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Foster home care for the dependent aged : a study of the values and limitations of family placement in… Deildal, Robert Michaux 1955

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^FOSTER HOME CARE FOR THE DEPENDENT AGED A Study of the Values and Limitations of Family Placement i n the care of the Dependent Aged.  by ROBERT MICHAUX DEILDAL  Thesis Submitted i n P a r t i a l Fulfilment of the Requirements f o r the Degree of MASTER OF SOCIAL WORK i n the School of S o c i a l Work  Accepted as conforming to the standard required f o r the degree of Master of Social Work  School of Social Work  1955 The University of B r i t i s h Columbia  ABSTRACT  The purpose of t h i s study has been to determine the f e a s i b i l i t y of introducing a foster home placement service f o r the aged i n B r i t i s h Columbia, A number of s o c i a l agencies have concerned themselves with o l d people who are no longer able to care f o r themselves, and are dependent upon others f o r many of t h e i r dependency needs. With many senior c i t i z e n s , a b i l i t y to function independently i n the community i s l i m i t e d by problems of health, n u t r i t i o n , or other b a s i c a l l y economic considerations. Very often, family support, and help from r e l a t i v e s are not available, and they must seek assistance from s o c i a l welfare agencies," At the present time, the resources offered by agencies are, f o r the most part, i n s t i t u t i o n a l , I.e., care i n licensed boarding homes, nursing homes, hospitals et cetera. I n s t i t u t i o n a l care i s , of course, required f o r those whose dependency needs are acute. I t i s not considered the best resource, however, f o r those who are dependent to the extent where they cannot l i v e alone, but whose dependency needs are not s u f f i c i e n t l y grave to require I n s t i t u t i o n a l protection. The theme of t h i s study has been an exploration of the values of foster family placement as an additional and appropriate resource f o r the care of the aged. Social agencies i n the Greater Vancouver and New Westminster areas were most co-operative i n permitting the use of case f i l e s f o r purposes of research. Over f i f t y cases were examined, of which twenty-four were selected as conforming to the d e f i n i t i o n s outlined i n Chapter I I , Home v i s i t s were made i n each case, and b r i e f s o c i a l h i s t o r i e s obtained from both c l i e n t s and foster guardians. The development of the c r i t e r i a outlined i n Chapter I I I has been based to some extent on comparable studies of placement services f o r the chronically i l l , mentally i l l , as well as f o r adoptive and f o s t e r children. In setting f o r t h the implications of the study, emphasis i s given to the professional requirements of the s o c i a l work p r a c t i t i o n e r s engaged i n the finding of suitable foster homes, the s e l e c t i o n of c l i e n t s , and the supervision of those placed i n f o s t e r care. P r a c t i c a l suggestions have been offered on subjects as, desirable physical standards of the prospective homes, the q u a l i f i c a t i o n s desired i n those who assume the major r e s p o n s i b i l i t y f o r the care of the c l i e n t , and the organization of community resources to f a c i l i t a t e the operation of the programme. The study not only I l l u s t r a t e s the v a l i d i t y of estab l i s h i n g a programme of foster home placement f o r the dependent aged, but emphasizes the need of Immediate action to a l l e v i a t e the urgent housing problems of old people.  ACKNOWLEDGEMENTS  Many people had a part In the formulation and carrying out of t h i s project.  F i r s t and foremost, thanks  are extended to members of the Lions Ladles Club of Vancouver f o r t h e i r generosity i n providing a bursary which made the research possible.  In expressing thanks, t r i b u t e  must be paid to Miss Z e l l a C o l l i n s , Miss Amy B. Edwards and Mr. Theodore Exner, the thesis advisory panel members who gave generously t h e i r experience  of t h e i r time and assistance, and of  i n the l o c a l f i e l d .  Thanks are also extended to Dr. L.C. Marsh and Mrs. Joan Grant, f a c u l t y members of the School of S o c i a l Work, who gave valuable assistance i n the organization and presentation of the research material. The writer i s very appreciative of the assistance and co-operation of a l l the i n d i v i d u a l s who helped i n the study I t s e l f .  Some represented  organizations or i n s t i t u t i o n s ,  and offered help i n t h e i r capacity as private c i t i z e n s .  Many  old people showed keen i n t e r e s t i n the project and gave p r a c t i c a l help to the study.  Because of the nature of the  study, assistance was required of many people to whom personal acknowledgement cannot be given, and i t i s p r i m a r i l y due to them that i t has been completed.  TABLE OP CONTENTS Page Chapter 1  Problems o f Adjustment In Old Age . . . . 1 General problems of the aged. Primary needs of o l d people. Medical problems of the aged. Home f a c i l i t i e s f o r the dependent aged. Purpose of the study.  Chapter I I The,Values of Foster Home Care i n Meeting the Needs of the Aged . . . . . .16 C o l l e c t i n g the necessary data - methods and procedures* Placement of o l d people. Limitations and d e f i n i t i o n s . Nineteen oase examples. Chapter I I I Evolution of C r i t e r i a  ^3  Old people suitable f o r f o s t e r home care. Family care as a therapeutic measure. Q u a l i f i c a t i o n s required i n guardians. Standards required In the foster home. Physical standards of the home. S a t i s f a c t i o n s gained i n caring f o r o l d people. Role o f the s o c i a l worker. The f i r s t period i n foster family care. Relationship of s o c i a l worker to c l i e n t and guardian. Problems and techniques of supervision. Chapter IV  The Role of the Social Worker i n a Foster Placement Programme . . . . • • ,&0 Recommendations f o r the s e l e c t i o n of homes. Professional q u a l i f i c a t i o n s of the s o c i a l worker. Evaluation of the study.  Appendix:  Bibliography  Chapter I  PROBLEMS OF ADJUSTMENT IN OLD AGE  Of the many s o c i o l o g i c a l changes taking place i n family l i f e i n Canada, those r e l a t i n g to r e s p o n s i b i l i t y f o r the care of the aged are being recognized as having increasing importance.  S c i e n t i f i c Interest i n t h i s age-group has been  greatly accelerated i n recent years.  Perusal of the programmes  of various professional conferences show that an increasing number of meetings have been planned to di<scuss the health and s o c i a l problems of o l d people, problems i n the administration of p r i v a t e and p u b l i c s o c i a l welfare programmes, and the need for  specialized s o c i a l work s k i l l s i n planning f o r the aged  person.  Social workers are becoming more and more aware that  to work e f f e c t i v e l y with the aged, they must apply the same basic casework p r i n c i p l e s that have been developed over a longer period, and with more concentration, i n work with c h i l dren, adolescents, and others with problems of s o c i a l adjustment.  These p r i n c i p l e s Include sympathetic understanding of  the i n d i v i d u a l c l i e n t , and recognition of the multiple factors of physical and mental health and well-being, family and s o c i a l s i t u a t i o n , and personality differences which affect d i f f e r e n t periods of l i f e experience.  2  There i s a need to view the p o s i t i o n of the aged i n the  community i n the new perspective and, therefore, to co-  ordinate and consolidate the t o t a l community resources to care f o r the aged dependent i n a way most s a t i s f a c t o r y to him and most advantageous f o r those responsible f o r h i s care.  In  recent years, i n B r i t i s h Columbia, there has been a growing i n t e r e s t i n the study of the problems of the o l d age. the  In 19^5  Community Chest and Council of the C i t y of Vancouver  published a "Study of the S i t u a t i o n of the Aged i n Vancouver".  1  This study, which was revised i n 19^-8, included consideration of several f i e l d s of i n t e r e s t - Maintenance; Care and Accommodation; Housing; Medical Care; Other Health Requirements and Recreation.  In addition, three studies undertaken by students  of the University of B r i t i s h Columbia School of S o c i a l Work have dealt with s p e c i f i c problems concerning the care of the aged.  The Leydier project was. a general survey of the conditions  i n licensed boarding homes i n Vancouver, with an analysis of t h e i r l i m i t a t i o n s , and recommendations f o r future p l a n n i n g .  2  The McKenzie thesis included a comprehensive survey of the f a c i l i t i e s f o r the care of the aged war veterans i n Shaughnessy Hospital.3  A c r i t i c a l evaluation of a y l o r Manor, a large T  1 Community Chest and Council; "Study of the Situation of the Aged i n Vancouver". Report of the Special Committee of the Committee on the Care of^tne Aged. Vancouver 1Q48. r  2 Bernice Leydier, Boarding Home Care for the Aged. Master of S o c i a l Work Thesis, University of B r i t i s h Columbia, I j ^ g . 3 M.B. McKenzie, "The Care of an Ageing and Disabled Group i n a Veterans Hospital". Masier or Social Work 'I'hesls. University of B r i t i s h Columbia, * 1  3 Vancouver i n s t i t u t i o n f o r o l d people, was included In the Guest Study,'  1  Other thesis studies, while not concerned  p r i m a r i l y with senior c i t i z e n s , have given consideration to various aspects of t h e i r problems, and have contributed to the general body of knowledge of the aged. More recently, the National Council of Jewish Women of Canada provided a fellowship to the School o f S o c i a l Work to be used f o r the study of the recreational Interests and a c t i v i t i e s of the aged i n Vancouver.  The report of the study,  which was printed i n mimeograph form In 195^,  2  Includes a des-  c r i p t i o n of the e x i s t i n g recreational f a c i l i t i e s f o r senior c i t i z e n s , with recommendations f o r further research p r o j e c t s .  General Problems of the Aged There are several facets o f the study of the aged yet to be explored.  As f a r as age groups are concerned, s o c i a l  research i n Canada has been more generally d i r e c t e d to infancy, childhood and adolescence.  Also, p a r t i c u l a r attention has been  given to s p e c i f i c economic groups, minority groups, and deviant groups, such as criminal offenders, the mentally i l l , p h y s i c a l l y and mentally defective.  and the  Because the s o c i a l problems  1 Dennis T, Guest. "Taylor Manor - A Survey of the F a c i l i t i e s of Vancouver's Home f o r the Aged". Master of S o c i a l Work Thesis, University of B r i t i s h Columbia, 1952. 2 Joan Grant. "Recreational Interests and A c t i v i t i e s f o r Senior C i t i z e n s i n Vancouver". School of S o c i a l Work Unlvers i t y of B r i t i s h Columbia, August, 195^. r  of the aged In British Columbia are rapidly becoming acute, the need for immediate research and the development of resources for their care are urgent matters.  The increase i n  the number of persons over sixty-five years of age i n British Columbia has been approximately eighty percent during the past decade,! during which time the total population has increased by approximately  forty percent.  It appears to be unlikely  that there w i l l be a diminution of the numbers of the aged In the future.  The fight against death, and the prolongation of  l i f e i s the legitimate concern of science, and i s resulting i n a great numerical increase of aged persons on this continent and elsewhere. The solution of any one or more of the problems of old people affects personally every member of society. A l l people hope to l i v e long and useful lives and should, therefore, be concerned.  Since many aspects of modern l i f e make individual  preparations for old age very d i f f i c u l t , everyone has some personal involvement i n the problems.  In many respects, the  way of l i f e i n British Columbia i s very demanding, and requires much effort on the part of individuals.  Because of i t s com-  petition character, i t s constant changes and quickness of pace, irregularities of employment, and the demands on current incomes i n the modern consumer's market economy, saving and  1 See the Canadian Year Book for 195^, Chapter 3 Population. Published by the Dominion Bureau of Statistics, Ottawa, 195^  5 preparation for the future i s very d i f f i c u l t , i f not impossible. Thus a large proportion of the aged are dependent upon others for financial support.  There i s good reason for concern about  not being able to meet the needs of old people i n the community i n the traditional ways. Two generations ago, the care of the aged was considered to" be a family matter and, to some extent the legal philosophy reflected this attitude.  The Parents'  Maintenance Act i s a statute remaining, which i f enforced, can ' 1  make sons and daughters liable for the support of their aged or incapacitated parents.  The fact that this legislation i s seldom  enforced i s indicative of the recognition that the care of the aged i s also a public responsibility. The recently accelerated transition of Canadian culture from a rural to the predominantly urban way of l i f e , accompanied by an increase i n home building costs, i s resulting the reduction of l i v i n g space per family unit.  F i f t y years ago, i t was the  custom to have homes sufficiently large to accommodate grandparents, children and grandchildren.  The greatest number of  homes now being constructed are only capable of accommodating parents and children.  In most instances, i t i s no longer  possible for the three generations to live i n one house, and i t i s usually the aged grandparents who must l i v e elsewhere.  The  increased cost of l i v i n g , accompanied by the higher standards  1 Revised Statutes of British Columbia - 19H-B, "An Act to provide for the Maintenance of Parents by their Children" PP. 3775*77, Vol, 3, King's Printers, Victoria, B.C.  6 of care considered appropriate for the aged, make the f u l f i l ment of the traditional family obligations very d i f f i c u l t . Many young people feel a moral obligation to assist their parents i f they are not self-supporting, and to furnish them with l i v i n g quarters and board, as well as with any medical care they might need.  Sometimes sons and daughters  assume duties which often become Increasingly arduous; 6r i f they refuse to assume them, face social censure, resentment, and feelings of guilt.  Neither course offers a satisfactory  solution. On the other hand, the individual's adjustment to old age i s often d i f f i c u l t .  Human l i f e includes a period of growth,  a peak i n capacities, and f i n a l l y , a decline i n physical and mental capacities.  Each stage of development requires that the  individual adopt different patterns of behaviour i n order to adjust himself to l i f e .  Those who have not the ability to  adapt themselves to changes i n status and function constitute a sociological problem.  There i s a tendency i n Canadian society,  as i n other countries, toward the "age-typing  11  of roles and the  individual status. Society designates certain roles and compensations as being appropriate for different age levels. Because of this typing", which often seems to be arbitrary, the individual must give up certain behaviour and forego accustomed compensations as he enters a new age-group. The ease or d i f f i culty of change depends on whether the new behaviour and compensations are desirable i n terms of the cultured values of the total social group.  7 Related to this, there has been an Increasing trend i n industry, the c i v i l services, and other occupations, toward compulsory retirement at a comparatively early age level.  In  a large number of instances, the employee i s obliged to terminate his employment years before the time when his productivity f a l l s below the level at which he i s s t i l l able to make a positive economic contribution to society.  This results i n a  large number of elderly people with leisure time, and with l i t t l e to do to occupy themselves. Many must be dependent on reduced incomes, perhaps wholly or partly dependent on old age pensions, or, to a greater or lesser extent, upon children  and  relations. Work, Independence, and freedom seem to be among the highest social values i n this society, and limitations of behaviour are prone to be considered as a hardship, particularly since l i t t l e compensation in status i s offered for such l i m i t ations.  This means that a l l ages except early adulthood tend  to be problem ages.  The special problem character of old age  i s inherent i n the fact that i t s limitations are experienced after a period of freedom from such restraints.  It i s d i f f i c u l t  for old people to rationalize the changes as a transition to a more desirable situation.  The limitations of childhood, and  especially of adolescence, may  be mitigated by expectation of  their removal in the future, but the limitations of old must increase rather than diminish.  age  Added to this, the way i n which age-groups are typed tends to aggravate the d i f f i c u l t i e s of adjustment i n old age. In this respect, the Western Canadian attitudes are different from those of many other cultures, and also from Its own earlystages.  In primitive communities, and formerly i n this country,  age-typing depended on the actual biological impact of ageing, rather than the rather rigid chronological age-typing that i s now employed. With the mathematical awareness of age as demonstrated by the frequent use of birth certificates and formal age grouping, and compulsory retirement at a certain chronological age, the point has been reached where age-typing i s based, not so much on manifestations, as on expectations of changes with age. The result of this, therefore, i s that behaviour changes are expected from people whose manifestations of age would not require i t .  This creates many a r t i f i c i a l  tensions, and contributes to their special problems of adjustment.  Primary Meeds of Old People To gain knowledge which w i l l provide a basis for organizing programmes to help older people find effective and satisfactory adjustment, i t i s necessary to analyze the problems of ageing, and the individual's reactions to those problems. It i s also necessary to relate both problems and reactions to the Individual level of adjustment, Meeds may be described as conditions of dissatisfaction  9 wherein the individual experiences a lack of adjustment. The individual i s impelled to behave i n ways calculated to satisfy whatever requirement Is unfulfilled at the time being. When the need i s satisfied, the Individual i s adjusted insofar as the particular need i s concerned, although he may not be adjusted with respect to other needs that are manifest at the same time. The well-adjusted person i s one who i s able to satisfy his needs quickly and adequately as they arise.  A poorly-adjusted person,  on the other hand, i s unable to satisfy his needs, and remains i n a condition of "unadjustment", which i s more or less severe depending on the nature and strength of his unsatisfied needs. Basically, the needs of old people are like those of a l l other people.  They want, primarily, financial security,  freedom from concern about their next meal, and freedom from worry about housing.  They desire security, not only for the  present, but for the rest of their days.  They need housing  with the sort of l i v i n g conditions that are most suitable to their individual situations.  Those who are i l l want good  medical care. Most of a l l , they want emotional security.  They  need to feel that they are wanted, and to have a sense of "belonging".  Old people want to feel that they s t i l l matter  to someone, and are Important and useful beings.  1  They want  t  to be considered as individuals, and not Just the group that i s loosely classified as "the aged".  1 Tbwle, Charlotte, Common Human Needs, Washington, United States Government Printing Office, 1945, pp. bg-72.  10 Recently, the -writer had a discussion with a delegate who had attended the "Northwest Institute on Serving the Needs of Our Ageing Population" held i n Seattle, Washington on November 11, 12 and 13, 195*-. The Conference agenda included 1  discussions of many of the facets of the study of old age. It was reported, however, that although there was a great divergency of subject matter from session to session, nearly every speaker re-iterated the Importance of emotional security to the social adjustment of old people.  Evidently, a l l authorities agree that,  to the old person, the satisfactions acquired i n a home where he i s wanted, loved, and i s considered to be an important family member, transcend such values as high material standards, Income, et cetera. These objectives are not very different from the. average objectives of the average citizen.  I t i s essential  that there be a re-orientation of thinking and approach i n the planning for the welfare of senior citizens.  It must be recog-  nized that the old react to l i f e experience i n as many ways as do the young. Fundamentally, the needs of the old person are those common to a l l people, and must be met on an individual basis.  Although the need may be similar, the method of g r a t i f i -  cation i s often different from that of the younger person. For example, a youngster might sublimate his aggressiveness through participation in a hockey game. The older person, too, has a need of an outlet of his aggressive and pleasure-seeking tendencies.  In the role of a spectator, he might be able to  gratify the need by vicarious participation.  11 Medical Problems of the Aged There has been a greater emphasis on the study of the b i o l o g i c a l factors of ageing than on i t s s o c i e t a l problems. There has been extensive research i n matters pertaining to the health, nursing, and medical care of the aged.  The development  of these studies has given r i s e to the science of g e r i a t r i c s , i . e . the study of the various diseases and p h y s i c a l disorders suffered by old people, the most suitable techniques f o r t h e i r treatment, and measures f o r preventative medical care,?" A discussion of the s p e c i f i c medical problems of t h i s age-group i s not necessary f o r the purposes of t h i s study. Nevertheless, the medical implications of the processes of ageing have an impact on the t o t a l problem.  Old age i s i n v a r i a b l y  accompanied, to a greater or l e s s e r degree, by a d e t e r i p r a t i n g physical condition.  Although most of the p h y s i c a l disorders  and diseases of o l d people are not very d i f f e r e n t from those suffered by the young, proportionately, the incidence of i l l n e s s i s much higher.  A person i n poor physical health may often have  a constructive and happy l i f e i f , otherwise, h i s emotional and material needs are f u l f i l l e d .  With many o l d people, however,  t h i s i s v i r t u a l l y impossible. Too often, the d e t e r i o r a t i n g physical condition which comes with age may be aggravated by inadequate diet and poor housing conditions - sometimes with both.  1 Newsweek, Advancing Age: How I t Comes and How to Ad.lust. February g, 195^-, Weekly Publications, Inc., Dayton, Ohio. ~  12  Home F a c i l i t i e s for the Dependent Aged There i s already i n British Columbia, and especially in the Greater Vancouver area, growing interest i n the housing problems of senior citizens.  An evaluation of their housing  needs, and recommendations for future planning was included i n the Vancouver Community Chest and Council surveys.  Several  thesis written by University of British Columbia Social Work students have added to the knowledge of this social problem. The problem, has been given further discussion and consideration in social work and medical conferences, newspaper articles, professional periodicals, et cetera. For the most part, the study of the housing problems of the aged has been directed toward evaluation of the existing f a c i l i t i e s for care of old people without homes, and plans for the Improvement of these resources. At the present time the major resources for senior citizens who require protective care are restricted to institutions. In the Lower Mainland area of British Columbia exist several types of institutions, i . e . infirmaries for the aged, nursing homes, low-cost housing projects, boarding homes licenced under the Welfare Institutions Licencing Act, and Old Folks homes operated and owned by church and national groups. In addition to these, both the Provincial Mental Hospital at Essondale, and the Veterans Hospital i n Vancouver have units 1  for aged patients.  Rural areas of the province, of course,  cannot provide the same variety of services.  13 The standards of care of the various Institutions vary, and while i t i s f e l t that there are inadequacies, there are indications that steps are planned to meet these i n the next few years.  The fact that there i s a variety of institutions  designed for dependent old people certainly does not mean that their housing needs are being met adequately.  On the contrary,  as the number of old people i n the province progressively Increases, institutional resources are less able to assume the responsibility for the care of a l l the aged.  The development  on institutional f a c i l i t i e s i s simply not keeping pace with the increase i n the number of old people requiring protective care. People concerned with the care of the aged are becoming more and more aware that however valuable institutional care may be for many old people In need of protection and specialized help, i t i s not the most suitable resource for many others whose dependency needs are less acute. The findings of previous surveys illustrate the limitations of institutional care for the aged - limited i n the sense that they often cannot f u l l y meet the special Individual needs of many old people, and cannot keep up with the housing requirements of the increasing number of senior citizens. There appears to be no doubt that the development of a method of alleviating the situation i s a matter of immediate necessity. The suggestion that the placement of old people with private families on a "foster" home basis, as a means of reducing the housing problem, has occurred i n several studies. To date, however, this proposal has not been explored thoroughly.  1*  Purpose of the Study Some social agencies in British Columbia, notably the Children's Aid Society and the Social Welfare Branch of the Provincial Department of Health and Welfare, have staff members specifically trained and experienced inrthe placement i  of children.  These agencies have social workers who are  skilled i n the techniques of finding and evaluating of foster and adoptive homes for dependent children who, for a variety of reasons, are no longer receiving.care from natural parents. These workers are also skilled i n the placing of an adoptive or foster child i n a home that might best meet i t s particular emotional and material needs. At the present time, no social agency has Instituted similar services for the dependent aged as a specified part of agency function.  In actual practice, however, social  workers in some agencies occasionally place old people i n the protective care of private families.  Such placements are  usually made by workers with generalized case loads.  There are  no workers who have been specially trained In the techniques of selecting suitable foster homes for old people, and are skilled i n the classification procedure of finding suitable clients for particular homes. It was the intention of this study to determine the f e a s i b i l i t y of instituting such a service.  Although no attempt  has been made here to prepare a s t a t i s t i c a l evaluation of the need for a foster home care programme, an effort has been made  15 to indicate the need i n a non-statistical way, by evaluating the merits of foster homes that already exist, and by reporting the benefits gained by the aged recipients of this type of care.  Chapter I I  THE VALUE OP POSTER CARE IN MEETING THE NEEDS OP THE AGED  Collecting; the Necessary Data - Methods and Procedures As mentioned before, no s o c i a l agency i n B r i t i s h v  Columbia has developed a programme of f o s t e r home f i n d i n g and placement f o r the dependent aged.  This i s s i g n i f i c a n t  because, when an aged person who previously has l i v e d independently or with h i s family or r e l a t i v e s , loses h i s a b i l i t y to l i v e by himself, or when the family situation deteriorates, the only resources the s o c i a l agency has immediately available for h i s care are i n s t i t u t i o n a l . I n s t i t u t i o n a l care includes nursing home, boarding home and h o s p i t a l care.  As yet, there i s no intermediary  resource f o r caring f o r old people who are p a r t i a l l y dependent, though not to the extent where they require the specialized care of i n s t i t u t i o n s . Since there were no documented cases of old people who had been formally placed by an agency i n private family care, t h i s study posed the problem of f i n d i n g existing foster homes f o r the aged that might meet the conditions of the foregoing d e f i n i t i o n s .  S o c i a l case workers of the  Social Welfare Branch o f f i c e s i n Vancouver, New Westminster  17  and Burnaby were most co-operative i n giving the names of people i n their respective case loads who might be considered to be r e c i p i e n t s of foster care. Thirty-three such cases were presented, of which twenty-one have been selected as meeting the requirements of foster homes according to d e f i n i t i o n .  Two more cases  were obtained through a Salvation Army o f f i c e r i n New Westminster,  and another was recommended by a friend of  the writer.  The case recording i n none of these cases was,  s u f f i c i e n t f o r the purpose of the enquiry, therefore v i s i t s were made to a l l foster homes.  In every home, except two,  both guardians and t h e i r foster charges were interviewed. In two cases the o l d person had recently been h o s p i t a l i z e d f o r a temporary period, and was not available f o r interview. Information received from the other foster homes varied considerably from one to the other.  In some situations,  f u l l h i s t o r i e s were obtainable from both hosts and f o s t e r charges.  I n other Instances the information received was of  a r e l a t i v e l y s u p e r f i c i a l nature. for this.  There were several reasons  In two homes the aged person was s e n i l e .  other homes there were d i f f i c u l t i e s i n language,  In two  A very o l d  Chinese immigrant l i v i n g happily i n the home of a middle-aged Chinese couple could speak no English, nor could an aged Norwegian gentleman who was l i v i n g with f r i e n d s .  I t was  therefore impossible to acquire information d i r e c t l y from these men.  18  In addition to the information and ideas r e s u l t i n g from interviews with caretakers and c l i e n t s i n foster homes, valuable suggestions were obtained through discussions with s o c i a l workers i n other agencies, from laymen interested i n the subject, and from old people i n i n s t i t u t i o n s .  The  matter of placement f o r family care was discussed with the inmates and superintendents of f i v e boarding homes f o r aged, and i n the f i v e boarding homes, twenty-one Inmates were Interviewed,  Two nursing homes i n Burnaby were v i s i t e d  discussions* were held with s t a f f members.  and  In Burnaby and  New Westminster three low-rent housing projects f o r the aged were v i s i t e d .  Several people were asked to give t h e i r  personal opinions regarding p r i v a t e family placement. A l l i n a l l , most old people indicated great i n t e r e s t i n t h i s alternate proposal f o r care of the aged, and many of t h e i r opinions and suggestions have been incorporated i n the present text. Two boarding homes i n South Burnaby were v i s i t e d . Each home had four o l d men  as Inmates, and was licensed under  the Welfare I n s t i t u t i o n s Licensing Act,  The general f a c i l -  i t i e s of these i n s t i t u t i o n s are good compared with others of t h e i r sort i n the Municipality of Burnaby, inmates range from 72  to 90 years.  The ages of these  Each inmate i s able to be  up and about and to look after h i s own personal needs In the matter of dressing, feeding himself and personal hygiene.  19  Two of the men had l i v e d i n the same boarding home f o r over seven years, two for over four years, and the remaining four f o r l e s s than four years. i t a t e d or senile. an independent  None are completely incapac-  Since l o s i n g t h e i r a b i l i t i e s to l i v e i n  fashion, and becoming p a r t i a l l y incapacitated  for work and productive a c t i v i t y , these o l d men have been alone i n t h e i r rooms f o r many years.  Aside from simple work  i n the home, with t h e i r hobbles, helping with dishes and making beds, they are unproductive.  Because of diminishing  physical f a c u l t i e s , each has experienced, a rather sudden t r a n s i t i o n from independent  l i v i n g i n the active world, to  a state of inactive dependency i n which he has l i t t l e or no opportunity to make use of h i s remaining productiveness. They have good care with regard to t h e i r material needs, but are no longer able to make a contribution to the general welfare of the community.  Placement of Old People The f i l e s of the Social Welfare Branch O f f i c e s show many instances of o l d people l i v i n g by themselves i n homes of t h e i r own, facilities.  or i n rented rooms with very meagre  Because of feebleness or other forms of i n -  capacitation, these people are dependent on others - t h e i r neighbours, the v i s i t i n g s o c i a l worker, the p u b l i c health nurse, or r e l a t i v e s , f o r the fulfilment of many of t h e i r  20  needs.  Yet, because they c l i n g tenaciously to the residue  of t h e i r former Independence, and because they may not be e l i g i b l e f o r i n s t i t u t i o n a l care, t h e i r needs are not met adequately enough to provide them with normal s a t i s f a c t i o n s . Many of t h i s group have raised f a m i l i e s , or at l e a s t , have had many years of p a r t i c i p a t i o n i n a family setting.  Many  people i n t h i s category, with proper methods of selection, would be placed i n private homes i n family settings that approximate t h e i r former homes.  These might be the most  l i k e l y candidates f o r f o s t e r home placement.  The i n d i v i d u a l ' s  need f o r a degree of independence could be re-directed so he might obtain g r a t i f i c a t i o n by contributing to the home management i n many ways, such as help In the garden, with house work, cooking, baby-sitting, et cetra. Some aged persons with a mild s e n i l i t y , though harmless to themselves and to others, are f a r removed mentally from the r e a l i t i e s of l i f e .  Often such a person  l i v e s contentedly i n the dream wo rid..he has created f o r himself with h i s delusions, reminiscences and bizarre ideas. His i l l n e s s may not be acute and he may not be i n need of the more highly specialized services offered by boarding . homes and nursing homes.  Though he i s not well enough  mentally to do much work, he may enjoy caring f o r h i s room and doing small tasks around the home, . A simple wholesome environment  w i l l meet h i s emotional needs, and close.sym-  pathetic supervision of a c a r e f u l l y chosen home w i l l give  21  him the necessary protection and sense of 'belonging*. This study has been of an exploratory nature and, as such, no attempt has been made to present a s t a t i s t i c a l assessment of the need f o r 'foster homes' for the dependent aged.  Rather, i t has been an attempt to indicate i n fact  that such a need i s existent, through a comparative study of licenced boarding and nursing homes and of 'foster homes  1  where old people have more or l e s s inadvertently found themselves to be.  The cases described i n the study would  c e r t a i n l y suggest that placement  In private homes has much  to o f f e r f o r many of the aged i n terms of personal happiness and fulfilment of i n d i v i d u a l requirements.  I t i s evident  from the cases studied that family care can have a p o s i t i v e therapeutic value, i n many cases f a r more so than i n s t i t utional placement.  Too often, i n s t i t u t i o n a l care i s the  only resource remaining f o r aged people whose dependency needs have increased to the extent where they can no longer l i v e with t h e i r immediate f a m i l i e s .  Most i n s t i t u t i o n s must  adopt more or l e s s uniform techniques i n caring f o r t h e i r charges, necessarily with l e s s emphasis on i n d i v i d u a l i z a t i o n of treatment*  However well the Individual's material  requirements might be met, he usually misses the personal attentions to which he was formerly accustomed.  The Imper-  sonal, and occasionally, cold regimented routine of an i n s t i t u t i o n can be conducive to d e t e r i o r a t i o n o f the person's feelings of well being, p a r t i c u l a r l y to h i s self-esteem.  22  It seems obvious to him that he i s not wanted or r e a l l y needed, and he tends to give up the struggle f o r prestige and recognition. The personalized, i n d i v i d u a l i z e d care that can be gained i n family placement should prove to be more conducive to the arrest of personality d e t e r i o r a t i o n . Although family care i s not necessarily of greater value i n restoring the aged person's a b i l i t y to function i n a more independent manner, i t should tend to arrest or slow down the process of decline i n a greater number of cases. It i s by no means suggested that family care i n 'foster homes' should be a substitute f o r placement i n i n s t i t u t i o n a l homes f o r the aged.  Rather, i t can, at best,  be only another means by which a s o c i a l agency i s able, to expand and augment the present services offered to the aged. The l i m i t a t i o n s of t h i s type of s o c i a l service must be recognized by a placement worker, and each case evaluated on i t s own merits,  ,  Limitations and D e f i n i t i o n s Primarily, t h i s study i s an enquiry into the f e a s i b i l i t y of i n s t i t u t i n g a plan i n which f o s t e r care or private family care could be used as an additional resource i n the care of the dependent o l d people.  Since the object  of the investigation i s the study of a s p e c i f i c group, i t i s f i r s t necessary to delimit the areas of relevant research. This poses some important conceptual questions: (1) Should  23  the d e f i n i t i o n of o l d age be chronological of functional? (2) Should i t be general or s p e c i f i c ? several age sub-groups or only one?  (3) Should i t cover  {K) What constitutes  dependency? The terms 'old age and 'dependency' are both 1  r e l a t i v e and require d e f i n i t i o n and d e l i m i t a t i o n . Some people are p h y s i c a l l y and mentally old at f i f t y  years,  while others are robust and strong at seventy-five.  I t Is  impossible to plan f o r the extremes In the same way. The term 'aged', as generally applied, covers a large proportion of the population.  In Canada, one may become e l i g i b l e at  the age of s i x t y - f i v e f o r public assistance under the provisions of the Old Age Assistance Act,  I t would there-  fore appear that s i x t y - f i v e i s the chronological age that i s generally accepted as the beginning of o l d age. Throughout t h i s study, therefore, o l d age f o r both males and females w i l l be considered  to mean the chronological age  of s i x t y - f i v e or over. In a s i m i l a r way, the term 'dependent' i s r e l a t i v e , and there are many degrees and forms of dependency. At b i r t h and during the early years of a c h i l d ' s development, he i s completely dependent on others f o r the g r a t i f i c a t i o n of a l l h i s needs.  A l l physical and emotional requirements  have to be f u l f i l l e d by h i s parents and others who may have the r e s p o n s i b i l i t y of h i s care.  During the process of  maturation the c h i l d becomes progressively l e s s dependent  upon h i e parents, and r e l i e s more and more upon others In his  s o c i a l environment to meet h i s needs.  He becomes pro-  gressively more s e l f - r e l i a n t and, In turn, learns to contribute to the well-being and protection of others i n h i s s o c i a l group.  No one ever achieves the state of complete  independency, but throughout l i f e one i s always dependent on others to some extent i n order to l i v e happily.  The mature  adult person i s not independent, but i s i n a state of l n t e r dependency with others In h i s s o c i a l m i l i e u .  As the  i n d i v i d u a l ages, there i s a lessening of h i s physical, and occasionally, h i s mental c a p a b i l i t i e s , and he i s gradually, and .sometimes suddenly, reduced from t h i s state of i n t e r dependency to one of p a r t i a l or complete dependency. It i s i n connection with dependency that the element of protective care a r i s e s .  Children need protection because  of t h e i r immaturity of Judgment, and because of the fact that,, i n the formative period of childhood, opportunities f o r f u l l mental and emotional growth need to be safeguarded.  In o l d  age, on the other hand, the i n d i v i d u a l needs protection or supportive help to the extent that h i s diminishing p h y s i c a l or mental c a p a b i l i t i e s prevent continuing function at the previous l e v e l o f inter-dependency. The degree of one's dependency i s l a r g e l y based on two f a c t o r s :  the functional capacity of the i n d i v i d u a l , and  the state of h i s mental health.  Functional capacity i s deter-  mined by the extent to which he i s able to provide f o r h i s  25  physical requirements. Mental health includes h i s attitudes, f a c u l t i e s f o r reasoning., s o c i a l adjustment, i n t e l l e c t , memory, et cetera.  To determine the degree to which a person i s  dependent, i t i s necessary to know both h i s physical or funct i o n a l capacity and the state of h i s mental health, and to assess the relationship of one with the other. The expression 'dependent aged' i s used i n t h i s study as applying to those persons of either sex, of s i x t y f i v e years or over who are incapable, f o r physical or mental reasons, of providing f o r t h e i r own needs, to the extent where they require some form of protective care.  Since t h i s study  i s concerned with that category of the aged that might best benefit from a private home placement, i t i s preferable that the d e f i n i t i o n be further l i m i t e d to exclude the mentally i l l , It can, however, include individuals who are m i l d l y senescent, but not to the degree where conduct Is seriously disorientated, destructive, or uncontrollable. The term 'foster home' here r e f e r s to the family situation i n which the dependent aged person might be placed for protective care.  A rather broad d e f i n i t i o n has been used,  to include situations where the aged Individual i s l i v i n g with a family group comprised of a husband and wife with or without children, or with a single i n d i v i d u a l upon whom he i s dependent f o r some of h i s needs.  I t may also include the s i t u a t i o n where  an aged person who i s dependent l i v e s with another dependent  26  person, but whose dependency needs are complementary, that Is,  where each i s able to meet the other's dependency require-  ments to the s a t i s f a c t i o n of both.  The d e f i n i t i o n also i n -  cludes those homes which accept remuneration f o r the care of the dependent person. The terms 'hostess' or '.guardian' are used to mean the person i n the foster family who takes the major responsib i l i t y i n caring f o r the aged c l i e n t .  In r e f e r r i n g to the  hostess or guardian as 'she' i n the text, there i s no intention of b e l i t t l i n g the importance o f the man's part i n caring f o r the c l i e n t .  Rather, t h i s merely follows accepted  usage which, because of the nature of the work, gives the woman the more prominent place. Nineteen Case Examples The remainder of t h i s chapter contains nineteen case studies that I l l u s t r a t e the values as well as the l i m i t ations of family placement f o r old people.  Chapter I I I  attempts to establish c e r t a i n c r i t e r i a with reference to the cases described, and Chapter IV includes an evaluation of the t o t a l study. Case 1, Social History: A woman, s i x t y - f i v e years of age, was p a r t i a l l y incapacitated because of f r a i l health. In appearance, she appeared to be a good deal older than her actual age. She showed l i t t l e a b i l i t y to form friendships and her emotional adjustment was not good. After her husband's death i n 1950, she began to l i v e with her daughter and son-in-law.  27  Reason f o r Placement: Because t h i s woman was i r r i t a b l e and very impatient with her grandchildren, her daughter decided that It would be better f o r a l l concerned that she l i v e elsewhere. It was explained to the o l d lady that the home was not s u f f i c i e n t l y large to accommodate the parents and children, as well as her. Choice of Placement; She was placed by her daughter as a boarder i n the home of a widow who was i n receipt of an old age pension. The guardian was i n good health, and was a w e l l adjusted and extrovertic person. She welcomed a boarder i n order to defray some of the expenses of maintaining her home. Period of Adjustment: The relationship of the boarder to the guardian was one of dependency and she r e l i e d on her to a great extent f o r guidance and f o r the f u l f i l m e n t of many of her needs. The guardian treated her with patience and tolerant understanding. She i n s i s t e d , however, that she a s s i s t i n a l l household tasks such as cooking, sewing, and housework. She interested her i n church a c t i v i t i e s , and included her i n her own c i r c l e of friends. Evaluation: The woman's health improved considerably and, over a period of eighteen months, she became progressively less dependent upon her guardian. She regained much o f her a b i l i t y to function i n a more independent manner. Several months ago she accepted $he proposal of a" seventy-two year o l d man and l e f t the home to be married. Case 2,  Social History: A s i x t y - s i x year o l d woman spent two years In the P r o v i n c i a l Mental Hospital following a "nervous breakdown". On her release she was returned to her family. Her behaviour i n the home was sometimes unpredictable and she had occasional lapses of memory, Under the supervision of her husband she managed to function f a i r l y s a t l s f a c t o r . i l y . A f t e r h i s death i n 1952, her behaviour became more eccentric, and the son and daughter-in-law, with whom she l i v e d , could no longer put up with her. Reason f o r Placement: Her e r r a t i c behaviour proved to have a disrupting influence on the children i n the home. She developed a habit of wandering away from home and becoming l o s t . The  28  daughter-in-law did not have the time nor patience to care f o r her properly, so placement in.another home became necessary. Choice of Placementt The o l d lady's son found a woman of her own age who agreed to accept $65.00 a month f o r her care. The two women had known each other f o r years, although they had never been close f r i e n d s . Period of Adjustment: At f i r s t , the old woman took very lixitle interest i n her new surroundings, and her manner with her guardian was demanding and petulant. She resented the fact that she had to leave her former home. For the f i r s t two weeks, she sat i n the shade of a tree a l l day except when called f o r her meals. L i t t l e by l i t t l e she began to form an attachment f o r her hostess, who was a patient and understanding woman. Gradually, she began to take part i n the performing of household tasks and now, after two years, takes almost as much r e s p o n s i b i l i t y f o r the housekeeping, cooking, and gardening as does her guardian. Evaluation: This woman, who previously had been surly and d i f f i c u l t , has become pleasant around the house and i s now taking her place as a cont r i b u t i n g member of the family. She i s s t i l l very dependent upon her guardian f o r many of her needs, p a r t i c u l a r l y those with emotional content, and also, she i s s t i l l an i l l person with l i t t l e hope of complete recovery. But, i n t h i s home her adjustment i s s u f f i c i e n t f o r her own personal happiness, and further d e t e r i o r a t i o n of persona l i t y has evidently been arrested. Case 3. Social History: On the death of her husband a f t e r fifty-two years of marriage, one o l d woman became very despondent and r e c l u s i v e . Her income from her husband's estate was s u f f i c i e n t for her to l i v e comfortably, but she r e t i r e d to the seclusion of her apartment and rejected a l l overtures of f r i e n d l i n e s s from r e l a t i v e s and old acquaintances. For several months, the only people with whom she had contact were those who made store d e l i v e r i e s to her door. She no longer took pride i n her appearance, and there was a marked d e t e r i o r a t i o n i n her habits of cleanliness. Reason f o r Placement:  F i n a l l y , she became i l l  29  and was h o s p i t a l i z e d f o r several weeks. I t was found that she had no organic disease, but was suffering from neglect and under-nourishment. She appeared to respond to the s o c i a l contacts with other patients during her convalescence and, with the help of a medical s o c i a l worker, began to r e a l i z e that i t would be better not to return to her home. Choice of Placement: On discharge from the hospital,, a home was found for her. The family comprised of parents of early middle-age and three teen-age children. Period of Adjustment: She was treated kindly, and soon assumed the t r a d i t i o n a l r o l e of "Grannie" i n the home. She was, i n f a c t , distinguished by t h i s name by a l l members of the family. Within a few weeks, she was taking part i n a l l family group a c t i v i t i e s . Evaluation: The old woman's p h y s i c a l health improved as time went on. This was accompanied by a renewal of i n t e r e s t i n former friends and s o c i a l a c t i v i t i e s . In her reminiscences, she speaks n o s t a l g i c a l l y of her l a t e husband, but the thought of h i s death no longer provokes a mood of despondency. Case ^. Social History: An eighty year o l d man was released from the P r o v i n c i a l Mental Hospital after treatment extending over a period of three months. Evidently, he had suffered a mild psychotic disorder but had responded favourably to electro-shock therapy. While i n the i n s t i t ution, a worker of the Essondale p s y c h i a t r i c s o c i a l service p a r t i c i p a t e d i n h i s treatment and pre-discharge planning. A good deal was known of the man's s o c i a l and family h i s t o r y and the environmental circumstances that evidently had contributed to h i s i l l n e s s . For some years p r i o r to h i s committal he had l i v e d with h i s second wife, who was many years h i s junior, i n the house of h i s son and daughter-in-law. The home was characterized by discord and excessive drinking, along with a deplorable neglect f o r the old man's needs. Reason f o r Placement: The h o s p i t a l a u t h o r i t i e s considered that return to this home would be a very i l l - a d v i s e d course, so a special placement was made i n the private home of a young couple with two children.  30  Period of Adjustment: So f a r , t h i s placement has continued for almost two years. The old gentleman's mental health has not deteriorated and, i n f a c t , there are i n d i c a t i o n s that i t has improved to some extent. Evaluation: He appears to be quite content i n the home and, i n recent months, has been working as a clerk i n a small store on a part-time basis. This i s the f i r s t time he has been able to work for a number of years. Case 5.  Social History: Another family could no longer look a f t e r an aged father who constituted a f i n a n c i a l burden to them. In addition, he was * an irascible, o l d man and was continually provoking quarrels with h i s son and daughter-in-law. He became progressively more unhappy and more d i f f i c u l t to please as time went on, and was very disrupting to the family routine. There were, nevertheless, strong bonds of a f f e c t i o n between a l l members of the family, and the son f e l t a great r e s p o n s i b i l i t y f o r the care of h i s father. Reason f o r Placement: The clergyman of the church to which they belonged suggested they t r y l i v i n g apart from each other f o r a few months. He went further to o f f e r to take the old man into his home f o r a while. Period of Adjustment: The minister, a very tolerant man with a profound understanding of human relationships, worked i n t e n s i v e l y with both the old man and the family. Both p a r t i e s were helped to understand t h e i r own and each others f a i l i n g s and strengths. During t h i s period of separation, which extended over almost a year, the minister encouraged frequent v i s i t i n g , and, as well as t h i s , contact was maintained through the medium of church a c t i v i t i e s . Evaluation: Gradually, the old man began to stay with h i s son and daughter-in-law f o r periods of several days at a time. With the help of the minister,'he had beoome more tractable and w i l l i n g to conform to the demands of the home. Several months ago he moved back on a permanent basis.  It was evident during the course of t h i s study that  31  i n c e r t a i n cases,, improvement can be expected when the o l d person i s removed from an i n s t i t u t i o n and placed In a private home.  The greater variety of a c t i v i t i e s i n a family  setting tends to cause the person to be more responsive and interested i n h i s environment. Case 6. Social History: One s e l f - s u f f i c i e n t old gentleman, a widower, managed to l i v e alone u n t i l 1952, at which time he severely ruptured himself i n a f a l l . U n t i l then, with the help of his old-age pension, he had been able to meet h i s own needs without other help. He r e s ponded favourably to an operation, but on h i s release from h o s p i t a l , he found that he could no longer l i v e alone. A s o c i a l worker of the Social Welfare Branch found a placement f o r him i n a licenced boarding home where he remained for two years. He describes t h i s as the unhapplest period of h i s l i f e . He says that he was well cared f o r , the meals were good, and the home was warm and comfortable, but the i n a c t i v i t y was 'unbearable'. When, interviewed, the supervisor of the home described him as a morose, unhappy old man, who 'wouldn't l i f t a finger to help h e r and had not been known to do anything but s i t q u i e t l y i n h i s room or. pace up and down the h a l l s of the home i n utter boredom. 1  1 Choice of Placement: F i n a l l y , i n 195! -., on h i s own i n i t i a t i v e , the old man arranged to l i v e with a middle-aged couple i n the c i t y . He p a i d 14-5.00 o f - h i s $50,00 old age pension to the landlord, and i n return, received h i s board and room.  Evaluation: When v i s i t e d , he was s i t t i n g i n the warm, sunny kitchen of h i s 'foster home', preparing vegetables and helping with other l i g h t household tasks. The people with whom he l i v e 6 , said that he helps with the flower garden to such an extent that he f e e l s i t to be h i s own creation, and h i s pride i n i t 1B unbounded. This man's Interest i n work and other purposeful a c t i v i t y had not been evident during h i s placement i n the boarding home. As i n others, t h i s  32  case demonstrates that when an aged person i s able to become more useful and productive than he has been previously, he i s usually much happier and more content, This i s almost Invariably accompanied by other Improvements i n habits and behaviour. Case 7. Social History: A very old lady f e l t both hurt and resentful toward her son and daughter-inlaw. Not r e a l i z i n g that t h e i r home was too small for the growing family, and that they were f a r too busy to give her the special care she required, she thought, they had been very unjust i n arranging f o r her care i n a licenced boarding home. In the i n s t i t u t i o n she refused to take part i n any of the a c t i v i t i e s and remained aloof from the rest of the inmates. After a l i f e t i m e of family l i v i n g , to her, l i f e i n the boarding home was monotonous, f r u s t r a t i n g and lonely. Whereas formerly she had been an active, easygoing extroverted person, she was reduced to bitterness and passive rebelliousness. Reason f o r Placement: Her daughter-in-law, who v i s i t e d frequently, became very concerned about her change i n demeanour, and a f t e r several months, made arrangements for her to l i v e with a middle-aged widow i n the same small town. Evaluation: The old woman had known her guardian and her children f o r years, so welcomed the change of environment. Since her return from the i n s t i t u t i o n , she has regained her former attitudes of optimism and cheerfulness and, In spite of her physical f r a i l t y , seems quite content. Social workers generally consider i t not f e a s i b l e to select f o r placement i n family care, c l i e n t s who  are i n a  stage of advanced s e n i l i t y , or helpless p h y s i c a l I n f i r m i t y , Two  cases examined i n t h i s survey, however, were concerned  with people who were quite s e n i l e . placement concerned an o l d man Case g. Social History:  who  Another successful family was  t o t a l l y disabled.  Forty-five years ago, when he  33  was twenty-two years of age, t h i s old man emigrated from Sweden to B r i t i s h Columbia. He worked for over f o r t y years i n the logging industry, during which time he made regular ° savings. With h i s savings he purchased a Canadian Government annuity., thus establishing a retirement income. About f i v e years ago,, he r e t i r e d from logging and decided to obtain board and room i n town. Reason f o r Placement: The o l d man found that he could no longer meet the strenuous demands of the logging industry. Although he had no other specialized skills,, he had established an income s u f f i c i e n t to keep him f o r the rest of his days, so he decided to r e t i r e . Choice of Placement: Some years before he retired", the old man had formed a friendship with a middle-aged couple of Swedish descent. When he l e f t the forestry work, they welcomed him to t h e i r home as a boarder. Period of Adjustment: A r e a l friendship had existed between h i s hosts and himself f o r a number of years, so there were no problems with regard to h i s adjustment i n the home. Evaluation: Approximately f i v e years ago, t h i s man began to experience occasional lapses of memory, and from then on, h i s mental condition deteriorated steadily. There i s no doubt that he i s now i n a f a i r l y advanced state of s e n i l i t y . However, the fact that he i s no longer able to speak coherently, i s eneuretic, and cannot feed himself, has not interfered with h i s adjustment i n the family home. In spite of the special attention he requires, h i s guardians are s t i l l fond of him and reject the thought of his, transfer to an i n s t i t u t i o n . Case 9« Social History: An o l d woman, eighty-two years of age, had been senile f o r several years. L i t t l e was known of her previous h i s t o r y . Reason f o r Placement: Because of senile r e gression she could not l i v e alone. Choice of Placement: A f r i e n d of long standing arranged f o r her boarding care with a woman her own age.  3^  Period of Adjustment: She was a very tractable old woman, and became s e t t l e d In her new home almost Immediately, Evaluation: The o l d lady was quite senile, and spends most of her time picking imaginary d e v i l s off the window panes and f u r n i t u r e . She i s quite harmless with her d i s t o r t e d ideas, and appears to be very happy and contented. She i s almost completely detached from r e a l i t y , but i s pleasant and cheerful, and appreciates any attention offered her. Her guardian adores her and says that she and her family "would be l o s t without her". When f i r s t placed i n t h i s home by her friend, she was already senile. Throughout her f i v e years with the family, there has been no appreciable change i n her condition. For her care, the guardians receive severity-five d o l l a r s a month. Her o l d age pension of f o r t y d o l l a r s monthly i s augmented by t h i r t y d o l l a r s c o n t r i buted by her sons. Case 10, Social Histpry: Several years ago a man, now seventy-eight years of age, was injured i n an automobile accident. Since the accident he has been almost completely paralyzed i n both legs and, i n addition, i s seriously crippled by a r t h r i t i s . He i s bed-ridden a good deal of the time when the a r t h r i t i s condition i s acute. At other times he i s able to be i n a wheelchair. Choice of Placement: This man chose the home where he has boarded f o r the past seven years. Evaluation: This man i s , of course., a very dependent person but has managed to r e t a i n an a i r of aheerfulness and optimism. The responsib i l i t y f o r h i s care has been assumed by the woman i n the home, whose husband i s incapacitated as a r e s u l t of a series of heart attacks. She explained that she must remain at home at a l l times, even though her husband who i s ohrqnically i l l , does not require a great deal of attention. The presence of the old man has brought a new Interest to both of them and has made her f e e l that she i s doing something useful. Case 11. Social History: An eighty-two year o l d man r e t i r e d from business fourteen years ago. He i s a widower, with no r e l a t i v e s remaining to care  35  for him. Although h i s health i s good, h i s v i s i o n and hearing are f a i l i n g , and he requires protective supervision. Choice of Placement: The o l d man has a very substantial retirement income. He chose to board i n h i s present home about eight years ago. Evaluation: He responds very favourably to the care of h i s guardians l a r g e l y because the husband brings i n interests from the outside world. Before h i s retirement the old man was a successful business man and s t i l l considers himself an authority on business matters. He derives a great amount of s a t i s f a c t i o n from h i s conversations with the husband regarding matters of business. The wife i s amused at the high respect the old man has f o r her husband and h i s p o l i t e contempt f o r her because of her lack of business knowledge. He w i l l r e a d i l y accept male decisions from the husband without a protest, but w i l l argue and complain f o r days about a similar decision i f made by the wife. Fortunately, both husband and wife are mature, tolerant people and have a genuine fondness for the o l d man. They have a good understanding of h i s personality and are doing a good Job of meeting h i s needs. Case 12, .Social History; After her children and grandchildren had l e f t to l i v e i n another province, an eighty-two year old woman had to be placed f o r care. Choice of Placement: A place was found f o r her with a family In town. The standards of l i v i n g i n the home were comparable to those to -which she was accustomed. Evaluation: The old xtfoman i s very attached to the twenty-year old daughter of her guardians and takes a vicarious interest i n her s o c i a l l i f e . She i s proud of the g i r l ' s new clothes and other possessions as i f they were her own. S i m i l a r l y , she i s unobtrusively possessive when speaking of the daughter's boy f r i e n d who has her high approval. The usual a c t i v i t i e s and diversions of the rest of the family provide Interests f o r her, although there i s l i t t l e active p a r t i c i p a t i o n on her p a r t . S i g n i f i c a n t l y , t h i s woman was quite unhappy and withdrawn when.sharing a quiet apartment with her daughter. There i s no doubt that her placement i n a family setting has had an excellent therapeutic value f o r her.  36  The foregoing cases were chosen to i l l u s t r a t e the broad p o s s i b i l i t i e s that foster home care has to offfcr f o r the care of the dependent aged.  They are a l l examples of  successful placement i n terms of s a t i s f y i n g relationships between both c l i e n t s and guardians, and each represents a s i t u a t i o n with a degree of permanency.  This l a s t factor i n -  v a r i a b l y proves most conducive to the aged persons' emotional security and sense of well-being.  There were, however, f o s t e r  home situations that were f a r from being successful, r  Case 13,  Social History: A middle-aged man and h i s wife l i v e i n a comfortable home i n a r e s i d e n t i a l d i s t r i c t i n New Westminster, The man has a good job as manager of a downtown store, and h i s wife has an income from an inheritance. Their greatest disappointment has resulted from having no children. The husband i s a quiet s e l f effacing man whose every move i s dominated by h i s wife. She i s an energetic and t a l k a t i v e woman, active i n church and club groups. She i s not p a r t i c u l a r l y well l i k e d , but i s a very capable person, and usually holds the chairmanship of three or four committees of the organizations to which she belongs. Evidently, her husband admires and respects her c a p a b i l i t i e s , and accepts her leadership i n the home without any i n d i c a t i o n of resentment. She makes a l l the decisions with regard to the family budgeting and expenditures. According t o community gossip, for many years the husband has neither voiced an opinion nor made a decision without f i r s t cons u l t i n g h i s wife. Reason f o r Placement: Several months ago, the husband's eldest brother, a widower of sixty-' nine years, came to l i v e i n the home during h i s convalescence following a serious medical operation. Evaluation: He remained f o r three months, during which time he was constantly subjected to the wife's 'bossiness'. He described t h i s period as one of quiet desperation, He was unaccustomed  37  to peremptory orders as to when he should bathe, go to bed, or come to meals. He says that he resented every minute spen$ In the home of h i s sister-in-law, and that he l e f t at the f i r s t opportunity. Case 1^, Social Hi story: An eighty-six year o l d woman was released" from h o s p i t a l a f t e r an i l l n e s s extending over a period of several months, She had no immediate family to care f o r her, so placement was necessary. Reason f o r Placement: The o l d lady was very r e s i s t a n t toward the idea of placement i n an i n s t i t u t i o n . She had always been an active, hard-working person, and she was convinced that she could not be happy unless she l i v e d with a family. Choice of Placement: The s o c i a l worker of the h o s p i t a l , i n co-operation with the Social Welfare Branch, chose a f o s t e r home f o r her. Evaluation: For over f i f t y years she had l i v e d i n a modest four-roomed house that, although clean, was always i n a mild state of disorder. In her foster home she was treated l i k e an honoured guest, Because of her f r a i l t y , she was discouraged from doing any work at a l l . Her material requirements were provided i n a manner she had never known before, but she had no opportunity to make use of her remaining capaci t i e s . After a few months the o l d lady became very vrnhappy, and was petulant and demanding t o ward her hosts. They, i n turn, became more r e s e n t f u l and h o s t i l e toward her because of what they considered her lack of gratitude. Eventually, the situation became i n t o l e r a b l e to both hosts and c l i e n t , and the placement was terminated. I t was reported that the old woman i s now l i v i n g happily with two other very o l d l a d i e s i n a small licensed boarding home. She i s permitted to a s s i s t the matron i n l i g h t tasks about the house, such as preparing vegetables f o r meals, making her own bed, and so on. There were several cases where the placement proved to be very satisfactory because the guardian seemed to have a neurotic need to care f o r someone who,  i n turn, derived an  3*  Inordinate s a t i s f a c t i o n from h i s role of dependency. The following case affords an example of t h i s . Case 15.  A woman was so deeply attached to her father that her own marriage was never happy. Before h i s death, the father l i v e d with the family f o r many years. The husband s i n t e r e s t s were constantly subordinated to those of the o l d man, so that there was always discord in-the family. The old man died In 194-9, and the following year the husband was k i l l e d i n an i n d u s t r i a l accident, leaving the woman alone with her twenty-»year: o l d son. She was considered to be rather shy and unsocial i n the small town where she l i v e d . I t seemed that her own a f f a i r s x\rere so absorbing that she saw very l i t t l e of her neighbours, 1  Her son was quite a normal young man, but she made every e f f o r t to keep him attached to her. As f a r as possible, she t r i e d to have him at home every evening with her, and she gave him a l l her attention. This l e f t the son In a very uncomfortable p o s i t i o n . He was very fond o f h i s mother and wanted her to be happy but, at the same time, he preferred to associate with h i s own friends. In the meantime, the woman took i n three or four successive boarders. F i n a l l y , a gentle o l d man began to board with her. He was an old age pensioner and was quite feeble and very dependent upon her. She began to shower attention upon him and became very engrossed i n h i s welfare. This l e f t the son f r e e r and l e s s g u i l t y about leaving his mother while he associated with h i s friends away from home. This r e a l l y Improved the family situation and, i n c i d e n t a l l y , the o l d man thrived on the affectionate i n t e r e s t . Case 16.  Social History: A very o l d lady had been i n h o s p i t a l f o r several months following a heart attack. Before her i l l n e s s she had l i v e d with a daughter and son-Sln-law, both of whom worked. She had taken a large part i n the upkeep of the home and caring f o r her daughter's c h i l d . Reason f o r Placement: On leaving h o s p i t a l she was no longer able to accept these r e s p o n s i b i l i t i e s . The situation i n the home became very strained and placement elsewhere became necessary.  39 e  Choice of Placement; The daughter soon found a middle-aged couple who agreed to look a f t e r the old lady f o r |6o.,00 a month. The guardians were c h i l d l e s s , and wished to augment t h e i r income by admitting a boarder. The foster home was but a few c i t y blocks from the home of the daughter, who was s t i l l anxious to assume some of the r e s p o n s i b i l i t y f o r her mother's care. Period of Adjustment: For a while a f t e r the placement was made, the relationship between mother and daughter continued to be strained. In the meantime, the o l d woman settled down f a i r l y well i n the f o s t e r home. She became quite fond of her guardians and was reasonably happy although she missed the company of her daughter and grandchild. Evaluation: A f t e r a period of several weeks, on the urging of a family friend., the daughter began to v i s i t her mother to look a f t e r various needs that could not be provided by the f o s t e r home. Soon a f t e r t h i s , the mother began to v i s i t the daughter quite frequently, returning to the f o s t e r holne at night, She often takes care of her grandc h i l d when her daughter and son-in-law have an evening out. In a more limited way than before, she i s s t i l l able to contribute to her daughter's family. At the same time, as her health Is improving, she i s becoming more content i n her f o s t e r home, and i s helping her guardian i n some of the household tasks, This plan has worked out to the s a t i s f a c t i o n of everyone. Case 17,  Social History: A widower of eighty years could not care f o r himself a f t e r the death of h i s son, with whom he had l i v e d f o r several years. He had a number of r e l a t i v e s , but none would take the r e s p o n s i b i l i t y f o r h i s care because of h i s v i o l e n t temper and i r a s c i b l e behaviour. His personality was such that he projected a l l h i s d i s s a t i s factions upon others, or upon situations over which he had no control. Choice of Placement: The old man had an income of approximately $150.00 a month, so was able to e h o o s 3 h l s own placement. He f i n a l l y began to board with a c h i l d l e s s middle-aged couple i n the town. Period of Adjustment:  During the early part of  the placement, the family found h i s conduct to be almost i n t o l e r a b l e , and were strongly tempted to force him to move elsewhere. As time went on, there was no improvement i n h i s behaviour, but there was a change i n attitude on the part of the guardians. Evaluation: The o l d man's requirements were met i n an adequate manner by the guardians and he was probably as content as he ever had been. Although the guardians found him to be very t r y i n g to t h e i r patience at f i r s t , as time passed they began to understand that h i s behaviour was r e a l l y the " manifestation of a mental i l l n e s s . They soon r e a l i z e d that the only way he could f i n d s a t i s faction i n l i v i n g was by f e e l i n g that the whole world was at f a u l t except him. The guardians began to see humour i n the s i t u a t i o n , and even derived a c e r t a i n enjoyment from h i s outbursts of rage. They were able to treat him with a f f e c t i o n and kindness u n t i l h i s death i n 195^. Case 16,  Social History: A seventy-six year o l d woman was widowed two years ago, and shortly afterward suffered a heart attack that l e f t her p a r t i a l l y Incapacitated. In addition to her o l d age pension, she had a moderate Income from an annuity l e f t her by her husband. Reason f o r Placement: Because of her f r a i l health, she could no longer l i v e alone, so decided to seek room and board i n a home with standards comparable to her own. Choice of Placement: By placing an advertisement i n the l o c a l newspaper she made contact with a young man and h i s wife who agreed to care f o r her for 175.00 a month. By taking her into t h e i r home, the guardians were motivated by. the opportunity to augment t h e i r Income. Period of Adjustment: The guardians considered themselves to be modern and progressive, and viewed the old lady's "old-fashioned" ideas and prejudices with an amused tolerance. Their home was modern and, i n many ways, well suited to her requirements. The husband, however, soon began to address the old lady by her f i r s t name. He was a man of t h i r t y - f i v e , and such f a m i l i a r i t y was thoroughly repugnant to her sense of propriety. The wife, without any genuine a f f e c t i o n f o r her,  4-1  would c a l l her "Dear" and "Honey", at the same time preventing her from doing the things she wanted, and dominating her every a c t i v i t y . The guardians, who were a c t u a l l y kind people, wondered at the old lady's decline and increasing unhappiness. Evaluation; F i n a l l y , the association ended with the o l d lady's move to a small licensed boarding home. Case 19.  Social History; a r t her h r i t isci s widow s i xeight tyeight years l i v e d An with t e r f oof r the years following her husband's death. The s i s t e r was committed to the P r o v i n c i a l Mental Hospital i n 1953 a woman was no longer able to care for h e r s e l f alone i n the home. n d t  n  e  Reason f o r Placement; She was i n receipt of s o c i a l allowances at the time and was p e r i o d i c a l l y v i s i t e d by a representative of the Social Welfare Branch. The social worker persuaded her to accept boarding care i n a selected home. Choice of Placement: The s o c i a l worker found a home f o r the o l d lady i n the neighbourhood where she had l i v e d since the death of her husband. The guardians were both about f o r t y years o f age and parents of three teenage children. woman i s a person of very r i g i d views, p a r t i c u l a r l y i n r e l i g i o u s matters. The morals and behaviour of a l l members of the family are of deep concern to her, and she i s usually very disapproving of the conduct of the children. Nevertheless, she i s fond of them and enjoys t h e i r presence. The home i s characterized by democratic p a r t i c i p a t i o n i n a l l a c i t i v i e s and planning. Although the o l d woman i s a boarder, she i s accepted as having the status of a member o f the family. The rest of the family recognize the significance to her of nhat she says, believes, and -does. They share things with her and make her believe that what i s happening to her i s important to them because she believes i t so. Because they have a sincere a f f e c t i o n for her, her opinions are also important to them, whether or not they f u l l y understand them, or care about them personally. Evaluation: This placement has been very s a t i s fying to the c l i e n t . Although the family members  42  do not take her opinions and dogmatic judgments seriously, they provide an audience f o r her, and she achieves g r a t i f i c a t i o n i n thinking that she i s guiding them i n the paths of righteousness. Her material requirements are adequately cared f o r and she i s a contented person. Having i l l u s t r a t e d a number of foster homes that s a t i s f a c t o r i l y met the special needs of c e r t a i n dependent o l d people, there appears to be v a l i d i t y i n the conclusion that the i n s t i t u t i n g of a formal programme of placing o l d people f o r family care would have merit.  Thus, the task at hand i s  to give further discussion to the type of person suitable f o r placement, the standards required f o r h i s care, and the techniques of supervision of both c l i e n t and f o s t e r home on the part of the s o c i a l worker.  Subsequent chapters w i l l be  devoted to these c r i t e r i a , as well as the probable l i m i t a t i o n s of such a programme.  Chapter III  EVOLUTION OF CRITERIA  Old People Suitable For Foster Home Care Desirable as i t i s to this study, i t i s not a simple task to make a systematic classification of the old people suitable for foster placement within families. From the cases described i n Chapter II i t can be concluded that those who were able to respond to such care represent a wide variety of people.  Although a l l were over  sixty-five years of age and unable to l i v e by themselves and function without help from others, their dependency requirements varied from the need for minimal help and supervision, to the need for constant surveillance and skilled assistance on the part of guardians. The following c r i t e r i a that are suggested for the selection of suitable candidates for family care are not based on the study of a large number of cases. Rather, they are based largely on comparable studies of child placement services, and similar services for the blind, the chronically i l l and the mentally i l l .  The twenty-four cases under study do, of course,  demonstrate the scope as well as the limitations of family 0  placement.  H4.  It appears that the most suitable candidates for foster family placement would come from the following sources: from licenced boarding homes; from nursing homes; from hospitals (those temporarily incapacitated through i l l n e s s ) ; from families (those who are l i v i n g with relatives); and from Independent living, (those l i v i n g alone, or i n a rented room, who are dependent upon others for some of their needs). Proper classification procedures would be an essential part of a good foster home system for the aged.  It would be  advisable to obtain as much social history material regarding the client as possible. Prospective candidates should be selected carefully and not too hurriedly.  They should be inter-  viewed several times to obtain f u l l information as to their educational, social and economic backgrounds, their health, their mental capacity and their general interests and a b i l i t i e s . Much useful information could be obtained from families, local agencies and other sources with whom the aged client has previously been i n contact.  On the basis of his case history  the social worker would be enabled to reach a decision as to the particular home i n which the client i s to be placed. In considering an old person for family care, one must know how he has been adjusted i n his former social environment. People who are emotionally disturbed or physically infirm obviously should not be placed i n homes, nor should destructive clients, or those i n stages of advanced senility.  The quiet  person who has adjusted well i n a boarding home, or with his own  •+5  relatives, usually adjusts well In family care.  But much more  than his overt behaviour patterns must be considered.  He must  be able to look after his own physical needs with perhaps a l i t t l e assistance from the guardians.  Some quite dependent  clients would require help from their hostesses to take baths, and get dressed, and with feeding, but a hostess should not be expected to look after a helpless old person who requires constant help i n keeping himself clean and presentable, nor should nursing care be required of her, except for short periods of i l l n e s s . In considering the individual for family care, one must know his interests and recreational preferences, and to what extent this can be replaced by the recreational resources offered i n the prospective home. The things that i r r i t a t e and upset the old person must be known so that the guardian can be helped to avoid them. For instance, one aged woman i n a foster home became much excited at the striking of a clock because she thought i t warned one of the approach of the f i r e department. So her guardian merely kept the grandfather clock from striking, with the result that the old lady lived quite comfortably with her distorted ideas. It i s important to know whether the aged individual gets along with other people.  I f he does not, he w i l l be l i k e l y  to find i t hard to become a harmonious member of a family group. On the ether hand, i f he has a number of close friends, he may miss their companionship i n his new home, or he may be the kind who w i l l readily make friends wherever he i s .  46  Some old people, who have found their entire security In Institutional l i f e , may become quite upset when the less formal routine of a home i s substituted.  The writer was told  of an intelligent and attractive elderly woman of 6g years, who had been i n the T.5. Sanitarium for seven years.  On her  recovery, she was placed by her family i n a private home. In the home she was expected to assist the guardian i n housework and i n caring for the children. Although the woman's recovery was considered complete, she could not adapt herself to the lack of strict routine i n the home. Finally, she was removed to a nursing home where she made a more satisfactory adjustment. In the f i l e s of the Social Welfare Branch offices i t i s not uncommon to find a similar preference for congregate placement on the part of those released from mental hospitals and other institutions.  Within the institutional setting,  people tend to become accustomed to a l i f e of well-ordered routine and may find l i f e i n a family situation upsetting, with i t s irregularities with regard to the times meals are served, bed-times, and other distractions. For several months during 1954, the writer was employed as a social worker at Oakalla Prison Farm. His duties were concerned primarily with the classification and segregation of prisoners within the Institution.  Almost dally, interviews  took place with old men who had been committed to gaol.  Although  they were committed on a variety of offences, and the duration of the sentences varied, most of them were admitted for short  periods upon conviction under the P r o v i n c i a l Liquor Act,  A  large majority of these men formerly had been loggers and miners, a f t e r emigrating from European countries as young men.  Many had  not married, and over the years had formed no family attachments. Work In the logging and mining camps was hard and demanding and they had to be i n good physical health.  They found t h a t . i n the  camps, a man's prestige was largely based on h i s a b i l i t y to •high-ball* - that i s , h i s a b i l i t y to work hard without v i s i b l y tiring.  I t was c h a r a c t e r i s t i c of loggers and miners to take  pride i n t h e i r p h y s i c a l prowess and e f f i c i e n c y on the Job, and during t h e i r younger years they could meet the demands of the industry as d r i l l e r s , f a l l e r s , buckers, r i g g i n g slingers, chokermen, et cetra.  Many of them^ unfortunately, placed too  much emphasis on this single method of gaining self-esteem. When the pattern of l i v i n g was upset as a r e s u l t of the development of a chronie i l l n e s s , permanent physical Injury, or simply growing too old and feeble f o r camp-life, the i n d i v i d u a l suffered a severe n a r c i s s i s t i c trauma.  Too often, these men  knew no other resource to restore self-esteem, nor d i d they have adequate psychological defence mechanisms to combat t h e i r basic emotional i n s e c u r i t i e s .  Many of those who sought solace through  the indiscriminate use of Intoxicating l i q u o r were Imprisoned as vagrants and drunkards. on the same charge.  Some had been i n gaol a good many times  The experience of going to prison tends to  reinforce the individual's feelings of inadequacy, and many of these men are now v i r t u a l l y l o s t to society as happy and proud c i t i z e n s who might have made a further contribution to the community.  4g  These old men require special training and reeducation for other s k i l l s , through which they might bolster their f a i l i n g egoa. Provincial gaols,  Such f a c i l i t i e s are not found i n our  A few might be suitable for placement with  families, but usually i t would be inadvisable to consider them for this type of care.  The long years of bachelorhood, and  the congregate existence of camp l i f e do not condition a person for placement i n an ordinary home. In most cases, placement i n licenced boarding homes, with other men of similar backgrounds would, no doubt, be more appropriate. The advisability of making use of foster family care for the senile aged was discussed with a number of social workers. Although this study brought to light two cases where people i n advanced stages of senility were being cared for i n foster homes, i t was, nevertheless, the opinion of most workers, that the practise of placing the senile aged i n family care should be avoided.  At the same time, It was generally agreed  that family care might have advantages over institutional care In those cases where senile regression extends no further than mild displays of eccentricity, occasional lapses of memory, et cetra.  F a m i l y Care as a Therapeutic Measure  A programme for foster family care could be developed for two general groups of the aged.  The largest group would be  the continuous treatment type of person whose chief needs are a  49  moderate degree of physical comfort, sympathetic guardians, some freedom to wander about the home and grounds, and simple work and recreation of various kinds, according to h i s i n t e r e s t and c a p a b i l i t i e s .  With the greatest majority selected f o r  family care, marked improvement could not be expected.  Although  they should improve as a r e s u l t of the i n d i v i d u a l attention they would receive i n homes, i t i s not to be expected that they would improve enough to be r e h a b i l i t a t e d , that i s , to restore . !  t h e i r former degree of independence and a b i l i t y to support; themselves.  !  Most have suffered a reduction i n t h e i r a b i l i t i e s  to care f o r themselves and earn a l i v i n g , and there i s l i t t l e hope f o r the restoration of former independence. This study has indicated that there i s a second and smaller group for whom family f o s t e r care might be used almost e n t i r e l y as a therapeutic measure.  This means that the permanent  and t o t a l r e h a b i l i t a t i o n of the i n d i v i d u a l might be expected, and that family care i s used as a treatment measure to bring this result. Family placement as a therapeutic measure could be used for many o l d people who come to h o s p i t a l i n periods of confusion or extreme i r r i t a b i l i t y due to the onset of s e n i l i t y .  These  symptoms .frequently clear up somewhat with treatment i n the hospital.  Because the previous family s i t u a t i o n might be con-  ducive to the recurrence of the symptoms, placement of these patients i n family care, other than t h e i r own, might keep them  50  from becoming permanently i n s t i t u t i o n a l i z e d .  Careful selection  of such homes would be necessary, and the guardians chosen should have a good knowledge of the individual's needs.  When  these patients have made an adjustment to the family care home, they could be given some r e s p o n s i b i l i t y f o r managing t h e i r own a f f a i r s , and eventually, they might be able t o l i v e without h o s p i t a l supervision, but with the assistance of suitable community agencies. When an aged person i s placed In a f o s t e r home where he f i n d s the security and protection that he would with h i s own r e l a t i v e s , but without the emotional complications, he i s often able to work out h i s own adjustment.  There were several  examples where the family of the old person could not care f o r him without provoking resentment, dissension and unhappiness. When placed with another family who could handle him more objectively, and without the emotional involvement, he was able to f i n d a way to establish himself and h i s own Independence. A revievr of the c h a r a c t e r i s t i c s oil. the o l d people who i  have made s a t i s f a c t o r y adjustments i n t h e i r 'foster homes' suggests that a f a i r l y large proportion of the aged could be considered f o r family placement. No attempt has been made to estimate the percentage of o l d people now i n i n s t i t u t i o n s , or l i v i n g an insecure existence alone, who might benefit from family care.  However,  the d i f f e r i n g degrees of dependency need, both physical and  51  mental. In the cases Illustrated, suggest that a large number of old people should, at least, undergo consideration for this type of care. The particular needs of aged individuals vary, one from the other, to quite a large extent, and particular care must be taken to find homes that best suit their individual requirements.  Qualifications Required In Guardians In the cases studied, i t was observed that successful family care was found to develop around the personality of the guardian.  The old person's adjustment i n the foster home i s  directly related to the Interest, help and understanding he receives from the family with whom he i s placed. In some homes i t i s the wife who seems to be the most potent therapeutic agent, or who gives the client the greatest security by meeting h i 8 needs.  In other cases the husband i s the person to whom  the client relates more readily. The children i n the home, i n some instances, seem to mean most to the aged client.  But in every case the recog-  nition of the therapeutic potentialities of the family members i s the most important part of the evaluation of the home. i  In the most successful homes the general family relationship was found to be harmonious, and there was a high t  degree of mutual appreciation.  Emotional balance between  members of the family i s essential before a stranger i s placed  52  i n the home. Even though a submissive husband may l i v e with a dominating wife quite happily, there i s no reason to suppose that an old person w i l l share the husband's happiness in such a domination. In the interviews with operators of boarding homes, and with the guardians of the better foster homes for the aged, i t appeared that, i n general, people who have made good parents do the best work i n caring for aged clients.  Mature people  whose greatest satisfactions have always been In family and home l i f e and whose parental love has been satisfying, but not hampering, to their children, are the best guardians.  Those  who are known to be kind and generous i n the community, who can always find time to help others i n case of i l l n e s s , are usually people who can gain satisfaction from doing what they consider helpful things for the old person In the home. There were homes where the husband had died and the wife, much attached to the home, wished to keep i t but at the same time, was lonely, and had financial d i f f i c u l t i e s .  In these  cases, real satisfactions were gained in caring for old people. Usually, the expressed reason for taking i n the dependent old person i s because of the financial remuneration.  But, i n the  greatest number of instances, the actual financial gain i s negligible since most clients are totally reliant upon old age assistance for their support.  Often the real reason for  admitting the dependent into the home appears to be an attempt to make a substitute for a lost spouse; someone whom she may  53  interest i n working with her to maintain the home comfortably and attractively, someone with whom to communicate and reduce the curse of loneliness, or someone with whom she may share her recreational interests. Families who w i l l take old people should have an understanding of old people and a generous philosophy toward them.  In addition to this, they must have a certain f l e x i b i l i t y ,  warmth and adaptability i f l i f e Is to be pleasant for their charges.  Too much emphasis cannot be placed on the personal  Qualities of the guardians.  In the most successful cases they  were found to be sympathetic, tolerant people who were not easily upset or i r r i t a t e d .  For the most part, they w i l l be well  adjusted and secure within themselves and with others. They were firm when the occasion demanded, yet essentially kind. They were the kind of people who do not l e t small unimportant things or events bother them. Most of them displayed a sense of fun and were able to see the humorous aspects of i r r i t a t i n g situations, without any suggestion of unkindness i n their humor. They were stable people with a good deal of common sense, and ability to accept the client on the level at which he could function.  Some took great pride of the fact that, because of  their patience and interest, the client Improved and has become more responsible and more willing and able to take part i n family and community activities.  One middle aged lady, casing  for a seventy-one year old man said, "The old boy has been with us six months now and i s just beginning to thaw out.  Before  5*  I'm through with him, I ' l l have him going to old-time dances". When there are young children i n the family, the advisability of placing an old person with them may be questionable.  Very often, these young children may have a therapeutic  effect on the l i f e of the old Individual, but one has to consider the effect of another adult on the child and his. a b i l i t y to accept the possibility that he might receive less attention from his parents now that they have assumed the responsibility of another charge.  In some instances there  might be the real danger of rivalry between the child and the aged guest for the affection of the mother. This would be comparable to a sibling rivalry, and could increase the feeling of insecurity of both child and old person,. On the other hand, i f the family l i f e i s so organized that the child's l i f e may keep normal and wholesome i n spite of the boarder, the home may be suitable.  One woman who has been  caring for an old woman who i s seventy-three and i n poor health, said that she likes having the old lady i n the home, because i f increased the number of errands and amount of work her nine year old boy was able to do. She believes that every child should have responsibilities for tasks i n his own home, and these had been hard to find before 'Grandma' came. Now that the old lady i s i n the home, there are continual errands which he can do, and the extra work has made him feel that he Is a part-proprietor i n the enterprise.  The boy himself appears  to accept the situation as very normal and has a comfortable  55  relationship with the old lady.  Since he has his own room and  a rumpus room In the basement where he and his friends can enjoy uninterrupted activities, he accepts "Grandma" as a normal part of the family l i f e . Standards Required In the Foster Home The f i r s t homes i n the community i n which placements are made should be ones i n which the families are known and respected.  If a well-selected family accepts an old person,  and finds caring for him to be a satisfying undertaking, before long applications to the agency should come i n from other people in the v i c i n i t y .  Illustrative of this point i s the experience  of a social worker i n a Vancouver social agency which has foster home finding services for children as part of i t s programme.  The worker placed a child for temporary foster care  in the home of a moderately well-to-do couple.  The parentless  child was of average intelligence and good physical condition, but presented behaviour disorders arising from an unfortunate early environment.  For some legal reason the l i t t l e g i r l could  not be adopted by the foster parents, but they accepted the child and her problems as a challenge to their a b i l i t y as parents.  The placement was very successful and, through parental  acceptance, accompanied by affectionate and understanding care, the child has overcome her behaviour d i f f i c u l t i e s .  She i s s t i l l  In the home and appears to be a secure normal l i t t l e g i r l .  A  few months ago the foster parents accepted the responsibility  56  for the care of another child, a four year old boy who appeared emotionally disturbed. The foster parents are i n their middlethirties and have a large circle of friends, most of them with good modern homes and i n the same Income bracket. them had previously considered adopting a child.  Some of To love and  nurture a child that was to belong to them was acceptable,,but nurturing one who belongs to someone else, was something that they had never considered. In the past three years, however, the friends have been interested observers of the experiences of these foster parents.  They began to realize that foster parenthood calls  for a l l the usual virtues, and i n addition, qualities above and beyond those customarily associated with parenthood. It i s significant that i n the past year the agency has received three applications for foster children from among their circle of friends. In child placement work, social workers find that such experiences are not infrequent. Often, the workers attempts 1  to place children for foster care are met with community apathy for quite some time.  After two or three successful placements,  however, i t i s not uncommon for the agency to receive applications for foster children from friends and relatives of the successful foster parents.  In most Instances these people had  previously refused to give consideration to the idea.  57  In a similar way, i t could be anticipated that the establishment  of a foster home programme for the dependent aged,  would not be readily accepted by most people i n a community. In time, after i t s benefits and advantages have been illustrated by several successful placements, community apathy should become progressively less i n Importance. The social worker should make every effort to evaluate the family situation and the assets that i t w i l l have for a particular client.  However, i n the light of our present  knowledge, the only way that one can make sure of a home Is by trying i t out.  It has been the experience i n the placement  of children, unmarried mothers, and the mentally i l l , a home may seem quite ideal for family placement, yet almost every person placed there w i l l deteriorate Instead of improve.  Good  casework practices should minimize the chances of failure. It i s no brief task to try to determine the suitability of a. foster home. I f a home has been used previously by the local agency and found satisfactory for the placement of children, unmarried mothers, or the chronically i l l , the evaluation of i t s capacity for the care of the aged i s much easier.  Records of the social  agency's work with the family would throw much°light on the personalities i n the home, and on their physical well-being and economic status.  After one v i s i t the social work could  probably determine i f they were Interested i n the care of the aged, and whether they have the capacity for developing the necessary s k i l l s .  5*3  Where a family has had no previous experience i n working with the agency, however, the evaluation of the home becomes more d i f f i c u l t .  For example, the a b i l i t y of the family  to work with and co-operate with the agency i s very important. The homefinder must determine the willingness to accept agency help i n arranging for the medical care of clients, budgeting, and other details important to the smooth operation of the foster care programme. I f the importance of these things i s not clearly understood from the f i r s t , i t might mean far more effort on the part of the social worker to establish and retain a satisfactory working relationship. The physical health of the members of the family i s also important.  In most cases It Is desirable that they have  a clean b i l l of health. But, at times, illness of a member of the family group can be an advantage. When one member of a family gladly stays home to look after a chronically i l l person, and that person accepts his illness cheerfully, It can be a desirable home for a client. Needless to say, the guardian herself must be i n good health to be able to assume the responsibility of the care of a dependent. In a foster placement programme It might be advisable to insist that prospective guardians meet the requirements of a medical examination as i s required by foster mothers of children. In evaluating prospective foster homes, the social  59  worker should consider the guardians* a b i l i t y to develop. They should be able to respond to the educational and interpretive efforts of the social worker.  Should families apply  to the agency for an old person, i t i s l i k e l y that many w i l l have l i t t l e knowledge of the kinds of old people they w i l l have. Before a f i n a l decision has been made, the family members should be fully aware of the responsibilities they w i l l have, the help that the agency w i l l give them, and their duties and responsibilities i n caring for the client.  It would be  expected that some families, when they realize the extent of their duties, w i l l withdraw their applications.  Other families,  after thorough investigation w i l l be found unequal to the undertaking. Most prospective guardians w i l l have hope for some small financial gain as a result of their efforts.  This i s  very natural and Justifiable, but they should be helped to realize that the greatest return would be the satisfaction of helping the dependent aged to have a more normal and happier life. The majority of guardians chosen should be sufficiently well-adjusted to look after any old person selected for foster care.  Occasionally, however, a home placement could be made  wherein the special emotional needs of both client and guardian may be met. Careful consideration of the needs of both, and the ability of each to meet the others' needs i s very important.  60  But generally, i t would be best to choose guardians who are themselves quite secure emotionally and not overly dependent on others for the gratification of their needs.  I f emotional  disturbances on the part of the client can be avoided by careful placement at f i r s t , i n the long run, less time and effort w i l l be required for subsequent adjustment.  Physical Standards of the Home In considering foster home placement for an old person, there are certain essentials necessary for his physical wellbeing.  The house should be of sufficient size to afford the  old person a comfortable bed of his own, and a place to keep his own personal possessions.  In every one of the cases studied  the client had his own room i n the home and set high value on this fact. It Is one of the common complaints of Inmates of licensed boarding homes that one has l i t t l e privacy. Most aged individuals value the opportunity for some privacy and a place where his possessions may not be disturbed. His personal possessions may be very meagre, perhaps a few pictures, a clock and books, but usually he treasures them, and i s very upset when his privacy i s violated. The physical set-up of the home need not be elaborate in the greatest number of cases.  It Is a striking fact that  most of the clients interviewed had drifted into home situations  6l  that came close to approximating the homes to which they had been accustomed for many years, prior to becoming dependent. In none of the cases under study did the old person complain about the physical standard of care, with the exception of not having enough money for clothing, bus fare and incidentals. It would appear that, generally, old people are very conservative i n their attitude toward improving their l i v i n g standards. It i s true that they resent a lowering of these standards, but they seem to feel most secure l i v i n g under conditions that are similar to their previous l i v i n g accommodations. The home need not be elaborate, but there should be some minimum standards.  The two modern conveniences that  should be required are electric lights, as i t i s hazardous for a shaky old person to have to use lamps, and a telephone. The home should have a telephone, or be close to someone who has, so that the guardian can readily c a l l for medical assistance, and also, that she may contact the agency for advice and help i f necessary.  No specific requirements need be made regarding  a furnace or a bathroom, although the house should be adequately heated, and there should be warm water for washing, available at a l l times, and bathing f a c i l i t i e s should be practical and comfortable.  If the house does not have central heating, there  should be a warm comfortable place for the old person to s i t , and ample bedding to keep him warm and comfortable at night. In rural homes a check should be made on the adequacy of the  62  water supply.  In case there are no plumbing f a c i l i t i e s i n  the house, a check should be made to see that adequate and sanitary t o i l e t f a c i l i t i e s are arranged for the client. It was found that a yard or garden added materially to the pleasure of many of the clients In foster homes, depending on the ease with which they could get about. In some cases a lawn and a garden provided a setting when they could wander about without being annoyed by other people. In two homes there are f a c i l i t i e s for the old person to have his meals apart from the rest of the family. In each case this has been an asset.  In the f i r s t instance, the old man needs  help with his meals because his movements are too uncontrolled for him to feed himself.  In the other, the old lady becomes  so diverted by the lively conversation of the family group that she does not eat as she should.  The size of the house  and i t s assets from a physical standpoint, are not important factors as long as the client has the care and physical comforts that are essential for his well-being. The social worker should be sure that the guardian has some idea of what constitutes well-balanced meals, and that she w i l l take an interest i n providing these.  A renewed interest  in cooking may be aroused i n the guardian as a result of added responsibility.  One sixty-four year old woman who had lost her  husband said that before taking i n an old lady to live with her, she lived alone, and found l i t t l e incentive for cooking. She  63  neglected her own d i e t , and began to lose weight.  Now,  with  someone to care f o r , she again enjoys preparing meals and no longer has to have her meals alone.  S a t i s f a c t i o n s gained i n caring f o r Old People Material requirements of foster homes may be simple, but high personality q u a l i f i c a t i o n s are e s s e n t i a l .  One of the  most encouraging things about the foster homes under study, i s that people who meet these personality q u a l i f i c a t i o n s received s a t i s f a c t i o n from taking i n old people, and are doing everything they can to be successful i n t h e i r e f f o r t s . Families who  take o l d people into t h e i r homes as part  of the family f i n d t h i s has r e a l value to them.  Most people  l i k e to f e e l they are doing something f o r someone else.  When  a family, not related to a c l i e n t , takes him from an unhappy environment, help.  that family f e e l s that It i s doing something to  Most of the o l d people interviewed i n such homes were  appreciative of the freedom and care they receive i n l i v i n g as part of a family, and t h i s created an increasing s a t i s f a c t i o n on the part of t h e i r hosts. The majority of o l d people i n private homes were l i v i n g with middle aged couples whose families had grown up and l e f t home.  With just the husband and wife alone, the house  seemed lonely and empty.  The aged c l i e n t could occupy empty  64-  rooma and provide some companionship hosts.  and i n t e r e s t for the  Caring f o r dependents u t i l i z e s a l l the guardian's  domestic s k i l l s , and most of them expressed pride i n t h e i r work.  The o l d person's appreciation of good food and  attention makes them f e e l that t h e i r pride Is J u s t i f i a b l e . Old  people are happier i f they are busy, and i t  often takes ingenuity on the guardian's part to keep them occupied.  Caring f o r the aged appears as a challenge to  most guardians and u t i l i z e s a l l t h e i r s k i l l s , and they appear to enjoy the challenge. In a f o s t e r placement programme f o r the aged, there would be a need f o r the s o c i a l worker to keep close contact with both c l i e n t and hosts.  The c l i e n t must be helped  through counselling to adjust to the home.  The family must  be helped to understand the reasons f o r the c l i e n t ' s strengths and l i m i t a t i o n s .  The s o c i a l worker can help the family to  r e a l i z e the value of i t s services by pointing out improvements noticed i n the o l d person, mentioning appreciation expressed by him, and making the family aware of the confidence the agency s t a f f has In i t s a b i l i t y as a therapeutic agent.  Role of the Social Worker The s o c i a l worker engaged i n the f i n d i n g of suitable •foster homes' and the p l a c i n g of o l d people In the homes should have special knowledge, t r a i n i n g , and s k i l l .  He must  65  learn to know each member of the family, understand their lnter-relationships, evaluate their capacities, and Judge the effect on them of the placement of an aged client.  He  must help them to comprehend how the social agency works, what i t s plans are, and what the respective responsibilities of the family and agency w i l l be.  He must be able to under-  stand old people and the special problems created by the family situation and the placement.  Disturbed guardian-  client relationships need to be recognized and treated early i f re-placements are to be avoided,  Before an aged client i s  placed i n foster family care the social worker must know him well.  Careful study should be made of his history.  Since  there may be circumstances and experiences i n the client's past which have had a deleterious effect upon him, an understanding and knowledge of his previous environment, l i v i n g habits, and behaviour patterns i s necessary to make sure that his new home w i l l not revive memories and disturbances that have an adverse effect on his adjustment. The client's present physical and emotional conditions, and any limitations that these conditions may impose, must be considered, as well as his recreational interests and skills.  Religious interests and the extent to which he  participates i n church activities are also important to know. In eighteen of the twenty-four cases studied, the religion of the clients coincided with that of the guardians.  Similarly,  several of the inmates of boarding homes stated preference  66 i  for placement In homes of the same religious beliefs. The social worker must know how the client feels about his future., what his aims are, and why he wishes to have foster family care.  He must be made to realize the  limitations of such care, as well as the advantages. The Inmates of boarding homes for the aged, with whom foster home care was discussed, were inclined to idealize family placement and lose sight of i t s possible Inconveniences and disadvantages.  Unless the individual realizes the  limitations as well as the advantages i n family l i f e , he may not make a good adjustment i n the home.  This factor  indicates the necessity for a good deal of interpretation on the part of the social worker. The social worker must have frequent discussions with the client prior to his placement and, so far as possible, must gain his confidence i f successful plans for him to l i v e outside an institution are to be realized. I f he has a family or relatives of his own to whom he wishes to go and who, for some reason or other, cannot take him, he should have an understanding of why i t i s not possible for him to live with them. He should know how they feel about his placement, how often v i s i t s may be made, and what he may expect from them i n other ways. It would probably be reassuring to most old people to know that their families and friends have been consulted.  Probably, with the greater  67  freedom offered by family care, their relatives may be able to show them more attention and interest than they have had in the past while In an institution. One aim of supervision, i n many cases, should be to develop wholesome and understanding attitudes on the part of the old person's relatives towards him and to make their v i s i t s to. him meaningful.  Interest and co-operation of  relatives and family can have a definite therapeutic value, and should be fostered as an integral part of the supervisory services.  An example of family co-operation as a therapeutic  aid i s afforded by Case l 6 i n Chapter I I . Relatives would often have to be helped to understand and accept the guardian's role i n the old person's l i f e . They may not realize that instructions to the guardian should come from the social agency that makes the placement, and that the foster home i s responsible to the agency, rather than to the relatives, for supervision. Any criticism of the old person's care, which the relatives may have, must be discussed with the social worker rather than with the guardian.  She  should not be put i n the d i f f i c u l t position of being responsible to numerous relatives as well as the agency, for the welfare of the dependent. Should the old person be placed temporarily i n the foster home for therapeutic purposes, with a view to an ultimate  6g  return to his relatives, the social worker should offer guidance and help to the family In preparation for his return. On the other hand, should return to the family continue to be impossible, i t might be necessary for the family to help i n considering an alternate plan.  None of the cases studied  presented such situations. However, i n the foster home placement of children, such situations constantly arise and often constitute a problem. In addition to the old person's own family, i f he has one, the social worker must know a l l the members of the family i n the home where the individual i s to go.  He  should  talk to each member of the family to make sure that a l l are Interested i n the project and have a good understanding of what i t means to take care of a dependent old person.  The  social worker should discuss what plans the guardians have for the care of the aged individual when they themselves go out for recreation and a change.  It i s important for the guardian  to be able to carry out her own interests, but suitable supervision must be arranged for the old person when she i s absent. It i s advisable for the social worker to discuss with the guardian beforehand, the old person who i s coming to the home, so that something w i l l be known of his personality and individual needs.  The family should be given an idea of  what things interest him and cause him to respond more favourably.  The old person's religion and church activities may  69 mean a great deal to him.  The guardian must realize the  value of these interests and encourage him to continue i n them. The guardian should know a l l the facts that can be used constructively i n the care of the old person, but the social worker should never reveal anything which i s confidential i n nature, or unessential i n the handling of the individual.  The First Period i n Foster Family Care The aims and procedures of placing the aged dependents for foster family care would vary with the i n dividual.  In some cases, the purpose would be a temporary  placement when the aim i s to f a c i l i t a t e the convalescence and rehabilitation of an old person who has been hospitalized.  In this type of case, and i n Instances where the aged  individual has been suddenly bereft of his spouse, placement might be therapeutic, and efforts would be made to restore the individual to his former state of relative independency. In such instances, the old person should be taken to v i s i t the prospective foster family before f i n a l arrangements have been made, to see how he feels about l i v i n g there.  I f i t appears  satisfactory to him after meeting members of the family, plans for his placement could be carried through. In many instances, when the social worker takes the old person to the home for the f i r s t time, i t w i l l be with the  70 understanding that he i s to remain there.  After introductions  between the client and members of the family have been made, the social worker should remain until a considerable rapport has been made. The worker must be prepared to offer supportive help to both client and hosts during the early part of their  relationship. During the f i r s t few weeks, i t would be advisable  for the social worker to make frequent v i s i t s to the home, perhaps once a week. This would be the period when problems of adjustment are most i n evidence, and supervision would provide the supportive help necessary for permanent adjustment.  There  may be things about the aged person's care that the guardian does not f u l l y understand, and that require specific advice. The social worker could offer encouragement and reassurance to the guardian in handling the client, and perhaps by simple explanations help i n understanding some of the reasons for the c l i e n t s actions. !  The client may bring up many questions.  He may not  accept his role of dependency, and may not understand why he might be restricted i n his activities. The change of environment may make him feel somewhat Insecure at f i r s t , and this insecurity may appear i n sleeplessness, or some other manifestation such as Increased i r r i t a b i l i t y or despondency. The supportive guidance of the social worker would help to direct the client's behaviour Into more acceptable and satisfactory channels.  71  There are a number of details to be considered i f the transition i s from institutional care i n hospital or boarding home to family l i v i n g .  For instance, some individuals  placed i n family foster care may have been i n an Institution so , long that they are no longer familiar with some of the f a c i l i t i e s of community l i f e .  This can result i n many minor annoy-  ances and frustrations.  The old person may have lost the habit  of turning off the gas stove or the electric toaster, with disastrous results, or he may not know how to regulate the heat from the furnace, or how to use a washing machine.  From a  postion of dependency i n the institution he must re-learn how to become self-sufficient for some of his needs.  One old  gentleman now in a foster home had spent two years In a hospital, followed by three years i n a boarding home, before his present placement.  One evening recently, he was replacing a light globe  in his room and accid,entally gave himself a severe electric shock.  The old person i n the home should be, encouraged to re-  learn former s k i l l s gradually, and to accept new responsibilities only as quickly as he i s able. In boarding homes and hospitals, food i s usually served on the inmate's plate, so that he Is no longer accustomed to helping himself to food i n the way customary to many families.. Often, too, he has become very casual about matters of table etiquette.  Sometimes old men are very lax about shaving, and  they may have to be told when to wash and take a bath.  72 These may seem to be t r i f l i n g details, but problems of adjust** ment may arise from them unless they are taken into consideration, and the aged person s l i f e i n the home planned accordingly. 1  Problems seem as varied as the old people themselves, and the adjustment each w i l l have to make, and the meaning of family care for him must be understood by the social worker and the hostess If the placement i s to be successful. When the old person has been i n a foster home for a few weeks, i t should be evident whether or not he w i l l be comfortable and happy there for an indefinite period.  In a number  of the cases studied, some of the clients were withdrawn and taciturn at the time of placement, but they have responded to some extent to the warmth and Interest of the guardian. Most of the old people Interviewed i n the foster homes expressed their feelings toward the homes. It appeared that those i n the more stable situations, where the best client-guardian relationships prevailed, were best able to express their opinions and even criticisms. Each social agency that was contacted cited Instances where a private family placement had to be'terminated because the caretaker found the client to be d i f f i c u l t , unhappy or unresponsive.  In none of these cases had sufficient selectlve-  ness been carried out i n the home-finding or client selection processes.  In cases of failure, the old person should not be  given a feeling that he.is at fault because he has been unhappy  73  in one family. On the contrary, he should be made to feel that the social worker will have a greater understanding of him as a result of the experience, and that a home better adapted for his needs might be found.  Similarly, i t should  be made clear to the guardian that the fact that the placement was unsuccessful i s not necessarily a reflection on her capabilities.  She should be given to understand that the  reactions of old people are far from predictable, and for this reason, changes of placement may often have to be made.  Relationship of Social Worker to Client and Guardian In v i s i t s to the home, the social worker should always make a point of being alone with the client for a while so that he can feel free to talk about any d i f f i c u l t i e s .  Even  i f he i s somewhat senile and his thoughts are not clear, i t i s important to know what his general ideas and trends seem to be. If, on the other hand, the aged person i s mentally alert, and something has happened which has upset him, he should be secure enough i n his relationship with the social worker to discuss the problem.  Furthermore, individual attention would give him  a feeling that his welfare i s important to the social worker. He should feel that he i s recognized as a person, and that he has someone to rely upon i f any d i f f i c u l t y arises.  It would be  reassuring to him to know that he w i l l have the opportunity to discuss confidentially with someone, what i s troubling him.  7*  The same opportunity should be given the guardian, so that both sides of any situation may be understood.  On listening  to old people both i n boarding homes and i n foster homes, one hears many strange ideas, and one feels that often their complaints and demands have l i t t l e validity.  This may be  true, but one must understand their ideas thoroughly to know how to meet their d i f f i c u l t i e s , real or Imaginary,  With such  cases, the guardian requires much help to understand the client and to accept his eccentricities. The social worker should avoid concentrating his efforts solely on the member of the family group who assumes the major responsibility for the old person's care. The rest of the family might need much help, and i f this help i s given, they a l l might be helped to become effective therapeutic agents. At the same time, the social worker must be prepared to give the client time and attention i f he i s to have the sense of security he needs.  The aged client must feel that i n the  social worker he has someone who w i l l understand and help him, and the guardian has a right to expect interpretation  of the  client's behaviour, and practical suggestions how to handle specific problems.  Problems and Techniques of Supervision The supervision of old people i n foster homes would be no work for an amateur.  I f i t i s to be carried out  75  successfully. It would require the services of a social worker well versed In a knowledge of human behaviour, particularly the behaviour of old people.  There would be  a number of routine matters of supervision, such as arranging for medical care and examinations, advising him as to the expenditure of money he may have, and perhaps arranging for the purchase of clothing.  The actual casework  services offered the guardian i n the care of the aged, however, i s quite a different matter.  This would come about  through discussion of the old person's behaviour peculiari t i e s , and methods of handling them. The guardian w i l l need concrete suggestions as to when to offer encouragement and praise, what the client should be encouraged to do on his own i n i t i a t i v e , and when his interests and energies should be diverted into other channels.  The guardian and members  of her family may be discouraged and frustrated because the old person does not respond to their care as i t i s f e l t he should.  They must be helped to understand that many old  people tend to be r i g i d i n their attitudes and relationships, and are more resistant to change and forming new relationships than younger people.  At times some recognized improvement  could be pointed out, and the family given credit for their part i n bringing i t about. In some instances, the emotional needs of an old person can never be met. Their reaction patterns have become so solidified over the years that no change i n personality  76 or behaviour can be expected.  The old man described i n  Case 17 i n Chapter II was Intractable and demanding, i n addition to having very rigid ideas and standards of behaviour.  Only because the people with whom he lived had  exceptional qualifications, the placement' was successful. In an established agency programme for the placement of old people for family care, i t i s questionable whether this extreme type of person should be considered as suitable. Many old people, however, do present such personality disorders to a lesser degree, and It should be the duty of the social worker to help the caretaker to understand that this Is a form of Illness and, although incurable, may be dealt with through sympathetic understanding. In some situations where the foster placement seems quite successful, problems may arise about the client's overzealousness toward work around the home. He may show an unusual amount of Initiative i n finding Jobs to do around the house and garden.  The family may not have a f u l l under-  standing of the client's limited capacity for work, and may. encourage, or at least, not discourage him to undertake something that i s far beyond his a b i l i t y .  The social worker,  prior to placement,, should take care to warn them of the client's physical limitations, and the hazards of overstepping them. A f r a i l old lady of eighty, was very appreciative of the affectionate care she had been receiving i n her foster  77  home. She tried to express this appreciation by helping her hostess with the housework and other household duties. One day last summer she tried to move a heavy piece of furniture, strained her back, and was bed-ridden for three weeks. Although she i s again able to assist i n the house work, the family has learned to keep a close watch over her, and now insists that she confine her efforts to light work. After the old person has found his place In the home and seems to feel that he Is a part of the family and the community, less frequent contacts with the social worker would be necessary.  While some v i s i t s would be made on the  basis of need, monthly routine calls would probably be sufficient.  The reassurance and encouragement which the  client and guardians receive would be essential to continued adjustment.  The social worker would be helpful i n straighten-  ing out small d i f f i c u l t i e s which may arise between client and family.  Furthermore, the social worker should always be an  interested and encouraging listener.  Most old people achieve  great satisfaction from t e l l i n g of the social functions they have attended, or ehowing people how their gardens have grown, or what they have achieved along the lines of their special interests. It would seem wise to put only one aged client i n the home at a given time, or possibly two i f they are congenial and interested i n one another.  When an old person has settled  7&  down and become part of the home, perhape he w i l l be glad to have the company of another old-timer so that there w i l l be a sufficient number i n the family group to carry on certain activities.  For instance;, there are old men who are  not able to do enough puttering around the house to keep themselves busy.  They may enjoy companionship of their own  age and w i l l welcome someone with whom they can play cribbage or discuss p o l i t i c s , who w i l l be a companion on a walk, or share special interests. Furthermore, old people love reminiscing about the past.  An audience of the same age i s  satisfying for the often repeated story of halcyon days when l i f e was, to their minds, f u l l of exciting adventures. Through the use of available social history material and from his own observation of the aged client, the placement social worker must make an evaluation of the client's a b i l i t y to participate i n the social activities of a prospective home. He should also determine his recreational interests and preferences, and evaluate the home partly i n terms of i t s ability to f u l f i l these interests. Boarding home supervisors seem to agree that card games and puzzles Is far less general among the old women than among the old men.  The women enjoy doing some kind of  handiwork as a form of recreation rather than playing games. Elderly women are far more self-reliant and resourceful, and better able to amuse themselves than are old men.  When a  79  man, because of physical incapacitation, i s no longer able to work f o r a l i v i n g , he tends to lapse into a greater degree of dependency than a woman. A dependent woman, although l i m i t e d i n her a b i l i t y to get around, usually has a number of s k i l l s which she may s t i l l pursue, such as sewing, mending, k n i t t i n g and so on. Because of her greater resource of s k i l l s , an o l d woman i s not usually so r e l i a n t on group a c t i v i t i e s f o r her entertainment.  By making a contribution to the family group  through use of her remaining s k i l l s she i s able to gain much more s a t i s f a c t i o n out of family l i f e and i s l e s s l i k e l y to become as lonely as an o l d man does i f there i s no group around.  Therefore, sex d i f f e r e n t i a t i o n of s k i l l s i s an  important factor that the s o c i a l worker must consider i n the placement of an aged Individual. The p o s s i b i l i t i e s of the o l d person's adjustment i n the f o s t e r home depend to a marked degree on the guardian. The o l d individual's ideas and patterns of response are usually well f i x e d .  A guardian must be chosen f o r her a b i l i t y to accept  these, and she should be able to gain s a t i s f a c t i o n In creating situations i n which the dependent o l d man or aoman responds favourably.  The supervision of o l d people i n family care i s  a continual case work process, which aims to secure from the guardian an increasingly understanding acceptance of the c l i e n t , and from the c l i e n t , an improved response to normal family relationships.  Chapter IV THE ROLE OF THE SOCIAL WORKER IN A FOSTER PLACEMENT PROGRAMME  For  most people, the Increase in.the number of  people over s i x t y - f i v e years of age has been interpreted mainly i n terms of need f o r larger old-age assistance appropriations, the  S o c i a l workers concerned with the care o f  aged, however, rjtust v i s u a l i z e what a gradually ageing  of population w i l l mean i n terms of need f o r case work, f o r medical and mental hygiene f a c i l i t i e s , f o r r e - t r a i n i n g programmes f o r older workers, f o r sheltered work and r e c r e a t i o n a l opportunities, and f o r semi-protected l i v i n g arrangements especially geared to the needs of elderly people. U n t i l the present time, most s o c i a l agencies engaged i n providing care f o r the aged, according to the various means at t h e i r disposal, have been so involved i n establishing a smoothly run administration that they have been unable to view the situation of the aged i n the community i n i t s t o t a l perspective.  There i s a necessity f o r s o c i a l workers to  examine the problem In i t s entirety and, to co-ordinate and consolidate the t o t a l resources available for the purpose of caring f o r the aged dependent i n a way most s a t i s f a c t o r y to him and most advantageous f o r those responsible f o r h i s care.  Bl  The theme of the present study has been the assumption that social workers i n British Columbia are not aware of, or, are not making use of the total resources for the care of the aged, with the result that quite often the plan for meeting the special needs of the aged Individual i s not the most suitable.  For the most part, social agency  personnel are cognizant of the f a c i l i t i e s offered by the hospitals, licensed boarding homes, and nursing homes i n their d i s t r i c t s , but have l i t t l e awareness of the practically untapped resources available through placement of the dependent aged i n foster homes. The results of this study strongly suggest that a substantial proportion of the aged in the community could benefit through this measure. There appears to be l i t t l e doubt that the Institution of a 'foster home placement programme for the dependent aged would be a 1  valuable adjunct to existing methods of placing old people for  specialized care i n licensed boarding homes, nursing  homes, et cetra. Much of the current literature on the various aspects of gerentology Indicate recognition of the necessity of individualizing services to the.aged.  Because no two  private family homes are quite alike, and because they vary, one from the other, as individual personalities d i f f e r , they would offer a great range of resources to meet the individual needs of old people.  82  Private family homes may offer special opportunities for individualized planning i f there are sufficient homes available, and therefore a wide choice as to location, religion, cultural, and nationality backgrounds, social interests and standards of l i v i n g .  In this kind of arrangement the indiv-  idual's need for personal attention and assistance with certain aspects of daily l i v i n g are f u l f i l l e d along with the individual's need to continue to be part of the community. If family.care had no value other than It gives to old people, i t would have demonstrated i t s worth.  It gives  opportunities for more or less normal l i v i n g to people who  may  have been isolated and restricted because of the inadequacy of other methods for the meeting of their needs.  Throughout this  study, i t became more and more evident that, for some old people whose dependency needs were only p a r t i a l , prolonged institutional l i f e tended to have a deleterious effect on the personality.  Somehow, the common experience of neglect,  Illness, or dependency, which cause people to be placed in institutions, did not help them to live i n love and affection. Loss of security in these fundamental relationships causes much unhapplness amongst inmates of institutions and they react in various ways to the experience.  Their reactions are  intensified by the lack of attention to their individual needs and by the regimentation so d i f f i c u l t to avoid in institutional life. In contrast, family care can increase the measure of  S3  human happiness by restoring to normal l i f e i n a friendly world, and sometimes to a more useful and active l i f e , people whom the monotony, loneliness, and frustration of institutional l i f e have reduced to passive indolence and, at worst, to bitterness and rebellion.  Although treatment  in institutions i s necessary and valuable for many, more emphasis should be made toward placement i n the community, and utilization of f a c i l i t i e s for l i v i n g that are nearly normal as possible, with the aim that the individual should have the opportunity to make f u l l use of his remaining capacities i n an environment i n which the usual l i f e experiences predominate.  Should foster family care be utilized  extensively for the placement of old people, we could probably anticipate some administrative results, effective for the following reasons; i t would release space i n i n s t i t u tions f o r others who are i n need of specialized treatment; i t would provide care for the aged at less cost than institutional maintenance; and, a large proportion of people so placed would make a relatively permanent and satisfactory adjustment.  Recommendations for the Selection of Homes In introducing family care for the aged, the social worker should go into the community f i r s t of a l l to give certain key people an understanding of the whole philosophy of the project.  The plan might be discussed with the agencies  directly concerned with programmes for the care of the aged.  84  These might be private or public agencies Interested i n programmes for housing of the aged, employment agencies, recreational centres, and old people's own organizations. The experience of the writer has been that when laymen, or even social workers, are approached with the idea of considering foster placement, the reaction i s one of mild surprise.  The proposal i s , at f i r s t , alien to their prior  thinking.  Their interest, however, i s readily aroused after  interpretation.  People who are familiar with the inadequacy  of the existing programmes for the care of the aged are, i n most cases, glad to welcome and consider a new proposal. Often they suggested cases as examples of foster home placement, although they themselves had never before considered them as such. For help and advice i n the selection of homes, the placement worker would be advised to make contact with the community physicians and nurses, particularly the public health nurses.  They usually have an extensive knowledge and  understanding of the problems of many of the old people under their care. In spite of the various social implications of old age, i t i s s t i l l largely a medical problem.  For this  reason, and also because many prospective guardians would be well known to them, members of the medical professions should prove of great assistance i n a family placement  service.  Social agency supervisors and community social  *5  workers also, often may be able to recommend people who have cared for various local charges, such as unmarried mothers prior to birth of their babies, foster children and chronically i l l .  For instance, the child welfare worker  may know of foster parents with whom children have been placed for years, but who have reached the age where the care of young children i s now too strenuous for them, a l though they would s t i l l be able to provide a good environment for older dependents.  In the cases studied, the age of  the guardians has not seemed to be a major factor i n evaluating the a b i l i t y to look after old people.  In fact,  In a number of instances, people of middle age gave more capable supervision because they were more willing to remain at home with their charges and give them the attention they need, than young people whose recreational interests tended to take them away from home more often.  Guardians whose ages  are from f i f t y to sixty might prove to be best suited to care for old people.  This might prove to be particularly true If  they have had previous experience i n caring for other types of cases i n co-operation with welfare agencies. Clergymen should also be visited by the social worker.  They usually know the church members well, and are  able to give some Idea as to the suitability of people for such an undertaking.  They might prove to be particularly  helpful i n recommending homes for old persons who express a desire to live with people of similar religious faith.  26  If-there happens to be an organization of a p a r t i cular national group, the social worker may discuss the project with i t s leaders, i n case one wishes to place a non-English v  speaking old person i n a family home where his native language i s spoken. The object of interviewing these various people i n the community i s twofold:  to interpret the project to them,  and to find suitable homes for the aged clients..  The social  worker w i l l l i k e l y find that many people are astonished by the prospect of having aged foster charges i n their midst, and i t may take some time for them to accept the fact that family care may be a community asset.  For this reason, i f the pro-  gramme i s to be successful, a good deal of preliminary work w i l l be necessary to make sure that there i s general understanding of what family care means, particularly on the part of the community leaders. The preparation of a community for family care would be a time-consuming task.  It i s something that must be done  in an unhurried way and many resistances and prejudices must be overcome i f the recipients of this care are to enJay the maxim satisfactions from l i v i n g in the community. The education of the community would be accelerated by the placing of clients.  No patient should be placed i n  the community, however, unless some responsible people besides the guardian know and understand the situation.  Usually the  S7  family physician of the guardian and the clergyman of the old person's f a i t h know of h i s placement.  I t could be  anticipated that knowledge of the placement would spread, p a r t i c u l a r l y i f the placement I s i n a r u r a l or semi-rural d i s t r i c t , so i n a short time, quite a number of neighbors would know something of family care.  Service clubs and  Neighbourhood Houses Interested i n the care of the aged should have a r e a l i z a t i o n of the placement programme, and t h e i r co-operation should be used as a resource f o r the recreational and avocational needs of the c l i e n t s . When a s o c i a l agency sets up a programme with a s o c i a l worker appointed as a f o s t e r home f i n d e r , the d i s t r i c t should be canvassed f o r homes that might o f f e r the aged c l i e n t s the maximum amount of freedom within t h e i r l i m i t a t i o n s , and with the fewest possible hazards.  The homefinder should c a l l  upon the various people who might be recommended as desirable guardians by other s o c i a l workers, clergymen, and other interested i n d i v i d u a l s . When the home finder goes to a house to i n t e r e s t the family i n caring f o r old people, the educational process i s repeated.  The immediate response that might be expected  from any prospective guardians i s that they could not put up with a doddering,  cranky o l d man or woman who might  thoroughly  disrupt the home. When, however, they are helped to understand the type of people who w i l l be placed In family care, t h e i r assets as well as t h e i r l i a b i l i t i e s , i t i s anticipated that interest w i l l soon be shown.  S3  The home finder might f i n d that the wife i n a home i s very much interested i n undertaking such a p r o j e c t , but that when the husband i s interviewed, he i s emphatic i n refusing to have the equilibrium of h i s home disturbed by having a stranger l i v e with the family.  Sometimes i t may  take a long time and a great deal of i n t e r p r e t a t i o n to give the husband an understanding of what to expect from an aged guest, and to overcome h i s prejudices.  In some situations  l i k e t h i s , the husband's f e e l i n g about old people may be so deep-seated that i t w i l l not be advisable to t r y to have him receive them i n h i s home.  Often, when the husband and wife  look upon the caring f o r an old i n d i v i d u a l as something Interesting to do, and something that has p o s s i b i l i t i e s of s a t i s f a c t i o n and some f i n a n c i a l gain, other members of the family, possibly sons and daughters who contribute to the maintenance of the home, may o f f e r objections.  This would  necessitate more i n t e r p r e t a t i o n on the part of the home finder.  A l l members of the family s i t u a t i o n should be helped  to accept the old person because of the e f f e c t t h e i r attitudes might have on the old person's adjustment.  I d e a l l y , the  entire family should be Interested i n carrying out the project i f i t I s to be successful. Professional Q u a l i f i c a t i o n s of the Social Worker The use of family care f o r therapeutic purposes would require intensive case work, not only with the o l d person and h i s f o s t e r family, but often with h i s own family  29 and r e l a t i v e s .  I f i t i s intended to prepare him f o r h i s  eventual return from h i s foster home to h i s family, the r e l a t i v e s must know what the placement I s expected to do for him, and why one home was chosen i n preference to another.  Even though t h e i r attitudes toward him may be  h o s t i l e , r i v a l r o u s , or r e j e c t i n g , i t i s important to i n t e r pret the aged person's problems to the r e l a t i v e s , and to Include them i n each step of the foster placement.  Often,  when a family gains a certain insight into the d i f f i c u l t i e s of adjustment  experienced by an aged person, a sympathetic  understanding may replace former Intolerance, and the home may again be prepared to assume the r e s p o n s i b i l i t y of h i s care. If placement In family care i s Intended f o r the purpose of hastening convalescence a f t e r an I l l n e s s , with the goal of permanent restoration of health, the s o c i a l worker should have the s k i l l to be able to consider the home i n terms of i t s therapeutic p o s s i b i l i t i e s , and must be able to help the people who make up the family group to become therapeutic agents.  The patient must be helped and  protected from misunderstandings,  anxieties, and other  factors that may have played a destructive r o l e In h i s l i f e . Experiences i n the f o s t e r home placement of aged mental patients has shown that materially, the home should be on a par with the home to which the patient w i l l return, or i n keeping with the standards he may expect to have when he  90 re-establishes himself..  Otherwise, he may  set a standard  for himself that he cannot a t t a i n l a t e r , with r e s u l t i n g f r u s t r a t i o n s and d i s s a t i s f a c t i o n s that may be disastrous to h i s mental health.  I t may be possible f o r him to adjust  comfortably to standards of l i v i n g lower-than those to which he has been accustomed, while d i f f i c u l t i e s arise i f he attempts to adjust on a higher l e v e l than he can hope to maintain. Needless to say, special professional q u a l i f i c a t i o n s would be required of the s o c i a l workers who would specialize i n the techniques of foster home finding f o r the aged, the selection of suitable c l i e n t s , and t h e i r supervision a f t e r placement.  He should be well trained i n generic s o c i a l work  p r i n c i p l e s and techniques but, i n addition, he would require a thorough knowledge of the c h a r a c t e r i s t i c s and the special problems of adjustment  experienced by the aged i n the  community. In the course of t h i s study i t became increasingly evident that the longer a human being l i v e s , the more l i k e himself and the more unlike anyone else he becomes. younger people that are the conformists and who other more.  It i s  resemble each  Yet, i t i s a c h a r a c t e r i s t i c of youth to tend to  consider the aged i n our midst as a separate category having i d e n t i c a l feelings, thoughts, l i k e s , d i s l i k e s and ambitions. In actual fact, each o l d person, whether sick or well,  91 wealthy or poor, bright or d u l l , happy or sad, i s an i n d i v i d u a l human being, and each wants to be considered as an i n d i v i d u a l .  Indeed, the right of each to be treated as  an i n d i v i d u a l must be recognized by the s o c i a l worker concerned with h i s placement., whether i t be i n an I n s t i t u t i o n , boarding home, h o s p i t a l or private home, Lawton discusses a number of the "rights" of the 1  aged.  The s o c i a l workers recognition of these rights i s  essential i n giving the most e f f e c t i v e assistance to make.the adjustments c a l l e d f o r by l a t e r maturity. to be treated as a person.  F i r s t , Is the r i g h t  As they become older, people may  become slower In t h e i r a c t i v i t i e s , both physical and mental, and cannot function as e f f i c i e n t l y as younger people can. Along with the diminishing of t h e i r f a c u l t i e s , there may be a lessening of interest and an increase i n e c c e n t r i c i t y .  But  they are s t i l l people, old people, not a sub-species of homosapiens.  Old men and women are more.like people of younger  ages than unlike them.  Should the worker not know how to act  toward them on some p a r t i c u l a r matter, a good general rule i s to treat them the way he would wish to be treated.  The Golden  Rule includes o l d people too.  1. Lawton, George, Aging Successfully. Columbus Univers i t y Press, New York, l$Wbl pp7~236 - 253.  92 The right to be treated as an adult i s equally important,  A paternal and protective attitude may  stem  from the best of intentions, but carried too f a r , can lead to unfortunate r e s u l t s .  It i s true that some people of  advanced years are dependent to the extent of needing nurses and guardians a l l the time.  The greatest number of o l d  people, however, have many remaining strengths that can be utilized. t h e i r own  They are grown-ups and quite capable of using judgment and making decisions.  They have a need  to use t h e i r remaining c a p a b i l i t i e s , because i f others do a l l the thinking and deciding f o r them, they tend to become helpless c r i p p l e s , both morally and mentally.  Inactivity  can sometimes do more harm than over-exertion and they should not be kept from developing  i n i t i a t i v e of t h e i r  own  unless they are obviously doing themselves harm. The aged, no more.than the very young, cannot be deceived  by patronizing a f f e c t i o n . They are quick to discern  the difference between genuine a f f e c t i o n with a r e a l i n t e r e s t , and an affected tolerance toward t h e i r a f f a i r s . Case IS, outlined i n Chapter I I , i l l u s t r a t e s a foster placement that was unsuccessful.  I t s f a i l u r e may  attributed to the lack of genuine interest on the part of the guardians toward the aged c l i e n t . the woman described i n Case 19  On the other hand,  thrived on the sincere  a f f e c t i o n shown her by a l l members of her f o s t e r family.  be  93  In comparing these two examples of private home placements, i t i s important to recognize the second was successful because the guardians respected the c l i e n t ' s status as an adult i n the home.  Although she i s dependent  upon the family f o r emotional support and f o r protective help, she i s permitted to make f u l l use of her remaining capabilities.  She i s thus a happy and contented person.  A s o c i a l worker should be s u f f i c i e n t l y s k i l l e d to evaluate a prospective foster home i n terms of i t s a b i l i t y to accept the aged person as an adult.  An old person able  to function as a grown-up and with the a b i l i t y to make h i s own adjustments and decisions should be placed i n such a home.  On the other hand, an o l d man or woman with a  neurotic need to be dominated and treated as a c h i l d would perhaps be better suited f o r placement i n a home such as the f i r s t described. Most o l d people want an opportunity f o r s e l f expression and self-development avocation or an education.  and many f o r a vocation,  As a r i g h t , they should be  granted a f a i r chance on their merits.  Within the l i m i t s  imposed by the degree of the individual's dependency, he should be permitted, and encouraged, to compete with others for the jobs and i n other constructive p u r s u i t s . One seventy-one year old gentleman, l i v i n g by himself, re-defined the term "democracy" to mean "a place where people can com-  pete f o r opportunites regardless of race, colour, creed, or age.  11  opponent.  He demands the right to be regarded as a worthy He said that nothing annoys him more than to have  a younger person shrug h i s shoulders, smile generously., and say or imply, "After a l l , he i s an o l d man,"  This man  is in  receipt of the old age pension but wishes to Implement h i s income by taking part time work.  By doing so, he hopes to  avoid or delay lapsing to the p o s i t i o n where he i s dependent upon others for h i s material needs.  Although s t i l l a capable  and experienced tradesman, and i n good health, he i s not considered acceptable f o r a Job because of h i s advanced age, A chance to advance on h i s merits i s not being recognized, and therefore h i s r i g h t s are being v i o l a t e d . No old person should be deprived of the inalienable right to make h i s own mistakes and do h i s own discovering. Many o l d people were interviewed during the course of t h i s study, and It was remarkable the number who  struggle to r e t a i n  t h e i r adult r e s p o n s i b i l i t i e s i n spite of a l l the things that reduce t h e i r Independence; inadequate  energy, money, health.  They want the chance to remain u n t i l the l a s t minute, managers of t h e i r own l i v e s and a f f a i r s .  It would be well f o r any  s o c i a l worker Involved In the placement of the aged to allow the c l i e n t to make h i s own decision and assume r e s p o n s i b i l i t y for them.  Before the worker o f f e r s help or advice, he should  95  wai-t u n t i l he i s aeked f o r i t .  x  In t h i s way  the placement  programme could conceivably increase the o l d person's a b i l i t y to solve h i s own problems.  Except i n instances where depend-  ency needs are acute, the worker should avoid making a r b i t r a r y decisions f o r the care of the c l i e n t .  The emphasis should be  on giving him guidance and assistance i n making h i s own Everyone who  l i v e s wants something to look  to, to plan f o r , to work f o r .  plans.  forward  This Includes the aged a l s o .  Food, lodging and clothes are necessities, but no one i s s a t i s f i e d with just these, whether young or old.  One  commonly  hears about old people l i v i n g i n the past, and i t i s true that they tend to reminisce a great deal more than younger people. The past, however, i s often the only place they can v i s i t . In so many instances the i n d i v i d u a l i s denied the opportunity to make a contribution to the world.  His present  existence  i s drab and uninteresting and the future holds no promise of betterment.  The only way he knows to gain s a t i s f a c t i o n i s to  think and talk of the "good old days" of long ago.  I t was  noted i n the course of this survey that, by and large, the old man  or woman, l i v i n g happily In a home., took a greater  Interest i n h i s personal future and was l e s s i n c l i n e d to  1, Marc L. Hollender, M.D. and Stanley A, Frankel, "Don't Baby the Old Folks". Today's Health, August, 1951!-, pp. 2b Published by the American Medical Association, Chicago, I l l i n o i s .  96  dwell upon past experiences.  An assessment of the aged  c l i e n t ' s tendency to dwell upon old triumphs, as a mechanism to r e l i e v e current feelings of inadequacy or helplessness, could be of value to a placement worker In two ways. I t s Inclusion i n a s o c i a l history would help determine the need of the c l i e n t f o r special placement.  I t would also be a  guide In evaluating the success of a home placement.  Should  a c l i e n t , after a period of time i n a foster home, show indications of ceasing to r e l y on memories of past achievements i n order to gain s a t i s f a c t i o n , and begin to make r e a l i s t i c plans f o r the future, one could conclude that he had benefited from the placement. I t i s possible to understand many of the emotional reactions of older people i f the stresses of the l a t t e r years of l i f e and their e f f e c t s upon the previously existing personality structure are considered.  Such understanding i s  essential to the s o c i a l worker concerned with t h e i r home placement and h i s s k i l l s must Include the a b i l i t y to make a careful evaluation along these l i n e s .  The most common  stresses are physical and mental l i m i t a t i o n s or d i s a b i l i t i e s , retirement, loss of r e l a t i v e s and friends, and r e j e c t i o n by children.  I t i s true, of course, that the hardships to which  some people are subjected are l i g h t , while those that others must bear are heavy.  A mild stress that touches a weak spot  may be as disruptive as one of greater magnitude which s t r i k e s a l e s s vulnerable area.  Physical and mental l i m i t a t i o n s ,  97 retirement, and l o s s of r e l a t i v e s often produce  their  effects i n two important emotional areas: self-esteem, as well as dependency (one's need f o r emotional sustenance).  1  When latent but Intense c o n f l i c t s about self-esteem or dependence are mobilized by stress, a serious emotional upheaval may r e s u l t .  When, on the other hand, these areas are  not unduly vulnerable, the reaction to .the stress may be appropriate and mild.  As have been stated, the s o c i a l worker  must recognize that the individual's response w i l l depend on the severity and kind of stress and the previous personality structure. The reactions to l o s s of self-esteem are evoked by stresses such as heart disease, and a r t h r i t i s , which l i m i t a c t i v i t y by loss of physical attractiveness, and by enforced retirement.  They occur because the stresses disrupt o l d  methods of keeping an unacceptable picture of oneself submerged.  When external assurances, derived from productive  work, and i t s accompanying recognition, are no longer a v a i l able to combat the unacceptable picture stemming from e a r l i e r years when the basic attitude about oneself was formed, the hidden feelings threaten to emerge.  Those people  1. For a detailed discussion see: Marc L. Hollender,M,D, I n d i v i d u a l i z i n g the Aged, Social Casework, Volume XXXII, No, &, October, 1952, New York, N.Y.  SB  who suffered the most early injury to t h e i r self-esteem, and who were most dependent upon a single method of obtaining external supplies, are hardest h i t when stresses upset t h e i r pattern of l i v i n g . Oiletson  1  c i t e s the case of the business man who  had a heart condition that required a reduction of h i s a c t i v ities.  He reacted to t h i s threat by declaring that h i s  physicians were p l o t t i n g to get him out of business. Another business man of s i x t y - f i v e developed street phobia that prevented him from going down to h i s o f f i c e .  It  was easier f o r him to tolerate h i s symptoms than I t was to face the fact that he was d e c l i n i n g and being eased out of h i s business p o s i t i o n . In both cases the n a r c i s s i s t i c blow resulted from i n a b i l i t y to continue at work, and the loss of t h i s source of prestige.  Very d i f f e r e n t mechanisms of defence, however, were  called f o r t h .  One man used paranoid projection and the other  resorted to a phobia.  Both were over-worked individuals who  had not developed secondary ways of obtaining meaningful support of t h e i r egos.  When'the prime method of holding  1. Maxwell Giletson, "The Emotional Problems of E l d e r l y ' People". Geriatrios, Volume 3, 11948 J, pp. 135-150.  99 feelings of worthlessness i n check were taken away, an emotional i l l n e s s resulted. In selecting old men and women f o r placement i n "foster homes", the s o c i a l worker should not be expected to make a p s y c h i a t r i c diagnosis of the c l i e n t .  He should,  however, be able to make gross d i f f e r e n t i a t i o n s between the reactions, (neurotic and psychotic i n type), which may occur when undue stress deprives a person, with a deep n a r c i s s i s t i c wound, of h i s major means of defense.  Among the cases  studied there were a number of aged people with whom there was l i t t l e evidence of such a wound.  Even so, i n every  instance there was some reaction, however s l i g h t , to the feelings of uselessness and inadequacy r e s u l t i n g from i l l n e s s or retirement. Nearly a l l tend to use some of the defences that are so common i n older people that they help to form part of the stereotype of the aged.  Among these are:  a  turning to the past; a r e f u s a l to t r y new things; the development of a set way of doing things; and a s e l f - a s s e r t iveness to the point of being domineering.  For discussion  purposes a sharp l i n e has been drawn between these reactions and those i n the cases c i t e d previously.  Actually there can  be no sharp d i v i s i o n , but rather, a shading from one group to another. Therapeutic measures, i f they are to be well suited to the o l d person,, should be based on a thorough s o c i a l  100  history and a careful evaluation. When the aged man or woman suffers from a deprivation of r e a l i s t i c needs, the worker should do whatever he can to f i l l these needs. In some instances, acceptance  by and supportive help from a  s o c i a l worker w i l l be of benefit.  In other cases, encourage-  ment to j o i n clubs and recreational groups w i l l f i l l the void.  When an o l d person has turned to the past, or developed  fixed ways of doing things as a prbtectlon against i n j u r i e s to self-esteem, the worker should not tamper with these defences unless he Is sure that he can provide adequate substitutes for them. Evaluation of the Study Despite the exploratory nature of the study, several tentative, conclusions can be drawn; 1.  The examples of successful foster family placements  described i n Chapter II demonstrate the f e a s i b i l i t y of making more extensive use of private family care as a resource for the care of the dependent aged, 2.  Poster home care would require special attention  to i n d i v i d u a l i z e d planning, and therefore, a wide choice as to location, r e l i g i o n , c u l t u r a l and natural backgrounds, s o c i a l interests and standards of l i v i n g .  In  t h i s type of care, the individuals need for personal attention and assistance with certain aspects of d a i l y  101  l i v i n g are f u l f i l l e d along with the i n d i v i d u a l s need 1  to continue to be part of the community, 3,  Foster home care could be used as a therapeutic  measure f o r two general categories of the aged. The largest group would be people who require continuous treatment.  Those whose capacities f o r earning a  l i v i n g and meeting t h e i r own needs have been reduced, and who require protective care.  Another smaller  group would be those f o r whom f o s t e r family care would be used as a treatment measure to bring about the t o t a l r e h a b i l i t a t i o n of the i n d i v i d u a l , 4,  Social agencies engaged in., foster home placement  work with the aged would require s o c i a l work personnel with special d i v e r s i f i e d s k i l l s .  The- work would  require well-developed techniques i n community organi z a t i o n , the f i n d i n g of suitable homes,, the selection of c l i e n t s , and professional supervision of c l i e n t s and guardians following the actual placements. Many people l i v e through t h e i r advanced years without any conscious planning or assistance from others. Some have the advantage of l i v i n g i n a m i l i e u that i s inherently h e l p f u l ; others must have more consciously planned assistance.  Regardless of whether the o l d person  i s struggling through h i s problems with minimal help, or i s aided i n h i s adjustment by means of group a c t i v i t i e s .  102  personal case work relationships, environmental  manipulation  through special i n s t i t u t i o n a l or family placement, or whether he i s r e c e i v i n g medical or nursing care, one generali z a t i o n seems to have v a l i d i t y ; o l d age can s t i l l be a r i c h , constructive and enjoyable phase of the l i f e  span.  Treat-  ment, of whatever nature, should be geared by helping him u t i l i z e h i s remaining years optimally.  I t should never.have  as I t s goal the relegation of the o l d one to the dependency of  the armchair or rocker, but should encourage always the  personal expression and self-development  of the i n d i v i d u a l .  The present study has been l i t t l e more than a preliminary evaluation of the p o t e n t i a l i t i e s of foster home placement f o r the dependent aged.  The need f o r further and  more extensive research has been indicated throughout.  As  further s t a t i s t i c a l evidence of the housing and other dependency needs of the aged becomes available, I t i s a n t i cipated that, f o r a large number of senior c i t i z e n s , the opportunity to r e a l i z e personal s a t i s f a c t i o n s can be better provided by foster home placement than through i n s t i t u t i o n a l care.  103  BIBLIOGRAPHY  GENERAL REFERENCES  Chalmers, E.E., "Goals f o r Older People", Western goals In S o c i a l Welfare. Second Biennial Western Region Conference i n Social Work, B r i t i s h Columbia, 1949. Child Welfare League of America, i n c . , Standards of Foster Care f o r Children i n I n s t i t u t i o n s . C h i l d Welfare League of America, Inc., New York,  1937,  Family Welfare Association of America, Individual!zed Services f o r the Aged. Family Welfare Association of America, New York, 1 9 4 l . Grant, Joan,  Recreational Interests and A c t i v i t i e s f o r Senior C i t i z e n s i n Vancouver. School of Social Work, University of B r i t i s h Columbia, August, 1954,  Guest, Dennis T. Taylor Manor - A Survey of the F a c i l i t i e s of Vancouver's Home f o r the Aged. Master of S o c i a l Work Thesis, University of B r i t i s h Columbia, 1952, Leydier, Bernice, Boardlng_Home Care f o r the Aged. Master of Social Work Thesis, University of B r i t i s h Columbia, 1948. Mead, Margaret, "Growing Older i n the Community", Aged W i l l be Served. Brooklyn Council f o r S o c i a l Planning, New York, October, 1948, McKenzie, M.B.  The Care of the Ageing and Disabled Group i n a Veterans' Hospital. Master of S o c i a l Work Thesis, University o f B r i t i s h Columbia,  1950.  P e a r l s t e i n , Dorothy, "The Public Agency Develops a Foster Home Service f o r the Aged", Age W i l l Be Served. Brooklyn Council f o r Social Planning, New York, October, 194g. Toronto Welfare Council, Suggestions f o r a Co-ordinated Programme of Community Services f o r Older People In Toronto. Toronto Welfare Council,. Mav 1957. T  104 BIBLIOGRAPHY  SPECIFIC REFERENCES  Community Chest and Council, "Study of the Situation of the Aged i n Vancouver", Report of the Special Committee of the Committee on the Care of the Aged, Vancouver, 194S. Glletson, Maxwell, "The Emotional Problems of E l d e r l y People", G e r i a t r i c s . Volume 3 , 194S. Government of B r i t i s h Columbia, Annual Report of the S o c i a l Welfare Branch. King's P r i n t e r s . V i c t o r i a .  1947-1951.  Hollander, Marc. L., M.D. "Individualizing the Aged", S o c i a l Casework. Volume XXXII, No. g, New York, October, 1952, Hollender, Marc, L,, M.D, and Frankel, Stanley, A,, "Don't Baby the Old Folks", Today's Health. The American Medical Association, Chicago, I l l i n o i s , August, 1954. Lawton, George,  Ageing Successfully. Columbia University Press, New York, 1946,  Proceedings,  Governors Conference on the Problems of the Ageing. Sacramento. C a l i f o r n i a . 1951. 1  Towle, Charlotte, Common Human Needs. Washington, United States Government P r i n t i n g O f f i c e , 1945. Wallace, Elizabeth, "Old Age Security i n Canada - Changing Attitudes", The Canadian Journal of Economics and P o l i t i c a l Science.  Volume fflTL, Number 2, May, 1$52.  Wagner, Margaret W., "Foster Home Care f o r the Aged", Journal o f Social Casework, Volume XVII,  1946.  Wlckenden, Elizabeth, "The Needs of Older People", The American Public Welfare Association, Chicago, I l l i n o i s , 1953.  

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