f o r m a t i o n about each p a t i e n t i n the group so  t h a t he c o u l d be a d e q u a t e l y  assessed.  T h a t i s , i n terms o f the f o c u s  t h i s study, c o u l d the c l i n i c a l team e v a l u a t e what i t proposed t o  of  evaluate  w i t h any degree o f a s s u r a n c e t h a t the r e s u l t s would n o t be i n c o n c l u s i v e because o f gaps i n the i n f o r m a t i o n a v a i l a b l e . each p a t i e n t was  therefore assessed  A l l a v a i l a b l e data  i n terms o f i t s s o u r c e ,  about  ( f o r example,  from t h e s o c i a l worker, o r the p a t i e n t h i m s e l f ) , and the amount a v a i l a b l e ( t h a t i s was  t h e r e i n f o r m a t i o n from s o c i a l a g e n c i e s  o r r e l a t i v e s i n the  community about t h e p a t i e n t , o r were the doctor's n o t e s and p a p e r s the o n l y s o u r c e s ) .  the  admission  - 35  TABLE  2.  The amount o f information a v a i l a b l e on a group o f twenty-four patients at the Homes f o r the Aged, Port Coquitlam, 1958.  Description  Number  1.  Recorded information based upon observations of a professional s o c i a l worker ( l ) or doctor during the patient's previous adjustment i n the community i n addition to the information a v a i l a b l e on the regular admission forms. This data i s supplemented by the p s y c h i a t r i c or nursing recording while the patient i s i n h o s p i t a l r e garding h i s needs and resources which i s judged by the therapeautic t e a i r t o be v a l i d .  7  2.  In a d d i t i o n t o the admission forms, information written i n by r e l a t i v e s or f r i e n d s or given t o and recorded by p r o f e s s i o n a l h o s p i t a l personnel or an assessment of needs and resources as given by patient and f e l t by the therapeutic team to be p a r t i a l l y v a l i d .  3.  Recalled information by professional h o s p i t a l personnel or written a nd v e r b a l information regarded as only p a r t i a l l y v a l i d as submitted by friends and r e l a t i v e s i n addition to that found on the admission forms.  2  A.  Incomplete information as found only on admisforms, voluntary l e t t e r s from f r i e n d s or r e l atives or from the patient with a permanent psychiatric residual.  1  1A  (1) The term "professional s o c i a l worker" implies any s o c i a l worker hired by a bona-fide public or private agency. (2) Those on the therapeutic team include the p s y c h i a t r i s t o r patient's doctor the nurse i n charge o f the patient's ward and/or other nurses f a m i l i a r with the patient's case and the s o c i a l worker.  - 36 -  The  r e s u l t s o f t h i s assessment i n d i c a t e d t h a t f o r t h e most p a r t  (twenty-one o f t w e n t y - f o u r p a t i e n t s ) t h e c l i n i c a l team c o n s i d e r e d t h e i n f o r m a t i o n r e l i a b l e and s u f f i c i e n t f o r t h e i r p u r p o s e s . Who a r e t h e P a t i e n t s ? From the i n f o r m a t i o n a v a i l a b l e on t h e p a t i e n t p o p u l a t i o n o n t h e whole, i t was c o n s i d e r e d  t h a t t h e group s e l e c t e d f o r study was f a i r l y  r e p r e s e n t a t i v e i n terms o f t h e i r s o c i a l background.  Information about the  r e s i d e n t p o p u l a t i o n i n these i n s t i t u t i o n s i s , u n f o r t u n a t e l y , n o t a v a i l a b l e to  any g r e a t e x t e n t  so t h a t i n many a r e a s  the w r i t e r had t o r e l y on t h e  o b s e r v a t i o n s made by the M e d i c a l S u p e r i n t e n d e n t  and o t h e r s working  with  t h e s e p a t i e n t s as t o whether o r n o t t h e group s e l e c t e d was r e p r e s e n t a t i v e . O f t h e t w e n t y - f o u r p a t i e n t s s t u d i e d , t e n o f them were men and f o u r t e e n , women*  The group was p r e d o m i n a n t l y o f C a n a d i a n o r B r i t i s h e x t r a c t i o n .  Ten o f t h e group were b o r n i n Canada (seven o f B r i t i s h p a r e n t s ) b o r n i n England, f o u r i n S c o t l a n d and f o u r i n ether c o u n t r i e s . for  s i x were Figures  t h e p o p u l a t i o n a s a whole would i n d i c a t e t h a t t h e group s e l e c t e d i s  n o t t o o r e p r e s e n t a t i v e i n terms o f sex i n t h a t t h e male p o p u l a t i o n approximately  o n e - f i f t h o f t h e t o t a l number i n r e s i d e n c e .  represents  I t s h o u l d be  p o i n t e d o u t , however, t h a t t h i s f i g u r e would be somewhat more r e p r e s e n t a t i v e o f the p o p u l a t i o n o f the Homes f o r the Aged, a s a whole, s i n c e t h e V e r n o n u n i t houses o n l y men. concerning  Unfortunately,  figures regarding c u l t u r a l  patient population are not a v a i l a b l e .  Superintendent's  opinion t h a t approximately  origin  However, i t i s t h e M e d i c a l  e i g h t - f i v e percent o f the t o t a l  p a t i e n t p o p u l a t i o n a r e o f B r i t i s h o r i g i n which i s r e f l e c t e d i n t h e group selected f o r  study.  - 37 As might be expected from a group o f t h i s age, ten of the group were widows o r widowers and only f i v e o f the twenty-four were married. Two of the remaining nine patients had been separated or divorced from t h e i r spouse and the remaining seven were s i n g l e .  Thus, f o r one reason  or another, nineteen o f our group of twenty-four patients had no m a r i t a l partner which, a t the age o f 70 or over contributes heavily t o f u r t h e r personal i s o l a t i o n .  In keeping with p o l i c y that the Port Coquitlam u n i t  services people of the Lower Mainland area, ALT, the patients i n our sample group had resided i n the Vancouver Island or Lower Mainland area p r i o r to t h e i r admission to the Homes f o r the Aged. The patients ranged i n age between 70 and 88 years and were f a i r l y evently d i s t r i b u t e d within these years. approximately 77 years.  The average age was  Although the majority o f the group (nine o f the  twenty-four) were between the ages o f 78 and 82 years, there was a considerable " s c a t t e r " i n aged.  For example, three of the patients were  between 70 and 74 years of age and ranged between 84 and 88 years. S i m i l a r information about the t o t a l population of the i n s t i t u t i o n i s not a v a i l a b l e , as the figures about age are t r a d i t i o n a l l y grouped i n t o ten year periods ( i . e .  70-80, 80-90) rather than the two year i n t e r v a l s  which have been used f o r c l a r i t y i n discussing the sample group.  There  was considerable v a r i a t i o n regarding the length of time (from 6 months 24 years) that members of the group had spent i n the Hbmes f o r the Aged.  - 38 -  TABLE  3.  The l e n g t h o f s t a y o f a group o f 2A p a t i e n t s a t t h e Homes f o r t h e Aged* P o r t C o q u i t l a m * 1958.  Length o f Stay  1  year  Male  Female  2  2  Total  1-2  years  2  A  6  2-5  years  2  3  5  2  2  A  2  3  5  5-10  10 /  TOTAL  years  years  10  U  2A  A l t h o u g h t h e average l e n g t h o f s t a y was about 5§- y e a r s , f i g u r e i s somewhat m i s l e a d i n g as t h e group i n d i c a t e d a f a i r l y even  this spread  throughout a l l t h e e n t i r e p o p u l a t i o n r e g a r d i n g l e n g t h o f s t a y a r e n o t a v a i l a b l e , b u t i t i s assumed t h r o u g h t h e e x p e r i e n c e  and o b s e r v a t i o n s o f  the c l i n i c a l team t h a t the sample group i s f a i r l y r e p r e s e n t a t i v e . I t i s a l s o i n t e r e s t i n g t o note t h a t o u t o f t h e t w e n t y - f o u r men and women i n our group* o n l y two i n d i c a t e d a h i s t o r y o f p r e v i o u s p s y c h i a t r i c hospitalization.  - 39 The  o t h e r twenty-two, a c c o r d i n g t o the i n f o r m a t i o n a v a i l a b l e , had n o t been  h o s p i t a l i z e d f o r p s y c h i a t r i c i l l n e s s p r i o r t o t h e i r admission t o the P r o v i n c i a l M e n t a l H o s p i t a l and subsequent  t r a n s f e r t o the Homes f o r t h e Aged,  o r a d m i s s i o n t o t h e Homes f o r t h e Aged a f t e r assessment  at the P r o v i n c i a l  Mental H o s p i t a l as a "guest". One  would conclude t h a t many o f t h e p a t i e n t s who had been i n  h o s p i t a l f o r over t e n y e a r s had been e i t h e r viewed  as h a v i n g c h r o n i c  p s y c h i a t r i c i l l n e s s e s o r had n o t been c o n s i d e r e d f o r d i s c h a r g e because o f l a c k o f r e s o u r c e s i n the o u t s i d e community. I t i s e x t r e m e l y d i f f i c u l t t o make any m e a n i n g f u l  classification  o f the p s y c h i a t r i c d i s o r d e r s w i t h which p a t i e n t s were d i a g n o s e d .  An  a r b i t r a r y c l a s s i f i c a t i o n ( T a b l e A) does i l l u s t r a t e t h a t a l l t w e n t y - f o u r p a t i e n t s have a n o r g a n i c element  i n t h e i r i l l n e s s e s w h i c h a r e accompanied  f o r t h e most p a r t w i t h some b e h a v i o u r a l o r p s y c h o t i c r e a c t i o n .  -  AO -  TABLE  A.  The diagnosis o f a group of twenty-four patients at the Homes f o r the Aged* Fort Coquitlam, 1958*  Number  Illness 1. Senile Brain Disease (a) With q u a l i f y i n g p h r a s e — Depressive Features (2) Psychosis (3) (b) Without q u a l i f y i n g phrase (7) 2.  12  Cerebral A r t e r i o s c l e r o s i s (a) With q u a l i f y i n g p h r a s e Reactive depression ( l ) Behavioural reaction ( l ) (b) Without q u a l i f y i n g phrase (3)  3.  5  Chronic Brain Syndrome (a) Due to Cerebral A r t e r i o s c l e r o s i s (6) (b) With Senile Brain Disease ( l ) TOTAL i  7  24  Information about the resident population o f the Homes f o r thej Aged regarding i l l n e s s e s i s not a v a i l a b l e .  However* published s t a t i s t i c s r e i  garding f i r s t admissions according t o diagnosis indicate that over 95% of f i r s t admissions to the Port Coquitlam u n i t are diagnosed i n one o f the three (l) ! categories i n the above table. j  (1) B r i t i s h Columbia, Report of the Mental Health Services* Queen's P r i n t e r V i c t o r i a , 1958 P L 119, Table 3.  - 41 -  I n summary, t h e sample group o f t w e n t y - f o u r p a t i e n t s i s , from the i n f o r m a t i o n a v a i l a b l e , f a i r l y r e p r e s e n t a t i v e o f t h e p a t i e n t p o p u l a t i o n as a whole i n the P o r t C o q u i t l a m u n i t o f the Homes f o r t h e Aged. o f t h e "average"  I n terms  a t y p i c a l p a t i e n t w i t h i n the group i s s e v e n t y - s e v e n y e a r s  o f age and has been i n h o s p i t a l between f i v e and s i x y e a r s . B r i t i s h e x t r a c t i o n , a P r o t e s t a n t and s i n g l e .  He i s o f  He s u f f e r s from a n o r g a n i c  i l l n e s s which i s accompanied by changes i n h i s t h i n k i n g and b e h a v i o u r . There a r e many needs w h i c h t h e c l i n i c a l caseworker  has t o c o n s i d e r  when a s s i s t i n g these p a t i e n t s i n t h e i r d i s c h a r g e f r o m a p r o t e c t i v e i n s t i t u t i o n a l s e t t i n g t o t h a t o f t h e o u t s i d e community.  I n one the f u l f i l -  lment o f t h e s e needs i s t h e r e s p o n s i b i l i t y o f t h e i n s t i t u t i o n .  I n the other*  the former p a t i e n t , as a c i t i z e n , must take some i n i t i a t i v e and r e s p o n s i b i l i t y i n f i n d i n g and u s i n g t h e r e s o u r c e s w h i c h t h e community p r o v i d e s .  Patients  l e a v i n g t h e Homes f o r the Aged have h e i g h t e n e d d i f f i c u l t y i n t h i s r e g a r d because  o f the l e n g t h o f time t h e y have s p e n t i n h o s p i t a l and h a n d i c a p s t o  adjustment  added by t h e i r age.  one would e x p e c t , because  During t h i s lengthy period o f h o s p i t a l i z a t i o n  o f the dependency f o s t e r e d upon p a t i e n t s i n a n y  i n s t i t u t i o n a l s e t t i n g , some d i m i n u t i o n o f these p a t i e n t s ' a b i l i t y t o l o o k a f t e r themselves, drastic  i n a d d i t i o n t o t h i s l o s s , one would a l s o e x p e c t a  weakening o f community t i e s , t h a t i s ,  some l o s s i n r e l a t i o n s h i p s  w i t h f r i e n d s and f a m i l y , i n community a f f a i r s and i n community r e s o u r c e s . Coupled w i t h t h e problems a c c r u e d from h o s p i t a l i z a t i o n a r e t h o s e o f s o c i a l and community i s o l a t i o n , p h y s i c a l f r a i l i t y and a tendency psychological r i g i d i t y . ning.  toward  A l l t h e s e must be c o n s i d e r e d i n any d i s c h a r g e p l a n -  - A2 -  CHAPTER I I I  NEEDS AND RESOURCES IN DISCHARGE PLANNING  S i n c e i t would be d i f f i c u l t ,  i f not impossible, t o assess  e v e r y i n d i v i d u a l need w i t h i n t h e group, some common needs w i l l be examined i n terms o f t h e p a t i e n t ' s p o t e n t i a l i n b e i n g f o r d i s c h a r g e t o community. t h a t two broad  considered  The p r e c e d i n g c o n s i d e r a t i o n s suggest  c a t e g o r i e s must be t a k e n i n t o  account.  F i r s t t h e r e a r e t h e needs d i r e c t l y r e l a t e d t o t h e p a t i e n t ' s p e r i o d o f h o s p i t a l i z a t i o n and which must be met some o t h e r way i n community t o p r e s e r v e t h e w e l l - b e i n g o f t h e p a t i e n t . chosen f o r assessment i n c l u d e d * need f o r f u r t h e r treatment  The a r e a s  M e d i c a l needs ( f o r example, t h e  o f p h y s i c a l ailments; f o r special  diets  o r v i t a m i n t h e r a p y ) ; p s y c h i a t r i c casework o r c o u n s e l l i n g needs (pharmacological therapy, psychotherapy  o r s u p p o r t i v e casework a r e some  o f t h e ways o f meeting t h e s e needs t h a t were i n c l u d e d i n t h i s c a t e g o r y ) * The need f o r p e r s o n a l s u p e r v i s i o n , ( t h a t i s t h e need f o r guidance f r i e n d s o r r e l a t i v e s i n c o p i n g w i t h day-to-day problems);  from  and h o u s i n g  needs ( t h e s p e c i a l a s p e c t s o f h o u s i n g accommodation r e q u i r e d f o r t h e o l d e r p e r s on,  such a s a s h e l t e r e d b o a r d i n g home o r a housekeeping  room c l o s e t o community r e c r e a t i o n f a c i l i t i e s ) . The  second group o f needs s e l e c t e d a r e more s p e c i f i c a l l y  r e l a t e d t o t h e p a t i e n t ' s adjustment i n t h e o u t s i d e community and f o r which t h e p a t i e n t u s u a l l y has some r e s o u r c e s t o meet t h e s e needs.  -  Since his  i t i s the caseworker's f u n c t i o n t o a s s i s t the p a t i e n t t o  own  personal  were c o n s i d e r e d i n community.  resources  motivation l a c k s any  w h i c h he  can use t o f a c i l i t a t e h i s adjustment  Those f a c t o r s a s s e s s e d were* p h y s i c a l a b i l i t y ,  the number and  use  s t r e n g t h as much as p o s s i b l e , the f o l l o w i n g f a c t o r s  and m a t e r i a l r e s o u r c e s ,  and  43  s o c i a l , r e c r e a t i o n a l and  i n t e r e s t o f f a m i l y and  f o r discharge. o f these,  the  f r i e n d s and  financial  religious interests, the  patient's  I t i s apparent, however, t h a t i f t h e  community w i l l have t o p r o v i d e  patient  f o r these  lacks  t h e s e f a c t o r s w i l l t h e r e f o r e become needs.  Psychiatric.  Casework and M e d i c a l  Needs  Of p r i m a r y concern t o the s o c i a l worker i n any  institutional  s e t t i n g o f t h i s nature i s the need f o r e x t e n d i n g h o s p i t a l s e r v i c e s a f t e r discharge  or i n p r o v i d i n g s e r v i c e s i n community r e l a t e d t o  p a t i e n t ' s h o s p i t a l i z a t i o n o r h i s need f o r p o s t - d i s c h a r g e  treatment.  O f t e n the s u c c e s s o f the p a t i e n t ' s attempt t o r e - a d j u s t i n the community depends on the e x t e n s i o n  the  outside  o f casework s e r v i c e s o r psycho-  t h e r a p y t o him  from p e o p l e w i t h whom he  trust.  need t o c o n t i n u e w i t h p r e s c r i b e d d i e t s or m e d i c a t i o n  He may  i s f a m i l i a r and  t o m a i n t a i n h i s p h y s i c a l o r mental h e a l t h and encouragement t o do  f e e l s he  r e q u i r e support  and  so.  An attempt was  made by the c l i n i c a l team t o a s s e s s the  p s y c h i a t r i c , casework and m e d i c a l needs i n terms o f t h e i r implications.  can  For example, any p a t i e n t r e q u i r i n g f r e q u e n t  m e d i c a l s u p e r v i s i o n would o f n e c e s s i t y have t o l i v e t o a medical doctor or medical  facilities.  patient's  social and  i n close  constant proximity  -  u  TABLE  5.  The need f o r casework c o u n s e l l i n g and p s y c h o t h e r a p y o f a group o f 24 p a t i e n t s o f the Homes f o r the Aged, F o r t C o Q u i t l a n u 1958.  E x t e n t o f Need  1. F r e q u e n t & I n t e n s i v e .  2.  S u p p o r t i v e & Br?.ef.  Description  P a t i e n t r e q u i r e s weekly o r t w i c e weekly c o n t a c t s *• by a caseworker and/or p s y c h i a t r i s t i n order to i n t e r p r e t o r to support the p a t i e n t i n d e a l i n g w i t h h i s adjustment t o f a m i l y or friends or i n using medical, s o c i a l * recreational or religious resources* M o n t h l y o r b i - m o n t h l y contacts of a b r i e f supportive nature by the p s y c h i a t r i s t o r caseworker t o a s s i s t the p a t i e n t i n c o p i n g w i t h any occasional d i f f i c u l t i e s or t o observe and t r e a t any s i g n s o f permanent m a l adjustment i n i t s b e g i n ning stages.  Number  10  7  3. O c c a s i o n a l & P r e v e n t a t i v e . O c c a s i o n a l s u p p o r t i v e c o n t a c t s 7 o f a r o u t i n e n a t u r e based upon a r e q u e s t by t h e p a t i e n t o r those i n cont a c t w i t h them o r a t t h e convenience o f the c a s e worker w i t h the f o c u s on o b s e r v i n g and t r e a t i n g any b e g i n n i n g s o f maladaptive behaviour.  TOTAL  24  - U5 -  The p s y c h i a t r i c and  c o u n s e l l i n g needs were a s s e s s e d t o g e t h e r ,  so t h a t t h e f o c u s on the need f o r casework s e r v i c e s would remain the p a t i e n t ' s p s y c h i a t r i c c o n d i t i o n . in  That i s , t o m a i n t a i n the g a i n s  treatment which the p a t i e n t made d u r i n g h o s p i t a l i z a t i o n and  him t o use r e s o u r c e s i n community t o keep up h e a l t h . a c t i v i t y around events in  enable  Thus casework  s p e c i f i c a r e a s such as d i s c h a r g e p l a n n i n g o r  the p a t i e n t ' s readjustment  on  unforeseen  i n community were not i n c l u d e d .  " P s y c h i a t r i c s e r v i c e s " i m p l i e d the use o f p s y c h o t h e r a p y  and  the p r e s c r i b i n g o f t r a n q u i l i z e r s and o t h e r drugs r e l a t e d t o m a i n t a i n i n g mental h e a l t h o f t h e p a t i e n t .  E x c l u d e d were t h e more i n t e n s i v e  t h e r a p i e s such as e l e c t r o s h o o k t r e a t m e n t o r s u r g e r y .  somatic  -46-  It  ( T a b l e 5)  i s not s u r p r i s i n g t o note  t h a t t e n o f t h e twenty-  f o u r p a t i e n t s , a c c o r d i n g t o t h e assessment of the c l i n i c a l team, need f r e q u e n t and i n t e n s i v e f o l l o w - u p care on a weekly o r t w i c e weekly basis.  I t i s i n t e r e s t i n g t h a t the m a j o r i t y o f the group do  require counselling of t h i s intensity. c o n t a c t s would seem t o be  Rather  not  b r i e f and o c c a s i o n a l  adequate.  These r e s u l t s , however, do imply t h a t f o l l o w - u p c a r e i s r e q u i r e d by the m a j o r i t y o f t h e p a t i e n t group i n o r d e r t o m a i n t a i n t h e i r p r e s e n t l e v e l o f mental h e a l t h and would i n d i c a t e t h a t i f t h e s e p a t i e n t s were d i s c h a r g e d , some p o s t - d i s c h a r g e treatment would be e s s e n t i a l .  These f a c i l i t i e s  facilities  should i n c l u d e , a c c o r d i n g t o  the r e s u l t s o f t h i s assessment, t h e s e r v i c e s o f a caseworker t o p r o v i d e the support and  encouragement some of these people  As i n the case o f p s y c h i a t r i c treatment  need.  and casework c o u n s e l l i n g  needs most p e o p l e as t h e y grow o l d e r r e q u i r e more f r e q u e n t m e d i c a l examinations  and treatment.  Many are r e s t r i c t e d t o s p e c i a l d i e t s  have t o t a k e d a i l y m e d i c a t i o n .  The  clinical  team a s s e s s e d  needs o f t h i s group o f t w e n t y - f o u r p a t i e n t s i n o r d e r t o wiether o r not t h e s e c o u l d be met  i n the community.  or  the m e d i c a l  determine  - 47 -  TABLE  6.  The e x t e n t o f m e d i c a l needs o f a group o f t w e n t y - f o u r p a t i e n t s i n the Homes f o r the Aged, P o r t C o q u i t l a m ,  1958-  E x t e n t o f Need  Description  1.  Constant S u p e r v i s i o n .  Patient i s required to maintain schedules i n t a k i n g m e d i c i n e s and t o m a i n t a i n r e g u l a r (weekly) or f o r t n i g h t l y ) contact with the medical d o c t o r and/or P u b l i c H e a l t h Nurse.  2.  Regular Supervision.  Patient i s required to maintain regular medical s c h e d u l e s , but r e q u i r e s no more than p e r i o d i c checkups w i t h the m e d i c a l d o c t o r or P u b l i c H e a l t h Nurse.  3.  Occasional Supervision.  R e q u i r e d t o m a i n t a i n no more than normal m e d i c a l schedules (vitamins, etc.,) and o c c a s i o n a l checkups w i t h the f a m i l y d o c t o r o r P u b l i c H e a l t h Nurse.  ,  Number  6  10  8  24  TOTAL , .,.  - A& I t w i l l be noted ( T a b l e 6) t h a t no attempt was made t o a s s e s s the s p e c i f i c needs o f each p a t i e n t .  Rather the extent  o f each p a t i e n t ' s  m e d i c a l needs were examined i n terms o f the demand t h e s e p a t i e n t s  t t  would make f o r m e d i c a l care c l i n i c a l team, e i g h t e e n regular or occasional  i n t h e community.  I n the opinion o f the  o f t h e group o f t w e n t y - f o u r r e q u i r e  only  s u p e r v i s i o n so t h a t t h e m a j o r i t y o f t h e p a t i e n t s  would have l i t t l e d i f f i c u l t y i n o b t a i n i n g s u i t a b l e accommodation  since  the demands t h e y would make f o r care would n o t be t o o a t y p i c a l f o r p e r s o n s now i n t h e community o f a s i m i l a r age group. There was a s i g n i f i c a n t c o r r e l a t i o n between t h e e x t e n t o f need f o r m e d i c a l ,  p s y c h i a t r i c and c o u n s e l l i n g s e r v i c e s and t h e  patient's length o f stay. F o r example, i t was observed t h a t s i x o f t h e t e n p a t i e n t s who had been i n h o s p i t a l f o r l e s s t h a n two y e a r s r e q u i r e d  "frequent"  p s y c h i a t r i c o r casework c o u n s e l l i n g s e r v i c e s whereas o n l y one o u t o f f i v e o f t h e group h a v i n g l i v e d similar services.  i n h o s p i t a l over t e n y e a r s  required  The r e m a i n i n g f o u r p a t i e n t s s t a y i n g over t e n  years required only "supportive  and o c c a s i o n a l s e r v i c e s . "  These f i n d i n g s would i n d i c a t e t h a t t h e s o c i a l worker would have t o h e l p t h e p a t i e n t who has remained f o r a r e l a t i v e l y s h o r t on an i n t e n s i v e b a s i s t o f i n d and use t h e m e d i c a l and o t h e r provided  i n the p a t i e n t ' s  community.  time  services  - 49 -  Housing Needs The p r o v i s i o n o f s u i t a b l e h o u s i n g accommodation f o r o l d e r i s a major problem time.  people  i n most communities i n N o r t h America a t t h e p r e s e n t  As p r e v i o u s l y o u t l i n e d  (Chapter I ) d u r i n g t h e p a s t few decades  o l d e r people have become s e p a r a t e d from t h e p r i m a r y f a m i l y group and t h u s have been f o r c e d t o seek s e p a r a t e h o u s i n g accommodation.  Newer  housing u n i t s c o n s t r u c t e d f o r a s m a l l e r f a m i l y do n o t p r o v i d e f o r o t h e r than immediate f a m i l y members.  Coupled w i t h t h i s l a c k o f space  i n t h e modern home i s t h e d i f f i c u l t y t h a t o l d e r people sometimes have i n l o o k i n g a f t e r themselves w i t h o u t a s s i s t a n c e from o t h e r s so t h a t t h e y o f t e n a r e unable t o p r o v i d e f o r themselves housekeeping  i na suite or light  room and have t o seek a home where t h e y can be  partially  l o o k e d a f t e r by o t h e r s . The c l i n i c a l team a s s e s s e d t h e s e l e c t e d p a t i e n t group of  how t h e s e people c o u l d a d j u s t i n t h e v a r i o u s t y p e s o f h o u s i n g found  i n t h e community a t t h e p r e s e n t time.  E a c h p a t i e n t was e v a l u a t e d b y  t h e c l i n i c a l team i n terms o f h i s o r h e r adjustment is,  i n terms  on t h e ward.  That  t h e p a t i e n t ' s a b i l i t y t o l o o k a f t e r h i s own p e r s o n a l hygiene,  g e t t i n g a l o n g w i t h o t h e r p a t i e n t s and a b i l i t y t o assume some r e s p o n s i b i l i t y for  c l e a n i n g up t h e ward and making beds, t o mention  a few examples. I t  s h o u l d be added t h a t t h e p a t i e n t ' s b e h a v i o r was reviewed o v e r a p e r i o d of  s e v e r a l months i n o r d e r t o o b t a i n some i d e a o f h i s c o n s i s t e n c y .  I t i s r a t h e r s u r p r i s i n g t o note ( T a b l e 7) t h a t t h i r t e e n o f t h e twenty-four p a t i e n t s r e q u i r e d o n l y a "board and room" type of residence i s provided  r a t h e r t h a n t h e more s h e l t e r e d t y p e o f housing w h i c h i n t h e community.  Two o f t h e p a t i e n t s who r e q u i r e d  " s h e l t e r e d b o a r d i n g home c a r e " ,  i n t h e opinion o f the c l i n i c a l  team  would have been b e t t e r s u i t e d t o a n u r s i n g home i n view o f t h e i r severe p h y s i c a l handicaps. require assistance  These two p a t i e n t s , b o t h women, would  i n almost a l l a c t i v i t y such as g e t t i n g up f o r  meals, g o i n g t o t h e bathroom, e t c . a l t h o u g h t h e y d i d not r e q u i r e constant  medical or p s y c h i a t r i c care.  Of t h e t h r e e  remaining  p a t i e n t s r e q u i r i n g t h e " s h e l t e r e d b o a r d i n g home" two needed t h i s t y p e o f h o u s i n g because o f t h e i r i n a b i l i t y t o c l i m b s t a i r s , t h e i r p h y s i c a l and e m o t i o n a l c o n d i t i o n was good.  otherwise  These two p a t i e n t s  would r e q u i r e housing s i m i l a r t o t h a t o f any p e r s o n w i t h a s e v e r e heart condition r e s t r i c t i n g t h e i r p h y s i c a l a c t i v i t y . I t would seem s i g n i f i c a n t t h a t most o f t h e group c o u l d g e t along  i n a "board and room" type o f r e s i d e n c e  i n view o f t h e l e n g t h y  time most o f t h e p a t i e n t s have s p e n t i n t h e h o s p i t a l where f u l l i n s t i t u t i o n a l care  i s provided.  That i s , one would wonder i f a  l o n g p e r i o d o f h o s p i t a l i z a t i o n would n o t r e s u l t i n a dependency on f u l l y i n s t i t u t i o n a l c a r e .  Perhaps t h e answer t o t h i s  question  i s t h a t t h e aim o f t h e h o s p i t a l s t a f f i s t o h e l p t h e p a t i e n t as much ;  - 51 -  p o s s i b l e maintain h i s or her optimal l e v e l o f f u n c t i o n i n g . the methods t h e n u r s i n g  One o f  s t a f f employ ( e s p e c i a l l y when the amount o f  s t a f f a v a i l a b l e t o c a r e f o r t h e s e p a t i e n t s i s c o n s i d e r e d ) i s t h a t o f encouragi n g t h e p a t i e n t t o l o o k a f t e r h i m s e l f as mueh a s he i s a b l e . he i s encouraged t o h e l p i n l o o k i n g a f t e r o t h e r s d u t i e s around t h e ward such as c l e a n i n g ,  In addition,  or i n performing  s e r v i n g food  o r other  other  activities  i • not u n l i k e those r e q u i r e d t o m a i n t a i n a normal household. A l t h o u g h t h e r e s u l t s o f t h i s assessment i m p l y t h a t most p a t i e n t s do n o t appear t o r e q u i r e a s h e l t e r e d type o f housing, a s o c i a l worker would have t o bear i n mind t h a t t h i s s t u d y was conducted i n a s e t t i n g where s h e l t e r e d care, a l t h o u g h n o t n e c e s s a r i l y r e q u i r e c d b y most o f t h e p e o p l e i n t h e group, was however i m p l i e d . remembered t h a t t h e r e  i s a ready o p p o r t u n i t y  A l s o i t must be  f o r each p a t i e n t t o f i n d  support and acceptance through h i s f e l l o w p a t i e n t s and t h e s t a f f i n p e r f o r m i n g any d u t i e s around t h e ward. n e c e s s a r i l y invalidate the conclusions  These c o n s i d e r a t i o n s d o n o t but might i n d i c a t e t h a t s i m i l a r  r e l a t i o n s h i p s may be n e c e s s a r y t o t h e p a t i e n t l i v i n g i n a home where board and room a r e p r o v i d e d ,  and s h o u l d  i n t h e s o c i a l worker's p l a n n i n g as r e p r e s e n t e d  by t h i s group.  be a m a t t e r o f c o n s i d e r a t i o n  i n p r o v i d i n g housing f o r the p a t i e n t s I t would n o t seem t o o s u r p r i s i n g t h a t  o n l y two p a t i e n t s were capable o f r e s i d i n g i n a s u i t e or l i g h t k e e p i n g room i n view o f t h e age and r e s u l t a n t p h y s i c a l o f most o f t h e s e p a t i e n t s .  house-  infirmities  - 52 -  Personal  Supervision Most o l d e r p e o p l e , because o f t h e i r i n c a p a c i t i e s , need some minor  guidance o r h e l p i n c o p i n g w i t h day-to-day problems t h a t younger age groups would have l i t t l e d i f f i c u l t y i n h a n d l i n g . p e r s o n o f t e n needs some a d v i c e o r encouragement  F o r example, a n o l d e r keeping w i t h i n a budget,  i n answering correspondence o r i n m a i n t a i n i n g c o n t a c t s w i t h f r i e n d s o r relatives. A l t h o u g h t h e p a t i e n t s i n t h e groups were a s s e s s e d i n terms o f t h e i r need f o r p r o f e s s i o n a l p s y c h i a t r i c and casework  counselling  s e r v i c e s , t h e c l i n i c a l team was aware o f t h e need o f most o f t h e p a t i e n t group f o r o c c a s i o n a l , i n f o r m a l and i n s t r u c t u r e d g u i d a n c e . T h i s e v a l u a t i o n was o b t a i n e d c h i e f l y from t h e n u r s i n g s t a f f , who have t h e o p p o r t u n i t y t o observe t h e p a t i e n t ' s r e a c t i o n s t o f r u s t r a t i o n s d u r i n g t h e t w e n t y - f o u r hours o f t h e d a y and t h e amount o f h e l p t h e y need from o t h e r p a t i e n t s o r s t a f f .  /  - 53 TABLE  7  An assessment of the type of housing needed by a group of twenty-four patients i n the Homes f o r the Aged, Port Cqqujtlam. 1958.  Type of Home  Pescr^ption  Number  1. Sheltered Boarding Home  Patient requires: private room on ground f l o o r close to f a c i l i t i e s without being required t o climb s t a i r s . Home i s i n close proximity to medical and/or p s y c h i a t r i c resources.  2. BoardjLne Home Care  Patient requires s o c i a l and recr e a t i o n a l f a c i l i t i e s i n the home, but i s capable o f climbing s t a i r s and i n caring f o r personal household needs.  3. Board and Room  Patient i s able t o make f u l l use of household f a c i l i t i e s i n caring f o r personal hygeine. S o c i a l and r e c r e a t i o n a l f a c i l i t i e s are needed within close proximity (within 3 or L blocks).  A. Supervised L i e h t Housekeeping Facilities  Patient i s capable o f maintaining l i g h t housekeeping room with occasional guidance and superv i s i o n . Needs only normal access to s o c i a l and r e c r e a t i o n a l f a c i l ities.  1  5. Suite or L i e h t Housekeeping Room  Patient i s capable o f l i v i n g i n and managing a suite o r l i g h t housekeeping room without superv i s i o n . Needs no more than normal social outlets.  1  TOTAL  5  K  13  24  - 54 -  TABLE 8 The Amount o f P e r s o n a l S u p e r v i s i o n R e q u i r e d by a Group o f 24. P a t i e n t s i n t h e Homes f o r the Aged. P o r t Coquitlam. 1 9 5 8 . .  E x t e n t o f Need  Description  Number  1* F u l l S u p e r v i s i o n  P a t i e n t requires constant s u p e r v i s i o n i n a l l phases of p e r s o n a l care ( i . e . s a n i t a t i o n , meals, e t c . ) and needs support and encouragement i n making use o f r e c r e a t i o n a l and s o c i a l f a c i l i t i e s and i n a l l o t h e r phases o f activity  5  2. L i g h t S u p e r v i s i o n  Patient occasionally r e q u i r e s some guidance i n keeping with the i n c a p a c i t i e s o f o l d age. T h i s would i n c l u d e o c c a s i o n a l support and encouragement i n u s i n g community r e s o u r c e s , I n housekeeping, e t c .  17  3. No S u p e r v i s i o n  P a t i e n t i s able to f u n c t i o n a d e q u a t e l y i n community and a t home w i t h no guidance o r supervision, i s w e l l motivat e d and capable o f u s i n g s o c i a l , r e c r e a t i o n a l and r e l i g i o u s a c t i v i t i e s and i s c o m p l e t e l y independent i n p e r f o r m i n g normal household "functions.  2  TOTAL i.  24  - 55 Most o f t h e twenty-four  -  p a t i e n t s , w h i l e not r e q u i r i n g  s u p e r v i s i o n do r e q u i r e o c c a s i o n a l guidance  (Table 8 ) .  The  constant  social^worker  would t h e r e f o r e be w e l l a d v i s e d t o make c e r t a i n t h a t the p a t i e n t had someone i n the community who  could provide a f a i r l y c o n s i s t e n t contact  f (such as a r e l a t i v e or l a n d l o r d ) r e s p e c t t o a c c e p t h i s guidance Physical  and f o r whom the p a t i e n t had  or c o u n s e l .  Ability One  o f the most v a l u a b l e r e s o u r c e s the o l d e r p e r s o n has  w i t h any age group) i s t h e a b i l i t y t o perform  p h y s i c a l a b i l i t y i s r e q u i r e d t o c a r r y on almost i n the case o f t h e o l d e r person,  Others may  p e r s o n a l hygiene  In some cases,  r e q u i r e s tremendous e x e r t i o n . activities in their  the narrowing  of s o c i a l contacts.  c l i n i c a l team, i n a s s e s s i n g the p a t i e n t group, e v a l u a t e d  each p a t i e n t ' s b e h a v i o r manifested  him  l e i s u r e time which i n c r e a s e s w i t h o l d e r age because o f  the l o s s o f employment and The  and  t h i s r e s o u r c e becomes more v a l u a b l e t o  have the a b i l i t y t o e n j o y strenuous  l e i s u r e time*  Some  any a c t i v i t y ,  as he r e a l i z e s t h a t h i s powers are b e g i n n i n g t o wane. t a k i n g care of one's own  (as  the v a r i e t y o f p h y s i c a l  a c t i v i t i e s e s s e n t i a l i n m a i n t a i n i n g a h e a l t h y adjustment.  i n terms o f the m o b i l i t y and  i n h i s ward b e h a v i o r .  The  stamina  consequently  he  scope o f a c t i v i t i e s p r o v i d e d i n  the h o s p i t a l o f f e r s ample o p p o r t u n i t y f o r the p a t i e n t ' s and  sufficient  involvement  h i s p h y s i c a l a b i l i t y i s e a s i l y measurable.  There i s  work t o be done i n the wards o r on t h e h o s p i t a l grounds r e q u i r i n g v a r i o u s l e v e l s o f s t r e n g t h and stamina (bowling, d a n c i n g ) and  and  informal a c t i v i t i e s  other organized r e c r e a t i o n ( g o l f i n g , f i s h i n g ) are  a l s o a v a i l a b l e t o the p a t i e n t and p r o v i d e a r e a d y index o f h i s a b i l i t i e s .  - 56 -  TABLE  9  The p h y s i c a l a b i l i t y o f a group o f t w e n t y - f o u r i n the Home f o r t h e Aged, F o r t C o q u j t l a m .  patients  ¥?5&  E x t e n t o f Need  1.  Consistently Active  2, M o d e r a t e l y Active  3, R e s t r i c t e d  A.  Partially Handicapped  5. S e v e r e l y Handicapped  Description  Number  Patient i s able t o maintain a normal stream o f p h y s i c a l a c t i v i t y i n keeping with the f r a i l t i e s o f o l d age. Patient i s a b l e t o do l i g h t work (such a s j a n i t o r i a l d u t i e s , watchman, e t c . ) w i t h a minimum o f a b s e n t eeism o r p a r t i c i p a t e moderately i n such a c t i v i t i e s i n g o l f , dancing, etc*  5  Occasionally able t o p a r t i c i p a t e I n such a c t i v i t i e s as l i s t e d 7 above i n c l u d i n g l i g h t work on a casual or part-time basis. Patient i s consistently able, however, t o e n j o y such moderate a c t i v i t y as h i k i n g , f i s h i n g , e t c . , and t o i n v o l v e h i m s e l f i n s p e c * tator sports. Unable t o p a r t i c i p a t e i n any a c t i v i t i e s other than walking or spectator a c t i v i t i e s . Patient i s , however, s u f f i c i e n t l y m o b i l e t o l o o k a f t e r p e r s o n a l needs i n the home and t o m o d e r a t e l y p a r t i c i p a t e i n such p h y s i c a l a c t i v i t i e s as found i n t h e normal household.  7  P a t i e n t i s mobile o n l y t o t h e e x r 3 o f c a r i n g f o r h i s own p e r s o n a l needs i n the home such as g o i n g f o r meals, g o i n g t o the bathroom, e t c . O c c a s i o n a l l y goes o u t on s p e c i a l occasions o r f o r p e r i o d i c v i s i t s with f r i e n d s or r e l a t i v e s , e t c . Patient i s p h y s i c a l l y able only t o p a r t i a l l y l o o k a f t e r h i s own p e r s o n a l needs a t home.  2  - 57 -  Extent  5.  Severely Handicapped  Nnmbp.r  Description  of- Meed  2  May o c c a s i o n a l l y need some a s s i s t a n c e t o come f o r meals, e t c . , l e a v e s home o n l y r a r e l y and when a b s o l u t e l y n e c e s s a r y and i s always accompanied by an e s c o r t .  24  TOTAL  Although there  seems t o be l i t t l e  information  regarding the  l e v e l o f f u n c t i o n o f t h o s e v i n a s i m i l a r age group i n t h e o u t s i d e community, one would s u s p e c t in this  t h a t t h i s p a t i e n t group i s n o t a t y p i c a l  respect. I t i s a l s o i n t e r e s t i n g t o note t h a t there seemed t o be  no c o r r e l a t i o n between t h e p a t i e n t ' s p h y s i c a l a b i l i t y and o t h e r f a c t o r s , s u c h as h i s l e n g t h o f s t a y o r d i a g n o s i s . " s c a t t e r " i s evident  A similar  i n comparing each p a t i e n t ' s p h y d c a l  w i t h h i s or her "medical,  ability  p s y c h i a t r i c and casework c o u n s e l l i n g needs",  a l t h o u g h two p a t i e n t s who a r e p h y s i c a l " s e v e r e l y handicapped" r e q u i r e "constant"  m e d i c a l and p s y c h i a t r i c c a r e . I n terms o f S o c i a l Work p l a n n i n g ,  t h i s p a t i e n t group i n d i c a t e s  a wide range o f p h y s i c a l a b i l i t y s e e m i n g l y u n r e l a t e d resources ficient  t o other  needs and  found i n t h e i r r e s p e c t i v e communities a s t h e y i n d i c a t e s u f -  p h y s i c a l a b i l i t y t o make use o f t h e s e r e s o u r c e s ,  ( i n most c a s e s ) , on a r e s t r i c t e d  basis.  even though,  - 58  -  F i n a n c i a l and M a t e r i a l R e s o u r c e s . Most p e o p l e , as t h e y approach o l d e r age provisions f o r t h i s period i n t h e i r l i v e s .  have made some f i n a n c i a l  Because o f the l o s s o f  to be g a i n f u l l y employed o r because o f f o r c e d r e t i r e m e n t  ability  schemes most  themselves dependent on the f i n a n c i a l and m a t e r i a l r e s o u r c e s  amassed  find during  t h e i r e a r l i e r y e a r s such as income d e r i v e d from i n v e s t m e n t s , o r p e n s i o n s g r a n t e d t h r o u g h former employment.  A s i z e a b l e p o r p o r t i o n o f the o l d e r  group however, have f i n a n c i a l d i f f i c u l t i e s . p r o v i s i o n s f o r o l d age  and  o t h e r s who  Some were u n a b l e t o make  d i d , have found t h e i r s a v i n g s  i n the l a s t decade because o f the d i m i n i s h e d  age  depleted  v a l u e o f the d o l l a r through  inflation. I t i s r e a d i l y apparent t h a t f i n a n c i a l p r o v i s i o n s are e s s e n t i a l i n planning  f o r the d i s c h a r g e  o f any p a t i e n t from h o s p i t a l .  Money i s needed  f o r c l o t h i n g , s h e l t e r and m e d i c a l c a r e , t o mention o n l y the bare n e c e s s i t i e s . I n a d d i t i o n the o l d e r p e r s o n o f t e n r e q u i r e s s p e c i a l f a c i l i t i e s f o r h i s and may  need more money than the average p e r s o n t o m a i n t a i n Because o f the importance o f these r e s o u r c e s ,  m a t e r i a l possessions  himself.  the f i n a n c i a l  o f each p a t i e n t were c a r e f u l l y a s s e s s e d .  I t was  t h a t t h i s e v a l u a t i o n would h e l p the team determine the amount o f  T h i s assessment was  through h o s p i t a l records t o supplement t h i s  and  made on the b a s i s o f i n f o r m a t i o n  i n two  information..  and hoped  financial  a s s i s t a n c e those i n the group would r e q u i r e i f t h e y were d i s c h a r g e d community.  care  to  provided  c a s e s from i n t e r v i e w s w i t h the  patient  A t t h e time a p a t i e n t i s admitted t o h o s p i t a l a statement i s taken by t h e b u s i n e s s o f f i c e a s t o what f i n a n c i a l and m a t e r i a l r e s o u r c e s possesses.  T h i s d e s c r i p t i o n o f the p a t i e n t ' s e s t a t e  the p a t i e n t  i s f i l e d and i f no  r e l a t i v e o r r e s p o n s i b l e p e r s o n e x i s t s i n the community t o a d m i n i s t e r t h e e s t a t e t h e o f f i c e o f t h e O f f i c i a l Committee ( a branch o f t h e A t t o r n e y G e n e r a l ' s Department) assumes r e s p o n s i b i l i t y f o r a d m i n i s t e r i n g  the p a t i e n t ' s  affairs. T h e r e was some q u e s t i o n about whether t h e p a t i e n t ' s and  needs s h o u l d  resources  n o t have been b r o k e n down i n t e r m s o f sums o f money.  I t was f e l t t h a t s u c h a s u r v e y would be e x t r e m e l y d i f f i c u l t t h a t i t would be a l m o s t i m p o s s i b l e  t o make i n  t o a s s e s s the e s t a t e s o f some o f t h e  p a t i e n t s i n terms o f a c t u a l cash v a l u e .  A l s o , i t was hoped t h a t t h e  c l i n i c a l team measure the p a t i e n t ' s r e s o u r c e s own concept o f h i s s o c i a l f u n c t i o n i n g .  i n terms o f t h e p a t i e n t ' s  F o r example, one o f t h e group,  P a t i e n t A, was r e c e i v i n g a n income of $750. monthly a s a p e n s i o n .  Patient  B c o u l d be r e c e i v i n g a $35. a month p e n s i o n supplementary t o the F e d e r a l O l d Age P e n s i o n .  P a t i e n t A would have d i f f i c u l t y i n c o n s i d e r i n g  o f P a t i e n t B a s even p a r t i a l l y s u s t a i n i n g . was made t o e v a l u a t e  the income  I n o t h e r words, some attempt  t h e adequacy of t h e p e r s o n ' s r e s o u r c e s  i n terms o f  h i s own p a r t i c u l a r l e v e l o f s o c i a l f u n c t i o n i n g , r a t h e r t h a n making t h i s assessment e n t i r e l y i n terms o f community s t a n d a r d s .  60 -  TABLE 10. The F i n a n c i a l and M a t e r i a l Resources o f a Group of Twenty-four Patients i n the Homes f o r the Aged, Port Coquitlam. 1958.  Extent of Need  Description  Number  1.  Comfortably Self-Sustaining  Patient has c a p i t a l investment with a steady income and own home or money to buy own home and other material goods which enable him t o l i v e comfortably, Patient has enough resources so that he need not worry about anything other than outstanding expenses such as law s u i t s , e t c .  2  2.  Completely Self-Sustaining  The patient has some property, p o s s i b l y own home, furniture, etc. S u f f i c i e n t c a p i t a l t o buy property as well as a small income or resources i n the form of investment, e t c .  2  3. P a r t i a l l y Sustaining  Patient has l i m i t e d personal property such as furniture, e t c . and some income (excluding Old Age Security). There i s a need, however, f o r some budget c o n t r o l and assistance i n extra expenses ( i . e . medical expenses, glasses, dentures, etc.).  8  4. P a r t i a l l y Dependent  Patient has some personal income of a l i m i t e d nture t o supplement Old Age Security or Old Age Assistance ( i n the case where Old Age Security cannot be granted). Patient has personal property of l i t t l e significance or value and i s dependent on welfare programmes f o r meeting expenses other than the bare necessities.  1  5.  Patient's personal property of an i n s i g n i f i c a n t nature and has no income other than that provided through Government Pension or Welfare.  11  Completely Dependent  TOTAL «sj  24  - 61 I t i s apparent ( T a b l e be c o n s i d e r e d  10)  t h a t few  of the p a t i e n t groups  c o m p l e t e l y f i n a n c i a l l y independent.  The m a j o r i t y  e i t h e r p a r t i a l l y or c o m p l e t e l y dependent on f i n a n c i a l r e s o u r c e s can be p r o v i d e d  t h r o u g h the community.  A  can  are which  comparison o f t h e s e r e s u l t s w i t h  the p a t i e n t ' s l e n g t h o f s t a y i n d i c a t e s t h a t most p a t i e n t s r e m a i n i n g i n h o s p i t a l f o r extended p e r i o d s resources  o f time have c o r r e s p o n d i n g l y  t o employ when t h e y r e t u r n t o t h e community.  s e v e r a l reasons f o r t h i s c o n d i t i o n .  One  There may  r e a s o n c o u l d be  p a t i e n t s w i t h more f i n a n c i a l and m a t e r i a l r e s o u r c e s  less  that  through t h e i r  own  e f f o r t s and t h r o u g h t h e e f f o r t s o f t h e i r r e l a t i v e s and  may  be d i s c h a r g e d  nursing  homes, l e a v i n g t h o s e w i t h no r e s o u r c e s  view o f the e x t r e m e l y low d i s c h a r g e  as the major p a r t  T h i s would seem u n l i k e l y i n rate.  A second r e a s o n f o r t h i s d i m i n u t i o n  o f these r e s o u r c e s  t o charges l e v i e d on the p a t i e n t ' s e s t a t e by the  i n terms o f payment f o r t h e i r care who  q u a l i f y may  t h i s toward the  friends  or t r a n s f e r r e d to other p r i v a t e h o s p i t a l s or  o f t h o s e r e m a i n i n g over t e n y e a r s .  be due  be  (#1.50 d a i l y ) .  r e c e i v e the F e d e r a l Old Age  may  hospital  Although p a t i e n t s  P e n s i o n and  contribute  c o s t o f t h e i r h o s p i t a l i z a t i o n many o f t h e  patients  r e m a i n i n g i n h o s p i t a l f o r a l o n g e r p e r i o d than t e n y e a r s may  have  had  charges l e v i e d on t h e i r e s t a t e p r i o r t o the time t h e s e p e n s i o n s were g r a n t e d .  I n a d d i t i o n , ( p a r t i a l l y because o f the l a c k o f s e r v i c e s  o f a s o c i a l worker i n the Homes f o r t h e Aged) t h e r e have been some delays may  i n r e c e i v i n g the p e n s i o n so t h a t u n f o r t u n a t e l y  have had' t o pay  considerable  f o r the  the  patient  c o s t o f h i s h o s p i t a l i z a t i o n f o r some  time p r i o r t o r e c e i v i n g i t .  'I  62 -  Since  the m a j o r i t y  o f t h i s p a t i e n t group w i l l r e q u i r e  a s s i s t a n c e when t h e y r e t u r n t o the community a g r e a t d e a l o f a worker's time would be r e q u i r e d f i n a n c i a l planning.  social  i n terms o f h e l p i n g the p a t i e n t w i t h  T h i s a c t i v i t y would i n f e r the assessment of each  patient's e l i g i b i l i t y Pensions Act  financial  for f i n a n c i a l assistance  or o t h e r r e s o u r c e s  as p r o v i d e d  under the Old  w i t h i n the  Age  framework  o f s o c i a l l e g i s l a t i o n as w e l l as some m o b i l i z a t i o n o f any e x i s t i n g resources  t h a t c o u l d be p r o v i d e d  any p o s s i b l e f i n a n c i a l h a r d s h i p . person represents  by e i t h e r f a m i l y or f r i e n d s t o ease F i n a n c i a l planning  or a s s i s t a n c e created  the  more expensive h o u s i n g  o c c a s i o n a l need f o r s p e c i a l r e c r e a t i o n a l a c t i v i t i e s  in transportation.  In o t h e r words, i n c a p a c i t i e s  i n gorwing o l d o f t e n times r e s u l t i n the need f o r a  t y p i c a l and more expensive r e s o u r c e m a i n t a i n an o p t i m a l The  older  a g r e a t many d i f f i c u l t i e s e s p e c i a l l y i n terms o f  the need i n some cases f o r s p e c i a l and o r d i e t s and  f o r the  Friends  patient's contacts  i n community r e p r e s e n t  f o r the most  p a r t r e l a t i o n s h i p s made p r i o r t o h i s a d m i s s i o n t o h o s p i t a l and not  o n l y a p a r t o f the  outside  where he wishes t o r e t u r n . many f u n c t i o n s f o r the greater  can  l e v e l o f adjustment.  I n t e r e s t of F a m i l y and The  i n o r d e r t h a t these p e o p l e  are t o  community but a l s o a " b r i d g e " from the h o s p i t a l  F r i e nds  and  relatives,  o f course, p e r f o r m  o l d e r person, f u n c t i o n s which assume an even  significance i n older  him  years.  - 63 "....•Let  i t never be f o r g o t t e n t h a t t h e key t o p h y s i c a l  i n so many o l d p e o p l e l i e s  vigour  i n t h e i r s t a t e o f mind and t h a t n o t h i n g s o  s u r e l y saps t h e p h y s i c a l s t r e n g t h o f o l d p e o p l e than a complete l o s s o f i n t e r e s t i n l i f e . . . I t behooves us t o pay r e g a r d  t o those f a c t o r s i n  the environment which can h e l p t o p r e c i p i t a t e t h i s p e c u l i a r m i x t u r e o f sadness and apathy.  Of t h e s e o f course, b y f a r t h e most t r a g i c and by  (1) f a r t h e most important, i s l o n e l i n e s s . " . I n t e r e s t e d p e o p l e can perform a c o u n s e l l i n g , s u p p o r t i v e and s u p e r v i s o r y a c t i v i t y , and c a n a l s o be used by t h e s o c i a l worker i n terms o f a s s i s t i n g t h e p a t i e n t i n h i s p l a n n i n g  o r i n heightening the  p a t i e n t s l e v e l o f i n t e r e s t and a c t i v i t y . 1  The  patient's  contact  with the outside  encouraged a t t h e Homes f o r the Aged. and  community i s a c t i v e l y  There a r e d a i l y v i s i t i n g hours  e v e n i n g v i s i t i n g p r i v i l e d g e s once a week.  Evening v i s i t i n g i s  sometimes somewhat r e s t r i c t e d because o f t h e l a c k o f e x t r a required f o r dealing with v i s i t o r s . requesting  information  staff  I n a d d i t i o n , any correspondence  about t h e p a t i e n t i s answered i n t h e hope t h a t  these i n t e r e s t e d p a r t i e s w i l l maintain  contact.  P a t i e n t s who a r e a b l e t o r e t u r n t o t h e community f o r periods  short  o f time a r e encouraged t o take l e a v e from t h e h o s p i t a l t o  v i s i t f r i e n d s and r e l a t i v e s .  Many cases v a r i o u s members o f t h e h o s p i t a l  (1) Report o f the 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 , London, 1954* " O l d Age and t h e Modern World. E . & S. L i v i n g s t o n e , L t d . , 1955. P.23.  - 64 -  p e r s o n n e l m a i n t a i n c o n t a c t w i t h f r i e n d s and r e l a t i v e s o f p a t i e n t s , r e p o r t i n g any changes i n the p a t i e n t f o r week-end l e a v e s , e t c . The  c l i n i c a l team surveyed t h e number o f p e o p l e who  i n t h e p a t i e n t and the e x t e n t o f t h e i r i n t e r e s t .  are i n t e r e s t e d  These two a r e a s ,  t h a t i s t h e e x t e n t and l e v e l o f i n t e r e s t by o t h e r s o u t s i d e o f h o s p i t a l were s e p a r a t e l y a s s e s s e d , because,  i n seme c a s e s , p a t i e n t s may  number o f v i s i t o r s but t h e s e v i s i t o r s may  have a  n o t be t o o i n t e r e s t e d i n  p l a n n i n g w i t h the h o s p i t a l s t a f f f o r the c a r e o f the p a t i e n t o r In the  comfort o f t h e p a t i e n t d u r i n g h i s s t a y i n the hospilaL. I n f o r m a t i o n i s r e a d i l y a v a i l a b l e r e g a r d i n g the number o f  v i s i t o r s a p a t i e n t may  have.  Each time a p e r s o n comes t o v i s i t  p a t i e n t , h i s name and a d d r e s s a r e r e c o r d e d i n the p a t i e n t ' s book and t h i s f i l e addition, a f i l e  visitors  i s kept i n t h e nurse's o f f i c e on t h e ward.  c a r d .is kept up t o date r e g a r d i n g inquiries  i n t e r e s t e d p a r t i e s and t h i s a l s o i s kept i n the nurse's  a  In  by  office.  R e g a r d i n g correspondence about the p a t i e n t , a l l s u c h i n q u i r i e s  and  c o p i e s o f r e p l i e s a r e r e c o r d e d i n the p a t i e n t ' s correspondence  file,  so t h a t the c l i n i c a l team was  a l s o a b l e t o e v a l u a t e the i n t e r e s t  f r i e n d s and r e l a t i v e s through t h e i r  correspondence.  of  - 65 -  TABLE 11 The Quantity of Family and Friends of a Group of Twenty-Four Patients i n the Homes f o r the Aged, Port Coquitlam. 1958*  Extent of Need  Description  Number  L. Large C i r c l e  The patient has retained a good number of t i e s i n the community i n d i c a t i n g a lengthy period of establishment i n t h i s community. Patient has a spouse or children and several long term acquaintances.  2  2. Moderate C i r c l e  Patient retains a group of relatives or friends i n the one community. Has some close r e l a t i v e s and a few friends remaining.  4  3. Limited  Patient has a few close r e l a t i v e s and old friends i n former community.  6  Patient has some r e l a t i v e s or friends whose t i e s are not close and who are scattered i n various communities, has some old f r i e n d s i n former community.  10  U  Circle  Scattered Remote  5. None  TOTAL  &  No r e l a t i v e s or friends i n former or other communities. Patient i s completely alone and i s o l a t e d .  2  24  - 66 E v i d e n t l y most o f t h e p a t i e n t s had a l i m i t e d c i r c l e o f f r i e n d s o r o n l y s c a t t e r e d and remote c o n t a c t s (Table  i n thecommunity.  1 1 ) . I t i s a l s o n o t s u r p r i s i n g t o note t h a t t h e p a t i e n t ' s  c i r c l e o f f r i e n d s tend t o diminish increased.  a  s h i s length o f h o s p i t a l i z a t i o n  F o r example, f i v e o f t h e t e n p a t i e n t s h a v i n g been i n  h o s p i t a l f o r l e s s t h a n two y e a r s had a l a r g e o r moderate c i r c l e o f friends.  Of those p a t i e n t s i n h o s p i t a l o v e r f i v e y e a r s ,  eight of  the n i n e p e o p l e i n d i c a t e d a l i m i t e d o r s c a t t e r e d c i r c l e o f c o n t a c t s . A l t h o u g h t h i s assessment r e f l e c t s t h e tendancy f o r a l l o l d e r p e r s o n s t o become s o c i a l l y i s o l a t e d , t h e s e r e s u l t s p a r t i c u l a r ^ show t h e added i s o l a t i o n o f t h e o l d e r p e r s o n i n an i n s t i t u t i o n .  - 67  -  TABLE 12 The Interest of the Family and/or Friends ..of a group of Twenty-Four Patients i n the Homes f o r the Aged, Port' Cocmltlam. 1958.  Extent of Need  Description  Number  1. Strong  Patient has frequent v i s i t o r s or correspondence from family or f r i e n d s . Frequent i n q u i r i e s are received of how the patient's condition i s . Patient i s granted leaves from h o s p i t a l on a f a i r l y frequent basis to his friends or family.  8  2. Moderate  Patient has friends or r e l a t i v e s who v i s i t or correspond on a casual basis and on holidays or f e s t i v e occasions, ( i . e . birthdays, etc). Periodic i n q u i r i e s are received about the patient and he i s allowed week-end leaves to v i s i t r e l a t i v e s or f r i e n d s .  5  3. Casual  Occasional v i s i t s by a few close friends or r e l a t i v e s and periodic i n q u i r i e s regardingthe patient's condition. Patient i s granted leave from hospital on rare occasions ( i . e . once or twice yearly)  4  4* Remote  Annually or semi-annually on a s o c i a l nature by one or two close f r i e n d s . Patient goes out on leave only on very rare occasions.  3  5. None  No friends or r e l a t i v e s v i s i t . No i n q u i r i e s regarding patient.  4  TOTAL  24  - 68 -  Motivation f o r Discharge The  s u c c e s s o r f a i l u r e o f any p a t i e n t ' s d i s c h a r g e i s  dependent i n a l a r g e p a r t upon h i s own m o t i v a t i o n towards l e a v i n g the h o s p i t a l .  I f he i s anxious  t o r e t u r n t o h i s former community,  he i s q u i t e o f t e n a b l e t o f a c i l i t a t e  h i s own d i s c h a r g e by m o b i l i z i n g  h i s own r e s o u r c e s or i n s e e k i n g o t h e r r e s o u r c e s o u t s i d e o f t h e hospital.  The p a t i e n t ' s m o t i v a t i o n a l s o i n f l u e n c e s t h e r o l e o f the  s o c i a l worker t o a g r e a t e x t e n t .  E s s e n t i a l t o the a c t i v i t i e s o f  a s o c i a l worker i s t h e r i g h t t o s e l f d e t e r m i n a t i o n by t h e c l i e n t ( t h a t i s , t h e h e l p t h e c l i e n t t o h e l p h i m s e l f ) and i f t h e c l i e n t l a c k s t h e d e s i r e t o i n v o l v e h i m s e l f i n p l a n n i n g w i t h t h e worker, v e r y l i t t l e p r o g r e s s w i l l be made. The  c l i n i c a l team, aware o f t h e importance o f t h i s  area,  a s s e s s e d t h e p a t i e n t group t o d e t e r m i n e t h e s e p a t i e n t s l e v e l o f m o t i v a t i o n i n terms o f w i s h i n g t o l e a v e t h e h o s p i t a l .  These p a t i e n t s  were e v a l u a t e d a c c o r d i n g t o t h e i r w i l l i n g n e s s t o l e a v e t h e h o s p i t a l , i n c l u d i n g t h e i r expressed  views.  s e v e r a l d i f f i c u l t i e s t o t h e team.  E v a l u a t i n g t h e group p r e s e n t e d F o r example, s e v e r a l p a t i e n t s who  i n d i c a t e d a good p o t e n t i a l f o r adjustment had never e x p r e s s e d and w i l l i n g n e s s or d e s i r e t o leave the h o s p i t a l .  Other p a t i e n t s , when  t h e y were d i s t u r b e d , would r e q u e s t d i s c h a r g e from h o s p i t a l  primarily  because t h e y were s e e k i n g some s o l u t i o n f o r t h e i r f e e l i n g s o f upset and a g i t a t i o n .  T h i s survey t h e r e f o r e o f n e c e s s i t y had t o i n c l u d e ,  not o n l y t h e p a t i e n t ' s own expressed  wishes about l e a v i n g t h e h o s p i t a l  but some i d e a o f h i s p o t e n t i a l f o r d i s c h a r g e i n terms o f h i s m e d i c a l and p s y c h i a t r i c c o n d i t i o n .  -6 9 -  The r e s u l t s o f t h i s Worker  assessment would i n d i c a t e t h a t a S o c i a l  c o u l d be o f c o n s i d e r a b l e h e l p t o most o f t h e s e p a t i e n t s i n  making d i s c h a r g e p l a n s . It i sd i f f i c u l t  t o p r e d i c t what r e s u l t s would o c c u r i f a  s u p p o r t i v e type o f r e l a t i o n s h i p was e s t a b l i s h e d w i t h some o f t h e patient's relatives.  One would f e e l t h a t t h e e f f o r t s o f a c a s e -  worker i n t h i s r e g a r d would produce v e r y b e n e f i c i a l r e s u l t s b y t h e i n t e r p r e t a t i o n o f t h e p a t i e n t ' s i l l n e s s t o them, support  t o the  f a m i l y i n terms o f f o l l o w - u p care when t h e p a t i e n t was d i s c h a r g e d , or through the m o b i l i z a t i o n o f resources a v a i l a b l e through the r e l a t i v e s o r f r i e n d s t o a s s i s t the p a t i e n t i n h i s r e t u r n home and i n m a i n t a i n i n g him once d i s c h a r g e d .  C e r t a i n l y t h e assessment does  i n d i c a t e c o n s i d e r a b l e weakening o f community in hospital  lengthens.  t i e s , as t h e i r  stay  70 -  TABLE 13 THE L e v e l o f M o t i v a t i o n o f a Group o f Twenty-Four P a t i e n t s i n t h e Homes f o r t h e Aged a t P o r t Coquitlam i n 1958  jevel  of Motivation  Description  Number  iigh  P a t i e n t f r e q u e n t l y and r e g u l a r l y has d i s c u s s e d and r e q u e s t e d h i s d i s c h a r g e and i n d i c a t e s a w i l l i n g n e s s t o involve himself i n planning.  5  lood  P a t i e n t has expressed some w i s h to be d i s c h a r g e d y e t v a c c i l a t e s i n terms o f h i s u n w i l l i n g n e s s t o l e a v e the p r o t e c t i o n o f t h e h o s p i t a l and to face the d i f f i c u l t i e s involved i n preparing himself f o r discharge  A  Fair  P a t i e n t seldom e x p r e s s e s any wish t o l e a v e h o s p i t a l y e t h i s adjustment on the ward i n d i c a t e s a p o t e n t i a l f o r m o b i l i z i n g h i s r e s o u r c e s and as such c o u l d be a c a n d i d a t e f o r p r e p a r i n g for discharge.  9  Poor o r None  P a t i e n t has expressed l i t t l e w i s h t o l e a v e h o s p i t a l and has made o n l y a f a i r ward adjustment and i n d i c a t e s l i t t l e potential for mobilizinghis own i n n e r r e s o u r c e s .  TOTAL  b  24  - 71  -  The p a t i e n t group ( T a b l e 13) l e v e l s of motivation.  i n d i c a t e d a wide range o f  F i f t e e n o f the twenty-four were i n the  "fair"  t o "poor" c a t e g o r i e s and the r e m a i n i n g n i n e seemed t o be eager p a r t i c i p a t e i n any p l a n s f o r d i s c h a r g e . those of the group who  to  I t should be noted t h a t  had remained i n h o s p i t a l f o r a p e r i o d o f  l o n g e r than f i v e y e a r s e x p r e s s e d t h e l e a s t w i l l i n g n e s s t o l e a v e the i n s t i t u t i o n ; seven o f these n i n e p a t i e n t s expressed no  wish  t o l e a v e h o s p i t a l even though the team c o n s i d e r e d them as good discharge p o s s i b i l i t i e s .  On the o t h e r hand, s i x o f the t e n  p a t i e n t s r e m a i n i n g i n h o s p i t a l l e s s t h a n two y e a r s e i t h e r a " h i g h " o r "good"motivation.  indicate  I t would seem t h e n t h a t  the p a t i e n t ' s highest m o t i v a t i o n f o r discharge ( a t l e a s t i n t h i s p a t i e n t group) o c c u r s d u r i n g t h e f i r s t is  i n hospital.  and second  year  he  Perhaps t h i s i s the p e r i o d o f time t h a t h i s  communities t i e s are s t r o n g e s t and foremost  i n h i s mind and h i s  p s y c h i a t r i c c o n d i t i o n has r e m i t t e d t o the e x t e n t t h a t he he would be a b l e t o g e t a l o n g i n the community.  feels  A f t e r a two  year  p e r i o d i n the i n s t i t u t i o n the p a t i e n t s would appear t o a c c e p t h o s p i t a l i z a t i o n as a permanent p l a n r a t h e r t h a n a means o f improving t h e i r h e a l t h so t h a t t h e y c a n r e t u r n t o t h e i r type o f l i v i n g .  former  T h i s l a c k o f i n t e r e s t i n any o t h e r a r e a t h a n  h o s p i t a l would, o f c o u r s e , be heightened  by the g r a d u a l  the  withdrawal!  - 72 -  o f c o n t a c t s w i t h f r i e n d s and r e l a t i v e s  (1)  and  o f t h e p a t i e n t t h a t h i s needs are b e i n g met  a l s o by the  realization  i n the i n s t i t u t i o n  i t would be d i f f i c u l t f o r him t o change h i s way  and  of l i v i n g that discharge  t o the community would demand. The above r e s u l t s have c o n s i d e r a b l e i m p l i c a t i o n s t o t h e s o c i a l worker concerned discharge.  w i t h a s s i s t i n g these p a t i e n t s i n t h e i r  A l l o f the p a t i e n t s , however, i n d i c a t e d t h a t b e f o r e  t h e y c o u l d be d i s c h a r g e d t h e y c o u l d b e n e f i t through s o c i a l work a c t i v i t y w i t h i n one o r more areas a s s e s s e d . those o f the group who  As was  anticipated  had remained In h o s p i t a l f o r an  extended  p e r i o d o f time e x p e r i e n c e d a weakening o f t h e i r t i e s i n community and a s t r o n g e r dependency on t h e i n s t i t u t i o n .  Thus t h e j o b o f  the s o c i a l worker becomes more complex w i t h t h e s e p e o p l e  i n that  t h e y have fewer r e s o u r c e s t o i m p l y and l e s s w i l l i n g n e s s t o c o n s i d e r the p r o s p e c t o f l e a v i n g  hospital.  The r e s u l t s o f the t o t a l assessment a l s o i m p l y a need f o r casework a c t i v i t y w i t h these p a t i e n t s both d u r i n g the time t h e y a r e i n h o s p i t a l and d u r i n g a p o s t - d i s c h a r g e p e r i o d .  (1)  See Page 65  - 73 -  I t would appear t h a t c o n s i d e r a b l e i n t e r v i e w time would have t o be spent p r e p a r i n g t h e s e p a t i e n t s t o f a c e the p r o s p e c t o f l e a v i n g h o s p i t a l , i n a s s e s s i n g t h e i r r e s o u r c e s and  the r e s o u r c e s  provided  by the community i n o r d e r t h a t the p a t i e n t can e n j o y the b e s t p o s s i b l e adjustment.  I n a d d i t i o n , t h i s p a t i e n t group  evidenced  a need f o r e x t e n s i o n o f h o s p i t a l s e r v i c e s such as f u r t h e r c o u n s e l l i n g and m e d i c a l  care.  The  s o c i a l worker c o u l d p l a y a v i t a l r o l e i n  t h i s r e g a r d as a " b r i d g e " f o r the p a t i e n t between the and  the  community.  hospital  - 74  CHAPTER  IV  SOCIAL WORK TREATMENT OF THE AGED PSYCHIATRICALLY I L L  Summary and Assessment. A t t h e b e g i n n i n g o f t h i s s t u d y , t h e s o c i a l adjustment o f t h e aged was b r i e f l y o u t l i n e d .  I t was c o n c l u d e d  that, f o r various  reasons,  o l d e r p e o p l e a r e becoming an i s o l a t e d group and i t s members r e g a r d e d by many i n the community a s h a v i n g t h e c h a r a c t e r i s t i c s common t o t h i s group.  Thus t h e r e i s a tendency f o r o l d e r p e o p l e  t o be s t e r e o t y p e d a s  dependent p e o p l e , i n c a p a b l e o f assuming t h e r e s p o n s i b i l i t y f o r t h e i r own c a r e and h a p p i n e s s . A r e v i e w o f some o f the a v a i l a b l e  s t a t i s t i c s regarding the  economic adjustment o f t h e a g i n g , r e v e a l e d t h a t n o t a l l aged p e o p l e a r e dependent p e o p l e .  Many r e m a i n p r o d u c t i v e and s e l f s u s t a i n i n g even though  t h e y have become "aged" a c c o r d i n g t o the d e f i n i t i o n imposed upon them through the implementation  o f f o r c e d r e t i r e m e n t schemes and p e n s i o n p l a n s .  E v e n though some remain independent, i t was p o i n t e d o u t t h a t o l d e r people  tend t o become i l l more o f t e n and need a l o n g e r p e r i o d o f time  to recover.  H o s p i t a l s t a t i s t i c s f o r example, i n d i c a t e t h a t a l a r g e r p r o -  p o r t i o n o f t h e o l d e r aged group spend a l o n g e r time t h a n any o t h e r age group. Although  t h e c h r o n i c i t y o f t h e o l d e r p a t i e n t s ' i l l n e s s was acknowledged t o  be t h e major r e a s o n f o r l e n g t h y h o s p i t a l i z a t i o n t h e r e was some q u e s t i o n a s t o the i n f l u e n c e o f delays i n d i s c h a r g e a s a r e s u l t o f the l a c k o f community f a c i l i t i e s t o care f o r these p e o p l e d u r i n g t h e i r  convalescence.  - 75 -  A b r i e f assessment was made o f some o f the newer t r e n d s i n p s y c h i a t r y w i t h r e s p e c t t o t h e treatment concluded  o f the o l d e r p e r s o n .  I t was  t h a t w i t h the development o f newer t h e r a p i e s and s p e c i a l  treat-  ment f a c i l i t i e s f o r t h e c a r e o f the g e r i a t r i c p a t i e n t , many a r e r e s p o n d i n g t o t h e i r h o s p i t a l i z a t i o n t o t h e e x t e n t t h a t many r e c o v e r  sufficiently  f r o m t h e i r m e n t a l i l l n e s s t o be c o n s i d e r e d r e a d y f o r d i s c h a r g e . T h i s t r e n d i s r e f l e c t e d i n t h e B r i t i s h Columbia Homes f o r t h e Agedj which p r o v i d e c a r e f o r t h e aged p e r s o n w i t h m e n t a l i l l n e s s .  After  a b r i e f d e s c r i p t i o n o f the development and the p r e s e n t programme o f t h e s e i n s t i t u t i o n s , i t was c o n c l u d e d  t h a t , although treatment  c o n s i s t e d prim-  a r i l y o f c u s t o d i a l m e d i c a l and n u r s i n g c a r e , some o f the p a t i e n t s respond t o t h i s regime and a r e thus c a p a b l e  of leaving hospital.  •'•o a c h i e v e t h e purpose o f t h i s study - t o determine i f s o c i a l s e r v i c e s c o u l d make some c o n t r i b u t i o n i n h e l p i n g some o f these p a t i e n t s l e a v e h o s p i t a l - i t was n e c e s s a r y t o s e l e c t and d e f i n e some o f t h e a r e a s i n which t h e s o c i a l worker would be a c t i v e w i t h the p a t i e n t .  I n other  words, the f i r s t t a s k was t o determine some o f t h e needs o f t h e p a t i e n t t h a t would have t o be c o n s i d e r e d i f he were p l a n n i n g t o l e a v e h o s p i t a l . I n o r d e r t o a v o i d t h e c o n f u s i o n o f a l o n g grouped i n t o two broad categories:  ( l ) t h e p a t i e n t s ' needs and (2) r e s o u r c e s he c o u l d employ.  Needs were d e f i n e d a s t h o s e a r e a s w i t h which t h e p a t i e n t r e q u i r e d h e l p and emanated d i r e c t l y f r o m h i s h o s p i t a l i z a t i o n .  Those s e l e c t e d were m e d i c a l ,  p s y c h i a t r i c and casework c o u n s e l l i n g , p e r s o n a l s u p e r v i s i o n and h o u s i n g  needs.  R e s o u r c e s - t h o s e f a c t o r s which depended i n p a r t on the p o s s e s s i o n s o f t h e p a t i e n t - i n c l u d e d p h y s i c a l a b i l i t i e s , f i n a n c i a l and m a t e r i a l r e s o u r c e s , s o c i a l , r e c r e a t i o n a l and r e l i g i o u s i n t e r e s t s and t h e p a t i e n t ' s m o t i v a t i o n f o r discharge.  - 76  -  Twenty-four p a t i e n t s f r o m the P o r t C o q u i t l a m u n i t o f t h e Homes f o r the Aged were s e l e c t e d f o r the assessment.  They had been i n h o s p i t a l  f o r p e r i o d s r a n g i n g from s i x months t o twenty-three chosen by a r o u t i n e sampling procedure  years.  They were  from a l a r g e r group who  were  j u s g e d t o be m e d i c a l l y and p s y c h i a t r i c a l l y s u i t a b l e f o r d i s c h a r g e . l a t t e r group had been d e t e r m i n e d through  by t h e m e d i c a l and n u r s i n g s t a f f ,  the use o f a q u e s t i o n n a i r e s u r v e y e d  This who  the e n t i r e p a t i e n t p o p u l a t i o n  i n o r d e r t o i d e n t i f y those p a t i e n t s w e l l enough t o l e a v e the h o s p i t a l . A l t h o u g h the r e s u l t s o f the assessment o f the group s e l e c t e d f o r study (accomplished  p r i m a r i l y through  d i c a t e d t h a t the needs a n d i t was  the use o f r a t i n g s c a l e s ) , i n -  r e s o u r c e s o f the group v a r i e d c o n s i d e r a b l y ,  e v i d e n t t h a t a l l o f these p a t i e n t s c o u l d b e n e f i t from t h e  s i s t a n c e o f a s o c i a l worker i n one  o r more o f the a r e a s  as-  evaluated.  There were some i n d i c a t i o n s t h a t the p a t i e n t ' s l e n g t h o f s t a y had a c o n s i d e r a b l e e f f e c t upon the type o f s o c i a l work a c t i v i t y  they  use. Those r e m a i n i n g  i n h o s p i t a l f o r a p e r i o d o f l e s s than  two  y e a r s had u s u a l l y r e t a i n e d some r e s o u r c e s i n t h e i r f o r m e r community which c o u l d be m o b i l i z e d t o a s s i s t them i n d i s c h a r g e .  On  the o t h e r hand, the  m a j o r i t y o f t h i s group i n d i c a t e d t h e y would need an e x t e n s i o n o f h o s p i t a l s e r v i c e s i f t h e y were d i s c h a r g e d .  That i s most o f t h e s e p e o p l e  would  r e q u i r e e i t h e r p s y c h i a t r i c , casework o r m e d i c a l f o l l o w - u p c a r e i n o r d e r t o m a i n t a i n the g a i n s they had made i n  treatment.  77  The  motivation  -  o f these p e o p l e t o l e a v e h o s p i t a l was  good, perhaps  because o f the maintenance o f s t r o n g community t i e s , which was e v i d e n c e d i n the  also  assessment.  Those p a t i e n t s who  had  remained i n h o s p i t a l f o r a  longer  p e r i o d o f t i m e , i n d i c a t e d l e s s need f o r m e d i c a l o r c o u n s e l l i n g s e r v i c e s y e t had  little  i n the way  of s o c i a l resources,  such a s wide s o c i a l  i n t h e i r former community, o r f i n a n c i a l and m a t e r i a l p o s s e s s i o n s . group a l s o e v i d e n c e d l e s s m o t i v a t i o n  f o r discharge  and  seemed t o  contacts This  regard  t h e i r h o s p i t a l i z a t i o n as a permanent l i v i n g arrangement. T h e r e was  no  s i g n i f i c a n t c o r r e l a t i o n with patient's physical  a b i l i t y o r s o c i a l r e c r e a t i o n s and length of stay. each o f the  r e l i g i o u s i n t e r e s t s i n terms o f  As p r e v i o u s l y mentioned the  s e l e c t e d needs and  resources  r e s u l t o f the assessment o f  i n d i c a t e d t h a t a s o c i a l worker  c o u l d make some c o n t r i b u t i o n i n d i s c h a r g e  planning  with each p a t i e n t .  T h i s p e r i o d i n h i s h o s p i t a l i z a t i o n , however, r e p r e s e n t s o f the p a t i e n t ' s total t r e a t m e n t programme. the p a t i e n t ' s needs and p e r s o n a l  resources  i n c l u d e a s u r v e y o f community r e s o u r c e s  o n l y one  In a d d i t i o n to the  s o c i a l worker would have t o  t o b e undertaken i n o r d e r  the  This study therefore  of possible s o c i a l service contributions  p a r t o f the p a t i e n t ' s i n s t i t u t i o n a l i z a t i o n .  part  assessing  i n o r d e r t o determine how  p a t i e n t c o u l d meet h i s needs most e f f e c t i v e l y . r e v i e w s o n l y one a s p e c t  their  Further  t o determine more f u l l y how  c o u l d a s s i s t the a g e d p a t i e n t h o s p i t a l i z e d f o r m e n t a l  during  s t u d i e s w o u l d have a s o c i a l worker illness*  - 78 -  A Transition  Period.  This  s t u d y would seem t o i n d i c a t e not o n l y t h a t the  patient  group would b e n e f i t by the s e r v i c e s o f a sodS.al worker, but a l s o t r a n s i t i o n p e r i o d has  r e s u l t e d i n the  a b i l i t y of older persons. ( p r i m a r i l y c u s t o d i a l ) has i n the  older personleing  poor p r o g n o s i s .  The  increase  i n the  psychiatric treat-  t r e a t m e n t program o f t h i s  r e f l e c t e d the associated  institution  common concept o f m e n t a l  w i t h c h r o n i c i t y and  However, p a r a l l e l i n g the  a  the  illness  resultant  growing awareness i n o t h e r  a r e a s o f a newer more o p t i m i s t i c o u t l o o k the  s t a f f o f the Homes f o r  the  Aged have i n d i c a t e d t h a t many p a t i e n t s c o u l d be r e t u r n e d t o t h e i r community a f t e r s u i t a b l e treatment.  At the  p r e s e n t time most o f the  separations  from h o s p i t a l r e s u l t f r o m the d e a t h o f the p a t i e n t j v e r y few  patients  are  r e t u r n e d t o t h e i r homes o r a r e d i s c h a r g e d t o p r i v a t e h o s p i t a l s o r b o a r d i n g homes. A t the  same t i m e , t h e r e i s a growing l i s t o f p e o p l e a w a i t i n g  a d m i s s i o n t o t h i s i n s t i t u t i o n r e s u l t i n g i n i n c r e a s i n g p r e s s u r e by community f o r these f a c i l i t i e s .  There i s a need t h e r e f o r e ,  the  to i n s t i t u t e  an a c t i v e program i n the h o s p i t a l f o c u s s e d on h e l p i n g p a t i e n t s , who w e l l enough t o r e t u r n t o the  community.  t h a t s o c i a l s e r v i c e a c t i v i t y would be  The  are  r e s u l t s o f the s t u d y i n d i c a t e  e s s e n t i a l i f such a programme were  initiated. The the  problem o f d e a l i n g w i t h over-crowding i n the f a c i l i t i e s  aged i s not u n i q u e t o the P r o v i n c e o f B.C.  o l d e r and  A s t u d y o f the  for  needs o f  c h r o n i c a l l y i l l persons i n Ottawa completed u n d e r the d i r e c t i o n  of Miss Marjory Bradford i n d i c a t e d  s i m i l a r problems i n t h a t C i t y .  - 79 -  In commenting on the results of the committee's survey of institutional  (1) f a c i l i t i e s for the aged Miss Bradford pointed out:  "The present over-  loading of nearly a l l institutions, and much excess stay of older patients in hospital, are partly a problem of bottlenecks for which not one, but many new channels must be opened. One of these i s a social work services associated with a l l institutiohs;:and hospitals, to help the right people in, help the right people out, and work on patient and family problems in between. No institution dealing with human l i f e i n sickness and trouble f a i l s to run into such difficulty, or achfeves i t s highest pinnacle of usefulness without such a f a c i l i t a t i n g service.  11  The number of patients  who are ready for discharge increased significantly as a result of a more active psychiatric treatment programme within mental hospitals. Recently the results of an accelerated programme i n a state (2) hospital at Camarillo, California was published. the results as follows:  The author summarized  "Since 1952, we have given more than 26,000  electric treatments to over 600 patients between the aged of sixty and ninetytwo.  We have been able to send on convalescent leave more than 200 patients,  twenty-eight of whom had been on the most disturbed geriatric female ward in our hospital. (1) Bradford, Miss Marjorie, A study of the Needs of Older and Chronically i l l persons in the City of Ottawa, publi shed by the Council of the Corporation of the City of Ottawa, 1954« P» 5* (2) Geriatric Mental Patients and How we can help Them» Geriatrics? Devoted to Diseases and Processes of Aging. Volume 14, February 1959* Lancet Publications Incorporated, Minneapolis, Minn., U.S.A.  - 80 -  B e f o r e i n s t i t u t i o n o f t h i s form o f t h e r a p y , p r a c t i c a l l y no one t h i s ward o f 100  from  p a t i e n t s had been a b l e t o go on c o n v a l e s c e n t l e a v e .  However, a l l o f t h e s e p a t i e n t s are now r e q u i r e i n t r a m u s c u l a r s e d a t i o n , and  a b l e t o go to the d i n i n g room, none  none a r e i n r e s t r a i n t .  F o r t y per  a r e a b l e t o go on s h o r t home v i s i t s o r have r i d i n g p e r m i s s i o n w i t h  cent  their  relatives. I t i s r e a d i l y apparent  t h a t such a programme would i n v o l v e a  g r e a t d e a l more c o n t a c t between the p a t i e n t and h i s o u t s i d e community t h a n i n now  i n evidence  a t the Homes f o r the Aged i n P o r t C o q u i t l a m .  Social  work a c t i v i t y i n such a programme would a l s o no doubt show c o n s i d e r a b l e acceleration. I t i s i n t e r e s t i n g t o note the P o r t C o q u i t l a m p a t i e n t group.  t h a t the m e d i c a l and  setting eagerly participated  nursing s t a f f of  i n the s t u d y o f the  They o f f e r e d many s u g g e s t i o n s and i d e a s as to how  i n f o r m a t i o n c o u l d be o b t a i n e d and what o t h e r needs c o u l d be The  q u e s t i o n they most o f t e n asked was  further  assessed.  "when w i l l t h e r e be a s o c i a l s e r v i c e  department a c t i v e i n the h o s p i t a l ? " Although  the members o f the c l i n i c a l  team have evidenced  their  w i l l i n g n e s s t o work w i t h p a t i e n t s toward d i s c h a r g e , t h e r e remains the problem o f the o l d e r p e r s o n b e i n g a c c e p t e d  i n the community.  These  people,  i n a d d i t i o n t o b e i n g o l d , have had a m e n t a l i l l n e s s and some w i l l no doubt f a c e added r e j e c t i o n by t h e i r f r i e n d s because o f t h i s c o u p l e d w i t h the a t t i t u d e o f the community the o l d e r p e r s o n has t o f a c e a shortage o f e s s e n t i a l r e s o u r c e s such as s u i t a b l e h o u s i n g accommodation and centres.  recreational  -  81  Thus the s o c i a l worker would l i k e l y f i n d h i m s e l f v e r y much i n v o l v e d i n making a thorough assessment o f e x i s t i n g r e s o u r c e s and perhaps i n deve l o p i n g f u r t h e r f a c i l i t i e s i n community t o h e l p t h e s e  people.  There a r e i n d i c a t i o n s o f c o n c e r n i n t h i s r e g a r d i n many comm u n i t i e s a t the p r e s e n t time.  I n Vancouver f o r example the Community  C h e s t and C o u n c i l S o c i a l P l a n n i n g S e c t i o n  have r e c e n t l y completed  two  s t u d i e s which i n c l u d e d p u b l i c a t i o n o f a hand book f o r f a m i l i e s f a c e d w i t h the c a r e o f o l d e r people  a t heme and .an e v a l u a t i o n o f p r e s e n t mental  h e a l t h s e r v i c e s f o r the aged i n B r i t i s h  Columbia.  S i m i l a r c o n c e r n has been shown i n the U n i t e d S t a t e s .  F o r example,  i n the s t a t e o f Ohio recommendations neve been made f o r f u r t h e r t h e r a p e u t i c r e s o u r c e s i n the community t o b e  concerned  n i n g f o r the g e r i a t r i c m e n t a l p a t i e n t .  with post h o s p i t a l  The a u t h o r observed  s o c i a l plan-  t h a t "the  (2) change from h o s p i t a l l i f e The  t o community must be an u n i n t e r r u p t e d p r o c e s s " .  r e p o r t o f the committee s t u d y i n g needs and r e s o u r c e s i n the C i t y o f  Ottawa f o r the o l d e r p e r s o n i n c l u d e d i n i t s recommendations e x p a n s i o n  of  s u c h r e s o u r c e s as casework s e r v i c e s p r o v i d e d by p u b l i c w e l f a r e a g e n c i e s , h o s p i t a l s o c i a l s e r v i c e s , the u s e o f v i s i t i n g home-makers and  housekeeping  a i d e s , and more d i v e r s i f i e d h o u s i n g accommodation t o meet the p a r t i c u l a r h o u s i n g needs o f t h i s group.  (3)  (1) P l a n n i n g Report 1958, S o c i a l P l a n n i n g S e c t i o n , Community C h e s t and C o u n c i l o f G r e a t e r Vancouver, March 1959* Pages 4,7. (2) P o s t H o s p i t a l P l a n n i n g f o r G e r i a t r i c M e n t a l P a t i e n t s , G e r i a t r i c s Devoted t o D i s e a s e d and P r o c e s s e s o f A g i n g . Volume 14, Number 3 . March 1959L a n c e t P u b l i c a t i o n s I n c o r p o r a t e d , M i n n e a p o l i s , Minn. U.S.A. (3) B r a d f o r d , M i s s M a r j o r i e , A S t u d y o f the Need3 o f O l d e r and Chroni c a l l y i l l persons i n the C i t y o f Ottawa, the C o u n c i l o f the C o r p o r a t i o n o f the C i t y o f Ottawa, 1954* Paged 71,75-  - 82 -  New  G o a l s f o r S o c i a l Work R e s e a r c h . A t t h e p r e s e n t time as a l r e a d y i n d i c a t e d ( C h a p t e r I ) t h e r e i s  no s o c i a l s e r v i c e department though it  i n the Homes f o r t h e Aged.  Therefore, al"  t h e r e i s no body o f i n f o r m a t i o n a v a i l a b l e o f p a s t s o c i a l work a c t i v i t y  i s hoped t h a t f u r t h e r r e s e a r c h i n the a r e a s o f the need f o r , and  o f , a s o c i a l s e r v i c e department department  function  c o u l d r e s u l t i n the e s t a b l i s h m e n t o f a  o f peak e f f i c i e n c y . I n view o f the p r o b a b i l i t y t h a t a s o c i a l work department  will  be  s e t up i n the near f u t u r e , thexe i s a need f o r r e s e a r c h i n two broad a r e a s . F i r s t , d e f i n i t i v e assessments, perhaps  a l o n g the l i n e s o f t h i s p r e s e n t s t u d y ,  s h o u l d be made i n o r d e r t o determine more f u l l y , the p o s s i b l e scope o f a c t i v i t i e s o f a s o c i a l worker i n t h e s e u n i t s .  I n o t h e r words, how  the  s o c i a l worker would f u n c t i o n i n a l l a r e a s o f the t o t a l h o s p i t a l programme. Casework a c t i v i t i e s i n p r e - a d m i s s i o n s e r v i c e s would m e r i t some analysis.  As p r e v i o u s l y o u t l i n e d ( C h a p t e r l ) a g r e a t d e a l o f time i s s p e n t  by the h o s p i t a l s t a f f ( p a r t i c u l a r l y the M e d i c a l S u p e r i n t e n d e n t ) i n d e a l i n g w i t h the problems o f p r o s p e c t i v e p a t i e n t s , t h e i r f a m i l i e s and  interested  s o c i a l a g e n c i e s i n o r d e r t o t e m p o r a r i l y s u s t a i n the p a t i e n t p r i o r t o h i s coming t o h o s p i t a l o r i n making e f f e c t i v e a l t e r n a t e p l a n s .  I t would seem  t h a t working w i t h t h e s e p e o p l e t o h e l p them employ community r e s o u r c e s o r g i v e support and guidance t o those c a r i n g f o r these d i s t u r b e d  elderly  p e o p l e c o u l d be competently handled by a s o c i a l worker knowledgeable t h e s p e c i a l problems these p e o p l e have.  of  O t h e r p r e - a d m i s s i o n a c t i v i t i e s which  c o u l d be a s s e s s e d i n c l u d e an e v a l u a t i o n o f the need f o r s o c i a l i n f o r m a t i o n i n t r e a t m e n t p l a n n i n g and some e v a l u a t i o n o f the b e n e f i t s t h a t c o u l d r e s u l t  - 83 -  f r o m the i n t e r p r e t a t i o n o f to admission  s e r v i c e s t o p a t i e n t s and t h e i r f a m i l i e s  i n o r d e r t o e n l i s t t h e i r c o o p e r a t i o n i n treatment  prior  and p r e -  discharge planning. E n l i s t i n g casework h e l p d u r i n g t h e p a t i e n t ' s t r e a t m e n t p e r i o d (1) s h o u l d a l s o be examined.  There a r e many examples o f a r e a s  needing  a n a l y s i s i n c l u d i n g the s p e c i a l problems t h e aged p r e s e n t i n casework treatment, m a i n t a i n i n g community t i e s d u r i n g p r o l o n g e d and h e l p i n g the o l d e r p e r s o n remain m o t i v a t e d  hospitalization  f o r discharge.  F u r t h e r r e s e a r c h i n p r e - d i s c h a r g e p l a n n i n g and f o l l o w i n g up c a r e would a l s o be e s s e n t i a l . ning i n t h i s area.  The p r e s e n t s t u d y r e p r e s e n t s o n l y a b e g i n -  Other questions  have t o be answered such a s : What  s p e c i f i c r e s o u r c e s a r e a v a i l a b l e t o meet these p a t i e n t s ' needs i n community and how c o u l d t h i s be accomplished  most e f f e c t i v e l y ?  What would be t h e  caseworker's s p e c i f i c a r e a o f competence i n r e l a t i o n t o o t h e r members o f the C l i n i c a l team? The second major a r e a - t h a t o f o r g a n i z i n g t h e S o c i a l S e r v i c e Department t o p r o v i d e the most e f f i c i e n t p o s s i b l e s e r v i c e 0 a l s o m e r i t s c o n s i d e r a b l e a t t e n t i o n i n terms o f r e s e a r c h .  Assuming t h a t t h e a c t i v i t i e s  o f the s o c i a l worker i n t h e h o s p i t a l were c l a r i f i e d : most e f f e c t i v e l y ?  F o r example, how c o u l d m e a n i n g f u l  How c o u l d he f u n c t i o n l i a i s o n s be made w i t h  o t h e r a g e n c i e s and i n s t i t u t i o n s and what r e f e r r a l p r o c e d u r e s  would be u s e d .  ( l ) A q u a l a t i v e a n a l y s i s o f casework s e r v i c e s a t the Crease C l i n i c o f P s y c h o l o g i c a l M e d i c i n e , a p s y c h i a t r i c i n s t i t u t i o n i n B r i t i s h Columbia p e r f o r m e d b y Mr. E . S c h l e s i n g e r i l l u s t r a t e s some o f t h e c o n t r i b u t i o n s a s o c i a l worker c a n make d u r i n g a p a t i e n t ' s h o s p i t a l i z a t i o n . Schlesinger, Ernest.  S o c i a l Casework i n the M e n t a l H o s p i t a l , M a s t e r 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, 1954-.  - 8A -  P r o v i d i n g f o r f u r t h e r r e s e a r c h i s another i m p o r t a n t p l a n n i n g an agency f u n c t i o n .  area i n  Through r e s e a r c h , f u r t h e r knowledge i s  g a i n e d w i t h the r e s u l t t h a t new and better ways o f d o i n g  things are  developed* r e s u l t i n g i n t u r n i n the g i v i n g o f more s e r v i c e t o p e o p l e which is  the fundemental g o a l o f s o c i a l work.  ording information,  A standardized  system o f r e c -  ( f o r example, r e f e r r a l systems and d i a g n o s t i c  summaries)  as w e l l a s p l a n n e d r e s e a r c h programmes would c o n t r i b u t e t o an i n c r e a s e d e f f i c i e n c y i n the S o c i a l S e r v i c e Present  t r e n d s i n p o p u l a t i o n gowth i n d i c a t e an even g r e a t e r  p r o p o r t i o n o f o l d e r people, future.  Department.  as compared  w i t h o t h e r age groups, f o r t h e  An i n c r e a s e d demand f o r p s y c h i a t r i c f a c i l i t i e s  o f t h i s group would appear i n e v i t a b l e .  to treat  those  A t the same time, w i t h t h e dev-  elopment o f newer t h e r a p i e s , the o l d e r p e r s o n has an i n c r e a s i n g l y b e t t e r chance o f b e i n g d i s c h a r g e d f r o m a p s y c h i a t r i c i n s t i t u t i o n . developments w i l l b r i n g g r e a t e r p r e s s u r e  A l l o f these  on the community t o p r o v i d e f o r  t h e d i s c h a r g e p a t i e n t o f o l d e r y e a r s and as a r e s u l t a l a r g e r demand f o r s o c i a l workers t o h e l p these  people.  - 85 -  BIBLIOGRAPHY  S p e c i f i c References  Books: Gruenberg, Dr. E r n e s t M. and Kaufman, D r . R a l p h M., C h a r t e r f o r the A g i n g , Report o f t h e New York S t a t e Conference a t A l b a n y , New Y o r k , 1956. Shock, Nathan, Trends i n G e r o n t o l o g y , S t a n f o r d U n i v e r s i t y P r e s s , S t a n f o r d , C a l i f o r n i a , 1957.  A r t i c l e s , R e p o r t s and Other  Studies:  B r a d f o r d , M i s s M a r j o r i e , A Study o f the Needs o f O l d e r and C h r o n i c a l l y 111 P e r s o n s i n the C i t y o f Ottawa, p u b l i s h e d by the C o u n c i l o f the C o r p o r a t i o n o f t h e C i t y o f Ottawa, 1954, P. 81. B r i t i s h Columbia, Annual Report of the M e n t a l H e a l t h S e r v i c e s , Queens P r i n t e r s , V i c t o r i a , 1958. Canada, M e n t a l H e a l t h S e r v i c e s i n Canada, R e s e a r c h D i v i s i o n , Department o f N a t i o n a l H e a l t h and W e l f a r e , Ottawa, J u l y , 1954. C l a r k , R i c b a r James. Care o f the M e n t a l l y 111 i n B r i t i s h Columbia, M a s t e r 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, 1945. " G e r i a t r i c M e n t a l P a t i e n t s and How we can H e l p Them", G e r i a t r i c s , Volume 14, Number 2, F e b r u a r y , 1959. "Post H o s p i t a l P l a n n i n g f o r G e r i a t r i c M e n t a l P a t i e n t s " , Volume 13, Number 3, March, 1959.  Geriatrics,  R e p o r t o f the T h i r d Congress o f the 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 , London, 1954, O l d Age and t h e Modern ? f o r l d , E . and S. L i v i n g s t o n e L t d . , 1955.  - 86 -  General References  Books: H a m i l t o n , Gordon, Theory and P r a c t i c e U n i v e r s i t y P r e s s , New York, 1951. Lowrey, Lawson G., P s y c h i a t r y P r e s s , New York, 1946.  A r t i c l e s , R e p o r t s and Other  o f S o c i a l Case Work, Columbia  f o r S o c i a l Workers, Columbia U n i v e r s i t y  Studies:  Group f o r the Advancement of P s y c h i a t r y , "The P s y c h i a t r i c S o c i a l Worker i n the P s y c h i a t r i c H o s p i t a l , Report Number 2, J a n u a r y , 1948. Ross, R o b e r t M., A V o l u n t e e r Programme f o r the P a t i e n t s o f a" M e n t a l H o s p i t a l , M a s t e r 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, 1958. S c h l e s i n g e r , E r n e s t . S o c i a l Casework i n the M e n t a l H o s p i t a l , M a s t e r of 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, 1954.  

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0106185/manifest

Comment

Related Items