UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

From custodial care to rehabilitation : the changing philosophy at Valleyview Hospital Josey, Kay 1965

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

Item Metadata

Download

Media
831-UBC_1965_A5 J6.pdf [ 7.16MB ]
Metadata
JSON: 831-1.0302509.json
JSON-LD: 831-1.0302509-ld.json
RDF/XML (Pretty): 831-1.0302509-rdf.xml
RDF/JSON: 831-1.0302509-rdf.json
Turtle: 831-1.0302509-turtle.txt
N-Triples: 831-1.0302509-rdf-ntriples.txt
Original Record: 831-1.0302509-source.json
Full Text
831-1.0302509-fulltext.txt
Citation
831-1.0302509.ris

Full Text

PROM CUSTODIAL CARE TO REHABILITATION: THE CHANGING PHILOSOPHY AT VALLEYVIEW HOSPITAL A Study of Treatment F a c i l i t i e s Discharge Planning and Community Resources A v a i l a b l e f o r the P s y c h i a t r i c G e r i a t r i c P a t i e n t by KAY JOSEY CLAYTON HERBERT TODD MOORHOUSE IGOR STARAK Thesis Submitted i n P a r t i a l F u l f i l l m e n t 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 r e q u i r e d f o r the degree of Master of S o c i a l Work School of S o c i a l Work 1965 The U n i v e r s i t y of B r i t i s h Columbia I n p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r an a d v a n c e d d e g r e e a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t t h e L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and s t u d y . I f u r t h e r a g r e e t h a t p e r -m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s may he g r a n t e d by t h e Head o f my D e p a r t m e n t o r by h i s r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t . c o p y i n g o r p u b l i -c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t be a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . The U n i v e r s i t y o f B r i t i s h C o l u m b i a , V a n c o u v e r 8, C a n a d a ABSTRACT In I960, the Home f o r the Aged, an i n s t i t u t i o n of the Province of B r i t i s h Columbia, underwent an o f f i c i a l name change to Valleyview Hospital. The change i n name indicated a change i n the philosophy toward the treatment of the aged mentally i l l person. This change can be equated with new knowledge about the physical, psychological and s o c i a l aspects of aging. Formerly the program and the goal were related to custodial care; now, the program and the goal are related to treatment which w i l l r e s u l t i n the aged mentally i l l patient returning to a l i v i n g arrangement i n the community that i s most appropriate to his needs. This study, c i t e s the problems of aged people i n t h i s province, with p a r t i c u l a r reference to problems of mental i l l n e s s . The process of admission to hosp i t a l , treatment programs and discharge procedures, p a r t i c u l a r l y as they r e l a t e to the work of the S o c i a l Service Department, are described. Against t h i s background of procedures, the p a r t i c u l a r c r i t e r i a f o r discharge and r e h a b i l i t a t i o n planning, as re l a t e d to the hospital and to the resources available i n the community are examined. P a r t i c u l a r patient groups are noted i n rel a t i o n s h i p to the p a r t i c u l a r resource required to receive them back into community. The study reveals that, although, using hospital c r i t e r i a f o r discharge, a large number of patients could be approp-r i a t e l y r e h a b i l i t a t e d , but s u f f i c i e n t community resources, including family care, boarding and nursing homes, are lacking f o r such patients. Furthermore, community attitudes towards the aged mentally i l l person have not changed to meet the new philosophy about th e i r treatment i n Valleyview Hospital. Since correspondence revealed that Valleyview Hospital i s unique amongst mental hospitals f o r the aged on this continent, the study was of necessity a p i l o t one, and i s primarily d e s c r i p t i v e . However, the questionnaire method was used to gather data about e x i s t i n g l i v i n g accommodation available to discharged patients. F i n a l l y , the study o f f e r s some suggestions f o r improve-ment and expansion of community resources, and of l e g i s l a t i o n concerning them which, i f c a r r i e d out, would ensure, to a greater extent, that the philosophy of treatment and r e h a b i l i t a t i o n , rather than custodial care, could be translated into p r a c t i c e . ACKNOWLEDGEMENTS T h i s study has been made p o s s i b l e through the u n s t i n t i n g c o o p e r a t i o n and suggestions o f f e r e d by many i n d i v i d u a l s . The w r i t e r s , t h e r e f o r e , wish to o f f e r s i n c e r e thanks to those many people who have given of t h e i r a d v i c e and time i n o r d e r to c l a r i f y p o i n t s from the i n c e p t i o n o f the study u n t i l the f i n a l d r a f t emerged. We wish, e s p e c i a l l y , to acknowledge the generous s e r v i c e s o f our t h e s i s a d v i s o r , Miss Frances A. McCubbin, School of S o c i a l Work, U n i v e r s i t y of B r i t i s h Columbia, whose a b i d i n g f a i t h i n and knowledge of the aged, s t i m u l a t e d and guided us throughout the p r e p a r a t i o n and f i n a l w r i t i n g of the study. To Dr. John Walsh, M e d i c a l Superintendent and Mr. Lindsay McCormick, S u p e r v i s o r , S o c i a l S e r v i c e Department a t V a l l e y v i e w H o s p i t a l , we wish to extend our thanks f o r t h e i r k i n d a s s i s t a n c e . But f o r t h e i r encouragement at the i n c e p t i o n of the study, t h i s study may not have been p o s s i b l e . Throughout, they have remained approachable when t h e i r help was needed. Mr. A. I . Smith, Business Manager at V a l l e y v i e w H o s p i t a l has a l s o been most generous of h i s time and suggestions throughout the study. Mrs. P. White of Welfare I n s t i t u t i o n s and Mr. A. Rose, I n s p e c t o r of H o s p i t a l s c l a r i f i e d many p o i n t s f o r us. We wish to extend our thanks to them. And to Mrs. J . D. Archer, we say thank you f o r her u n f a i l i n g c h e e r f u l n e s s , humour, and the t y p i n g of t h i s study d u r i n g her evening hours. F i n a l l y , we wish to acknowledge the kindness of many othe r i n d i v i d u a l s : the s t a f f and p a t i e n t s at V a l l e y v i e w H o s p i t a l who were w i l l i n g t o t a l k about t h e i r experience w i t h i n the h o s p i t a l ; the owners and o p e r a t o r s of v a r i o u s b o a r d i n g and n u r s i n g homes who spoke w i t h a candor and openness about t h e i r problems i n o f f e r i n g a s e r v i c e to the e l d e r l y w h ile t r y i n g to earn a l i v i n g . To these i n d i v i d u a l s we say thank you. TABLE OP CONTENTS Chapter I . Problems and P o t e n t i a l s of Aging I n t r o d u c t i o n . General Problems of Aging. P o t e n t i a l s of Aging. General Problems of Aging i n B r i t i s h Columbia. P s y c h i a t r i c D i s o r d e r s Among the Aging i n B r i t i s h Columbia. Chapter I I . Scope and Method of Study V a l l e y v i e w H o s p i t a l , G e o g r a p h i c a l L o c a t i o n and D e s c r i p t i o n . The Changed P h i l o s o p h y Toward the Aged. The Scope of the Study. The Method of Study and Sources of Data. Chapter I I I . Admission, Treatment and S e l e c t i o n o f P a t i e n t s f o r Di s c h a r g e . Admission. Treatment F a c i l i t i e s . Treatment Toward R e h a b i l i t a t i o n . F a c t o r s C o n s i d e r -ed i n D i s c h a r g e . P a t i e n t S e l e c t i o n f o r /Discharge. Chapter IV. Discharge C r i t e r i a and Community Resources. Discharge R e l a t e d to Resources. V a l l e y v i e w H o s p i t a l C r i t e r i a as R e l a t e d to Resources. D i s c h a r g e . Follow-up S e r v i c e s . Chapter V. A n a l y s i s of Study and C o n c l u s i o n s . Case I l l u s t r a t i o n s . C o n c l u s i o n s and Resources. V a l l e y v i e w H o s p i t a l Discharge C r i t e r i a . Recommendations. F u t u r e Research. Appendices: A. B i b l i o g r a p h y B. L e t t e r s C. N u r s i n g Form D. Boarding and N u r s i n g Home Que s t i o n n a i r e TABLES IN THE TEXT T o t a l P a t i e n t s i n Residence, A p r i l 1, 1963. Number of Discharges Made to Each of the Resources During the F i s c a l Year 196U-65. Breakdown of P a t i e n t P o p u l a t i o n by Ward on March 31 , 1965. PROM CUSTODIAL CARE TO REHABILITATION:  THE CHANGING PHILOSOPHY AT VALLEYVIEW HOSPITAL A Study of Treatment F a c i l i t i e s Discharge Planning and Community Resources Available for the Psychiatric G e r i a t r i c Patient CHAPTER I PROBLEMS AND POTENTIALS OF AGING Introduction Aging i s a universal process. It is a process both slow and gradual. It i s a process which cannot be halted except by the death of the individual. Even with this inevitability, aging has different meanings within various human societies, and the way In which the individual prepares for his aged period is partially decided by the culture in which he has developed. The classical Greek considered old age as an "unmitigated misfortune" since "many are the i l l s that invade the heart" 1 in old age. On the other hand, the peasants, in the high valleys of the Andean regions of Ecuador, Peru, and Bolivia, after a l i f e of hard t o i l to gain a subsistence livin g , looked to old age as a time when the aged one assumed a respect and honour not accorded during the earlier part of l i f e . This respect and honour is also given to the aged members of the St. Lawrence Island Eskimo whose 1 Slater, Philip E. "Cultural Attitudes Toward the Aged." Geriatrics, vol. 18, number k, (April, 1963), p .308 Holmberg, Allan R. "Age in the Andes." Aging and Leisure. Oxford University Press, New York, 1961, p . 8 6 - 9 0 2 i s l a n d home i s i n the Bearing Sea, one hundred miles from Alaska and within sight of S i b e r i a . These Eskimos, however, expect the aged one to carry out tasks which are within his capacities f o r t h e i r philosophy of l i f e , "work i s l i f e and l i f e i s work", applies to a l l members of that c u l t u r e . 1 While the Eskimos work as long as possible, the Japanese and Burmese aged assume new r o l e s of contemplation and l e i s u r e . In the Japanese case, the aged i n d i v i d u a l receives marked respect 2 from other age groups insid e and outside the family. The same respect holds true f o r the Burmese aged i n d i v i d u a l , although one group receives s p e c i a l deference as "those who eat i n t r a n q u i l i t y " . This group i s i n receipt of pensions.3 B a s i c a l l y , therefore, the attitudes toward aging i n the f i v e cultures c i t e d , with the possible exception of the Ancient Greeks, are i n d i r e c t contrast to the attitudes which are directed toward the aged i n Canadian society. Charlotte Buhler suggests that the "culture of the modern western world i s one of action....Action ( i s our) means of mastery over our environ-ment (and) our means of s e l f expression as well as s e l f f u l f i l l m e n t . " One of the r e s u l t s of t h i s a t t i t u d e i s a lack k of time f o r contemplation. It i s , then, no surprise to learn that the aged have l i t t l e wish f o r contemplation since "people 1 Hughes, Charles C. "The Concept of Time i n the Middle Years: The St. Lawrence Island Eskimos." Aging and Leisure. p .9 1 ""95 Smith, Robert J . "Japan: The Later Years of L i f e and the Concept of Time.". Aging and Leisure, p .95-100 3 Ruston, Colleen.' "The Later Years of L i f e and the Use of Time Among the Burmanese." Aging and Leisure, p .100-103 ^ "Meaningful L i v i n g i n the Mature Years." Aging and Leisure. P.3^9 • ' 3 who are not active are made to f e e l useless and even worth-l e s s " . 1 Prom t h i s attitude, springs many of the d i f f i c u l t i e s which the aged experience i n Canada. Now a question a r i s e s . What i s aging? Perhaps, Leonard Z. Breen has given the best answer when he declares that: "For t h i s writer aging i s a process of change; i t i s not a state of being. I t i s dynamic. Aging i s not adjustment, physical structure, or s o c i a l d i s s a t i s -f a c t i o n . I t i s i t s e l f a process without inherent q u a l i t i e s of goodness and badness. This continuous change, Is what we i n 2 general may understand as 'aging'. Aging and the i n d i v i d u a l have a unity. Prom t h i s idea, aging becomes part of the l i f e l o n g processes of development, change and evolution. A l l these processes are known to happen simultaneously with respect to a single i n d i v i d u a l and at d i f f e r e n t rates within and among i n d i v i d u a l s . These points suggest that work with the aged should include under-standing of the past experience and maturation of the i n d i v i d u a l . To leave t h i s important aspect out of the t o t a l consideration would create a d i s t o r t i o n which would r e s u l t i n f a u l t y reasoning when attempting to explain the actions of a given aged i n d i v i d u a l at a given point i n time. Perhaps t h i s i s where the d i f f i c u l t y l i e s i n the general Canadian a t t i t u d e . So often i t i s easier to ignore the Ibid, p.350 "The Aging Individual." The Handbook of Social Gerontology, editor: Clark T i b b i t t s , University of Chicago press, Chicago, i 9 6 0 , p.147 4 individual sufferings of the aged person while understanding the general problems of the aged group. As a result, fewer services are supplied to the aged group even though the aged people have thoughts, feelings and impressions which have been sharpened by the struggles of l i f e . It might even be suggested that the aged individual i s open to a greater number of problems as a direct result of the cultural demands of Canadian Society. In any case, the aged group must either receive equal treatment i n the supplying of services, or be considered as a minority group with a l l of the lack of understanding, stereotyping and prejudice that such a term implies. As more aged individuals swell the Canadian population, there w i l l grow a stronger demand for services in a l l aspects of l i v i n g from increased pensions to more, and more adequate housing and liv i n g arrangements. A projection of the aged population numbers i s suggested by Dr. Schevenger. He declares there w i l l be more than two million Canadians over the age of sixty-five by I 9 8 O . 1 This does not seem to indicate any change i n the l i f e span of the individual, only a greater number of "people...living...out their expected l i f e span". Thus, i t can be expected, as the aged population increases, the demands from this group for more services w i l l become more insistent. Gn the one hand, the aged population increases while, on the other hand, Canadians, in general, seem to maintain a somewhat 1 "How Shall the Aging Lif e . " Canadian Welfare, vol. 40, number 5 , (September / October, 1964), p.208 2 Towards Better Understanding of the Aged. Seminar at Aspen, Colorado, September, 1958, p.10 5 negative view of old age. Why should such a negative view be held? Might the answer l i e in the way our society i s geared to action? Sustained action requires the v i t a l i t y of youth, and so i t i s assumed that the old person cannot offer much to society because he lacks the v i t a l i t y and quickness of youth. Such an attitude i s an unfortunately narrow one. Although the aged may lack a sustained v i t a l i t y , they are able to offer many other useful contributions to Canadian society. Accumu-lated l i f e experience and the reasoned decisions which can accompany such l i f e experience, hint at the usefulness, the productivity, of older people which remain untapped by Canadian communities. Perhaps the negative view can be traced to another general d i f f i c u l t y for the aged. In the past f i f t y years, at least, great changes have advanced Canada in many different ways, for example, industrialization. So great are the changes that a v i s i t o r from f i f t y years ago would scarcely recognize his country. These changes were hastened by the Great Depression of the 1930's and by two World Wars. As a result, the present aged group has passed through a period of rapid changes which has forced them to make a transition from the l i f e of their past experience, that i s , farms, small towns, a more leisured pace of l i f e , to a l i f e which i s chiefly spent in urban areas with the crowds, t r a f f i c and a fast pace of l i f e . The transition seems to have l e f t the present aged population i l l -prepared to meet the new demands of modern Canadian society. 6 In t h i s sense, the present negative view of the aged may be j u s t i f i e d . Nevertheless, whether condemnation or p i t y i s given to the aged group, there remain many problems which the aged i n -d i v i d u a l faces when he must make t h i s t r a n s i t i o n . In l i g h t of t h i s d i f f i c u l t y , i t seems wise to discuss b r i e f l y a few of these problems, always bearing i n mind that, although these problems are evident, there remains another side: the potentials of aging. This balanced view i s e s s e n t i a l because aging i s not a t o t a l problem area. It also retains a promise which t h i s society has not yet considered of value to any great degree. There follows, then, a b r i e f discussion of these problems; absence of c l e a r l y defined r o l e s , i s o l a t i o n , economic i n s u f f i c i e n c y , retirement, and health. General Problems of Aging ( l ) Absence of Clearly Defined Roles. In general, the aged i n d i v i d u a l has no guide l i n e s to indicate the r o l e s to be assumed a f t e r the age of s i x t y - f i v e . Cavan (et a l ) outlines t h i s d i f f i c u l t y : "The s o c i e t a l pattern f a i l s to define c l e a r l y what the r o l e of the old person i s with reference to other age groups or within the old groups. This f a i l u r e i s e s p e c i a l l y marked i n the case of the old man, whose r o l e was previously c l o s e l y r e l a t e d to h i s For purpose of t h i s thesis, the age of s i x t y - f i v e has been selected as the beginning of that time i n l i f e known as the aged period. 7 employment and his position as chief wage earner in the family. For the old married woman, the shift of role i s less marked. In fact, such a shift may never be necessary i f she is able to maintain her position as manager of her house." 1 This absence of clearly defined roles for the aged re-inforces the fact that Canadian society expects very l i t t l e i n the way of a contribution from the aged individual. Gn the other hand, action i s stressed as an essential ingredient to contentment and success. It is not surprising, therefore, that the aged individual gains the strong impression that he i s useless and worthless and cannot contribute any s k i l l to his country. It might be speculated that this basic conflict causes many of the emotional problems in old age. (2) Isolation Each individual needs interaction with other individuals for both support and mental stimulation. Mental health can only be maintained i f satisfying interpersonal relationships are available for everyone. This i s especially true for the aged who face inevitable readjustment d i f f i c u l t i e s as loved ones die, or move away or re t i r e and as loss of health threatens. To make new friends under these conditions, might prove to be an overwhelming strain which the elderly person is unable to tolerate. Then again, there might be resentment toward younger age groups. 1 Cavan, Ruth S.; Burgess, E. W.; Havighurst, R. S.; and Goldhamer, H. "Personal Adjustment in Old Age." p.23, reported by. Williams, Richard H. "changing Status, Roles, and Relationships." Handbook on Social Gerontology, p.276 8 These issues could drive the aged individual into a sense of isolation heightened by loneliness. (3) Economic Insufficiency An adequate income is essential to meet the daily maintenance needs of each individual. Prom income the individual is able to provide adequate food, housing, clothing, medical attention and recreation. If these ideas regarding income are applied to the aged, i t can be readily seen how anxiety and stress are created in the individual aged person who must exist on an inadequate income. Coupled with the fact that physical and psychological reserves may be low, such stress can be so overwhelming that breakdown of various types can result. Williams sums up the problem in this way: "Thus, in general, older people seem to be notably disadvantaged in terms of wealth or in their command over scarce means. This, in turn, placed restrictions on the type of social systems i n which they can participate. However, i t must be remembered that this problem tends to be cumulative with others and to be acutely concentrated in certain groups. When i t i s com-bined with poor health, loss of power, prestige and recognition through loss of employment, and loss of emotional response through death of a spouse and friends, the problem can indeed become acute." 1 Williams, Richard H. "Changing Status, Roles and Relation-ships." Handbook on Social Gerontology, p.280 9 (k) Retirement The problem of retirement i n Canadian society continues to receive a great deal of c r i t i c a l attention from many quarters. The reason f o r t h i s can be found, perhaps, i n the f a c t that retirement a f f e c t s v i r t u a l l y every employed man and woman and, therefore, poses a threat to the i n d i v i d u a l ' s known way of l i f e . As Dr. Tyhurst notes, retirement involves change or t r a n s i t i o n , bereavement or g r i e f , loss of a c t i v i t y , degree of s o c i a l i s o l a t i o n , loss of income and changes i n s o c i a l s t a t u s . 1 Since retirement may force an aged i n d i v i d u a l from an active to a l e i s u r e l y way of l i f e , a complication i s added to an already threatening s i t u a t i o n . How w i l l the person use his l e i s u r e time? This question must be asked and answered, i f possible, by the i n d i v i d u a l about to r e t i r e . I f he i s f o r -tunate enough to r e t i r e to other work, i t can be presumed that his adjustment w i l l not be great, f o r his whole way of l i f e , including t r a i n i n g , i s geared toward a l i f e of work. Unfortunately, those who r e t i r e to a l i f e of l e i s u r e without preparation are faced with great adjustments for which t h e i r l i f e work and education gave them l i t t l e preparation. This l a t t e r group may suffer emotional problems. Because retirement poses such an emotional s t r a i n , there might be a need for retirement counselling to help the 1 Tyhurst, J . S. "Retirement". Neurologic and Psychiatric  Aspects of the Disorders of Aging.(eds.) Joseph E. Moore (et a l ) , v o l . XXXV of the Association for Research i n Nervous and Mental Disorders, Williams and Wilkins, B a l t i -more, 1955, p.237-242 10 Individual to plan c a r e f u l l y for.the day he leaves his work. How such a program would be prepared and whether professionally trained personnel would be needed i s beyond the scope of thi s t h e s i s . Nevertheless, the adoption of such a program might pay dividends through reduction of stress and anxiety associated with retirement. Some day, Canadians may have to consider and develop t h i s idea. (5) Health There have been many advances and discoveries i n the f i e l d of medicine. These have resulted i n a good health standard f o r most people i n Canada; they have resulted i n lower death rates among babies; they have res u l t e d i n more el d e r l y people l i v i n g longer. But many of the areas i n medicine which have not advanced are i n those very areas of i l l n e s s which plague individuals as they grow older. It i s suggested, therefore, that: "Medical advances by and large have been b e n e f i c i a l i n the f i e l d of active b a c t e r i a l ailment -such as Smallpox, Diptheria, and Cholera, Pneumonia and Mennin-g i t i s - but chronic rheumatism, degenerative diseases of the heart and blood vessels and se n i l e mental disorders have remained untouched by modern discoveries and with large -numbers of old people i n the community t h e i r t o t a l incidence i s higher than ever." 1 Health, therefore, can become a problem of considerable Andrews, C. T. "The Problems of the Aged." So c i a l Problems.  A Canadian P r o f i l e . 11 concern t o the aged person. I t i s at t h i s p e r i o d i n l i f e when he i s more s u s c e p t i b l e t o the degenerative d i s e a s e s , both p h y s i c a l and mental. To face the prospect of r e c o v e r i n g from an i l l n e s s which has a f f e c t e d the person adversely, can cause p s y c h o l o g i c a l disturbances of v a r y i n g s e v e r i t y . How these can be combatted depends p a r t l y on the s k i l l of the medical doctor and p a r t l y on the amount of p h y s i c a l reserves which the o l d e r i n d i v i d u a l can draw on at the time of h i s i l l n e s s . A l s o , i t has been suggested t h a t " o l d people are more depressed and d i s t u r b e d by i l l n e s s than younger people because of t h e i r diminished body reserves and because of our s o c i e t y ' s emphasis on youth. " 1 Many other problems can face the aged i n d i v i d u a l , ranging from f e a r and u n c e r t a i n t y of the f u t u r e to d i f f i c u l t i e s w i t h r e l a t i v e s . Nevertheless, the aging process cannot be considered i n t o t a l as a problem p e r i o d . I t i s granted that problems can e x i s t , as b r i e f l y discussed above, and as amply explored i n the growing amount of l i t e r a t u r e on the s u b j e c t . But there i s a gradual i n c r e a s e i n emphasis upon aging as a p e r i o d of p o t e n t i a l s . This more balanced view of aging suggests t h a t a new philosophy i s beginning t o permeate the f i e l d of gerontology.^ 1 Bonner, Judy (ed) The Word i s Hope. An I n s t i t u t e on R e h a b i l i t a t i o n of the Aging, A u s t i n , Texas, 1961, P«5 2 Gerontology, i n t h i s sense, r e f e r s to the study of o l d persons as suggested by E n g l i s h , Horace B. and E n g l i s h , Ava C. A Comprehensive D i c t i o n a r y of. P s y c h o l o g i c a l and Psycho- a n a l y t i c a l Terms. Longman, Green & Co., New York, 1958. 12 Potentials of Aging As knowledge increases, there i s an increasing awareness of the potentials of aging. This i s , perhaps, best noted i n the wealth of l i t e r a t u r e ranging from the "popular" writings to large compilations o f present day knowledge about aging. Journals are devoted to the subject and cover every aspect of aging from medical studies to s o c i o l o g i c a l and anthropological data. This accumulation of knowledge i n the l i t e r a t u r e strongly suggests the waste i n allowing the aged population to under-produce i n a myriad of ways f o r themselves and hence f o r society. Much of t h i s knowledge i s beginning to reach the general public who are beginning to respond through the development of clubs f o r e l d e r l y people i n various communities, as a means of r e l i e v i n g the sense of i s o l a t i o n experienced by the aged as loved ones and close friends d i e . A better step i n t h i s d i r e c t i o n might be seen i n the functional community centres which o f f e r multipurpose a c t i v i t i e s f o r most age groups. This type of development holds a promise of communication between the various age groups and l a t e r may be a means of welding the experience of age with the v i t a l i t y of youth. A further benefit could be found i n the development of new rol e s f o r the aged within these centres through the aged acting as leaders for some of the children's and young adults' groups. Other signs of public i n t e r e s t are evidenced i n the gradual increase i n pensions, and with the pensions approp-13 r i a t e l y planned In r e l a t i o n to the c o s t - o f - l i v i n g index, income d e f i c i e n c i e s may disappear to a large extent. This, of course, means better food, enough clothing and more adequate housing, a l l of which would r e s u l t i n a better l e v e l of good health and wellbeing. These changed attitudes on the part of the public suggest a more p o s i t i v e philosophy of aging which the aged group senses. This encourages the e l d e r l y to begin wondering about the growing opportunities f o r leaving t h e i r mark on society. Kenneth Duncan emphasizes that the "aged seem increasingly to conclude that age means opportunity to undertake f o r themselves the creation of a new place i n s o c i e t y . " 1 He goes on to argue that people want to help, therefore, the aged must somehow " c a p i t a l i z e on t h i s unprecedented i n t e r e s t and willingness to help, while i t e x i s t s . " 2 In spite of t h i s evident i n t e r e s t i n the aging, society retains a fundamental ambivalence toward the aged. On the one hand, they are seen as figures of authority while on the other hand, they are viewed as dependent and c h i l d l i k e i n d i v i d u a l s . Aft e r pointing t h i s out, Jerome Kaplan declares that there might be a swing toward the former view, " i n the immediate years ahead, i t i s not inconceivable that the older person may be more f u l l y equated with authority." 3 What t h i s means i n 1 "Modern S o c i e t i e s 1 Attitude Toward Aging." G e r i a t r i c s . v o l . 18, number 8, (August, 1963), p.635 . 2 Loc. c i t . 3 "New Theories A f f e c t i n g G e r i a t r i c S o c i a l I n s t i t u t i o n s . " G e r i a t r i c s , v o l . 17, number 3 , (March, 19^2), p .171 Ik terms of the Canadian culture i s impossible to predict today. The aged i n d i v i d u a l does have certain advantages when compared with the younger age groups. As an example, consider the f a c t that the aged have r e l a t i v e l y free time following t h e i r retirement. One of the questions which the r e t i r i n g person must consider i s what he plans to do with his time following the f i n a l day of his work. It i s suggested that aged ind i v i d u a l s can c a p i t a l i z e on the free time and use i t to t h e i r own constructive advantage, including the development of meaningful hobbies, the change to new work, or i n any other constructive way which w i l l s a t i s f y the aged i n d i v i d u a l . Once t h i s s a t i s f y i n g a c t i v i t y i s found for the retirement years^ the aged i n d i v i d u a l can remain a contented, s a t i s f i e d c i t i z e n . This aspect also has d i r e c t implications f o r better mental health. The aged i n d i v i d u a l who keeps active, as the culture demands, continues to have an i n t e r e s t i n l i f e . One survey even suggested that an active int e r e s t i n community l i f e aids the aged i n d i v i d u a l to remain healthier mentally than i s usual for the population as a whole. 1 S t i l l , i n spite of these potentials, the aged must continue to face f o r some time the pervading community a t t i -tude that the aged, i n general, have reached t h e i r d eclining years and are, therefore, of l i t t l e use to society. T i b b i t t s takes issue with t h i s idea when he argues that: 1 Bonner, Judy (ed) The Word i s Hope, p.5 15 "ideas abound that a person undergoes growth u n t i l middle age then gradually declines i n a l l f a c u l t i e s u n t i l death. (This i s ) not necessarily true. (There are) d i f f e r e n t q u a l i t i e s of (the) human organism (which) have d i f f e r e n t rates of achiev-ing the prime l e v e l , e.g. physical a b i l i t i e s may decline . a f t e r middle age, yet i n t e l l -ectual functions may gradually increase u n t i l very old age." 1 The two sides of aging discussed so f a r , the problems and potentials, place the aged i n a new l i g h t . There i s a suggestion, also, of a three dimensional view, as society begins to consider how best to allow the aged to take part i n act i v e l i f e which adds greatly to the resources of Canada. Perhaps T i b b i t t s concludes t h i s idea as well as any writer when he suggests "that a population with a sizeable portion of the persons surviving beyond t h e i r 6.5th birthday preserves mental and physical a b i l i t i e s which add immeasurably to the i n t e l l e c t -ual and material wealth of the community." Now that b r i e f consideration has been given to the problems and potentials of aging i n general, the focus can be narrowed to consider the aged i n the Province of B r i t i s h Columbia. T i b b i t t s , Clark. "Social Gerontology." G e r i a t r i c s , v o l . 15, number 10, (October, i 9 6 0 ) , p .709 . Loc. c i t . i 6 General Problems of Aging i n B r i t i s h Columbia The Lower Mainland 1 and Vancouver I s l a n d i s blessed w i t h a temperate cl i m a t e which encourages the growing of flowers from February t o November. I t i s t h i s . t y p e of cli m a t e which seems t o draw people, i n c l u d i n g the aged, t o t h i s area. S t a t i s t i c s seem t o po i n t up t h i s assumption although the w r i t e r s are not aware of any s t u d i e s t h a t provide c o n c l u s i v e evidence. Vancouver I s l a n d has a po p u l a t i o n of 291 ,000 2 w h i l e the Lower Mainland has 866,200 people. The t o t a l i s 1 , 157 ,200. By way of comparison, Canada's t o t a l p o p u l a t i o n i s 18 ,238,200 and B r i t i s h Columbia's i s 1 , 6 2 9 , 0 0 0 . The aged p o p u l a t i o n of s i x t y - f i v e and up are considerably l e s s i n the t o t a l p o p u l a t i o n but they nevertheless represent a s i g n i f i c a n t group of people. Vancouver I s l a n d has 3 5 * 9 0 0 of them whi l e the Lower Mainland has 9 9 * 9 0 0 which makes a t o t a l of 135,800 aged c i t i z e n s . Again, as a means f o r comparison, Canada has 1 ,392,100 aged and B r i t i s h Columbia has 165 ,600. 1 The Lower Mainland i n c l u d e s the Fraser R i v e r V a l l e y from Vancouver to Hope and from the United States Border t o the mountains on the north s i d e of the Fraser R i v e r . The V a l l e y i s approximately 100 miles long by 15 m i l e s at the widest p o i n t . Vancouver I s l a n d i s approximately iho miles long by 60 wide. p A l l f i g u r e s are approximate and have been rounded out t o the nearest zeros f o r ease of c a l c u l a t i o n . The f i g u r e s were obtained from the Government of Canada Census T r a c t s , 1961; B. C. Government's Department of S o c i a l Welfare Annual Report, 1964; and B. C. Government's Annual Budget, 1965. IT When these f i g u r e s are assessed and c a l c u l a t e d i n t o percentages,^ some i n t e r e s t i n g f a c t s are re v e a l e d w i t h re f e r e n c e t o the p o p u l a t i o n spread i n B r i t i s h Columbia. For example, B r i t i s h Columbia's general p o p u l a t i o n i s eig h t percent of Canada's p o p u l a t i o n . Yet, s i x percent of that e i g h t percent r e s i d e i n the Lower Mainland and on Vancouver I s l a n d . The f i g u r e s are even more s t a r t l i n g when i t i s known that t h i s s i x percent represents seventy-one percent of the t o t a l p o p u l a t i o n of B r i t i s h Columbia. The aged p o p u l a t i o n assumes s i m i l a r c h a r a c t e r i s t i c s . Twelve percent of Canada's aged p o p u l a t i o n r e s i d e i n B r i t i s h Columbia. Of that twelve percent, nine percent l i v e w i t h i n the Lower Mainland-Vancouver I s l a n d area. This nine percent represents eighty-two percent of B r i t i s h Columbia's t o t a l aged p o p u l a t i o n . In other words only eighteen percent of the aged l i v e outside of the Lower Mainland-Vancouver I s l a n d area and w i t h i n the boundries of B r i t i s h Columbia. These f i g u r e s prove i n t e r e s t i n g when a c o n t r a s t i s made between the aged p o p u l a t i o n and the t o t a l p o p u l a t i o n . For example, seven percent of the t o t a l Canadian p o p u l a t i o n i s s i x t y - f i v e and up whereas B r i t i s h Columbia's aged po p u l a t i o n i s t en percent of i t s t o t a l p o p u l a t i o n . This comparison between the two f i g u r e s , t h a t i s seven percent f o r Canada and the ten percent f o r B r i t i s h Columbia, i n d i c a t e s the greater p r o p o r t i o n of aged i n B r i t i s h Columbia when compared t o the r e s t of Canada. 1 A l l percentages are approximate. 18 Comparing the figures further, reveals that the Lower Mainland-Vancouver Island area has eight percent of the aged population as compared with the ten percent f o r the whole province of B r i t i s h Columbia. Thus, as revealed, only two percent of the t o t a l aged population l i v e s within the border of B r i t i s h Columbia and outside the Lower Mainland-Vancouver Island area. What do these figures reveal? There i s a larger propor-t i o n of the aged population i n the Lower Mainland-Vancouver Island area of B r i t i s h Columbia than i n the whole of Canada. I t would follow, then, that t h i s lower south-western corner of B r i t i s h Columbia has a larger proportion of the problems of the aged such as: i s o l a t i o n , economic i n s u f f i c i e n c y , retirement and health. It follows, too, that the demand for services for the aged would be greater than elsewhere. A further r e s u l t would be an increased demand f o r monetary aid from l o c a l governments. On the other hand, questions could be asked about the remaining eighteen percent of the t o t a l aged population i n the remainder of B r i t i s h Columbia. Since there i s a larger population of younger age groups i n other centres i n B r i t i s h Columbia, there may be a greater number of services for these age groups rather than including the aged groups i n the o v e r a l l service pattern. And again, the figures could suggest a scattering of the aged population with resultant increased problems i n i s o l a t i o n . 19 Since B r i t i s h Columbia then has as residents a high proportion of Canada's el d e r l y people, and since i t i s recognized that there are problems rel a t e d to old age, i t would follow that mental i l l n e s s i n t h i s age group would be more prevalent i n B r i t i s h Columbia than i n other parts of Canada. This i s d i f f i c u l t to document and, i n f a c t , may be impossible to document i n d e t a i l . However, whether the incidence of mental i l l n e s s can be documented or not, the fa c t remains that many aged individuals do suff e r from mental i l l n e s s e s and are admitted to Valleyview Hospital for t r e a t -ment . Psychiatric Disorders Among the Aging i n B r i t i s h Columbia Psychiatric disorders among the aging, including the complex causes leading to these disorders, are not well known to or understood by the general public. In f a c t , there exists considerable fear of such i l l n e s s e s which these writers have found prevalent during the tours conducted f o r the general public at Valleyview Hospital. Much of t h i s fear might be rooted i n a general ignorance about mental i l l n e s s but there might be an added factor insofar as the mental i l l n e s s of the aged i s concerned. Psychiatry has developed considerable knowledge about ps y c h i a t r i c i l l n e s s e s of the aged. As t h i s knowledge developes and progresses, the names of the i l l n e s s e s change causing confusion. To the person unversed i n psychiatric 20 terminology such terms as "senile dementia" and " a r t e r i o s c l e r o -t i c brain disease" are incomprehensible and, hence frightening. In view of t h i s confusion i n terminology another approach must be taken f o r the purposes of t h i s t h e s i s . Rather than describing i n d e t a i l the various psychiatric disorders associated with the aging process, the aged person's i l l n e s s w i l l be considered from the Social Worker's point of view, that i s , i n terms of i t s s o c i a l s i g n i f i c a n c e . What caused the aged person's breakdown? How did he react? What were the symptoms? What i s the person l i k e i n personality? What i n his background might have p a r t i c u l a r bearing on the present i l l n e s s ? These and a myriad of other s o c i a l questions asked i n the l i g h t of the aged patient's hi s t o r y o f f e r data to the p s y c h i a t r i s t who diagnosis the i l l n e s s . This diagnosis must not detract the Social Worker from the s o c i a l aspects of the patient. These s o c i a l aspects make the aged patient an i n d i v i d u a l among aged individuals within the h o s p i t a l s e t t i n g . To understand a l i t t l e about the psychiatric disorders among the aging, there must be a beginning somewhere. This beginning must be found i n the causes. Such i l l n e s s e s are "induced by a complex of chronic poor physical health, enforced idleness, reduced income, lack of s o c i a l outlets ( s o c i a l obsolescence) and other emotional, psychological and environmental stresses peculiar to older people i n our culture." 1 Caufrey, Eugene A. and Goldstein, Marcus S. "The Health Status of Aging People." Handbook of Social.Gerontology. p.184 . . 21 Attached to the understanding of the causes of these disorders, there must be as much understanding of the person-a l i t y as possible. This includes some knowledge of the background of the aged person who i s mentally i l l f o r should "an aged person become mentally i l l , h is behaviour w i l l depend on h i s character throughout l i f e . A person who has had emotional problems throughout l i f e w i l l evidence m u l t i p l i c a -tions of them i n advanced years." 1 It i s within an understanding of these two aspects, that i s , the causes of the breakdown and the aged in d i v i d u a l ' s personality, that a diagnosis can be developed by the p s y c h i a t r i s t . Prom t h i s diagnosis, treatment i s suggested. Successful treatment means that the patient i s returned to a former l e v e l of good health which i s appropriate to the p a r t i c u l a r age of the patient. Treatment may be successful for "there i s evidence to support the claim that, given appropriate treatment and r e l i e f from major environmental stress, many aged patients can be restored to a state of mental health normal f o r t h e i r age." 2 This i s the hope at Valleyview Hospital. To o f f e r t h i s hope to the ps y c h i a t r i c g e r i a t r i c patient,3 a team comprised of P s y c h i a t r i s t , Medical Sta f f , Social Workers, Occupational Therapists, and other s t a f f a l l cooperate to give a service to t h i s type of patient of whom there are a great many. For 1 The Word i s Hope, p.5 2 Ibid, p.184 3 Aged p s y c h i a t r i c a l l y i l l patient. 22 example, Valleyview Hospital had seven hundred and forty-one patients i n residence at the end of March 2>1, 1^6k, 1 There i s a growing b e l i e f that the aged psy c h i a t r i c patient can respond to treatment i f the treatment i s given early enough. Coupled with t h i s b e l i e f , i s the b e l i e f that mental hospitals f o r the aged should have "open door" p o l i c i e s to allow the ambulatory aged patient to come and go at w i l l about the grounds of the h o s p i t a l . Also related, i s the b e l i e f that custody i s not necessary f o r the aged patient during the remainder of his natural l i f e . As a r e s u l t of these b e l i e f s , f a i r l y recent i n o r i g i n , a l l the Valleyview s t a f f considers that a patient should be discharged from the ho s p i t a l as soon as he has made a s a t i s f a c t o r y response to treatment appropriate to his age. No longer w i l l t h i s i n s t i t u t i o n act as a t o t a l custody unit. A l l of these points suggest a new philosophy toward aging. This philosophy i s r e f l e c t e d at Valleyview Hospital and w i l l be enlarged upon i n the succeeding chapters. I j 6 k Annual Report. Mental Health Services, Province of B r i t i s h Columbia, p.10 CHAPTER I I SCOPE AND METHOD OF STUDY In Chapter I some of the problems and p o t e n t i a l s of the aged person, g e n e r a l l y , were examined; p a r t i c u l a r a t t e n t i o n was then focused on the mentally i l l aged i n the Province of B r i t i s h Columbia. Reference was made t o V a l l e y v i e w H o s p i t a l , and s i n c e the study i s concerned w i t h p a t i e n t s ' discharge from t h i s h o s p i t a l , a d e s c r i p t i o n of i t w i l l provide an appr o p r i a t e background agai n s t which t o present the scope and method of the study. V a l l e y v i e w H o s p i t a l V a l l e y v i e w H o s p i t a l i s s i t u a t e d twenty miles east of Vancouver on the north s i d e of the Fraser R i v e r about one m i l e beyond Crease C l i n i c and Essondale Mental H o s p i t a l . The grounds f r o n t on a busy highway which i s an a l t e r n a t i v e route i n t o the i n t e r i o r of B r i t i s h Columbia. In g e n e r a l , V a l l e y v i e w H o s p i t a l i s organized i n t o separate b u i l d i n g s l i n k e d together by spacious lawns and w e l l 2k kept, p a r k l i k e landscaping. The l a r g e s t b u i l d i n g , the a d m i t t i n g area, i s f l a n k e d by seven other b u i l d i n g s . These b u i l d i n g s , placed as they are on the s i d e of a h i l l to take advantage of the view l o o k i n g east, a c t u a l l y pose many problems f o r the aged p a t i e n t s who must walk between b u i l d i n g s . For younger i n d i v i d u a l s , the h i l l s would not hamper movement but t o the e l d e r l y person they r e q u i r e a great de a l of s t r a i n and e f f o r t beyond the c a p a c i t i e s of many aged people. W i t h i n the a d m i t t i n g b u i l d i n g are the d i a g n o s t i c s e r v i c e s : M e d i c a l , Laboratory, X-Ray, and others. R e h a b i l i t a t i o n s e r v i c e s are provided a l s o i n t h i s b u i l d i n g and i n c l u d e Occupational and R e c r e a t i o n a l Therapy and S o c i a l S e r v i c e s . S i x other b u i l d i n g s house the p a t i e n t s . The seventh has a small d i n n i n g room and "Tuck Shop". There are two other h o s p i t a l s s i t u a t e d at Vernon and Terrace which are p a r t of the p s y c h i a t r i c g e r i a t r i c u n i t f o r the e l d e r l y mentally i l l . D e l l v i e w at Vernon and Skeenaview a t Terrace are only mentioned at t h i s time t o show the extent of the s e r v i c e s provided to t h i s e l d e r l y group. This study w i l l not i n c l u d e these two h o s p i t a l s s i n c e n e i t h e r provides a discharge s e r v i c e which i s our main area of f ocus. The MacLean t h e s i s 1 has o u t l i n e d the h i s t o r y of V a l l e y -view H o s p i t a l . Although there i s no need t o r e i t e r a t e the 1 MacLean, Jean E t h e l . Admission P o l i c y f o r an I n s t i t u t i o n  f o r the S e n i l e . Thesis submitted i n P a r t i a l F u l f i l l m e n t of the requirements f o r the Degree Master of S o c i a l Work, U n i v e r s i t y of B r i t i s h Columbia, 1962, p.22-27 25 h i s t o r y , i t i s worth n o t i n g that as the h i s t o r y of Va l l e y v i e w has evolved, there has a l s o evolved a philosophy toward the aging. Dr. John Walsh, the Medical Superintendent at V a l l e y v i e w H o s p i t a l , explained h i s ideas w i t h the authors i n a personal i n t e r v i e w about the philosophy at the i n s t i t u t i o n . He noted that s o c i e t y , i n gener a l , wants to put the aged away. P r e v i o u s l y , many e l d e r l y p s y c h i a t r i c p a t i e n t s were sent to the Home f o r the Aged but when t h i s i n s t i t u t i o n became known as Va l l e y v i e w H o s p i t a l i n January, i 9 6 0 , the change of name r e f l e c t e d adequate experience and f a c i l i t i e s to r e t u r n the aged t o t h e i r normal environment, that i s , the community. Today, as Dr. Walsh suggests, V a l l e y v i e w "receives (the mentally i l l aged) i n order t o help them over t h e i r present d i f f i c u l t i e s or c r i s i s or episode and l e t them ca r r y on as before." In h i s concluding remarks, Dr. Walsh s t r o n g l y emphasized tha t " r e c o g n i t i o n of s o c i a l and p s y c h o l o g i c a l f a c t o r s c o n t r i b -u t i n g to p s y c h i a t r i c i l l n e s s i n the aged i s probably the most important advance made i n recent years. This r e c o g n i t i o n means that the p a t i e n t i s t r e a t e d using medical, s o c i a l and s c i e n t i f i c knowledge. Recovery i s a good prospect. In other words, we are f o l l o w i n g through on what i s known." Such views imply a change of philosophy at V a l l e y v i e w and suggest a j u s t i f i c a t i o n f o r the many changes which have taken p l a c e . For example, there has been a change from c u s t o d i a l care to a c t i v e treatment; from locked doors t o the "open door" p o l i c y ; from the almost t o t a l segregation of the sexes i n 26 b u i l d i n g s t o the mixed wards. 1 In a d d i t i o n , the idea t h a t most p a t i e n t s can be returned to the community, i s , perhaps, the g r e a t e s t change t o be developed at V a l l e y v i e w H o s p i t a l . I n the f o l l o w i n g Table, the changed philosophy at V a l l e y v i e w H o s p i t a l can be seen i n concrete form. TABLE I . __ MALE FEMALE TOTAL T o t a l P a t i e n t s i n Residence A p r i l 1, 1963 252 729 T o t a l Admissions 188 141 329 T o t a l Under Care 458 636 1,094 T o t a l Separations * 181 172 353 (Discharged i n P u l l ) (10) (9) (19) (Died) (123) (125) (248) Net Increase or Decrease +25 -13 +12 T o t a l P a t i e n t s i n Residence March 31 , 1964 277 464 7 4 i Separation means discharges through deaths, t r a n s f e r s , p r o b a t i o n , e t c . 1964 Annual Report, Mental Health S e r v i c e s , Province of B r i t i s h Columbia, p.122 The mixed wards a l l o w the mingling of sexes during the day although s l e e p i n g quarters are placed at opposite ends of the b u i l d i n g and are separated from each other. 27 This chart a l s o suggests t h a t a beginning movement of p a t i e n t s t o the community i s t a k i n g p l a c e . Although the number of discharges are small during the F i s c a l Year, A p r i l 1, 1963* t o March 31, 196^, I t suggests the growing importance of the S o c i a l S e r v i c e Department i n preparing the p a t i e n t f o r discharge and i n seeking the necessary resources t o r e c e i v e the p a t i e n t i n the community. With the expansion of t h i s r o l e of the S o c i a l S e r v i c e Department, a study of the e f f e c t i v e n e s s of the Department i n terms of discharge procedure and the problems the Department must face i n i t s e f f o r t s to discharge p a t i e n t s seems, important. The focus of t h i s study, then, i s on the r o l e of the S o c i a l Worker w i t h i n the h o s p i t a l and, i n p a r t i c u l a r , w i t h i n the process of discharge of p a t i e n t s back t o the community. In order t o l e a r n whether other i n s t i t u t i o n s shared the philosophy r e g a r d i n g the mentally i l l aged as i t i s r e f l e c t e d at V a l l e y v i e w H o s p i t a l , l e t t e r s were sent t o appropriate n a t i o n a l department i n Canada, Great B r i t a i n and the United S t a t e s . The r e p l i e s i n d i c a t e t h a t no s i m i l a r i n s t i t u t i o n s e x i s t i n these c o u n t r i e s , w i t h the p o s s i b l e exception of V i l l a S e l i c i n i a G e r i a t r i c H o s p i t a l , Jackson, L o u i s i a n a . The l e t t e r from Washington, D. C , dec l a r e d t h a t "the V i l l a i s reporte d to have g e r i a t r i c wards of good repute. T h e i r main o b j e c t i v e i s t o r e l i e v e the pressure upon p s y c h i a t r i c i n s t i t u t i o n s throughout L o u i s i a n a , and improve the care of the g e r i a t r i c p a t i e n t who does not r e q u i r e extensive p s y c h i a t r i c h o s p i t a l -i z a t i o n . " (See Appendix B.) Whether t h i s means that a 28 s i m i l a r philosophy has been developed i n Louisiana i s d i f f i c u l t to determine. The assumption, therefore, i s that Valleyview Hospital i s a unique i n s t i t u t i o n and that any study of various aspects of the work of the i n s t i t u t i o n would not only be h e l p f u l to the i n s t i t u t i o n i t s e l f , but would, to some extent, provide further knowledge about the aged. Certain points have been outlined above i n order to emphasize the need of a study around the aspects of discharge from Valleyview Hospital. F i r s t , a p o s i t i v e philosophy, which emphasizes the many potentials of the aged group, has pervaded the h o s p i t a l and enabled active treatment of the mentally i l l aged patient with the thought that eventually the aged person can be discharged from the h o s p i t a l . Secondly, Table I indicates a small number of discharges as a d i s t i n c t sign of the increasing effectiveness of the new philosophy. Thirdly, Valleyview Hospital appears to be a unique i n s t i t u t i o n with a s p e c i a l focus on the p s y c h i a t r i c g e r i a t r i c patient, his t r e a t -ment, and probable return to the community. These points indicate the reasons f o r a study such as t h i s at t h i s time. me Scope pf the study Primarily, t h i s study must remain as a descriptive one. No previous studies have been completed i n the area of discharge and the re l a t e d resources with the r e s u l t that an overview i s 29 needed at t h i s time to indicate some of the s p e c i f i c problems which the So c i a l Worker must face each time a patient i s discharged. To say that the h o s p i t a l i s oriented toward treatment and discharge answers one question but ra i s e s another; i s the community ready to receive the patient? Our study w i l l attempt to answer the l a t t e r question. Although a theory of discharge may state that a l l patients are possible discharge prospects, i n pra c t i s e c e r t a i n problems a r i s e which are p a r t l y a t t r i b u t a b l e to the types of resources or lack of resources i n the community, and p a r t l y a t t r i b u t a b l e to the stages of recovery to which a patient has advanced. I f the community i s not ready to receive the patient, what other a l t e r n a t i v e s must the Social Worker seek to e f f e c t the discharge? By gaining such an overview, perhaps, other research studies might be indicated which might a s s i s t the h o s p i t a l S o c i a l Worker toward an understanding of the community i n i t s r o l e as the receiver of the patient. The study i s l i m i t e d to the study of Valleyview Hospital i n the Lower Mainland of B r i t i s h Columbia i n order to determine whether the resources f o r the psy c h i a t r i c g e r i a t r i c patient are adequate to receive these patients upon discharge. It i s proposed to examine the present c r i t e r i a of discharge as i t i s set against the avail a b l e community resources. Is t h i s c r i t e r i a u n r e a l i s t i c ? Does each patient a c t u a l l y reach the point of discharge? I f a patient i s deemed dischargeable, are there adequate resources to receive him? An attempt w i l l be 30 made to answer such questions as these. In addition, there w i l l be an attempt to view r e a l i s t i c a l l y some of the gaps i n the e x i s t i n g c r i t e r i a of discharge and the e x i s t i n g c r i t e r i a f o r reception of these patients i n the community. In t h i s way, a demonstration of l i m i t a t i o n s i n the c r i t e r i a may pave the way toward an adequate discharge p o l i c y based on adequate resources. The t o t a l patient group w i l l be included i n the study but w i l l be divided into two groups, those who progress to the point of discharge and those who must remain i n custodial care f o r various reasons. Further, f o r purposes of t h i s study no age l i m i t a t i o n i s set because admission to Valleyview Hospital takes into account various factors associated with the aging process. There are at present, therefore, some patients i n Valleyview Hospital who are below the age of s i x t y - f i v e . To a r b i t r a r l y set age s i x t y - f i v e as the admission age to Val l e y -view Hospital would prevent t h i s small group from obtaining the treatment Valleyview o f f e r s . The Method of Study This study examines the c r i t e r i a of discharge against the community resources. To understand these c r i t e r i a , i t i s necessary to analyze the process of admission to hos p i t a l and also the treatment process. With t h i s backdrop, an evaluation of the discharge c r i t e r i a can be developed both i n terms of the h o s p i t a l and i n terms of the community. 31 For t h i s study, s t a t i s t i c s have been analyzed f o r the past year t e r m i n a t i n g on March 31 , 1965, the end of the j u s t past F i s c a l Year. P a r t i c u l a r a t t e n t i o n has been pa i d t o the discharge s t a t i s t i c s and the r a t e of p a t i e n t r e t u r n s t a t i s t i c s t o suggest the weaknesses i n the discharge c r i t e r i a . A q u e s t i o n n a i r e was developed t o assess c e r t a i n randomly s e l e c t e d boarding and nu r s i n g homes i n the Lower Mainland i n the hope th a t t h i s method might help i n an understanding of the a t t i t u d e s which those people managing these resources may have toward the aged p s y c h i a t r i c a l l y i l l p a t i e n t . C e r t a i n s e l e c t e d cases have been s t u d i e d t o i l l u s t r a t e both s u c c e s s f u l placements i n the community and problems i n discharge t o the community. Case h i s t o r i e s have been s e l e c t e d to i l l u s t r a t e as much of the procedure i n the h o s p i t a l as p o s s i b l e . The sources of data have been many and v a r i e d . The V a l l e y v i e w H o s p i t a l S t a f f have provided much i n f o r m a t i o n of value which otherwise might have remained unknown f o r purposes of t h i s study. The same help was extended by randomly s e l e c t e d boarding and nu r s i n g homes from Vancouver C i t y through t o Abbotsford. To o b t a i n some i n f o r m a t i o n about other p o s s i b l e i n s t i t u t i o n s s i m i l a r t o V a l l e y v i e w H o s p i t a l i n Canada, Great B r i t a i n and the United S t a t e s , l e t t e r s were sent asking f o r in f o r m a t i o n . Other sources of i n f o r m a t i o n have been: Mental Health Reports, Mental Health Acts and Census Reports. 32 Within t h i s chapter, changing philosophy has been noted as an important aspect i n bringing about many of the changes within Valleyview Hospital. One change of utmost importance was suggested i n the name change from the Home for the Aged to the present name. This change i s suggested i n the concept that Valleyview's prime focus i s on treatment of the psyc h i a t r i c g e r i a t r i c patient, not on custodial care. With t h i s focus i n mind, Chapter I I I w i l l discuss the admission procedures and treatment processes. CHAPTER II I ADMISSION, TREATMENT, AND SELECTION OF PATIENTS FOR DISCHARGE 1 It i s l o g i c a l , before examining discharge c r i t e r i a , to examine some of the ways i n which the changing philosophy a f f e c t s the treatment of the psychiatric g e r i a t r i c patient i n Valleyview Hospital. T r a n s i t i o n from custodial care to re-h a b i l i t a t i o n and discharge to the community i s the basis of the present "open door" philosophy i n Valleyview. This "open door*' philosophy:(l) eliminated the patient waiting l i s t which neared the two hundred mark i n 1 9 6 2 ; 2 (2) created heterosexual (mixed) wards which house male and female patients i n the same quarters and engaging i n common treatment a c t i v i t i e s ; ( 3 ) provided an addi t i o n a l "short term" treatment service f o r patients who are able to stay at home, but occasionally require a short stay (no longer than three months) i n Valleyview Hospital; and (k) pro-vided more s o c i a l work s t a f f to provide better service i n discharging patients from Valleyview Hospital. This chapter i s focused primarily on the p s y c h i a t r i c ger-i a t r i c patient. His progress i s examined from the time of admission to Valleyview Hospital to his eventual placement on 1 For Pre-Admission see: MacLean, J . Ethel, "Admissions Policy f o r an I n s t i t u t i o n for the Senile." M.S.W..Thesis, Univers-i t y of B r i t i s h Columbia, 1962. 2 I b i d p.20 3* one of the treatment wards. F i n a l l y , when the patient success-f u l l y responds to the spe c i a l i z e d treatment i n the ho s p i t a l , he i s prepared f o r discharge. The discharge c r i t e r i a and the resources available i n the community w i l l be examined i n the following chapter. ADMISSION As soon as the psy c h i a t r i c g e r i a t r i c patient i s admitted to the Valleyview Hospital his r e h a b i l i t a t i o n treatment begins. In the examination room the physician meets the patient f o r the f i r s t time. As a standard procedure at admission to the ho s p i t a l , the physician performs a complete physical and mental examination. In addition, he compiles a short medical and s o c i a l h i s t o r y of the patient which he may obtain from one or several of the following sources: 1. The patient himself - i f the mental condition i s stable enough. 2. The r e l a t i v e s - i f they have a r r i v e d with the patient to the h o s p i t a l . 3. The pol i c e o f f i c e r s - i f they have brought the patient to the h o s p i t a l . 4. The ambulance attendants and nurse - i f no one else accompanied the patient to the h o s p i t a l . I f , i n the opinion of the examining physician, there i s a need f o r further background information on the patient, he may request the Valleyview Hospital Social Worker to obtain 35 a more d e t a i l e d s o c i a l h i s t o r y . The S o c i a l Worker may o b t a i n i t : ( l ) from other agencies i n the community; (2) from v a r i o u s agencies throughout the province; (3) from other h o s p i t a l s where the p a t i e n t has had treatment at some other p e r i o d of time. At the end of the general examination by the V a l l e y v i e w H o s p i t a l p h y s i c i a n , the p a t i e n t i s placed f o r observation on the admission ward which i s s i t u a t e d i n the main V a l l e y v i e w B u i l d i n g . The observation c o n s i s t s of as s e s s i n g the p a t i e n t ' s s o c i a l behaviour on the ward, h i s mental c o n d i t i o n , and h i s p h y s i c a l c o n d i t i o n . A l l necessary l a b o r a t o r y t e s t s are per-formed (blood, X-Ray, and others) and continued r e h a b i l i t a t i o n treatment i s given . The p a t i e n t remains on the admission ward f o r one week and i s l a t e r introduced to the treatment team. The treatment team convenes, as a r u l e , every Tuesday morning - t h i s meeting i s c a l l e d "The Case Conference". The Treatment Team The Treatment Team c o n s i s t s of the p r i n c i p a l s t a f f members from the var i o u s s p e c i a l i z e d departments i n V a l l e y v i e w H o s p i t a l . I t i s headed by the Medical Superintendent and i t s r o l e i s t o e s t a b l i s h and put i n t o e f f e c t the r e h a b i l i t a t i o n p l a n t h a t i s best s u i t e d t o each p a t i e n t . The team members' f u n c t i o n s are as f o l l o w s : (a) The Medical Superintendent - as mentioned above -i s the chairman of the treatment team. He introduces the p a t i e n t t o the other members and 36 personally interviews him i n order to re-evaluate his a f f e c t i v e capacities. At t h i s time the Medical Superintendent encourages the patient to express his personal concerns and problems. (b) Staff physicians - a l l four physicians take part i n the conference. Here the examining physician presents to the team the patient's medical history, the r e s u l t s from laboratory tests and reads the patient's s o c i a l h i s t o r y . F i n a l l y , the physician proposes the diagnosis and makes recommendations regarding the treatment needed i n order to r e h a b i l i t a t e and event-u a l l y discharge the patient. If the patient has made s u f f i c i e n t improvement i n the past week, the team makes a decision f o r immediate discharge. (c) Nursing Supervisors and Charge Nurses. The Charge Nurse at t h i s point i s requested to give a detailed de s c r i p t i o n of the patient's every day condition from the time that he was f i r s t admitted on the ward. The nurse evaluates any s i g n i f i c a n t changes of the past week and discusses the patient's adjustment to the hos p i t a l s i t u a t i o n . (d) Occupational Therapist and Recreational Therapist -the representatives of these departments examine and make recommendations concerning the patient's a b i l i t y to take f u l l advantage of the various Occupational Therapy and Recreational Therapy a c t i v i t i e s i n the 37 h o s p i t a l . They also indicate ways i n which these a c t i v i t i e s may enhance the patient's r e h a b i l i t a t i o n and discharge p o s s i b i l i t i e s . 1 (e) The Social Worker - the Social Worker's r o l e at the Case Conference has many purposes: 1. He may be requested to provide detailed s o c i a l assessment of the patient. 2. He may receive a d i r e c t r e f e r r a l from the team to discharge the patient. 3 . He may make recommendations regarding the resources a v a i l a b l e i n the community. 4. He may be assigned to the patient f o r provision of casework services during the patient's stay i n Valleyview Hospital. Purpose of the Case Conference The purpose of the Case Conference i s to decide on a cooperative r e h a b i l i t a t i n g goal of treatment f o r each patient admitted to Valleyview Hospital. Ultimately t h i s goal i s to enable the patient to be discharged to the community. The goal i s established i n three steps: 1. The patient i s assessed i n d i v i d u a l l y . 2. He i s introduced to each member of the Treatment Team. 3 . The Treatment Team f i n a l i z e s the patient's transfer 1 Some of these a c t i v i t i e s are woodwork, painting, k n i t t i n g , bingo, sing-songs, movies. 38 from the admission ward to the l e v e l of treatment best suited f o r h i s diagnosed mental and physical condition. The patient's evaluation or assessment, therefore, i s based on a detailed c l i n i c a l examination and diagnosis of his somatic condition, determination of his functional p o t e n t i a l -i t i e s and the degree of his i n t e l l e c t u a l d e t e r i o r a t i o n . Since the entire team par t i c i p a t e s i n t h i s assessment, i t i s considered the f i r s t step i n introducing the patient to the therapeutic a c t i v i t y . Therapy i s planned a f t e r there i s a complete understanding of the dynamics of the disorder and the a f f e c t i v e and i n t e l l e c t u a l p o t e n t i a l of the patient. Since the most important therapeutic e f f o r t s are directed towards the preparation of the patient f o r f u l f i l l m e n t of h i s future s o c i a l r o l e i n the community, he i s transferred to the approp-r i a t e treatment f a c i l i t y a vailable i n the h o s p i t a l . It i s there that he w i l l be helped to develop his remaining a f f e c t i v e and i n t e l l e c t u a l c a p a b i l i t i e s and s o c i a l p o t e n t i a l i t i e s . Further treatment on each ward i s directed at reorientation to the future environment i n the community, by way of Environ-mental Therapy, Group Therapy, 1 Physiotherapy, Podiatry, Recreational Therapy and Occupational Therapy. Occupational Therapy i s aimed mainly at r e a c t i v a t i o n and improvement of manual s k i l l s . Since a l l work i n Occupational Therapy i s 1 By group therapy we mean a l l a c t i v i t i e s performed i n groups - i n Valleyview Hospital s o c i a l group therapy was done on a study basis i n 1962 and was very successful. 39 performed i n groups, i t also aids resocializatiori"" and communication among patients engaged i n manual projects. TREATMENT FACILITIES In accordance with the Treatment Team's decision, the patient i s transferred to one of the following treatment f a c i l i t i e s of Valleyview Hospital. 1. Infirmary Wards The patients who are transferred here, i n addition to t h e i r mental condition, need complete bed care and maximum nursing attention. The various physical d i s a b i l i t i e s encountered here, range from t o t a l p a ralysis to p e r i o d i c a l incapacitating cerebro-vascular strokes. Patients from these wards are discharged to nursing homes, providing they respond successfully to treatment of t h e i r mental i l l n e s s to the extent that they can be accepted for nursing home care i n the community. 2. Closed Wards These wards are divided into separate male and female quarters. Patients who are transferred-here are predominantly ambulant, but need close supervision because of extreme mental confusion, wandering and seemingly i r r e v e r s i b l e i n t e l l e c t u a l d e t e r i o r a t i o n . Here there are also special f a c i l i t i e s f o r those patients who are i n need of cl o s e l y c o n t r o l l e d d i e t s , and who have sp e c i a l somatic problems. Some patients here are * D e f i n i t i o n of r e s o c i a l i z a t i o n : A process by which the human being acquires the knowledge of his group and learns the s o c i a l r o l e s appropriate to h i s p o s i t i o n i n i t . ko s u f f e r i n g from c i r c u l a t o r y and cardiac i n s u f f i c i e n c i e s , endocrine disorders and respi r a t o r y malfunctions. The Nurse's r o l e i n the r e h a b i l i t a t i o n of the patient on the closed wards i s li m i t e d to r e a c t i v a t i o n of the patient's remaining physical and i n t e l l e c t u a l capacities, s t a r t i n g at the minimum l e v e l of his a b i l i t i e s . When the patient responds successfully to small tasks, f o r example, walking to the dining room, s i t t i n g at the table, and feeding himself, the Nurse progressively increases the patient's r e s p o n s i b i l i t i e s . They w i l l probably be always l i m i t e d i n nature, however. In the closed wards are encountered the largest number of patients who can eventually be discharged but for whom there are presently no appropriate f a c i l i t i e s a v a i l a b l e i n the community. As a r e s u l t , such patients stay i n ho s p i t a l longer than i s necessary and constitute, t h e o r e t i c a l l y , one group of patients. Another group of patients i n the closed wards may never be discharged because of t h e i r extreme and progressive mental and physical d e t e r i o r a t i o n . (This subject w i l l be dealt with more f u l l y i n Chapter IV.) 3« Open Wards or "Mixed Wards" 1 The open wards occupy three buildings and house both men and women patients. Some of the patients transferred here may be a n t i c i p a t i n g the f i n a l stages of t h e i r discharge (as recommended by the Treatment Team). Others may require a longer r e s o c i a l i z a t i o n period before being ready f o r discharge 1 Mixed Ward - u n o f f i c i a l name given to the wards that house both male and female patient population engaging i n common r e h a b i l i t a t i o n therapy. The wards are never locked by key and have unlimited v i s i t i n g hours. hi t o the community. Here the p a t i e n t s are helped, encouraged and motivated to be s e l f - s u f f i c i e n t i n a l l aspects of everyday l i f e . TREATMENT TOWARDS REHABILITATION The fundamental r e h a b i l i t a t i o n p l a n In V a l l e y v i e w H o s p i t a l i s t o t r e a t the i n d i v i d u a l p a t i e n t according t o h i s or her remaining c a p a b i l i t i e s , both i n t e l l e c t u a l and a f f e c t i v e . The p a t i e n t ' s assignment t o one of the wards described above i s c a r e f u l l y planned by the Treatment Team i n order that a s t a b i l i z i n g environment may be provided i n h o s p i t a l to prevent the slow-down or f u r t h e r d e t e r i o r a t i o n of the p a t i e n t ' s mental and p h y s i c a l c a p a c i t i e s . (See Factors Considered i n Discharge Pla n n i n g , p. h"^.). The problems of p h y s i c a l d e t e r i o r a t i o n are d e a l t w i t h by engaging the p a t i e n t i n r o u t i n e d a i l y a c t i v i t i e s of elementary nature which are aimed at r e t r a i n i n g the p a t i e n t i n such r o u t i n e s as bedroom, d i n i n g room and t o i l e t h a b i t s . This r e t r a i n i n g i n the elementary d a i l y r o u t i n e i s introduced g r a d u a l l y t o the p a t i e n t by competent n u r s i n g s t a f f at r e g u l a r i n t e r v a l s . The p a t i e n t ' s i n t e l l e c t u a l (mental) c a p a c i t i e s are maintained and, where p o s s i b l e , improved by the a d m i n i s t r a t i o n of psychogenic drugs which are p r e s c r i b e d by the h o s p i t a l s t a f f of p h y s i c i a n s . Drug Therapy i s not s u f f i c i e n t i n i t s e l f t o r e s t o r e and maintain the p a t i e n t ' s mental arid i n t e l l e c t u a l p o t e n t i a l i t i e s . The p a t i e n t r e q u i r e s , i n a d d i t i o n , constant 42 motivation. Motivation i s regarded by the Valleyview Hospital s t a f f as the process of organization which gives s e l f - d i r e c t i o n and guides the a c t i v i t i e s of the person involved. There are e s s e n t i a l l y two components of motivation: one i s some degree of discomfort about his present condition; the other i s some degree of hope or some goal sought to be worth achieving by the patient. In Valleyview Hospital, the goal i s discharge to the community. The patient, therefore, i s motivated to achieve h i s goal by various a c t i v i t i e s on the ward that w i l l prepare him, both p h y s i c a l l y and mentally, f o r his return to the community. The patient i s encouraged to est a b l i s h friendships and rel a t i o n s h i p s with members of both sexes; i s engaged i n a l l types of group a c t i v i t i e s on the ward and i s encouraged to take the i n i t i a t i v e f o r attending the various occupational and rec r e a t i o n a l a c t i v i t i e s and r e l i g i o u s services. Such a patient has ground p r i v i l e g e s ; he may go i n and out of the ward at any time, entertain v i s i t o r s i n the Valleyview "Tuck Shop" and go on week-end leaves with r e l a t i v e s and f r i e n d s . Event-u a l l y t h i s patient i s able to return either to se l f - c a r e , to family care or to any suitable r e s t home or boarding home i n the community. Motivation of the patient towards eventual discharge i s also the function of the Social Worker. Throughout the patient's stay i n Valleyview Hospital, the Soc i a l Worker provides casework services and acts as a l i a i s o n between the t 3 p a t i e n t , h i s f a m i l y and the community. The S o c i a l Worker's major r o l e , however, i s i n s e l e c t i o n and discharge of the p a t i e n t from V a l l e y v i e w H o s p i t a l . FACTORS CONSIDERED IN DISCHARGE Although every p a t i e n t i n V a l l e y v i e w H o s p i t a l i s considered f o r discharge, p r o v i d i n g that he or she responds s u c c e s s f u l l y t o treatment, there are c e r t a i n d i s t i n c t groups i n the p a t i e n t p o p u l a t i o n . These f a l l i n t o three c a t e g o r i e s , depending on the degree of care and s u p e r v i s i o n they may r e q u i r e at the time of discharge. Each category i s i l l u s t r a t e d by a c t u a l cases i n Chapter V. (a) The ambulant p s y c h i a t r i c g e r i a t r i c p a t i e n t who s u f f e r e d a f u n c t i o n a l i l l n e s s a s s o c i a t e d w i t h the aging process, f o r example, a psy c h o t i c or psycho-n e u r o t i c r e a c t i o n w i t h a s o c i a l or p s y c h o l o g i c a l s t r e s s as a b a s i s . This person, g i v e n proper treatment at V a l l e y v i e w H o s p i t a l , r e q u i r e s minimal care or s u p e r v i s i o n , and i s able to f u n c t i o n s u c c e s s f u l l y i n any boarding home or r e s t home i n which he may be placed. A f t e r h i s treatment i n Va l l e y v i e w H o s p i t a l , he i s l u c i d (aware of h i s environment), w e l l o r i e n t e d to time, place and person, and of t e n i s able to care f o r h i m s e l f . (See Case H i s t o r y I , Chapter V.) (b) The "in-between" ps y c h i a t r i c g e r i a t r i c patient:-This patient does not require complete nursing care, but needs close supervision and s p e c i a l under-standing from competent nursing s t a f f . This patient's medication has to be supervised and the nurse must have an awareness of his changes of behaviour and his mental condition which may c a l l f o r changes i n medication or s p e c i a l d i e t . This patient i s ambulatory but tends to be f o r g e t f u l and disoriented. The "in-between" patient constitutes the major patient population i n Valleyview Hospital. (See Case History II, Chapter V.) (c) The psychiatric g e r i a t r i c patient who needs f u l l nursing care and supervision: This patient i s either bedridden or i n a wheel chair at a l l times. In addition to his severe degree of mental deter-i o r a t i o n , he also suffers chronic physical d e t e r i o r a t i o n due to the aging process. This patient may be discharged from Valleyview Hospital when his mental condition improves to the extent that he w i l l not be disturbing to others. (See Case History I I I , Chapter V.) In addition .to the above three categories, there are patients who w i l l not be discharged from .Valleyview Hospital 1 This i s an informal term used i n Valleyview Hospital. 4 5 because of t h e i r chronic physical and mental status. If some respond successfully to treatment and are considered f o r discharge, t h e i r stay i n Valleyview Hospital i s often prolonged because of cert a i n e x i s t i n g impediments that make a l l attempts to discharge such a patient time consuming and, usually, f u t i l e . Some Of these impediments are: 1. The need of these patients for a selected and highly protective environment i n the community because of t h e i r l i m i t e d c a p a c i t i e s . Resources to meet such needs are almost nonexistent. (See Chapter IV, Section II.) 2. Where suitable accommodation i n the community i s located, i t i s more expensive than other types of accommodation. The reason f o r t h i s i s found i n the greater amount of services and f a c i l i t i e s required to care f o r these patients. 3 . In order to obtain the additional assistance required fo r the patient i n t h i s type of accommodation, i t i s necessary to seek the cooperation of community Social Welfare Departments. Unfortunately, some departments do not cooperate with Valleyview S o c i a l Service. As a r e s u l t of the above impediments, much e f f o r t and time i s required from the Social Worker. More important, i s the delay i n discharge the patient faces as a r e s u l t of the above impediments. This delay i s r e f l e c t e d i n the patient who has-been prepared f o r discharge but i s unable to leave h o s p i t a l . (See Case History IV, Chapter V.) k6 The above impediments are a r e f l e c t i o n of the broad s o c i a l and psychological problems of today with which the aging population i s faced i n general. (See Chapter I.) Valleyview Hospital attempts to overcome these impediments. This i s seen i n the philosophy which pervades the process of treatment, s e l e c t i o n and discharge of the patients. PATIENT SELECTION FOR DISCHARGE The S o c i a l Service Department of Valleyview Hospital has developed a l i a i s o n with community agencies and has located some suitable resources f o r the care of the discharged patient. However, t h i s s e l e c t i o n of boarding homes and nursing homes i s done i n a random way and at the present time there are no s p e c i f i c , well-formulated c r i t e r i a against which to measure resources. Neither are there s p e c i f i c c r i t e r i a within h o s p i t a l which can be used i n the se l e c t i o n and r e f e r r a l of patients f o r discharge planning. The s e l e c t i o n of patients f o r discharge planning i s on a very informal basis. One procedure has been t e n t a t i v e l y developed whereby three months from the date of admission, the patient's f i l e i s brought to the attention of the Social Service Supervisor. The names of those patients are brought forward, who appear to have responded to treatment, as indicated i n the medical records. These names are assigned to the i n d i v i d u a l S o c i a l Worker. The Social Worker, i n turn, consults the hos p i t a l physician for a f i n a l decision concern-*7 ing the patient's successful response to treatment which would indicate h i s readiness f o r discharge planning. Three months was selected by the Valleyview Hospital s t a f f as a suitable period of time at which the patient's progress may be evaluated. However, there are many except-io n a l cases where patients responded to treatment i n Valleyview Hospital before the three month period.. Such patients are selected p r i o r to the three months period and r e f e r r e d by the attending physician to the Social Service Department fo r discharge planning. As the physician himself cannot constantly be aware of a l l the patients a l l the time, i t was, therefore, agreed by the Treatment Team members that i t i s i n order f o r any one of them to bring to the attention of the physician any patient who appears to be a possible candidate for discharge. This procedure i s a c t i v e l y c a r r i e d out at a l l times during the patient's stay i n Valleyview Hospital i n order that an early response to treatment may not be overlooked. The above methods of selection of patients has c e r t a i n advantages; f o r example, the informality of the r e f e r r a l of patients eliminates the necessity f o r formal written communication between departments within Valleyview Hospital. Nevertheless, there are disadvantages i n t h i s informal procedure; i t creates duplication, confusion, overlapping of services, disagreements and a lack of coordination between the physician and the other Treatment Team members. I t also. 48 allows f o r the occasional patient suitable f o r discharge to go unnoticed. The physician i n charge examines the re f e r r e d patient and o f f i c i a l l y declares the patient no longer i n need to remain i n h o s p i t a l . Then, with the consultation of the Social Worker, the physician decides whether the patient may be discharged to se l f - c a r e , family care, nursing home care or boarding home care. Prom then on the remaining planning i s the r e s p o n s i b i l -i t y of the Soc i a l Worker. The S o c i a l Worker informs the Valleyview Hospital Business O f f i c e that discharge i s being considered and requests information concerning the patient's f i n a n c i a l status and other assets that are available to support the patient i n the community. The Social Worker also gathers, from the Head Nurse on the ward, by way of a written nursing assessment, information concerning the patient's everyday behaviour, his mental and physical needs (see nursing assessment form, Appendix C). In addition, the Social Worker obtains a one month supply of the required medications prescribed by the physician. Other pertinent information may be requested from the Occupational and Recreational Therapy Departments, or from any other person that i s known to be i n close contact with the patient. This person could be the Chaplain, Dentist, Beauty Parlor Operator and also interested friends or r e l a t i v e s . The So c i a l Worker then contacts a selected community resource(s) to determine the s u i t a b i l i t y of placing the patient. Having 4 9 completed the preliminary work, the Social Worker consults the physician again to discuss the discharge plan and to r e -evaluate the patient's condition before discharge i s f i n a l i z e d . A f t e r the completion of these plans at the h o s p i t a l , the patient's family i s contacted again and involved i n the f i n a l d e t a i l s of the discharge planning. Some in t e r p r e t a t i o n to the family regarding the patient's needs and c a p a b i l i t i e s i s often necessary. Reassurance i s given that the patient may return to the h o s p i t a l without any formal c e r t i f i c a t i o n , when and i f his condition deteriorates to the extent that he w i l l require further h o s p i t a l i z a t i o n and treatment i n Valleyview H o s p i t a l . 1 The patient himself i s made aware of the planning at a l l times. He i s a c t i v e l y involved i n the o v e r a l l planning of his discharge by the Social Worker and the Nursing Staff on the ward. Sometimes the patient himself i n i t i a t e s a request f o r discharge. If his request i s r e a l i s t i c , the patient i s given a l l the support and assistance from the Social Worker to return wherever he wishes i n the community. The following chapter w i l l examine i n d e t a i l the c r i t e r i a f o r discharge from Valleyview Hospital In comparison with the resources ava i l a b l e i n the community. Comparatively few patients return to h o s p i t a l - i n the F i s c a l Year of A p r i l 1, 1964, to March 31 , 1965, out of l 4 3 discharged, 12 returned - 8 from boarding homes, 3 from family care, and one from nursing home. (See Chapter IV.) Patients have been discharged to I t a l y , India, and Hong Kong. CHAPTER IV DISCHARGE CRITERIA AND COMMUNITY RESOURCES Chapter I presented i n general the "open door" philosophy of Valleyview Hospital; Chapter I I I demonstrated the effects of t h i s philosophy on treatment and r e f e r r a l of patients f o r discharge planning. Since the success of the "open door" philosophy i s i n d i r e c t r e l a t i o n s h i p to an e f f e c t -ive discharge program, t h i s chapter w i l l examine the discharge program and process i n e f f e c t at Valleyview Hospital at t h i s t ime. Discharge Related to Resources Although the philosophy of Valleyview Hospital may regard a l l patients who have responded to treatment as dischargeable, discharge i t s e l f i s d i r e c t l y linked to the resources available i n community. The q u a l i t y and quantity of the l a t t e r are major factors i n determining the extent of a discharge program. There are two reasons for t h i s . In the f i r s t place, hospital p o l i c y must be p r a c t i c a l and workable at Valleyview Hospital as i n a l l ho s p i t a l s . A discharge program cannot exist i n a t h e o r e t i c a l vacuum. Consideration must be given not only to 52 d e c i s i o n s about the s u i t a b i l i t y of a p a t i e n t f o r discharge but a l s o , and perhaps even more imp o r t a n t l y , to the type of p a t i e n t the community i s equipped and w i l l i n g t o r e c e i v e from the h o s p i t a l . Secondly, w i t h reference t o the s i t u a t i o n i n community, one must consider the d i f f e r e n c e s between p s y c h i a t r i c g e r i a t r i c p a t i e n t s and younger mentally i l l p a t i e n t s . In planning discharge w i t h and f o r younger p a t i e n t s the problems of resumming customary r o l e s and r e s p o n s i b i l i t i e s a w a i t i n g them i n the community must be considered and c a r e f u l l y examined. The problems of the aged have been presented i n d e t a i l i n Chapter I under the headings "Absence of Roles, Economic I n s u f f i c i e n c y , Retirement and Health." These problems represent a l a c k of r o l e s and r e s p o n s i b i l i t i e s . For p s y c h i a t r i c g e r i a t r i c p a t i e n t s the b a s i c f a c t o r t o be considered i n discharge planning I s the amount of care and s u p e r v i s i o n they r e q u i r e w i t h i n the community. I t i s , t h e r e f o r e , necessary at t h i s p o i n t i n time, t o assess what resources are a v a i l a b l e w i t h i n the community i n order to determine c r i t e r i a f o r discharge from V a l l e y v i e w H o s p i t a l . The Resources There are f o u r types of resources a v a i l a b l e f o r V a l l e y v i e w H o s p i t a l p a t i e n t s i n the community. They are: (1) Family ( i n c l u d i n g r e l a t i v e s and f r i e n d s ) and s e l f -care. (2) Licensed Nursing Homes. The H o s p i t a l Act defines these i n the f o l l o w i n g way: 53 "Licensed hospital means a private hospital i n respect of which a license has been issued pursuant to t h i s act which has not been revoked. 'Private Hospital' or 'hospital' means a house i n which two or more patients, other than the spouse, parent, or c h i l d of the owner or operator thereof, are l i v i n g at the same time, and includes a nursing home or convalescent home...." (3) Licensed Boarding Homes. The l i c e n s i n g Act r e f e r s to such a home (with s p e c i f i c reference to the aged) as: "a building or part of a building...conducted or operated by a person which i s used, i n whole or i n part...(c) as a boarding home or other i n s t i t u -t i o n wherein food or lodging together with care or attention are furnished, with or without charge, f o r two or more persons who, on account of age, i n f i r m i t y , physical or mental defect, or other d i s a b i l i t y , require the attention or care, excepting a home maintained by a person to whom , the inmates are r e l a t e d by marriage...." 2 The l a t e s t figures ava i l a b l e for the province indicated 4,8^3 licensed beds f o r adults (the i n f i r m and the unemploy-abl e ) . Well over half of these are located i n the Lower Mainland-Vancouver Island area.3 Hospital Act, Part II "Private Hospital", para. 7, (B. C.) Welfare I n s t i t u t i o n s Licensing Act (Province of B r i t i s h Columbia), R.S. 19^8, C363, Section 1, para. 2 Welfare I n s t i t u t i o n s Annual Report 1963-6^ (telephone conversation with Welfare I n s t i t u t e s , 635 Burrard Street, Vancouver, B. C.) 5 4 (4) Licensed "Boarding Homes S p e c i a l " (of which two e x i s t at t h i s time w i t h a t o t a l bed c a p a c i t y of f i f t y - e i g h t ) . These homes, while l i c e n s e d under the same p r o v i s i o n s as " (3) Licensed Boarding Homes", have been placed i n a separate category i n t h i s p r e s e n t a t i o n because of t h e i r s p e c i a l a b i l i t y i n p r o v i d i n g care f o r the p s y c h i a t r i c g e r i a t r i c p a t i e n t . For c l a r i t y they s h a l l be r e f e r r e d t o as "Boarding Homes S p e c i a l " . I t i s our i n t e n t i o n t o examine each of the resources s e p a r a t e l y and i n d e t a i l i n the next s e c t i o n . F i r s t , a b r i e f examination w i l l be made of s t a t i s t i c s which r e v e a l the resources used i n the past year and the r e l a t i o n s h i p of these t o the care needs r e q u i r e d by p a t i e n t s i n h o s p i t a l . TABLE I I The number of discharges made t o each of the resources during the F i s c a l Year 1964-65 ( A p r i l 1 to March 3 1 ) . RESOURCES USED TOTAL NUMBER PERCENT-AGE Nursing Homes 55 3 9 * Boarding Homes 42 2 9 * "Boarding Homes S p e c i a l " 9 6* Family 30 21* S e l f - C a r e • » • • - , -7 5* T o t a l 143 100* 55 TABLE I I I A breakdown of patient population by ward 1 on March 31, 1965. Where possible, the comparable type of resource required i n the community i s given. HOSPITAL WARD COMPARABLE COMMUNITY RESOURCE TOTAL NUMBER PERCENT-AGE Infirmary Nursing Homes 186 25^ Open Boarding Homes, Family, Self-Care 176 23^ Closed "Boarding Homes Special" 176 23^ Admitting 2 - 81 llfo Closed "A"3 - iho l 8 j * T o t a l 759 100$ The most obvious fact evident i n Table I I I i s the t o t a l number of patients requiring "Boarding Homes Special" care. This i s a conservative figure but i t i s s t i l l more than double the present capacity i n the community. See Chapter I I I "Treatment F a c i l i t i e s " which describes the wards i n d e t a i l . • For these patients the poten t i a l need f o r community resources have not yet been determined. 3 These patients have not responded to treatment. They require custodial care because of t h e i r extreme mental dete r i o r a t i o n and even on the closed wards i t i s necessary to segregate them from the other patients. Therefore, any resource capable of accepting these patients could accommodate t h i s category of patient only. Some patients, should they deteriorate ph y s i c a l l y , might be e l i g i b l e f o r nursing home placements but the majority w i l l remain i n h o s p i t a l . 5 6 VALLEYVIEW CRITERIA AS RELATED TO THE RESOURCES !• Family and S e l f - C a r e While the p r o v i n c i a l government sets standards f o r board-i n g and nursing homes there are no government standards f o r , or p a r t i c u l a r community i n t e r e s t i n , f a m i l y care or s e l f - c a r e . The c r i t e r i a f o r discharge to t h i s resource are set by the h o s p i t a l . A. Family Although twenty-one percent of a l l discharges w i t h i n the past F i s c a l year were f a m i l y placements, f o r the most part t o a husband/wife or daughter, t h i s i s not considered a major resource by the h o s p i t a l . Much has been w r i t t e n i n c urrent l i t e r a t u r e on the changing nature of f a m i l y l i f e under such t o p i c s as " u r b a n i z a t i o n vs. r u r a l l i v i n g " and "the nuclear vs. the extended f a m i l y " . However, i n t e r v i e w s w i t h many f a m i l i e s both at the time of admission and at the time of discharge have i n d i c a t e d two primary areas which have c u r t a i l e d the number of p o t e n t i a l discharges t o f a m i l i e s . The f i r s t i s the absence of space w i t h i n the home or apartment f o r the aged member. The second and more d e c i s i v e f a c t i s that f a m i l i e s , p r i o r to the p a t i e n t ' s admission t o h o s p i t a l , had been endeavour-in g t o cope, f o r v a r i o u s reasons and o f t e n f o r a p e r i o d of up t o t e n years or more, wi t h a parent or r e l a t i v e who a c t u a l l y needed h o s p i t a l i z a t i o n f o r most of t h a t time. This has o f t e n i n v o l v e d unsuccessful placements w i t h 57 various family members, numerous emergencies at a l l hours of the day or night, and unsuccessful attempts at placement i n various boarding or nursing homes. In a l l such instances, not only the amount of time, but the amount of money and emotional stress have been consider-able. F i n a l l y , i n sheer desperation, admission i s sought to h o s p i t a l . Often, i n the past, t h i s has been complicated by the hospital's long waiting l i s t which often kept prospective patients waiting f o r periods of up to a year or more. Once the i n i t i a l shock of admission with i t s c e r t i f i c a t i o n of a parent i s over, families are consoled by the care and treatment the patient i s receiv-ing. In many cases, and understandably so, no emotional or physical energy i s l e f t , only fear and concern about the p o s s i b i l i t y of having to cope with the parent once again i n the home. Because of such experiences some family members strongly r e s i s t the discharge of an e l d e r l y family member. When reconciled to the discharge, they often prefer to " l e t the experts handle i t " . Whether or not the new "open door" philosophy with i t s increased admission and p o t e n t i a l for taking younger, less deteriorated patients w i l l ever change the circumstances surrounding t h i s s i t u a t i o n i t i s perhaps too early to ascertain. Nor can one predict what changes i n attitude toward r e s p o n s i b i l i t y f o r care of e l d e r l y family members w i l l accompany changes i n society's view of the aged person. 58 The C r i t e r i a f o r discharge to the family are: 1. Both the patient and family member ( or interested friends, r e l a t i v e s ) must be motivated toward (desirous of) t h i s type of placement. 2. Family members should be able to cope with the mental and physical needs of the patient by understanding what the care needs are and how best to meet them. (Patients who would normally require twenty-four hour care and supervision are not considered suitable for discharge to the family.) 3 . The patient must be oriented to person and place. That Is to say, the patient must be aware of and able to recognize the s i g n i f i c a n c e of meaningful people i n his l i f e . He must also have some general awareness of where he i s and how f a r away other places are i n r e l a t i o n to his own location at any one time. Not infrequently psychiatric g e r i a t r i c patients l i v e completely i n the past, e.g. children are i d e n t i f i e d as s i b l i n g s , children's home become the scene of t h e i r own c h i l d -hood, with accompanying i r r i t a t i o n s and confusion. Such indicat i o n s r e f l e c t a need fo r s p e c i a l care, understanding and supervision by trained persons. 4. The patient must have some awareness of h i s own physic-a l and mental c a p a b i l i t i e s and l i m i t a t i o n s , that i s , a r e a l i s t i c recognition of his or her c a p a b i l i t i e s as l i m i t e d by age and health. Some examples would be: r e a l i z a t i o n that his or her memory i s not as good as i t used to be; an awareness of the i n a b i l i t y to'perform the r o l e of breadwinner. F a i l u r e to have t h i s awareness or acceptance can r e s u l t i n 59 various manifestations of h o s t i l i t y , paranoid delusions and depressions. 5 . Proper f a c i l i t i e s must exist f o r the patient within the home. For example, the absence of s t a i r s f o r the patient with a cardiac i n s u f f i c i e n c y . B. Self-Care This i s a form of placement where the patient i s discharged on his/her own devices, usually to the home vacated at the time of admission. The Table on page 5^ indicates the r a r i t y with which t h i s type of placement i s made. Not only do few patients show such mental improve-ment that they can function without any supervision, but, because of the age factor alone, discharge candidates are discouraged from thinking i n terms of s e l f - c a r e . Very careful consideration by both the Medical and Soc i a l Service Departments i s given before a placement of t h i s nature i s made. The c r i t e r i a f o r discharge to self-ca r e are: 1. Oriented i n a l l spheres (time, place, person). In other words, mentally bright and a l e r t . 2. Awareness and acceptance of t h e i r own mental and physical c a p a b i l i t i e s . 3 . Memory - i n t a c t . k. A b i l i t y to function without supervision. 5 . Motivation - t h i s type of placement must be requested by the patient. 6. Interested family member or f r i e n d i n the area. 6o Someone who would normally be i n touch with the patient by telephone or i n person on a d a i l y basis as a precaution i n the event that the patient might suffer from an accident or i l l n e s s within the home. The study of each of the licensed resources i n community w i l l begin with a s i m p l i f i e d chart based upon the l i c e n s i n g A c t s 1 and twenty-four questionnaires (Appendix D) completed by both boarding and nursing home s t a f f . The hospital-set c r i t e r i a f o r discharge w i l l follow an examination of each resource. 2. Licensed Nursing Homes Nursing f a c i l i t i e s - minimum-good bedside nursing care. Physical f a c i l i t i e s - Private rooms, semi-private and four-bed wards. Lounges. St a f f Training - Graduate nurse i n charge. Supervision - Twenty-four hour care (three s h i f t s ) . Cost of Care - Private $ 1 0 .-l6. per day and up. Welfare $205. per month (ward only). Patient's degree of physical d e t e r i o r a t i o n - No l i m i t . Nursing Homes vary i n the amount of nursing care f a c i l i t i e s they are prepared to o f f e r . The minimum requirement as outlined i n the chart i s "good bedside care". However, the majority of nursing homes b u i l t within the past few years are modern-1 Hospital Act, op. c i t . and Welfare I n s t i t u t i o n s Licensing Act, op. c i t . 2 The O f f i c e of the Inspector of Hospitals i s currently pre-paring, for government acceptance and publication, d e f i n i t i o n s covering such terms. 6i styled, one-storey buildings o f f e r i n g complete nursing f a c i l i t i e s (excluding surgery). They are usually known as Private Hospitals. It i s to these resources that Valleyview patients who require nursing care are discharged as the services and f a c i l i t i e s offered are comparable to those a v a i l -able on the infirmary wards within Valleyview i t s e l f . Nursing home placements have been very successful to date. There was only one return to ho s p i t a l i n the past F i s c a l Year and the demands of post discharge follow-up i n t h i s area have been minimal. 1 One of the reasons f o r t h i s has been the r e -peated use of those homes wherein successful discharges have already been made. One home has accepted over f o r t y patients i n the past two years with no returns to h o s p i t a l . The majority of nursing homes accept welfare patients, although t h i s i s not a l i c e n s i n g requirement. However, the number of welfare beds i s l i m i t e d and t h i s presents a problem of delay i n discharge. Welfare beds f o r Valleyview patients are extremely l i m i t e d i n number. A second area of concern i n nursing home placements i s the fa c t that while supervision i s given by Graduate Nurses, there i s no assurance that these nurses are experienced i n psychiatric nursing. The pre-admission h i s t o r i e s and assessments made at intake conferences of patients who have been admitted from nursing homes give a f a i r l y r e l i a b l e picture of the c a l i b r e and nature of the services given by the homes involved. 1 Returns to hos p i t a l w i l l be discussed under the section "Discharge Follow-up". 62 There i s also a shortage of Occupational Therapy and Recreational Therapy i n nursing homes, although recognition of the need for Physiotherapy i s becoming more and more apparent. The c r i t e r i a of the hospital f o r discharge to a nursing home are: 1. The patient must be ph y s i c a l l y i n need for nursing care. 2 . The patient must not be a disturbing influence for other patients. 3. Licensed Boarding Homes Nursing f a c i l i t i e s - none required. Physical f a c i l i t i e s - Private, semi-private, three to four-bed wards. Dining room or tray service. Lounges. Staff Training - none required. Supervision - Day care (operator and/or owner or s t a f f member must be present i n the home at a l l times. Patient's degree of physical d e t e r i o r a t i o n - ambulatory. Cost of Care - Private $110.-250. per month (based on general accommodation and care needs. Welfare $95* P e r month (ward only). Boarding homes, res t homes, guest houses or comfort homes, whichever the owners prefer to c a l l them, range i n d i v i d u a l l y from warm, comfortable "homes away from home" to l i t t l e more than barren rooming houses. As indicated i n the outline, no nursing f a c i l i t i e s are 63 required. The patients have t h e i r i n d i v i d u a l doctors within the community and day care only i s provided within the b u i l d -ing at a l l times. Usually the operator and/or owner l i v e s within the home. A l l patients must be ambulatory. Regardless of how long they have l i v e d i n the home, when a patient's condition and care needs require chronic nursing care, the patient must be moved to a licensed nursing home. Those persons with temporary i l l n e s s e s , of course, can remain i n the boarding home under t h e i r physician's care. Twenty-nine percent of patients discharged within the past F i s c a l Year were discharged to boarding homes. Returns to hos p i t a l from these placements w i l l be discussed l a t e r . It i s noted, however, that boarding home placements tend to be the most d i f f i c u l t and unstable. Such placements tend to require the closest follow-up care and attention. Some of the reasons f o r t h i s w i l l be discussed i n the following paragraphs. One of the most d i f f i c u l t problems i n using boarding homes as a resource i s the lack of trained s t a f f . I t i s unfortunate that the regulations which give such s t r i c t and det a i l e d attention to the physical aspects of the bui l d i n g i t s e l f , do not go further to provide assurance that candidates f o r licenses have a working knowledge and understanding of the patients who are entrusted to t h e i r care. Many, although licensed to care f o r the aged, have no understanding of the needs and behaviour patterns of the patients who are s e n i l e . Others do t r y with good intentions, but, without t r a i n i n g of 6k any kind, they must r e l y only on t h e i r own p e r s o n a l i t i e s and any clues they may learn, r i g h t l y or wrongly, from experience. This creates a range of operators from "the warden" who sub-s t i t u t e s authority f o r knowledge to the "timid one" who fears the use of authority of any kind. Equally lacking i n r e a l i s t i c understanding and controls, both types of operators f a i l . Night courses have been offered from time to time to boarding home operators by the Health and Welfare Department but on a voluntary basis only. Another problem i n t h i s area i s the l i m i t e d amount of supervision. The q u a l i t y of care and supervision has been discussed i n the preceding paragraph. Here the amount of supervision w i l l be discussed. Many aged patients can manage quite well during the day with minimum supervision but t h e i r peak of confusion, and, i f they are so i n c l i n e d , tendency to wander, usually comes at night. Although the regulations require a s t a f f member i n the home at a l l times, t h i s does not mean that they are on duty at night but only that they must be sleeping i n the home. A t h i r d problem i s the physical layout of many of the homes. Converted older homes present a problem i n the number of s t a i r s between h i g h - c e i l i n g f l o o r s and at the entranceways to the b u i l d i n g . With a lounge and kitchen f a c i l i t i e s , l i t t l e sleeping room i s available on the main f l o o r . Most patients, therefore, must be able to climb a f l i g h t of s t a i r s , or at l e a s t , i f they are on the main f l o o r , handle the outside s t a i r s . 6 5 Another problem i s the lack of opportunities f o r Occupational and Recreational a c t i v i t i e s . Boarding homes i n the country with acreage around them have less of a problem with the l a t t e r but many patients, accustomed to urban l i v i n g , n a t u r a l l y wish to return to f a m i l i a r surroundings. As a natural r e s u l t of these problems there are a number of vacant beds In boarding homes which are unsuitable f o r Valleyview patients because of shortcomings i n the qu a l i t y and quantity of supervision, s t a b i l i z i n g therapeutic l i m i t s , or just the physical layout of the home. On the other hand, there are patients ready f o r discharge to boarding home f a c i l i t i e s who must await suitable vacancies. Based upon the c a p a b i l i t i e s and l i m i t a t i o n s of boarding homes which have been ci t e d , the hos p i t a l has set the following c r i t e r i a f o r discharge to such homes: 1. Oriented to place, person. That i s to say, s u f f i c i e n t l y a l e r t mentally to cor r e c t l y recognize t h e i r surroundings and the people with whom they are l i v i n g . 2. A b i l i t y to e s t a b l i s h some degree of r e l a t i o n s h i p , to communicate, verbally or otherwise, with t h e i r fellow patients and with s t a f f . 3 . Cooperative toward taking medication and observing the boarding home regulations. 4. Desirous of a placement i n a boarding home as opposed to, f o r instance, s e l f - c a r e . 5. Memory s a t i s f a c t o r y f o r recent and past events. 6. Good sleep habits. ( i . e . no habits that would be 66 deemed p e c u l i a r or d i s t u r b i n g t o other guests.) 7. Ambulatory. 8. Able to care f o r personal needs wi t h minimum degree of s u p e r v i s i o n . 9 . I f d e l u s i o n a l , such delusions should not be i n t e r f e r i n g or pose a t h r e a t t o s a f e t y of p a t i e n t or to others w i t h whom he w i l l be a s s o c i a t e d . The p h y s i c a l l i m i t a t i o n s of p a t i e n t (e.g. a p a t i e n t with a heart c o n d i t i o n ) are considered on an i n d i v i d u a l b a s i s when s e l e c t i n g an appropriate home. The extent of the p a t i e n t ' s a c t i v i t y i n Occupational and R e c r e a t i o n a l Therapy i s h o s p i t a l i s compared w i t h what the i n d i v i d u a l home has to o f f e r . For example, a p a t i e n t who l i k e s gardening i s placed i n a home which has gardening f a c i l i t i e s . k. "Boarding Homes S p e c i a l " Nursing f a c i l i t i e s - Emergency equipment (e.g. oxygen). P h y s i c a l f a c i l i t i e s - P r i v a t e , semi-private and three and four-bed wards. Dining room or t r a y s e r v i c e . Lounges. (Same as standard boarding home.) S t a f f T r a i n i n g Trained p s y c h i a t r i c nurse i n charge and p r o v i d i n g s u p e r v i s i o n f o r a l l other s t a f f . S u p e r v i s i o n Twenty-four hour care (three s h i f t s ) . P a t i e n t ' s degree of p h y s i c a l d e t e r i o r a t i o n Ambulatory (same as standard 'boarding homes). 6 7 Cost of Care - Private $125.-250. based on care needs. Welfare $95* P e r month - accept-ed on temporary, emergency basis only. Although a conservative estimate of twenty-three percent of our patients presently q u a l i f y for t h i s type of placement less than ten percent were placed i n such homes i n the l a s t F i s c a l Year. Yet the two homes involved are constantly faced with vacant beds. The reason i s primarily f i n a n c i a l . As outlined i n the chart the Welfare rate i s accepted on a temporary basis only. This f i n a n c i a l problem l i e s i n the fac t that these homes are not prepared to of f e r the type of service they can give on a welfare rate f o r boarding homes of $95* P e r month. To the present time, any increase i n the amount of boarding home rates for care needs has not been forthcoming from the Department of Welfare. With a s t a f f under the charge of a trained Psychiatric Nurse, patients are supervised by a person with suitable t r a i n i n g and q u a l i f i c a t i o n s . With twenty-four hour care they have the amount of supervision needed as we l l . The major r o l e of such homes i n r e l a t i o n to Valleyview Hospital had been i n managing temporarily with d i f f i c u l t patients who were awaiting admission to the h o s p i t a l . With the elimination of the waiting l i s t , t h i s r o l e has v i r t u a l l y disappeared. Because of the s t a f f i n these homes, t h e i r understanding, 68 t r a i n i n g and spe c i a l a b i l i t y to manage, c r i t e r i a of Valleyview Hospital f o r discharge to such homes are: 1. Patient must have ample private means of support. 2. Patient must be ambulatory. (Licensing regulation.) To date, these homes have been able to cope with a l l p s y c h i a t r i c g e r i a t r i c problems and with the close supervision provided by an interested community doctor, have been able to provide treatment and to s t a b i l i z e the condition of many patients who would otherwise have required admission to Valleyview Hospital. I t i s unfortunate, however, that a patient's f i n a n c i a l p o s i t i o n i s a determining factor i n whether he spends the remainder of his l i f e i n a mental hospital or returns to a boarding home i n the community. DISCHARGE In order to introduce and maintain the "open door" philosophy of Valleyview Hospital i t was necessary to have support from such resources i n community as various Welfare Departments, Health Departments, V i c t o r i a n Order of Nurses, Medical Doctors, and Pol i c e . It was, and i s , necessary to a l l e v i a t e any concern they may have regarding discharges of psy c h i a t r i c g e r i a t r i c patients back into community, some of whose s o c i a l h i s t o r i e s indicate long and frequent involvement of the time and e f f o r t of many, i f not a l l , of the afore-mentioned agencies. At the same time, boarding home operators, nursing home owners, and families had to be assured that they 6 9 were not leaving themselves open to unwelcomed g r i e f with a discharged patient they could not handle and could not have removed without overcoming almost insurmountable obstacles. In short, the era of waiting l i s t s at Valleyview Hospital had l e f t i t s mark and these people, agencies and groups, were understandably cautious about again assuming the care of a patient t h i s h o s p i t a l considers ready f o r discharge. In order to of f e r assurance and support to those i n the community involved d i r e c t l y or i n d i r e c t l y with discharged patients, and to the patients themselves, an i n d e f i n i t e form of probation was created. It allows a patient to return to ho s p i t a l , i f necessary, at any time a f t e r discharge, quickly and without the need f o r r e c e r t i f i c a t i o n . By i t s very nature, t h i s type of probation provides an easy flow back into h o s p i t a l and, i n t e r e s t i n g l y enough, has helped operators, owners, and fa m i l i e s to cope with many more problems since they know that the h o s p i t a l i s ready and w i l l i n g to be of assistance i f c a l l e d upon. Unfortunately, there remain some l o c a l Departments of Welfare and nursing homes which are extremely reluctant to accept patients from Valleyview Hospital under any conditions. Usually these Welfare Departments regard committal of the aged to be permanent. With t h e i r own busy schedules, they resent applications f o r the return of former c l i e n t s whom they f e e l are better cared f o r i n h o s p i t a l . At the same time they.expect the ho s p i t a l to be prepared for admissions i n d e f i n i t e l y . The atti t u d e of the nursing homes would appear, for the most part, 70 to r e f l e c t the age-old stigma of mental i l l n e s s , as well as an outmoded philosophy regarding the care of the aged. There are two other forms of discharge but these are seldom used at t h i s time. These are: 1. Discharge i n P u l l It must be used under the following conditions: a) f o r voluntary admissions b) f o r those discharged to addresses outside the province. (e.g. I t a l y and Alberta within the past F i s c a l Year.) 2. Six-months Probation This i s used i n cases of s e l f - c a r e or family placement at the request of the patient or family members. Depending upon the adjustment the patient makes to his environment he or she w i l l , at the end of the six-month period, be either discharged i n f u l l or transferred to the i n d e f i n i t e form of probation. Neither form of probation i s meant to be r e s t r i c t i v e i n any way and, should the family wish i t , t h i s can be changed to a f u l l discharge at any time. An important aspect of discharge planning i s the r o l e of the Public Trustee. Most persons admitted to Valleyview Hospital w i l l , by the very nature of t h e i r condition, be considered "incapable of managing t h e i r own a f f a i r s " . Where the appointment of a "Quasi Committee" has not been made by the Supreme Court p r i o r to admission of such a patient, action i s automatically taken to designate the Public Trustee as the 71 guardian or "committee" of the patient. The function of the Public Trustee i s (in a trust capacity) to receive and disburse a l l monies on behalf of the patient; to receive, hold, protect and, i f necessary, s e l l such property or assets of a patient, and to invest monies i n approved s e c u r i t i e s . By the very nature of t h e i r condition, the majority of patients w i l l be discharged as "incapable of managing t h e i r own a f f a i r s " . This means that the Public Trustee must assume r e s p o n s i b i l i t y for more and more patients. (472 admissions i n the F i s c a l Year 1964-65 at Valleyview Hospital a l o n e . ) 1 Lack of s t a f f and, therefore, i n s u f f i c i e n t time to deal adequately with the problems of i n d i v i d u a l patients has resulted i n delays both i n actual discharges from ho s p i t a l and i n i n i t i a l payments to operators, owners, and patients a f t e r discharge. This has created undue stress and hardship on those affected. Such stress has often hampered a patient's adjust-ment i n community and has complicated the post discharge follow-up service from h o s p i t a l . FOLLOW-UP SERVICES Those patients discharged within the Lower Mainland receive follow-up services, assistance, and advice where needed, from the S o c i a l Workers at Valleyview Hospital. In the remainder of the province the Mental Health Centres have been 1 Valleyview Hospital s t a t i s t i c s as yet unpublished. 72 of tremendous assistance to the patients and have kept Valleyview Hospital i n touch with the ..progress and adjustment of each patient i n the community. Most of the l o c a l Department of Social Welfare have cooperated with the hos p i t a l Social Service Department i n placement and follow-up services. Many of these Departments welcome the ho s p i t a l assistance; the Vancouver Department, however, prefers to provide these services from t h e i r own agency to welfare patients returned to that c i t y . Although a large majority of patients are admitted from the Vancouver area, the number of discharges to the City are very small. Nursing homes i n t h i s area are reluctant to accept Valleyview Hospital patients, p a r t i c u l a r l y those i n rec e i p t of government f i n a n c i a l assistance and many delays are experienced i n placing such patients i n boarding homes because of the heavy demands fo r t h i s type of placement. Although the returns to h o s p i t a l have been less than ten percent (sixty-one percent of t h i s from boarding home placements), the demands f o r follow-up e s p e c i a l l y i n boarding home placements have been extensive. The main reason f o r t h i s has been the inexperience of operators. Their lack of under-standing of the problems of t h e i r aged patients creates a constant need for assistance and advice from the hos p i t a l workers. Unfortunately the Soc i a l Workers are often unable, with the demands on t h e i r time, to give as much help to each operator as required. There have been four family, one nursing home, and eight 73 boarding home returns to ho s p i t a l of those discharged within the F i s c a l Year 1 9 6 ^ - 6 5 . 1 This represents a t o t a l of thi r t e e n or nine percent of discharges. One patient readmitted from a boarding home was discharged again two weeks l a t e r to another boarding home and has adjusted well i n the second home. One readmission from a family placement was depressed over a daughter's i l l n e s s but was able to return to the family eight days l a t e r . A second return from family was due to sudden physical d e t e r i o r a t i o n . The patient has since expired. The remaining ten patients suffered relapses and were returned to hos p i t a l because they had become management problems. The stay out of ho s p i t a l ranged from ten days (for an a l c o h o l i c ) to seven months. There i s one area where valuable help has been f o r t h -coming, and, i n f a c t , has made discharge possible. This i s the service offered by the V i c t o r i a n Order of Nurses and Public Health Nurses. Diabetic patients have been discharged to t h e i r homes, and boarding homes, because of the willingness and cooperation of these agencies to provide d a i l y i n s u l i n therapy. One patient has been out of ho s p i t a l two years because of the a v a i l a b i l i t y of t h i s service. This chapter has presented some of the problems and li m i t a t i o n s inherent i n the resources presently available i n community and the eff e c t s of these problems and l i m i t a t i o n s on the discharge c r i t e r i a of Valleyview Hospital. The next, concluding chapter w i l l present a summary, case h i s t o r i e s , the findings and recommendations of t h i s study. 1 Valleyview Hospital S t a t i s t i c s . CHAPTER V ANALYSIS OP STUDY AND CONCLUSIONS There are ever increasing demands from the,community for the services of Valleyview Hospital. The ho s p i t a l has endeav-oured to meet these demands by changing i t s r o l e from that of custodial care of patients to treatment and discharge of patients: the "open door 1 philosophy. This study has attempt-ed to assess the effectiveness of t h i s "open door" philosophy which permeates the l i f e of the hospital and the hospital's function i n r e l a t i o n to the community. We have presented a general view of the problems and pot-e n t i a l s d i r e c t l y bearing on aging i n B r i t i s h Columbia and, i n turn, on psy c h i a t r i c g e r i a t r i c patients i n Valleyview Hospital. Secondly, we have discussed the team approach to treatment and f i n a l l y , discharge c r i t e r i a i n r e l a t i o n to community resources. Discussion of such matters as a team approach, treatment plans, c r i t e r i a f o r discharge i s , i n the long run, s i g n i f i c a n t only i n terms of human beings. In order to bring a l i v e , to give added meaning to the study, we are c i t i n g , i n thi s chapter, some case i l l u s t r a t i o n s . 75 Case H i s t o r y I Discharged t o Boarding Home. Admitted t o V a l l e y v i e w H o s p i t a l J u l y 20 , 1964. Mrs. A., 90 years of age, i s a woman w i t h gradual mental d e t e r i o r a t i o n causing p a r a n o i d a l t h i n k i n g f o r the past two years. She has been known t o the S o c i a l S e r v i c e Department i n Vancouver s i n c e 1958* Mrs. A. i s a widow; she has one married son, but was l i v i n g alone. Recently she became confused, s t a t i n g t h a t a "man was persecu t i n g her and c o n t r o l l i n g her mind wi t h a machine". The son took her i n t o h i s home where, f o r a short w h i l e , she improved. But e v e n t u a l l y she became su s p i c i o u s of the f a m i l y , accusing them of s t e a l i n g her belongings and "poisoning" her food. She f i n a l l y attacked her daughter-in-law and had t o be taken as an emergency case to Vancouver General H o s p i t a l . Nothing could be done f o r her there and she was admitted to V a l l e y v i e w H o s p i t a l . In h o s p i t a l her diagnosis was "Paranoidal Delusion S t a t e , w i t h very l i t t l e Chronic B r a i n Syndrome". Remarkable progress has been noted s i n c e admission. By August 2 , 1964, the p a t i e n t improved to the extent t h a t she was f r i e n d l y , cooperative and not d e l u s i o n a l . She attended Occupational Therapy and had ground p r i v i l e g e s . In October, 1964, Mrs. A. was r e f e r r e d to S o c i a l S e r v i c e Department f o r discharge planning. The discharge plan was discussed w i t h Mrs. A. and her f a m i l y and i t was evident t h a t the f a m i l y would be unable to care f o r her s u c c e s s f u l l y . Therefore, the S o c i a l Worker e n l i s t e d the cooperation of the Vancouver C i t y 76 S o c i a l S e r v i c e Department i n p r o v i d i n g f i n a n c i a l a s s i s t a n c e . Mrs. A. was subsequently discharged t o a boarding home a f t e r she had v i s i t e d the proposed boarding home and agreed to go there. Mrs. A. i s known to be doing w e l l i n the boarding home and i s very happy. The f a m i l y i s very s a t i s f i e d w i t h t h i s arrangement. Case H i s t o r y I I "in-Between" Case. Discharged t o Boarding Home s t a f f e d w i t h p s y c h i a t r i c nurses. Mrs. B. i s a seventy-two year o l d woman who has one son and two daughters, a l l of whom are married. This p a t i e n t l i v e d w i t h one of her daughters and managed f a i r l y w e l l u n t i l October, 19^2, when she had a c e r e b r a l v a s c u l a r accident and as a r e s u l t experienced m i l d memory l o s s and confusion. She developed unreasonable f e a r and apprehension; she was a f r a i d to do anything or go anywhere, a f r a i d of f a l l i n g and of g e t t i n g l o s t . She s t a t e d t h a t she i s "going completely to pieces mentally". Mrs. B. was admitted to V a l l e y v i e w H o s p i t a l i n May, 19&3* and diagnosed as "Chronic B r a i n Syndrome a s s o c i a t e d w i t h Cerebral A r t e r i o s c l e r o s i s w i t h Behavioural R e a c t i o n " . The prognosis was good and she was r e f e r r e d to S o c i a l S e r v i c e Department f o r discharge planning a f t e r the admission conference. 77 In h o s p i t a l her whole mental outlook s t e a d i l y improved. She.became interested i n Occupational Therapy work and i n the various rec r e a t i o n a l a c t i v i t i e s . The Social Worker had a series of interviews with Mrs. B. during which her discharge was discussed. Although Mrs. B. was w i l l i n g to t a l k about discharge to community, she was reluctant to leave the hos p i t a l as she was very dependent upon her doctor and the nurses on her ward. On September of the same year, Mrs. B.'s doctor considered that she was ready for discharge. The So c i a l Worker spoke with the family about plans f o r discharge and by t h i s time Mrs. B. herself was well able to accept discharge. A supervised boarding home was considered most appropriate for her because there she would receive the necessary support and attention of the s t a f f . She i s expected to become apprehensive and upset p e r i o d i c a l l y and w i l l become very attached to the boarding home s t a f f as she was to the nursing s t a f f i n , Valleyview Hospital. The family agreed to v i s i t r e g u l a r l y and Occupational Therapy w i l l be provided to help her to r e t a i n her inte r e s t i n manual work. In addition, periodic follow-up from the Valleyview Hospital Social Service Worker w i l l be necessary to give Mrs. B. additional support so that she may function well i n the community. Case History I II Discharge to a Nursing Home. Admitted to Valleyview Hospital June, 1962. Mr. C , who i s seventy-nine years old, was admitted from 78 S t . Paul's H o s p i t a l where he had been admitted because of an acute episode of nausea, vomiting and d i s t e n t i o n . He had been ma n i f e s t i n g signs of f o r g e t f u l n e s s f o r seven years p r i o r t o admission to V a l l e y v i e w H o s p i t a l . He p r o g r e s s i v e l y became s u s p i c i o u s , d i s t u r b i n g , s e l f i s h , and h o s t i l e to everyone. He was o f t e n described as having l o s t i n t e r e s t i n l i f e , but he never d i s p l a y e d s u i c i d a l tendencies. Mr. C. had l i v e d w i t h h i s bed-ridden w i f e i n a d i l a p i d a t e d house and cared f o r her u n t i l her death i n 1961. F o l l o w i n g her death h i s mental: c o n d i t i o n . d e t e r i o r a t e d . He drank a l c o h o l i c beverages e x c e s s i v e l y , was undernourished and had many p h y s i c a l problems. E v e n t u a l l y he was admitted to St. Paul's H o s p i t a l , and from there t o V a l l e y v i e w H o s p i t a l . Diagnosis on admission to V a l l e y v i e w H o s p i t a l was "Chronic B r a i n Syndrome a s s o c i a t e d w i t h S e n i l e B r a i n Disease aggravated w i t h A l c o h o l i s m , M a l n u t r i t i o n and Anemia". At V a l l e y v i e w H o s p i t a l t h i s p a t i e n t was g r a d u a l l y brought back to a b e t t e r p h y s i c a l and mental s t a t e . He became cooperative, pleasant and f r i e n d l y . His c o n d i t i o n was considered s a t i s f a c t o r y d e s p i t e some general p h y s i c a l d e t e r i o r -a t i o n . He was r e f e r r e d t o V a l l e y v i e w H o s p i t a l S o c i a l S e r v i c e Department f o r discharge planning i n February, l$6k. Because of h i s p h y s i c a l d e t e r i o r a t i o n , i t was considered t h a t a n u r s i n g home was the most appropriate placement f o r Mr. C. His f a m i l y , when consulted, were s u r p r i s e d t h a t discharge was being considered and were d i s t u r b e d about such a p l a n . Several i n t e r v i e w s w i t h the S o c i a l Worker r e s u l t e d i n 79 better understanding of the discharge plan and the family agreed to the plans. The Social Worker made the necessary arrangements and Mr. C. was discharged to a nursing home where he i s getting the required physical care. Although he remains somewhat confused and disoriented, his condition i s not disturbing to patients or s t a f f . Case History IV Discharge uncompleted. Mr. D. was admitted to Valleyview Hospital i n March, 1961. He was a seventy-eight year old r e t i r e d labourer, who came to Canada from Scotland s i x t y years ago. He was admitted to Valleyview Hospital because of severe mental confusion. In addition to mental confusion, he was a known diabetic for many years, and had been taking i n s u l i n . Mr. D. denied having any serious problems i n c o n t r o l l i n g his diabetic condition, although according to his family, he was i n a state of diabetic coma not long before his admission to Valleyview Hospital. Mr. D.'s diagnosis a f t e r admission to Valleyview Hospital was "Chronic Brain Syndrome associated with Senile Brain Disease with Behavioural Reaction". In Valleyview Hospital, the patient's diabetes was brought under control and his mental condition improved to the extent that he was able to go out on weekend leaves to v i s i t his family. 80 In June, 196k, Mr. D. was r e f e r r e d to the S o c i a l S e r v i c e Department f o r discharge planning, by the a t t e n d i n g p h y s i c i a n . The S o c i a l Worker learned t h a t the p a t i e n t was pleasant and cooperative only i f he had h i s own way r e g a r d i n g h i s d i e t . When Mr. D. was r e q u i r e d t o pay s p e c i a l a t t e n t i o n t o h i s d i e t i n order t o c o n t r o l h i s diabetes, he became stubborn and h o s t i l e . I n view of h i s behaviour, e x t r a care, understanding and a t t e n t i o n on the part of the nursing s t a f f was r e q u i r e d . Several boarding homes i n the community were considered i n planning Mr. D.'s discharge, but none of them had the t r a i n e d s t a f f or the f a c i l i t i e s needed f o r the c o n t r o l of the p a t i e n t ' s diabetes and the p r o v i s i o n of c l o s e care and s u p e r v i s i o n . Without such s e r v i c e s , the p a t i e n t could not f u n c t i o n adequately i n the community. Mr. D.'s discharge planning was, t h e r e f o r e , postponed i n d e f i n i t e l y because no s u i t a b l e accommodation i n the community was a v a i l a b l e . Case H i s t o r y V Discharge to Family. Admitted to V a l l e y v i e w H o s p i t a l J u l y , 1963. Mr. E., e i g h t y - t h r e e years of age, i s a r e t i r e d farmer. U n t i l r e c e n t l y he had no problems with e i t h e r h i s p h y s i c a l or mental h e a l t h . He was admitted to St. Paul's H o s p i t a l f o r treatment of diabetes and head i n j u r y . A few weeks p r i o r t o admission to S t . Paul's H o s p i t a l Mr. E. had symptoms of confusion and l a c k of c o o r d i n a t i o n . One day he f e l l down s t a i r s , l o s t consciousness; subsequently he became more 81 confused, r e s t l e s s and drowsy. In St. Paul's Hospital his diabetes was brought under control i n twenty-four hours and his head i n j u r y investigated. He recovered from the accident well but continued to be very disoriented and confused. P e r i o d i c a l l y he displayed episodes of aggressiveness and h o s t i l i t y . As a r e s u l t no nursing home would take him and he was admitted to Valleyview Hospital. Mr. E.'s diagnosis on admission to Valleyview Hospital was "Chronic Brain Syndrome associated with Cerebral A r t e r i o -s c l e r o s i s with Psychosis and Diabetes". In Valleyview Hospital the patient responded well to treatment and soon became pleasant, quiet, and cooperative i n a l l respects. His movements were rather slow but he was quite t a l k a t i v e and his response generally r e l i a b l e and coherent. He expressed a wish to go home to his wife and was, therefore, re f e r r e d to the Social Service Department. The Valleyview Hospital Social Worker interviewed the patient and l a t e r his eighty-one year old wife and i t was learned that she was eager to have her husband home again. Only one problem needed to be solved; control of his diabetes. The Social Worker solved t h i s problem. Accordingly, arrange-ments were made to have a nurse from the V i c t o r i a n Order of Nurses c a l l r e g u l a r l y to help Mr. &. Mrs. E. with the control of Mr. E.'s diabetes. Mr. E. was subsequently discharged to the care of his wife i n October, 1963. A recent follow-up v i s i t by a Valleyview Hospital Social 82 Worker i n d i c a t e s that Mr. E. i s doing w e l l a t home and the couple are very happy. Case H i s t o r y V I Discharged t o S e l f - C a r e . Mrs. P. i s seventy-seven years of age. She was brought, by ambulance, t o V a l l e y v i e w H o s p i t a l on January 10, 19&4, from her home i n Vancouver. She had been i n f a i r l y good h e a l t h and had been able to look a f t e r h e r s e l f u n t i l January ~J> 19°*4. Her f r i e n d , who accompanied her to V a l l e y v i e w H o s p i t a l , s a i d t h a t he and h i s wife had c a l l e d to see her on that date and found her i n a s t a t e of mental confusion. She had a f l i g h t of ideas and b e l i e v e d that her husband had died the night before. He had, i n f a c t , d i e d i n June, 1963. The f r i e n d s managed t o calm her, but e a r l y next morning the p o l i c e were c a l l e d because Mrs. P. was wandering i n the s t r e e t and shouting i n c o h e r e n t l y . Mrs. F. was admitted to V a l l e y v i e w H o s p i t a l and her mental dia g n o s i s as "Minimal Degree of Chronic B r a i n Syndrome assoc-i a t e d w i t h Cerebral A r t e r i o s c l e r o s i s " and "a H i s t o r y of Epolepsy". A f t e r a short p e r i o d of treatment, Mrs. F. was t r a n s f e r r e d from the main V a l l e y v i e w B u i l d i n g t o a "mixed ward". She had improved t o a considerable extent, was p a r t i c i p a t i n g i n s o c i a l groups on the ward and was subsequently r e f e r r e d t o the S o c i a l S e r v i c e Department f o r discharge planning. Mrs. F. was interviewed by the S o c i a l Worker s e v e r a l times and the p o s s i b i l i t y of discharge to a boarding home was 83 discussed with her. She wished, however, to return to her own home and be near her fr i e n d s . This was considered a r e a l i s t i c plan. In March, Mrs. P. was discharged to her own home "on probation". A f r i e n d volunteered to v i s i t her p e r i o d i c a l l y to ensure that she was managing adequately. Follow-up v i s i t s to her home by the Valleyview Hospital S o c i a l Worker were made and up to t h i s time she i s known to be managing very wel l . The cases c i t e d outline some of the successful discharges from Valleyview Hospital to community resources. In addition, one case has been c i t e d which i l l u s t r a t e s the problems inherent i n discharge from h o s p i t a l . CONCLUSIONS By accepting and implementing the "open.door" philosophy of treatment and discharge, Valleyview Hospital has at t h i s time progressed i n i t s thinking far i n advance of community resources and community attitudes toward care of psych i a t r i c ; g e r i a t r i c patients. This study has pointed out some of the d i f f i c u l t i e s and problems inherent i n the resources presently a v a i l a b l e . i n community.1 THE RESOURCES 1. Family and Self-Care . As presented i n Chapter TV, the family i s not a major 1 Despite the inherent problems the h o s p i t a l i n the l a s t F i s c a l Year (196^-65) discharged i n numbers the equivalent of patients from three h o s p i t a l wards and admitted for treatment a number equal to nine wards. There are f i f t y patients on each ward. &H resource f o r the discharge of h o s p i t a l p a t i e n t s . S e l f - C a r e , because of the nature and age of the g e r i a t r i c p a t i e n t , i s r a r e l y used. 2. Licensed Nursing Homes These have been a r e l i a b l e and s a t i s f a c t o r y resource f o r h o s p i t a l p a t i e n t s . Only one r e t u r n t o h o s p i t a l came from a nurs i n g home. The d i f f i c u l t y l i e s i n the l i m i t e d number of s a t i s f a c t o r y homes a v a i l a b l e f o r V a l l e y v i e w 1 s discharged p a t i e n t s because of a r e l u c t a n c e , p a r t i c u l a r l y i n Vancouver where a l a r g e number of these homes are l o c a t e d , to accept h o s p i t a l p a t i e n t s . 3. Licensed Boarding Homes As i n d i c a t e d by the s t a t i s t i c s of r e t u r n s and by the de-mands f o r follow-up s e r v i c e s , the gre a t e s t problems r e l a t e d t o discharge l i e i n t h i s area. The causes are l a c k of t r a i n i n g of the s t a f f s and the l a c k of a requirement t h a t s t a f f be t r a i n e d , by l i c e n s i n g r e g u l a t i o n s . The problems of the p a t i e n t s are not understood and the p s y c h o l o g i c a l and s o c i a l needs of the p a t i e n t s are not met. k. "Boarding Homes S p e c i a l " These homes are very s u i t a b l e f o r discharged p a t i e n t s , p a r t i c u l a r l y f o r those p a t i e n t s who r e q u i r e twenty-four hour s u p e r v i s i o n by t r a i n e d s t a f f . These homes are, however, l i m i t e d by t h e i r shortage i n numbers and by the f i n a n c i a l d i f f i c u l t i e s which deprive welfare r e c i p i e n t s of t h i s type of care outside of.the h o s p i t a l . A l l the l i c e n s e d f a c i l i t i e s i n the community are l a c k i n g 8 5 i n programs of Occupational and Recreational Therapy. There i s also a tremendous gap i n the type of care and supervision offered between the present boarding and nursing homes. This gap can be f i l l e d only by an increase i n the number of "boarding homes s p e c i a l " and tr a i n i n g f o r boarding home operators. VALLEYVIEW HOSPITAL DISCHARGE CRITERIA An examination of admission and treatment f a c i l i t i e s indicate that these aspects of the service are very s a t i s -factory. However, the method of sel e c t i o n and r e f e r r a l of patients for discharge planning Is less well structured. The problem l i e s i n the lack of suitable resources i n community to accept patients once they have responded to treatment. The c r i t e r i a f o r discharge from hospital are r e s t r i c t e d because of the necessity of considering what types of resources are ac t u a l l y available within the community. DISCHARGE There are d i f f i c u l t i e s inherent i n the communities' attitudes toward discharging patients. Moreover, there remains i n the community agencies, p a r t i c u l a r l y i n some l o c a l Depart-ments of Welfare, the reactionary view that Valleyview Hospital should serve i n the r o l e of "home for custodial care". The O f f i c e of the Public Trustee represents f r u s t r a t i n g delays i n the area of discharge because of the i n a b i l i t y to cope with the increasing load which more and more discharges represent. 86 RECOMMENDATIONS Based on our conclusions concerning community resources, ho s p i t a l c r i t e r i a f o r discharge and community attitudes toward discharge, the following recommendations are made: I. Implementation of an organized public r e l a t i o n s program i s needed within the h o s p i t a l . With such a program closer l i a i s o n with the community i n general and with various government de-partments, p a r t i c u l a r l y the l o c a l Department of Welfare, could be maintained. Such a program could in t e r p r e t the needs of the aged person, generally, but more p a r t i c u l a r l y , could interpret the philosophy, purpose and program of Valleyview Hospital to appropriate community health, welfare, and other agencies, as well as to the general public. I I . Creation of smaller psychiatric g e r i a t r i c treatment units throughout the province. Some of the advantages of such units would be: 1) To permit the patient to receive treatment within f a m i l i a r surroundings. 2) To enable community p a r t i c i p a t i o n and involvement i n providing resources such as the licensed homes and Occupational and Recreational f a c i l i t i e s within the community i t s e l f . 3) To provide smaller units with more i n d i v i d u a l treatment as opposed to the large impersonal type h o s p i t a l s . k) To provide an available resource for day or night care when advisable and desirable thus enabling the patient 87 to remain with his family while receiving treatment. I I I . The establishment of government subsidization for " i n -between" care homes. This includes "boarding homes s p e c i a l " and those homes providing "in-between" care on a physical needs bas i s . the need f o r t h i s type of treatment has already been demonstrated i n Chapter IV of t h i s study. The present welfare rate for "licensed boarding homes" i s i n s u f f i c i e n t to cover the cost of care provided i n the homes already i n existance. It i s our b e l i e f that an increase i n the present welfare rate of $5°«~ 6 0 . per month per patient would enable better use of the present homes and encourage the establishment of s t i l l more homes of t h i s c a l i b r e . 1 IV. Government subsidization f o r an after-care program of Recreational Therapy and Occupational Therapy within the licensed homes i n community.' U n t i l such time as t h i s program can be implemented an increase i n the number of occupational and r e c r e a t i o n a l s t a f f i n h o s p i t a l i s recommended i n order to carry out a weekly program with patients already i n community. V. Compulsory courses f o r operators of boarding homes catering 1 The present cost of care i n Valleyview Hospital i s $ 7 . 5 2 P e r day (this f i g u r e does not include building and equipment costs). The patient pays $1 .50 per day of t h i s amount. 2 The need for such a program has been demonstrated by a study of the Community Chest and Council "A Study of Unmet Needs i n the R e h a b i l i t a t i o n of the Adult Chronically 111." A. report of the Sub-Committee on Chronic I l l n e s s , Social . Planning Section, Committee on the Welfare of the Aged, Community Chest and Councils of the Greater Vancouver area, September, 196k. 88 t o the g e r i a t r i c p a t i e n t . The l e a d e r s h i p f o r such a program should be provided by V a l l e y v i e w H o s p i t a l . This could c o n s i s t of an i n t r o d u c t i o n to V a l l e y v i e w H o s p i t a l , i t s s e r v i c e s and discharge program; i t s changed philosophy toward the aged; and i t s f u n c t i o n w i t h i n the community. Such an i n t r o d u c t i o n could i n c l u d e a s e r i e s of evening l e c t u r e s on s e l e c t e d subjects concerned w i t h the aging process. V a l l e y v i e w H o s p i t a l i s p r e s e n t l y being used as a teaching f a c i l i t y f o r student psych-i a t r i c nurses from the P r o v i n c i a l Mental H o s p i t a l . The a s s i s t a n c e of the teaching s t a f f of the Mental H o s p i t a l could be of a i d i n preparing such a course f o r boarding home operators. V I . I t i s s t r o n g l y recommended th a t a separate department be created w i t h i n the O f f i c e of the P u b l i c Trustee w i t h head-quarters at V a l l e y v i e w H o s p i t a l t o deal w i t h the l e g a l and f i n a n c i a l problems of V a l l e y v i e w p a t i e n t s . I t i s f e l t t hat such a step, by s i m p l i f y i n g the channels of communication between the h o s p i t a l and the O f f i c e of the P u b l i c Trustee, could provide an e f f i c i e n t s e r v i c e and reduce the problems p r e s e n t l y created by delays i n the a d m i n i s t r a t i o n of p a t i e n t accounts. FUTURE RESEARCH Because of the subject matter, t h i s study has been p r i m a r i l y d e s c r i p t i v e i n nature. In essence i t has been an examination of a philosophy concerning, i n a broad sense, the acceptance and understanding of the e l d e r l y person i n s o c i e t y ; i n the narrow sense, i t has been an examination of some of the 89 problems posed for a progressive G e r i a t r i c Hospital, i n which the e f f o r t s of a l l s t a f f members are directed towards approp-r i a t e treatment of the mentally i l l e l d e r l y person and his return to the community when treatment has been concluded. In the course of such a pioneer study many questions have been r a i s e d . Such questions can only be posed here. Answers can only be found by further research. Translating our questions into concrete research p o s s i b i l -i t i e s , the following areas of study seem to be important: 1. An assessment of discharged patients - t h e i r adjustment and s o c i a l well being within the community. 2. A study of reasons f o r , and patterns of behaviour i n , returns to h o s p i t a l . 3 . A q u a l i t a t i v e and quantitative assessment of the present c r i t e r i a f o r discharge from Valleyview Hospital with the use of controlled and experimental groups of patients within h o s p i t a l over a s p e c i f i c period of time. k. A study of community attitudes and agency attitudes toward Valleyview Hospital; i t s philosophy, i t s function, i t s f a c i l i t i e s . Such a study might r e f l e c t changing community attitudes toward the aging person, p a r t i c u l a r l y the psychiatric g e r i a t r i c patient. 5. An assessment of the effectiveness of the "mixed, open wards" presently operating at Valleyview Hospital. This i s a new experiment introduced i n 1963• ^ e e ^ ^ e c ^ n a s yet to be s c i e n t i f i c a l l y evaluated i n terms of helping patients toward r e h a b i l i t a t i o n and discharge. 1 90 6. A study of the p o s s i b i l i t y of implementing a discharge program at Skeenaview and Dellview Hospitals. These units could become extensions of the model of Val l e y -view serving some of the needs within the Interi o r of the Province. In conclusion, we look o p t i m i s t i c a l l y to the future and the effects of the changing philosophy toward the aged i n our aff l u e n t society. We have t r i e d to indicate some of the li m i t a t i o n s apparent i n the present community resources and i n the government l e g i s l a t i o n regulating them. Many psychiatric g e r i a t r i c patients have been successfully discharged from Valleyview Hospital to resources i n the community. Many obstacles remain but the ground-work has been l a i d and the future of Valleyview Hospital as a treatment f a c i l i t y appears to be a bright one. 91 APPENDIX A Bibliography 92 (1) A r t i c l e s Alderman, T. "The Gold Watch." Imperial Gold Review. February, 1964. Imperial O i l Review, Toronto. Al l e n , Ruth. "A Study of Subjects Discussed by Eld e r l y Patients i n Group Counselling." Social Casework. 43'>~[, July, 1962. p .3 6 O . Family Service Association of America, Albany, N. Y. Andrews, C. T. "The Problem of the Aged." So c i a l Problems A Canadian P r o f i l e . Richard Laskin, ed. -McGraw-Hill, Toronto, 1964. PT323. Arsenian, John. "Situational Factors Contributing to Mental I l l n e s s i n the E l d e r l y i n the U. S." Mental Hygiene. 45, 1961. p.194. National Association.for Mental Health, Albany, N. Y. Beattie, Walter M.. J r . "Mobilizing Community Resources f o r Older Persons. Public Welfare. 19 :3 , July, 1961. p.97. American Public Welfare Association, Chicago. Berl, Fred. "Growing Up to Old Age." So c i a l Work. 8 : 1 , January, 1963. P»85» National Association of Social Workers Albany, N. Y. Bowmann, K. M. " G e r i a t r i c s , A Review of Psychiatric Progress American Journal.of Psychiatry. 115 :7> January, 1959* p.621 American Psychiatric Association, Hanover, N. H. Brecher, Edward and Brecher, Ruth. "Nursing Homes." Consumer Reports. 2 9 : 1 - 4 , January-April, 1964. Consumers Union of U. S., Mount Vernon, N. Y. Busse, E. W. "Treatment of the Non-Hospitalized Emotionally Disturbed E l d e r l y Persons." G e r i a t r i c s . 11:3, March, 195^. p.173. Lancet Publications, Minneapolis, Minnesota. Butler, Robert N. "Some Observations on Culture and Personality i n Aging." Social Work. 8 : 1 , January, 1963. p.79. National Association of S o c i a l Workers, Albany, N. Y. Cameron, Jean. "Living Arrangements f o r Older People." Canadian Welfare. 3 1 : 1 . p.42. The Canadian Welfare Council Ottawa. Doodson, Norman. "Services for the Aged i n B r i t a i n . " Canadian Welfare. . 4 0 : 1 , January-February, 1964. p.23. The Canadian Welfare Council, Ottawa. 93 Duncan, Kenneth J . "Modern Society's Attitude Toward Aging." G e r i a t r i c s . 1 8 : 8 , August, 1963* p.629. Lancet Publications, Minneapolis, Minnesota. Emory, Marion. "Casework with the Aging: Today's F r o n t i e r . " S o c i a l Casework. 3 9 ; 8 , October, 195°* P«^55« Family Service Association of America, Albany, N. Y. Farber, Arthur. "Non I n s t i t u t i o n a l Services for the Aged." So c i a l Work. 3 : 4 , October, 1959* P«58. National Association of Social Workers, Albany, N. Y. F i l e r , R. N. and O'Commell, D. D. "Motivation of Aging Persons." Journal of Gerontology. . 19 :1 . p . l 5 » Gerontol-og i c a l Society, St. Louis, Missouri. Freeman, David. "Rehabilitation of the Mentally 111 Aging." Social Work. 4 : 4 , October, 1959- National Association of . S o c i a l Workers, Albany, N. Y. Galpern, Marie, et a l . "The Psychiatric Evaluation of Applicants f o r a Home for the Aged." Social Casework. 3 3 : 4 , -A p r i l , 1952. p.152. Family Service Association of America, Albany, N. Y. Gold, S: "Social Services i n a G e r i a t r i c Setting." The  Soc i a l Worker. 2 9 : 3 , June, 1961. p.28. Canadian.Association of Social Workers, Ottawa. Goldner, Jack. "Locating Housing for the Aged." Canadian  Welfare. .36:5 , September 15, i 9 6 0 , p .217 . The Canadian Welfare Council, Ottawa. Good, Jean. "Community Organization for Older People." Canadian Welfare. 31 :1 , May 1, 1955. P-7* T h e Canadian Welfare Council, Ottawa. Goodman,-Anne. "Medical Social Work with the Aged i n a Public I n s t i t u t i o n . " S o c i a l Casework. 3 6 : 9 , November, 1955* p.4 l 7 : Family Service Association of America, Albany, N. Y. Greenleigh, Lawrence. "Some Psychological Aspects of Aging." Social Casework. 36:3,.March, 1955. P«99«. Family Service . Association of America, Albany, N. Y. Harper, Georgina. "A Club for Older People." Canadian Welfare. 3 1 : 1 , May 1, 1955. .p.17. The Canadian Welfare Council,.. Ottawa. Hauser, P h i l l i p M. "Facing the Implications of an Aging Population." Social.Service Review. 2 7 : 6 , June, 1953* p . l6"2 . University of Chicago Press, Chicago. 9 4 Herkimer, J e s s i e K. and Meerloo, J . A. M. "Treatment of Mental Disturbances i n E l d e r l y Women." S o c i a l Casework. 32:10 , December, 1951. ' p . 4 l 9 . H o l l e n d e r , Marc H. " i n d i v i d u a l i z i n g the Aged." S o c i a l  Casework. 3 3 : 8 , October, 1952. P-337. Family S e r v i c e A s s o c i a t i o n of America, Albany, N; Y; Kalb, L. "The Mental H o s p i t a l i z a t i o n of the Aged: Is I t Being Overdone?" American J o u r n a l of P s y c h i a t r y . 112:8, February, 195&*- p.627. American P s y c h i a t r i c A s s o c i a t i o n , Hanover, N. H. Kaplan, Jerome. "New T h e o r i e s A f f e c t i n g G e r i a t r i c S o c i a l I n s t i t u t i o n s . " G e r i a t r i c s . 17:3 , March, 1962. p . 1 7 1 . Lancet P u b l i c a t i o n s , M i nneapolis, Minnesota. Kaplan, J . and T a i e t z , P. "The R u r a l Aged." G e r i a t r i c s . 14 : 1 0 , October, 1959. p . 7 5 2 « Lancet P u b l i c a t i o n s , Minneap-o l i s , Minnesota. Katz, Sidney. " S h e l t e r e d Employment f o r Older People." Canadian Welfare. 31 :1 , May 1, 1955- p.38. The Canadian Welfare C o u n c i l , Ottawa. Lambert, C a m i l l e . "Reopening Doors t o Community P a r t i c i p a t i o n f o r Older People: How R e a l i s t i c ? " S o c i a l S e r v i c e Review. 3 8 : 1 , May, 1964. p.42. U n i v e r s i t y of Chicago Press, Chicago. Lenzer. Anthony. " S o c i o c u l t u r a l I n f l u e n c e s on Adjustment to Aging. ' G e r i a t r i c s . l 6 : 1 2 , December, 1961. p . 6 3 1 . Lancet P u b l i c a t i o n s , M i n n e a p o l i s , Minnesota. Linden, Maurice. " C u l t u r a l and S o c i o - p s y c h o l o g i c a l C o n s i d e r a t i o n s i n Work with the Aged." S o c i a l Casework. 4 0 : 9 , November, 1959. P«479» Family S e r v i c e A s s o c i a t i o n of America, Albany, N. Y. Linden, Maurice E. and Courtney, Douglas. "The Human L i f e C y c l e and I t s I n t e r r u p t i o n s . " American J o u r n a l of P s y c h i a t r y . 109:12, June, 1953. p.906. -American P s y c h i a t r i c A s s o c i a t i o n , Hanover, N. H. Lo k s k i n , Helen. "Casework Counseling with the Older C l i e n t . " S o c i a l Casework. .36:6 , June, 1955* P« 2 57« Family S e r v i c e . A s s o c i a t i o n of America, Albany, N. Y. * L o k s k i n , Helen. " C r i t i c a l Issues i n S e r v i n g an Aging P o p u l a t i o n . " S o c i a l Casework. 4 2 : 4 , January, 1961. p.21. F a m i l y S e r v i c e A s s o c i a t i o n of America, .Albany, N. Y. 95 Lowy, Louis. "The Group i n Social Work with the Aged." Soc i a l Work. 7 :4 , October, 1962. p.43. National Assoc. of Social Workers, Albany, N. Y. MacMillan, Duncan. "Mental Health Services f o r the Aged - A B r i t i s h Approach -." Canadian Mental Health; Supplement # 29, June, 1962. Mental Health D i v i s i o n , Department of National Health and Welfare, Ottawa. M i l l e r , M. B. and Harris, A. P. "Family Cognizances of D i s a b i l i t y i n the Aged on Nursing Home Placement." Social  Casework. 4 5 : 3 , March, 1964. p . 1 5 0 . Family Service Association of America, Albany, N. Y. Morris, Robert. "The Future of I n s t i t u t i o n a l Programs f o r the Aged." Social Service Review. 3 3 : 2 , June, 1959. p . l 4 . University of Chicago Press, Chicago. Osborn, P h y l l i s . "Selected Observations on the National Assistance Program.of Great B r i t a i n . " S o c i a l Service Review. 3 2 : 3 , September, 1958. p.258. University of Chicago Press, Chicago. Page, H. S. "Our Older Population." Canadian Welfare. 31:1 , May 1, 1955. p.2. The Canadian Welfare Council, Ottawa. Peck, R. "Psychological Developements i n the Second Half of L i f e . " Anderson, J . E. ed. Psychological Aspects of Aging. American Psychological Association, Washington. 1 9 5 ° • p . 4 2 . Ranta, Lawrence E. "Health of the Aged." Canadian Welfare. 31:1 , p.53. The Canadian Welfare Council, Ottawa. Romney, Leonard. "Extension of Family Relationships into a Home for the Aged." Social Work. 7 :1 , January, 1962. p.31. National Association of Soc i a l Workers, Albany, N. Y. Rose, Arnold M. "Mental Health and Normal Older Persons." G e r i a t r i c s . 16 :9 , September, 1961. p.459. Lancet Public-ations, Minneapolis, Minnesota. Rosen, T. "The Significance of the Family i n the Resident's Adjustment i n a Home for the Aged." Social Casework. 43:5> May, 1962. p.238. Family Service-Association of America, Albany, N. Y. Ruse, E. "Income Maintenance i n Later L i f e . " Canadian Welfare. 3 1 : 1 , May,.1955, p.28. The Canadian Welfare Council, Ottawa. Schwenger, Cope. "How Shall the Aging Live?" Canadian Welfare. 4 0 : 5 , September-October, 1964. p . 2 0 8 . The Canadian Welfare Council, Ottawa. 96 S c o t t , T. and Devereaux, C. P. " R e l a t i v e s 1 Role i n the R e h a b i l i t a t i o n of E l d e r l y P s y c h i a t r i c P a t i e n t s . " J o u r n a l  of Gerontology. 1 8 : 2 , A p r i l , 1963. p . 1 8 5 . G e r o n t o l o g i c a l S o c i e t y , S t . L o u i s , M i s s o u r i . Sharkey, H a r o l d . " S u s t a i n i n g the Aged i n the Community." S o c i a l Work. January, 1962. p . l 8 . N a t i o n a l A S S O C T i a t i o n of S o c i a l Workers, Albany, N. Y. Sheeley, W. F. "The F a m i l y P h y s i c i a n , the Community and the Aged." G e r i a t r i c s . l 6 : 7 , J u l y , 1961. p.322. Lancet P u b l i c a t i o n s , M i n n e a p o l i s , Minnesota. S i b u l k i n , L i l l i a n . " S p e c i a l S k i l l s i n Working with Old Peopl S o c i a l Casework. 4 0 : 4 , A p r i l , 1959- p . 2 0 8 . Family S e r v i c e A s s o c i a t i o n of America, Albany, N. Y. S l a t e r , P h i l l i p E. " C u l t u r a l A t t i t u d e s Toward Aging." G e r i a t r i c s . 18 : 4 , A p r i l , 1963. p . 3 0 8 . Lancet P u b l i c a t i o n s , M i n n e a p o l i s , Minnesota. S t r a t t e n , Douglas and Barton, Walter E. "The G e r i a t r i c P a t i e n t i n the P u b l i c Mental H o s p i t a l . " G e r i a t r i c s . lj'-l, January, 1964. p.55- Lancet P u b l i c a t i o n s , M i n n e a p o l i s , Minnesota. S t r e i b , Gordon F. and Thompson, Wayne E. "Adjustment i n Retirement." The J o u r n a l of S o c i a l I s s u e s . l 4 : 2 , 1958. Swenson, Wendell M. "Many Faces of Aging." G e r i a t r i c s . 17:10, October, 1962. . Lancet P u b l i c a t i o n s , M i n n e a p o l i s , Minnesota. T i b b i t t s , C l a r k . " S o c i a l Gerontology." G e r i a t r i c s . 15:10, October, i 9 6 0 , p . 7 0 5 . Lancet P u b l i c a t i o n s , M i n n e a p o l i s , Minnesota. T i b b i t t s , C. "Aging as a Modern S o c i a l Achievement." Donahue, Wilma, et a l , eds. Challenge to L a t e r M a t u r i t y . U n i v e r s i t y of Michigan Press, Ann Arbor, 1 9 5 8 - p . 1 7 • Tuck, Helen H. " R e c r e a t i o n f o r the E l d e r l y i n Great B r i t a i n . Canadian Welfare. 31 :1 , May 1, 1955. p . l 4 . The Canadian Welfare C o u n c i l , Ottawa. Turner,-Helen. "Promoting Understanding of Aged P a t i e n t s . " S o c i a l Casework.. 34:10, December, 1953. P . 4 2 8 . Family . S e r v i c e A s s o c i a t i o n of America, Albany, N. Y. 97 Twente, E s t h e r E. " i f Older People Are to be Well Served." P u b l i c Welfare. 2 2 : 3 , J u l y * 1964. p . l 8 l . American P u b l i c Welfare A s s o c i a t i o n , Chicago. Tyh u r s t , J . S. "Retirement." Moore, Joseph E. et a l , eds. N e u r o l o g i c and P s y c h i a t r i c Aspects of the D i s o r d e r s of Aging; v o l . 35 °f the A s s o c i a t i o n f o r Research in.Nervous and Mental D i s o r d e r s , p.237* W i l l i a m s and W i l k i n s , B a l t i m o r e . 1955* Wasser, Edna. "The Sense of Commitment i n S e r v i n g Older Persons." S o c i a l Casework. 4 5 : 8 , October, 1964. p.443. F a m i l y S e r v i c e A s s o c i a t i o n of America, Albany, N. Y. Wiggins, James W. and Schoeck, Helmut. "A. P r o f i l e of the Aging: U. S. A." G e r i a t r i c s . 16 :8 , August, 1961. p.336. Lancet P u b l i c a t i o n s , M i n n e a p o l i s , Minnesota. W i l l i e , Charles W. "Group R e l a t i o n s h i p s of the E l d e r l y i n Our C u l t u r e . " S o c i a l Casework. 3 5 : 5 , May, 1954. p . 2 0 6 . F a m i l y S e r v i c e A s s o c i a t i o n of America, Albany, N. Y. (2) J o u r n a l R e p r i n t s Carver, Humphrey. "The E x t r a S l i c e of L i f e . " r e p r i n t e d from Habitat.. M a r c h - A p r i l , 1961. C e n t r a l Mortgage and Housing C o r p o r a t i o n , Ottawa. "Casework With the Aging." Seminar h e l d a t Arden House, Harriman Campus,' C o l u m b i a . U n i v e r s i t y , October 30-November 4, i 9 6 0 , r e p r i n t from S o c i a l Casework. May-June, 1961. G r e e n l e i g h , Lawrence. "Some P s y c h o l o g i c a l Aspects of Aging." i n "Understanding the Older C l i e n t . " R e p r i n t e d from S o c i a l , Casework. 1951-1955. Family S e r v i c e . A s s o c i a t i o n of America, Albany, N. Y. Ho l l e r i d e r , Marc H. " i n d i v i d u a l i z i n g the Aged." i n "Under-s t a n d i n g the Older C l i e n t . " R e p r i n t e d from S o c i a l Casework. 1951-1955. F a m i l y S e r v i c e . A s s o c i a t i o n of America, Albany, N. Y. ' 98 (3) Books Bernard, J e s s i e . S o c i a l Problems at Mid Century. The Drydon Press, New York. 1957* B i r r e n , James E. Handbook of Aging and the I n d i v i d u a l : P s y c h o l o g i c a l and B i o l o g i c a l A s p e c t s . U n i v e r s i t y of Chicago Press, Chicago, 1959. B i r r e n , James E. The Psychology of Aging. P r e n t i c e H a l l I n c o r p o r a t e d , Inglewood C l i f f s , New J e r s e y . 1964. Corson, J . J . and McConnell, J . W. Economic Needs of Older  People. 20th Century Fund, New York! 1956. Cumming, E l a i n e and Henry, Wm. E. Growing O l d . B a s i c Books In c o r p o r a t e d , New York. 1961. Donahue, Wilma. E d u c a t i o n f o r L a t e r M a t u r i t y . ¥. M. Morrow, New York. 1955. Donahue, Wilma and T i b b i t t s , C l a r k . The New F r o n t i e r s of  Aging. U n i v e r s i t y of Michigan Press,.Ann Arbor. 1957* Friedman, E. S. and Havighurst, R. J . The Meaning of Work  and Retirement. U n i v e r s i t y of Chicago Press, Chicago... 1954. Kaplan, Jerome. A S o c i a l Program f o r Older People. U n i v e r s i t y o f Minnesota Press, M i n n e a p o l i s . 1953* Kleemeier, Robert W. ed. Aging and L e i s u r e . Oxford U n i v e r s i t y P ress, London. I 9 6 I . Lawton, George. Aging S u c c e s s f u l l y . Columbia U n i v e r s i t y P ress, New York. 1946. Lehman, H. C. Age and Achievement. P r i n c e t o n U n i v e r s i t y P r e s s , P r i n c e t o n , N. J . 1953. Shock, H. E. Trends i n Gerontology. S t a n f o r d U n i v e r s i t y P ress, S t a n f o r d , C a l i f o r n i a . 1957. Smith, E t h e l Sabin. The Dynamics o f Aging. W. W. Norton, New York. 1956. Soule, George. Longer L i f e . The V i k i n g Press, New York. 1958. T i b b i t t s , C. ed. Aging i n the Modern World. A Book of  Readings• U n i v e r s i t y o f Michigan Press, Ann Arbor, 1957* 99 T i b b i t t s , Clark. Handbook of Soc i a l Gerontology. University of Chicago Press, Chicago, i 9 6 0 . T i b b i t t s , C. ed. Living Through the Older Years. University of Michigan Press, Ann Arbor. 1959-T i b b i t t s , Clark and Donahue, Wilma. eds. Aging i n Today's  Society. Prentice H a l l , Incorporated, Inglewood C l i f f s , New York. i 9 6 0 . Towsend, P. The Family L i f e of Old People. Free Press, Glencoe, I l l i n o i s . 1957• Tyhurst, J . S. More for the Mind: a study of psy c h i a t r i c services i n Canada. The Canadian Mental Health Association, Toronto. 1963. Welford, A. T. Aging and Human S k i l l . Oxford University Press, London. 195°'. (k) Reports and Government Publications The Added Years. A Major Challenge for our time. Report of the New York State Committee of 100 f o r the 1961 White House Conference on Aging. United States Government Printing. O f f i c e , Washington, November 1, i 9 6 0 . Administration of Services for the Aging Through Local  Public Welfare Agencies. Report of an Institute.held May, 1961, at Chicago.American Public Welfare Association, November, 1961. Age Is No B a r r i e r . New York State Joint L e g i s l a t i v e Committee on Problems of the Aging. L e g i s l a t i v e Document No. 35, Albany, New York, 1952. Background Paper on Religion and Aging. White House Conference on Aging January 9"12, 1 9 6 I . United States Government P r i n t i n g O f f i c e , Washington, i 9 6 0 . Background Paper on Services of Religious Groups f o r the Aging. White House Conference on Aging January 9~12, 19°1• United States. Government Prin t i n g O f f i c e , Washington, i 9 6 0 . Bleukner, Margaret. Social Work with the Aging. Report on an experiment conducted by the Community Service Society of New York. August, i 9 6 0 . Aging with a Future. White House Conference on Aging. United States Government Prin t i n g O f f i c e , Washington. 1961. 100 Bonner, Judy ed. The Word Is Hone. An I n s t i t u t e on R e h a b i l i t a t i o n of the Aging. U n i v e r s i t y of Texas, A u s t i n . 1 9 6 l . Community Chest and C o u n c i l s of the Greater Vancouver Area. B r i e f t o The Senate of Canada S p e c i a l Committee on Aging. Vancouver. 1 9 6 4 . ' ' The Canada Pension P l a n . Government of Canada. Department of N a t i o n a l H e a l t h and Welfare. Queen's P r i n t e r , Ottawa. 1964. "Casework wi t h the Aging"; Proceedings of a Seminar h e l d a t Arden House, Harriman Campus of Columbia U n i v e r s i t y , October 30 t o November 4, i 9 6 0 . S o c i a l Casework. 6 2 : 5 - 6 , May-June, 1961. Family S e r v i c e A s s o c i a t i o n of America, Albany, N. Y. Dynamic F a c t o r s i n the Role of the Caseworker i n Work with the Aged. An I n s t i t u t e D edicated t o the Memory of W i l l i a m Posner, sponsored by The C e n t r a l Bureau f o r Jewish Aged, New York. October, •1961. E n r i c h i n g The Y e a r s . New York State J o i n t L e g i s l a t i v e Comm-i t t e e on Problems of the Aging. L e g i s l a t i v e Document # 3 2 . Albany, N. Y. 1953-Meeting the Challenge. 2nd B. C. Conference on Aging. Sponsored by the Community Chest and C o u n c i l s of Greater Vancouver and the U n i v e r s i t y of B r i t i s h Columbia. June, i 9 6 0 . The N a t i o n and I t s Older People. Report of the White House Conference on Aging. January 9 " 1 2 , I96-I. U n i t e d S t a t e s Government P r i n t i n g O f f i c e , Washington. 1961. The Needs and Problems of the Aging. 1st B. C. Conference on Aging. Sponsored by the Community Chest and C o u n c i l s of G r e a t e r Vancouver and the U n i v e r s i t y of B r i t i s h Columbia. May, 1957. The Needs of the Aged. F i r s t Report of the Nucleus Group of the P u b l i c Welfare D i v i s i o n ' s Committee on the Needs of the Aged. New Channels f o r the Golden Years. New York S t a t e J o i n t Leg-i s l a t i v e Committee on Problems of the Aging. L e g i s l a t i v e Document # 3 3 . Albany, N. Y. 1956. The Older American. P r e s i d e n t ' s C o u n c i l on Aging. U n i t e d S t a t e s Government P r i n t i n g O f f i c e , Washington. 1963.' 101 Planning Improved Services for the Aging Through Public  Welfare Agencies. Report of I n s t i t u t e held i n Chicago, November, i 9 6 0 . American Public Welfare Association, Public Welfare Project on Aging. August, 1961. Programs and Resources for Older People. Report to the President. United States Government Pr i n t i n g Of f i c e , Washington. 1959. Public Relations Focuses on the Aging. Report of a Seminar held May, 1 9 6 2.American Public Welfare Association, Public Welfare Project on Aging. 1962. Research i n Gerontology: Medical. White House Conference on Aging, January I 9 6 I . United States Government Printing O f f i c e , Washington. Problems of Aging. Extract from the Problems of Aging published by the Board of Evangelism and S o c i a l Service, the Baptist Convention of Ontario and Quebec reproduced by D i v i s i o n on Older Workers, C i v i l i a n R e h a b i l i t a t i o n Department of Labour, Ottawa. 1962. Ross, Mathew. ed. Survey of Mental Health Needs and  Resources of B r i t i s h Columbia. Queen*s Printer, Province of B r i t i s h Columbia. 1961. Strengthening Social Services f o r the Aging through Public  Welfare Staff Developement. Report of I n s t i t u t e held A p r i l , 1961, Chicago. American Public Welfare Association. Public Welfare Project on Aging. 1961. Services f o r the Aged i n Canada. Research and S t a t i s t i c s D i v i s i o n , Department of National Health and Welfare. June, 1957. Towards Better Understanding of the Aging. Seminar on the Aging. Aspen, Colorado, September 8-13, 1958* Council on So c i a l Work Education, vol #1. New York. (5) Pamphlets and Monographs At Home After 6*5. Housing and Related Services for the Aging. The Canadian Welfare Council, Ottawa, May, 1964. Bryson, B. F. Memo for S t a f f . Suggested Policy and Procedures i n Selecting Patients f o r R e h a b i l i t a t i o n and Preparing Suitable Candidates for Discharge from Valleyview Hospital. March, 1962 102 E p s t e i n , Lenore A. Money Income of Aged Persons. A t e n Year Review 1948-1958, S o c i a l S e c u r i t y B u l l e t i n No. 22 , June, 1959. Lowy, L o u i s . Needs of Old A d u l t s . Background paper f o r a c t i o n f o r Boston Community Developement. June, 1961. McCormick, L. V a l l e y v i e w H o s p i t a l . Essondale, B. C , unpublished - 2nd d r a f t 1964.~ McCubbin, Prances. Growing Old Challenge or Problem? Notes from an I n s t i t u t e presented by Miss McCubbin of the S t a f f at the School o f S o c i a l Work t o a Conference of Regions 1, 4, and 6, of the Department of S o c i a l Welfare a t Abbotsford, B r i t i s h Columbia, mimeographed, October, 1961. Old Age i n a Changing World. C i t i z e n s Porum. Canadian A s s o c i a t i o n f o r A d u l t Education, Pamphlet # 4, December, i 9 6 0 . P e r t i n e n t F a c t s about the Older Worker. Prepared j o i n t l y by the D i v i s i o n on Older Workers, C i v i l i a n R e h a b i l i t a t i o n Branch, and the Info r m a t i o n Branch, Department of Labour. June, 1961. The S o c i a l Challenge of Old Age. The Royal Bank of Canada Monthly L e t t e r . 41:8, October, i 9 6 0 . M o n t r e a l . Sorum, Wm. R. B a s i c Emotional Needs of the Old Person. A paper presented a t the American P u b l i c Welfare A s s o c i a t i o n ' s Southwest R e g i o n a l Conference, i 9 6 0 . (6) Theses and S t u d i e s D e i l d a l , Robert Michaux. F o s t e r Home Care f o r the Dependent  Aged. S o c i a l Work T h e s i s , U n i v e r s i t y o f B r i t i s h Columbia. 1955. Guest, Denis. T r e v o r . T a y l o r Manor. A Survey o f the F a c i l i t i e s  f o r the Aged. Master of S o c i a l Work T h e s i s , U n i v e r s i t y of B r i t i s h Columbia. 1952. Keyes, E f f i e K a t h l e e n . An Experimental Program f o r I n s t i t u t i o n -a l i z e d Older People. Master of S o c i a l Work T h e s i s , U n i v e r s i t y of B r i t i s h Columbia. 1963. L e y d i e r , B e r n i c e Rae. Boarding Home Care f o r the Aged. Master of S o c i a l Work T h e s i s , U n i v e r s i t y of B r i t i s h Columbia. 1948. 103 McCubbin, Prances. A Study of the P o s s i b l e Role of the  Department of U n i v e r s i t y E x t e n s i o n In the F i e l d of  Gerontology. School of S o c i a l Work, U n i v e r s i t y of B r i t i s h Columbia. September, 1961. N i c h o l l s , Wm. M. A Study of Current Research on the Aging. Seminar Notebook. U n i v e r s i t y of B r i t i s h Columbia. 1964. A Study of Current Research on the Aging - Seminar, A p r i l 23-June 4 , 1 9 6 4 . E x t e n s i o n Department, U n i v e r s i t y of B r i t i s h Columbia. A. Study of Unmet Needs i n the R e h a b i l i t a t i o n of A d u l t  C h r o n i c a l l y 111. S o c i a l P l a n n i n g S e c t i o n Committee on the Welfare of the Aged. Community Chest and C o u n c i l s of Greater Vancouver. September, 1964. 10k APPENDIX B Letters December 2 3 r d , 1964. Dr. M. M a r t i n , C h i e f , Mental H e a l t h D i v i s i o n , Dept. of N a t i o n a l H e a l t h and Welfare, Ottawa, O n t a r i o Dear Dr. M a r t i n : I w r i t e from V a l l e y v i e w H o s p i t a l , Essondale, the l a r g e s t of three u n i t s comprising the G e r i a t r i c D i v i s i o n of the Mental H e a l t h S e r v i c e s of B r i t i s h Columbia. .The purpose of t h i s l e t t e r i s t o determine whether c o m p a r a b l e . I n s t i t u -t i o n s e x i s t i n other Provinces and i f so, to determine t h e i r whereabouts so t h a t we might communicate with them to share i d e a s and experiences with r e g a r d to programs. I would l i k e t o s t a t e t h a t t h i s h o s p i t a l has 7 9 1 beds and i t s purpose i s to p r o v i d e treatment and r e h a b i l i t a t i o n f o r e l d e r l y men and women s u f f e r i n g from p s y c h i a t r i c i l l n e s s consequent t o the aging p r o c e s s . P a t i e n t s are admitted d i r e c t l y from the Community. P a t i e n t s with p s y c h i a t r i c d i s o r d e r s of l o n g standing, e.g. Chronic S c h i z o p h r e n i c s , are not i n c l u d e d . We have an a c t i v e Rehab-i l i t a t i o n and Discharge program. I t would be a p p r e c i a t e d , t h e r e f o r e , i f you would l e t me have the names of other h o s p i t a l s with s i m i l a r programs. Yours t r u l y , J . Walsh, M.B., Medical Superintendent. JW:p«r N A T I O N A L . H E A L T H A N D W E L F A R E D E P A R T M E N T O F S A N T E N A T I O N A L E E T D U B I E N - E T R E S O C I A L C A N A D A F i l e : 435-2-9 Ottawa 3, Ontario, January 6, 1965. Dr. J. Walsh, Medical Superintendent, Valleyview Hospital, Essondale, B.C. Dear Doctor Walsh: I was interested in your enquiry as to whether there are com-parable institutions to yours in other provinces. I have not been to Valleyview since 1961 but I recall the impressive pro-gram and f a c i l i t i e s at that time. The Dominion Bureau of Statistics recognizes nine types of mental institutions, one of which i s the "Aged and Senile Home". Valley view and Dellview are in that category as you w i l l see from the attached Directory. Some institutions with excellent programs for the aged may be classified in other categories. I do not find Rosehaven which is at Camrose, Alberta, in the 1962 directory. It has a fine program for the aged and you could get details from Dr. Randall Maclean or from Mrs. Olive Noonan, i f she i s s t i l l Superintendent You w i l l note that there are five county hospitals listed for Nova Scotia. These hospitals are developing rapidly and there are many aged patients. Dr. Clyde Marshall could provide infor-mation. Your question i s an interesting one and I would like very much to hear from you i f you make additional discoveries"of i f you have additional questions. Re: Institutions for the Aged Yours sincerely, Morgan Martin, M.D., M.Sc., Chief, Mental Health Division. Encl. 152 DIRECTORY Directory of Psychiatric In-patient Facil it ies, 1960 Repertoire des hopitaux de so ins psychiatriques, 1960 Location Situation Name Norn Category Catggorie Type of institution Affectation Ownership Apparte-nance Psychiatric bed capacity Capacity en llts psy-chiatriques Newfoundland Terre-Neuve St. John's Prince Edward Island Ile-du-Prlnce-Edouard Charlottetown Charlottetown Hospital for Mental and Nervous Diseases Pub. Provincial Infirmary (Welfare Institution since April 1, 1960) Riverside Hospital and Hillsborough General Hospital Nova Scotia Nouvelle-Ecosse Bridgetown Cole Harbour Dartmouth Halifax Halifax Halifax Mulgrave Pugwash Stellarton Sydney River Truro Waterville New Brunswick Nouveau-Brunswick Campbellton Lancaster Lancaster Moncton Saint John Quebec Austin Baie-Saint-Paul Beaconsfield Chicoutimi Disraeli Gamelin Joliette Lac Etchemin LSvis Masta'i Masta'i Masta'i Mont-Joli Montreal Montreal Montreal Montreal Montreal Montreal Montreal Montreal Montreal Montreal Montreal Montreal Montreal Montreal Quebec Quebec Quebec Quebec Riviere-des-Prairies Roberval Ste-Anne-de-Bellevue St-Ferdlnand Annapolis County Hospital 1  Halifax County Hospital 1  Nova Scotia Hospital (T.B. Unit) Camp Hi l l Hospital Halifax Mental Hospital 1  Victoria General Hospital' Inverness County Hospital' (closed 1960) (fermee 1960) Cumberland County Home1 '....i Pictou County Hospital? Cape Breton Hospital 1  Nova Scotia Training School Kings County Hospital 1 : •. Provincial Hospital Lancaster Hospital Provincial Hospital Moncton Hospital' .• Saint John General Hospital' Cecil Memorial Home' HOpital Sainte-Anne Allancroft" Hotel-Dieu St-Vallier Foyer Ste-Luce' HOpital Saint-Jean-de-Dieu Hopital St-Charles de Joliette .-. Sanatorium Begin Hotel-Dieu de Livls Clinique Roy-Rousseau Hopital Saint-Michel-Archange Sanatorium Masta'i1  Sanatorium St-Georges1  Allan Memorial Institute* Centre D'Orientation1  Hopital de Bordeaux Hopital Maisonneuve et Institut de Cardiologie Hftpital Notre-Dame1  Hopital Ste-Jeanne-d'Arc1  Hopital Ste-Justine1  Hotel-Dieu de Montreal" Institut Albert PrSvost Jewish General Hospital' Montreal Children's Hospital' Montreal General Hospital' Queen Mary Veterans' Hospital' Hopital Saint-Benott Hopital de l'Enfants-Je'sus1  Hopital du St-Sacrement' HOpital Ste-Foy' H6tel-Dleu-du-Sacrg-Coeur-de-J£sus HOpital Mont-Providence HOpital Salnte-Elizabeth Ste-Anne's Hospital HOpital SalnUJullen Pub. Pub. Pub. Pub. Fed. Pub. Pub. Pub. ,Pub.-Pub. Pub. Pub. Pub. Pub. Fed. Pub. Pub. Pub. Pte. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Fed. Pub. Pub. Pub. Fed. Pub. Pub. Pub. Fed. Pub. Ment. Ment. Ment. Ment. Ment. Gen. Ment. Gen. Ment. Ment. Ment. Ment. H.M. Def. Ment. • Ment. Gen. Ment. Gen. Gen. Ment. Ment. Dist. Chid. Gen. Ment. Ment. Ment. Ment. Gen. Ps. H. Ment. Ment. San. Gen. DisL Chid. Ment. Gen. Gen. Gen. Gen. Gen. Ps. H. Gen. Gen. Gen. Gen. Ment. Gen. Gen. Gen. Ep. H . H.M. Def. Ment. Gen. Ment. Prov. Prov. Mun. Mun. Prov. D.V.A. Mun. Prov. Mun. Mun. Mun. Mun. Prov. Mun. '" Prov. D.V.A. Prov. Mun. Mun. L . Rel . Prov. Rel. L . Rel. L . L . Rel . Rel . Rel. Rel . . L . L . Rel. Prov. Rel. L . L . L . Rel. L . L . L . L . D.V.A. Rel. Rel. Rel. D .V .A. Rel. Rel. Rel . D .V .A. Rel. 835 377 60 500 650 22 330 24 200 160 500 168 105 600 . 25 1,350 11 27 225 1,150 14 50 164 5,695 1,333 220 10 160 5.000 33 240 128 21 700 39 26 24 12 41 145 16 14 30 50 140 20 20 25 275 1,100 750 498 1,463 See footnotes and abbreviations at end of directory. - Voir renvois et abrgviatlons a la fin du repertoire. REPERTOIRE 153 Directory of Psychiatric In-Patient Facil i t ies , 1960 - Cont inued Repertoire des h6pitaux de soins psychiatriques, 1960 — sui te Location Situation Name Nora Category Categorte Type of institution Affectation Ownership Apparte-nance Psychiatric bed capacity Capacity en lits psy-chiatriques Quebec-Con. — fin St-Hilaire Sherbrooke Trois-Rlvieres Verdun Ontario Aurora -. Brantford Brockville Cobourg Guelph Hamilton Kingston Kingston Kingston Kingston London London London London Newmarket New Toronto North Bay Orillia Ottawa Ottawa Ottawa Owen Sound Penetanguishene Plainfield Port Arthur St. Catharines St. Thomas Smiths Falls Sudbury Thistletown Toronto Toronto Toronto Toronto Toronto Toronto Toronto Toronto Toronto i Vineland Whitby Wlllowdale Windsor Woodstock Manitoba Brandon Portage la Prairie St. Boniface St. Vital Selkirk Winnipeg Winnipeg Winnipeg Winnipeg Winnipeg Saskatchewan Moose Jaw Moose Jaw North Battleford Regina Regina Saskatoon Weybum Foyer Diepne' Hopital General St-Vincent-de-Paul' Hopital Ste-Marte' Verdun Protestant Hospital The Ontario Hospital Brantford General Hospital The Ontario Hospital The Ontario Hospital Homewood Sanitarium The Ontario Hospital i Institute of Psychotherapy Kingston General Hospital (opened Sept. 1960) - (ouvert le 12 sept. 1980) The Ontario Hospital Sunnyside Children's Village* St. Joseph's Hospital The Ontario Hospital Victoria Hospital Westminster Hospital Warren Dale School For Gir ls ' 12. The Ontario Hospital The Ontario Hospital The Ontario Hospital School Ottawa Civic Hospital (opened Nov. 8, 1960) -(ouvert le 8 novembre 1960) Ottawa General Hospital Protestant Children's Village' General and Marine Hospital' The Ontario Hospital Ontario Home For Mentally Retarded Patients' The Ontario Hospital St. Catharines General Hospital The Ontario Hospital The Ontario Hospital School Sudbury General Hospital The Ontario Hospital St. Michael's Hospital Sunnybrook Hospital Sunnyside Private Hospital Alcoholism and Drug Addiction Research Foun-dation1  The Ontario Hospital Wellesley Hospital Toronto Psychiatric Hospital . Toronto Western Hospital Women's College Hospital Bethesda Home The Ontario Hospital Wlllowdale Private Hospital ... Metropolitan General Hospital The Ontario Hospital Hospital for Mental Diseases Manitoba School for Mentally Defective Persons St. Boniface Hospital St. Boniface Sanatorium' !".!!!!'.!!!!!!!'.!! Hospital for Mental Diseases Children's Home of Winnipeg' ; Deer Lodge Hospital Winnipeg Psychopathic Hospital Misericordia Hospital Winnipeg General Hospital Moose Jaw Union Hospital Saskatchewan Training School Saskatchewan Hospital Regina General Hospital, Munroe Wing Regina Grey Nuns' Hospital' University Hospital Saskatchewan Hospital Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pte. Pub. Pte." Pub. Pub. Pub. Pub.-Pub. Pub. Fed. Pte. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Fed. Pte. Pub. Pub. Pub. Pub. Pub. Pub. Pte. Pub. Pte. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Fed. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Pub. Ep. H. Gen. Gen. Ment. H.M. Def. Gen. Ment. Ment. Ps. H. Ment.' ' Ps. H. Gen. Ment. Dist. Chid. Gen. Ment. Gen. Gen. Dist. Chid. Ment. Ment. H.M. Def. Gen. Gen. Dist. Chid. Gen. Ment. H.M. Def. Ment. Gen. Ment. H.M. Def. Gen. Ment. Gen. Gen. Ment. Ale. Ment.. Gen. Ps. H. Gen. Gen. Ment. Ment. Ps . H . Gen. Ment. Ment. H.M. Def. Gen. T .B. Ment. Dist. Chid. Gen. Ps. H. Gen. Gen. Gen. H.M. Def. Ment. Gen. Gen. Gen. Ment. L . Rel . Rel. L . Prov. L . Prov. Prov. L . Prov. L . L . Prov. Prov. Rel . Prov. Mun. D.V.A. L . Prov. Prov. Prov. Mun. Rel. L . L . Prov. • L . Prov. L . Prov. Prov. Rel. Prov. Rel. D .V.A. L . Prov. L . Prov. L . L . Rel. Prov. L . Mun. Prov. Prov. Prov. Rel. Rel. Prov. L . D.V.A. Prov. Rel. L . Mun. Prov. Prov, Mun. Rel. Prov. Prov. 120 10 12 1,574 250 24 1.544 320 225 1,465 14 40 1,445 14 30 1,100 52 873 18 1, 100 764 2,400 40 30 13 20 600 43 764 24 1,822 2,038 ' 33 75 30 55 9 15 850 40 64 35 20 85 1,574 9 30 1,518 1,350 1,014 24 58 1,005 10 60 56 17 86 21 1,109 1,120 34 11 39 950 See footnotes and abbreviations at end of directory. - Voir renvois et abreviations a la fin du repertoire. 154 D I R E C T O R Y Directory of Psychiatric In-Patient Faci l i t ies , 1960 - Conc luded Repertoire des hdpitaux de soins psychiatriques, 1960 - fin Location Situation Name Norn Type of Category institution Ownership Categorie Affectation Apparte-nance / Pub. Gen. / Mun. Fed. Gen. / D .V.A. Pub. A.S.H. v Prov. Pub. Ment. Prov. Pub. Ment. Prov. Pub. Gen. Prov. Pub. Ment. Prov. Pub. Ment. Prov. Pub. H.M. Def. Prov. Pub. H.M. Def. Prov. Pub. Dist. Chid. Prov. Pub. Ment. Prov. Pub. Ps . H. Prov. Pub. Ment. Prov. Pub. A.S.H, . Prov. Pte. Ps . H. L . Pub. H.M. Def. Prov. Pub. A.S.H. Prov. Pub. H.M. Def. Prov. Fed. Gen. D.V.A. Pub. Gen. L . Pub. A.S .H. Prov. Pub. Gen. L . Psychiatric bed capacity Capacity en lits psy-chiatriques Alberta Calgary Calgary Camrose Claresholm Edmonton Edmonton Ponoka Raymond .-. Red Deer Red Deer Red Deer British Columbia Colombie-Britannique Colquitz Essondale Essondale Essondale New Westminster New Westminster Terrace Tranqullle Vancouver Vancouver Vernon Victoria Calgary General Hospital Colonel Belcher Hospital Rosehaven Home for the Aged' Provincial Auxiliary Mental Hospital Provincial Mental Institute University of Alberta Hospital* Provincial Mental Hospital Provincial Auxiliary Mental Hospital Deerhome Provincial Training School Linden House Provincial Mental Hospital Crease Clinic of Psychological Medicine Provincial Mental Hospital (T.B. Unit) ... Valleyview Hospital Hollywood Hospital Woodlands School Skeenavlew Hospital Tranqullle School Shaughnessy Hospital Vancouver General Hospital Dellview Hospital Royal Jubilee Hospital 22 15 510 112 1,600 68 1.077 134 1,050 792 28 222 228 2,602 780 73 1,473 300 150 42 40 239 24 1 Based on period of operation. — D'apres la perlode d'actlvlW. ' Did not report morbidity data for 1960. — N'ont pas envoye de flches de morbidity pour 1960. ' Did not report In any form for 1960. — N'ont fait aucun rapport pour I960. 4 Includes temporary transfers from the Provincial Mental Hospital, Ponoka. - Y compris les transferts temporaires de l'hopltal psychiatrlque provincial de Ponoka. Category — Catjgorle Pub. Public - Publlque Pte. Private — Prlve Fed. Federal - Federal Type of Institution — Affectation A l e . Hospital for alcoholics — Hdpital pour alcooliques AJ5.H. Aged and senile home — Hospice pour vleillards Dist . Chid. Hospital for emotionally disturbed children - Hopital pour enfants souffrant de troubles emotifs Ep. H . Epilepsy hospital — Hopital pour epileptlques Gen. General hospital — Hopital general H.M. Def. Hospital for mentally defectives — Hopital pour deficients mentaux Ment. Mental hospital — Hopital pour maladies mentales Ps . H . Psychiatric hospital — Hopital psychiatrlque San. Sanatorium Ownership — Appartenance D . V . A . Department of Veterans Affairs — Affaires des anclens combattants L . Lay — Lalque Mun. Municipal — Municlpale Prov. Provincial — Provlnciale R e l . Religious - Rellgleuse R E P E R T O I R E 155 Directory of Mental Health Clinics and Out-patient Departments, 1960 Repertoire des dispensaires d'hygiene mentale, 1960 Location Name Parent hospital Auspices Sessions per week1 Type of patient1 Situation Norn Institution mere Responsabllite' Nombre de stances par semaine1 Genre de patient1 Newfoundland • Terre-Neuve St. John's St. John's General Hospital Hospital for Mental and Nervous Diseases. Nfld. Dept. of Health' Nfld. Dept. of Health 1 A, C A, C St. John's 8 St. John's Psychiatric Clinic — Out-patient Department. St. John's General Hospital Nfld. Dept. of Health 2 A, C St. John's Mental Health Clinic St. Clare's Mercy Hospital Prince Edward Island Ile-du-Prince-Edouard Charlottetown Mental Health Clinic P .E. I . Dept. of Health 10 A, C Nova Scotia Nouvelle-Ecosse Antigonish Eastern Counties Mental Health Cl inic . St. Martha's Hospital N.S. Dept. of Health and Board of Direc-tors (Local) 10 A, C Mental Health Clinic Digby General Hospital Digby Western Nova Scotia C l i n i c . Western Nova Scotia Mental Health Group Incorporated 18 A, C Halifax Halifax Mental Health Clinic for Children. - N.S. Government; City of Halifax; Dalhousie University 11 C Halifax Out-patient Department Camp Hi l l Hospital Victoria General Hospital Dept. of Veterans Affairs N.S. Government; Victoria General Hospital; University 3 A Halifax 11 A Cape Breton Mental Health Centre. - Cape Breton Board of Directors 10 A, C Truro Colequid Mental Health Centre. - N.S. Government; Canadian Mental Health Association 10 A, C Wolfville Pundy Mental Health Centre - N.S. Government; Acadia University Insti-tute, Kings Co.; Mental Hygiene Society 10 A, C Yarmouth Mental Health Clinic Yarmouth General Hospital New Brunswick Nouveau-Brunswick Edmundston Mental Health Clinic N .B . Dept. of Health and Social Services N . B . Dept. of Health and Social Services N . B . Dept. of Health and Social Services N . B . Dept. of Health and Social Services 10 10 10 A, C A, C A, C A, C Predericton Mental Health Clinic Moncton Mental Health Clinic Saint John Mental Health Clinic 10 Qui bee Service de neuropsychiatry HOtel-Dieu St-Vallier Service social psychiatrique Sanatorium Ross Levis HOtel-Dieu de Levis • Centre d'orientation Montreal HOpital Maisonneuve • • HOpital Notre-Dame HOpital Ste-Jeanne d'Arc HOpital St-Joseph de Rosemont • • HOpital Ste-Justine HOpital St-Luc Montreal HOtel-Dieu Institut Albert Prevost Jewish General Hospital Mental Hygiene Institute See footnotes and abbreviations at end of directory. — Voir renvois et abre'viatlons a la fin du repertoire. 1 5 6 DIRECTORY Directory of Mental Health Clinics and Out-patient Departments, 1960 — Continued Repertoire des dispensaires d'hygiene mentale, 1960 — suite Location Situation Name Nom Parent hospital Institution mere Auspices Responsabilite Sessions per week1 Nombre de seances par semaine1 Type of patient1 Genre de patient1 Quebec-Con. - fin s Montreal Children's Hospital Montreal General Hospital • Royal Edward Laurentian Hospital. Royal Victoria Hospital St. Mary's Hospital Montreal Quebec Hopital de 1'Enfant-Jesus Quebec Hopital St-Francois d'Assise Hopital St-Sacrement H6tel-Dieu de Quebec Quebec H6tel-Dieu du Sacre-Coeur Jeffery Hale's Hospital Service de ^adaptation so-ciale. Service d'hygiene mentale .... Hopital St-Vincent-de-Paul ilfltel-Dieu de Sherbrooke Sherbrooke . •• Trois-Rivleres Hopital General de Verdun ' Ontario Mental Health Clinic Ontario Hospital Ont. Dept. of Health 10 A, C Oobourg Ontario Hospital Ont. Hospital Cobourg 13 A, C Dunnville Haldimand War Memorial Hospital Hamilton Mental Health Clinic Ontario Hospital Ont. Dept. of Health 8 A, C Mental Health Clinic Ont. Dept. of Health .10 A, C Psychiatric Clinic Hamilton General Hospital City of Hamilton 1 A. C Mental Health Clinic Ontario Hospital Ont. Dept. of Health . 13 A, C Mental Health Clinic Kingston General Hospital Kitchener - Waterloo Mental Kitchene'r General Hospital Ont. Dept. of Health 10 A, C t Health Service. Mental Health Clinic St. Mary's Hospital Child Guidance Clinic War Memorial Children's Hospital Ont. Dept. of Health 11 C Ontario Hospital Ont. Dept. of Health 10 A, C Institute for Retarded Chil- Ont. Dept. of Health 10 A. C dren. Mental Health Service Victoria Hospital Ont. Dept. of Health; City of London 11 A. C North Bay Mental Health Clinic Ontario Hospital Ont. Dept. of Health 10 A, C Division of Child Psychiatry Ottawa General Hospital Ottawa General Hospital 10 C New Toronto Mental Health Clinics Day Pa-tient. Ontario Hospital Ont. Dept. of Health 10 A , C Ottawa Ottawa Civic Hospital Ont. Dept. of Health 10 A, C Out-patient Department of Ottawa General Hospital Ottawa General Hospital 10 A Psychiatry. Pembroke Mental Health Clinic General Hospital Pembroke Pembroke Cottage Hospital Peterborough Civic Hospital Ontario Hospital Victoria Hospital St. Catharines General Hospital Ontario Hospital Ontario Hospital Ont. Government Ont. Dept. of Health St. Catharines General Hospital Ont. Dept. of Health Ont. Dept. of Health Ont. Dept. of Health 10 u 10 10 10 A, C A. C A. C A. C A. C Peterborough Mental Health Service Port Arthur • -Mental Health Clinic St Catharines Mental Health Service St Thomas See footnotes and abbreviations at end of directory. — Vols renvois e't abrevlatlons a la fin du repertoire. RFPERTOIRF. 157 Directory of Mental Health Clinics and Out-patient Departments, 1960 — Cont inued Repertoire des dispensaires d'hygiene mentale, 1960 - sui te Location Situation Name Nom Parent hospital Institution mere Auspices Responsabilite Sessions per week' Nombre de seances par semaine1 Type of patient1 Genre de patient1 Ontario —Con. - fin Sault Ste-.tarie Toronto Toronto Toronto Toronto » Toronto Toronto .". Toronto Toronto Toronto ... Toronto Toronto Toronto Toronto Toronto Toronto Toronto Toronto Toronto Windsor Windsor Windsor Whitby Woodstock Manitoba Brandon Gilbert Plains Portage-la-Prairie Selkirk '. Selkirk • St- Boniface Winnipeg ; Winnipeg Winnipeg Winnipeg Winnipeg Saskatchewan Assiniboia Biggar Davidson Estevan Fort Qu'appelle Grenfell Mental Health Clinic Alcoholism and Drug Addic-tion Research Foundation. Mental Health Clinic Child Adjustment Services .... Clinic for Psychological Me-dicine. Toronto General Hospital Day Care Centre Division of Mental Health Child East York Leaside Guidance Clinic. Forensic Clinic Mental Health Clinic Out-patient Department Out-patient Clinic Out-patient Department Psychiatric Clinic , O.P.D Mental Health Clinic Toronto Mental Health Clinic Mental Health Clinic York Township Child and Ad-olescent Guidance Clinic Mental Health Clinic Child Guidance Clinic Mental Health Clinic Mental Health Clinic Mental Health Clinic Child Guidance and Out-patient Cl inic . Mental Health Clinic Out-patient Department Mental Health Clinic Out-patient Department Psychiatric Clinic, Out-Pa-tient Department. Child Guidance Clinic of Greater Winnipeg. Mental Health Clinic Neuropsychiatric Service Out-patient Department Out-patient Department Mental Health Clinic .... Mental Health Clinic ... Mental Health Clinic Mental Health Clinic Mental Health Clinic (Part-time) Grenfell Mental Health Clinic (Part-time) General Hospital Baycrest Hospital Hospital for Sick Children Toronto General Hospital Toronto Psychiatric Hospital Toronto Psychiatric Hospital Northwestern General Hospital St. Joseph's Hospital Ontario Hospital Toronto Psychiatric Hospital New Mount Sinai Hospital St. Michael's Hospital Toronto Western Hospital Hotel-Dieu Ontario Hospital Ontario Hospital Hospital for Mental Diseases Gilbert Plains Medical Nursing Unit. Manitoba School for Mentally Defective Persons. Selkirk Mental Hospital Hospital for Mental Diseases : St. Boniface Hospital Children's Hospital of Winnipeg Deer Lodge Hospital Winnipeg General Hospital Psychopathic Hospital St. Margaret Hospital Weybum Hospital Indian Hospital and Sanatorium Ont. Dept. of Health Toronto Board of Education Hospital for Sick Children Toronto General Hospital Toronto Psychiatric Hospital City of Toronto Dept. of Public Health Ont. Government Ont. Dept. of Health . Sisters of St. Joseph . Ontario Hospital Ont. Dept. of Health New Mount Sinai Hospital United Community Fund . City of Toronto Board of Health Ont. Dept. of Health City of Windsor Ont. Dept. of Health " ' ' Ont. Dept. of Health Man. Government Man. Dept. of Health and Public Welfare Man. Government Man. Government St. Boniface Hospital Man. Dept. of Health and Winnipeg School Division Man. Hospital Service Plan Dept. of Veterans Affairs Winnipeg General Hospital Man. Dept. of Health and Public Welfare Sask. Dept. of Public Health Sask. Hospital North Battleford Sask. Dept. of Public Health Sask. Dept. of Public Health Sask. Dept. of Public Health Sask. Dept. of Public Health 13 10 10 12 10 10 10 10 1 11 11 7 10 10 10 10 10 10 10 10 1 8 3 10 10 10 5 10 , per month par mois . per month par mois 2 per month par mois per month par mois C •  C A A A, C C A, C A, C A, C A A , C A, C A, C C A, C A, C A , C A, C A, C A . C A. C A . C A A A, C A , C A. C A, C A, C A, C A. C See footnotes and abbreviations at end of directory. - Voir renvois et abreviatlons a la fin du repertoire. 15fi DIRECTORY Directory or Mental Health Clinics and Out-patient Departments, 1960 — Concluded Repertoire des dispensaires d'hygiene mentale, 1960 — fin Location Situation Name Nom Parent hospital Institution mere Auspices Responsabilite Sessions per week1 Nombre de seances par semaine' Type of patient1 Genre de patient1 Saskatchewan—Con. — fin K am sack Kindersley ... Leader Maple Creek . Melfort Moose Jaw Moosomin Nipawin North Battleford ... Prince Albert. Regina Rosetown Saskatoon Saskatoon Shaunavon .... Swift Current Tisdale. Weybum Yorkton .. Yorkton . Alberta Calgary Calgary Edmonton Lethbrldge .— Ponoka Red Deer British Columbia Colombie-Britannique Bumaby Powell River Vancouver...-Vancouver. Victoria Mental Health Clinic (Part-time) Kindersley Mental Health Clinic Mental Health Clinic Mental Health Clinic Mental Health Clinic Moose Jaw Mental Health Clinic Moosomin Union Hospital .... Mental Health Clinic Union Hospital Union Hospital Swift Current Mental Health Clinic Maple Creek Hospital Moose Jaw Union Hospital Moosomin Union Hospital North Battleford Mental Health Clinic Prince Albert Mental Health Clinic Mental.Health Clinic Mental Health Clinic Department of Psychiatry. MacNeill Clinic Mental Health Clinic Swift Current Mental Health Clinic Mental Health Clinic Weybum Mental Health Clinic Yorkton Mental Health Clinic Mental Health Clinic (Part-time) Provincial Guidance C l i n i c , Mental Health Clinic Provincial Guidance Clinic .. Provincial Guidance Clinic .. Provincial Guidance Clinic .. Provincial Guidance Clinic Mental Health Centre Mental Health Clinic Out-patient Department: Health Centre for Children Mental Hygiene Division Child Guidance Clinic .... Regina General Hospital University Hospital Shaunavon Union Hospital Calgary General Hospital Provincial Mental Hospital Powell River General Hospital Vancouver General Hospital Sask. Dept. of Public Health Sask. Hospital North Battleford Sask. Dept of Public Health Sask. Dept. of Public Health Sask. Dept. of Public Health Sask. Dept. of Public Health Sask. Dept. of Public Health Sask. Dept. of Public Health Sask. Dept. of Public Health Sask. Sask. Sask. Sask. Sask. Sask. Dept. of Public Dept. of Public Government Dept. of Public Dept. of Public Dept. of Public Health Health Health Health Health Sask. Dept. of Public Health Bask. Dept. of Public Health Monroe Wing, Regina General Hospital Sask. Dept. of Public Health Alta Dept. of Public Health Alta Dept. of Public Health Alta Dept. of Public Health Alta Dept. of Public Health Alta Government B . C . Government Lay Corporation Metropolitan Health Committee B .C . Government . per month par mois , per month par mois „ per month par mol s 2 per month par mois 2 per month par mois 10 , per month par mois 10 , per month par mois 9 10 2 per month par mois per month par mois o per month par mois . per month par mois 10 10 1 2 10 10 20 10 1 Unless otherwise specified. — A moins d'avls contralre. 1 A - A d u l t s ; C-Chi ld ren . - A—Adultes: C-Enfanta. December 1, 1964. Department of Heal t h , Welfare, & Education, U n i t e d S t a t e s Government, WASHINGTON 25, D. C., U. S. A. Dear S i r s : T h i s l e t t e r comes to you from V a l l e y v i e w H o s p i t a l , the l a r g e s t of three u n i t s comprising the G e r i a t r i c D i v i s i o n of Mental H e a l t h S e r v i c e s f o r the Province of B r i t i s h Columbia, Canada.. The purpose of t h i s l e t t e r i s t o determine whether i d e n t i c a l . i n s t i t u t i o n s e x i s t i n the Un i t e d S t a t e s and, i f so, t o determine t h e i r whereabouts so t h a t we might communicate w i t h them t o share i d e a s , concerns and experiences, e t c . , with r e g a r d t o r e s p e c t i v e programs. F i r s t of a l l , I would l i k e t o s t a t e t h a t the purpose of V a l l e y v i e w H o s p i t a l (bed c a p a c i t y of approximately 800) i s t o p r o v i d e care and treatment f o r e l d e r l y men and women who are s u f f e r i n g from p s y c h i a t r i c i l l n e s s e s "consequent t o the  aging p r o c e s s " . Most p a t i e n t s are admitted as c e r t i f i e d p a t i e n t s but i t i s a l s o p o s s i b l e to g a i n admission on a v o l u n t a r y b a s i s . V a l l e y v i e w H o s p i t a l i s an i n s t i t u t i o n separated from the l a r g e Mental H o s p i t a l complex f o r the Prov i n c e , a t Essondale, B . C . In the performance of our f u n c t i o n s and d u t i e s , the a d m i n i s t r a t i o n of t h i s h o s p i t a l i s r e s p o n s i b l e d i r e c t l y t o the Deputy M i n i s t e r of Mental H e a l t h S e r v i c e s Branch o f the Pro v i n c e of B r i t i s h Columbia. We f e e l t h a t we are d i f f e r e n t from most of the known p s y c h i a t r i c h o s p i t a l s f o r the'aged i n t h a t we are s t r i c t l y a p s y c h i a t r i c g e r i a t r i c h o s p i t a l . An a p p l i c a n t f o r admission i s not a c t u a l l y r e q u i r e d t o be a c e r t a i n age such as s i x t y -f i v e or seventy, but c o u l d come i n t o h o s p i t a l a t any e a r l i e r age i f h i s mental, emotional, or b e h a v i o u r a l d i s o r d e r were p r i m a r i l y a s s o c i a t e d w i t h the aging p r o c e s s . On the other hand, such p a t i e n t s f o r example as the c h r o n i c s c h i z o p h r e n i c or the p a r a n o i d a l p a t i e n t - even of s e v e n t y - f i v e y ears of age - would not be admitted t o t h i s h o s p i t a l i f he were b a s i c a l l y w e l l o r i e n t e d but with p s y c h i a t r i c d i s o r d e r s of long s t a n d i n g . - 2 -Dept. of H. ¥. & E d u c , Washington 25 , D. C. December 1, 196k. I t has been r a t h e r encouraging to note the number of our p a t i e n t s whose response to care and treatment permits them to r e t u r n t o community. Such p a t i e n t s r e t u r n to f a m i l y or r e l a t i v e s , t o Boarding and Rest Homes, and t o P r i v a t e H o s p i t a l s i n community -. depending on t h e i r r e s p e c t i v e circumstances and care needs. The number who r e t u r n to h o s p i t a l f o r f u r t h e r care has been almost n e g l i g i b l e . For example - d u r i n g the f i r s t e i g h t months of t h i s f i s c a l year, 1964-65, w © have d i s c h a r g e d from h o s p i t a l one hundred and f o u r p a t i e n t s . During t h i s same p e r i o d of time o n l y e i g h t p a t i e n t s have r e t u r n e d t o h o s p i t a l and some of these had been out of h o s p i t a l f o r as long as two and a h a l f y e a r s . Because of the f o r e g o i n g and because the f i e l d of g e r i a t r i c s i s r e l a t i v e l y new, we would l i k e t o know about s i m i l a r i n s t i t u t i o n s so t h a t we might communicate with them. We would be g r a t e f u l f o r any i n f o r m a t i o n you might be a b l e to supply i n r e g a r d to t h i s matter. Yours t r u l y , Dr. J . Walsh, Med i c a l Superintendent, V a l l e y v i e w H o s p i t a l , Essondale, B r i t i s h Columbia, Canada. JW:jda OFFICE OF AGING DEPARTMENT OF HEALTH. EDUCATION, AND WELFARE W E L F A R E A D M I N I S T R A T I O N WASHINGTON. D.C. 20201 March 4, 1965 .Dear Dr. Walsh: We wish to apologize f o r the long delay i n r e p l y i n g to your l e t t e r , forwarded to the O f f i c e of Aging. We have contacted the Pu b l i c Health Service and i t s National I n s t i t u t e of Mental Health to obtain information about i n s t i t u t i o n s i n the United States that provide p s y c h i a t r i c g e r i a t r i c treatment. The National I n s t i t u t e of Mental Health has made a number of grants to support studies i n several i n s t i t u t i o n s . A few persons to whom you may address i n q u i r i e s are: (1) Mrs. Marjorie Fiske Lowenthal, Langley Porter Neuro-p s y c h i a t r y I n s t i t u t e , 401 Parnassus Avenue, San Francisco, C a l i f o r n i a . This i n s t i t u t e , f o r the past s i x years, has engaged i n a research study centering about mental health problems of aged patients ad-mitted to and discharged from a c i t y general h o s p i t a l . (2) The D i r e c t o r , Y p s i l a n t i State H o s p i t a l Y p s i l a n t i , Michigan,* also Dr. Wilma Donahue, Chairman, D i v i s i o n of Gerontology, The U n i v e r s i t y of Michigan, 1510 Rackhara B u i l d i n g , Ann Arbor, Michigan. Dr. Donahue has conducted a number of comprehensive studies on„the g e r i a t r i c mentally i l l at Y p s i l a n t i . (3) Superintendent of Boston State H o s p i t a l , 591 Morton . Street, Boston 24,. Massachusetts. They d i d a study of g e r i a t r i c patients admitted to a state mental h o s p i t a l ; a m u l t i d i s c i p l i n a r y team i n v e s t i g a t e d p h y s i c a l , s o c i a l , economical, and emotional problems of such h o s p i t a l i z e d p a t i e n t s . - 2 -(4) Superintendent of DeWitt State Hospital, Auburn, California. They conducted a study to evaluate the potentials for social rehabilitation of state mental hospital patients,.65 and over, including patients i n a wide variety of diagnostic categories, and varying periods of hospitalization. The study centered about pre-placement services, follow up, and community services. (5) Mr. Jack London, Administrator, V i l l a S e l i c i n i a Geriatric Hospital, Jackson, Louisiana. The V i l l a i s reported to have geriatric wards of good repute. Their main objective i s to relieve the pressure upon psychiatric institutions throughout Louisiana, and improve the care of the geriatric patient who does not require extensive psychiatric hospital-ization. I hope the foregoing information w i l l s t i l l be timely and useful. Please l e t us know i f we can be of further assistance. Sincerely, t Donald P. Kent Director Dr. J. TJalsh Medical Superintendent Valleyview Hospital Essondale, British Columbia Canada January 2 7 t h , 19&5• Ministry of Health, Alexander Fleming House, Elophant and Castle, London S. E. 1, ENGLAND Dear S i r s : This l e t t e r comes to you from valleyview Hospital, the largest of three units comprising the G e r i a t r i c D i v i s i o n of the Mental Health Services f o r the Province of B r i t i s h Columbia, Canada. The purpose of t h i s l e t t e r i s to determine whether i d e n t i c a l i n s t i t u t i o n s e x i s t i n the United Kingdom, and i f so to determine t h e i r whereabouts so that we might communicate with them to share ideas, concerns and experiences, etc., with regard to respective programs. Valleyview Hospital (bed capacity approx. 800) i s designed to provide care, treatment and r e h a b i l i t a t i o n f o r e l d e r l y men and women who are suffering from ps y c h i a t r i c . i l l n e s s e s (consequent to the aging process). Most patients are admitted as c e r t i f i e d patients but i t i s also possible to gain admission on a voluntary or informal basis. Acceptance for admission i s based on c l i n i c a l factors i n accordance with i l l n e s s e s r e s t r i c t e d to aging rather than on a s p e c i f i c age. This would exclude chronic psychoses e.g. Schizophrenia or dementias due to other causes. My experience i n Mental Hospitals i n England up to 195 2 suggests that G e r i a t r i c Psychiatry may s t i l l be part of each Mental Hospital program. Under these circumstances our s t a t i s t i c s would not be comparable. I have reason to believe, however, that much progress i n g e r i a t r i c s has been made i n recent years and would be grat e f u l f o r any information you may be able to supply on t h i s matter. Yours t r u l y , J . Walsh, M.B., Medical Superintendent, Valleyview Hospital, Essondale, B. C , Canada JW:pw MINISTRY OP HEALTH Alexander Fleming House Elephant and Castle LONDON S.E.I ' ^ te£rvtaxy 19^5 Dear Sir, I am replying to your let t e r of 27th January. The responsibility for the provision of services for the elderly mentally, infirm in Great Britain i s jointly held by the Local Authorities and Hospital Services. Local Authorities care for the majority of such patients i n welfare homes, but i t i s recognised that there i s a need to separate the more d i f f i c u l t management problems into Homes for the Elderly Mentally Infirm. I f the Local Authority are unable to manage elderly infirm patients because they are i n need of considerable nursing care, or other f a c i l i t i e s of a hospital, the patients may be admitted to a geriatric unit. Here assessment of medical,psychiatric and social factors take place, and the disposal of the patient i s decided. The majority of such patients are sent to, and are looked after, i n chronic annexes to geriatric units. The patients with more d i f f i c u l t behaviour problems (because of dementia or personality disorder) are looked after i n psychiatric hospitals. Another f a c i l i t y , of which increasing use i s being made, i s the Day Hospital. This may cater for the aged with physical handioaps, the elderly mentally infirm or both. There seems l i t t l e doubt that this typo of f a o i l i t y i s useful i n ( l ) f a c i l i t a t i n g early discharge of patients, (2; lightening the burden on relatives, and thus enabling patients to stay i n the community, who would otherwise have been admitted to a long-stay bed. You may care to write to Dr. L. Z. Cozin, Clinical Director Cowley Road Day Hospital Oxford, for further information i n this f i e l d . You may also be interested i n the study done by Dr. C. B. Kidd at Purdysburn Hospital Belfast, published i n the British Medical Journal, Volume II page 149"-> 1st December 1962; or i n Professor Martin Roth's study carried out in the Newcastle-upon-Tyne area and published in the B r i t i s h Journal of Psychiatary, Volume 110, pages 146-15B and 668-682 in February and September 1964. I should stress that I have used the term "elderly mentally infirm" to indicate aged individuals who have a mild degree of dementia, often accompanied by physical handicap. There are of course a group of patients whose main problem i s a potentially recoverable psychiatric oondition, (e.g. depression, paraphrenic); these are dealt with by psychiatric units and are frequently able to return to the community. Yours f a i t h f u l l y , J. Walsh Esq. M.B. Medical Superintendent Valleyview Hospital ESSONDALE B.C. CANADA BY AIR MAIL M/Health ref: P/M121/2/TF1 /\0 1 1 — \ i ' . i 109 APPENDIX C Nurs i n g Form ASSESSMENT FOR PROSPECTIVE DISCHARGE PATIENTS -NURSING Ward: Patients's Name: Physical care needs: Please note i f patient requires help or supervision with any of the following a c t i v i t i e s : 1. Dressing neatly and appropriately 2. Washing hands, face and teeth, caring for hair and shaving 3. Bathing 4. Using the t o i l e t 5« Getting up or going to bed 6. Walking ( s t a i r s or l e v e l ) Does patient eat well? Any special problems? Is special diet required? Are table manners disturbing to others? Sleep well? Does patient snore, scream or wander at night? Incontinent? Constipation? Could patient care for own room? Help around house? Attitude to medication:• cooperative? Requires supervision? Resists? Sight: Hearing: Nursing Form cont'd. Social patterns: Interaction with other patients -friendly,; shy or withdrawn; co n t r o l l i n g ; c r i t i c a l ; sarcastic or quarrelsome? Interaction with s t a f f - What attention does patient require from s t a f f (other than physical care needs)? Does he/she make excessive demands on s t a f f ? What means of control seem necessary or effec t i v e ? Interested and v i s i t i n g r e l a t i v e s and fri e n d s : Has leave been permitted? Has he/she ground privileges? Nurse's evaluation of patient's a b i l i t y to function i n  boarding; home/nursing home placement*: Please add any comments that person caring f o r patient should note. Date: Charge Nurse: 112 APPENDIX D Boarding  and Nursing Home  Questionnaire QUESTIONNAIRE FOR BOARDING HOME OPERATORS AND NURSING HOME MATRONS 1. (a) Identifying Information Name of Home -Address -Type of License - nursing home/boarding home Owner -(b) Finances Number of private patients -Number of welfare patients - Sex: M -F -Total Is cost determined by: a- physical f a c i l i t i e s ? ( i . e . private room, -ward) b- the i n d i v i d u a l care needs? c- by patient's a b i l i t y to pay? Range of Costs -. Measurement of the home "tolerance l e v e l " and a b i l i t y  to cope with the psychiatric g e r i a t r i c patient. (a) Are there patients who are: - incontinent? ( i f yes, i s cause physical or mental) - not ambulatory? (include bed patients, deck chair, wheelchair and those who can walk only with assistance) - delusional? ( d e t a i l s ) - hallucinating? (visual? auditory? d e t a i l s ) Questionnaire cont'd. - confused? (degree-memory? disorientated to time? place? • person? a l l spheres? Details) - wandering? ( i f yes, means of control) - r e s t l e s s at night? - i r r i t a b l e , agitated: (b) Any patient on discharge from Valleyview? Any patient on waiting l i s t at Valleyview? Why? Admitted to Valleyview? Why? Are there patients presently i n home from P.M.H.? Crease? other boarding home? nursing home where • patient evicted? 3• Staff and Patient R e s p o n s i b i l i t i e s What i s the r a t i o of s t a f f to patients? What i s the time extent of care and supervision offered by s t a f f on a d a i l y basis? (maximum-24 hrs.) What r e s p o n s i b i l i t i e s are expected of patients? ( i . e . caring for own room, own laundry, etc.) . 4 . Medical Is there a house doctor or i n d i v i d u a l family doctors? Are tranqualizing medications used? to what extent? 5. Staff Training a. psychiatric.nurses b. registered nurses c. trained p r a c t i c a l nurses, aides and/or o r d e r l i e s , where trained? d. untrained but with previous experience i n homes e. none of the above Worker's comments: 

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.831.1-0302509/manifest

Comment

Related Items