A PLAN FOR THE DEVELOPMENT OF SERVICES FOR SENIOR CITIZENS IN EDMONTON
RECOMMENDATIONS AFFECTING CIVIC SERVICES
PREPARED BY:
SOCIAL PLANNING SECTION EDMONTON SOCIAL SERVICES CITY OF EDMONTON
RECOMMENDATIONS
I.
That the Edmonton Home Services for Seniors Program further develop its capacity and that service be available through area offices of Edmonton Social Services.
That the Edmonton Home Care Program further develop its capacity to enable it to serve an equivalent of 5 cases per 1,000 population per year.
That the Edmonton Local Board of Health develop public health nursing outreach visiting services to seniors. That Outreach visiting be provided on a yearly basis to all non-institutionalized people over the age of 75 and to those in the 65 - 74 year age group "at-risk".
IV.
That Edmonton Social Services further develop its counselling capacity, and make service available through senior citizens centres.
V.
A. That the City of Edmonton establish a three tier classification system for senior citizens centres. This classification is to consist of: 1. Multi-purpose centres 9.
Neighborhood centres
3. Special Needs centres
B. 1. That the following existing centres be designated multi-purpose centres: a. Society for the Retired and Semi-Retired b. Strathcona Place Society c. Lions Senior Citizens Recreation Centre 2. That the following existing centres be designated neighborhood centres: a. West Edmonton Seniors b. Jewish Senior Citizens Drop-In c. Alex Taylor School Drop-In
3. That the following existing centres be designated Special needs centres: a. McCauley Drop-In b. Bissell Drop-In
c. Senior Citizens Opportunity Neighborhood Association
C. 1. That all senior centres offer the following services: a. Drop-In facility b. Information-referral service c. Recreational and Educational programs d. Outreach
2. That multi-purpose and Special Needs Centres offer in addition to the above, congregate meals.
3. That all centres be permitted to offer other services deemed necessary by the directing authorities of the centres.
VI.
That the standard of one multi-purpose senior citizen centre per 10,000 seniors and one neighborhood centre per 5,000 seniors be adopted as a basis for funding.
VII.
That the City of Edmonton explore the feasibility of a subsidized "taxi" service for semi-ambulant seniors.
VIII.
That the City of Edmonton approach the Edmonton and Rural Auxiliary Hospital and Nursing Home District 1/24 with the objective of examining the feasibility of associating the Edmonton Home Care Program and the Central Placement Offices of the District.
IX.
X.
That the City of Edmonton co-ordinate its efforts in serving senior citizens.
That the Plan for the Development of Services for Senior Citizens in Edmonton be examined at five year intervals. That these intervals correspond to the availability of new data from the Census of Canada.
A PLAN FOR THE DEVELOPMENT OF SERVICES FOR SENIOR CITIZENS IN EDMONTON RECOMMENDATIONS AFFECTING CIVIC SERVICES
I. Recommendation - That the Edmonton Home Services for Seniors program further develop its capacity and that service be available through area offices of Edmonton Social Services. Justification - This program began in the Fall of 1975 with service units in each of the seven area service offices of Edmonton Social Services. Budget restrictions necessitated the reduction of service to three from seven area offices, yet attempting to serve an increasing clientele.
Statistics provided by the program indicate that cumulative applications for service totalled approximately 1200 by May, 1976. Approximately 500 people per month were being served to the point when service was cut back. The natural increase in demand for service did not materialize because applications were discouraged. Service was reduced to 383 cases in May, 1976. Service statistics for May 1977, state that 435 households were served (an increase of 13%) with the substantially reduced capacity.
Based on the survey conducted in early 1976, by the Beverly Unit Edmonton Social Services, indications are that city-wide demand for service is greater than 1,000 cases per month. Increasing this service to its pre 1976 capacity is necessary to meet the demand.
Action -
a. In 1978, four additional Home Services for Seniors program units be added. b. In 1981 and 1986 respectively an additional Home Services for Seniors Program unit be added.
Demand -
1976
1117 cases per month
1981
1353 cases per month
1986
1638 cases per month
Additional Operating Cost Estimated additional operating costs holding 1977-78 dollars constant would be:
Funding -
1978
- $177,836
1981
-
1986
- $ 44,459
$ 44,459
This program is currently funded through Preventive Social Services. The cost sharing formula under the arrangement is 80% provincial and 20% municipal. If this service continues to be funded through this arrangement, the City of Edmonton would incur the following additional costs: 1978
- $ 35,567
1981
- $
8,892
1986
-
8,892
$
II. Recommendation - That the Edmonton Home Care Program further develop its capacity to enable it to serve an equivalent of 5 cases per 1,000 population per year. Justification - The Edmonton Home Care Program is a relatively new program. It began in the latter part of 1973. It is unique of Home Care Program in Canada in that it operates with a balanced health and social service orientation. Home Care has been seen as one of the major factors permitting the Province of Ontario to reduce its active treatment hospital bed complement, particularly by reducing length of stay in hospitals. Home Care is presently being used as an alternative to institutional placement for some extended care needs. Home care over the long term, can reduce the overall costs of the health care system. In these respects, Home Care should be developed as a separate level of care.
Home Care Programsacross Canada serve between 2 and 5 people per 1,000 population. The Provincial Government has suggested that Home Care can serve 15% of the population 65 years of age and over plus another 20% of that number from other age groups. In 1976 Edmonton Home Care served 2.67 people per 1,000 population for a total of 1246 cases. It should be noted that due to budget restrictions, new admissions were not accepted for a two month period. It is expected that in 1977, Edmonton Home Care will serve over 2,000 cases (about a 60% increase). The expected caseload is approaching the 5 per 1,000 population factor.
Action -
a) The Edmonton Home Care Program increased its capacity to allow it to provide care to the equivalent of 5 cases per 1,000 population per year, beginning in 1978. b) The standard of 5 cases per 1,000 population, per year, be reexamined by 1986 in light of the developments in the Home Care field and impact on the health care delivery system.
Demand -
(Based on 5 cases per 1,000 population) 1976 - 2332 cases per year 1981
(1246 actual)
2546 cases per year
1986 - 2762 cases per year
Additional Costs -
Estimated additional operating costs holding 1976 dollars constant would be: 1978 - $358,380 1981 - $ 70,620 1986 - $ 71,280
Funding -
The Edmonton Home Care Program is jointly funded by the Edmonton Local Board of Health and Edmonton Social Services on an approximate 50-50 basis. The Local Board of Health share is funded wholly by the Provincial Government. Edmonton Social Services share is funded through Preventive Social Services (80% provincial, 20% municipal).
The additional costs to the City would be approximately 10% of total additional costs, estimated as follows: 1978
- $35,838
1981
- $ 7,062
1986
-
$ 7,128
III. Recommendation - That the Edmonton Local Board of Health develop public health nursing outreach visiting services to seniors. That outreach visiting be provided on a yearly basis to all non-institutionalized people over the age of 75 and to those in the 65-74 year age group "at-risk".
Justification - People over the age of 65 use more of our medical treatment services per 1,000 population than does any other age group. Prevention of health problems is viewed by professionals as "better" than treatment. Little has yet been done in the area of early diagnosis, treatment and screening. Indications are that adequate preventive services can save up to 25% of the need for crisis treatment.
Such a program would be one of outreach visiting to all non-institutionalized people over the age of 75, and those "at-risk" in the 65-74 year age group. Such outreach visiting will consist of case finding, referral, information provision, basic "living assessment" and follow-up.
Initial contact would be through a public health nurse, follow-up visits could be conducted by staff with lower levels of training, e.g. C.N.A.'s. The population of people over the age of 75 is expected to be about 11,500 (1976)
No estimates of the numbers of "at-risk"
people are available, those in institutions would not require such a service and some others may refuse. In addition, visits might not be required every year. Based upon the capacity of the average public health nurse, the Local Board of Health estimates the need for
12 public health nurses for initial visits and follow-up of difficult cases. In addition "almost as many" staff of lower training level would be required for general follow-up.
Action -
a) The Edmonton Local Board of Health add the equivalent of 12 full-time public health nurses to its staff plus an additional 10 staff of lesser training. b) That a standard of one public health nurse per 1,000 persons over the age of 75 be maintained. That the standard of one additional staff person per 1,150 people over the age of 75 be maintained. c) In 1981 an additional 2 nurses be hired and an additional 2 staff of lower training. d) That in 1986 an additional 3 public health nurses and 2.5 persons of lower training be hired.
Demand -
1976 - 11,408 people over 75 years of age 1981 - 13,575 people over 75 years of age 1986 - 16,506 people over 75 years of age
Cost -
The average cost of a public health nurse in the employ of the Local Board of Health is $19,946. Though the Local Board of Health does not have a salary range for persons of lower training, it is estimated that the cost would be roughly 10% below that of a public health nurse. Holding 1976 dollars constant, the estimated additional cost of the program would be:
Funding -
1978
- $418,866
1981
-
$ 75,795
1986
-
$104,717
The Edmonton Local Board of Health is funded wholly by the Province of Alberta. If funding continues in its present pattern no additional costs would accrue to the City.
IV.
Recommendation - That Edmonton Social Services further develop its counselling capacity and make service available through senior citizens' centres. Justification - Services of professional counselling agencies do not appear to be widely used at the present time by seniors. Those counselling agencies which have contact with seniors through other services have found that their counselling caseloads of older people are increasing. Most senior centres reported an increased awareness of the need for individual counselling services. Operation Friendship staff have noted an increasing number of seniors with emotional and family problems related to aging and lonliness. Staff at the Society for the Retired and Semi-Retired have noted a difference in attitude toward counselling between older and younger seniors. An increased demand can be expected as more people, accepting counselling as a useful service, reach retirement. Existing counselling agencies have estimated that only a small proportion of their caseloads are made up of seniors (most frequently said is 5% of caseload) with the exception of the Jewish Family Service. The Jewish Family Service provides counselling in the Jewish Senior Citizens Drop-in and approximately 20% (estimated to be 77) of its caseload is seniors. The Society for the Retired and Semi-Retired has counselling available and in 1976 served 79 "long term" cases. Edmonton Social Services has noted an almost doubling (33 to 64) of its counselling caseload in the group over 60 years of age between May 1976 and May 1977, due to the department's Home Services to Seniors program.
To meet the needs of seniors, counselling services must take into account the seniors desire for "comfort" in asking for help. Location of counselling services in senior centres is an effective way of reaching seniors. This service should be provided through Edmonton Social Services. The Department can provide supervision and service on a part-time basis in senior centres. Additional available staff time is to be utilized in area offices of the Department.
Action -
a) That Edmonton Social Services add the equivalent of four full-time social workers to its staff in 1978. b) These social workers provide service 3 half days per week at the large senior citizens centres, and two half days per week at smaller centres. c) The remaining time be utilized in counselling seniors in the department area services offices. d) That one additional social worker be added in 1981 and 1986 respectively.
Cost -
Estimated additional operating costs, holding 1976-77 dollars constant would be:
Funding -
1978
- $106,820
1981
- $ 26,705
1986
- $ 26,705
Services operated by Edmonton Social Services have been funded through Preventive Social Services. If this funding arrangement continues to be used, the added cost to the City would be: 1976
-
$21,364
1981
- $ 5,341
1986
- $ 5,341
V.
Recomwendation - A. That the City of Edmonton establish a three tier classification system for senior citizens centres. This classification is to consist of: 1. Multi-purpose centres 2. Neighborhood centres 3. Special Needs centres B. 1. That the following existing centres be designated multi-purpose centres: a. Society for the Retired and Semi-Retired b. Strathcona Place Society c. Lions Senior Citizens Recreation Centre 2. That the following existing centres be designated neighborhood centres: a. West Edmonton Seniors b. Jewish Senior Citizens Drop-in c. Alex Taylor School Drop-In 3. That the following existing centres be designated Special needs centres: a. McCauley Drop-In b. Bissel Drop-In c. Senior Citizens Opportunity Neighborhood Association C. 1. That all senior centres offer the following services: a. Drop-1n facility b. Information-referral service c. Recreational and Educational programs d. Outreach 2. That Multi-purpose and Special Needs Centres offer in addition to the above, congregate meals. 3 That all centres be permitted to offer other services deemed necessary by the directing authorities of the centres.
Justification - The senior citizen centre provides a facility at which services to older people can be delivered and where seniors can meet and interact. Senior citizen centres are a relatively recent innovation in the City of Edmonton. The first centre, the Society for the Retired and SemiRetired, was established in 1970. Studies in the United States indicate that the number and use of centres has grown substantially. In 1962 it was indicated that centres reached about 5% of their target population. More recent information indicates that centres serve between 22 and 33% of seniors. Assuming no duplications of membership, centres in Edmonton serve 31.4% of seniors. It is expected that the number and proportion of centre users will grow.
Senior citizens centres have developed somewhat haphazardly in the City of Edmonton with funding being provided by two Civic Departments and other funders (including, United Way, L.I.P., United Jewish Appeal, etc.).
The services provided by centres have been determined by two factors, the needs of the users and the ability of the agency to obtain funding. The City of Edmonton through Edmonton Parks and Recreation and Edmonton Social Services fund different types of centres with different types of services. An attempt must be made to rationalize the services available in City-funded centres, and the level of funding.
The above designations with the included core services would set limits on the types of services that the City would fund while assuring equal availability of the basic services.
Cost -
Senior centres do not break down costs on a service-byservice basis. Additional cost estimates are not available.
VI. Recommendation - That the standard of one multi-purpose senior citizen centre per 10,000 seniors and one neighborhood centre per 5,000 seniors be adopted as a basis for funding. Justification - The number of centres and the number of people they serve has grown. Presently centres in Edmonton serve 31.4% of the senior population, it is expected that both the number and proportion served will grow. The National Institute of Senior Centres indicates that senior centres across the United States serve between 22 and 33% of their target population. Edmonton is approaching the upper limits of this range. Edmonton currently has 3 large senior citizen centres and six smaller centres with two additional centres in planning or construction stages. Senior centres should be established on two bases, a neighborhood centre serving approximately 5,000 seniors and a large multi-functional centre serving about 10,000 seniors. The multi-purpose centres would each specialize in a particular service area (e.g. the Society for Retired and Semi-Retired in information provision and the Lions Senior Citizens Recreation Centre in leisure services) they would then be resources to the other centres in their particular specialized area. There are presently four areas in the City with relatively high concentration of seniors where there is no centre: the Bonnie Doon area, the Beverly area, Jasper Place and Calder. (A centre is being considered in the Calder area under NIP financing). Two areas in the City have more than one centre - Oliver with two centres (West Edmonton Seniors and Jewish Senior Citizen Drop-in) and the Boyle Street-McCauley area with three centres (Bissel Drop-in, McCauley Drop-in, Alex Taylor School - all three funded at least in part by the City of Edmonton).
Two areas in the City have high concentrations of senior citizens many of whom are lonely and isolated - Boyle Street-McCauley, and the Whyte Avenue Strip. The special problems of those two areas should be recognized with resources over and above the regular allocation. (See recommendation V. - C. - special needs centres). Neither of the two centres in the Oliver area are presently funded by the City. The three centres in the Boyle StreetMcCauley area are all funded by the City, (2 through P.S.S. and one through community use of schools grant). The duplication of service in this area could be rectified by moving one of the centre programs into the Beverly area. A centre in Calder is being planned. Additional centres would be needed in the Bonnie Doon, and Jasper Place area. The two remaining centres in the Boyle Street-McCauley area and centre in the Whyte Avenue area, designated "Special Needs Centres" are to be resources above the recommended allocation. Action -
1. That the proposed Calder and Northgate Lions Centre be established in 1978. 2. That the Alex Taylor Drop-in program be moved further east 3. That in 1979, consideration should be given to funding West Edmonton seniors. 4. That by 1981 centres be established in Jasper Place and Bonnie Doon areas. 5. That by 1986 an additional multi-purpose centre and two neighborhood centres be established.
Additional Costs - Based upon costs for existing Senior Centres holding 1976 dollars constant, additional operating costs would be in the following range:
Funding -
1978
- $ 86,500
- $136,000
1979
-
$ 18,000
-
1981
-
$ 36,000
- $ 50,000
1986
-
$ 90,000
- $161,000
$ 25,000
Ongoing funding for Senior Centres can be provided by Edmonton Social Services through Preventive Social Services and/or Edmonton Parks and Recreation.
VII. Recommendation - That the City of Edmonton explore the feasibility of a subsidized "taxi" service for semi-ambulant seniors. Justification - The private automobile is the single most important mode of transportation used by seniors. The 1971 Federal Census indicates that 8475 (50%) of households with heads over the age of 65 own automobiles in Edmonton. The City of Edmonton allows the free use of Edmonton Transit service by seniors during non-rush hour periods. Of trips made on Edmonton Transit during the 17 month period between August 1975 and December 1976, seniors used 10.7% (total trips - 79,137,660, by seniors - 8,462,968). The Disabled Adult Transportation System (D.A.T.S.) provides a door-todoor service to disabled people registered with the system for 50c per one-way trip. At March 31, 1976, 62.5% of registrants were over the age of 65 (it is speculated that this high proportion is due to wholesale registrations by nursing homes and auxiliary hospitals). The D.A.T.S, is particularly designed to accommodate wheelchairs. The following table indicates the proportion of registrants over the age of 65 not confined to wheelchair.
TABLE I Proportion of D.A.T.S. Registrants 65 Years of Age and Over not Confined to Wheelchair Age
% Male
% Female
65 - 74
41.5
51.4
75 - 84
39.1
51.9
85 - 94
44.0
42.8
41.7
30.0
95+
A survey of D.A.T.S. trip users was conducted from October 20-26, 1976. It was found that 8.4% of trips made by people over the age of 65 involved people who did not require wheelchairs. The average weekly trip rate for medical purposes by seniors is 4.4 compared to 4.7 for all users. Personal, recreational and shopping trip rates for seniors is 4.2 while all users have an average rate of 3.6. The D.A.T.S. service was particularly designed to provide transportation to and from employment and educational activities. No educational trips and only 2.2% of trips were made by seniors to places of employment. 33.3% of recreational trips, 39.4 medical trips, 30% personal and 28.4% shopping were made by seniors. The cost of trips on the D.A.T.S. are between $2.50 and $5.95 (gross) or $2.00 and $5.45 net. Although the number is not known, professionals have stated that many seniors have difficulty using the regular Edmonton Transit particularly in wintertime. Further indications are that some seniors who qualify for D.A.T.S. service have difficulty understanding how to use the service particularly the waiting period for the vehicle, the necessity of booking in advance and the sometimes long rides. What would be needed by seniors is an "on-demand" service which could be booked over a shorter period.
Action -
1. This item be referred to the Transportation Planning Branch, Planning Department for detailed study. 2. That the recommendation of the study be brought to City Council for policy direction.
VIII. Recommendation - That the City of Edmonton approach the Edmonton and Rural Auxiliary Hospital and Nursing Home District #24 with the objective of examining the feasibility of associating the Edmonton Home Care Program and the Central Placement Offices of the District. Justification - The Edmonton Home Care Program is a mechanism for assessing, drawing up a comprehensive plan of care, arranging and paying for needed health and related social services in the home. The Central Placement Office of the Edmonton and Rural Auxiliary Hospital and Nursing Home District #24 provides assessment for and allocates space in auxiliary hospitals, nursing homes and day hospitals. In June 1977, 63 people receiving Home Care had applied for Nursing Homes or Auxiliary Hospitals of which 39 were approved applicants. Home Care staff estimate that 6 people receiving home care were also in Day Hospital. As the population over 65 grows, it is expected that more people will have chronic health problems. More efficient use of our resources will be necessary. Home Care and institutional care should be more closely aligned to provide for better "continuity of care". Associating these two programs would be a beginning toward providing a more efficient use of resources. Action -
The management committee of the Edmonton Home Care Program and the Director of the Edmonton and Rural Auxiliary Hospital and Nursing Home District #24 should jointly explore the feasibility of associating the two programs.
IX. Recommendation - That the City of Edmonton co-ordinate its efforts in serving senior citizens.
Justification - Various departments in the Civic Administration provide special services for senior citizens including Edmonton Social Services, Edmonton Local Board of Health, Edmonton Parks and Recreation, Real Estate and Housing, Edmonton Transit. Frequently each department develops services in isolation from the others, without consideration of the impact such development will have on other services.
An interdepartmental mechanism within the Civic Administration would provide each relevant department with information about proposed developments. This would allow each department to study the proposal, examine potential impacts and make recommendations concerning the services.
Action Options - a. That the proposed "Social Planning Commission" be established; b. That an interdepartmental committee be struck; c. That a full-time person be hired for this purpose who would report directly to the Commissioner; d. That better information be provided to the City of Edmonton Social Services Advisory Committee from concerned departments.
X. Recommendation - That the Plan for the Development of Services for Senior Citizens in Edmonton be examined at five-year intervals. That these intervals correspond to the availability of new data from the Census of Canada.
Justification - The Plan for the Development of Services for Senior Citizens in Edmonton is to be a dynamic document. Recommendations for ways to deliver service are reflective of the values of the community. Community values change and new ways to deliver service may became appropriate. New data from the census may indicate changes in trends which would necessitate modification to the plan.
Recommendation of the plan, when implemented, will have a major impact on the service delivery network. This impact must be assessed. Further recommendations for change may come from such an assessment. Action -
In 1983 and 1988 respectively, Edmonton Social Services and Edmonton Parks and Recreation prepare a review and update of the Plan for the Development of Services for Senior Citizens in Edmonton.
Cost -
The major portion of the review and updating of the plan will be a part of the responsibility of existing staff. It is estimated that one additional person will have to be employed for data gathering. It is estimated that costs for additional staff for the plan review, based on 1976-77 dollars will be about $16,000.
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