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UBC Theses and Dissertations

An experimental program for institutionalized older people : a study of response to a volunteer visiting… Keays, Effie Kathleen 1963

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AN EXPERIMENTAL PROGRAM FOR I N S T I T U T I O N A L I Z E D OLDER PEOPLE A S t u d y o f R e s p o n s e t o a V o l u n t e e r V i s i t i n g a n d G r o u p R e c r e a t i o n P r o g r a m i n S e l e c t e d R e s i d e n t i a l I n s t i t u t i o n s f o r O l d e r P e o p l e hy E P F I E KATHLEEN KEAYS T h e s i s S u b m i t t e d i n P a r t i a l F u l f i l l m e n t o f t h e R e q u i r e m e n t s f o r t h e D e g r e e o f MASTER OF SOCIAL WORK i n t h e S c h o o l o f S o c i a l Work A c c e p t e d as c o n f o r m i n g t o t h e s t a n d a r d r e q u i r e d f o r t h e d e g r e e o f M a s t e r o f S o c i a l Work S c h o o l o f S o c i a l Work 1963 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 \ In presenting this thesis in p a r t i a l fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make i t freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the Head of my Department or by his representatives. It i s understood that copying or publication of this thesis for financial gain shall not be alkwed without my written permission. Department of The University of British Columbia, Vancouver 8, Canada. Date ^y^Uj / , 3 . A b s t r a c t I n I960, t h e J u n i o r League o f Vancouver u n d e r t o o k a t h r e e - y e a r e x p l o r a t o r y program o f r e c r e a t i o n and v i s i t i n g a c t i v i t i e s i n s e l e c t e d r e s i d e n t i a l i n s t i t u t i o n s f o r t h e aged. The p r o j e c t had been s u g g e s t e d b y t h e Committee on t h e W e l f a r e o f t h e Aged, a s u b d i v i s i o n o f t h e S o c i a l P l a n n i n g S e c t i o n o f t h e Community.Chest and C o u n c i l s o f G r e a t e r V a n c o u v e r , who were aware o f t h e d e a r t h o f d i v e r s i o n a l r e s o u r c e s i n t h e s e i n s t i t u t i o n s . The R e s e a r c h Department o f t h e Community Chest and C o u n c i l s o f G r e a t e r V a n c o u v e r was a s k e d by t h e A d v i s o r y Committee t o t h e J u n i o r League S e n i o r C i t i z e n s P r o j e c t t o u n d e r t a k e an e v a l u a t i v e s t u d y o f t h e program.' The p r e s e n t s t u d y , a s e l f - c o n t a i n e d segment w i t h i n t h e b r o a d R e s e a r c h Department e v a l u a t i o n , i s d e s i g n e d t o t e s t two r e l a t e d h y p o t h e s e s , (a) t h a t t h e l e v e l o f p a r t i c i p a t i o n i n a group r e c r e a t i o n program w i l l be p o s i t i v e l y r e l a t e d t o t h e l e v e l o f p r e v i o u s p a r t i c i p a t i o n i n g r o u p a c t i v i t y , and (b) t h a t t h e l e v e l o f p a r t i c i p a t i o n i n a g r o u p r e c r e a t i o n program w i l l be i n v e r s e l y r e l a t e d t o t h e degree o f h e a r i n g " i m p a i r m e n t . Case m a t e r i a l as w e l l as s t a t i s t i c a l r e c o r d i n g i s as s e m b l e d t o examine t h e s e q u e s t i o n s . 3 4 r e s i d e n t s o f T a y l o r Manor, a c i t y -owned and o p e r a t e d b o a r d i n g home f o r dependent o l d e r men and women, c o n s t i t u t e d t h e s t u d y sample. There i s s t r o n g s t a t i s t i c a l s u p p o r t f o r t h e f i r s t s e c t i o n o f t h e h y p o t h e s i s . F o r t h e second s e c t i o n , t h e d a t a a r e n o t o f s t a t i s t i c a l s i g n i f i c a n c e , p o s s i b l y because o f t h e l i m i t e d sample s i z e . However, e x a m i n a t i o n o f r e l a t e d f a c t o r s i n d i c a t e s t h e q u e s t i o n o f a r e l a t i o n s h i p between program r e s p o n s e and i m p a i r e d h e a r i n g s h o u l d be c o n s i d e r e d an open one. S o c i a l C o n t a c t s i s t h e o n l y o t h e r v a r i a b l e i d e n t i f i e d w h i c h seems t o have a s t a t i s t i c a l l y s i g n i f i c a n t r e l a t i o n s h i p t o program r e s p o n s e . There was i n a d e q u a t e s t a t i s t i c a l e v i d e n c e t o s u p p o r t the b e l i e f t h a t t h e program had m e a s u r a b l e e f f e c t upon a t t i t u d e s and b e h a v i o u r o f T a y l o r Manor r e s i d e n t s , a l t h o u g h s u b j e c t i v e o b s e r v a t i o n s and t r e n d s e v i d e n t i n g r a p h s i n d i c a t e t h e program d i d have p o s i t i v e e f f e c t upon a number o f p a r t i c i p a n t s . A l a r g e r p o p u l a t i o n w i t h a matched c o n t r o l sample would be n e c e s s a r y b e f o r e s t r o n g e r c o n c l u s i o n s c o u l d be drawn on whether program p a r t i c i p a t i o n i m p r o v e d a t t i t u d e s and b e h a v i o u r . Some i m p l i c a t i o n s f o r community p l a n n i n g a r e drawn, and s u g g e s t i o n s a r e made f o r f u t u r e r e s e a r c h . The p o s s i b i l i t i e s o f program development are. d i s c u s s e d u n d e r f o u r h e a d i n g s : community e d u c a t i o n , r e c r u i t m e n t and t r a i n i n g o f community v o l u n t e e r s , programming a n d . ^ c o n t i n u i n g a s s e s s m e n t . Ackno wl e'dgement s The completion of this thesis has required the co-operation of a large number of people, few of whom can be i d e n t i f i e d i n d i v i d u a l l y . Their help, d i r e c t l y and i n d i r e c t l y , has made the present thesis possible. The Junior League volunteers, the Advisory Committee, and Project Director of the Junior League Senior Citizens' Project were most generous i n sharing t h e i r experiences i n the project. Their interest and cooperation made the research study an enjoyable and stimulating experience. Dr. J. Lagey, Research Director, and the s t a f f of the Research Department of the Community Chest and Councils of Greater Vancouver were u n f a i l i n g l y helpful and cooperative. Their wide range of pr a c t i c a l research experience has made the opportunity to work with the Department i n the project a rewarding one. I would l i k e p a r t i c u l a r l y to acknowledge the help of M l ton S. Hicks, B. Arch., whose time and s k i l l made the finished, charts, an asset to the thesis study. F i n a l l y , I wish to express special appreciation to Dr. Leonard Marsii who aided i n the thesis study formulation, and to Miss Frances McCubbin, Faculty Consultant, who was most generous with both her time and her broad knowledge of socia l work and gerontology. The finished product has gained through the comments and helpful c r i t i c i s m s o€ these and others, to a l l of whom I extend my thanks. The opinions expressed i n the thesis are those of the writer, unless drawn from or d i r e c t l y quoted from the pertinent l i t e r a t u r e references. TABLE OF CONTENTS Page Chapter 1. Old Age i h Western Culture 1 Changing Societal Attitudes. Old People and Their Social Roles. Community Responsibility f o r the Aged. Contributions of Recreation. The Concern of Social V/ork. I n s t i t u t i o n a l i z e d Aged People i n Vancouver. Chapter 2 . A Recreation Program ' 2 3 The Junior League Program. The Community Chest and Councils Study. Current Views and Projects. Nature and Scope of the Present Study. Chapter 3 - The Response to the Program 61 1 . S t a t i s t i c a l Data: Program P a r t i c i p a t i o n and Past A c t i v i t i e s . Program P a r t i c i p a t i o n and Hearing Impairment. Other Variables. Problems i n Community Research. Limitations of S t a t i s t i c a l Data. 2 . The Persons Case Study Material. Chapter 4. Assessment of the Response Patterns 1 0 3 Some Observations Based on Study Data. General Conclusions. Need for Further Research. Chapter 5 - The Program and the Community 1 2 7 Community Education. Recruitment and Training of Volunteers. Programming. Assessment of Programs. Appendices: A. Bibliography B. Tables Giving Background S t a t i s t i c a l Data C. Program P a r t i c i p a t i o n and Selected Variables D. Interview Schedules, Selected Sections TABLES AND CHARTS IN THE TEXT (a) Tables Page Table 1. Program P a r t i c i p a t i o n and Past A c t i v i t i e s 66 Table 2. Program P a r t i c i p a t i o n and H e a r i n g C a p a c i t y 68 Table 3. Program P a r t i c i p a t i o n and H e a l t h Handicap 72 Table k. Program P a r t c i i p a t i o n and Other V a r i a b l e s 7^ (b) Charts F i g u r e 1. Program P a r t i c i p a t i o n v s . Past A c t i v i t i e s showing H e a r i n g Impairment 69 F i g u r e 2. Program P a r t i c i p a t i o n and Change i n S o c i a l Awareness 73 F i g u r e 3- Program P a r t i c i p a t i o n and Change i n A t t i t u d e to T a y l o r Manor 79 AM EXPERIMENTAL PROGRAM FOR INSTITUTIONALIZED OLDER PEOPLE A Study of Response to a "Volunteer V i s i t i n g and Group Recreation Program i n Selected Residential I n s t i t u t i o n s for Older People C h a p t e r 1 O L D A G E I N W E S T E R N C U L T U R E S o c i e t a l A t t i t u d e s t o O l d A g e A s a s o c i e t y w e h a v e p r o g r e s s e d b e y o n d t h e p o i n t o f r e g a r d i n g o l d p e o p l e a s n o t h i n g m o r e t h a n " u s e l e s s m o u t h s " . ^ Y e t a s a s o c i e t y w e h a v e d i f f i c u l t y i n f i n d i n g w a y s t o p r o g r e s s t o s a t i s f a c t o r y a l t e r n a t i v e s . W e h a v e g e n e r a l l y a c c e p t e d v a l u e s w h i c h m a k e i t s o c i a l l y o b l i g a t o r y t o p r o v i d e m i n i m a l p h y s i c a l c a r e f o r e v e r y o n e . H o w e v e r , t h e r e h a s b e e n g r o w i n g r e c o g n i t i o n t h a t t h e b e s t o f p h y s i c a l c a r e - a d e q u a t e f o o d , c l o t h i n g , s h e l t e r a n d m e d i c a l t r e a t m e n t - a l t h o u g h e s s e n t i a l i s f a r f r o m s u f f i c i e n t . T o d a y ' s o l d p e o p l e h a v e t h e s a m e b a s i c n e e d s a s t h e a d u l t s w h o w i l l b e t h e o l d o f c o m i n g d e c a d e s : t h e n e e d f o r r e c o g n i t i o n , f o r a f f e c t i o n a n d r e s p o n s e , f o r t h e r e w a r d s 2 o f p e r s o n a l a n d s o c i a l c r e a t i v i t y . I n c r e a s i n g l y , s o c i e t a l v a l u e s a r e r e q u i r i n g t h a t t h e s e n e e d s , t o o , b e a d e q u a t e l y m e t . T h o s e w h o s e c o n c e r n i s w i t h t h e t o t a l w e l l - b e i n g o f o l d . 3 p e o p l e a r e u r g i n g t h e i m p o r t a n c e 'to t h e . c o m m u n i t y a n d t o t h e o l d p e o p l e t h e m s e l v e s o f f i n d i n g c o m m u n i t y w a y s t o m e e t t h e ^ M i r a b e a u , O c t a v e . " U s e l e s s M o u t h s " , i n M a u g h a m , . S o m e r s e t , e d . T e l l e r s o f T a l e s , D o u b l e d a y , D o r a n a n d C o m p a n y , I n c . , N e w Y o r k , 1939, pp.316-19. 2 P o l l a k , O t t o . S o c i a l A d j u s t m e n t i n O l d A g e , A R e s e a r c h P l a n n i n g R e p o r t , S o c i a l S c i e n c e R e s e a r c h C o u n c i l , N e w Y o r k , 19^8. O n p a g e 46 i t i s s t a t e d t h a t b a s i c h u m a n n e e d s e x p r e s s t h e m s e l v e s i n a d e s i r e f o r : 1. p h y s i c a l h e a l t h a n d c o m f o r t , 2. a f f e c t i o n a n d l o v e , 3. r e c o g n i t i o n , 4 . e x p r e s s i o n o f i n t e r e s t s , a n d 5» e m o t i o n a l s e c u r i t y . 3 R e p r e s e n t a t i v e d i s c u s s i o n s o f t h e s e c o n s i d e r a t i o n s a r e t o b e f o u n d i n t h e w r i t i n g s o f J e r o m e K a p l a n , a n d m o r e r e c e n t l y i n t h e p u b l i c a t i o n s o f D r . T i b b e t t s a n d D r . D o n a h u e . S e v e r a l b o o k s b y t h e s e a u t h o r s a r e i n c l u d e d i n t h e g e n e r a l b i b l i o g r a p h y . - 2 -total needs of what has frequently "been a neglected part of the population. Without such provision for a l l , none can enjoy for long or with a clear conscience the f u l l benefits of the affluent society. The consequences of indifference to the needs of the old form a continuum of tragedy - those who are neglectful today w i l l be the neglected of tomorrow. The growing concern for the total needs of a l l citizens i s one aspect of the increasing concern for the quality of l i v i n g i n our society, a slowly evolving attempt to think through the values by which men l i v e , to apply in growing social maturity the dictate of conscience that man cannot l i v e by bread alone, that we are our brother's keeper, and that our brother i s "everyman". The multiplicity of problems inherent both in revising personal values and expectations and in meeting the tot a l i t y of needs of older people are not readily solved in a complex transitional society which i s s t i l l predominantly work-oriented and youth-oriented. This society has undergone massive change since i t s old people were themselves young, dynamic and economically productive. Individual and community patterns have shifted in ways which have combined to deprive most old people of satisfying social and work roles. Medicine and technology have succeeded in developing a society in which an increasing number of people have more years to spend, but l i t t l e of interest with which to spend them. Too often the old are doomed to unproductive and uncreative vegetation. Combined with the stresses of shifting values, complicated problems of inter-generational adjustments and economic dependency for many who have "never been beholden to anyone", there i s the further problem posed by the sheer weight of numbers. There are ever greater millions of old people"*" who, as a consequence of improved general care, have an increasing number of years extending beyond the span a r b i t r a r i l y defined as productive. It has taken a long time for Western democracies to come to a tentative, grudging and s t i l l partial acceptance of older citizens as worthwhile members of society despite their unpro-ductiveness, their lack of glamour and aesthetic appeal, and the 1 -exaggerated idiosyncrasies of the ancient. As the focus slowly changes, becoming people-centred rather than youth-centred, there i s growing readiness to look upon older community members as people with "hands, organs, dimensions, senses, affections, 2 passions" - to recognize that age i s but youth extended. Within the s t i l l persisting community framework of neglect or of inadvertent crowding out through indifference or the press of other labours, the problem of individual old age may be further complicated by a multiplicity of personal variables. Education, social-cultural attitudes, dependency needs and attitudes, leisure time patterns and expectations are a l l affected by the concepts and reactions of the cultural groupings to which each individual has belonged. There are added differences in the ways in which the problems appear to the old people and the ways in which they are perceived by the variety of concerned people in the broad society. ^"Wheeler, Michael. A Report on Heeded Research in Welfare in  British Columbia,. Community Chest and Councils of the Greater Vancouver Area, Vancouver, B.C., 196l. p.173. 2 Shakespeare, V/. The Merchant of Venice, George G. Harrop and Co., Ltd., London, 1 9 5 ^ . Act III, Scene I, p.82. - k -The physiological aspects of aging are unquestionably important, but-social and psychological processes seem to be of considerably greater significance in their effect upon the level and quality of old age adjustment. Because of the combination of physical deterioration and the customary retirement patterns of industrial society, sixty-five has generally come to mark an arbitrary dividing lin e . It separates active, valued, socially respected workers and rejected, passive social discards -a discontinuity which is meaningless and a l l too frequently disastrous. Significant elements in gerontology are often obscured by a widespread tendency to categorize a l l those over sixty-five as "old people", and to assume un c r i t i c a l l y that they constitute a unitary demographic segment."'" This tendency results i n the use of catchall phraseology and generalized stigma for what i s in r e a l i t y an increasingly heterogeneous part of Western society. These "old people" are characterized as lacking in vigor and are often a r b i t r a r i l y superannuated from responsibility i n social, community, occupational and family roles. They are crowded out • on the comfortable assumption that the process i s natural, inevitable, and just the right thing for the "old folks". There is unquestionably a need for some ageing people to have gradual and progressive r e l i e f from the more arduous of ' society's requirements. Some people are old, wearied of responsibility Wheeler, op c i t . p.174, observes that there is progressive, l i f e -long development which results in wide variations between individuals. - 5 -and i n need of rest at s i x t y - f i v e - some reach a comparable l e v e l at f o r t y - f i v e - a fortunate few are s t i l l occupationally and s o c i a l l y competent at eighty-five. As the years advance many people suffer from too much rather than too l i t t l e freedom, too much l e i s u r e a r i s i n g from a general indifference and not being needed."'" The judgment as to what s h a l l be deemed s o c i a l l y desirable or undesirable f o r old people, or what constitutes "good adjustment", i s a function of community mores. I t i s not r e a l l y known i n 2 any absolute sense just what are the elements of "the good l i f e " f o r a l l old people, or even f o r any single old person. "The good l i f e " i s more than an ahsence of negations, but • perhaps a consideration of what things are contrary to t h i s ideal could help towards sounder long range recognition of what the positive elements ac t u a l l y are and which of them .are indeed universal. I t i s generally agreed that vegetative withdrawal, loneliness, f r u s t r a t i o n - the l o t of so many old people - are undesirable, that they are barriers to sound adjustment and contrary to "the good l i f e " however th i s be defined. The concepts "^Gruenberg, Ernest M. and Kaufman, M. Ralph. "Programming f o r Mental Health of the Aging", i n Charter f o r the Aging, New York State Conference, Albany, New York, 1955« p.37^. "There i s such a thing as too much freedom to be present or absent, too much freedom to be a l i v e or dead without making a s i g n i f i c a n t difference to anyone else." 2 Havighurst, R. " F l e x i b i l i t y and the Social Roles of the Retired" American Journal of Sociology, Vol.59, University of Chicago Press, Chicago, 1954. pp.309-11, suggests that f o r many older people happiness can generally, be equated with good adjustment and favors using the terms interchangeably. - 6 -of role performance and interpersonal relationships may provide some objective measurable c r i t e r i a for assessing both the individual and the broad social problem. Old People and the Social Roles Many primitive and agrarian societies afforded old people a significant role as "the ancient ones", rich in wisdom and honoured in decision making''". Many of today's old people grew up accustomed to seeing fathers and grandfathers enjoy something of this influential position, either in European villages and towns or in frontier New World centres where the few who did survive to old age were respected bearers of tradition, heroes of a raw, recent history. Many of the old at midcentury have tended to anticipate comparable favored status for themselves, simply by virtue of advancing years. Their actual lowered status is a reflection both of the increased numbers of older citizens, and of the shifting value patterns of the twentieth century. These changes have deprived age, per se, of traditional respect and 2 veneration, without as yet providing satisfactory alternatives. Common social roles, whether i n primitive or contemporary societies, are more than simply socially defined and prescribed patterns of behaviour. They are learned, "internalized", by 1Clinard, Marshall B. Sociology of Deviant Behaviour, Rinehart and Co., New York, 1957. p.413. 2 ' ' Clinard, op cit.21_. each individual, so that the roles become self-expectations, integral parts of each person's unique identity and meaning as a person. Consequently, major changes in or loss of roles which are of primary significance in the total self-concept w i l l have a disturbing effect upon the individual. 2 Havighurst found that the greatest internalization and the highest levels of satisfaction were found i n the roles he classified as "primary", those of worker, parent, spouse and homemaker. These are the very roles in which earliest and greatest changes arise with advancing years, as a consequence both of the nature of the l i f e processes and of societal organization. The role losses and the accompanying stresses are most l i k e l y to approach a maximum at the very time when the capacity to handle stress i s reduced by declining vigor and when l i t t l e outside support i s available. Concurrent with the curtailment of primary family and work roles there may sometimes be generalized community role loss as a consequence of the mistaken assumption that the retired worker should be relieved of other responsibilities in church, club or community group. Parsons, T. and Bales, R.F. The Family, Socialization and Interaction  Process, The-Free- Press, Glencoe, 111 . , 1955. p.107. "the social role expectation...which i s a unit of a system of social interaction, is i t s e l f a motivational unit....when a person i s f u l l y socialized in the system of interaction, i t i s not so nearly correct to say that a role i s something an actor 'has' or 'plays' as that i t i s something he i s . " ^Havighurst, R. "Social Competence of Middle Aged People", Genetic  Psychology Monograph Ho. 5^, pp.297-375, The Journal Press, Province-town, Mass., 1957. p.341. - 8 -Alternative Roles for the Aged Communities of the contemporary V/estern world do not provide opportunities for satisfying substitute roles even for active, well-adjusted and economically independent older people. Much less do they provide such alternatives for those entering the role change-of-life hampered in addition by poverty, loneliness, physical deterioration, i l l n e s s , f r a i l t y of flesh or s p i r i t - the anomie of the useless and unwanted. There are undoubtedly alternative roles that can and in time w i l l be developed for the f u l l spectrum of old people. The areas of education, religion, p o l i t i c s and recreation have been 1 suggested as promising avenues for the development of such roles. However, as yet there has been l i t t l e exploration of pos s i b i l i t i e s , much less planned effort to modify social attitudes and promote 2 social action towards their development. Havighurst found the secondary roles of "friend" and "user of leisure time" appeared to be less deeply internalized than were the primary roles, but he judged.these had enough reward value to be performed f a i r l y well by most people. Tertiary roles of "citizen" and "club or association member" were least meaningful, and had no great reward value for a majority of those studied. Yet these secondary and tertiary roles are those among which new role patterns for "^Pollak, op c i t . p.153. 2 Havighurst, "Social Competence of Middle Aged People", op c i t . , p.3^1. - 9 -older people must be sought. If Havighurst's findings are generally applicable, major societal reorientation of thinking and of value patterns may have to accompany any comprehensive change in meanings attached to those residual roles which might be available to large numbers of older people. Nevertheless, whatever their particular unique role problems may be, old people are alike, and l i k e people i n a l l age groups, in needing some feeling of individual security and s t a b i l i t y as a basis for contentment and personal satisfaction. A l l people need a sense of worth, a sense of identity as worthwhile parts of the community, as individual people worth talking with and sharing with. With the general loss of primary roles and inadequate preparation for finding satisfaction through accessible alternative roles, the "sense of belonging", the group bond which i s an integral part of the feeling of personal security, may become tenuous. In order to achieve and maintain the sense of worth there i s lifelong need for a f f i l i a t i v e ties; failure to achieve and retain such ties contributes to loneliness, frustration and bitterness. Community Responsibility for the Aged With the increasing numbers of older people and the gradually expanding social conscience, i t i s inevitable that increasing attention and community concern w i l l be devoted to these problems of the older citizen. Community consensus has already been generally achieved relative to basic material needs and to a considerable extent c r i t i c a l problems in this area are well on - 10 -the way to solution. Concern i s shifting to the non-material needs - the need for recognition, for a sense of belonging, for warmth to delay a l i t t l e the deepening cold. Various ways of meeting these relationship needs are s t i l l in process of study. Role learning and' capacity for new satisfactions need not stop at any arbitrary age. The potential for growth and development can continue throughout the life-span. However, the individual rarely has within himself, particularly in old age, a l l the resources necessary to i n i t i a t e independent redevelopment and to seek out new and unfamiliar role patterns. The necessary stimulation and reeducation can be accomplished, in part, through planned leisure time activities and judicious use of both individual and group recreation. Old People in Small Institutions Among the total aged population, perhaps the most c r i t i c a l l y deprived are those l i v i n g in the variety of small institutions. The role loss and concomitant stress which are severe for most older people may be particularly c r i t i c a l for those who become institutional inmates. Frequently, indeed, people are l i k e l y to be in stich institutions because of breakdown in some v i t a l area of l i v i n g , physical or interpersonal or both."'" Such breakdown may come as a consequence of particularly severe stress. It is almost certain to engender added stress through Burgess, Ernest ¥. "Social Relations, Activities and Personal Adjustment", American•Journal of Sociology. Vol . 5 9 , University of Chicago Press, Chicago, 1955. PP«352 - 60. - 11 -accompanying feelings of inadequacy and lack of worth. Such negative feelings are magnified by additional role losses involved i n moving into what often appears as a wholly dependent l i v i n g s i t u a t i o n , with l i t t l e prospect of return to independence and s o c i a l l y defined "worthwhile." l i v i n g . There i s too often the f e e l i n g that a prison door has closed. In general these small r e s i d e n t i a l i n s t i t u t i o n s are a commercialized and profit-motivated response to the expanding need for care of older people apart from the family un i t . They can, and i n some cases have, become inadvertent or even deliberate means of exploiting individual old people and t h e i r families. The cost of the necessary care, p a r t i c u l a r l y f o r bed-patients, i s inescapably high. Private resources are rare l y adequate for sa t i s f a c t o r y , comprehensive care.. Concerned c i t i z e n s f i n d themselves confronted with a s i t u a t i o n of which no one can approve, but for which there i s no ready solution. prevailing community attitudes have tended by default, rather than by conscious approval, to permit and perpetuate the use of the m u l t i p l i c i t y of small, p r i v a t e l y operated r e s i d e n t i a l i n s t i t u t i o n s as a s o c i a l dumping ground f o r the outworn and useless who have to be looked after somewhere. In these cases, i n s t i t u t i o n a l i z a t i o n of •the kind available to many old people " i s death xvithout death's f i n a l i t y a n d w i t h o u t d e a t h ' s d i g n i t y . " P e r s o n a l a n d c o l l e c t i v e g u i l t f e e l i n g s h a v e b e e n p a r t i a l l y a p p e a s e d b y e n s u r i n g s t a n d a r d s o f p h y s i c a l f a c i l i t i e s a n d c a r e . T h i s w a s a n e c e s s a r y a n d s i g n i f i c a n t a d v a n c e . Y e t t h e s o c i a l i n d i f f e r e n c e a n d r e j e c t i o n r e m a i n s a l l t h e m o r e i n v i d i o u s b e c a u s e i t h a s p e r s i s t e d s u b t l y a n d o f t e n u n c o n s c i o u s l y . I t r e f l e c t s u p o n a n d i s r e f l e c t e d b y t h e a t t i t u d e o f t h e s t a f f i n m a n y o f t h e s e i n s t i t u t i o n s , a n d m a y r e s u l t i n a s e l f - d e p r e c i a t i n g n e g a t i v e n e s s 2 t o w a r d s b o t h t h e m s e l v e s a n d t h e i r a g e d c h a r g e s . M o s t f r e q u e n t l y , a r r a n g e m e n t s f o r f u l f i l l i n g i m m e d i a t e c o m m u n i t y r e s p o n s i b i l i t y t o w a r d s o l d p e o p l e w h o s e f a m i l i e s c a n n o t c a r e f o r t h e m h a v e f a l l e n t o p r o f e s s i o n a l m e d i c a l a n d s o c i a l w o r k , p e r s o n n e l . T h e s e p e o p l e r e c o g n i z e t h e g l a r i n g i n a d e q u a c i e s o f t h e a v a i l a b l e r e s o u r c e s , b u t t h e y a r e g e n e r a l l y s o p r e s s e d b y i m m e d i a t e d i f f i c u l t i e s i n v o l v e d i n g e t t i n g p a r t i c u l a r n e e d y o l d p e o p l e s h e l t e r e d r e a s o n a b l y a d e q u a t e l y t h a t t h e y d o n o t h a v e t h e t i m e n o r e n e r g y t o a s s e s s t h e t o t a l s i t u a t i o n a n d t o e d u c a t e a n d a r o u s e t h e c o m m u n i t y t o c o n c e r t e d s o c i a l a c t i o n . T h e w h o l e p r o b l e m h a s ' ' " J o i n t C o m m i s s i o n o n M e n t a l I l l n e s s a n d H e a l t h , P i n a l R e p o r t , A c t i o n f o r M e n t a l H e a l t h , B a s i c B o o k s , I n c . , N e w Y o r k , 1961. T h e o r i g i n a l r e f e r e n c e i s t o " m a d n e s s " , p . 5 8 . 2 S t i e g l i t z , E d w a r d J . " T a l k i n g A b o u t L i v i n g L o n g e r " i n L a n g , G l a d y s E n g e l , O j d A g e i n A m e r i c a , T h e H . W . W i l s o n C o m p a n y , N e w Y o r k , 1961. p . 9 6 . T h e m o r a l e o f t h e i n s t i t u t i o n a l s t a f f i s t h e k e y t o o l d p e o p l e ' s h o m e s t h a t a r e n o t d e p r e s s i n g . T h e a u t h o r b e l i e v e s t h a t p r e v a i l i n g c o m m u n i t y a t t i t u d e s h a v e m u c h t o d o w i t h d e v e l o p i n g a n d m a i n t a i n i n g a p o s i t i v e l e v e l f o r t h i s m o r a l e , i n i n s t i t u t i o n a l s t a f f . - 13 -been approached on a haphazard and fragmented basis which a l l who have any direct experience with the si t u a t i o n - the old people, t h e i r f a m i l i e s , professional workers, concerned l a y individuals and community groups, even many of the private home operators - recognize as unsatisfactory and inadequate. I f , as has been suggested, the needs of old people i n re s i d e n t i a l i n s t i t u t i o n s are greater and t h e i r personal-social resources more l i m i t e d , i t follows that t h e i r need f o r community concern and assistance i s l i k e l y to be greater than that of old people l i v i n g independently i n the community. Unfortunately, no-where has there been a more serious gap between theory and practice than i n community f a i l u r e to provide adequately f o r the to t a l needs of these old people. Many, probably a majority of the residents of such i n s t i t u t i o n s , are iso l a t e d , lonely and frustrated i n t h e i r basic human needs, cut off from the well-springs of t h e i r society. Their horizons have been narrowed, t h e i r l i v e s made bleak and without purpose. Many are separated from family and friends, many more have no one to be concerned about them. The r e s i d e n t i a l s t a f f , be they ever so concerned and w i l l i n g , are usually overworked and untrained i n recognizing and coping with any needs beyond the physical l e v e l of care. Budgets are (too r e s t r i c t e d to permit independent h i r i n g of recreational leadership, even were the need recognized. When old people become i n s t i t u t i o n a l inmates, they do develop contact of a sort, as a consequence of enforced proximity - 14 -where rooms and f a c i l i t i e s are shared. However, contacts thus enforced may remain impersonal and negative. Often they res u l t i n h o s t i l i t y growing out of the sense of loss and of personal devaluation. Help i s needed to f i n d ways of building the inescapable contacts into positive and s a t i s f y i n g ones, to establish sound a f f i l l a t i v e contacts so that "warmth begins to flow instead of hatred."''" It i s possible, i n theory, f o r aged i n s t i t u t i o n a l residents to become, of t h e i r own i n i t i a t i v e , an in t e r a c t i n g group or number of groups. They could provide peer group and r o l e networks f o r one another at a l e v e l that could compensate i n large measure for l o s t roles and e a r l i e r s a t i s f a c t i o n s . Even without basic changes i n societal values towards l e i s u r e and work, a c t i v i t i e s performed together can develop positive satisfactions i n group l i v i n g . Such a c t i v i t i e s can r e l i e v e stress and create opportunities f o r constructive and creative aspects of individual personalities, even for people of advanced years. However, only the very a l e r t and competent aged person might be able to i n i t i a t e such a c t i v i t i e s and contacts. For those i n s t i t u t i o n a l residents who are usually incapable of such a high l e v e l of independent i n i t i a t i v e , sustained community assistance might be of s i g n i f i c a n t help. The Contribution of Recreation Recreation and l e i s u r e time a c t i v i t i e s have been suggested as one of the broad areas of a c t i v i t y o f f e r i n g unexplored p o s s i b i l i t i e s Ko.nopka, Gisela. Group Work i n the I n s t i t u t i o n , Whiteside Inc. and William Morrow and Company, Hew York, 1954, p.288. - 15 -f o r d e v e l o p m e n t o f n e w r o l e s f o r o l d e r p e o p l e . " R e c r e a t i o n , i n t o d a y ' s c o n c e p t , i s a n y f o r m o f f r e e - t i m e a c t i v i t y e n g a g e d i n v o l u n t a r i l y , a n d f o r t h e e n j o y m e n t a n d s a t i s f a c t i o n i t b r i n g s t o t h e p a r t i c i p a n t s . I t m a y p r o v i d e a n o p p o r t u n i t y f o r s e l f -e x p r e s s i o n , c r e a t i v e a c t i v i t y , s e r v i c e t o o t h e r s , o r t h e p u r e e n j o y m e n t o f l i v i n g . M o t i v a t i o n i s i m p o r t a n t . I f a m a n e n j o y s p l a y i n g g o l f o r s e r v i n g h i s n e i g h b o u r o r i n b e t t e r i n g h i s c o m m u n i t y , t h a t i s r e c r e a t i o n . ( s i c ) I f a m a n d e t e s t s g o l f a n d p l a y s o n l y b e c a u s e h i s d o c t o r o r d e r s i t , o r g e t s n o s a t i s f a c t i o n i n a s e r v i c e a c t i v i t y , t h a t i s n o t r e c r e a t i o n , b u t e i t h e r a m e d i c a l p r e s c r i p t i o n o r a s u r r e n d e r t o s o c i a l p r e s s u r e . " 1 T h e p o s s i b i l i t i e s i n h e r i n g i n a b r o a d , t h e r a p e u t i c a p p r o a c h t o b o t h p e r s o n a l r o l e p r o b l e m s a n d t h e e x c e s s i v e f r e e t i m e n e e d s o f t h e a g e d t h r o u g h r e c r e a t i o n d e f i n e d i n t h e s e t e r m s a r e a s y e t i n t h e e a r l y s t a g e s o f e x p l o r a t i o n . F o r i n s t i t u t i o n a l i z e d r e s i d e n t s , a r e c r e a t i o n p r o g r a m c a r e f u l l y / p l a n n e d a n d g u i d e d t o p r o v i d e r e d e v e l o p m e n t i n t e r m s o f i n d i v i d u a l n e e d s , c a p a c i t i e s a n d i n t e r e s t s c o u l d c o n c e i v a b l y c o m p e n s a t e i n l a r g e m e a s u r e f o r s t r e s s e s t h a t c a n n o t b e r e l i e v e d . I t m i g h t h e l p d e v e l o p n e w a n d s a t i s f y i n g e x p e r i e n c e s a s " f r i e n d " a n d " u s e r o f l e i s u r e t i m e " e v e n f o r t h o s e who h a v e h a d l i t t l e p r e v i o u s p r a c t i c e i n e i t h e r r o l e . P r e n d e r g a s t , J . C h a i r m a n o f C o m m i t t e e , " B a c k g r o u n d P a p e r o n F r e e T i m e A c t i v i t i e s " , W h i t e H o u s e C o n f e r e n c e o n A g i n g , V o l . 1 , U n i t e d S t a t e s G o v e r n m e n t P r i n t i n g O f f i c e , W a s h i n g t o n , D . C , I960, p . l . L e i g h t o n , A . T h e G o v e r n i n g o f M e n , 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 . , 19^6, p.283, s t a t e s " I t i s n o t j u s t a m a t t e r o f g i v i n g i d l e h a n d s s o m e t h i n g w i t h w h i c h t o k i l l t i m e , b u t o f h a v i n g p e r s o n a l i t i e s d e v e l o p a n d e x p r e s s t h e m s e l v e s , a n d i n t h e p r o c e s s b e c o m i n g s o m e t h i n g r i c h e r t h a n t h e y w e r e . " > ' H a v i g h u r s t , " S o c i a l C o m p e t e n c e o f M i d d l e A g e d P e o p l e " , o p c i t . p .375. - 16 -F i n d i n g s i n g r o u p p s y c h o t h e r a p y s u p p o r t t h e b e l i e f t h a t t h e r e a r e p o t e n t i a l p o s i t i v e r e s u l t s t o b e d e r i v e d f r o m c a r e f u l l y p l a n n e d g r o u p r e c r e a t i o n f o r o l d e r p e o p l e . S l a v s o n comments"'" t h a t i n t h e t h e r a p e u t i c s e t t i n g t h e g r o u p i t s e l f becomes a t h e r a p e u t i c a g e n t , h e l p i n g t o m o d i f y e g o c e n t r i c i t y a n d s o c i a l i s o l a t i o n . R e p o r t s o f c o n t r o l l e d e x p e r i m e n t a l s t u d i e s a r e s p a r s e i n t h e p u b l i s h e d l i t e r a t u r e , b u t t h e a c c u m u l a t e d w e i g h t o f e v i d e n c e b a s e d u p o n s u b j e c t i v e o b s e r v a t i o n i s s u b s t a n t i a l . 2 :.. E x p e r i e n c e a t V a l l e y v i e w , t h e G e r i a t r i c U n i t o f t h e P r o v i n c i a l M e n t a l H e a l t h S e r v i c e s at. E s s o n d a l e , h a s r e v e a l e d r e m a r k a b l e p o t e n t i a l f o r r e s p o n s e t o , a n d s t i m u l a t i o n t h r o u g h , r e c r e a t i o n a l a n d o c c u p a t i o n a l t h e r a p y . V a r i o u s homes f o r t h e 3 a g e d h a v e r e p o r t e d s i m i l a r p r o m i s i n g r e s u l t s . A l t h o u g h n o n e o f t h e s e known p r o g r a m s h a v e a t t e m p t e d o b j e c t i v e e v a l u a t i o n o f c o n t r o l l e d e x p e r i m e n t a l s t u d y , t h e w o r k e r s c o n c e r n e d h a v e r e p o r t e d p o s i t i v e c h a n g e s i n b e h a v i o u r a n d g e n e r a l r e s p o n s i v e n e s s when o p p o r t u n i t i e s f o r r e c r e a t i o n a n d s o c i a l i n t e r a c t i o n h a v e b e e n p r o v i d e d . C o m p a r a b l e b e n e f i t s w o u l d seem l o g i c a l l y a t t a i n a b l e f o r t h e o l d p e o p l e i n c o m m u n i t y r e s i d e n t i a l i n s t i t u t i o n s i f t h e y h a d o p p o r t u n i t y f o r a w e l l - p l a n n e d p r o g r a m o f a c t i v i t y . I n d i v i d u a l s who h a v e come t o f e e l i s o l a t e d a n d r e j e c t e d r e q u i r e c o n s i d e r a b l e o u t s i d e e f f o r t , s u s t a i n e d a n d i n d i v i d u a l i z e d , t o l e a d them i n t o t h e k i n d o f g r o u p i n t e r a c t i o n w h i c h c a n h a v e • ^ S l a v s o n , S . R . The F i e l d s o f G r o u p P s y c h o t h e r a p y , I n t e r n a t i o n a l U n i v e r s i t i e s P r e s s , I n c . , Hew Y o r k , 1956. 2 R e p o r t e d b y D r . B r y s o n , M e d i c a l S u p e r i n t e n d e n t , a t t h e J u n i o r L e a g u e o r i e n t a t i o n v i s i t t o V a l l e y v i e w O c t o b e r 1961. ^The M a r & o l a i s Home, A u b u r n , W a s h i n g t o n , a n d t h e M o n t e f i o r e Home, C l e v e l a n d , O h i o . L e t t e r s i n b o t h c a s e s c o n f i r m e d t h a t no o b j e c t i v e a s s e s s m e n t .;had b e e n made. - 17 -b e n e f i c i a l long range r e s u l t s . I n i t i a l l y most i n s t i t u t i o n a l i z e d old people might be able to participate only on a l i m i t e d and largely passive basis. Yet sporadic entertainment, passive looking on, a program or a series of programs which do " f o r " rather than "with" residents, cannot accomplish long-term r e s u l t s . Such a c t i v i t i e s , and so many well-meant efforts to meet the l e i s u r e needs of i n s t i t u t i o n a l i z e d old people f a l l into one of these categories, are evanescent i n effect and i n value. "Doing together" with an outside catalyst to provide i n i t i a t i v e and support through individual personal interest, to supply guidance and occasional material assistance, might provide progressive and l a s t i n g benefit f o r many residents. The results could be manifest through greater s a t i s f a c t i o n i n personal l i v i n g , broadened interests and more rewarding s o c i a l interactions with s t a f f and other residents. The Concern of Social Work The soc i a l work profession, with i t s high valuation upon the dignity of human, l i f e at every age, and with i t s basic commitment to the improvement of l i v i n g conditions f o r a l l people, has a v i t a l interest i n the expanding areas of concern f o r older people. Attempts to a l l e v i a t e d i s t r e s s , to improve conditions f o r a l l who are handicapped and deprived psychologically as well as physically and materially are increasingly acknowledged elements i n s o c i a l work professional emphasis. As a profession, s o c i a l work has a s i g n i f i c a n t function, here as elsewhere, i n emphasizing - 18 -individually divergent elements often overlooked in generalized social planning, in helping to prevent the individual human being becoming lost i n the shuffle of mass society. 1 Social work has the added function of helping to educate the community to a r e a l i s t i c awareness of and acceptance of responsibility for the t o t a l i t y of needs which older people cannot readily articulate or publicize for themselves. Social workers are among the earliest to come into direct contact with obviously needy old people whose f i r s t overt community dependency is l i k e l y to become apparent through economic distress or c r i t i c a l health problems. Social workers have an unequalled opportunity to identify and to understand the range of unmet needs, to interpret the growing awareness and expanding responsibilities to the community whose basic humanitarian concern they represent. Theirs i s , in part, a primary responsibility for leading concerned citizens to broader, more informed and more effective concern. Unfortunately' most professional social workers who have the direct contact are too overburdened to undertake this added educational function. Yet i f the community is to develop the needed awareness and i f social policy i s to keep pace with need, ways must be found to make factual knowledge about old people's needs available to the ^Titmuss, Richard. Essays on the Welfare State, George Allen and Unwin Limited, London, 1958. p.19. It i s noted that the role of the social worker is to provide the concrete acquaintance with the individual old person in a particular social setting as distinct from the social sciences' abstract knowledge about the problems of the aged. - 19 -community and to the makers of public policy. Social workers can help focus community concern r e a l i s t i c a l l y to ensure that well-meant efforts are not wasted through misapplication of values or superimposing of interests. They need to be prepared to provide active, informed leadership to concerned groups and individuals who might otherwise act on subjective assumptions and generalizations growing out of the stereotypes of conventional wisdom. Individual social workers, despite pressures, can try to help ensure that the specific needs and interests of specific old people in various settings are recognized and dealt with in their uniqueness as well as in the universality which is the responsibility of community planning and social policy. This comprehensive social work responsibility must include a concern for and participation in research to determine what the range of needs actuallyis and to evaluate ways in which various needs can be met more effectively. Institutionalized Aged in Vancouver Within the general framework of increasing public concern there has been progress i n Vancouver, as elsewhere, in dealing with the general problems of the aged, but much remains to be 1 2 done. The Committee on the Welfare of the Aged a subdivision of the Social Planning Section of the Community Chest and Councils ''"Wheeler, op c i t . p.184. 2 hereafter referred to as "the Committee". - 20 -o f G r e a t e r V a n c o u v e r , has been w o r k i n g s i n c e 1951 t o f i n d ways t o p l a n f o r and meet t h e needs o f o l d e r p e o p l e i n Vancouver as a d e q u a t e l y and on as wide a f r o n t as p o s s i b l e . There has been p r o g r e s s i n i d e n t i f y i n g some s p e c i f i c l o c a l n e e d s . The e f f o r t s h ave been f r u i t f u l i n s t i m u l a t i n g a t t e m p t s a t u n d e r s t a n d i n g and s o l u t i o n i n some a r e a s . Y e t , d e s p i t e t h e b e s t e f f o r t s o f d e d i c a t e d and c o n c e r n e d p e o p l e , t h e Committee s t i l l f e e l s t h a t " i n r e l a t i o n t o need t h e s e r v i c e s e s t a b l i s h e d t o d a t e a r e f a r wl more i n a d e q u a t e t h a n t h o s e f o r any o t h e r age group. In. J a n u a r y i 9 6 0 t h e r e were a p p r o x i m a t e l y 1500 p e o p l e i n 2 B o a r d i n g Homes and P r i v a t e H o s p i t a l s i n V a n c o u v e r . By J a n u a r y 3 1962 t h e r e were 1800 beds i n 120 i n s t i t u t i o n s . Most o f t h i s a c c o m o d a t i o n i s f u l l y o c c u p i e d and p r e d o m i n a n t l y by aged p e o p l e . Many o f t h e r e s i d e n t s a r e e l d e r l y p e o p l e w i t h v a r y i n g d e g r e e s o f p h y s i c a l i m p a i r m e n t s u f f i c i e n t t o make i t i m p o s s i b l e f o r them t o l i v e i n d e p e n d e n t l y i n t h e community. Most o f the b o a r d i n g home r e s i d e n t s a r e a m b u l a t o r y , though u n a b l e t o l o o k a f t e r t h e i r t o t a l p h y s i c a l needs u n a i d e d . Those i n p r i v a t e h o s p i t a l s and many o f t h o s e i n b o a r d i n g homes have one o r more o f t h e c h r o n i c d i s a b i l i t i e s f r e q u e n t l y a s s o c i a t e d w i t h a g i n g . Many "'"Committee on t h e W e l f a r e o f t h e Aged, P r o j e c t S u g g e s t e d f o r t h e J u n i o r League, mimeographed, I960, p.4. ^ i b i d . 3 I n f o r m a t i o n o b t a i n e d f r o m t h e W e l f a r e I n s t i t u t i o n s O f f i c e , Department o f S o c i a l W e l f a r e , and f r o m t h e o f f i c e o f t h e I n s p e c t o r o f H o s p i t a l s . See A p p e n d i x B f o r c o m p l e t e d a t a . - 21 -p r i v a t e h o s p i t a l p a t i e n t s have s e r i o u s d i s a b i l i t i e s known to be t e r m i n a l . Many a r e confused, o t h e r s a r e b e d r i d d e n . Some i n s t i t u t i o n a l s t a f f p e o p l e , p r o f e s s i o n a l and n o n - p r o f e s s i o n a l , are warmly concerned and p e r s o n a l l y i n t e r e s t e d i n t h e i r charges . T h e i r e v i d e n t and c o n t i n u e d concern p r o v i d e s some warmth o f human c o n t a c t , some of the e s s e n t i a l f e e l i n g o f p e r s o n a l w o r t h , f o r the o l d people i n t h e i r c a r e . Other s t a f f people p r o v i d e c o n s c i e n t i o u s and adequate p h y s i c a l c a r e , but are o b l i v i o u s to almost e v e r y t h i n g a p a r t from the predominant ly m e d i c a l emphasis. The burden of c a r i n g f o r the p h y s i c a l needs f o r f o o d , c l e a n l i n e s s and m e d i c i n e , w i t h l i m i t e d and f r e q u e n t l y changing p e r s o n n e l , keeps them l a r g e l y and u n a v o i d a b l y r e s t r i c t e d i n any e x t r a a t t e n t i o n . G e n e r a l l y t h e r e i s no one apart from the s t a f f to meet the o t h e r needs of r e s i d e n t s on a n y t h i n g but a s p o r a d i c and haphazard b a s i s . P r o v i n c i a l l i c e n s i n g standards ensure t h a t a l l r e s i d e n t i a l i n s t i t u t i o n s meet and m a i n t a i n minimum standards w i t h r e g a r d to p h y s i c a l f a c i l i t i e s and s t a f f . However, these i n s t i t u t i o n s v a r y w i d e l y i n the extent and q u a l i t y of both s t a f f concern and space r e s o u r c e s beyond the minimum r e q u i r e d . Some b o a r d i n g homes have a s i t t i n g room w i t h r a d i o and t e l e v i s i o n a v a i l a b l e to r e s i d e n t s a l l o r p a r t of the t i m e . Many p r i v a t e h o s p i t a l s do not have any c e n t r a l g a t h e r i n g p l a c e a v a i l a b l e even p a r t of the t i m e . The d e a r t h o f r e c r e a t i o n a l and d i v e r s i o n a l a c t i v i t i e s i n these r e s i d e n t i a l i n s t i t u t i o n s i s a problem which the Committee - 22 -identified as urgent. In a brief prepared in I960 1 they indicated need for community action in this area, and suggested an experimental project to explore ways of providing a v i s i t i n g and group recreation program for a limited number of institutions. Since l i t t l e specific information was available about the homes and their operators, the residents, or the needs recognized by either group, i t was acknowledged that such a project might be a slow and uphill task. Further, there was no pattern to follow - any program would have to be developed experimentally on a t r i a l and error basis. The challenge was offered to the Junior League, and they undertook to work out a demonstration pilot project. Committee on the Welfare of the Aged, op c i t . Chapter 2 A Recreation Program - Some Variables On the basis of suggestions advanced by the Committee on the Welfare of the Aged"1" early i n I 9 6 0 , the Junior League decided to undertake a three-year exploratory volunteer v i s i t i n g and group recreation program i n selected old age r e s i d e n t i a l i n s t i t u t i o n s . The f i r s t programs were begun i n September I960, under the general guidance of the Advisory Committee to the Junior League Senior Citizen's 2 project , by a group of Junior League volunteers with a s o c i a l worker engaged as part-time Project Director. The Advisory Committee included representatives of the Junior League Board of Management, 3 the Project Director, the volunteer Team Captains and representatives of various interested community groups. Tentative screening of re s i d e n t i a l i n s t i t u t i o n s and i n t e r -pretation of the proposed exploratory program to home operators was undertaken by the Junior League member who served as Advisory Committee Chairman, i n cooperation with the Project Director. The f i n a l selection of homes f o r the programs was made by the Advisory Committee. The general information about d e t a i l s of the project development i s incorporated i n the annual reports of the project which are on f i l e at the Research Department of the Community Chest and Councils. 1 The Committee on the Welfare of the Aged, op c i t . 2 hereafter : referred to as "the Advisory Committee". 3 A Team Captain i s the Junior League volunteer who acts as program group coordinator and l i a i s o n between the volunteer program team and the Advisory Committee. - 24 -The number of homes f o r which programs could he planned was dependent i n part upon the interest of Junior League volunteers. The f i r s t year there were enough volunteers to provide a different four to six person team two program periods each week i n one boarding home and one private h o s p i t a l . The second year the programs were continued twice a week i n the o r i g i n a l two homes, and a second private hospital and a second boarding home were scheduled f o r once-a-week programs to begin i n October 1 9 6 1 . Self-Vindicating Nature of the Program To some extent a program of the kind undertaken by the Junior League i s s e l f - v i n d i c a t i n g . Whether or not there i s measurable improvement i n those elements of behaviour and attitude which might be selected as c r i t e r i a of program effectiveness, i t can well be argued on a pragmatic basis that the t o t a l program i s worthwhile: - i f residents attend v o l u n t a r i l y as regularly as they can - i f they say they l i k e individual programs - i f they f i n d pleasure i n anticipation i f they f i n d s a t i s f a c t i o n i n r e c a l l . On these bases, programs i n a l l homes f o r a majority of those residents who could participate were an undoubted success, Need f o r Objective Evaluation However, since to an increasing degree comprehensive s o c i a l policy and community planning must encompass a l l such programs fo r a l l age groups, and since both personnel and funds are l i m i t e d , i t becomes increasingly important to develop objective methods f o r - 25 -assessing the effectiveness of each general program. I t i s important to determine to what extent and i n what respects the needs of each age group are being met, and to develop understanding and techniques that can help towards improvement. I t i s important to know: - what the needs of the people concerned are - what factors are involved i n maximum program effectiveness - what bearing different settings have on program content and effectiveness - what factors contribute to effective p a r t i c i p a t i o n of different people. In i n i t i a t i n g the project the Junior League was undertaking an exploratory program with l i t t l e previous experience anywhere to serve as a guide. They wanted the project to serve as both an exploration and a community demonstration of what might be accomplished-by the type of voluntary program proposed. Since one part of the long range goal was better planning f o r a l l older people, i t was important that as complete information, as possible on the objective, measurable effects of the program should be available. Therefore the Advisory Committee requested the Research Department of the Community Chest and. Councils of Greater Vancouver to undertake an evaluative research study. The Underlying Philosophy The concept of "adjustment" which underlies the rationale f o r both the program and the research study i s a complex one. I t depends upon a wide range of value judgments and the process of selecting the applicable values can be hazardous since - 26 -"attempts to achieve adjustment envisage a state of happiness whose characteristics can be determined by s c i e n t i f i c means, with an inevitable temptation to presumption on the part of those who believe they know what i t i s . " 1 Although the dangers are acknowledged, some basic assumptions must be made i n order to establish a frame of reference fo r any so c i a l action. Protection against oversimplification and outright error l i e s i n the e x p l i c i t recognition of the assumptions and value judgments which are made, and the awareness that they may require modification and q u a l i f i c a t i o n . I n s t i t u t i o n a l i z e d old age seems frequently to be associated with deterioration and vegetative withdrawal which i s i n fundamental contraction to many accepted s o c i a l values. There i s l i t t l e l i k e l i h o o d of opposition to the assumption that loneliness and s o c i a l r e j e c t i o n or extreme withdrawal are undesirable, and that old people,, l i k e people of a l l ages, need some positive s o c i a l contacts and stimulating a c t i v i t y . As one writer observes: "A good s o c i a l l i f e i s promoted by common a c t i v i t i e s , interests and experiences through which contacts can be made i n creating s o c i a l behaviour of a high l e v e l an indi r e c t approach through materials and interests i s usually of more value than a direct approach. I t i s not enough just to t e l l children or adults to be s o c i a l , they need something to be so c i a l about." 2 "Keith-Lucas, Alan. Decisions About People i n Meed, The University of Worth Carolina Press, Chapel H i l l , 1957, p.2^9. 'Anderson, John E. The Psychology of Development and Personal  Adjustment, Henry Holt and Co., Mew York, 19^9, p.366. - 2? T As has already been observed, i n s t i t u t i o n a l i z e d old people do not have s u f f i c i e n t resources to develop patterns of friendship and shared a c t i v i t y of th e i r own accord. A program which attempts to contribute something f o r them "to be socia l about" has inherent value according to community standards. Old people tend to hoard t h e i r energies, because they have l i t t l e to invest and l i f e i s precious to them. They often r e s i s t being aroused, and t h e i r wishes merit respect. Yet as long as some p a r t i c i p a t i o n i s believed important, i t i s better to arouse them than to leave them to idleness and indifference."'' I f the assumptions are v a l i d , the consequences of a program such as the Junior League proposed to undertake should be both q u a l i t a t i v e l y and quantitatively measurable i n terms of changes i n behaviour and attitudes of the pa r t i c i p a t i n g residents both during and beyond the program periods. The research study i s an effo r t towards assessment of the kind and degree of success i n achieving a primary program objective, that' of helping some old people move towards f u l f i l l m e n t of personal and community values. The range of possible c r i t e r i a i s wide, and not a l l c r i t e r i a are equally applicable. The s u i t a b i l i t y of any selected group of objective c r i t e r i a w i l l be dependent upon the personalities and self-concepts of the people concerned. Some w i l l be absorbed '''Barron, Milton. The Aging American, Thomas Y. Crowell, New York 1 9 6 1 , p . 2 0 6 . - 28 -i n t h e i r physical condition. Some w i l l be more s o c i a l l y oriented, and the i r improvement or decline may be manifest most strongly i n attitudes of acceptance or h o s t i l i t y . S t i l l others w i l l be motivated primarily by feelings of usefulness and service. The various groups of c r i t e r i a which might provide meaningful measurement include: 1. attitudes to health and general physical condition 2. attitudes to the residence and to other people 3 . attention to self-care and personal grooming 4. contacts with family and friends outside 5 . social v i s i t i n g and a c t i v i t y within the i n s t i t u t i o n . The Community Chest and Councils Research Department Study Plans f o r the research study were formulated during the f i r s t year of the Junior League project, i n preparation for a p i l o t study during the second year, and, i f research funds could { be enlisted, a more refined- evaluative study during the t h i r d year. The additional funds were not available. Consequently the single year's research evaluation, with the inescapable shortcomings of a p i l o t research project, was the best that could be achieved. The Research Department study provided f o r a series of interviews with s t a f f and residents before the second year's - 29 -1 2 program series began and again after i t concluded. The experimental population consisted of a l l residents i n the four program homes. In addition, the f u l l battery of interview schedules and rating scales was to be completed for a l l residents of a carefully matched non-program boarding home and those of a private hospital. These two groups constituted the control population. The control homes were selected by the Junior League Project Director and the Director of the Research Department of the Community Chest and Councils on the basis of information gathered in the course of the assessment of homes for the programs. After the Project Director had gained the operators' comsent in principle to the research study, she and the Research Director made a joint v i s i t to confirm the general sui t a b i l i t y of the homes as control units for the project and to interpret the research purpose more f u l l y . Since nothing could be offered to these operators in terms of program service and a considerable amount of their time was needed to complete the research schedules, i t was necessary to find operators who were interested in the study for i t s own sake and for i t s possible future benefit to old people generally. It was also important to have resident populations as - • ••; '. .:: ^The f i r s t group of interviews and rating scales i s hereafter referred to as the pre-test. 2 The concluding series of interviews and rating scales i s referred to as the post-test. - 30 -far as possible comparable to the program home populations, although this was necessarily an approximate subjective judgment. The control boarding home was reasonably comparable to the i n i t i a l program boarding home which was continued as a program home in the second year. The control private hospital seemed generally comparable to the two program private hospitals. Taylor Manor, a large boarding home operated by the City of Vancouver, was the new program boarding home in the second year. There i s no other residential institution in the Greater Vancouver area comparable in size and population characteristics. The general research design proposed to use a series of four interview schedules"'" about each resident to be completed before and again after the program period by the staff member 2 who knew the resident best. Two other schedules were to be completed through direct interviews with each resident by a team of volunteer interviewers who would cover the same segment of the total study population in both pre-test and post-test series. A third schedule about reaction to the programs was to be completed with a l l program home residents 6-8 weeks after the program began, and again at the end of the program series. Research interviewers were introduced to each resident by the matron of each home. A few days later, interviewers visited Appendix D gives a l i s t i n g and summary statement of schedules used. 'Appendix D. Schedules 4 and 6 - 3 1 -residents i n d i v i d u a l l y to explain about the study, and e n l i s t the interest of residents i n the study as a means of helping towards better planning f o r other old people. The f i r s t two direct interview schedules were planned for two successive interview periods i n order not to overtire residents. The schedules provided f o r several different ratings f o r such items as: - objective health r a t i n g - self-health ratings, attitude to personal health - frequency of requests f o r medicine and medical attention - attention to personal grooming - attitude to l i v i n g i n the home - interaction with s t a f f and other residents s o c i a l contacts outside the home - interests and a c t i v i t i e s - attitudes to recreation program These are representative of the general c r i t e r i a which were thought to be p o t e n t i a l l y i n d i c a t i v e of attitudes and general adjustment i n areas which might be subject to change as a result of the Junior Leaguie program. In addition to the schedules completed by the research interviewers, the Junior League Team Captains made independent weekly ratings of attendance and program response^ f o r each resident. These ratings were completed at the conclusion of each ' program period and forwarded weekly to the Research Department. It was anticipated that comparison of pre-test and post-test scores i n the various areas'identified as potential c r i t e r i a of program effect might reveal measurable changes i n behaviour and Team Captains Rating Scale, Appendix D. - 32 -attitudes of program home residents, with no comparable change i n the control home populations. I t could then be assumed that the recreation programs, as the known independent variable, had probably contributed to the change. In actual practice the execution of the research design suffered a l l the hazards and unexpected complications which tend to beset community research studies. The new program private hospital rejected the research study. The o r i g i n a l program private hospital began during the research year to prepare f o r a change from a general care to a specialized r e h a b i l i t a t i o n centre, with consequent s h i f t s i n intake p o l i c y . There was a change of management i n the o r i g i n a l program boarding home and for the second half of the program period residents there were .seriously disturbed because i t was not known what would happen to the home or to them. They had l i t t l e energy or interest f o r anything else, including the recreation program. There were disturbances and unsettled conditions at Taylor Manor as a result of a change i n policy r e l a t i n g to the type of care provided. Extensive renovations were necessary to accomodate the expected new residents, v/heelchair and handicapped people who needed a type of care between that provided by standard boarding homes and the f u l l nursing care of the private hospitals. Because of the renovations there were no admissions to Taylor Manor from November to A p r i l . Early i n A p r i l the f i r s t group of handicapped residents - 33 -were admitted and several of the established residents had to be moved to d i f f e r e n t rooms. The control boarding home changed from a general care home predominantly f o r older people to a home providing more s p e c i a l i z e d care f o r mentally retarded women of a l l ages. The control private h o s p i t a l had a c r u c i a l change which resulted i n the e n t i r e o r i g i n a l population of 18 being moved out to some seven other private h o s p i t a l s throughout the greater Vancouver area just before the post-test interviews were to be made. This group were followed up as c a r e f u l l y as possible, but the r e s u l t s were of l i t t l e value f o r comparative purposes within the research design....-A l l of the disruptions and d i s t u r b i n g conditions introduced unexpected v a r i a b l e s f o r which no control was p o s s i b l e . They increased the already d i f f i c u l t problem of attempting to assess o b j e c t i v e l y any changes i n a t t i t u d e or behaviour which might be r e l a t e d to the program experience. There were also problems with the research instruments, only one of which w i l l be considered i n any d e t a i l . The f i r s t research interviewer to use the Kutner Morale Scale"1', one of the two schedules to be completed through d i r e c t interview with the residents, reported that the questions were s e r i o u s l y d i s t u r b i n g to the e l d e r l y women i n one program boarding home. A rearrangement of the seven scale items was undertaken i n an e f f o r t to make the 'Kutner, Bernard, et a l . F i v e Hundred Over Sixty. Russell Sage Foundation, Neivr York, 1956. The scale as t r i e d i s given i n Appendix D, 4. - 34 -schedule less upsetting. The f i r s t item, "How often do you f e e l there's just no point i n l i v i n g ? " became the l a s t item when the scale was reversed, and the new opening item was: "As you get older would you say things seem to he better or worse than you thought they would be?" The scale even i n the reversed order was s t i l l thought hy the interviewer to be too upsetting, and i t was eliminated from the study. There was serious question i n the minds of a l l research interviewers whether r e l i a b i l i t y of response could be assumed when the questions seemed to provoke such marked emotional disturbance. I t should be noted that the Kutner Morale Scale, as o r i g i n a l l y developed and used, was not the abbreviated seven-question scale proposed f o r the present study arid used i n other studies. In Five Hundred Over S i x t y 1 the items of t h i s scale were spaced at intervals throughout a questionnaire of some 94 items with many subsections. In the o r i g i n a l context, with reference to the people f o r whom the questionnaire was intended, the abstracted questions could well have been answered i n ways which were r e l i a b l y i n d i c a t i v e of the respondents' l e v e l of morale and general adjustment. In the present study, the questions i n the concentrated, short version seemed p o t e n t i a l l y damaging to the i n s t i t u t i o n a l i z e d old people, and therefore the use of the scale i n t h i s form could not be j u s t i f i e d . Kutner, Bernard, et a l . Five Hundred Over Sixty, Russell Sage Foundation, New York, 1956. The scale as t r i e d i s given i n Appendix D, 4. - 35 -The Thesis Research I t was decided at the beginning of the Research Department study that a l i m i t e d area within the general study would be isolated f o r the par t i c u l a r focus of a thesis design which would be complete i n i t s e l f , yet contribute to the broad research study and make use of the relevant data gathered for that study. An extensive survey of research i n gerontology, p a r t i c u l a r l y of research studies on recreation programs f o r old people, was undertaken to establish the focus f o r the thesis research. Research i n gerontology i s s t i l l i n the preliminary stages and there are few empirical studies to provide relevant factual background. Old people are d i f f i c u l t to study with any approximation of s c i e n t i f i c exactitude. Much of the s i g n i f i c a n t background material depends upon r e c a l l stretching back through long years, often by people unaccustomed to abstract thinking. Many old people cannot express r e l i a b l y and precisely t h e i r attitudes to what happens i n the present, l e t alone report accurately what they f e l t or did many years before. Research s k i l l s and funds are scarce and have tended to concentrate on more rea d i l y accessible or s o c i a l l y favored areas. There are few even approximately validated research instruments f o r use with older people and e s s e n t i a l l y none concerned with evaluation of recreation programs of the kind proposed. There are few studies that have - 36 -made any attempt to isolate and study any of the variables which might affect the level and quality of participation in recreation programs for old people. Studies of Old Age Recreation Programs Burgess 1, in a study at Moosehaven, relates social isolation to low participation in recreation activities and to low feelings of usefulness and happiness. However, he questions whether the relationship i s a reflection of long-established basic personality patterns which are normal for the age and personality of the people concerned, or whether i t i s a reflection of more recent withdrawal due to age and c r i s i s pressures. It i s suggested that older people may tend to be i n residential homes because they are suffering various disadvantages and are potentially less adaptable than are those who continue to manage in the community despite what may appear to be comparable objective d i f f i c u l t i e s . If Burgess' findings are generally applicable i t may be that many old people who become institutionalized could be unlikely to respond readily to group activities, either because they have life-long nonsocial personality patterns, or because they have tended to become r i g i d l y maladjusted and socially isolated as a consequence of pressures beyond their adaptive capacity. This would not necessarily suggest they could not or would not respond, Burgess, Earnest V. op c i t . - 3 7 -but rather that i t might take time and patience to reach them, and programming would need to take their differential personality patterns into account in order to he effective. Donahue and her coworkers"'" made one of the few attempts at objective measurement and evaluation of a concentrated program of therapeutic recreation as i t affected socialization patterns of old people in selected residential settings. The criterion used was that of social v i s i t i n g . The differences in the number and frequency of social contacts between program and control tome, populations were not significant at the . 0 5 level. It was thought this might be due in part to the small size of the sample and to the fact that a number of program home residents who did not participate showed no change in socialization pattern. There is no way of knowing whether the program content, the personalities of the recreation workers or of other residents, or the way in which the program was presented had any bearing upon individual decision to participate or to remain isolated. Neither i s there any analysis of differential personality characteristics which might account for the division into participants and non-participants. However, the practical value of the program was demonstrated to the extent that several operators subsequently joined together Donahue, Wilma, Hunter W., and Coons, Dorothy. "Socialization of Old People", Geriatrics, Yol. 8 , American Geriatrics Society, Minneapolis, 1 9 5 3 , pp.656-66. - 3 8 -to h i r e a recreational and occupational therapist to continue providing the observed advantages to those residents who chose to p a r t i c i p a t e . The non-participants might provide support f o r Burgess* suggestion that some, at l e a s t , among i n s t i t u t i o n a l residents may tend to be unresponsive to s o c i a l contacts because of basic personality patterns, and that i n s t i t u t i o n a l populations may tend to have a r e l a t i v e l y high proportion of these a-social people. A number of studies have stressed the generally poorer l e v e l of adjustment of i n s t i t u t i o n a l i z e d populations as compared with community samples of comparable age and general circumstance. I t i s not always clear i n these studies just what c r i t e r i a are used to definer"adjustment" and on what evidence judgments are based. Davidson and Kruglov^ used the Rorschach test to determine characteristics of i n s t i t u t i o n a l i z e d old people. Their results showed: - low productivity - high degree of i n e r t i a - fa u l t y perception and peculiar thought processes - narrow range of interests - lack of capacity f o r independent, creative thinking - decreased emotional responsiveness - inadequate feelings of s e l f - generalized feelings of insecurity The women i n the i n s t i t u t i o n a l population showed generally better personality patterns than did the men. This might be related to the more severe role changes required of the men i n loss of 1Davidson, Helen H. and Kruglov, Lorraine. "Personality Character-i s t i c s of the I n s t i t u t i o n a l i z e d Aged, Journal of Consulting  Psychology, Vol. 16, American Psychological Association, Lancaster, Pa. 1952, pp.5-12. - 39 -the work roles which were basic to t h e i r self-images throughout most of t h e i r adult l i v e s . Shore"1", drawing upon extensive experience with programs i n a variety of i n s t i t u t i o n a l settings, maintains that recreational services are of fundamental importance to good adjustment and sa t i s f y i n g l i f e . He claims that as a resul t of sound recreational programming: - communication among residents increases - interests are stimulated and future events planned so pass i v i t y decreases - creative expression develops as so c i a l contribution takes place - mental and physical vigor improve - ego strength i s restored - personality i s integrated to a point where i n i t i a t i v e , imagination and some degree of happiness are achieved. UnfortunateJ-y the terminology i s not ca r e f u l l y defined, and i t i s not always clear what bases are used f o r the value judgments. The discussions are s u p e r f i c i a l l y convincing and the observations reveal warm sympathy and understanding f o r the problems and needs of i n s t i t u t i o n a l i z e d old people. However, generalizations seem to be based on many empirically unsupported assumptions concerning the precise effects of the programs. There i s no indi c a t i o n of objective data on which the assessments could be made on any p a r t i a l l y quantitative basis. The subjective impression of improvement undoubtedly has a large measure of v a l i d i t y , but 'Shore, Herbert. "Group Work Program Development i n Homes f o r the Aged", Social Service Review, Vol. 26, pp.181-94 and 418-22, University of Chicago Press, Chicago, 1952. - 40 -i t i s not s u f f i c i e n t of i t s e l f to j u s t i f y development of a nebulous program on a community-wide basis i n anticipation of generalized improvements. ,"v\.'. '.Havighurst"'" has worked with a number of other researchers i n a series of studies of l e i s u r e time interests and patterns of le i s u r e time a c t i v i t i e s of adults i n various areas and types of communities i n the United States. In Older People, Havighurst 2 and Albrecht report that the most frequent l e i s u r e time a c t i v i t i e s of older people are radio l i s t e n i n g , reading and v i s i t i n g , with gardening as a lesser fourth. The number and var i e t y of l e i s u r e time a c t i v i t i e s appear to be p o s i t i v e l y related to socioeconomic class. I t i s concluded that people with higher soc i a l status tend to develop and re t a i n interest and vigor i n lei s u r e a c t i v i t i e s ; those of lower status tend to e a r l i e r and more marked constriction of inte r e s t s . This would seem to suggest that factors such as education might be related, since t h i s i s known to be i n part a function of so c i a l class l e v e l . 3 "'"Havighurst, Robert, see general bibliography f o r a number of studies read. 2 Havighurst, R. and Albrecht, R. Older People, Longmans, Green and Co., New York, 1953, p.135 f f . 3 Kahl, Joseph, The American Class Structure, Rinehart & Co., Inc., New York, I960, p.278. - kl -Havighurst did not find evidence of s t a t i s t i c a l l y significant differences in either number or kind of activities related to age or to sex. However, only two percent of the study sample rated high on the activity scale used.1' It i s commented that few older people have made a f u l l and active l i f e of leisure time activities and the authors conclude: "at least a quarter of a l l older people would get much more pleasure out of l i f e i f their roles as users of leisure time were stepped up to the level of mild activity that we have described. Another fourth of our older people would be happier i f their days were more f u l l of activity at the level to which only 2 percent of the Prairie City elders attain."^ 2 The Kansas City study of the social competence of .adults between forty and seventy years revealed that within this range people's social competence remains on a plateau which i s achieved in early middle age and which slopes slightly downward in later years. Again the empirical data shows some correlation between leisure time act i v i t i e s and socio-economic class. Age and sex seemingly have l i t t l e to do with patterns of leisure time interests or with the meaning which people attach to leisure time pursuits. This study notes that one of the most marked characteristics of advancing age i s the unavoidable loss of many significant 'Havighurst and Albrecht, op c i t . p.136. Havighurst, Robert. "The Social Competence of Middle'Aged People" op c i t . - 42 -primary roles. For people of lower socio-economic status, second and t h i r d order roles are less l i k e l y to have been internalized. Group a c t i v i t y and c h a r a c t e r i s t i c a l l y middle class l e i s u r e time pursuits may be a l i e n to many. The kind of communication patterns involved i n group interaction may be unfamiliar, the rewards unknown and undervalued. Any or a l l of these factors could increase a tendency towards indifference or resistance to group a c t i v i t y as the years advance. The report of a comprehensive community program of services f o r the aged i n Chicago notes: "There i s growing awareness that i d l e , lonely, emotionally disturbed people are d i f f i c u l t to deal with."^ i n r e s i d e n t i a l i n s t i t u t i o n s such people constitute a problem f o r themselves, f o r other residents and f o r the i n s t i t u t i o n a l s t a f f . Carefully planned recreation programs are claimed to help i n reducing or preventing the development of many of the negative reactions. An outline i s given of the kinds of recreational a c t i v i t i e s which were found valuable. 2 Kaplan observes that mental health i s related to the presence of outlets f o r companionship, useftxlness and c r e a t i v i t y , and that recreation can be an important preventive measure against "'"Community Project f o r the Aged, Community Services f o r Older  People,1 The Chicago Plan, Wilcox and F o i l e t t , Co., Chicago, 1952., p.84. 2 Kaplan, Jerome. A Social Program f o r Older People, The University of Minnesota Press, Minneapolis, 1953. - 43 -decay of the mind. He i s convinced that every home f o r the aged should have recreational services under the supervision of a q u a l i f i e d person, and he describes the efforts of the Hennepin County Welfare Board i n the Chicago area to stimulate such a comprehensive program through a consultative and advisory service. Farrar and F e r r a r i ^ report that Mthe group process helped develop i n i t i a t i v e , independence and a more optimistic outlook" i n the inmates of a home f o r the aged. They f e e l that the combined casework-groupwork program supported the sense of adequacy that comes from being active and f e e l i n g useful, and that i t provided an antidote f o r loneliness, unhappy introspection and hypochondria. Overall improvement of morale and emotional climate i n the home i s reported, but again there i s no statement of the c r i t e r i a used, nor i s there any attempt at objective evaluation or comparison with a nonprogram control home. If the findings outlined i n these general studies are true of an heterogeneous community sample of old people, and, further, i f the unfavorable comparisons between i n s t i t u t i o n a l i z e d and non-institutionalized old people are accepted as generally v a l i d , i t would seem to follow that f o r the population anticipated for the Junior League program l e i s u r e time a c t i v i t i e s might be Farrar, Marcella and F e r r a r i , Nelida. "Casework and Groupwork i n a Home fo r the Aged", Social Work, Vol.5, pp. 58-63, Journal of the National Association of Social Workers, Albany, N.Y. I960. - -at a markedly low level, and the need for positive leisure activities correspondingly greater than with groups such as the Prairie City sample.''' 1 In the L i t t l e House Study of Senior Citizens at 2 Menlo Park, California, i t was found that the previous history of joining in activities.was significant in establishing interest and continuing participation in L i t t l e House a c t i v i t i e s . Since habits are learned and social interaction patterns are part of the total l i f e style, i t would seem logical that what people have come to anticipate from others w i l l tend to be a determining factor in the spontaneous level of group responsiveness and participation. People who have taken part in group activities would be predisposed to ready response in a group program. Their response would be expected to be at a higher level of interests and active participation than would that of residents who have not had comparable previous learning experience. Effect of Physical Disability on Participation There is known to be more illness and consequent di s a b i l i t y among older people than among other age groups. The level of disabling illness i s highest for those over 75 years. Therefore the age level and the significantly related health level of institutional residents, who tend to be advanced in years, might have direct effect upon recreational response. The literature survey was extended to gather background data relevant to this '''Havighurst and Albrecht, op c i t . 2Schramm, Wilbur. The L i t t l e House Study, 1958-61. Summary of the Principal Findings, Stanford University, San Francisco, Mimeographed, 1961. - 45 -assumption. 1 Havighurst and Albrecht found that there was some correlation between Health Handicap Score and leisure time act i v i t i e s , although not at a sufficiently high level to .account for the differential responses to leisure time activities without giving considerable weight to variables other than health. In the Health Handicap Score they rated four areas of bodily activity: visual, auditory, motor and organic. Of these, the limitations imposed by impaired vision short of blindness are reasonably readily accomodated without conspicuous adjustment in a group recreation program. Moderately limiting motor d i s a b i l i t i e s are likewise readily apparent, generally accepted, and in part, able to be accomodated. Since the handicaps are obvious to everyone, the adjustments, i f they can be made at a l l , are li k e l y to be made matter-of-factly and taken for granted by both the recreation workers and the residents. Organic d i s a b i l i t y may constitute c r i t i c a l limitation, but i n general this w i l l be acknowledged, and if, participation i s possible at a l l , due allowance w i l l be made. Havighurst and Albrecht, op c i t . p.292. - 46 -Effects of Hearing D i s a b i l i t y However, i t . may be that f o r group recreation hearing d i s a b i l i t i e s have more c r i t i c a l and less generally acknowledged implications. "There i s no doubt that hearing loss of any type bites deep into man's well being.""'" Reduced hearing tends to 2 contribute to varying degrees of soci a l i s o l a t i o n which may become an habitual pattern. Although l i t t l e i s known of the precise ways i n which 3 man adjusts to sensory deprivation, Levine ci t e s a study of ex-servicemen with impaired hearing which suggests some of the possible considerations. A test-group of war-deafened veterans at the threshold of hearing incapacity could manage i n individual association but had d i f f i c u l t y hearing i n groups. This would dispose to so c i a l withdrawal which could probably increase according to the degree of hearing loss. Since there i s a natural decline i n hearing acuity with 4 age , hearing d i s a b i l i t y might well be a si g n i f i c a n t problem f o r many potential participants i n an old age recreation program emphasizing a group approach. Hard of hearing old people who have adapted by r e s t r i c t i n g s o c i a l interaction may f i n d any group a c t i v i t y poses too many problems. Even with sympathetic "'"Levine, E:dria>,, S. Psychology of Deafness, Columbia University Press, New York, I960, p.71. 2 Havighurst and Albrecht, op c i t . p . 6 8 . 3 Levine, op c i t . p.71. ^Canfield, Norton. Hearing, A Handbook f o r Laymen. Eyre and Spottiswoode Ltd., London, I 9 6 0 , p.163. - 47 -outside interest and stimulation i t may be exceedingly d i f f i c u l t for them to make the effort required.to renew even limited social interaction. Levine observes further than gradual hearing impairment, which i s the problem of most older people, may pose a greater problem than sudden, drastic loss which stimulates the victim to seek r e l i e f through hearing aids. Those who have become handicapped gradually may well pass unnoticed unless communicative demands reveal their d i s a b i l i t y . L i t t l e has been done to understand or to ease their d i f f i c u l t i e s . Studies are cited which indicate that the haxd of hearing are more emotional, more introverted and less dominant than the average of their hearing counterparts. 1 Hearing deficiency tends in contemporary society to be equated with a loss of the sense of worth, since i t i s frequently related to i n a b i l i t y to perform adequately i n a variety of occupational roles. Because of the generalized sense of stigma and personal disgrace, the gradual onset which i s common with advancing years i s l i k e l y to be denied and resisted as long as possible. Mien i t i s f i n a l l y acknowledged, the individual may be too accustomed to the dis a b i l i t y to accept correction with an aid, even where this might be possible. On the other hand: Levine, op c i t . p.71. - 4 8 -"Habits of l i f e play an important part. And gregarious and sociably inclined people are better communicators even with slightly dulled hearing, than are those who are mentally secluded."! Summary of Relevant Findings from the Literature The cumulative impression derived from the various studies cited, then, is that: 1 . Institutionalized old people tend to be more isolated, less socially active than their individual community counterparts. 2. Social interaction tends to be positively correlated with the level of happiness and adjustment however these be defined. 3. Past patterns of activity tend to have direct bearing upon the kind and quality of recreational participation in old age. 4. Factors of age and health have some positive relationship to leisure time act i v i t i e s and may have direct bearing upon group recreational participation. 5. Hearing d i s a b i l i t y i s an element in general health which may have particular significance for group recreation activity. On the basis of the literature survey and the general data expected to be available from the broad research study, i t was decided to focus the thesis design on intensive study of two variables which might have significant effect upon the level and kind of participation in the Junior Leaigtte programs: 1. level of group participation prior to institutional residence. 2. hearing impairment. ^Canfield, op c i t . p.l66 Hypothesis The thesis hypothesis developed f o r testing i s : (a) The l e v e l of pa r t i c i p a t i o n and interest i n a group recreation program w i l l be p o s i t i v e l y related to the l e v e l of previous p a r t i c i p a t i o n i n group a c t i v i t y . (b) The l e v e l of pa r t i c i p a t i o n and interest i n a group recreation program w i l l be inversely related to the degree of hearing impairment. In the subsequent discussion of data and research findings the primary emphasis w i l l be upon that which i s d i r e c t l y relevant to the thesis study. The necessary d i s t i n c t i o n w i l l be made between the thesis study, which refers to the findings assessed within the narrowed frame of reference r e l a t i v e to the thesis hypothesis, and the general research study. This l a t t e r study i s the t o t a l project of the Research Department of the Community Chest and Councils, i n which the writer assisted i n research interviewing and i n scoring and c o l l a t i n g data. Thesis Design The instruments used to gather data relevant f o r testing the hypothesis stated above include: 1. The Team Captains' Rating Scale 2. The A c t i v i t y Scale 3. Level of Hearing Capacity derived from s e l f assessment, operator ratings and experience of research interviewers i n the interview s i t u a t i o n . The Team Captains Rating Scale This scale i s used to provide the measure of program - 50 -response as indicated by attendance and by level of participation recorded by the Team Captains at the conclusion of each program session. It i s believed that, in general, those who join actively i n group programs wi l l gain greater satisfaction and wil l evidence greater positive change in behaviour and attitudes than w i l l onlookers or marginal participants. One assessment of the level and quality of response i s the observation of people present. The volunteers may tend to some degree to have a vested interest i n believing the participation i s high, and might rate somewhat high because 'of their bias. This was checked by having duplicate ratings on two successive programs midway i n the program series made by both Team Captains and by the research interviewers who had completed the pretest interviews. Since these ratings were the same in almost a l l instances, and the differences were not sufficient to result in any marked deviation in total scores, the Team Captains ratings are believed to be an adequately reliable measure of observed program response. The Activity Scale 1 This scale is.used to provide the measure of previous participation i n adult group a c t i v i t i e s . It was found in practice Adapted from""The Minnesota Follow-up Study,'' Minnesota Department of Welfare, 1959. Mimeographed. that accurate r e c a l l was impossible f o r many old people. In general, they were able to state s u f f i c i e n t factual information to indicate whether they had belonged to s p e c i f i c formal a c t i v i t i e s , and whether they had been active at the executive or committee l e v e l . The scale i s c u l t u r a l l y biased i n favor of organized a c t i v i t i e s , and does not provide f o r gathering data on informal a c t i v i t i e s , sports, and family l e i s u r e time a c t i v i t i e s . Level of Hearing Capacity Assessment of hearing capacity i s based on a gross d i v i s i o n into two groups, Normal Hearing and Impaired Hearing. The Normal Hearing group includes a l l those who state they have no hearing problems, and who evidence no d i f f i c u l t y hearing i n ordinary conversation. Persons who asked frequently f o r questions to be repeated or who needed a noticeably raised tone of voice i n order to hear i n the interview si t u a t i o n were judged to have hearing impairment at a l e v e l which could be l i m i t i n g i n the confusion of a group recreation s i t u a t i o n . This d i v i s i o n i s believed to correspond approximately to the moderate hearing loss described as the 20-40 decibel range, " d i f f i c u l t y hearing when t i r e d or inattentive, i n the noise of general conversation or when a r t i c u l a t i o n i s soft or poor".''' Levine, op c i t . p.311 defines "hard of hearing" i n these terms. The g e t t i n g I t was d e c i d e d e a r l y i n t h e g e n e r a l s t u d y t h a t a s i n g l e r e s i d e n t i a l u n i t w o u l d p r o v i d e a d e s i r a b l e m e a s u r e o f c o n t r o l .and a m a n a g e a b l e s a m p l e p o p u l a t i o n f o r t h e t h e s i s s t u d y . The f i r s t p r o g r a m b o a r d i n g home was a s m a l l one d e v o t e d t o t h e c a r e o f e l d e r l y women. The p r i v a t e h o s p i t a l p a t i e n t s were g e n e r a l l y c r i t i c a l l y i l l o r s e v e r e l y h a n d i c a p p e d b y m a j o r o r g a n i c o r p h y s i c a l d i s a b i l i t y . The p o p u l a t i o n t u r n o v e r i n s u c h i n s t i t u t i o n s i s h i g h , a n d few o f t h e s m a l l segment a b l e t o be i n t e r v i e w e d a t t h e b e g i n n i n g c o u l d b e e x p e c t e d t o c o m p l e t e a f u l l p r o g r a m s e a s o n o f e i g h t t o t e n m o n t h s . T h e r e f o r e , T a y l o r M a n o r , w i t h a p o p u l a t i o n o f 42 men a n d women, a l l o f whom a r e u u s u a l l y a m b u l a t o r y a n d i n r e a s o n a b l e p o s s e s s i o n o f s e n s o r y f a c u l t i e s , was s e l e c t e d a s p r o v i d i n g t h e b e s t s e t t i n g a n d p o p u l a t i o n f o r a l i m i t e d s t u d y . T a y l o r M a n o r i s a b o a r d i n g home f o r d e p e n d e n t o l d e r men a n d women. I t i s owned a n d o p e r a t e d b y t h e C i t y o f V a n c o u v e r , a n d i s t h e o n l y p u b l i c l y owned b o a r d i n g home a n d t h e l a r g e s t s i n g l e b o a r d i n g home u n i t i n t h e V a n c o u v e r a r e a . O f t h e 42 r e s i d e n t s l i v i n g t h e r e when t h e p r o g r a m b e g a n , 34 w e r e a v a i l a b l e f o r b o t h p r e - t e s t a n d p o s t - t e s t m e a s u r e m e n t s . The age r a n g e was f r o m 62 - 92 y e a r s , w i t h a m a j o r i t y o v e r 75 y e a r s . T h o s e u n d e r 75 y e a r s t e n d e d t o b e p e o p l e who h a d d e v e l o p e d p r e m a t u r e l y some o f t h e t r o u b l e s a n d p r o b l e m s g e n e r a l l y a s s o c i a t e d w i t h more a d v a n c e d y e a r s . Many o f t h e t o t a l g r o u p were s i n g l e a e n o r - 5 3 -widowed people with no close r e l a t i v e s . A number had developed health problems or chronic physical d i s a b i l i t i e s which rendered them p a r t i a l l y dependent, economically and physicallyy, The i n s t i t u t i o n i s an old building set i n spacious and a t t r a c t i v e grounds on the outskirts of Vancouver a considerable distance from any shopping centre and f a r removed from the a c t i v i t i e s of the downtown area. Because of the i s o l a t i o n , many old people have been reluctant to move here despite the generally pleasant accomodation. There i s a large comfortably furnished common room available at a l l times where residents have access to t e l e v i s i o n and a small l i b r a r y . There are long bright sunporches at both ends of the two f l o o r s . One i s reserved f o r the lad i e s , and they have tea served here every afternoon. A l l residents are expected to be ambulatory"1' and usually able to come to the dining room f o r meals. Each one has an assigned place i n the dining room, with men at tables on one side and ladies on the other. There i s l i t t l e s o c i a l interchange at mealtimes. Most people come i n promptly when the gong rings, eat as quickly as possible and go off singly with a minimum of conversation. Occasionally there i s a l i t t l e table conversation ox* one of the men stops to chat with a lady as he passes, but these are tb_e exceptions. The sta f f have a table at the end of ''"This was correct during the major part of the thesis study period. Subsequent changes i n admission policy have made Taylor Manor a between-type i n s t i t u t i o n . There are now a number of wheel-chair residents and people with severe handicaps. Some of them are unable to come to the dining room. the dining room with the same accomodation and the same food as the residents. There was a disturbed atmosphere for both s t a f f and residents f o r some months during the recreation program because of building a l t e r a t i o n s . No new residents were admitted during t h i s re;novation period, and consequently the population was unusually stable from November to A p r i l , the section of the t o t a l program period used f o r the thesis study. There were some losses i n the study population due to i l l n e s s requiring h o s p i t a l i z a t i o n and to several deaths. The s t a f f was constant throughout the.program period. Testing of the Hypothesis I t was proposed to test the thesis hypothesis by dividing the Taylor Manor population who participated i n both pre-test and post-test interviews into two groups, High and Low Participants, according to the combined attendance-attitude ratings made by the Junior League Team Captains. 1 The dichotomized population was to be further subdivided into those with High and those with Low Past A c t i v i t y scores, as established by information given on the A c t i v i t y Scale and rated on a five-point numerical scale. The Chi square was then to be used to compute the l e v e l of significance revealed between present program p a r t i c i p a t i o n and past organized group p a r t i c i p a t i o n . See p. 44-45, and Appendix D, Team Captains Rating Scale. A si m i l a r procedure was to be followed f o r determining the l e v e l of significance between Program P a r t i c i p a t i o n and Hearing D i s a b i l i t y . Since the study population was too small to permit testing three variables simultaneously, i f either combination of factors gave indication of s t a t i s t i c a l significance, t h i s data would be plotted on a l i n e a r graph and the t h i r d variable indicated f o r comparative purposes. It was further planned to calculate the Health Handicap Score according to the method of Havighurst and Albrecht''', and to compare t h i s score with hearing d i s a b i l i t y i n an ef f o r t to determine whether the effect of hearing, i f any, i s d i s t i n c t from or combined with that of a cluster of physical d i s a b i l i t i e s . Since there are a number of other variables covered i n the available general data which might also have a bearing upon program p a r t i c i p a t i o n , some of these were also to be checked for significance as a possible guide f o r future research. F i n a l l y , i t was planned that case study material would be introduced to supplement the s t a t i s t i c a l material and provide a three-dimensional setting f o r the empirical findings. Controlled Variables In the development of the thesis design, the following variables Havighurst and Albrecht, op c i t . p.292. were considered to be controlled to a reasonable extent: 1. The use of a single residence controlled the physical setting or the gross environment of the study sample. The st a f f remained constant, although due to holiday schedules the same s t a f f member was not available f o r provision of pre-test and post-test data. 2. Two research interviewers,completed pre-test and post-test interviews with the same group of residents. The t h i r d pre-test interviewer was unable to help with the post-test. Residents i n i t i a l l y interviewed by him were given post-test interviews by one of the other two o r i g i n a l Taylor Manor interviewers, both of whom had come to know a l l residents during the program period. 3. The experimental population was controlled since no new residents were admitted u n t i l almost the end of the program period studied. Losses due to deaths of three residents and c r i t i c a l i l l n e s s of several more i s believed to be a part of what would be the normally anticipated i n s t i t u t i o n a l l i v i n g s i t u a t i o n . One man who was present throughout the program and f o r whom pre-test and post-test interviews were completed was not included i n the f i n a l study population because he became extremely confused and his post-test responses seemed unreliable. The thesis study population consists of 34 Taylor Manor residents f o r whom a l l pre-test and post-test schedules were completed, and whose responses were judged r a t i o n a l and adequately r e l i a b l e according to the assessment of the research interviewers. 4. No si g n i f i c a n t changes i n recreational resources or a c t i v i t i e s f o r residents occurred during the program. -57-5. I t was assumed that the volunteer recreation s t a f f would he constant f o r the program period. This was not the case.. There were several changes and substitutions f o r periods varying from one afternoon to several weeks. One regular volunteer had to withdraw f o r personal reasons i n January, and the two Team Captains 1 withdrew i n A p r i l due to other organization commitments. The two new Team Captains had been , partb.ofbthe volunteer recreation group but had not made program ratings previously. 6. The major changes i n volunteer personnel were c a r e f u l l y interpreted to residents both by volunteers and by s t a f f , but because of personal relationship factors involved i n the program, these changes may have had effects on response patterns i n ways which could not be controlled. This i s l i k e l y to be a recurrent factor i n a l l volunteer programs involving a number of people and should probably be considered a part of the normal pattern, though for reasons discussed l a t e r i t i s considered important to keep changes i n program personnel to a minimum. 7 . The o r i g i n a l two Team Captains made p a r t i c i p a t i o n ratings from November to A p r i l . Since these ratings were an essential part of the thesis data, and since they have a strong subjective element despite the greatest ef f o r t s to achieve consistency, i t was decided to establish control over the p a r t i c i p a t i o n ratings f o r the thesis design by l i m i t i n g the study period to the six-month period covered by the o r i g i n a l raters. 'Because of the larger number of residents at Taylor Manor, the Junior League plan provided f o r a minimum of 8 volunteers with two Team Captains to share r e s p o n s i b i l i t i e s f o r coordination. Both Team Captains sent i n independent weekly ratings f o r as many residents as they had been able to observe. A range of additional general controls are automatically built into the study by the specific selection of Taylor Manor. A l l residents are placed here by the City Social Service Department, a l l are in receipt of some public assistance"'* and have at some point had to make the adjustment to a measure of economic dependence on public resources. They a l l have for their total personal needs the ten dollars a month comforts allowance provided for social assistance recipients in residential institutions. A l l have some dis a b i l i t y or limitation which makes i t inadvisable, i f not impossible, for them to carry on independently in the community, although most of them retain a f a i r l y large measure of individual independence and-general competence. Although a l l residents have the same general physical environment, some have the highly valued privilege of a private room. Others share double or quadruple rooms, or, in the case of a majority of the men, are accomodated in one of the two large dormitories. Few of the residents have any consistent or rewarding contact outside the home. A few maintain close contact with relatives, a few have friends with whom they keep i n touch, and two short-time residents of advanced years maintain regular contact with old people's groups in the community. Some individual residents are discussed in detail in the case study material. "'"Social Assistance for those up to 65 years of age, Old Age Assistance for the 65-69 year old group, and Old Age Security with Supplementary Assistance for those 70 and over. - 59 -In general, the study setting and personnel, including residents, s t a f f , program team and research i n t e r -viewers, were a l l r e l a t i v e l y constant or, a l t e r n a t i v e l y , i t was possible to provide f o r compensating control. I t i s believed that adequate control was achieved i n these areas despite the unavoidable changes which have been noted. Uncontrolled Variables Since the population was ready-made i n the i n s t i t u t i o n , no control was possible f o r such factors as sex, age, socioeconomic grouping or ethnic o r i g i n . Because the t o t a l sample i s small, p o s s i b i l i t i e s f o r s t a t i s t i c a l controls are severely l i m i t e d , although most of the necessary data i s available were the study population large enough to j u s t i f y analysis of t h i s kind. There are many complexities inherent i n any s o c i a l interaction, any one or any combination of which may be s i g n i f i c a n t l y related to behavioural change. The d i f f e r e n t i a l accomodation within the i n s t i t u t i o n and the interactions between s t a f f , residents and volunteers are p o t e n t i a l l y c r i t i c a l . The age, sex, socioeconomic background, education, c u l t u r a l and ethnic t r a d i t i o n s of residents could have s i g n i f i c a n t bearing. The selection of the two variables chosen f o r detailed study i s not intended to imply that they have necessarily greater influence upon p a r t i c i p a t i o n and response than do any of the large number of other.variables, i d e n t i f i e d or as yet unidentified. However, the selected variables can be studied with some degree of specificity through information available with a reasonable degree of accuracy and r e l i a b i l i t y . Study of this data may indicate, i n part, the effects these two specific variables might have upon the total configuration. Limitations of the Study Because of the limited size of the population, and because of unanticipated complications and uncontrolled variables which have been noted, any findings which may emerge are acknowledged.as tentative arid indicative rather than conclusive. However, positive findings could at least indicate specific points for consideration in programming and might serve as guide lines for more intensive and more comprehensive future research. Chapter 3 T-he Response to the Program A l l men develop some common characteristics of age with the advancing years. They age along different routes, influenced by di f f e r e n t circumstances and responding i n different ways. However, s t a t i s t i c a l analysis and c r i t i c a l study of individual responses can help to establish some of the common tendencies to changes i n socia l functioning which accompany the l a t e r years. Such knowledge i s essential to s o c i a l planning which can deal wisely and well with the emerging needs. 1. S t a t i s t i c a l Data Introduction Analysis of the s t a t i s t i c a l data from the Taylor Manor study i s carried out according to the pattern outlined below:-Relationship between Program P a r t i c i p a t i o n and Past A c t i v i t y Total attendance-attitude ratings are used to divide the study sample into two equal groups, High and Low Program Participants. A c t i v i t y Scale data scored on a 5-point scale are used to subdivide the High and Low Participant groups into those with High and those with Low Past Activity-ratings. The Chi Square applied to the data thus derived provides the test of the f i r s t section of the hypothesis, that s "the l e v e l of p a r t i c i p a t i o n and interest i n a group recreation program w i l l be p o s i t i v e l y related to the l e v e l of previous p a r t i c i p a t i o n i n group a c t i v i t y . " - 62 -Relationship Between Program P a r t i c i p a t i o n and Hearing Capacity  Information derived from s e l f and objective r a t i n g of hearing capacity i s used to divide the High and Low Participant groups into those with Normal Hearing and those with Impaired Hearing. The Chi Square applied to th i s data provides the test f o r the second section of the hypothesis, that: "the l e v e l of p a r t i c i p a t i o n and interest i n a group recreation program w i l l be inversely related to the l e v e l of hearing impairment." Relationship Between Program'Participation and Other _. . Variables Some additional variables are examined to determine whether available data permit i d e n t i f i c a t i o n of other p o t e n t i a l l y s i g n i f i c a n t relationships. A comparative examination of pre-test and post'Qtest scores f o r some c r i t e r i a of program consequences provide a basis f o r discussion of some p o t e n t i a l l y measurable results of the program experience. Program P a r t i c i p a t i o n Ratings P a r t i c i p a t i o n ratings were established as planned. Each resident's weekly scores as recorded by the two Tieam Captains were averaged to give one attendance and one attitude score f o r each program. The scores were t o t a l l e d f o r the 21 programs included i n - 63 -the thesis study period. The group of 3k residents was divided into two equal segments, High and Low Participants, according to the combined attendance-attitude scores. I t i s recognized that participants i n the median range may be somewhat a r b i t r a r i l y misplaced i n such a d i v i s i o n . However, examination of the few scores i n t h i s range indicated that the possible misplacement would not have s i g n i f i c a n t effect upon the analysis. The inescapable subjective elements i n the attitude scores are believed to be balanced i n part through combining t h i s with the attendance rating. In some instances voluntary attendance may be more in d i c a t i v e of the residents' own f e e l i n g of interest than i s t h e i r observed response. The volunteer ratings of attitude are to a considerable degree a r e f l e c t i o n of the q u a l i t y of relationship between the volunteers and the individual residents. They r e f l e c t also anticipations about "proper" or desirable group interaction patterns which are i n part defined by the terms of the research study and the r a t i n g scale used. The Team Captains were asked to score on a three point scale"*" to indicate whether the response was: 1. Hostile, uncooperative, querulous. 2 . Passive, s t o l i d , i n d i f f e r e n t , "just s i t s " . 3 . Enthusiastic, cooperative, interested. Team Captains found the three categories i n s u f f i c i e n t l y discriminating, and at t h e i r request a fourth c l a s s i f i c a t i o n was added, between Items 'The scoring i s i l l u s t r a t e d i n the sample Team Captains' Rating Scale, No.7, Appendix D. - 64 -2 and 3: Passively cooperative, exercises no i n i t i a t i v e but enters into activity when asked. For f i n a l scoring, a l l ratings made after this change were converted to the original three-point scale. Activity Scale The Activity Scale provided data to establish on a f i v e -point scale the range of formal group activity during the adult years between 40-60 years for each of the 34 residents of the study sample. It was planned to rate as "active" those who had belonged to two or more organized community, lodge, union, p o l i t i c a l or church groups, who had attended f a i r l y regularly, held office or helped on commitees, and taken a sustained part i n group a c t i v i t i e s . In practice, i t was found that there was considerable uncertainty in recall of detail. Frequently residents could not remember exactly when they had belonged to different groups, or what executive and committee positions they had held at various stages of their adult l i f e . For some, the information given about participation may go back before the age of 40. Others who belonged to various groups and continued active after they were 60 may have answered questions on the basis of these experiences. Those rated from 3-5 on the Activity Scale answered in ways which indicated sustained and active organization membership as an integral part of their se l f -conceived adult roles. They had served on executives or on committees in one or more groups, had helped with group projects, and appeared to - 65 -recall their activities with some evidence of a sense of belonging. Many of those rated from 0-2 stated they had not been interested in community groups, or that they had not had time for anything other than work. Some had attended church or union meetings but their participation had been passive. The Activity Scale provided a good test of the hypothesis as i t relates to formal associations. However, the scale is concerned exclusively with organized group ac t i v i t i e s , and does not e l i c i t information about informal participation. Resident comments indicated informal contacts may be more significant for many, particularly among the lower socioeconomic groups. This observation is particularly relevant for the single men who were casual labourers with high mobility during their working years. Their social l i f e was centred i n the bunkhouse, the beer parlour and the public dance halls. Some took an active part in sports. These informal ac t i v i t i e s may well have as great importance as other people's formal memberships in developing the significant group response patterns. It is the learned social patterns, whether developed i n formal or informal associations, which are believed to be significant determinants of the level of potential response to group recreation activities i n later maturity. Some residents for whom this observation i s particularly relevant w i l l be discussed i n case material following the s t a t i s t i c a l data. Relationship Between Program Participation and Past Activity The Chi Square is applied to the data from these two ratings in order to test the f i r s t section of the hypothesis. Table 1: Program P a r t i c i p a t i o n and Past A c t i v i t i e s .fast A c t i v i t y Program P a r t i c i p a t i o n High (105-126) Low (26 a -103) Total High (3-5) 12 2 b 14 Low (0-2) 5° • 15 20 . Total 17 17 34 2 X 12.14 1 d.r. P < . 0 0 1 d Source: Program Pa r t i c i p a t i o n derived from Team Captains' Rating Scale, No. 7, Appendix D. Past A c t i v i t y derived from theAActivity Scale, No. 10, Appendix D. &The theoretical minimum i s 42, the lowest possible score i f a l l ratings were made. The lower actual minimum i s due to omission of some individual scores i n the Team Captains' weekly l i s t i n g s of non-attending residents. ^One of these people was -bedridden throughout the program. The second i s a nearly b l i n d man with other physical d i s a b i l i t i e s . He was marginal i n attendance and t o t a l score, though generally responsive when he was able to attend. His t o t a l score i s 99. °Pour of t h i s group gave evidence of informal family or group contacts at a r e l a t i v e l y high l e v e l . Two have continued close family associations while l i v i n g at Taylor Manor. dCohen, L i l l i a n - S t a t i s t i c a l Methods for Social S c i e n t i s t s , Prentice-Hall, Inc., Englewood C l i f f s , N.J. 1954, p. 127. Any probability below .05 i s regarded as having s t a t i s t i c a l significance. - 67 -This data provide strong support f o r the f i r s t , section of the hypothesis, and establish that there i s a s t a t i s t i c a l l y s i g n i f i c a n t r e l ationship between present program p a r t i c i p a t i o n and previous group a c t i v i t y . This relationship i s not, of course, necessarily a causal one; the s t a t i s t i c a l relationship may be the product of a t h i r d underlying variable such as common personality characteristics which l e d to the group p a r t i c i p a t i o n and which s t i l l constitutes a s i g n i f i c a n t part of the self-image of p a r t i c i p a t i n g residents. Hearing Capacity Normal Hearing i s taken to be absence of perceptible hearing handicap. Hearing Impairment i s taken to be any hearing d i s a b i l i t y judged s u f f i c i e n t to contribute to possible d i f f i c u l t y i n group p a r t i c i p a t i o n . The residents' self-stated hearing capacity, s t a f f members' assessments and research interviewers' ratings of hearing capacity were considered i n order to derive the ratings used. In general the three judgments confirmed one another. Where there was discrepancy, the ra t i n g used was based on the experience of the research interviewers i n successive contacts with the residents. I t was assumed that i f the research interviewer had to raise his voice or repeat frequently to be understood, there was a degree of hearing impairment which might prove a handicap i n a group recreation program. Relationship Between Program P a r t i c i p a t i o n and Hearing Capacity The Chi square i s applied to the data from these two ratings i n order to test the second section of the hypothesis. Table 2' Program Participation and  Hearing Capacity Hearing Capacity Program Participation High l>ow Total Normal 6 7 13 Impaired 11 10 21 'Total 17 17 34 x 2 = .12 ! ' 1 d.f. P^ > .80 Source: Program Participation derived from Team Captains' Rating Scale, No. 7, Appendix D. Hearing Capacity derived from Schedules 1 and 6, Appendix D. F I G U R E I HEARING C A P A C I T Y P L O T T E D ON A GRAPH OF PROGRAM PARTIC IPAT ION V S P A S T ACTIVITIES PAST ACTIVITIES - 69 -The distribution does not indicate' that hearing capacity-is significantly related to participation in a group recreation program, since i t is close to that which would be expected according to normal frequency distribution. Graphical Representation In order to provide for further examination of the three variables relevant to the hypothesis, the averages of Program Participation scores at each point on the Past Activity scale were plotted on a linear graph. The resultant curve levels out rapidly after a median point which represents a limited level of past group activity. Thus i t i s evident that there is l i t t l e variation in present program participation between those with moderate and those with high past activity scores. Some a-social isolates who have never taken part in organized activities and who seem to have had l i t t l e satisfying family and informal socialization experiences participate in the programs at a generally low level, although they show wide individual variation. The impaired hearing participants who deviate more than five points from the curve have been plotted, as shown in Figure 1. Six of these people are above and six are below the curve. Four of those above the curve have high past activity patterns, formal or informal, and they seem to be sociable, gregarious people. Their social group expectations are probably at a level at which hearing impairment does not have a significantly negative influence on group activity. The other two high scores were recorded for two lonely, isolated men who - 70 -responded to the concentrated individual attention and interest shown them by the volunteers. Of the six who are below the curve, one man maintains close family ties and frequently missed programs because he was v i s i t i n g his family. One woman has a hostile, negative attitude which may or may not be related to her hearing handicap. One man is limited by poor sight and generally poor health in addition to the hearing impairment. The remaining three people with impaired hearing and lower program response do not appear to have factors other than'p the hearing handicap to account for their lo\>rer average response. In general, the curve for the six participants below the curve appears to parallel the general curve 6-10 points lower, but valid generalization from such a small sample i s impossible. However, the tendency for some hard of hearing residents to respond at a significantly lower level seems sufficiently indicated that further study might be of value. Such a study, with a larger sample and with careful control over methods used with the programs to compensate for hearing impairment, might help to determine more precisely how different people adapt their responses as a result of hearing impairment. Health Handicap Health Handicap1 scores were calculated on the pre-test data 1Havighurst and Albrecht, op..cit. p.292, outline the method for calculating health handicap. They report low but significant negative correlation between health handicap and both personal adjustment and role activity. It i s possible that a larger sample would have given more closely comparable results i n the present study. - 71 -to determine whether hearing impairment tended to be associated with other health d i f f i c u l t i e s which might exercise a combined negative influence upon program response. There were no significant changes i n hearing capacity during the program period. Relationship Between Program Participation and Health Handicap The Chi Square is applied to these two ratings to determine whether there i s a s t a t i s t i c a l l y significant relationship. - 72 -Table 3* Program Participation and  Health Handicap Health Handicap Program Participation . High Low Total 0-4 13 11 24 5-14 4 6 10 Total 17 17 34 x 2 = .56 1 d.f. P > .30 Source: Program Participation derived from Team Captains' Rating Scale, No. 7> Appendix D. Health Handicap derived from data in Schedules 1 and 6, Appendix D, calculated according to the method of Havighurst and Albrecht, op. c i t . p. - 73 -Although s l i g h t l y more s i g n i f i c a n t than the hearing alone, t h i s i s not at a l e v e l to suggest a strong relationship between Program P a r t i c i p a t i o n and Health Handicap. Examination of Hearing Impairment as a component of the Health Handicap scores does not suggest any consistent trend i n possible effect upon program pa r t i c i p a t i o n beyond that which has been tent a t i v e l y suggested f o r Hearing Impairment alone. Program P a r t i c i p a t i o n and Other Variables In order to i d e n t i f y some other variables which might be related to the observed program response, several additional population characteristics were checked further. Table 4 s Program Participation  and Other Variables a Variable Test of Signif icance Age 2 X = .14 1 d.f. .70 Marital Status 2 X =1.20 1 d.f. P >.20 Naftave Language 2 X = 0 1 d.f. P = 1 Time . in Taylor Manor 2 X =1.16 1 d.f. P > .20 Social Contacts 2 X =4.38 1 d.f. P < . 0 5 Source: Program Participation derived from Team Captains' Rating Scale, No. 7, Appendix D. A l l other information derived from Schedules 1 and 6, Appendix D. Complete data for these variables are given in Appendix C. - 75 -Social Contacts, is a composite rating which includes: frequency of v i s i t s to or from family or friends. frequency of correspondence with family or friends. frequency of v i s i t s with other residents in the home. Although this one variable does show low hut s t a t i s t i c a l l y significant correlation, neither this nor other combinations of items thus far identified are definitively predictive of program participation for a group as diverse as that found at Taylor Manor, and probably in mos'i- old age institutions. Past Activity offers the highest level of significant correlation of a l l the variables tested. 1 It had been planned to study, in addition, Sex, Attitude to Taylor Manor and Social Awareness, a second composite rating which includes: regularity and frequency of! - newspaper reading - radio listening - television viewing - walks outside - drives outside. None of these variables could be tested by the Chi Square method, since the distribution gave an expected frequency of less than 2 5 in two cel l s . "Visual examination indicated that no significant correlation could be expected, and i t was not considered necessary to test these variables precisely by an alternative s t a t i s t i c a l method. See page £^ Cohen, L i l l i a n , op. c i t . p.127. - 76 -Unfortunately data were not available to test socioeconomic status against program p a r t i c i p a t i o n . The indications are that many of the enthusiastic participants would have belonged to middle and lower middle class groups, while a number of the less responsive tended to be from lower socioeconomic groups. Socioeconomic class, factors would be expected to be related to formal group p a r t i c i p a t i o n patterns, since i t i s known that middle class, white-collar men and women tend to be the pr i n c i p a l organization members.''" This area would seem to be a f r u i t f u l one f o r further study. Pre-test and Post-test Comparison Comparison was made between pre-test and post-test scores i n a number of areas of attitude and behaviour which might have been affected by the a v a i l a b i l i t y of the program. Following a review of the complete schedules, the sp e c i f i c items selected to be examined i n d e t a i l were: 1. Social Awareness^ 2. Social Contacts^ 3. Self-health Rating 4. Attitude to Taylor Manor There are major problems inherent i n t h i s p a r t i a l analysis within the thesis study, since the population d i v i s i o n f o r the thesis """Kahl, op. c i t . p . Itfj o The c r i t e r i a included i n th i s composite rati n g are given on p.75« The c r i t e r i a included i n t h i s composite rati n g are given on p.75-- 77 -was n o t b a s e d upon t h e "program-no program" d e s i g n , b u t upon t h e d i v i s i o n i n t o H i g h P a r t i c i p a n t s - Low P a r t i c i p a n t s w i t h i n t h e s i n g l e program r e s i d e n c e . The program i s known t o have had some e f f e c t upon many o f t h o s e a s s e s s e d on a c o m p a r a t i v e • b a s i s as low p a r t i c i p a n t s . Indeed, some members o f t h i s s o - c a l l e d Low P a r t i c i p a n t g r o u p who needed and r e c e i v e d i n d i v i d u a l i z e d a t t e n t i o n r e s p o n d e d s l o w l y a t f i r s t , b u t a t t h e end t h e y showed s u b s t a n t i a l l y more change t h a n many o f t h e H i g h P a r t i c i p a n t g roup who had more p o s i t i v e a t t i t u d e s and f a i r l y a dequate s o c i a l c o n t a c t s b e f o r e t h e program s t a r t e d . F o r t h e s e b e t t e r a d a p t e d and more s p o n t a n e o u s l y r e s p o n s i v e p e o p l e , t h e program was a welcome a s s e t , and q u i t e p o s s i b l y an a n t i d o t e t o d e t e r i o r a t i o n . T h i s w o u l d be a l m o s t i m p o s s i b l e t o d e t e r m i n e s t a t i s t i c a l l y w i t h i n t h e t h e s i s d e s i g n , s i n c e i t w o u l d show o n l y as absence o f n e g a t i v e change. S t a t i s t i c a l l y s i g n i f i c a n t change w i t h i n t h e t h e s i s d e s i g n would i n d i c a t e t h a t t h e l e v e l o f o b s e r v e d p a r t i c i p a t i o n i s s i g n i f i c a n t l y r e l a t e d t o t h e l e v e l o f r e c o r d e d change i n b e h a v i o u r o r a t t i t u d e . T h i s i s a p o s s i b i l i t y b u t i t would n o t n e c e s s a r i l y be sound t o assume a c a u s a l c o n n e c t i o n even w i t h s t a t i s t i c a l s u p p o r t b e c a u s e o f t h e v a r i e t y o f i n d e p e n d e n t v a r i a b l e s w h i c h cannot be c o n t r o l l e d i n such an a s s e s s m e n t . On t h e o t h e r hand, l a c k o f s t a t i s t i c a l l y s i g n i f i c a n t r e l a t i o n s h i p does n o t i n v a l i d a t e f i n d i n g s b a s e d upon s u b j e c t i v e o b s e r v a t i o n , though i t n e c e s s i t a t e s c a r e f u l q u a l i f i c a t i o n and r e s e r v a t i o n s i n g e n e r a l i z a t i o n s drawn f r o m them. I d e a l l y , s t u d y F I G U R E 2 PROGRAM PARTICIPATION V S CHANGE IN SOCIAL AWARENESS BETWEEN P R E - T E S T AND P A S T - T E S T SCORES + 8 to UJ to o a. to UJ i -i UJ cr UJ UJ i -U m ui cr o o w UJ o z < X o CO to UI z UJ cr < < o o CO • >r -•—tr* • 1 o- •-• • • 7 t LOW 104 HIGH 10 20 30 40 50 60 70 80 90 100 120 130 PROGRAM PARTICIPATION - 78 -s a m p l e s s h o u l d b e s u f f i c i e n t l y l a r g e a n d s t a t i s t i c s s u f f i c i e n t l y c o n t r o l l e d t o p e r m i t g e n e r a l i z a t i o n s w h i c h a r e s t a t i s t i c a l l y v a l i d . I n t h e a b s e n c e o f s u c h i d e a l s t u d y c o n d i t i o n s , s o m e s u b j e c t i v e j u d g m e n t s a r e i n e s c a p a b l e . I t w o u l d b e u n s o u n d t o d i s m i s s a p p a r e n t r e l a t i o n s h i p s a s m e a n i n g l e s s b e c a u s e o f a b s e n c e o f s t a t i s t i c a l s i g n i f i c a n c e a t t h e p r e s e n t l e v e l o f k n o w l e d g e i n s o c i a l i n t e r r e l a t i o n s h i p s . T h e s e a p p a r e n t r e l a t i o n s h i p s c a n m a k e a c o n t r i b u t i o n t o p r o g r e s s i v e d e v e l o p m e n t o f k n o w l e d g e t h r o u g h a l e r t i n g t h o s e c o n c e r n e d t o a r e a s o f p o t e n t i a l s i g n i f i c a n c e , a n d p r e p a r i n g t h e w a y f o r m o r e p r e c i s e a n d c a r e f u l f u t u r e e x a m i n a t i o n . T h e r e i s n o e v i d e n c e o f s t a t i s t i c a l l y s i g n i f i c a n t c h a n g e f r o m p r e - t e s t t o p o s t - t e s t s c o r e s b e t w e e n t h e H i g h a n d t h e L o w P a r t i c i p a n t g r o u p s . H o w e v e r , t h e g r a p h i c a l d i s p e r s i o n f o r " S o c i a l A w a r e n e s s " a n d f o r " A t t i t u d e t o T a y l o r M a n o r " s u g g e s t . t h a t t h e r e a r e t r e n d s i n t h e s e c r i t e r i a w h i c h m i g h t s h o w s t a t i s t i c a l s i g n i f i c a n c e i f t h e s a m p l e w e r e l a r g e r o r i f t h e r e w e r e a t r u e c o n t r o l s a m p l e o f c o m p a r a b l e c h a r a c t e r i s t i c s . T h r e e o f t h e L o w P a r t i c i p a n t g r o u p , ; s h o w i n c r e a s e d S o c i a l A w a r e n e s s s c o r e s a s h i g h o r h i g h e r t h a n t h e r e c o r d e d i n c r e a s e a m o n g t h e H i g h P a r t i c i p a n t s c o r e s . T h e g r e a t e s t g a i n i s f i v e p o i n t s f o r o n e o f t h e L o w P a r t i c i p a n t g r o u p : . ( J 1 ) T h i s i s a m a n s e r i o u s l y h a n d i c a p p e d b y d e a f n e s s who w a s a r e l u c t a n t p a r t i c i p a n t i n i t i a l l y , b u t g a i n e d g r e a t l y i n c o n f i d e n c e t h r o u g h o u t t h e p r o g r a m p e r i o d . Two o t h e r L o w P a r t i c i p a n t s a n d o n e H i g h P a r t i c i p a n t m a d e g a i n s o f t h r e e T h e l e t t e r s i n b r a c k e t s r e f e r t o t h e g r a p h p o i n t s f o r t h e p e r s o n c o n c e r n e d , F i g u r e 2. F I G U R E 3 PROGRAM PARTICIPATION VS ATTITUDE TO TAYLOR MANOR LOW 104 HIGH 0 10 20 30 40 50 60 70 80 90 100' I 120 130 PROGRAM PARTICIPATION - 79 -points. In a l l , 17 residents show some increase in Social Awareness, 11 show no change, and 6 show decrease over the program period. The marked increase in Social Awareness for some low participants, when considered in conjunction with the observed behaviour and attitude changes, suggests that the program was a significant motivating force for positive change. Several of those for whom a decline in Social Awareness is recorded had had illnesses and physical deterioration for which a weighted correction might possibly be made. The changes in expressed attitude to factors associated with l i v i n g in Taylor Manor also provide interesting material for conjecture. Although again there i s no s t a t i s t i c a l l y significant difference in the attitude change when High and Low Participant groups are compared, the general distribution of the graph suggests that positive correlation might be evident for a larger sample compared with a matched non-program control group. One High Participant resident who shows deterioration in Attitude to Taylor Manor (01) i s a seriously hard of hearing woman. Her responses are somewhat suspect since i t i s d i f f i c u l t to be sure she understands v/hat she is answering. Her answers for parts of this composite item do not coincide with her own general comments. In both pre-test and post-test she stated she liked Taylor Manor. She was moved shortly before the post-test to a large bright private room about which she volunteered several enthusiastic comments. Yet her response to a direct question about the room elicit e d a neutral answer on the post-test, "'"The identifying letters refer to points as indicated on Figure 3. - 80 -t h o u g h s h e h a d g i v e n a p o s i t i v e a n s w e r o n t h e p r e - t e s t a b o u t a s m a l l e r , d a r k , s i n g l e r o o m . T h e o t h e r H i g h P a r t i c i p a n t w i t h a m a r k e d d e c l i n e i n A t t i t u d e t o T a y l o r M a n o r ( R ) i s b e l i e v e d t o h a v e b e e n a d v e r s e l y a f f e c t e d b y t h e i n f l u x o f n e w h a n d i c a p p e d p e o p l e s h o r t l y b e f o r e t h e p o s t - t e s t i n t e r v i e w s . H e i s a n a m p u t e e w h o h a d t a k e n p a r t i n a l l p r o g r a m a c t i v i t i e s , i n c l u d i n g o u t i n g s , a s a s p e c i a l , u n i q u e p e r s o n . H e m a y h a v e f e l t h i m s e l f t h r e a t e n e d b y t h e i n c r e a s e d n u m b e r s o f s i m i l a r l y h a n d i c a p p e d p e o p l e w h o r e q u i r e d m o r e s t a f f a n d v o l u n t e e r t i m e a n d a t t e n t i o n . A l s o , h e h a s a s m a l l p e n s i o n , a n d w a s d i s g r u n t l e d t h a t a s a p e r s o n w i t h s o m e i n d e p e n d e n t m e a n s h e i s t r e a t e d p r e c i s e l y t h e s a m e a s e v e r y o n e e l s e . B o t h t h e s e p e o p l e s a i d t h e y l i k e d T a y l o r M a n o r b o t h t i m e s . T h e d i f f e r e n t i a l r e s p o n s e s c a m e i n a n s w e r s t o s p e c i f i c q u e s t i o n s a b o u t t h e f o o d , m e d i c a l a t t e n t i o n , t h e r o o m , t h e s t a f f a n d o t h e r r e s i d e n t s . I n t h e p r e - t e s t b o t h t h e s e p e o p l e r e s p o n d e d p o s i t i v e l y t o m o s t q u e s t i o n s a b o u t p a r t i c u l a r a s p e c t s o f t h e h o m e s i t u a t i o n . I n t h e p o s t - t e s t b o t h w e r e n e u t r a l t o s o m e i t e m s . I n a s m a l l s a m p l e s u c h u n i q u e i n d i v i d u a l i d i o s y n c r a s i e s c a n d i s t o r t f i n d i n g s d i s -p r o p o r t i o n a t e l y . T w o H i g h P a r t i c i p a n t s ( W a n d P ) w h o s h o w a n i n c r e a s e o f 5 p o i n t s e a c h i n A t t i t u d e t o ' i ' a y l o r M a n o r a r e t h e w o m e n r o o m a t e s w h o a r e d i s c u s s e d i n t h e c a s e s t u d y m a t e r i a l . 1 T h e y l e a r n e d t o g e t a l o n g m u c h b e t t e r d u r i n g t h e p r o g r a m p e r i o d , i n p a r t p r o b a b l y a s a r e s u l t o f t h e p r o g r a m e x p e r i e n c e . T h i s c h a n g e i s r e f l e c t e d S e e p a g e s Sy -93. - 81 -in their respective attitudes to l i v i n g conditions in the home. The man who shows the greatest total change in Attitude to Taylor Manor was a marginal program participant. (X) His health improved so he was feeling better physically at the time of the post-test. This again i s an idiosyncratic uncontrolled variable which may appear to have undue significance in a small sample. The High Participant group show a total upward change of 28 points, the Low Participant group an upward change of 7 points. This would seem to suggest that the program, as the known independent variable, may well have had some influence upon the general attitude improvement, and that the level of attitude modification may be partially related to the level of participation. In a l l , 11 high participants and 6 low participants have higher post-test scores for Attitude to Taylor Manor, 2 high participants and 6 low participants have no change, 4 high participants and 5 low participants have lower scores. Although such a flimsy s t a t i s t i c a l structure scarcely supports concrete generalization, i t does suggest attitude improvement of sufficient proportions related sufficiently conclusively to program experience to warrant further examination. Problems in Community Research Since any research study in the community i s l i k e l y to be faced with variations of the problems encountered in the present study, i t seems of value before continuing with a discussion of case study material to indicate some among the problems and - 82 -d i f f i c u l t i e s which have arisen. The dearth of reliable instruments for use with older people has been noted. Some among the few instruments which have been validated either proved unsuitable for use with institutionalized 1 2 populations or were culturally specific in ways which rendered them somewhat inadequate for present study purposes. There was too l i t t l e time and lack of comparable population groups to allow for adequate preliminary testing and standardizing of the instruments used. A number of d i f f i c u l t i e s which might have been avoided as a result of adequate pre-testing came to light after the study was well under way. This i s l i k e l y to be a recurring problem with community research studies of action programs. There is unlikely to be time and opportunity for an adequate preliminary pilot study when the planning for both research and program proceed simultaneously. Some discrepancies and oversights are almost inescapable. The complications encountered in the Team Captains' rating i l l u s t r a t e the kind of problem which arises. It was only through experience in the use of the scale that Team Captains were able to identify the inadequate discriminating power of the original scoring method. Their request for a change and the addition of a new category corrected the i n i t i a l problem but created another d i f f i c u l t y , that of bringing a l l scores to a uniform base for purposes of analysis. In """The Kutner Morale Scale was eliminated because in abstract form i t was believed to be too threatening. See p . 3 4 . The Activity Scale i s predicated upon a. pattern which i s American middle class oriented, and i s incomplete for use with an heterogeneous socioeconomic cross-section. - 83 -the f i n a l rating, a l l scores had to be converted to the i n i t i a l pattern to achieve consistency. 1 Such ex post facto adjustments may tend to bias or distort data. There i s a further d i f f i c u l t y in that qualities such as adjust-ment and morale are not yet sufficiently clearly defined for the developers of scales to be certain just what i t i s they are attempting to measure. Consequently, in spite of validation with large populations, even scales which have been widely accepted and quoted may be of 2 doubtful precision. Cumming and Henry found their combination of the Kutner Morale Scale and the Srole measure of Anomie gave results which did not agree with the assessment of morale made by skilled research interviewers. Another research study is reported as concluding: "the data : ,yield no evidence justifying the assumption that adjustment 3 in i t s present state of definition should be considered a unitary t r a i t . " A primary essential of any scale i s that i t measure a single, identifiable variable in a way which can be replicated. Pew scales for community research and even fewer in the f i e l d of gerontology have approximated this level of sophistication. The results in use of what has been developed leave much to be desired. 1An example of the two forms and the method of conversion i s given in No. 7, Appendix D. 2 Cumming and Henry, op. c i t . , p.240. •^FiecRer, Fred E., Dodge, Joan S., Jones, Robert E. and Hutchins, Edwin B. "The Measurement of Personality Adjustment and Personality Change in Clinical Populations." reported in Psychological Abstracts, University of I l l i n o i s , Urbana, 1 1 1 . , April 1 9 5 9 , No. 3320, p.344. - 84 -There are a variety of further d i f f i c u l t i e s which arise as a consequence of contamination by uncontrolled variables. For example, i t was assumed that participation would be voluntary, v/ith encouragement and invitations from the volunteers, but v/ith no pressure on residents to attend. In actual fact i t i s believed that there are inescapable elements of coercion on the part of some home operations convinced that the program i s "good for the old people". This creates a problem d i f f i c u l t to assess and impossible to control. If the operators are sufficiently concerned about the needs of the residents, about community contacts and the reactions of other people, to be interested in having volunteer programs and to be willing to participate in research study, they are l i k e l y to feel some vested interest in the appropriate responsiveness of their charges. In view of the care which institutionalized old people require, i t i s almost inevitable that the residential settings will tend to be somewhat authoritarian. The old people may tend to passive submission, to efforts to behave as they feel they are expected to do. This is not to suggest that the pressure i s necessarily undesirable, nor other than in the best interests of residents. It does make suspect the use of attendance per se as a measure of response. Also i t identifies an unanticipated variable which should be-kept in mind even though i t may be impossible to control, to compensate for or to measure comparatively. Another related problem arose i n the operator responses to raltitvg' schedules. A l l schedules were carefully explained and - 85 -research requirements interpreted- to the operators. Yet those operators who were sufficiently interested to cooperate f u l l y became so involved they "changed a few items" on various occasions. Their enthusiastic helpfulness further complicated the already d i f f i c u l t problems of achieving consistency and r e l i a b i l i t y in the research data. In addition, research interviewers developed a personal concern in the effectiveness of the programs.. It was considered important that research interviewers take time i n i t i a l l y to become acquainted with residents so that interviews could be conducted with a maximum confidence in the general r e l i a b i l i t y of the responses. It is: believed this goal was attained. Most interviewees seemed to feel secure in speaking freely, even in areas relative to home operation and conditions which might have seemed d i f f i c u l t for them to discuss had they not had time and encouragement to feel assured of respect and confidentiality. However, in the process of developing this degree of rapport, research interviewers also tended to develop a vested interest in the program, and becameoconcerned when the recorded responses did not coincide with their observation of resident attitudes. On occasion they functioned almost as an auxiliary to the Junior League volunteers, supplying books, playing cards and counselling to residents. Three of the five research interviewers were social workers, who had d i f f i c u l t y maintaining the impersonal objectivity necessary for research interviewing. In general, limitations in interviewer objectivity were-counteracted by the detached objectivity of the Research Director. He consistently pointed out the i n i t i a l manifestations.of such subjective involvement and stressed - 86 -constantly the importance of factual precision and objectivity in recording, scoring and evaluating the data. Again the attitude of home operators proved a variable problem. Those who were helpful were almost overly helpful and directive, and "told" residents to talk to research interviewers. Although this may have had some effect upon early interviews, i t was generally allowed for by making the f i r s t v i s i t s general. A l l personal material was delayed until there was a comfortable relationship between interviewer and resident, and un t i l reassurances of confidentiality and explanation of the purpose of the study had been given to residents personally. Some operators- other than those directly involved in the original project were antagonistic to any outside inquiry. This became evident when the dispersion of the control private hospital residents necessitated follow-up contacts in various private hospitals to which residents were transferred. Most home operators have had limited experience with recreation programs and usually none with research studies. Their doubts and misgivings are an i n i t i a l obstacle which may be d i f f i c u l t -for program volunteers to overcome. They represent a major hurdle for research. Staff indifference or actual h o s t i l i t y may present c r i t i c a l problems for volunteers attempting to work in a program of the kind under discussion. The best and most careful advance planning and home selection w i l l not be able to forestall a l l the negative reactions on the part of the staff, particularly in beginning prog-ram homes. The - 8? -s k i l l of the volunteers in overcoming- negative staff attitudes may-be a crucial influence upon residents' responses and .possible'.benefit.^ since the interaction between staff and volunteers may have a determining influence upon the atmoshpere in which the program i s presented to residents. Both the quality of the program and the evaluation of effectiveness will be inescapably dependent to some degree on these nebulous qualitative differences which can at best be partially surmised. For research purposes, the operator attitude is highly significant, and d i f f i c u l t to assess even with considerable direct contact. Verbal expression of interest and concern may not necessarily conform to the actual attitude either to the residents' needs, or to the v i s i t i n g and recreation programs. The effect on residents of the operator's opposition or her over-encouragement may constitute an uncontrollable variable in any such comparative study. The direct interest of the staff in the individual residents i s a marked variable in the institutional setting, and this, too, i s d i f f i c u l t i f not impossible for an outsider to determine. Limitations of Statistical Data In any community research study using already existing groups there are many significant variables which can be controlled only by st a t i s t i c a l devices which are applicable to large samples. When adequately large samples are used, and analyzed s t a t i s t i c a l l y as i s done in general survey studies,' there often seems to be a sweeping disregard of significant individual human differences. These differences - 88 -are always an important component in understanding- and interpreting generalized s t a t i s t i c a l findings. The individual differences, rather than the s t a t i s t i c a l generalizations, are the primary conscious concern of social workers. Because of this divergent emphasis, social workers have often been unduly sceptical of what sc i e n t i f i c research into human behaviour might contribute that could have relevance for social work practice. Yet there is need to take what empirical research can offer and adapt i t to the growing pressure for evaluation of results in social work settings. The empirical data which have been presented are believed to have potential significance as an objective basis for identifying and assessing some factors which could have community significance in the development of effective recreation for old people. Such semi-quantitative data can contribute part of the generalizing power basic, to comprehensive, sound community planning. This kind of sound planning i s of great importance to social v/ork practice and to the concern, of social workers for improvement of the quality of community li v i n g . Acceptable social work research must include, in addition, provision for the concern of social workers that the individual shall not become lost in the shuffle of mass society, or in s t a t i s t i c a l generalizations which sometimes seem to obscure dynamic human reality. Statistical findings may be interpreted most meaningfully for social work purposes in combined terms of both the personalities involved and the bodies counted. - 89 -The effect upon group recreational participation of such factors as the feeling of belonging, the. sense of personal worth, the effect of varying self-images and individualized need patterns cannot he adequately measured in their uniqueness hy any testing techniques yet developed. In part, this i s due to limitations in instruments which are s t i l l relatively gross and undiscriminating. In part, i t is an ever-present and inescapable problem in attempting to generalize about dynamic human qualities. The case study material which follows helps to supplement the stati s t i c s , and to provide a more balanced picture than can be provided from numbers alone. 2. The Persons The similarities and contrasts between Mrs. ¥., a widow of 88, and Mrs. P., her 92-year-old roommate, reveal something of the range of qualities encompassed in the general category, High Program Participation-High Past Activity. Both women are of lower middle-class background. Both see themselves as people of social status superior to that of most other home residents including each other. Mrs. ¥. commented frequently how few residents she found tolerable as "people you can have an intelligent word with". Mrs. P., though generally more restrained in her personal criticisms, remarked that the other residents "aren't what I've been used to." Both women were active as citizens and as organization members, and both held a number of executive positions in the same kinds of - 90 -groups. Yet their seeming similarity of background in the community had apparently provided no awareness of common interest in the new setting which both resented. Mrs. W. has withdrawn completely from the community except for v i s i t s to her own doctor. Mrs. P. has maintained a number of active contacts with pensioners' groups; she accepts the institution doctor when she needs medical care. Mrs. ¥. has a large family of children and grandchildren who have carried on a tradition of public service and organized activity in which she takes vicarious pride. Perhaps their interpretation to her of the "proper" role of older people reinforced Mrs. ¥.'s insistence that "we old folk should step aside and let the younger ones have their chance". Yet she also stated, "I don't know whether I'd be considered elderly - I haven't f e l t that way yet." Mrs. P. has no relatives to point out when elderly people "should" withdraw. She has blithely continued active and satisfying contacts with a variety of community groups and has many friendships outside the home. At 92 she i s one of the only two residents who has maintained outside formal association memberships. She is scathing in her denunciation of the lazy inertness of residents who make no effort to "get out and keep themselves alive". Mrs. V.'s apparent preference for s i t t i n g on the sidelines - 91 -could "be an indication of disengagement1, a reflection of reduced energy. Yet she performed energetically and well i n programs which residents prepared for the volunteers when she could legitimately assume a featured individual role. It seems that the group role she prefers i s one which enables her to identify with those who provide service rather than v/ith those who need and accept i t . Therefore she seeks opportunities to engage one or another of the volunteers in private conversation, frequently about her family or about service activities in which she once played a leading role. This might help to preserve and reinforce her highly valued self-image as a person of community worth, and give her a sense'of indirect status. Her kind of participation in the programs seems satisfying and rewarding to Mrs. V/. Yet to the volunteers who look for active response to planned games or act i v i t i e s , she often appears detached and indifferent. In truth she i s probably neither. She is high in her praise of the program values, particularly for the men who, she feels, have much less to interest them than the women do. Moreover, the opportunity to talk with people with whom she can identify in a satisfying way, people v/ho give her a feeling of worth 1Cumming, Elaine and Henry, John, Growing Old, The Process of Disengagement; Basic Books, Inc., New York, 1961. The development of the concept of disengagement as a natural part of aging i s the theme of this book which views the adaptation of aging as the performance of a retrenching organism. The concept has interesting implications relative to the assumptions upon which the Junior League program and the research study are based, and to assumptions which are general in social work philosophy. - 92 -and importance, appears to have been directly constructive. Over the program period she has become more reconciled to being i n the home, less c r i t i c a l of the staff and other residents, less quarrelsome and fault finding with her roommate. Mrs. P. does not find her superiority feelings threatened by enthusiastic participation in a general recreation program. She throws herself wholeheartedly into every activity that is offered, and i s consistently one of the highest rated participants. Her measure of a person's calibre i s , in part, the degree to which he shows appreciation for what is done for him. Therefore, she is emphatic in her criticism of a l l who f a i l to attend the programs and to demonstrate active interest when the volunteers make such an effort to help residents have a good time. This, to Mrs. P., i s proof of their lack of good breeding and their general social i n f e r i o r i t y to a person like herself who i s always gailyyin the centre of activity. Mrs. P.'s self-image was enhanced by being obviously among . the most centrally active participants whatever the group composition, while Mrs. W.'s self-image gained by marginal identification v/ith the volunteers. Although both are in the "high" group according to numerical scores, they are at opposite extremes within the group, and were perceived very differently by the volunteers. Both have high past participation ratings, but the effects of similar earlier formal patterns have carried over quite differently into old age. A l l of these variations seem to be related to widely divergent self -images, past and present, and to marked differences in personality - 93 -characteristics. Mrs. P. was an asset in stimulating interest and. participation hy her example, and was a rewarding person for volunteers to work with. Apart from greater acceptance of her roommate and of the other residents, she shows l i t t l e outward change as measured by the research instruments, yet the program obviously brought her a large measure of immediate enjoyment and satisfaction. Also, since she had a c r i t i c a l heart condition develop during the program period, i t may well be a success for the program that her overall score showed essentially no deterioration. Mrs. W., often seemed a d i f f i c u l t person for volunteers to work with, yet her overall responses indicate that she derived more benefit in terms measured by research instruments than did her congenitally hyperactive roommate. This qualitative difference i s obscured in ratings and interview schedules, particularly when groupings are made for s t a t i s t i c a l generalization. Differential response patterns of the kinds represented by Mrs. V/., and Mrs. P., gain depth and significance through a combination of both s t a t i s t i c a l and case study material. Mrs.M., one of the Low Participant group, illustrates the effect of uncontrolled variables on the study population and findings. She had a running feud with both her roommate and the woman in the adjoining single room. These women considered Mrs. M. a religious fanatic, and she, in turn, found them intolerable. She was persuaded to attend a few early programs. Her responses were grudging and minimal. Most of the time she sat, seemingly beyond reach. - 94 -In the course of general reorganization in the late spring she was moved into a single room. Research volunteers were surprised at the cordiality and enthusiasm of her welcome when they arrived for post-test interviews. She had joined enthusiastically in the last few programs, and was looking forward eagerly to the renewal of activities in the f a l l . The move to a room of her own made such a difference to Mrs. M., that i t i s impossible to judge whether the recreation program had some part in helping to bring about the slightly changed attitudes, or whether the new room was responsible. It i s too soon to judge whether the incipient gains may be maintained. Mrs. M. may now have the capacity to respond to future programs in a way which- was not possible as long as the shared room kept her discontented and frustrated so there was no room for other feeling. Some of the men participated at a low level or not at a l l . 1 The two most conspicuous examples, are both in single rooms and have been for many years. Mr. M., i s an excessively aloof British India cavalry man of 79 who states categorically that he has never belonged to any group or activity, and has never found anyone whose company he likes as well as his own. He is r i g i d in his attitudes, and has a high degree of resistance to any modification of his fixed pattern. Years of isolation.! have so molded his thinking that he i s probably unable to mmeMei of himself as being different. He'bannot stand corruption at any prio'e", so he does not watch television, l i s t e n to the radio, or read the newspaper. So complete is his denial of - 95 -interest or satisfaction in human companionship that i t seems unlikely that any group recreation program could reach him. He has been chi l l i n g l y polite v/ith volunteers who attempted several times to interest him in coming to the programs. His self-image may be dependent upon sustaining the demonstration of complete self-sufficiency. Any intimation of willingness to tolerate others would appear threatening to him. He reads for hours every day. Although his eyesight i s f a i l i n g and he knows glasses could be provided, he refuses to admit any loss of physical or sensory capacity and w i l l not have his eyes examined. In post-test interviews he f i n a l l y concluded that the volunteers could do something worthwhile i f they brought ponies for the residents to ride. He also thought they might replenish the books in the library since he has read everything available. Ponies, even in the large Taylor Manor grounds, may not be a practical program suggestion, though the po s s i b i l i t i e s are intriguing. However, the provision of special books for such isolated individuals could be valuable, and i t may be important to seek for just such unique points of contact. Perhaps Mr. M. illustrates a fundamental error in the implicit assumption that a l l residents w i l l be, or should be, accessible to a group program, or that they can a l l benefit i f they can be persuaded to attend. Perhaps more thought should be given to experimenting with individual approaches and stimulation of long-range individual interests - 96 -which could continue between the program periods. This could include provision of tapes or recordings of talks on topics of interest to these isolated individuals, recordings of plays or stories which would supplement books and compensate f o r f a i l i n g eyesight. The other low participant among the men i s as different from Mr. M. as possible. Mr. V., a s e m i - i l l i t e r a t e Lithuanian of 70 years, has a busy and s a t i s f y i n g l i f e through h i s role as house messenger and general chore boy. He i s thus able to i d e n t i f y with the active, employed s t a f f , rather than with the "old" residents for whom he thinks the program i s highly appropriate. For some eight years, since an operation that could have been permanently d e b i l i t a t i n g , he has cleared and wiped the tables a f t e r meals. He, has undertaken the household errands, which involve going by bus a l l over Vancouver and Burnaby, making purchases f o r s t a f f and residents, delivering documents, paying b i l l s . ' He stretches h is errands to j u s t i f y two t r i p s every day, and demonstrates that he i s far too busy to take time f o r t r i v i a l i k e games and picture shows. He thinks when he i s old and decrepit a recreation program might be good for him, but not now. It would be possible to so arrange h i s errands that he could be present on program afternoons i f he so wished. Despite his busy s a t i s f y i n g l i f e , he found the program did have added pleasure to offer when he was persuaded to stay i n occasionally during spring r a i n s . He became an enthusiastic though s t i l l an infrequent - 97 -participant. This occasional attendance i s probably close to optimum f o r Mr. V. It may be s u f f i c i e n t to help him adapt to a new and different pattern i f and when major change becomes necessary, without doing anything to damage his present feelings of competence and general superiority over the less active residents. Mr. V., Mr. M. and Mrs. A., the three lowest participants a l l have normal hearing. This would suggest, as would be expected, that functional hearing does not predispose to active group p a r t i c i -pation, -although hearing impairment may predispose to lowered p a r t i c i p a t i o n . Among the high participants, Mr. P., an e p i l e p t i c Ukranian, of 78, was much more responsive than could be accounted f o r i n terms of past associations, formal or informal. As a casual labourer doing heavy and often dangerous work, he had l i t t l e time f o r l e i s u r e a c t i v i t i e s . He belonged to the appropriate trade unions, but attended i r r e g u l a r l y and took no active part. His marriage ended i n desertion by his wife when he became incapacitated after a mine accident. He has norrelatives and no friends. Pie claims to know everyone i n Taylor Manor and to v i s i t with them, but he i s tolerated rather than sought by the other residents. He i s not considered a desirable associate, and other residents do not want to l i s t e n i n d e f i n i t e l y to his garrulous wanderings about previous marital troubles. He i s s l i g h t l y hard of hearing, l i m i t e d i n his English vocabulary, and completely i l l i t e r a t e . For him, the recreation program appears to have helped f i l l a long-time void of loneliness and lack - 9 8 -of warm social ties. He attended every program, and tried his best to join in, even when, as with a variation of Twenty Questions, the activity was quite beyond him. The volunteers generally made him feel included and wanted, and he sorely needed to talk to someone who would take a personal interest in him. He, perhaps more than most residents, responded eagerly to the research interviews, not because he had any interest in "something that would help us plan better ways to help other older people", but because these interviews provided opportunity to talk about himself to someone who was interested. He does not care why. He cannot think beyond his own immediate boundaries. He is unable to express conceptual refinements of attitude and reaction, he cannot give reasons for his feelings or t e l l why he likes something. Because the volunteers made him feel included and wanted, he has a new sense of personal worth. He has been asked to do small chores, putting out chairs and arranging games. He was always on hand to be asked, and occasionally made spontaneous moves to anticipate what was required. He has never been a d i f f i c u l t or disagreeable person, according to the staff, and his responses do not show much modification, but his delight in the program in fact, as v/ell as in both anticipation and retrospect, was unusually high. He was the second highest participant among the Low Past Activity group. On an objective basis there do not seem to be any clues which could have predicted his response. His peculiarly individual reasons are probably a variation of the universal basic need for the feeling of belonging and of personal worth which he has gained through the program, - 99 -and particularly from the presence and friendly interest of the volunteers. J •Attendance-attitude ratings were checked for three separate periods of 6 - 8 programs each, to determine whether marked variation occurred at different stages of the program. There is no consistent variation evident in general response patterns, hut individual response patterns vary considerably with differing individual needs at different times. Mr. H. was a low participant in November and December and again in March and Ap r i l , but was a regular attendant with f a i r l y high response in January and February. He could not then get out for his daily walk which he has taken, weather permitting, at the same time every afternoon for years. He appreciates the program and welcomes the opportunity to attend i f he must stay in. However no program devised could be sufficiently enticing to substitute for his walk, which he is convinced i s responsible for restoring his health after a major operation. He defers not want any marked change in his self-sufficient and comparatively isolated pattern, certainly not to the extent of becoming regularly involved in group interaction which he finds t i r i n g and overly demanding. He is uncomfortable in cars and when outings were planned^as they frequently were for the f i r s t and last program divisions, he rarely appeared downstairs. Mr. J., the man with the most c r i t i c a l hearing impairment and with no previous pattern of social participation, shows progressively higher responsiveness which seems attributable to two factors unique - 100 -to him. F i r s t , the volunteers wheedled him individually and talked with him often enough to overcome in part his suspicious isolation and to persuade him that he really was welcome and wanted. Second, one volunteer effectively demonstrated active concern by locating and reestablishing contact for him with two daughters in the East. He i s now in regular correspondence with part of his family after many years' separation. He seemed to be developing a sounder attitude towards himself and towards other people, largely through these side effects growing out of the recreation program but not conclusively identified or measured by the research instruments. Although he i s s t i l l relatively isolated and does not mix with other residents apart from program periods, i t i s possible that over a longer time resocialization could progress u n t i l he would not be disagreeably belligerent and withdrawn. It might be a long time before he could achieve spontaneous interaction with other residents. It might be that this can no longer be a r e a l i s t i c expectation for this particular man although he shows signs of wanting to be friendly and accepted. He i s the one who shows the greatest change in Social Awareness.1 In any case, slowly and hesitantly, he has come to accept the volunteers and i s deriving obvious benefit from what they are seeking See graph, Chart 2, p. - 101 -to do, even though he had often appeared disagreeable and i s among the low participants. He did take willing part in the two programs which residents staged for the volunteers, and his renditions of Onward Christian Soldiers on the accordion lent to him as a con-sequence of a desire expressed early in the program made up in enthusiasm what they may have lacked in melodic accuracy. His parting comment was revealing - "people around here are getting better". The recreation programs have stimulated at least two hteter-sexual companionships that were not in evidence before the program started, and other evidences of incipient heterosexual interests have been apparent during some programs. Ho one among residents or s t a f f thought of these friendships, which had been observed with interest, as friendships growing out of the recreation program. Failure to identify interaction changes of this kind through research interview 1 schedules is due, in part, to inappropriate wording in the schedules. Items which were planned to identify such data were not appropriately worded for a residential institution in which a l l residents knew one another after a fashion when the program started. They do not consider even markedly increased interaction as a "new friendship". The two friendships that were mentioned only came up accidentally through casual comment outside the scheduled questions. The general reaction of the residents i s exemplified in such diverse comments as: "It perks the old boys up". 'They dress up and ''"Schedule 9 , Appendix D, attempted unsuccessfully to e l i c i t information of this kind. - 102 -shave to meet the nice g i r l s - they never used to do that," and "The program made quite a difference around here - i t really livened things up." The data which have been presented indicate that some st a t i s t i c a l generalizations are valid, even on the basis of a limited sample, and that even where s t a t i s t i c a l significance i s lacking certain potentially significant trends can be indicated. Though the generalizing validity increases as population size i s increased and variables more effectively controlled, even conclusions based on a large population study would s t i l l need to allow some f l e x i b i l i t y to accomodate individual differences, i f adequate recreational planning for a l l old people in residential institutions is to be achieved. Chapter 4 Assessment ti>f the Response Patterns Research and practice in the social sciences are engaged in a continuous game of leap-frog 1 - each successful research study leads to some new knowledge or s k i l l which can he tested in practice and further sharpened through the formulation of new hypotheses and new research studies. Any catisal assumptions based upon findings with a limited and select population holds numerous p i t f a l l s for the unwary formulator of generalizations. Nevertheless i t i s necessary to attempt assessment of what has been achieved in a program and research study of the kind herein discussed. It i s important to consider what has been learned, and to see how this increased understanding might be applied to advance both planning and practice. In this chapter, an attempt w i l l be made to assess the findings of the thesis research and some aspects of the general study, and to indicate some areas in which further research i s needed. On the basis of the s t a t i s t i c a l data and the qualitative case material a number of tentative generalizations can be made. These generalizations indicate some guide lines for community planning which have significant implications both for volunteer programs and for social work professional concern with the needs of older people. Lynd, Robert S. Knowledge for What? Princeton University Press, Princeton, N.J., 1 9 5 ^ , p . 1 2 1 . • - 104 -1. The capacity for active group socialization in old age is related to earlier adult participation in group a c t i v i t i e s . Previous formal group participation i s but one of several avenues to the same end. The positive correlation established between present program participation and past ac t i v i t y formal group patterns could have a number of implications for improvement of life-long adaptability, even though no direct causal connection i s established. It does suggest that organized adult leisure time ac t i v i t i e s may be a foundation for effective later adaptation as well as a source of immediate pleasure. Those who have been active in community groups appear able to use group association to develop in old age new social roles which can contribute to happier and more satisfactory l i v i n g . Also, the indications are strong that informal contacts equip old people for the development of new roles through group leisure time activities as effectively as does organized group experience. Sociological studies have found that middle class people tend to join formal associations while lower class people tend more to informal and family socialization patterns. 1 The long term effects appear to be much the same, whether they are achieved via the club, the lodge or the pubs. However, varied opportunities need to be available for people to have satisfying adult group contacts, formal or informal. Increased av a i l a b i l i t y and diversity of community group resources could help extend opportunity and incentive for more people to enjoy the kinds of adult Kahl, op. c i t . , p.l4?. Also reference 33, p.156 of this book cites a number of supplementary references. - 1 0 5 -experiences which might f a c i l i t a t e transition to more rewarding old age. This would seem to be a significant area of potentially valuable community contribution to improved preparation for old age in societies which are experiencing such rapid and extensive increases in older age groups. Within recreation programs, knowledge of the interrelatedness of past group activities and present program response could provide volunteers with one clue to supplement observation, as an aid to early identification of people most l i k e l y to respond easily and quickly. These are the people from whom program volunteers might anticipate early active cooperation and some internal leadership which could sustain program effectiveness between the program periods. Time spent on stimulating the potential resources of these people early in a program series could have long-term value both for the individuals directly concerned and for the other residents who would probably benefit indirectly through extension of program goals. This knowledge could also help volunteers identify more quickly the people most l i k e l y to need special attention and encouragement. People who have not learned earlier in l i f e to get along well in groups can be helped to learn new ways in old age, but individual effort and a great deal of time i s required from those who want to help them. If these people can be identified early in a program series, more time, understanding and effective individualized help can be given to them, * with benefit both to themselves and to the other residents with whom they share their days. Subjective observations indicated that con-- 106 -cent-rated attention to people of this kind does appear to pay-dividends in helping them become more contented and accomodating. This social adaptability i s of primary importance in residential institutions where people are necessarily in close, constant contact. 2 . People with active social contacts apart from the programs tend to be responsive to group activity at a higher level than do those whose social contacts are restricted. This fact provides a clue in present behaviour, to f a c i l i t a t e early identification of socially alert people who might help relatively early in a new program with details of planning and preparation. These, again, may be the people able to provide continuing leadership within the homes i f they are located early and given appropriate encouragement, their more active social contacts are l i k e l y to be indicative of a f l e x i b i l i t y and capacity for getting along comfortably with other people. These qualities could be consciously cultivated through the group programs to provide a continuing asset i n the residential institutions. These, again, may be the people who could be able to provide continuing leadership within the homes i f they are located early and given appropriate help and encouragement. Individual observations indicate a need for some qualification in this connection. There may be a rare few among institutionalized older people who have high Social Contacts because they have continued such close association with family and friends outside the institution that their need for additional social activity i s minimal. Whatever their past activity or present social contacts, these people w i l l be - 107 -marginally active i n any program because t h e i r s o c i a l needs are already adequately met. The main focus of t h e i r interest i s outside rather than inside the i n s t i t u t i o n . Their seeming indifference and l i m i t e d interest even when they do attend may require interpretation to beginning volunteers. Conversely, some who have been s o c i a l l y deprived and inactive i n adult years may be ready, although s o c i a l l y inept, to take enthusiastic advantage of any opportunity f o r f r i e n d l i n e s s . Occasionally these peopHLe.-t r y to respond a c t i v e l y even at advanced age and i n spite of sensory handicaps. Their behaviour i s l i k e l y to be unpredictable and sometimes both amusing and bewildering, as they t r y , fumbling, to learn i n old age how to get along i n a group. Mr. P.1 i l l u s t r a t e s well that such learning i s possible f o r the s o c i a l l y inept, and that i t can help modify loneliness and unhappiness. Warmth and sympathy can accomplish a great deal, whether or not there i s i n t e l l e c t u a l understanding of individual and c u l t u r a l dynamics. However, such e x p l i c i t awareness might help bring more controlled results i n a shorter time because i t could help eliminate r e p e t i t i v e t r i a l and error. 3 . Hearing impairment may have some r e s t r i c t i v e effect upon the l e v e l of group p a r t i c i p a t i o n , but careful attention to individual and group hearing problems can compensate i n large measure for such d i f f i c u l t i e s . Although hearing d i s a b i l i t y , as defined i n the present study, does not show s t a t i s t i c a l correlation with program p a r t i c i p a t i o n , See page 97. - 108 -examination of response patterns indicates that some residents with hearing impairment tend to participate at a lower level than might be anticipated on a basis of previous group activity patterns. A number of people commented on problems related to hearing in the confusion of group a c t i v i t i e s . The lack of s t a t i s t i c a l correlation may be due in part to the deliberate and.commendable effort of volunteers to compensate for hearing d i f f i c u l t i e s in presenting the programs. Volunteers were often stationed strategically to interpret information at close range for people who might have d i f f i c u l t y hearing general directions or travelogue descriptions. Residents were encouraged to help one another with games instructions. The general principle of auditory aids and concessions for the hard of hearing i s sound in any program for older people. One resident of 9 2 who does not have trouble herself suggested that a microphone would be a great help for "the poor old souls who can't hear what's going on." In general, the findings of the present study are in agreement with Havighurst and Albrecht!s conclusions 1 that response to social activity tends to be more a function of life-long personality characteristics than of physical limitations developed in later years. Residents who had rev/arding social experiences in earlier "'"Havighurst and Albrecht, op. c i t . p . 2 9 5 . While "health handicap scores are negatively correlated with personal adjustment and with role-activity, to a reliable degree, the coefficients are low enough to indicate that health handicaps alone do not cause poor adjustment or low role activity." - 109 -adult years tend to be sociable and eager to join in group activity despite hearing problems, while those who have been characteristically isolated tend to continue a similar pattern whatever their level of hearing capacity. For the volunteers, the possibility of uneasiness and suspicion among those with hearing defects may be a problem which requires deliberate, continuing individual attention such as that which v/as accorded to Mr. J . 1 It is readily evident from the case material that this man's progressive improvement was due to careful, sustained personal friendliness. This individual help overcame his suspicion and distrust. Through the mediation of sympathetic volunteers he appears to have been brought into somewhat better contact with other residents. Understanding the dynamics of this kind of response change is important for the development of a consciously effective volunteer role in programs of this kind. The interpretation of such individual dynamics i s one of the v i t a l contributions of the social work project director. 4 . Planned provision for probable differences in response and interests of different socioeconomic groups i s a v i t a l factor in program planning and assessment. Observations of the different response patterns which are' in part a result of earlier socioeconomic groupings suggest that this may be a significant factor in program planning for old age institutions. For example, one-time loggers1 and casual labourers might find pleasure in wood carving which would be acceptable in terms of their own self-See page 33 . - 1 1 0 -concept, but reject ceramic crafts >which :could appeal more readily to former office workers. Awareness of the origin and possible effect of such subcultural differences might help volunteers anticipate and fore-s t a l l some of the resistance which may arise i n social and l i v i n g situations when people of different socioeconomic backgrounds are in enforced proximity. It i s important to understand what each group may consider important, how their socioeconomic background may have conditioned their expectations and attitudes relative to themselves and to others of different backgrounds. Recognition of factors related to socioeconomic subcultural conditioning could aid volunteers in understanding the possibility of a r t i f i c i a l barriers within the institutional group. The division i s li k e l y to be particularly marked between the former casual labourers and the white collar groups, both of which are represented at Taylor Manor. The attitudes are indicated i n comments of Mrs. P.1 who found many residents "not what I've been used to." Through the programs residents of different backgrounds can be. and to some extent have been helped to find a new and rewarding community of interests in a current l i f e which they share with people" of many backgrounds and interests. When this capacity extends beyond the program periods, the total program can be considered effective on a long range as well as on an immediate basis. In part such extension is related to overcoming inappropriate socioeconomic barriers through See page 89. - 1 1 1 -the medium of shared recreation and new interests. The research study-was not set up to measure this factor. The available data are largely subjective, but sufficiently indicative to suggest further study. Conscious awareness of the meaning these background differences may have to different residents could help volunteers provide more effective service. 5. Recreation programs are believed to increase positive social contacts within the residential institutions, and to con-tribute to improvement in resident attitudes and l i v i n g satisfactions. Although s t a t i s t i c a l evidence is meagre and inconclusive, the graphs suggest there may be a positive trend in some of the selected c r i t e r i a of program effectiveness. Subjective observations of staff, volunteers and research interviewers support this belief. The f i r s t interviews revealed low or non-existent social interaction among residents. There were few spontaneous associations for card games, checkers or v i s i t i n g , an almost complete lack of heterosexual companionships. There are indications that program home residents increased the frequency'of contacts for conversation and shared activities between program periods. Some checkers partner-ships developed on a sustained though irregular basis. Throughout the program period there was a great deal of anticipation of programs. Many residents gathered in the ha l l to await the arrival of the volunteers, and there was some chatting and exchange of comments at a level which was not evident at the beginning of the program period. Social interaction of this kind \ - 112 -i s a v a l u a b l e by-product of the programs. I t i n d i c a t e d tha t the programs are p r o v i d i n g r e s i d e n t s w i t h "something to be s o c i a l a b o u t . " 1 The programs p r o v i d e d a channel f o r handicapped r e s i d e n t s who moved i n t o Taylor Manor i n the l a t e s p r i n g to become acquainted more e a s i l y and q u i c k l y than would have been l i k e l y o t h e r w i s e . S e v e r a l r e s i d e n t s named these new-comers on p o s t - t e s t schedules as "new f r i e n d s made through the programs . "^ T h i s u n a n t i c i p a t e d i n d i c a t i o n c o u l d have major s i g n i f i c a n c e f o r o l d age r e s i d e n t i a l i n s t i t u t i o n s i n which there i s a g r e a t deal of p o p u l a t i o n t u r n - o v e r . I t was ev ident i n comments about the new r e s i d e n t s tha t d i r e c t i n t r o d u c t i o n s are r a r e , and tha t t e n s i o n and u n c e r t a i n t y a s s o c i a t e d w i t h new r e s i d e n t s i s common. Although the r e a c t i o n s of the new r e s i d e n t s are not a v a i l a b l e , i t seems probable t h a t there would be a r e c i p r o c a l i n t e r a c t i o n . A program which c o u l d h e l p develop a f e e l i n g of b e l o n g i n g and ease the t r a n s t i t i o n i n t o a new and strange s e t t i n g would have h i g h community v a l u e . I t may be t h a t t h i s aspect of the program should be g i v e n s p e c i a l emphasis . Perhaps Welcome P a r t i e s f o r new r e s i d e n t s , w i t h games and a c t i v i t i e s d e l i b e r a t e l y designed to i n t r o d u c e them and make them f e e l welcome would ease t e n s i o n and r e l i e v e the p o s s i b l e resentment and h o s t i l i t y of o l d e r r e s i d e n t s . T h i s c o u l d c o n c e i v a b l y 1 A n d e r s o n , Tlie Psychology of Development and P e r s o n a l Adjustment op. c i t . p . 3 6 6 ? "Appendix D, schedule 9 . - 113 -make a contribution to improving the atmostphere of old age institutions for new and established residents alike. 6 . Programs may help to compensate for the inescapable problems of environmental i n s t a b i l i t y . !" Uncertainty and recurrent disruption of unexpected kinds seem to be the norm for many old people, particularly those l i v i n g in small private institutions. Experience in the broad research study indicated a l l too clearly how l i t t l e s t a b i l i t y is to be anticipated i n the environment of institutionalized old people, even over a period of a few months. The uncertainties may have to be accepted as inescapable hazards at the present stage of community development in provision for old age care. It seems more than coincidental that of the six carefully selected program and control homes none were free of major c r i t i c a l changes. Such changes could not help but prove traumatic and disruptive to more adaptable members of society, than old people are generally assumed to be. The effects of such disruption upon the old people are distressing to conjecture. Perhaps i t is l i t t l e to be wondered that so many of them seem to be withdrawn and apathetic - indrawing of ego boundaries i s a natural response to upheaval and threatening circumstances at any stage of the l i f e cycle, and old people in institutions seem to have a disproportionate share of such stresses. Of the six homes, Taylor Manor, the only publicly owned and operated boarding home in Vancouver, was the most stable even with the threat of major change overshadowing residents and staff alike for some months prior to and at the beginning of the program - 114 -period. The other homes had changes in operators, major changes in staff, disruptions due to staff illness and consequent shortages of help, and major changes i n admissions p o l i c i e s . 1 With this general background of environmental i n s t a b i l i t y i t seems evident that the cohesive values derivable from a recreation program which may help build feelings of acceptance and of comfortable belonging relatively quickly may be particularly important for old people subjected to so many problems which seem outside the bounds of immediate individual or community control. Inconclusive Findings The lack of significant s t a t i s t i c a l correlation between program participation and various factors such as age, marital status, 2 native language and length of time in the residence suggests that A private hospital changed from a general care to a specifically rehabilitative centre, a control home altered to care primarily for rmeriiaTly retarded people rather than aged women, the control private hospital was combined with another unit and most of the original population was distributed to different boarding homes and private hospitals throughout Vancouver and the lower mainland. One program private hospital rejected the research study as too time consuming after i n i t i a l plans ha"d; been made. The program was introduced here, but with severe and prolonged d i f f i c u l t y for volunteers. After 4-6 months, volunteers f e l t they had f i n a l l y overcome staff misgivings and found they had developed a cooperative and welcoming atmosphere with appreciative response from staff as well as patients. It took time, patience and s k i l l on the part of the volunteers, several of whom were trained nurses with practical appreciation of hospital problems i n terms of routine. See page 74(Ref. to Table 4, Chapter 3) - 115 -these have l i t t l e over-all effect upon the level of program participation, although they may he important influences upon any particular individual's response. The implications of subjective attitudes to age are particularly interesting. It seems probably that the individual self-concept as "middle-agedy "elderly" or "old" may be of greater significance than the chronological age. One man of 62 who referred to himself as "old" obviously f e l t and acted that way. A woman of 87, on the other hand, maintained sne;.had:,r;ot yet f e l t "elderly". Subjective differences of this kind are d i f f i c u l t to study precisely, but they are probably of considerable significance both as determinants and as c r i t e r i a of adjustment. They would probably provide valuable clues about general f l e x i b i l i t y and readiness to take part in group a c t i v i t i e s . General Conclusions The project study indicates that though there are undoubtedly ways to continue improving program effectiveness, there may be no failures i n a program such as the one under review. As long as there i s even minimal provision for both individual and group needs, most residents in program homes appear to gain something, even though the gains are not readily measured and not necessarily just what i s anticipated. It i s important to have as precise c r i t e r i a as possible, and to include continuing immediate and long-range evaluation of program results. These help provide for progressive growth and incentive for the volunteers, as well as dynamic guide lines for - 116 -program extension which are of direct concern to the social work profession. Some of the guide lines have been indicated. Some require further research to determine more precisely what needs are involved, how they can be met most effectively with the available resources, or how resources can be developed further to meet the needs as they are identified. Need for further Research There are many potential research problems which emerge from the present study and from general observations of the diverse needs of institutionalized old people. Some of these have been mentioned as they became evident in the study. The additional ones specifically suggested here may be divided into three broad areas within which research studies could hehp to improve understanding of the needs of old people, and to find better ways to meet some of these needs through recreational a c t i v i t i e s : 1. Studies relating to general characteristics of old people. 2 . Studies relating to differing needs of old people in different settings. 3. Studies relating to recreational programming, and the effect of various activities upon different old people. 1» Studies Relating to General Characteristics of Old People (a) Studies to identify the self-images of old people in institutional settings, their concepts of t h t i r own and oi" other people's roles* - 117 -Such studies would help delineate the broad problem of identifying and defining needs, which i s preliminary to appropriate provision for meeting them. It seems highly probable that many old people are clinging to anachronistic identifications and self-concepts which have carried over from earlier social contacts. It i s not known in any definite way who their reference groups a.re when they come to l i v e in an institution, and what changes, i f any, occur in the composition of significant reference groups as a consequence of institutionalized l i v i n g . It i s not known how they see themselves and their role as institutional inmates, although i t seems highly probable that for many the concept i s largely a negative one. More specific knowledge could indicate where recreation might help modify and. reshape outdated concepts, and build new ones to f a c i l i t a t e better social functioning i n the institutional setting. (b) Studies to assess the concept of "disengagement" as a part of the normal l i f e cycle, and to consider the appropriateness of efforts to stimulate reengagement for different people. No one prior to Cumming and Henry1 appears to have considered seriously the possibility that the generalized withdrawal of the old may be a normal part of the l i f e cycle, a pattern which should possibly be accepted and aided. If this i s indeed so, i t would necessitate rethinking of research designs, social work attitudes and recreational planning, a l l of which have tended to assume unc r i t i c a l l y that disengagement i s always undesirable and should invariably be Cumming and Henry, Growing Old, op. c i t . - U S -interrupted i f possible. It i s r e a l l y not known as yet the extent to which a l l or some old people do r e s t r i c t ego boundaries and withdraw from s o c i a l functioning as a part of a natural development sequence. This may coincide with or be an aspect of the breakdown which results i n entry into a r e s i d e n t i a l i n s t i t u t i o n . For some, with-drawal and disengagement may be a natural corollary to the gradual decline which made i n s t i t u t i o n a l care necessary. For others, the apparent "disengagement" may have been enforced as a result of overwhelming stress and may not be part of such a normative sequence. I t has been demonstrated that many who have seemed f a r advanced i n "disengagement" develop a measure of renewed interest and soc i a l responsiveness within i n s t i t u t i o n s when opportunities f o r r e s o c i a l i z a t i o n are provided."'" Studies which would help determine to what degree and f o r which people re-engagement can and should be stimulated would be helpful i n establishing the range of goals f o r recreation programs and i n planning the most effective deployment of available resources. Perhaps what appears to outside observers as "vegetative withdrawal" i s not an unqualified e v i l . . The p o s s i b i l i t y should be explored objectively no matter how contrary i t seems to s o c i a l workers' convictions about the l i f e - l o n g potential f o r growth and development, and the sweeping enthusiasm of some group work proponents who see joining i n group a c t i v i t i e s as the ideal desirable p a r t i c i p a t i o n f o r everyone. The function of research must be to examine such "'"Experience at Valleyview Hospital supports t h i s . - 219 -attitudes and the various possible programs with a view to determining what i s good for whom under what circumstances and with what results. This kind of objective examination i s one general contribution research can make to the growth of social work attitudes and practice in many areas. (c) Studies to identify and analyze cross-cultural communication patterns, and ways of modifying obstacles to effective communication. Generally, interactions within institutional settings appear to be routine and formalized. This i s believed to be due in part to d i f f i c u l t i e s arising out of differential communication patterns i n different socioeconomic subcultures. Middle class people are familiar with a host of distinct "reasons" for performing certain acts 1, a fact which was evident in many comments relative to the recreation programs. They understand appeals to values and abstract concepts; they might well enjoy projects with a community service connotation. Lower socioeconomic groups do not have comparable recognition of abstractvverbal "reasons". They have d i f f i c u l t y expressing attitudes or opinions about the programs, the home, or other residents. Their usual answers tend to be of the "It's alright" order. It i s probably f u t i l e to appeal to many lower socioeconomic class people for assistance in a research study "to help find ways of improving things for other old people". It i s quite possible to talk to them about what might make l i f e better for them and for their 1Schalzman, Leonard and Strauss, Anselm, "Social Class and Modes of Communication", American Journal of Sociology, Vol. '60, 1955. pp. 329-38. This study provides some foundation for assumptions relative to differing socioeconomic class communication patterns. - 12.GD -fellow residents here and now. Many of the research instruments which have been developed are reasonably well validated for the middle class groups who can respond i n the abstract terms anticipated by those who developed the instruments. The non-committal answers of many of the lower class groups may reflect, not their true reactions, but their i n a b i l i t y to express their feelings i n words which can be numerically scored. The responses which they give may well distort study findings i n unanticipated ways. Development of more adequate, comprehensive research instruments would be of great value for a l l studies of older people. (d) Studies relating to attitudes to authority, both generally and specifically relative to recreation. In ; any institutional setting, however permissive and considerate the management, the staff have to assume some authority, direct and indirect. Some elements of authoritarian direction are an almost inescapable consequence of the dependence which made institutional care necessary. Submissive acceptance and dependence upon others to make decisions may condition institutionalized old people to expect to be told what to do, and to assume i t i s right and necessary for them simply to follow directions. For those who are not withdrawing as part of a normative pattern, i t i s sound therapy to have as many areas as possible in which they can have a share, however slight i t may seem, i n deciding what they want to do and how. Such experience in independence could - 121 -be deliberately provided as a part of recreational programming i f the need f o r development of appropriate independence could be established. There would be value i n studies of different programs and t h e i r r e l a t i v e effects i n terms of dependence-independence stimulation. There i s no objective way to determine the r e l a t i v e effectiveness of past programs. However, knowledge of human dynamics would suggest that the greatest value f o r many Taylor Manor residents may have derived from the programs which residents planned together and staged f o r the Junior League volunteers. The values which were involved i n these programs might be translated into general programs by helping residents to take part i n planning and a c t i v i t y committees to carry out some of the program preparation. Research into the d i f f e r e n t i a l effects of p a r t i c i p a t i o n vs. passive onlooker programs would be of great value i n assessing results and providing a sound basis f o r long range planning. 2 . Studies Relating to D i f f e r i n g Heeds i n Different Settings (a) Studies of the v a r i a t i o n i n need patterns between old people l i v i n g i n t h e i r own homes, those i n public housing developments, and those i n boarding homes and private hospitals. Observations of program volunteers and research interviewers confirmed observations of the Committee on the V/elfare of the Aged that both boarding home and private hospital residents are recreationa deprived. They have further confirmed the Committee anticipations that recreational a c t i v i t i e s can be of value to some residents i n both the l a t t e r types of i n s t i t u t i o n a l settings. However, the pra c t i c a l experience of the volunteers has revealed that there are - 122 -marked differences in the kind of programs which can be most effective not only in the two broad institutional types but within the categories. What i s good programming in one boarding home may be generally unwelcome and ineffective in another. The whole range of differential leisure time capacities and requirements on a group as well as an individual basis requires a great deal more careful study. It seems probable that some of the differences are related to such variables as physical setting of the institution, location in relation to stores and other community resources, attitudes of the staff and time available for assisting residents outside routine care, as well as to personality and interests of particular groups of volunteers. Research examination of various combinations of relevant variables would be helpful in working towards general improvement i n community planning for institutionalized aged. A word of caution might be appropriate in this connection. The experience of the research study with reference to negative attitudes of home operators has been noted. These operators are busy and frequently not overly sympathetic to other than physical needs of their residents. They are l i k e l y to be resentful of inquiries which absorb their time for no return i n terms that are meaningful to them. Effective research in institutional settings i s possible only with the active staff interest and help which may be exceedingly d i f f i c u l t to enlist. One possible approach might be through general education and discussion in the Boarding Home Operators' Association. - 123 -(b) Studies of the effect upon residents of the physical location of the institutional residences. It may be that the distances people have to travel to use community leisure time resources has a direct bearing upon the kinds and variety of programs accessible to them in the community. There i s need for more accurate information about the effect of the location of both residential and recreational resources on the quality of old age l i v i n g . It may also be important to study the effect which the knowledge the home operators have about resources has upon the use residents make of those community resources which are physically accessible to them. 3. Studies Relating to Recreational Programming (a) Studies to determine what institutionalized old people perceive as their own leisure time needs, what activities they esteem and what they want from a recreation program. Many of the study population were inarticulate and unable to express preferences ov formulate interests verbally, yet this does not necessarily mean they lack preferences. It has been noted that their d i f f i c u l t y may be in some part a manifestation of differences in communication patterns. Lower socioeconomic groups tend to think at a concrete level and have had l i t t l e practice with or interest in abstract, generalized thinking. It may also be in part because institutionalized old people do curtail their individual preferences and desire for self-expression as an aspect of their institutionalized role. It would be helpful to explore through combined practice and research possible methods of helping people become more articulate, possibly through discussion and trial-and-error programs, with assessments by - 124 -groups of residents about their preferences and the reasons they can give together. Those unaccustomed to stating reasons could perhaps learn in this way from those who can express themselves more readily. (b) Studies of controlled experimentation with attempts to involve old people in planning and carrying out their own a c t i v i t i e s . It has frequently been observed that old people tend to be passive i n their response to recreation,, and want to 'have done for them".1 Other reports have indicated that creative leadership has sometimes been able to stimulate apparently dependent, passive groups to sustained and creative indigenous activity. Controlled experimentation with methods of involving old people in planning and carrying out various parts of their own programs would provide a f r u i t f u l f i e l d for research study. Such information needs to be more widely available in order to prevent prolongation of wasteful t r i a l and error in each new program, since there are unquestionably some common principles which could help towards more effective use of volunteer time and more rewarding program experiences for old. people. A further objective of studies in this area might be to determine variables related to different level of participation in various kinds of programs, and to study ways of allowing for differing' levels within any single program period. The programs cannot and should not be geared always at the level of Bingo and slide viewing, but those whose personal resources are limited should not be made to feel l e f t out when more demanding programs such as variations on Twenty Questions are planned. Andresson Edda. Local Recreational Resources for the Aged, A Comparative Study of Two Vancouver Districts. Master of Social V/ork Thesis, University of British Columbia, 1958. p.58* - 1 2 5 -(c) Studies to determine the optimum length and frequency of recreation programs for old people. In Taylor Manor, because of the large population and the number of volunteers required each time, programs were planned for once a week. This seemed the best arrangement according to residents who had not had other timing, although a few of the old people said the volunteers could come as often as they wanted and would always be welcome. In a private hospital in which twice-weekly programs were reduced to one a week, volunteers were surprised to be asked i f they could not come as they had i n i t i a l l y , and this by people apparently marginally responsive. It may be there i s a different optimum pattern for each setting. It would seem desirable to experiment and study the differential effects of program at different frequencies with controlled observation of different responses. (d) Studies to determine what kinds of activities are most effective in stimulating interaction which carries over between program periods. An excellent research study might be developed by enlisting the aid of residents to have them keep time diaries for a week prior to the introduction of a recreation program, and again after a six to eight month program series. Their reports could be related to program content in order to determine the extent to which various programs had affected differences in frequency of activities and inexpressed interests. (e) Studies of ways to create a stimulating and effective environment for older people in institutions, identifying the place recreation should have, the ways i t i s best presented, and by whom i t is most effectively planned and presented. - 126 -Controlled experiment could help establish whether recreation i£f most e f f e c t i v e l y provided by bringing recreational a c t i v i t i e s into the homes, or by trying to involve residents i n community a c t i v i t i e s . In one home close to a community centre t h i s has been done with f a i r l y good r e s u l t s . In Taylor Manor there was discussion i n the volunteer group about p o s s i b i l i t i e s f o r inter-group a c t i v i t i e s with Hastings Community Centre, but t h i s was not attempted i n the year of the study. The Objectives of Research and Planning Some of these and s i m i l a r questions research dould help to answer. Underlying a l l research and planning there must be constant awareness of the dangers inherent i n generalizations such as "p a r t i c i p a t i o n i n groups i s good f o r people", "leisure time a c t i v i t i e s help to good adjustment". The objective of research i s to help determine what kinds of p a r t i c i p a t i o n i n what kinds of a c t i v i t i e s o ffer what "good" f o r which people i n what ways and under what circumstances. This objective has s i g n i f i c a n t implications f o r s o c i a l work practice, which seeks answers to many of the same questions largely on an ind i v i d u a l basis which i s impractical as a foundation f o r sound s o c i a l planning. Both research studies and program planning need to be based upon an on-going developmental approach rather than upon any s t a t i c concept of adjustment. Since, r e a l i s t i c a l l y , funds f o r research study and people interested i n such study are severely l i m i t e d , much of t h i s kind of thinking and analysis needs to be b u i l t into the recreation programs. Therefore, the concluding chapter w i l l attempt to suggest a broad framework f o r an on-going program with such a research and evaluation orientation. Chapter 5 The Program in the Community The development of the thesis as suchhas been completed in the preceding chapters. It i s proposed in this concluding section to draw upon observations made i n the course of the thesis research, and upon experience gained as an interviewer in the general research .study, to outline some considerations which may be of value in considering extension of this kind of program within the broad community. The Junior League experimental project was planned for a three year exploratory period to determine what could be accomplished by a voluntary friendly v i s i t i n g and group recreation program. The broad purpose was to gather information concerning the needs of institutionalized older people and to develop some effective methods of meeting these needs. It has been demonstrated in the pilot project that trained volunteers working with professional consultation can achieve some results both satisfying to themselves and rewarding to many old people l i v i n g in boarding homes and in private hospitals. Even though precise s t a t i s t i c a l confirmation has not been possible, the results of the experimental program appear to have been sufficiently positive,- that i t i s to be hoped the experienced Junior League volunteers may be willing and able to continue through a further developmental stage to extend the program to more residential institutions in the community."'* The comments in the present discussion represent "'"Discussion in this chapter i s based upon observations made during the second year of the program when the Research Study was in progress. Since that time, a beginning has been made towards recruitment and training of community volunteers which might have a determining influence upon future developments which were not anticipated when this cehap-ter was written. The luiderlying principles discussed in this section are believed to be generally relevant whatever detailed decisions may be made. - 128 -an outside viewpoint which might provide a helpful focus for discussion to determine long range policy which wi l l ensure the more effective use of the experience already achieved. The experience and knowledge which have been gained in the exploratory phase of the program are social welfare assets which'should be shared with the community as a whole. There i s need; - To c l a r i f y long-range goals in terms of what seems desirable and possible on a continuing basis. - To chart as precisely as possible the requirements for volunteer programming of the kind required to achieve best results. - To provide for continuing assessment of the programs. The i n i t i a l project was a preliminary one, limited i n time and scope, in response to a broadly defined community need. That need is a continuing and increasing one. It is much more extensive than that which has been tentatively met i n the four program homes.1 Some awareness has been gained of the extent of the needs, and i t has been shown that these needs can be met in part through a friendly v i s i t i n g and general recreation program. Prom the community standpoint i t i s important that there should be development and extension of the results already achieved. Possible developments w i l l be considered under four general areas in which Junior League knowledge and practical experience represent a valuable community resource. It i s important that this resource should be available for community benefit whatever the organization or form of future programs may be. The areas proposed for discussion are: 1As this thesis i s being written, a beginning has been made to extend the program with community volunteers working cooperatively v/ith the Junior League volunteers in additional homes. - 129. -1. Community education, 2. Recruitment and training of volunteers. 3 . Programming for individual and group needs. 4. Assessment of programs. Community Education Volunteers who have participated in the exploratory programs have gained a wealth of knowledge and direct experience. A part of this i s recorded in the reports of the Project Director, a part i s recorded in the broad research study, a part rests in the personal awareness of each individual volunteer. This knowledge can be valuable in stimulating community concern for the general and recreational needs of older people in residential institutions - needs which generally are not now being met. The recreation program has developed a foundation of knowledge and practical experience which can be a basis for community action but the community w i l l not come seeking the knowledge. Moreover, with the ever-expanding dimensions of the total problem of old people 1 and of community social welfare needs, the community can i l l afford repeated t r i a l and error methods. Some mechanisms for sharing the knowledge gained, both on an individual and. on a group basis, i s believed to be an essential part of f u l f i l l i n g the social contract which was implicit in the undertaking of the exploratory program. 1. When the program was suggested originally, in January 1960^there were some 1500 residents in 80 licensed Boarding Homes and Private Hospitals. In January 1962 there were 1800 beds in 125 institutions, and most of these were for care of old people. - 130 -Effective fulfillment of this phase of public responsibility involves seeking opportunities to share the knowledge with as many segments of the community as time and opportunity w i l l allow. Programming of the kind required for a l l interested residential institutions would require both financial and volunteer support from additional community resources, private, public, or both. This kind of interest and support develops only out of gradually stimulated awareness and progressive knowledge. It takes time and effort. The responsibility of the knowledgeable volunteers i n this area of community education i s two-fold: (a) To help educate a responsible and concerned public opinion which w i l l support development on the foundation already begun. (b) To help educate groups and individixals to a special interest in the need, which may lead gradually to a broadened base of volunteer participation. Cooperative planning and action with the Committee on the Welfare of the Aged and the Volunteer Bureau would seem to be a logical approach to community education of the needed kind and dimensions. Letters to organizations advising them of the program and the need i t attempts to meet i s a beginning. Such letters alone cannot be expected to produce the kind of interest and sustained response needed. An aggressive seeking of opportunities to t e l l as many groups as possible about the kind and extent of the need, and what i s being done through the program, i s much more li k e l y to stimulate the kind of interest which would lead gradually to - 131 - . community support and active p a r t i c i p a t i o n . Much of t h i s •'te l l i n g " can be done most e f f e c t i v e l y by the volunteers who speak from f i r s t hand awareness - they can share what they themselves actually know and t e l l of what they have done i n ways which are f a r more meaningful to other potential volunteers than the most convincing and accurate speech any professional can make. 2. Recruitment and Training of Volunteers In addition to the general community education there i s the more intensive r e s p o n s i b i l i t y f o r recruitment and t r a i n i n g of volunteers to develop and extend the exploratory program. There may be many people who would be w i l l i n g to serve i n recreational programs of t h i s kind, were they aware of the need and aware of what can be accomplished, and, perhaps most important of a l l , i f they could be given continuing encouragement and support while they learn. Many of those v/ho could be potential r e c r u i t s might well need encouragement and extensive t r a i n i n g to equip them to f e e l comfortable i n work of t h i s kind. They would probably need more than was necessary f o r the Junior League volunteers who were already p a r t i a l l y trained through t h e i r own organization's program. The Junior League as an organization accepts r e s p o n s i b i l i t y f o r regular, dependable performance of i t s members. I t cannot undertake comparable r e s p o n s i b i l i t y f o r the performance of community volunteers. Yet there must be a comparable degree of - 132 -responsibility undertaken by a l l volunteers i f the program is to develop effectively. It i s thought that the Junior League volunteers could perform a valuable individual service through sharing with community recruits their awareness; - of the importance of consistent, dependable volunteer performance - of the meaning this dependability has for the old people - of the importance of careful program planning of the rewards that come from sustained and disciplined effort of the kind they have made. This emphasis also would reach potential volunteers with greater impact from people with direct comparable experience than from the words of a. professional expert. Erratic attendance and poor planning would be harmful both to the old people and to the volunteers, and would rapidly antagonize home operators. Some of the home operators' resistance and suspicion which was encountered at various points in the program and research study is believed to be rooted in unfortunate past experiences with groups who did undertake poorly planned, abortive programs. As a foundation for the extension of volunteer effort i t would be valuable for Junior League volunteers to define as clearly and precisely as possible the goals they as volunteers have sought to reach, and their thoughts about the best ways to reach these goals according to their present practical knowledge. This knowledge has been achieved through their direct experience, their study and evaluation in planning groups and in the Advisory Committee, and through the additional assessments of the research study. A l l this information - 133 -needs to be drawn together in a form that can be interpreted to people unfamiliar with the many aspects of the program and the kinds of problems encountered in various institutions. 1 Before wide extension on a community basis i s considered, i t is essential for the Junior League to determine what i t s own place can and should be i n an on-going program. If i t can be encompassed within the organization policy, i t i s believed to be of primary importance to the development of the program to have the experienced Junior League volunteers continue in an active capacity to provide demonstration and leadership for a further development period. The fundamental policy decisions are basic to whatever pattern of community development may be undertaken. When this basic policy i s established, i t w i l l be possible for those concerned to determine the best and most effective ways to develop program extension, either through a parallel community volunteer program with some guidance and assistance from the experienced Junior Leauge nucleus, or through some arrangement wherein community volunteers could share as observers and participants for an apprentice-ship period with experienced Junior League groups. The volunteers have a great deal of direct knowledge which would be of primary importance i n developing an effective training program for volunteers recruited from the community. Such a training program would need to provide for understanding of the individual and group needs of older people - their need for personal recognition, 1An excellent beginning has been made in the Volunteer Manual for Senior Citizens project which was for the 1962-63 season. - 134 -f o r f e e l i n g s o f b e i n g w o r t h w h i l e members o f s o c i e t y , f o r s a t i s f a c t i o n i n t h e s e c u r i t y o f f r i e n d s h i p and o f b e l o n g i n g t o a gr o u p . Some u n d e r s t a n d i n g o f t h e changes e n f o r c e d by i n s t i t u t i o n a l l i v i n g , t h e pro b l e m s w h i c h t h i s has r a i s e d i n terms o f i s o l a t i o n , l o n e l i n e s s and l o s s o f t h e sense o f p e r s o n a l w o r t h , a r e i m p o r t a n t b a s i c p a r t s o f v o l u n t e e r p r e p a r a t i o n . I t i s a l s o n e c e s s a r y f o r v o l u n t e e r s t o u n d e r -s t a n d what r e c r e a t i o n can be e x p e c t e d t o c o n t r i b u t e t o m e e t i n g t h e many needs, and t h e v i t a l l y i m p o r t a n t p l a c e o f t h e v o l u n t e e r i n t h i s k i n d o f a program. A p a r t o f n e c e s s a r y b a s i c t r a i n i n g i s an u n d e r s t a n d i n g o f f u n d a m e n t a l human needs, and t h e p a r t i c u l a r ways t h e s e needs a r e •being met o r d e n i e d i n t h e l i v e s o f i n s t i t u t i o n a l i z e d o l d p e o p l e . The d e t a i l e d s p e l l i n g out o f i n d i v i d u a l needs, and o f t h e program g o a l s w h i c h emerge f r o m them i s d i f f i c u l t . I t t a k e s t i m e and i t t a k e s u n d e r s t a n d i n g o f t h e o l d p e o p l e and t h e i r ways o f r e s p o n d i n g . I t i n c l u d e s l e a r n i n g s o m e t h i n g o f each o l d p e r s o n ' s f o r m e r l i f e and i n t e r e s t s , v/hat t h e i r p r e s e n t s o c i a l c o n t a c t s a r e , what moving t o an i n s t i t u t i o n meant t o t h e i r l i v i n g p a t t e r n s and t h e i r f e e l i n g s about t h e m s e l v e s . I t i n c l u d e s s t u d y i n g each p e r s o n i n terms o f h i s p a r t i c u l a r i n t e r e s t s , and what i s h a p p e n i n g i n t h e i n s t i t u t i o n t o f u r t h e r o r t o f r u s t r a t e t h e s e i n t e r e s t s . I t i n c l u d e s a s s e s s i n g what t h e group programs o r t h e p e r s o n a l c o n t a c t w i t h v o l u n t e e r s might have t o o f f e r each r e s i d e n t . The J u n i o r League v o l u n t e e r s have done many o f t h e s e t h i n g s . However, t h e y may n o t alw a y s have t h o u g h t out c l e a r l y and e x p l i c i t l y how p a r t i c u l a r p r i n c i p l e s were i n v o l v e d i n t h e i r p l a n n i n g d i s c u s s i o n s , i n t h e s e s s i o n s t h e y h e l d w i t h home o p e r a t o r s t o f i n d o u t about t h e - 135 -residents, i n t h e i r preliminary personal v i s i t s and. t h e i r continuing contacts- with each resident. To do t h i s kind of a n a l y t i c a l thinking as preparation f o r t r a i n i n g other people might well help to c l a r i f y t h e i r own understanding of what they actually have done, and how careful, c r i t i c a l self-analysis might help them accomplish more. For old people deprived of community contacts and of t h e i r former valued roles as worker, homemaker, spouse and parent of dependent children, volunteers can provide a personal linic during the time the old people are t r y i n g to begin new patterns, learning how to get along with those among whom they l i v e . I t i s , i n part, only as old people come to know a pa r t i c u l a r volunteer who has meaning for them i n d i v i d u a l l y as "friend" that theV can grow i n t h e i r feelings of self-worth, and move slowly towards new and s a t i s f y i n g friendships with other residents. Because of the deep importance of t h i s personal relationship, absences and changes i n volunteer personnel need to be avoided as much as possible. Each such change i s l i k e l y to appear to sensitive old people as rejection of them. This i s not to confuse the function of the volunteers i n a recreation program with the function of therapeutic s o c i a l caseworkers. I t i s to suggest that volunteers can most e f f e c t i v e l y f u l f i l l t h e i r own unique and essential function as they become more aware of what actu a l l y happens through t h e i r e f f o r t s , and why i t happens, and how i t Pan be more e f f e c t i v e l y directed towards achieving the predetermined - 136 -goals of both volunteers and r e s i d e n t s . Old Age R e c r e a t i o n a l Leadership T r a i n i n g To develop comprehensive community v o l u n t e e r t r a i n i n g of the k i n d which i s b a s i c to the long-term e f f e c t i v e n e s s of such a program, c o n s i d e r a t i o n might be given to the development of a s p e c i a l o l d age r e c r e a t i o n a l l e a d e r s h i p course. This might be done i n cooperation w i t h the Volunteer Bureau, through the Department of U n i v e r s i t y E x t e n s i o n , or the Adult Education s e c t i o n of the Vancouver School Board. Such a program could o f f e r p o t e n t i a l volunteers a 10-12 week s e r i e s of l e c t u r e s and d i s c u s s i o n s which would provide personal contact w i t h both p r o f e s s i o n a l workers and experienced v o l u n t e e r s . I t might be d e s i r a b l e to i n c l u d e observation of one or more programs i n a c t i o n as part of the b a s i c t r a i n i n g . There i s some precedent f o r such a program i n the general Volunteer Bureau t r a i n i n g f o r v o l u n t e e r s , i n the former Night School course f o r Boarding Home operators, and i n the current r e c r e a t i o n a l l e a d e r s h i p t r a i n i n g f o r youth groups i n the Night School s e r i e s . The training*'' would have to be e x p l o r a t o r y , as the p r o j e c t has been, but through the experience of the Junior League volunteers there i s much more s p e c i f i c knowledge a v a i l a b l e now to provide a p r a c t i c a l foundation i n known needs and ways of meeting some of them than there was three years ago. A program of the k i n d envisaged, developed c o o p e r a t i v e l y w i t h the Committee on the Welfare of the Aged and the Volunteer "'"There are d i s c u s s i o n s of t r a i n i n g of volunteers f o r work w i t h o l d e r people i n Kaplan, Jerome. A S o c i a l Program f o r Older People, The U n i v e r s i t y of Minnesota Press, Minneapolis, 1953. p.49, f f . and i n a d i s c u s s i o n by Lowy, L o u i s . "Volunteers i n Programs f o r the Older .Citizen" i n Cohen, Nathan E. ed. The C i t i z e n Volunteer, Harper and"Bros, New York, I960., pp. 141-56. - 137 -Bureau, might draw on the resources of such diverse groups as: The School of Social Work, University of B.C. The Medical School, University of B.C. The Boarding Home Operators' Association. The Yalleyview Hospital staff. The Shaughnessy Hospital staff. . The Marpole Informary staff. The Parks Board. The individual Junior League Volunteers. It would take time and effort to develop and carry through a f u l l lecture, study and discussion program. With experienced and interested volunteers to spearhead such an attempt, i t should be both possible and practical. This could provide one effective method for helping tte overcome some d i f f i c u l t i e s inherent in any attempt to integrate community volunteers into a program combined with, or parallel to that conducted by the Junior League. 3 . Programming The focus in programs for institutionalized old people is not upon the activities as ends in themselves, as means of f i l l i n g an otherwise idle hour for the residents or gaps in a volunteer program cha.rt for the next month. Rather, the focus i s upon what happens to the people as a result of each part of each program. The essential substructure includes an awareness of where the old people are in their l i v i n g and their expectations, where they want to go themselves, what the volunteers see as desirable and r e a l i s t i c goals, and what means they can find for working towards both immediate and long-range goals for a particular group of old people. Ideally, the overall goal both in program planning and in program doing includes making - 138 -the old people partners in the project, not the subjects of i t . Out of the preliminary training, volunteers should bring some understanding of the general problems of old people, an awareness of d i f f i c u l t i e s inherent in institutional l i v i n g , some knowledge of what different kinds of act i v i t i e s may be possible for people in the various settings and some awareness of what can be exptected to result from various activities in terms of changes in people. Volunteers who help in training new recruits could t e l l from their own expereince what has been tried and what results were achieved. The successful and the less successful programs have both been,important in the learning of the active volunteers and both could be helpful to prospective volunteers. Programs may be classified as those of looking, doing, going and giving 1. Ideally, for maximum stimulation and self-realization, a l l four aspects should be represented for each old person somewhere in a program series. It i s valuable to help people enjoy an afternoon playing Bingo i f that is what many of the particular group want to do. It may be more valuable to help a particular man feel worthwhile, to have a sense of lasting well-being, because he helped by calling out the numbers or setting up the cards for the Bingo, and had his ''giving" acknowledged before the group. Such a thing can seem small and unimportant to those who have not been helped to understand how and why i t may be specially significant. Planning deliberately for these small adventures in growth is a v i t a l l y important part of sound program design. "•"Woods, James H. Helping Older People Enjoy Life, Harper and Bros., Publishers, Hew York, 1953. p.44. - 139 -A l t h o u g h , f o r p u r p o s e s o f d i s c u s s i o n , p r o g r a m m i n g i s d i s c u s s e d s e p a r a t e l y f r o m c o n t i n u i n g a s s e s s m e n t a n d e v a l u a t i o n , i n p r a c t i c e t h e s e a s p e c t s a r e c o n c u r r e n t a n d i n s e p a r a b l e . F o r t h e k i n d o f p r o g r a m m i n g t h a t i s b e l i e v e d e s s e n t i a l t o a n e f f e c t i v e p r o j e c t i t i s i m p o r t a n t t h a t a l l v o l u n t e e r s u n d e r s t a n d s o m e o f t h e u n d e r -l y i n g r e a s o n s w h y a p a r t i c u l a r p r o g r a m h a s b e e n r e w a r d i n g a n d o f l a s t i n g v a l u e f o r s o m e r e s i d e n t s , w h i l e i t m a y h a v e b e e n a f r u s t r a t i n g a n d u n h a p p y e x p e r i e n c e f o r o t h e r s . I t i s i m p o r t a n t f o r v o l u n t e e r s t o r e c o g n i z e w h e r e a d i f f e r e n t a p p r o a c h o r a d i f f e r e n t a c t i v i t y o r p e r h a p s a n a l t e r n a t i v e t o t h e m a i n a c t i v i t y m i g h t h a v e h e l p e d o n e p a r t i c u l a r p e r s o n m o r e . T h i s k i n d o f g r o w i n g a w a r e n e s s a n d s e n s i t i v i t y c a n c o m e i n p a r t t h r o u g h t h e p r e p a r a t o r y t r a i n i n g - i t h a s t o b e a c o n t i n u i n g d y n a m i c p a r t o f p r o g r a m p l a n n i n g a n d d e v e l o p m e n t . I t i s a v i t a l a s p e c t o f t h e v o l u n t e e r s ' w o r k i n g t o g e t h e r t o i n c r e a s e t h e i r o w n s e n s i t i v i t y a n d s t r e n g t h e n t h e v a l u e s o f t h e p r o g r a m t h e y o f f e r . C a r e f u l d e t a i l e d c o n s i d e r a t i o n o f t h e e f f e c t s u p o n e a c h i n d i v i d u a l r e s i d e n t o f w h a t i s d o n e a n d h o w i t i s d o n e i s t h e e s s e n c e o f p r o g r a m p l a n n i n g - n o t t h e w r i t i n g d o w n o n a l i s t o f " s o m e t h i n g w e h a v e n ' t d o n e f o r q u i t e a w h i l e " o r s o m e t h i n g t h a t m i g h t b e e a s y t o d o . P r o g r a m a c t i v i t i e s m u s t b e w i t h i n t h e r e a l i s t i c l i m i t s o f v o l u n t e e r t i m e a n d c o m p e t e n c e , b u t r e s o u r c e f u l n e s s i n s e e i n g w h a t t h e v o l u n t e e r t e a m c a n a c h i e v e i n t e r m s o f l a s t i n g v a l u e t o o l d p e o p l e w i t h i n t h o s e n e c e s s a r y l i m i t s w i l l b e t h e m e a s u r e o f b o t h v o l u n t e e r a n d p r o g r a m e f f e c t i v e n e s s . - 140 -Evaluation This kind, of programming is intimately tied to the continuing assessment to see what each program or series of programs has actually accomplished, where each one has met or failed to meet the goals set, and why. If programs f a i l to accomplish what was expected for one or more residents, the evaluation part of the planning meetings should he the place to consider the reasons. Maybe the goals were unrealistic in the light of what can be expected for particular residents; maybe there were inappropriate elements in the programs which brought unanticipated negative results; maybe there was insufficient preparation. This kind of careful, detailed analysis of programs for a month or for six months i s needed to see what happens to any particular individual because he excelled in a word game and received recognition in terms of a small prize - and what the same worid game did to the man who could not join in because of i l l i t e r a c y , and who needed an alternative which this program did not offer him. Could he have been helped i f someone had thought ahead of time how he could be kept a happy and satisfied onlooker i f the activity were one i n which he could not be a participant? One stated long range purpose of the program is building towards more interesting and worthwhile activities and interests as a means of contributing to happier and more rewarding l i v i n g for institutionalized old people. There is one ultimate criterion! When the volunteers are no longer there, w i l l the program have been such that residents w i l l have more resources individually, in memory and in - 1 4 1 -shared experiences, in broadened interests and improved social relationships among themselves? In part the f i n a l answer w i l l depend upon how much the residents have participated in planning and carrying out the programs, in part i t w i l l depend upon how effectively the programs have developed the kind of activities and interests which can carry over into general institutional l i v i n g without the direct aid and encouragement of volunteers. New and experienced volunteers alike need to recognize that the active participation which may be allong range goal is not some-thing which can be expected immediately in any new program. It cannot be forced, but for many residents i t may be carefully stimulated and fostered.. It may take a year or more for many residents to achieve sufficient confidence to be aware of ideas and resources they might contribute, and to be able to offer them even with the direct encouragement of the volunteers. It is something which, by the very nature of the d i s a b i l i t i e s , may not be possible to any marked or continuing extent for most people in private hospitals. The Taylor Manor residents were helped to achieve active involvement in a number of ways, particularly- in the two programs which they staged to entertain the volunteers. It is of interest that the people who took active part in these entertainments were, with few exceptions, those who had active group contacts in earlier adult years and who joined actively in programs from the beginning. However, the man who probably gained the most through his program contribution i s a person who had few satisfying adult social experiences and who began - I'll -attending the Junior League program with considerable suspicion and doubt. A number of old people may need the kind of warm personal attention which volunteers gave this man in order to help them achieve active "doing" and "giving". For many, the beginnings have to come through "looking" and "going" where volunteers take a greater share of the responsibility, but always with an alertness to provide maximum opportunities for the old people to do as much as possible themselves. The implicit ideal of active participation may never be realizable for a l l residents. This, too, volunteers should be helped-tor understand. Indeed, i f gradual withdrawal or disengagement i s a normal part of the l i f e sequence, perhaps active involvement should not be assumed as part of the norm for many among the older age group who make up increasingly the greater body of institutionalized aged. It s t i l l remains the general goal of any group program to stimulate active involvement to the level which is best and most rewarding for each individual. To achieve this requires individual understanding of basic needs and lifelong development sequences, and a continuing assessment of what is happening to each person as he joins; in, or watches. Any evaluation which attempts to be beyond general, subjective judgment is faced with formidable d i f f i c u l t i e s , yet continuing effort towards objective evaluation i s essential for constructive progress. Four levels of such evaluation have been suggested;1 1Burgess, E. ed., Aging in Western Societies, A Comparative Survey, University of Chicago Press, Chicago, I960, p.385. - 142 -1. self evaluation by those active in the program. 2. opinions of experts. 3 . factual appraisals. 4. experiment and control. Self-evaluation This would include assessment by active volunteers, by the residents, and by the staff members who see the programs in action and who participate marginally. One device might be to have volunteers write a short sketch of each resident, outlining what their d i f f i c u l t i e s and assets seem to be, and what kinds of activities might help make l i f e pleasanter for them. The Research liepartmeni might be approached to help draw up a simple rating form for making such word-pictures in a uniform way. If this were done at the beginning of a program season and at the conclusion, a comparison of the two ratings might help indicate what effect programs have had. The residents themselves might be asked to keep short diary accounts of their a c t i v i t i e s for a period of a week at the beginning and again at the end of a program season, to help identify any changes. They could also be asked to write or t e l l an outside interviewer what things they had enjoyed and what their reactions to the programs were. This was done in part as one research device and though i t fa i l e d to yield as much information as had been hoped in the present study, the experience gained would help prepare a better schedule for future use. Opinions of Experts This would include staff judgments of changes they find in residents as a result of the programs. It might also be desirable to invite a social group worker to v i s i t an occasional program and to - i k j -attend a subsequent planning meeting to discuss observations with volunteers. It i s often possible for an outside observer to identify both strengths and weaknesses which the participants themselves may overlook. Discussing these detailed observations with a professional group worker could help volunteers c l a r i f y their own thinking and lead to sounder, more effective planning of future programs. Factual Appraisal Criteria for assessments in this area would include such items as: (a) Personal Appearance attention to grooming are men shaved for programs? do residents dress up for programs? (b) General attitude frequency of positive self-references personal health rating and objective health state frequency of complaints about health frequency of complaints about headaches, nervousness self-rating as middle-aged, elderly or old. (c) Program Response ready and waiting, or have to be wheedled expression of personal interests, program, preferences willingness to share volunteers' attention interaction - number of spontaneous remarks to other residents during the programs (d) Interaction between programs use of handicraft materials frequency of card games, checkers, etc. frequency of v i s i t i n g with other residents frequency and extent of dining room conversation Much of this information would need to be gathered, on a before-and-after basis in order to indicate the effects of the programs. This on-going kind of research study would require assistance in design _ 1Z44 -and rating which might he provided on a continuing basis by the Research Department of the Community Chest and Councils. It might be possible, for example, to develop a brief general interview schedule to be used at the beginning and end of each program period, which could be compared and assessed objectively to yield a general picture of program results. Experiment and Control Intensive controlled research study and assessment would only be possible in conjunction with the Research Department. The expense and the personnel shortages might make i t unmanageable at the present time. However, i t might be possible to work out simple methods to compare different program emphases in different homes v/hich could be correlated to some extent with behaviour and attitude changes in different populations. It might be possible, also, to try controlled use of different techniques to encourage resident participation and to compare results over a six-month period. Resident committees to work with volunteers would be one such technique. Asking different residents to undertake particular responsibilities to prepare for special programs i s another. To some extent this i s done on a t r i a l and error basis - planned, deliberate use of one particular technique over several months would help assess the effectiveness of each technique and could provide a better basis for general planning. The broad, long range purpose of the Junior League program can be f u l f i l l e d most effectively through continuing program-planning, program-action and program-evaluation. - 145 -C o n c l u s i o n T h e p r o b l e m o f e a s i n g t h e h e a v y b u r d e n o f l o n e l i n e s s a n d a t r o p h y b o r n e b y t h o s e a g e d c i t i z e n s who a r e f o r c e d b y c i r c u m s t a n c e i n t o i n s t i t u t i o n a l l i v i n g i s a s e r i o u s a n d c o n t i n u i n g o n e . I t i s o n l y t h r o u g h a n i n t e r w e a v i n g o f e f f o r t -o f p l a n n i n g , t e s t i n g , a n a l y s i s o f r e s u l t s - t h a t a n y p r o g r a m c a n a c c o m p l i s h i t s g o a l s f o r i n s t i t u t i o n a l i z e d o l d p e o p l e , a n d c a n p r o v i d e a t t h e s a m e t i m e a l a r g e m e a s u r e o f s a t i s f a c t i o n f o r t h o s e who d e v e l o p t h e p r o g r a m . I t i s o n l y t h r o u g h a s u s t a i n e d a p p r o a c h o f t h i s k i n d t h a t t h e k n o w l e d g e n e c e s s a r y f o r d i r e c t a n d e f f e c t i v e c o m m u n i t y p l a n n i n g c a n b e g a i n e d . T h i s i s t h e r e a l i s t i c a n d n e c e s s a r y a p p r o a c h f o r s o u n d s o c i a l p l a n n i n g w h i c h i s o f v i t a l c o n c e r n t o t h e p r a c t i c e o f s o c i a l w o r k . T h e d e g r e e o f p r o g r e s s i n a p r o g r a m w h i c h a t t e m p t s t o d o t h i s i s n o t e a s y t o a s s e s s e m p i r i c a l l y . T h e e f f o r t i s e f f e c t i v e a n d s u c c e s s f u l i f i t h e l p s e a s e t h e b u r d e n o f t h e l o n e l y i n t h e t w i l i g h t , e v e n i f i n t h e b e g i n n i n g o n l y a l i t t l e a n d e v e n i f o n l y f o r a f e w . - 146 -Bibliography Appendix A. ( 1 ) Books Aging in the State of Washington, A Report Prepared for the White House Conference, University of Washington Press, Seattle, Wn. 1 9 6 1 . Allport, Gordon V/. "Basic Principles in Improving Human Relations'" in Cultural Groups and Human Relations, Twelve Lectures before the Conference on Educational Problems of Special Cultural Groups, Bureau of Publications, Teachers College, Columbia University, Hew York, 1 9 5 1 . Anderson, John E. The Psychology of Development and Personal Adjustment, Henry Holt and Co., Hew York, 1 9 ^ 9 . , eci, psychological Aspects of Aging. George Ganta Co., Inc., for the American Psychological Association, Henaska, Wis., 1 9 5 6 . Barbara, D.A. ed., Psychological and Ps7^chiatric Aspects of Speech and Hearing. Charles C. Thomas, Springfield,- 1 1 1 . , i 9 6 0 . Barron, Milton. The Aging American, Thomas Y. Crowell, Hew York, 1 9 6 1 . Bernard, Jessie. Social Problems at Midcentury, The Dryden Press, Hew York, 1 9 5 7 . B i r r e l l , James E. ed., Handbook of Aging and the Individual, Psychological and Biological Aspects, University of Chicago Press, Chicago, 1 9 5 9 . Buell, Bradley and Associates. Community Planning for Human Service, Community Research Associates, Columbia University Press, New York, 1 9 5 2 . Burgess, Ernest W. ed. Aging in Western Societies, A Comparative Survey, University of Chicago Press, Chica,go, i 9 6 0 . Canfield, Norton. Hearing - A Handbook for Laymen, Eyre and Spottiswoode Ltd., London, i 9 6 0 . Carroll, Herbert A. Mental Hygiene, Prentice-Hall Inc., Englewood C l i f f s , N.J. 1 9 5 6 . Cavan, Ruth et a l . Personal Adjustment in Old Age, Science Research Associates, Chicago, 1 9 ^ 9 . Charter for the Aging, New York State Conference, Albany, New York, 1 9 5 5 * Clinard, Marshall B. The Sociology of Deviant Behaviour, Rinehart and Company, New York, 1 9 5 7 . - 147 -Community Project for the Aged of the Welfare Council of Metropolitan Chicago, Community Services for Older People, The Chicago Plan, Wilcox and Pollett Co., Chicago, 1952. Cumming, Elaine and Henry, William E. Growing Old. The Process of Disengagement, Basic Books, Inc., New York, 1961. Donahue, Wilma et a l . eds. Free Time, Challenge to Later Maturity, University of Michigan press, Ann Arbor, 1958. Drake, Joseph T. The Aged in American Society, The Ronald Press Co., New York, 1958. Friedman, Eugene A. and Havighurst, Robert H. The Meaning of Work and  Retirement, University of Chicago Press, Chicago, 1954. Havighurst, R. and Albrecht, R. Older People, Longmans, Green and Co., New York, 1953. Joint Commission on Mental Illness and Health, Final Report, Action for  Mental Health, Basic Books Inc., New York, 1961. Kaplan, Jerome. A Social Program for Older People, The university of Minnesota Press, Minneapolis, 1953-Keith-Lucan, Alan. Decisions About People i n Need, The University of North Carolina Press, Chapel H i l l , 1957-Kleemeier,' Robert W. ed. Aging and Leisure, A Research Perspective into the Meaningful Use of Time. Oxford University Press, New York, 1961. Konopka, Gisela, Group Work in the Institution, A Modern Challenge, Whiteside, Inc., and. William Morrow and Company; New York; 1954. Kotinsky, Ruth and Witmer, Helen L. Community Programs for Mental Health, published for the Commonwealth Fund by Harvard University Press; Cambridge, Mass.; 1955-Kutner,. Bernard et a l . Five Hundred Over Sixty, Russell Sage Foundation, New York, 1956. Lang, Gladys Engel. Old Age in America, The H.W. Wilson Company, New York, 1961. Lawton, George, ed. New Goals for Old Age, Columbia University Press, New York, 1943. Leighton, Alexander. The Governing of Men, Princeton University Press; Princeton, N.J.; 1946. - 148 -Levine, Edna Simon. The Psychology of Deafness: Columbia University-Press; New York; I960. Lynd, Robert S. Knowledge for What? Princeton University Press, Princeton, N.J., 1954. , Mirabeau, Octave. "Useless Mouths", in Maugham, S.(ed.), Tellers of Tales Doubleday, Doran Company Inc., New York 1939' Pollack, Otto. Social Adjustment in Old Age, A Research Planning Report, Bulletin 59, Social Science Research Council, New York, 1948. School of Social Work, Syracuse. Towards Better Social Work Services for  the Aging, An Institute on Social and Health Needs, Syracuse university, Syracuse, N.Y. I960. Shakespeare, W. The Merchant of Venice. -George G.. Harrop•;and'--C6.'-,-- Ltd".-,. London, 1954. Slavson, S.R. The Fields of Group Psychotherapy, International universities Press, Inc., New York, 1956. Stieglitz, Edward J. The Second Forty Years, J.B. Lippencott Co., New York, 1952. Thelen, Herbert A. Dynamics of Groups at Work, University of Chicago Press, Chicago, 1954. Tibbetts, Clark, ed. Handbook of Social Gerontology, University of Chicago Press, Chicago, I960. Tibbetts, Clark and Donahue, Wilma, eds. Aging in Today's Society, Prentice-Hall Inc., Englewood C l i f f s , H.J., i 9 6 0 . Titmuss, Richard M. Essays on the Welfare State, George Allen and Unwin Ltd., London, 1958. White House Conference on Aging, Vol. I. United States Government Printing Office, Washington, D.C, I960. Wickenden, E. The Needs of Older People and Public Welfare Services to  Meet Them, prepared for the Committee on Aging, American Public Welfare Association, Chicago, l / 5 3 . Wolff, K. The Biological, Sociological and Psychological Aspects of Aging, Charles C. Thomas, Publisher, Springfield, 111. , 1959. . Woods, James H. Helping Older People Enjoy Life, Harper and Bros., Publishers, New York, 1953. - 148 -(2) A r t i c l e s Beckman, R.O., William, Carl D. and f i s h e r , Granville E. "An Index of Adjustment to L i f e i n Later Maturity", G e r i a t r i c s , Vol. 13, 1958, American Geriatrics Society, Minneapolis, 1958. pp. 662-66?. Burgess, Ernest W. "Social Relations, A c t i v i t i e s and Personal Adjustment", American Journal of Sociology, Vol. 59, 1954. University of Chicago Press, Chicago, 1954. pp.352-60. Davidson, H. and Kruglov, L. "Personality Characteristics of the I n s t i t u t i o n a l i z e d Aged", Journal of Consulting Psychology, Vol. 16, American Psychological Association, Lancaster, Pa., 1952. pp. 5-12. Donahue, Wilmar^, Hunter, W., and Coons, Dorothy. " S o c i a l i z a t i o n of Old People", G e r i a t r i c s , Vol. 8 , American Geriatrics Society, Minneapolis, 1953. pp. 656^666^ Donald, M.N. and Havighurst, R.J. "The Meanings of Leisure", Social  Forces, Vol. 37, University of North .Carolina Press, Chapel H i l l , N.C 1959. pp. 355-360. Farrar, Marcella and E e r r a r i , Nelida. "Casework and Groupwork i n a Home f o r the Aged", Social Work, Vol. 15, Journal of the National Association of Social Workers, Albany, New York, I 9 6 0 , pp. 5 8 - 6 3 . Fieicjler, Fred E., Dodge, Joan S., Jones, R., and Hutchins, Edwin W. "The Measurement of Personality Adjustment and Personality Change i n Non-Clinical Populations" reported i n Psychological Abstracts from Interim Technical Report No. 15, University of I l l i n o i s , Urbana, 111. Psychological Abstracts, A p r i l 1959, American Psychological Association, Lancaster, Pa,, 1959, Item 3320, p.344. Freeman, David. "Rehabilitation of the Mentally 111 Aging", The Social  Welfare Forum, National Conference on Social Welfare, San Francisco, 1959. Granick, Samuel. "Adjustment of Older people i n Two F l o r i d a Communities" Journal of Gerontology, Vol. 7, C.cC. Thomas f o r the Gerontological Society, Springfield, 111. , 1952. pp. 419-425-"Personality Adjustment of the Aged i n Retirement Communities", Ge r i a t r i c s , Vol. 12, American Geriatrics Society, Minneapolis, 1957- P P - 381-385. Havighurst, Robert J. "The Social Competence of Middle-Aged people" Genetic Psychology Monograph, 56, The Journal Press, Provincetown Mass., 1957. pp.297-375. - 149 -L i n d e n , Maurice E . " E f f e c t s of S o c i a l A t t i t u d e s on the Mental H e a l t h of the A g i n g " , G e r i a t r i c s , V o l . 12, American G e r i a t r i c s S o c i e t y , M i n n e a p o l i s , 1957' L u c e r o , Rubel J . , and Meyer, B i l l T. "A Behaviour R a t i n g Sca le S u i t a b l e f o r Use i n Mental H o s p i t a l s " , J o u r n a l of C l i n i c a l  Psychology V o l . 7, F . C Thorne, B u r l i n g t o n , V t . , 1951, pp. 250-254. Orbach, H . L . and Shaw, D.M. " S o c i a l P a r t i c i p a t i o n and the Role of the A g i n g " , G e r i a t r i c s , V o l . 12, American G e r i a t r i c s S o c i e t y , M i n n e a p o l i s , 1 9 5 7 - .pp . 2 4 l r 246. . Osborne, H a z e l . "Some F a c t o r s of R e s i s t a n c e which A f f e c t Group P a r t i c i p a t i o n " , The Group, V o l . 11, American A s s o c i a t i o n of Group Workers , .New Y o r k , 1949. p p . 3 - 1 1 . Pan, Ju Shu. "A study o f ' t h e I n f l u e n c e of I n s t i t u t i o n a l i z a t i o n on the S o c i a l Adjustment of Old P e o p l e " , J o u r n a l of Geronto logy , V o l . 3 , C. cC . Thomas f o r the G e r o n t o l o g i c a l S o c i e t y , S p r i n g f i e l d , 1 1 1 . ; 1949. pp. 276-280. S c o t t , Frances G. " F a c t o r s i n the P e r s o n a l Adjustment of I n s t i t u t i o n a l i z e d and N o n - I n s t i t u t i o n a l i z e d Agedf ; American S o c i o l o g i c a l Review, V o l . 20, American. S o c i o l o g i c a l Society} Menaska, W i s . ; 1955* PP« 538-5^6. Schalzman, Leonard and S t r a u s s , Anse lm. " S o c i a l C l a s s and Modes of Communication"; American J o u r n a l of . S o c i o l o g y ; V o l . 60; U n i v e r s i t y o f Chicago P r e s s ; Chicago; 1955- PP- 329-38. '• Shore, H e r b e r t . "Group Work Program Development i n Homes f o r the A g e d " ; S o c i a l S e r v i c e Review, V o l . 26; U n i v e r s i t y of Chicago P r e s s , Chicago , 1 9 5 5 . P P - 3 2 9 - 3 3 8 . S l a v s o n , S-R. "Group Work and Mental H e a l t h " , The Group, V o l . 11 American A s s o c i a t i o n of Group Workers, New Y o r k , 19^9, pp . 4 -12 . (3) yancouver R e p o r t s , S p e c i a l S t u d i e s , Unpubl i shed M a t e r i a l s and L e t t e r s Andresson, Edda. L o c a l R e c r e a t i o n a l Resources f o r the Aged, A Comparative Study of Two Vancouver D i s t r i c t s , 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, 1958-Committee on the Wel fare of the Aged, p r o j e c t Suggested f o r the J u n i o r  League, January 4 , i 9 6 0 . Mimeographed. J u n i o r League of Vancouver S e n i o r C i t i z e n s P r o j e c t , Annual Reports of P r o j e c t f o r 1960-61 and 1961-62. Mimeographed. Minnesota F o l l o w - u p Study, Discharge p l a n n i n g and F o l l o w - u p of M e n t a l l y 111, Minnesota Department of W e l f a r e , Minnesota , 1959. - 1 5 0 -Schramm, W i l b u r . The L i t t l e House Study of Sen ior C i t i z e n s , The L i t t l e House Study 1 9 5 8 - 6 1 . Summary o f the P r i n c i p a l F i n d i n g s , S t a n f o r d U n i v e r s i t y . Mimeographed. Wheeler , M i c h a e l . A Report on Heeded Research i n Wel fare i n B r i t i s h  Columbia . S o c i a l P l a n n i n g S e c t i o n , Community Chest and C o u n c i l s of the Grea ter Vancouver A r e a , Vancouver , March 1 9 6 1 . W e i l , J u l i u s . E x e c u t i v e D i r e c t o r , The M o n t e f i o r e Home, C l e v e l a n d . O h i o . Persona l l e t t e r to the w r i t e r , March 1 6 , 1 9 6 2 . Appendix B - 151 -Background S t a t i s t i c a l Data Table 1 : Percentages of the P o p u l a t i o n S i x t y Years and Over, by Ages,  f o r Canada, B r i t i s h Columbia and Vancouver, 1951-1956-1961. I» — 1 Age Group Canada B r i t i s h Columbia — 1 Vancouver 1951 1956 1961 1951 1956 1961 1951 1956 1961 60-64 3.6 3 .3 3.2 . 4 . 8 3-7 3.45 5.5 4 . 5 _(a) 65-69 3.1 2-9 2.7 4 . 5 3 . 9 3.1 > 3 4 . 8 3-3 70 and over 4.7 4 . 8 4 . 9 6.3 6 .9 7.05 7-5 8.6 7.8 P o p u l a t i o n 60 and over 1 11 .4 , ' 11.0 10.8 15.6 14-5 13.6 • 18 .3 17.9 » Sources D . B . S . Census of Canada, 1956, as quoted i n Wheeler , M. op. c i t . p.173 f o r 1951-1956. D . B . S . Census of Canada, 1961 t o t a l p o p u l a t i o n f i g u r e s by age groups . (a) Census B u l l e t i n s p r e s e n t l y a v a i l a b l e do not g i v e t h i s f i g u r e s e p a r a t e l y f o r Vancouver . There i s a s l i g h t d e c l i n e i n percentages i n most age groups ; the a c t u a l numbers have i n c r e a s e d except i n the 65-69 b r a c k e t . Table 2; Boarding Home and P r i v a t e H o s p i t a l Accomodation i n Vancouver, January 1962  I n s t i t u t i o n s Bed C a p a c i t y B o a r d i n g Homes L i c e n s e d 87 929 Pending 17 171 T o t a l 104 1100 P r i v a t e H o s p i t a l s 21 ? 1 8 ( a ) T o t a l 125 1818 Source : Boarding Home i n f o r m a t i o n obta ined from the o f f i c e of f i r s . W h i t e , I n s p e c t o r of I n s t i t u t i o n s , p r i v a t e H o s p i t a l i n f o r m a t i o n obta ined from the o f f i c e of Mr . Rose, I n s p e c t o r of H o s p i t a l s . One P r i v a t e H o s p i t a l w i t h 18 beds c l o s e d d u r i n g 1962, r e d u c i n g the t o t a l number of i n s t i t u t i o n s to 124, bed c a p a c i t y to 1800. - 1 5 2 -Appendix C Program Participation and Select ed Variables Table 1 ; . Program participation and Age Age Program Participation .. High Low Total 60 - 7 4 6 5 1 1 7 5 and over 1 1 1 2 2 3 Total 1 7 1 ? 3 4 x = .14 1 d.f. Pjv, .80 Source- Program Participation from Team Captains'1 Rating Scale, Appendix No. 7 , Age from Basic Data, No. 1 Appendix D. This applies to a l l subsequent tables i n this Appendix unless otherwise indicated Table 2: program Participation and Sex , Sex High Low Total Male 11 14 2 5 Female 6 3 9 Total 1 7 1 7 34 x cannot be used because expected frequency in two cells is below 5 -Table 3 : Program Participation and Marital Status Program Participat ion Marital Status High Low Total Single 4 7 1 1 Widowed, Divorced, Separated. 1 3 1 0 2 3 Total 1 7 1 7 3 4 x = 1 . 2 0 1 d.f, p . 2 0 Table 4 : Program Participation and Native Language Program participation High Low Total English native L. 1 2 1 2 2 4 _Other than English 5 5 1 0 Total 1 7 1 7 3 4 2 x = 0 1 d.f. P - 1 - 153 -Table 5 : Program p a r t i c i p a t i o n and Time i n T a y l o r Manor Time i n T a y l o r Program P a r t i c i p a t i o n Manor H i g h Low T o t a l 0-3 years 9 6 ! 5 3-20 years 8 11 19 T o t a l 17 , x 7 34 x 2 - 1.16 1 d . f . P > .20 Table 6; program p a r t i c i p a t i o n and S o c i a l Contacts •—. , S o c i a l Contacts High Low T o t a l Moderate to High 13 7 20 Low or Min imal 4 10 14 T o t a l 17 17 34 2 X = 4.38 1 d.f. P < -05 Source : S o c i a l Contacts c a l c u l a t e d on items 8 , 9, 10, 11, 19, 20 o f p r e - t e s t Schedule 6, Appendix D. Table 7: Program P a r t i c i p a t i o n and S o c i a l Awareness Pre gram P a r t i c i p a t i o n S o c i a l Awareness High Low T o t a l Moderate to High 16 12 28 L i m i t e d 1 5 6 T o t a l s 17 17 34 2 x cannot be c a l c u l a t e d on t h i s d a t a , see Table 2. Source : S o c i a l Awareness c a l c u l a t e d on items 12, 13, 14, 17, 18 of p r e t e s t Schedule 6, Appendix -:.D. - 154 -Appendix D I n t e r v i e w Schedules There were a t o t a l of n i n e schedules used i n the Community Chest and C o u n c i l s Research Department S tudy. The ten th s c h e d u l e , the A c t i v i t y S c a l e , was added to p r o v i d e data f o r the t h e s i s s t u d y . In g e n e r a l , o n l y those items which have r e l e v a n c e f o r the t h e s i s d i s c u s s i o n are i n c l u d e d i n t h i s appendix . The complete schedules are on f i l e at the Research Department o f the Community Chest and C o u n c i l s o f G r e a t e r Vancouver. Form 1. B a s i c Data Sheet Completed hy Home Operator T h i s schedule p r o v i d e d age, sex , m a r i t a l s t a t u s , and n a t i o n a l i t y which was used to e s t a b l i s h n a t i v e language. In a d d i t i o n , the f o l l o w i n g i tems gave s p e c i f i c da ta t h a t are r e l e v a n t i n t h e ' t h e s i s d i s c u s s i o n : 23. P r i n c i p a l medica l reason f o r b e i n g i n home: 1. 2. 3 . k. N e u r o l o g i c a l M u s c u l a r - s k e l e t a l S p e c i a l senses C a r d i o - v a s c u l a r 5. S a s t r o - i n t e s t i n a l ^ 6. Endocr ine 7. Pulmonary 8 . Other ( s p e c i f y ) 24, 25. Other d i s a b i l i t i e s : Check where p r e s e n t . . 1 . 2. .3; k. 5-Poor s i g h t B l i n d or n e a r l y so_ Hard oof'ih e a r i n g Deaf or n e a r l y so C r i p p l e d , arms, hands or l e g s 6. 7. 8. 9-10. 11. General rheumatic s t i f f n e s s Heart t r o u b l e Stomach t r o u b l e High b l o o d pressure S e n i l i t y ' Other ( i n d i c a t e ) 26. Heed of a s s i s t a n c e i n c a r r y i n g out p a r t o r a l l of the s i g n i f i c a n t a c t i v i t i e s of d a i l y l i v i n g : T o t a l l y dependent M o s t l y dependent M o s t l y independent T o t a l l y independent 27. Heed of a s s i s t a n c e i n w a l k i n g : T o t a l l y dependent M o s t l y dependent M o s t l y independent T o t a l l y independent . These items p r o v i d e d e s s e n t i a l i n f o r m a t i o n f o r c a l c u l a t i n g the H e a l t h Handicap s c o r e . Form 2. Fergus F a l l s Behaviour R a t i n g Sca le A f i v e - p o i n t r a t i n g s c a l e w i t h d e s c r i p t i v e d e t a i l s p e c i f i e d f o r each r a t i n g i n the f o l l o w i n g a r e a s ; - 155 -A . Response to meals . B . Response to o t h e r p a t i e n t s . C. Response to a ides and n u r s e s . D. Occupat iona l and R e c r e a t i o n a l Therapy. E . A t t e n t i o n to dress and p u r p o s e . F . Speech. G. T o i l e t b e h a v i o u r . Some of t h i s i n f o r m a t i o n supplemented b a s i c data i n d e r i v i n g H e a l t h Handicap Scores . 3. S. Index, from Cavan, R. et a l . Personal Adjustment i n Old Age, op c i t . k. Kutner Morale S c a l e , g i v e n i n f u l l because of d i f f i c u l t y exper ienced i n use of t h i s concentra ted form i n the g e n e r a l r e s e a r c h s t u d y . 1. As you get o l d e r , would you say t h i n g s seem to be b e t t e r o r worse than you thought they would be? 1. Worse 2. About the same 3. ' B e t t e r 2. How do you. p l a n ahead the t h i n g s you w i l l be d o i n g next week or the week a f t e r - would you say you.make many p l a n s , a few p l a n s , o r almost none? 1. No p l a n s , or almost none 2'. A few plans 3. Many p lans . 3. On the whole , how s a t i s f i e d would you say you are w i t h your way of l i f e today? 1. No s a t i s f a c t i o n , or. v e r y l i t t l e . 2. Some , . „. , ' s a t i s f a c t i o n 3. very s a t i s f i e d . 4. A l l i n a l l , how much unhappiness i r o u l d . y o u say you f i n d i n l i f e today? 1. None, o r almost none . 2. Some unhappiness 3. Very much unhappiness '. 5. How much do you r e g r e t the chances you missed d u r i n g your l i f e to do a b e t t e r job of l i v i n g ? 1. None, no r e g r e t s at a l l , 2 . Some r e g r e t . 3. Regret v e r y much. . 6. Do t h i n g s j u s t keep g e t t i n g worse and worse f o r you as you get o l d e r ? 1. Yes 2. No 7. How o f t e n do you f e e l t h e r e ' s j u s t no p o i n t i n l i v i n g ? 1. A l l o f the time 2. Most of the time 3. Some of the t ime 4 . H a r d l y ever 5. Never . T h i s i s g i v e n i n the r e v e r s e of the form o r i g i n a l l y t r i e d . The i n t e r v i e w e r who t r i e d to use t h i s s c a l e i n the f i r s t form found i t d i f f i c u l t to progress beyond the f i r s t q u e s t i o n , i t em 7 above,, because i t seemed to be e x c e s s i v e l y d i s t u r b i n g to the e l d e r l y women i n the i n s t i t u t i o n . The - 156 -form given above was thought to be somewhat more useable, but s t i l l s ufficiently distressing to the people that the continuation of the scale in this form as part of the study seemed inadvisable. Therefore i t was not used in other homes. 5. Improvement Index, 12 items dealing with physical condition and attitudes to health, mental outlook etc. 6. Personal Data Completed by research interviewers in direct inter-views v/ith each resident. 3- How i s your hearing? 1. Deaf, hearing aid of no use 2. Dependent upon hearing aid but does not use i t . 3 . Dependent upon hearing aid and uses i t 4. Does not use hearing aid but necessary to raise voice and to repeat occasionally 5. Normal, able to hear ordinary conversation Item.3*--in! .conjunction v/ith item 2 4 - 3 and 4 , provided data to give the Hearing Capacity rating. The one man v/ho had a hearing aid and used i t was counted as having Normal Hearing for purposes of the thesis study. 4. Here is a l i s t of d i f f i c u l t i e s people often have. I'm going to read them to you and would like you to t e l l me which ones you have: 1. Shortness of breath at night 2. Shortness of breath after slight exercise 3 . Heartburn 4. Swelling of feet or legs. 5. Peeling tired 6. Have had nervous breakdown (hospitalized) 7- Difficulty in urination 8. Constipation 9- Aching joints 10. Backache 11. Gas pains 12. Belching . 13. Headaches 14. Anything else (specify) Which of the following things often trouble you? 1. Sleeplessness 2. Bad dreams 3 . Tire too easily 4. Pood doesn't taste good 5. Feel "blue" 6. Nervousness - 157 -5- Cont'd. 7- Dislike noise 8 . Worry about my health 9. Forgetfulness 10. Anything else This information helped provide data for the Health Handicap Score. 6. How do you feel about l i v i n g here? 1. Dislikes l i v i n g here 2. Ho strong feelings either way 3 . Likes l i v i n g here 7. Could you give me some of the reasons why you feel this way -How ahout Likes Ho strong Dislikes No. feeling response The food The workers The residents The service The medical treatment The room you're in Anything else? The data from this item gave the score used to rate Attitude to Taylor Manor. 8 . Do you receive mail from family, relatives or friends? 9- Do you write any letters or cards to family, relatives or friends How often? No Hardly ever Yes, at least once a. year Jes, at least once a month . 10. Do you have any family, relatives or friends who v i s i t you? 11. Do you ever v i s i t any family,•relatives or friends? How often? No Hardly ever Yes, at least on,ce a year Yes, at least once a month 19. Do you v i s i t with any of the people in other rooms? 20. Do any people from the other rooms v i s i t you? No Sometimes Yes The- above items were used to derive the Social Contacts Score. It was planned to obtain this information directly from residents, but some who do not have relatives or friends seemed to .find these questions upsetting, and therefore items 8 ,9 , 1 0 ,1 1 were scored from information given by operators, supplemented by resident information where volunteered. Items 19 and 20 were asked of residents. - 158 -12. Do you s t i l l read a newspaper? How often? No Hardly ever Yes, quite regularly Yes, daily 13. Do you liste n to the radio? How often? No Hardly ever Would i f one were available Yes, quite regularly i_. 14. Do you ever watch T.V.? How often? No Hardly ever Would i f one, were available Yes regularly 17. Are you able to go for walks outdoors? No Sometimes Yes, most of the ,time when weather permits 18. Are you able to go for rides? Ho Sometimes Yes, most of the time The above s i x items were used to derive the Social Awareness Score. 7. Team Captains Rating Scale - given in f u l l , see page 157. 8. Home Description. 9. Program Evaluation'Sheet i.5«Have you made any new friends here since the programs started? 6.Can you give me their names? (Only scored "yes" on 5 i f names' given reasonably correctly)., ?.Do you see any of these friends in between the meetings?-No Sometimes Yes In general, established residents did not consider development of friendships with other established residents as "new friends" but several named the new residents as "new friends" made through the programs when questioned for post-test. 10.Activities Scale - Given in f u l l , page /6.Q. - 159 -7. Team Captains Program Report, Showing Method of Scoring and Conversion & of Second Form. 7a Name 2. Name of Home 3. Volunteer Attendance Date No. Present No. Absent Name (Resident) 1. Mr. B. 2. Mr. H. 3. Mr. R. Scoring Method Pa r t i c i p a t i o n 1 2 3 Attitude 1 2 3 Notes 111 today Waiting f o r us to arrive Annoyed, no chess partner Pa r t i c i p a t i o n - termed ''Attendance" in thesis text, where "Par t i c i p a t i o n " i s used with reference to the combined attendance + attitude score. Pa r t i c i p a t i o n 1. =Absent, or i f present did not participate. 2. =Present for part of program 3. =Present for f u l l program Attitude  1. = Hostile, uncooperative, querulous. 2. = Passive, s t o l i d , i n d i f f e r e n t , "just s i t s " . 3. = Enthusiastic, cooperative, interested. Revised - Form No. 7a TEAM CAPTAIN'S PROGRAM REPORT Name Pa r t i c i p a t i o n Attitude Comments 1. Mr. B. 1. 3 1. 3 l . Back troublesome 2. Mrs. P. 2. k 2. 2 2. No one could please her. 3. Mr. R. 3. 4 • 3. 4 3. Bright and cheerful k. Mr. X. 4. 2 k. 1 4-. Does not want anyone to bother him. Par t i c i p a t i o n Attitude l . Absent 1. Hostile, uncooperative, querulous. 2. Attended program i n room. 2. Passive, s t o l i d , i n d i f f e r e n t , 3. Attended for part of program i n withdrawn, " just s i t s " . • a c t i v i t y room. 3. Passively cooperative, k. Attended for f u l l program. exercises no i n i t i a t i v e but enters into a c t i v i t y when asked. k. Enthusiastic , cooperative, interested. - 160 -Program Participation  Comparison of Scoring Method Form Wo. 7 Attendance + Attitude Form No. 7a Participation Form 7A. converted to Form 7 pattern. Mr. B. 1 Mir. B. 3 4 3 = 6 Mr. B. 2 .+ 2 = 4 Mr. H. 6 Mrs. P. 4 + 2 = 6 Mrs . P. 3 + 2 = 5 Mr. R. 5 Mr. R. 4 + 4 = 8 Mr. R. 3 + 3 = 6 Mr. X. 2 1 == 3 Mr. X. 2 + 1 = 3 A l l f i n a l scores were converted 10. Activities Scale When you were between 40-60 years of age, did you belong to any social club or organization? Union or work organization Fraternal (lodge) Neighborhood Hobby or activity_ No Athletic Veterans' Club Unspecified, Women's club_ Other"(please specify) Don't know 2. If yes, how often did i t meet? Once a. week or more Once a month or more Less than once a month. 3 . 4. How often did you attend meetings? Every meeting Almost every meeting Occasionally Other Don't know Never Con11 know Were you ever an officer or committee member? Yes No If yes, how did you feel about being an officer or committee member? Liked i t very much Liked i t somewhat Doubtful Did not like i t Don11 know -161 6. What church did you attend before you came here? 7.. How often did you attend church? Once a day, or more ' Once a year Once a week Almost never Few times a year Never Don't know 8 . Did you belong to a church sponsored group Yes No 9 . Did you belong to a pensioners* club before you came here? Yes No 10. What kinds of things did you most enjoy doing when you were between 40-60 years of age? Reading • Concerts Gardening Picture shows Carpentry Attending sports events, Cooking Playing cards, games, Visiting family or friends Active sports - bcwling etc. Sewing, knitting, handwork Listening to the radio. Family outings Tbis scale was adapted from the Activity Scale used in the Minnesota Followup Study, op. c i t . Item 10 was added but proved incomplete for ..eliciting necessary information on informal participation, and the responses were not included in the scoring. 

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