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The care of an ageing and disabled group in a veterans' hospital : an appraisal of the Domiciliary Care Programme provided by the Department of Veterans' Affairs in Vancouver McKenzie, MacQuarrie Bruce

Abstract

This study makes an appraisal of a special example of institutional care for aged and disabled persons, namely, the specific group of veterans in Vancouver who, under present D.V.A. regulations, are regarded as being "totally disabled" and in need of domiciliary care. Chronic illness of long duration is one of the principal characteristics, though not the only one, of this group, and of their various disablements. The appraisal of this group, in relation to the domiciliary care programme, is made in the light of modern concepts of treatment and rehabilitation, but gives special attention to the contributions in understanding and relationship which can be made by the social worker. In the welfare field, veterans are a special group because of their liability to disablement and to other possible causes of "premature ageing" which may have resulted from war service. They are a special group also because of the unusual number of facilities and opportunities for recovery and re-adjustment which have been provided for them. Domiciliary care is one of these special services, exclusively designed for veterans who require total care on a more or less permanent basis. Re-establishment of veterans with lesser handicaps already has been demonstrated on a vast scale since the end of the last war. But problems evidently remain for the type of veteran who is aged, whose disablements are of an extreme nature, and who, in spite of a superior treatment service, has not changed his total disability status. Lessons for other aged and disabled groups in the civilian population can be drawn from the present type of study. The material of the investigation includes, first, a review of the general provisions of domiciliary care for Class-Six patients, based on over one hundred district files and a similar number of medial social service files. Detailed personal information was also obtained in interviews with many of the patients. Discussions were held with doctors and departmental administrators, and needs and services were discussed with staff members acquainted with the Class-Six patient. The basic method of using this material was to review psycho-social aspects of the status and attitudes of individual cases, to delineate basic social and emotional problems, and to appraise the domiciliary care programme in terms of its ability to meet these problems. Social work practice and rehabilitation possibilities both reveal many gaps in the present programme, which is primarily designed to provide physical care. Case studies indicate that many of the critical factors in the older patient's adjustment are psycho-social as well as physical; yet little or no definitive treatment is given for psycho-social disorders. Recommendations, on the basis of these findings, include a method of classification and segregation of Class-six patients in groups, and the creation of rehabilitation-treatment services on an individualized basis. The role of the social worker is outlined in relation to the broader functions of the clinical team.

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