Edmonton (Alta.) - 1979 - Plan for the development of services for senior citizens in Edmonton... by Edmonton Tower Resource Centre Online Library

A PLAN FOR THE DEVELOPMENT OF SERVICES FOR SENIOR CITIZENS IN EDMONTON

REPORT PREPARED BY: SOCIAL PLANNING SECTION EDMONTON SOCIAL SERVICES CITY OF EDMONTON

LEISURE SERVICES SECTION PREPARED BY: EDMONTON PARKS AND RECREATION

TRANSPORTATION SECTION PREPARED BY: TRANSPORTATION PLANNING BRANCH, CITY OF EDMONTON PLANNING DEPARTMENT

A PLAN FOR THE DEVELOPMENT OF SERVICES FOR SENIOR CITIZENS IN EDMONTON Summary and Recommendations

A. Preamble People over the age of 65 are the fastest growing segment of our population. Between the years of 1976 and 1986, it is expected that the number of seniors will increase by almost 47%. A corresponding increase in the demand for all services can be expected. Attempts to fill unmet needs, inflation and the expected increase in demand will bring costs to a level substantially greater than would be the case if the present level and types of service were maintained. Preventive services, services to maintain people in their own homes, and more efficient use of our resources must be emphasized over the next ten year period.

B. Health and Medical Treatment Services 1. Prevention People over the age of 65 use more medical treatment services per 1,000 population than does any other age group. Prevention of health problems is viewed as "better" than treatment. Little has yet been done in terms of preventive health services for seniors. It has been estimated that adequate preventive services can decrease up to 25% of the need for crisis treatment of health problems. A greater emphasis should be placed on preventive health services.

It is recommended 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 noninstitutionalized people over the age of 75 and to those in the 65-74 year age _group "at-risk".

2. Chronic Health Care As the number of people in the age group over 65 years grows (and particularly those in the over 75 year age group) proportionately more people will have chronic health problems. The current supply of services is not meeting the present demand. To meet future need through traditional methods, more and more of our financial resources will have to be spent on construction and operation of extended health care facilities. Less costly alternatives to institutional extended care should be developed and more efficient use of facilities should be examined. a) It is recommended that the Edmonton Home Care Program be further developed to a capacity of serving 5 persons per 1,000 population. b) It is recommended that additional "Day Hospitals" be developed in the City of Edmonton. (Responsibility of Edmonton and Rural Auxiliary Hospital and Nursing Home District #24 and the Alberta Hospital Services Commission). c) It is recommended that a study be undertaken to determine: 1) the cost effectiveness of Home Care, Day Hospital, Nursing Homes; and Auxiliary Hospitals and 2) the appropriate mix of each in the City of Edmonton. (Responsibility of the City of Edmonton and Rural Auxiliary Hospital and Nursing Home District #24). d) It is recommended that associating the Edmonton Home Care Program and the Central Placement Office of Edmonton and Rural Auxiliary Hospital and Nursing Home District #24 be explored. e) It is recommended that the Edmonton and Rural Auxiliary Hospital and Nursing Home District #24 examine the feasibility of establishing a system of group foster homes for older people. f) It is recommended that the feasibility of a community reintegration program be exploretwith the objective of such a program being the reintegration of those people from extended care facilities who are capable of returning to community life. (Responsibility of the Edmonton and Rural Auxiliary Hospital and Nursing HenzDistrict #24).

3. Active Treatment Hospital Bed Use Seniors in Edmonton use more active treatment hospital bed days per 1,000 population than in any other city in Canada, similarly they are in hospital more frequently.

Their length of stay in

hospital is exceeded only by those in Calgary. Attempts should be made to reduce hospitalization of older people where appropriate. a) It is recommended that the cooperation of

physicians who admit

and treat older people in active treatment hospitals be enlisted to reduce hospitalization where possible. (Responsibility of the Alberta Medical Association). b) It is recommended that the Edmonton Home Care Program be further developed to enable it to become an effective means to reduce length of hospital bed stay. 4. Responsibility of Family It is widely believed that older people are "better off" being cared for in their own homes than in institutions. Family should take a greater responsibility in providing care. Support services should be developed to assist family to take greater responsibility in providing care to older members. It is recommended that the Edmonton Home Care Program provide holiday, weekend and emergency relief to families caring for their older members. 5. Physician and Home Visits In Edmonton it is the exception, rather than the rule, for physicians to make home visits to patients. Home visits would provide the physician with information relative to the context of the health situation of his patient, assistance available in dealing with health problems, and general living conditions.

Physicians should

be encouraged to make home visits. It is recommended that the Alberta Health Care Insurance Commission examine the fee-for-service rate naid to hysicians who provide home visits. A rate should be established which would be commensurate with the increased time necessary for home visits.

111

6. Geriatricians There is no physician practicing in the City of Edmonton with training in the specialization of dealing with the problems of older people. Aged people may show symptoms differently than do younger people and it must be recognized that with older people, the resolution of acute illness is not necessarily synonomous with recovery. Edmonton should have physicians with expertise and training in geriatric medicine. It is recommended

that two physicians with training and expertise in

geriatric medicine be brought to the City of Edmonton to establish practice. (Responsibility of the City of Edmonton and the University of Alberta). 7, Coordination Greater coordination of effort is necessary between institutional and community care services to provide for more efficient and effective use of our resources. A "comprehensive geriatric service" could lead to a more efficient and effective services for seniors. It is recommended that a local committee of health and related service professionals be established to examine the feasibility of the establishment of a c- ---rehensive c,eriatric service"

in Edmonton. The

terms of reference of such a committee should include: 1)

the definition of "co rehensive geriatric

service" in the

Edmonton context; 2) specific services to be included; 3) appropriate catchment pL(2pulation size; 4) management structure; 5) estimates of added costs; (The responsibillity for convening such a committee rests with the City of Edmonton). 8. Home Nursing Care The health care insurance system is one of the most significant developments in the service system. Yet some services still have restrictions as to the amount payable in a benefit year. Of import to seniors is the amount allowable for nursing care which is limited to $100 in a benefit year.

Restrictions of payments for this service by the Alberta

Health Care Insurance Commission should be reviewed.

It is recommended that the amount of benefits payable for nursing care in a benefit year by the Alberta Health Care Insurance Commission be examined. Increases in benefits should be commensurate with need and costs of service. C. Income Support 1. Maintaining Purchasing Power Senior citizens are generally seen as a low income group. More than half the seniors in Edmonton have a limited income. Although the Old Age Security Pension and Guaranteed Income Supplement are adjusted quarterly to reflect increases in the Comsumer Price Index, the income of senior citizens is not keeping pace with real increases in the cost of living. Purchasing power of senior citizens income should be maintained. It is recommended that the Alberta Assured Income Plan be adjusted with increases in the Consumer Price Index. (Responsibility of Alberta Social Services and Community Health). 2. Financial Planning Planning for retirement, particularly financial planning, must begin at an age when the most impact will be obtained for retirement years. Many employers have retirement pension provisions but most of these are not transferable. The Canada Pension Plan excludes those not in the labor force. Pension plans should be further developed to enable adequate financial planning and provide for an adequate income upon retirement. It is recommended that the Canada Pension Plan Act be amended to allow for benefits to people who have not been in the labor force for reason of raising children. (Responsibility of the Government of Canada). b) It is recommended that legislation be introduced which would make employment pensions transferable between employers and geographic location. (Responsibility of the Government of Canada).

D. Housing 1. Subsidized Housing There are a large number of senior citizens applying for admission to "senior citizen accommodation". Such accommodation is being constructed at a rapid rate, most of these as self-contained apartments.

Little

consideration is being given or resources invested in exploring other options. Options other than "self-contained apartments" and lodges should be explored. a) It is recommended that study be undertaken to determine acceptable options for senior citizen housing and the proper mixture of these in Edmonton. (Responsibility of Alberta Housing and Public Works). b) It is recommended that a study be undertaken to determine the proper criteria for site selection for senior citizen housing. (Responsibility of Alberta Housing and Public Works), 2. Rental Supplement The costs of rental accommodation in the City of Edmonton have increased greatly. Some seniors desire and are able to obtain subsidized accommodation. The low rental rates of subsidized accommodation have a significant impact on the discretionary income of those seniors. Other seniors desire to stay in other rental accommodations, or have applied for and not been able to obtain subsidized accommodation because of the limited supply. This latter group are left to compete in the market place for scarce housing at high costs. The situation is inequitable in that some have subsidized rents and others do not. Supply rather than need causes the inequality. Subsidies for housing should be more widely available for seniors who need them. It is recommended that the Province of Alberta institute a system of rental supplements under National Housing Act. 3. Temporary and Emergency Housing Recent developments in land utilization, particularly in the downtown area, have removed much of the low cost rental accommodation formerly available to seniors. It becomes more difficult to find adequate housing at a price the older person can afford.

Some seniors have difficulty

In finding alternative housing when time limitations are given to vacate premises. Temporary housing should be available to seniors unable to find suitable housing.

It is recommended that the Province develop temporary or emergency housing for displaced seniors. (Responsibility of Alberta Housing Corporation). 4. Home Owners Some home owners may be facing difficulties in keeping their homes in good repair and paying rising expenses. a) It is recommended that the Province of Alberta explore the feasibility of a home owners supplement. It is recommended that the Province of Alberta explore the feasibility of low cost home improvement loans as an extension of the Senior Citizens Home Improvement Program. 5. Central Application Office At present seniors must apply to each housing development indivdually. Each development has its own application procedure and priorities for admission. A central location for application, processing and placement would be of benefit. It is recommended that the feasibility of a central application office for senior citizen housing be explored. (Responsibility of the Province of Alberta, the voluntary sector and the Greater Edmonton Foundation

E. Community Support and Social Services 1. Counselling_ Many senior citizens in the City are lonely and isolated. Professionals have indicated an increasing number of seniors with emotional and family problems related to aging and loneliness. One psychiatrist indicated that 10% of older people have fairly serious mental health problems. Counselling services should be available to seniors citizens. It is recommended that Edmonton Social Services develop its counselling capacity and make this service available through the senior citizens centres.

vii

2. Home Support Services Many seniors presently living in their own homes are finding it difficult to maintain them or conduct many of the small repairs necessary to keep the home up Similarly, many seniors renting, find it difficult, because of fraility, to keep up their homes and apartments. Many of these seniors also require other services but do not know which are available or how to get them. Home support services should be expanded to meet the needs of seniors in their own homes and in rental accommodation. It is recommended that the Edmonton Home Services for Seniors Program be expanded arid be available in all offices of Edmonton Social Services.

3. Senior Centres Senior citizens centres have become a significant feature in the delivery of services to older people. Each of the senior centres in Edmonton is different and provides different services. The establishment of a set of core services, to be available at each centre, would make services more accessible to seniors. a)

It is recommended that basic services be designated for three types of Senior Citizens' Centres: "Multi-purpose Centres", "Neighborhood Centres", and "Special Needs Centres". That these basic services be: a) Drop-in b) Educational and recreational programs c) Information and referral d) Outreach programs e) Counselling and in Multi-functional and Special Needs Centres the following additional services: f) Congregate meals It is recommended that the following guidelines be adopted for the development of Neighborhood and Multi-functional Centres: a) one neighborhood centre per 5,000 seniors b) one multi-functional centre per 10,000 seniors c) special needs centres as required

viii

. Wheels-to-Meals While the existing Meals-on-Wheels program is an effective program it has limitations. People are not encouraged to leave their homes and seek outside activities. It becomes much easier for such seniors to become isolated and to avoid contact with people and activities. It is recommended that the feasibility of wheels-to-meals program be explored. (Responsibility of the City of Edmonton and the voluntary sector.)

Day Care The mental or physical health of a senior is often fragile enough to require constant supervision; even when medical treatment is not required. Because of this supervision requirement these seniors cannot partake of organized activities. These same seniors, not requiring medical attention, are also not likely to be admitted to Day Hospital. Activities for frail elderly should be developed. It is recommended that the idea of a "Day Care Centre" for frail .L4Ely_ptf2ple

be explored. (Responsibility of the voluntary

sector.)

Information One of the problems of accessibility of services is that many seniors do not know what services exist or know how to obtain these services. Senior citizens centres provide infoLulation to those who use the centres. However, only about 31% of seniors utilize such centres, liewesteT.

Information on available services should be more evenly

distributed to all seniors. It is recommended that an information brochure on senior citizen services be distributed to all seniors and -dated eve second veer.

Responsibility of the voluntary sector.)

F. Transportation The private automobile is the single most important mode of transportation used by seniors. The City of Edmonton allows the free use of Edmonton Transit by seniors during non-rush hours. The Disabled Adult Transportation System provides a door-to-door service for disabled people. Some seniors, while not disabled, have difficulty using the regular public transit service because of fraility and/or weather conditions. Difficult access to other services is compounded for those seniors because of transportation difficulties. It is recommended that the City of Edmonton explore the feasibility of a subsidized "taxi" service for semi-ambulant seniors.

G. Recreation and Education 1. Recreation That recreation services be provided to meet the following objectives: a) to provide experiences, activities, programs which generate a climate that is conducive to senior citizens finding companionship and developing friends. to find real and useful ways in which the skills, experience, and resources each individual person brings from his life experiences can be used to help himself, his associates and his community. to stimulate the renewal of abandoned hobbies and interests and to motivate the development of new interest and hobbies, to provide advice, resources and an atmosphere that will encourage self-help and self-government on the part of seniors. to provide entertainment, enjoyment, fun and purposeful activity to be enjoyed in both large or small groups, or as an individual. f) to provide information so older persons can locate other services. g) to raqintain or rebuild a person's self-respect.

h) to train seniors as volunteers in order that they may help other dependent seniors who may be shut-ins. i) to develop activities and programs that will help seniors have some time and opportunities to inter-act with other age levels. j) to provide opportunities for increasing community understanding of the needs of older persons and the aging process. That the following guidelines be followed in developing programs for senior citizens: Guidelines for Program Development a) An activity helps deal with the problem of isolation when it provides the individual with meaningful and self-enhancing opportunities to involve himself with others. b) An activity helps promote and reinforce self-confidence when it realistically engages the capabilities of the individual, while still offering a margin of challenge. c) An activity enhances inter-personal competence when it allows the individual to try himself out in a variety of situations, with a variety of different people. All activities must be planned with senior citizens and not for them. That senior citizens be encouraged to plan and organize their own activities based on the following process: a) The government, agency, individual initiates the program, sets the framework and introduces various program possibilities and resources to senior citizens at a neighborhood level. The program starts with a demonstrated need or indication from seniors in the area of their interest. Seniors are encouraged to become involved in the planning of new or continuation of established programs although most of the organization and resources come from the government, agency or individual.

c) Seniors assume some of the responsibilities for the organization as well as the planning, with the government, agency or individual still actively involved. d) The ultimate goal is for seniors to carry out their own planning and organization of activities, relying on the government, agency or individual simply for resources.

2. Education Seniors should be part of the planning process for educational opportunities.

These opportunities should be available in institutions

as well as community. Educational programs should be available on a neighborhood as well as centralized basis. That educational services be provided to meet the following objectives: a) to encourage seniors to know that they are not over the hill at 65, and that their mental facilities do not deteriorate. to educate seniors to learn new skills so that they may contribute to society. to ensure that seniors are able to put their resources to greatest advantage and not become a burden on society. to provide leadership training so that seniors can help others. e) to help seniors concentrate on their good qualities and capabilities. to ensure that seniors continue to have an interest in society and therefore exercise their rights intelligently. to bring about social fellowship through mutual learning by seniors.

It is recommended that education programs be set-up in consultation with seniors. b) it is recowwended that education programs be available for all seniors. c) It is recommended that educational programs be developed at the ne' hborhood level and at institutions.

xii

H. Other Areas 1. Standards for Services Population projections indicate a large increase in the population of seniors over the next ten years. An overall quantitative standard must be adopted which would ensure a basic level of services. Many of the services discussed in the report are not specifically mentioned in recommendations.

These existing services

should be expanded as the population increases. It is recommended that services not specifically mentioned in individual recommendations be maintained at the 1976 level with adjustments for population increase. 2. Co-ordination of Civic Services Civic services affecting the elderly are developed in isolation from one another without consideration of the implications of the developments on other services. An inter-departmental mechanism should be established in the civic administration which would review, consider, and co-ordinate developments of civic programs for the elderly. It is recommended that the City of Edmonton co-ordinate civic efforts in the area of senior citizens services. I. Plan Implementation and Review 1, Plan Implementation Recommendations of this report have wide implications for the three levels of government and many service providing agencies. It is necessary that a mechanism be established which would oversee the implementation of the plan. It is recommended that an intergovernmental committee be struck, consisting of representatives appointed by the City of Edmonton, Province of Alberta and Government of Canada, to oversee the implementation of the plan.

The terms of reference for such a committee would include: a) Delineation of respective responsibility for plan recommendations. b) Development of an action plan pertaining to the individual recommendations. c) Development of a time frame for plan implementation. (Responsibility for convening this coumittee rests with the City of Edmonton.)

2. Plan Review A plan must closely reflect the values of the community. Values as well as priorities change. There also need be at a later date an evaluation of the impact of the recommendations in this report. It is recointended 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. (Responsibility of the City of Edmonton.)

xiv

ACKNOWLEDGEMENTS

The authors would like to acknowledge the contributions of the many people, without whose efforts this report would not be possible. Particular acknowledgements to those who volunteered their time'3On the "Technical advisory committee"; Mary Behrey, Stu Bishop, Mary Cameron, Dr. J. Gillespie, Jan Craig, Wanda Cree, Mary Englemann, Greg Latham, Bob McArthur, Diana McIntyre, Stan Rodway, Thelma Scambler, Kildy Yuen. Special thanks to two of our colleagues in the department, George Diadio and Michael Sorochan and to project staff Susan Attenborough, John Hutton, Janet Wood. Steven A. Friedenthal Social Planner

TABLE OF CONTENTS

PAGE

Summary and Recommendations Acknowledgements Contents List of Tables List of Figures CHAPTER I - INTRODUCTION

A. History

B. Objectives

C. Values and Assumptions D. Methodology

CHAPTER II - SENIOR CITIZENS IN EDMONTON

2 4

A. General Demography

B. Population Comparisons

C. Location

D. Sex Ratio

E. Marital Status

F. Languages

G. Religion

H. Education

I. Life Expectancy

J. Conclusions

CHAPTER III - HEALTH AND MEDICAL TREATMENT

A. Health of Seniors

B. Use of Health and Medical Services

C. Orientation of the Health Care System

D. Health and Medical Treatment Services

E. Special Interest Areas and Suggested Options

(continued) PAGE CHAPTER IV - INCOME

A. Level of Income

B. Assets and Debt

C. Sources of Income

D. Adequacy of Income

E. Income Security Programs

F. Special Interest Areas and Suggested Options

CHAPTER V - HOUSING

A. Housing of Seniors

B. Housing Services

C. Special Interest Areas and Suggested Options

CHAPTER VI - COMMUNITY SUPPORT SERVICES

A. Community Support

B. Community Support Services

C. Special Interest Areas and Suggested Options

CHAPTER VII - PERSONAL SOCIAL SERVICES

A. Introduction

B. Personal Social Services

C. Special Interest Areas and Suggested Options CHAPTER VIII - LEISURE SERVICES

110 118

A. Recreation Services and Facilities for Senior Citizens in the 5 districts of Edmonton Parks and Recreation

120

B. Y.M.C.A.

124

C. Y.W.C.A.

124

D. Edmonton Art Gallery

124

E. Senior Citizen Organizations

125

F. Recreation for Seniors in Hospitals, Auxiliary Hospitals and Nursing Homes

127

(continued)

PAGE

G. Education

130

H. List of Possible Recreation Programs for Senior Citizens

139

I. List of Possible Educational Programs for Senior Citizens

141

CHAPTER IX - TRANSPORTATION

144

A. Existing Transportation

144

B. Identification of Problems

152

C. Priorities for Development

153

CHAPTER X - SERVICE PRIORITIES

156

REFERENCES

161

LIST OF TABLES

TABLES

PAGE

I. Senior Citizens in the Edmonton Population and Growth Rate

II. Population of the Elderly 1971 and Population Projections 1976, 1981, 1986 by Sex and Five Year Age Groups

III. Proportion of Senior Citizens in the Population Edmonton, Alberta, Canada 1931-1971

IV. Proportion of Population 65 Years of Age and Over Selected Canadian Cities 1971 V. Senior Citizens by Census Tract Edmonton 1971 VI. Marital Status by Age Group - Metropolitan Edmonton, 1971 VII. Mother Tongue, Metropolitan Edmonton 1971

10 11 13 14

VIII. Language Most Often Spoken at Home - Metropolitan Edmonton 1971

IX. Religious Denominations by Sex - Metropolitan Edmonton - 1971

X. Level of Schooling - Metropolitan Edmonton 1971 XI. Life Expectancies in Years - Edmonton and Alberta 1977

16 17

XII. Projected Requirements and Costs for Geriatricians in Edmonton 1976, 1981, 1986

XIII. Proportion of Seniors in Canada, Alberta and Edmonton receiving Federal Old Age Security and Guaranteed Income Supplement Benefits 1976 XIV. Monthly Income of Individual Seniors in Edmonton July 1976

51 52

XV. Monthly Social Allowance Rates Alberta Social Services and Community Health XVI. Proportion of Seniors Receiving O.A.S. and G.I.S. 1971, 1974, 1976

53 54

XVII. Types and Capacity of Accommodation for Senior Citizens in Edmonton 60 XVIII. Types of Accommodation and Basic Services Included XIX. Comparison of Costs Rental Supplement and Subsidized Housing XX. Comparison of Estimated Costs S.C.H.I.P. and Loan Program

61 79 81

XXI. Projections of Monthly Demand for Home Services for Seniors Based on 1976 Level of Service, Applicant Level and Population Projections 93 XXII. Home Services for Seniors Cost Projections Based on Present Level of Service and Present Level of Applicants

xix

(continued) PAGE

TABLES XXIII. Demand and Cost Projection for Home Services for Seniors Based on Beverly Unit Experience xxIV. Projection of Number of Senior Centre Users to 1986

94 116

XXV. Number of Senior Centres Needed in Edmonton Using Pennsylvania Guideline XXVI. Range of Costs of Centres Based on Existing Centres 1976-77

116 117

XXVII. Outline of Current Recreational Programs Offered to Senior Citizens in Edmonton XXVIII. Senior Citizens Groups XXIX. Outline of Current Educational Classes Offered to Senior

119 125

Citizens in Edmonton

130

XXX. Alberta College Statistics

137

XXXI. Grant MacEwan Community College Statistics XXXII. Total and Senior Citizen Ridership XXXIII. D.A.T.S. Registrants by Age Group XXXIV. Age - Sex Distribution of D.A.T.S. Registrants

137 146 147 148

XXXV. Walkers (Semi-Ind.) - Wheelchair (Dependents) Breakdown by Sex for Senior Citizens XXXVI. Age Distribution of Trip Makers by Mode of Mobility XXXVII. Trip Purpose by Age Group

149 149 150

LIST OF FIGURES

FIGURE NO.

AFTER PAGE

I. Tasks to be completed to Develop a Plan for Senior Citizens' Services II. City of Edmonton Age and Sex Distribution Pyramids 1961 - 1986 III. Proportion of Total Elderly by Census Tract

2 4 5

IV. Separations from Active Treatment Hospitals per 1,000 Population Edmonton Population 1972

V. Mean Length of Stay in Active Treatment Hospitals Edmonton Population 1972 VI. Costs of Medical Services Per Person in Alberta VII. Active Treatment Hospitals 1976 VIII. Specialized Hospitals 1976 IX. Board of Health Clinics 1976 X. Nursing Homes 1976 XI. Number of Persons on Waiting List for Nursing Home Beds XII. Auxiliary Hospitals 1976

19 19 21 21 22 25 26 29

XIII. Patient Days Per 1,000 Population 65 and Over in Active Treatment Hospitals in Selected Cities

XIV. Mean Length of Stay of People 65 and Over in Active Treatment Hospitals in Selected Cities

XV. Separations From Active Treatment Hospitals Per 1,000 Population 65 and Over in Selected Cities

XVI. Proportion of Seniors Receiving Old Age Security Pensions and Supplements Edmonton, Alberta, Canada 1976 XVII. Location of Senior Citizen Housing

51 61

XVIII. Number of Senior Citizen Housing Units

XIX. Senior Citiznes Residences - Municipal

XX. Senior Citizens Residences - Private

XXI. Number of Applicants to Senior Citizens Housing by Census Tract XXII. Homes for Special Care XXIII. Location of Social Services Offices XXIV. Senior Citizens Centres 1977 XXV. Senior Citizen Clubs

63 74 87 104 125

xxi

CHAPTER I INTRODUCTION

A. History In October of 1975, Edmonton Social Services and Edmonton Parks and Recreation were requested by the Commissioner of Public Affairs to outline what services should be provided by the City of Edmonton for senior citizens over the next 10-year period. Edmonton Social Services indicated that the services provided by the Civic Administration form only a small part of a total range of services needed by Edmonton's older citizens, that all services bear a relationship to each other, and therefore, it would be desirable to develop a plan for services on a comprehensive basis. Edmonton Parks and Recreation agreed to prepare the leisure section of the report. Edmonton Social Services undertook an examination of the rest of the service system. Later, the Land Use and Development Section, Transportation Planning Branch, Engineering and Transportation Department (now the Transportation Planning Branch, Planning Department) undertook the examination of transportation services. B. Objectives The plan was to achieve the following objectives: 1.

To define the needs of the population of older people in Edmonton;

To determine what services are necessary to meet the needs of the older population for the next 10-year period: a. To define the services needed by seniors in the areas of 1) health and medical treatment 2) community and social services 3) housing 4) transportation 5) income maintenance 6) leisure services b. To examine and (When possible) project the potential demsnd for existing services.

c. Identify new options to meet needs. d. Determine within the existing context how the service network interacts. e. To determine (when possible) where new service options fit into the service network and how they may affect other services 3. To provide a framework within which decision-makers can opt for implementation. a. Provide cost estimates (where possible) for existing services if no new services are added to the system. b. To identify priorities for needed services. c. To provide (where possible) cost estimates for needed services. d. To identify funding sources for new services based upon existing legislation and present funding patterns. C. Values and Assumption The basic values and assumptions underlying this study are: 1.

Aging is part of the growth process, not a pathology;

The older person has a wealth of knowledge and experience;

Optionsshould be open for seniors to have positive roles in society;

Seniors are a part of our community and should remain within the mainstream of community life;

Seniors are highly individualistic and have the right to choose their own life-style within the boundaries of their ability;

Seniors desire to care for their own needs when possible;

Services are to be aimed at maintaining the older person as an integral part of the community;

The contribution that a senior citizen makes to society should be solely dependent upon his knowledge, skills and desire.

D. Methodology A plan is an outline of how to reach a desired goal(s). The processes utilized in this study are identified in Figure 1.

Figure 1 TASKS TO BE COMPLETED TO DEVELOP A

Interview professionals in the field

PLAN FOR SENIOR CITIZENS SERVICES

Describe existing services for seniors

Establish technical Advisory Committee

Establish basic assumptions, goals and objectives Contact senior citizens organizations for information

Project demand for existing services

Establish priorities

Describe suggested new services

Indicate interrelationships between services

Write report

."7

Establish standards for services

Planning workshop for seniors and professionals

A technical advisory committee was established consisting of Civic personnel and other professionals with a wide knowledge of senior citizens and planning backgrounds. The purpose of this committee was to assist in identifying goals and assumptions, to consult on the planning process; and to provide information or access to information needed to develop the plan. Ninety professionals from 56 organizations were interviewed to obtain information on existing services, numbers served and costs, gaps in service and how to fill the gaps. Letters and an information brochure were sent to the 51 known senior citizen organizations. Resource people were offered to explore questions. Seven groups responded in writing indicating their concerns. A Planning Workshop for seniors and professionals was conducted to determine needs, service, priorities and to test whether polarities existed between seniors and professionals. Analyses of the existing services were prepared including descriptive material, demand and cost projections. Projections are based upon the present level of service (except where additional material was available) using the following assumptions: 1.

No additional services are added to the service system.

There are no severe economic, political or social changes which would significantly affect the City of Edmonton.

The present pattern of service utilization does not significantly change.

Population projections are relatively accurate - the projections used (unless otherwise stated) were those contained in the City of Edmonton, Planning Department's report "City of Edmonton and Edmonton Sub-Region Population Projections" assuming 'medium' fertility and an annual net migration of 2,000 people. A priority scheme was developed indicating where present emphases are,

where emphasis should be in the future and what needs further development. Except where otherwise indicated, the standard of service as of 1976 was accepted for the City. 3

CHAPTER II SENIOR CITIZENS (*) IN EDMONTON

This chapter will describe the general characteristics of the senior citizen population. The significance of the demographic material in relation to services will be identified. In the main 1971 federal census data is used as the 1976 data was not available in time for inclusion in the report. A. General Demography The age group 65 years and over is the fastest growing segment of our population. The 1971 Census of Canada states that there were 27,325 people (1) over the age of 65 in Edmonton. It has been projected that in 1976 there were 30,620 people in this age group, in 1981 there will be 37,100 and 1986 almost 45,000 (see Table II). Thus we can expect a 47% increase in the number of seniors between 1976 and 1986. In 1976, seniors form 6.56% of our population, in 1981 - 7.28% and in 1986 - 8.13%. The rate of increaseof seniors has been greater than that of the general population. Thus, not only will absolute numbers grow substantially but seniors will form a larger proportion of our population. A larger proportion of our resources will have to be spent on services for seniors.

B. Population Comparisons From 1931 to 1971, the number of seniors in the City of Edmonton increased thirteen times. During this same period the number for Alberta increased by four and a half times and Canada three times (see Table III). Comparison of numbers and percentages of senior citizens among Edmonton, Alberta and Canada indicates that the situation in this City varied sufficiently over this period that provincial or national statistics cannot be assumed to apply automatically to the City.

The terms senior citizen, senior, older people and elderly are used synonymously and refer to people 65 years of age and over. 4

City of Edmonton Age and Sex Distribution Pyramids 1961-1986 (1976,1981,1986 projected) 1961

1966

IIII d

" " • "

I 141

."...".••••,,,, \:•,"" • "*"...'

IIIII 114

3 0,0 00 20,000 10,000

90—+ 8 5 — 89 8 0 — 84 75 — 79 70 -- 74 65—69 60—64 55 —59 50—54 4 5 — 49 40—44 3 5 — 39 30—34 2 5 — 29 20 — 2 4 15— 19 10 — 14 5—9 0—4

10,000 20 000 30,000

rvi

. "1 N.—•""

• '

30 000 20,000 10,000

1971

10,000 20,000 30,000

1976

II' "

"I I •

3 0 000 20,000 10,000

11111 1

• " " " "

' I I Is :

"":" •

90—+ 85 — 89 80—84 75 — 79 70 — 74 6 5 — 69 60 — 64 5 5 — 59 5 0 — 54 4 5 — 49 4 0 — 44 3 5 — 39 30—34 2 5 — 29 20—24 I 5 — 19 10 —(4 5—9 0—4

10,000 20,000 30,000

3 0,00 0 20,0 0 0 10,000

•

" " • :II

" --"I; II

I ll

10,000 20,000 30,000

1981

1986

-" '" -1"â&#x20AC;¢"'

11"1111 11

6"1111111111

30,000 20,000 10,000

9085 - 89 80 - 84 75 -79 70- 74 65 - 69 60- 64 55 - 59 50 - 54 45 - 49 40 - 44 35- 39 30 - 34 25- 29 20 -24 15- 19 10 - 14 5-9 0-4

10p00 20000 30,000

- v -711 1111

30000 20,000 10,000

(Source: Census of Canada and Population Projections: City of Edmonton)

Ill

popoo max) 30,000

In 1971, Edmonton had the lowest proportion of seniors of major cities across Canada (see Table IV). It is speculated that this is due partially to climate as many older people leave Edmonton upon retirement. This should not be allowed to generate a false sense of security about services as the absolute numbers increased substantially as previously noted. C. Location People over the age of 65 live in all parts of the City. They tend, however to be more concentrated in the older areas of the city. In 1971, census tracts 32 and 34 each had more than 3% of the seniors living in Edmonton. Sixteen census tracts had 2-3% of the senior population. Thirty census tracts had 1-2% and 33 census tracts had less than 1% of the senior population (see Table V). It can be stated generally, the newer the area, the fewer the number and smaller the proportion of the elderly.

D. Sex Ratio There are only about 83% as many men in the over 65 year age group as there are women (13,920 men and 16,700 women in 1976). For Canada, 1971, there were only about 76% as many men as women. The higher proportion of men in Edmonton has been said to be due to the relatively recent frontier nature of Alberta. The proportion of men to women is expected to decline in the future. In 1981 the proportion is expected to be 81.4% and in 1986 - 79.15% and in 1991 about 77%. Thus, in the future, more of our services will have to be suitable for women. E. Marital Status Most senior citizens in Edmonton (Metropolitan area - 1971) are married, followed by widowed, single and divorced (see Table VI). Married men outnumber married women (9,875 - 61.4% and 6,195 - 38.5% respectively); more men than women have spouses of younger age. Widowed females outnumber widowed males by almost 4:1 (8,465 - 80% and 2,100 - 19.86% respectively).

Proportion of Total Elderly by Census Tract 1971 Under 1 % 1 — 1.99 % 2 — 2.99 %

3 % And Over

There are more single males, 1,440 (61.8%) than single females 890 (38.2%). The number of divorced men and women is about equal (255 men and 260 women). F. Languages The majority of older people have English as their mother tongue and speak English most often at home. This is followed by Ukrainian, German and French in that order (see Tables VII and VIII). 25.6% of seniors (Metropolitan Edmonton - 1971) speak languages other than English most often at home. This may indicate that some seniors would have problems receiving services only in English. G. Religion More people over the age of 65 profess to United Church adherence than any other single religious denomination. Roman Catholic adherents follow closely, than Anglican, Lutheran, Presybterian, Greek Orthodox, Ukrainian Catholic and others (see Table IX). H. Education In 1971, more than half (55.8%) of the seniors in metropolitan Edmonton had less than grade 9 education. This compares with 21.2% for the general population (15 years of age and over, not attending school). 28.4% of seniors had an education level of grades 9-13; 15.8% had other education or training (see Table X).

It is expected that as future generation of seniors become better educated, there will be a greater demand for leisure time and preventive services. Information and referral services will also be more widely utilized as it will be expected by seniors that services will exist to meet their needs. I. Life Expectancy People in Edmonton can look forward to long lives. The life expectancy for a male born in Edmonton in 1977 is 70.57 years; for a female 77.98 years. People reaching the age of 65 in 1977 can expect to live an additional 14.69 years (males) or 18.79 (females). This compares favourably 6

to the life expectancy rates for Alberta except for males reaching 65 where the expectancy for Alberta is 0.04 years longer (see Table XI).

J. Conclusions The number of seniors in the next ten years is expected to grow by 47%. An increase in demand for services with increased costs must be anticipated. Seniors in the future will be better educated and the demands for information, recreation, educational experiences and preventive programs are expected to increase beyond the proportional increase in the numbers of seniors. Women will continue to outnumber men in the age group over 65. Services of all types must therefore make provision for participation by women, many of whom will not have been part of the labour force. This is of special importance in respect to income maintenance.

TABLET

SENIOR CITIZENS IN iHE EDMONTON POPULATION AND RATES OF GROWTH*

YEAR

#65 +

1961 1966 1971 1976 1981 1986 Overall

TOTAL POPULATION

% INCREASE OF TOTAL POPULATION

%65 + 6.42 6.01 6.23 6.56 7.28 8.13

281027 18047** 22665 376925 27325 438150 466503 30620*** 509311 37109 552413 44908 Growth 1961 - 1986 Growth 1961 - 1976

34.12% 16.24% 6.47% 9.17% 8.46% 96.57% 65.99%

% INCREASE OF 65 + 25.58% 20.56% 12.05% 21.19% 21.01% 149 % 69.66%

* Not adjusted for boundary changes. ** 1961, 1966, 1971 Source: Census of Canada. ***1976, 1981, 1986 Source: City of Edmonton and Edmonton Sub-Region population projection.

TABLE II POPULATION OF THE, ELDERLY 1971 AND POPULATION PROJECTIONS 1976, 1981, 1986 BY SEX AND FIVE YEAR AGE GROUPS 1971*

1986

1981

1976** FEMALE

MALE

FEMALE

MALE

FEMALE

5,287 3,737 2,357 1,422 808 309

5,799 4,359 3,029 2,027 1,045 441

6,459 4,513 2,932 1,580 769 405

7,206 5,356 3,761 2,309 1,265 554

7,482 5,522 3,567 1,973 866 432

8,731 6,667 4,629 2,888 1,465 686

12,550 14,775 13,920

16,700

16,658

20,451

GROUP

MALE

FEMALE MALE

65-69 70-74 75-79 80-84 85-89 90 + SUBTOTAL

4,710 3,250 2,140 1,460 710 280

5,140 3,725 2,810 1,805 930 365

TOTAL 27,325

30,620

37,109

19,842 25,066 44,908

* 1971 Census of Canada ** City of Edmonton Population Projections, Planning Department, 1974.

TABLE III PROPORTION OF SENIOR CITIZENS IN THE POPULATION* EDMONTON, ALBERTA, CANADA 1931 - 1971 YEAR

EDMONTON**

ALBERTA

POPULATION TOTAL 65+

CANADA

POPULATION TOTAL 65+

POPULATION TOTAL

65+

1931

79,197

2,127

(2.7)

731,605

25,656

(3.5)

10,376,786

575,831

(5.6)

1936

85,774

3,820

(4.5)

772,782

32,726

(4.2)

10,950,000

(6.1)

1941

93,817

5,507

(5.9)

796,169

41,241

(5.2)

11,506,655

669,000 (est.) 767,815

1946

113,116

7,236

(6.4)

803,330

50,421

(6.3)

12,292,000

879,300

(7.2)

1951

159,631

11,014

(6.9)

939,501

66,943

(7.1)

14,009,429

1,086,273

(7.8)

1956

226,002

14,585

(6.5)

1,123,116

81,327

(7.0)

16,080,791

1,244,000

(7.7)

1961

281,027

18,047

(6.4)

1,463,203

93,078

(6.4)

18,238,247

1,391,154

(7.6)

1966

376,925

22,665

(6.0)

1,331,944

103,010

(7.7)

20,014,880

1,539,548

(7.7)

1971

438,150

27,325

(6.2)

1,627,875

118,750

(7.3)

21,568,315

1,744,405

(8.1)

Source: Census of Canada

** Not adjusted for boundary changes

(6.9)

TABLE IV PROPORTION OF POPULATION 65 YEARS OF AGE AND OVER SELECTED CANADIAN CITIES 1971

CITY

TOTAL POPULATION

# OF 65+

% OF 65+

EDMONTON

438,150

27,320

6.23

HALIFAX

122,035

10,095

8.27

HAMILTON

309,175

29,365

9.49

MONTREAL

1,214,350

109,320

9.00

CALGARY

403,320

25,380

6.29

OTTAWA

302,345

26,535

8.77

REGINA

139,465

11,380

8.15

SASKATOON

126,445

11,335

8.96

TORONTO

712,790

78,315

10.98

VANCOUVER

426,255

57,530

13.49

VICTORIA

61,760

14,130

22.87

WINNIPEG

246,245

31,780

12.90

* Source: Census of Canada, 1971

TABLE V SENIOR CITIZENS BY CENSUS TRACT EDMONTON 1971

TRACT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

# OF POPULATION PERSONS OF TRACT 65+ 3475 9900 6555 5295 2040 695 7350 4135 7705 5065 6850 9810 4745 5345 5545 4885 4935 385 5630 7860 6400 4385 4665 4915 4665 8365 7805 6890

55 180 220 95 15 10 180 70 205 320 665 615 480 470 360 220 395 20 140 690 740 460 550 270 185 325 345 235

% OF TRACT POPULATION

% OF TOTAL ELDERLY POPULATION

1.59 1.82 3.32 1.80 0.74 1.44 2.45 1.68 2.66 6.32 9.71 6.27 10.30 8.81 6.45 4.51 8.02 5.20 2.49 8.77 11.55 10.50 11.78 5.50 3.97 3.88 4.42 3.40

0.20 0.66 0.81 0.35 0.06 0.37 0.66 0.26 0.75 1.17 2.44 2.25 1.76 1.72 1.32 0.81 1.49 0.07 0.51 2.53 2.71 1.69 2.01 0.99 0.68 1.18 1.26 0.86

TRACT 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56

POPULATION OF TRACT 7420 3495 5100 7635 5165 7180 4345 5300 6335 5245 7890 7115 6275 7660 4045 6905 3025 4785 6795 4780 5370 5360 4155 5170 5355 5370 5755 5185

% OF % OF TOTAL TRACT # OF PERSONS POPUELDERLY LATION POPULATION 65+ 720 660 430 850 650 1240 395 355 280 155 535 380 100 260 540 590 580 295 380 510 365 335 110 310 515 600 755 555

9.71 18.80 8.44 11.13 12.58 17.28 9.10 6.70 4.40 2.96 6.79 5.34 1.59 3.40 13.37 8.54 19.40 6.23 5.60 10.75 6.80 6.25 2.64 6.00 9.60 11.18 13.10 10.70

2.63 2.42 1.15 3.11 2.38 4.55 1.44 1.30 1.03 0.57 1.96 1.39 0.37 0.96 1.98 2.16 2.12 1.08 1.39 1.87 1.33 1.22 0.40 1.14 1.88 2.20 2.76 2.03

continuation of Table V "Senior Citizens by Census Tract".

TRACT 57 58 59 60 61 62 63 64 65 66 67 68

POPULATION OF TRACT 4255 5825 8105 8090 4895 4330 6555 3585 8690 6130 6000 7320

# OF PERSONS 65+ 355 260 600 550 545 230 385 130 180 355 315 425

% OF TRACT POPULATION

% OF TOTAL ELDERLY POPULATION

8.33 4.47 7.40 6.80 11.13 5.31 5.87 3.62 2.07 5.80 5.25 5.81

1.30 0.95 2.20 2.05 1.99 0.84 1.46 0.48 0.66 1.30 1.15 1.55

TRACT

POPULATION OF TRACT

69 70 71 72 73 74 75 76 77 78 90

5025 6285 5785 5880 5235 150 7640 7045 1895 4540 370

% OF % OF TRACT TOTAL # OF PERSONS POPUELDERLY 65+ LATION POPULATION 65 165 175 70 365 15 40 45 20 40 10

1.29 2.63 3.02 1.19 6.98 10.00 0.52 0.64 1.06 0.88 2.70

0.24 0.61 0.64 0.26 1.34 0.06 0.15 0.17 0.07 0.15 0.04

TABLE VI MARITAL STATUS BY AGE GROUP - METROPOLITAN EDMONTON,

SINGLE

MARRIED

WIDOWED

DIVORCED

65-9

70-4

75-9

80-4

85-9

90-4

95+

TOTAL

MALE

525

395

215

175

1440

FEMALE

340

210

165

105

890

TOTAL

875**

605

380

280

135

2330

MALE

4140

2640

1630

950

405

9875

FEMALE

3020

1655

915

400

165

6195

TOTAL

7160

4300

2550

1350

570

130

16080

MALE

330

435

450

440

290

120

2100

FEMALE

2010

2025

1895

1415

790

265

1465

TOTAL

2340

2460

2345

1860

1080

385

100

10570

MALE

130

255

FEMALE

110

260

TOTAL

245

110

520

* Source: Census of Canada 1971 **

1971*

Items will not add due to rounding

TABLE VII MOTHER TONGUE METROPOLITAN EDMONTON 1971 English ALL PEOPLE

65+

TOT. 377,165 Male 188,385 Fe. 188,785 TOT. Male Fe.

16,440 7,105 9,335

French

Ch & Jap.

German

Ital.

Neth.

Pol.

13,265 9,115 9,150

4,595 2,435 2,160

26,155 13,110 13,045

6,735 3,545 3,185

6,685 3,455 3,230

5,185 3,695 2,735 2,090 2,450 1,610

1,735 770 965

400 220 175

2,760 1,315 1,450

260 190 125

375 195 180

900 475 415

Scan.

Uk.

Yid

31,550 535 15,625 245 15,930 290

905 515 290

4,115 195 2,165 75 1,955 115

10,420 135 5,150 60 5,270 75

Other 15,340 8,165 7,175 1,365 700 660

TABLE VIII LANGUAGE MOST OFTEN SPOKEN AT HOME - METROPOLITAN EDMONTON 1971 ALL PEOPLE 65+

TOT. 449,620 Male 225,995 Fe. 223,625

7,865 3,785 4,075

3,760 1,925 1,835

8,300 3,995 4,300

4,855 2,465 2,385

1,335 645 690

2,185 1,095 1,090

340 170 165

TOT. Male Fe.

1,100 485 615

355 205 155

1,245 555 690

105 55 60

175 85 85

485 260 215

15 10 10

21,905 9,970 11,935

NOTE: ENG. - English Ch & Jap. - Chinese & Japanese Ital - Italian Neth. - Netherlands TOT. - Total

Pol. - Polish Scan. - Scandanavian Uk. - Ukrainian Yid. - Yiddish

3,440 1,770 1,665

50 15 30

7,110 3,610 3,500 565 260 285

TABLE IX RELIGIOUS DONOMINATIONS BY SEX - METROPOLITAN EDMONTON 1971

ALL PEOPLE 65+

Pente.

Presb.

R. C.

2,475 37,680 1,590 1,305 18,845 865 720 1,175 18,835

6,680 3,085 3,600

15,205 7,665 7,540

127,275 63,315 63,970

60 30 30

450 185 260

1,920 910 1,005

6,040 2,770 3,275

Bap.

Greek Orth.

Jew

TOT. 50,785 Male 24,585 Fe. 26,195

14,605 7,015 7,530

22,005 11,430 10,575

3,595 1,520 2,065

1,160 470 685

2,180 1,245 935

Ang.

TOT. Male Fe.

Men. Hut.

Luth.

285 2,545 120 1,270 175 1,280

Salv. Army

Uk. C.

United

Other

No Religion

ALL PEOPLE

TOT. Male Fe.

1,120 535 585

18,505 9,275 9,230

130,475 63,735 66,735

30,755 15,390 15,365

36,755 21,805 14,950

65+

TOT. Male Fe.

125 60 65

1,725 880 840

6,795 2,815 3,985

1,540 695 845

1,045 720 490

NOTE: Ang. - Anglican Bap. - Baptist Greek Orth. - Greek Orthodox Jew. - Jewish Luth. - Lutheran Men. Hut. - Mennonite & Hutterite

Pente. - Pentecostal Presb. - Presbyterian R. C. - Roman Catholic Salv. Army - Salvation Army Uk. C. - Ukrainian Catholic TOT. - Total

TABLE X LEVEL OF SCHOOLING (Those not attending School Full-time) METROPOLITAN EDMONTON, 1971 (15 years of age and over)

AGE GROUP AND SEX

SECONDARY

LESS THAN GRADE 9

GRADES 9-13

WITH OTHER TRAINING

UNIVERSITY ONLY

TOTAL

NONE

Edmonton, Alberta T. M. F.

UNIVERSITY

ELEMENTARY

VOCATIONAL NONE

VOCATIONAL VOCATIONAL POSTSECONDARY AND POST NON-UNIV- SECONDARY ERSITY NON-UNIVERSITY

UNIVERSITY AND OTHER TRAINING

WITHOUT WITH WITHOUT DEGREE DEGREE DEGREE

WITH DEGREE

293,390 142,970 150,425

(21.2)*62,100 31,325 30,775

(2.4) 7,115 5,195 1,920

(43.4) (5.7) 127,290 16,765 56,125 9,545 7,220 71,160

(4.7) 13,905 5,270 8,640

(9.7) 28,685 14,080 14,605

(4.1) 12,260 5,775 6,490

(5.8) 17,085 10,830 6,250

(1.8) 5,490 3,020 2,475

(0.9) 2,685 1,810 880

29,375 13,640 15,735

(55.8) 16,395 7,885 8,510

(2.8) 820 555 265

(28.4) (2.3) 680 8,350 405 3,430 280 4,925

â&#x20AC;¢ (2.5) 760 185 575

(2.4) 715 310 400

(2.2) 665 275 390

(2.0) (0.5) 590 245 395 100 195 140

(0.5) 160 105 50

65 years and over T. M. F.

percentages in parenthesis

TABLE XI LIFE EXPECTANCIES IN YEARS - EDMONTON AND ALBERTA* 1977

EDMONTON

ALBERTA

At Birth

Males Females

70.57 77.98

70.39 77.56

At Age 65

Males Females

14.69 18.79

14.73 18.57

1977 Life Expectancy Tables. Alberta Bureau of Statistics.

CHAPTER III HEALTH AND MEDICAL TREATMENT

A. Health of Seniors Good physical health is basic to the well-being and life satisfaction of older people, as it is to people of all ages. In 1966, the Senate Special Committee on Aging estimated that more than 85% of the elderly in Canada are (2) TheSnider Study on health care utilization among seniors in good health. in Edmonton,(3) recorded that in the sample ". . . 11.7% self-rated their health as poor; an equal proportion saw their health as excellent. 47% saw their health as good, while 29.2% saw their health as only fair." Thus, the majority of seniors describe themselves as in relatively good health. Aging is not a disease but a part of the growth process of all living things. Chronic illness is perhaps the older person's main health hazard (although not exclusively a problem of age). Chronic disease, lowered resistance to stress, and anxiety over health are, generally speaking, more prevalent with those who are older. While there are diseases and illnesses among the aged, there are no special diseases of the aged. Although aged people may show disease symptoms differently, and resolution of health problems may not necessarily be cure, illnesses are the same as those for people of other age groups. With increased age, the physiological functioning of the body deteriorates. This aging process proceeds at different rates within the body, and differs between individuals. "It follows both from consideration of mathematical probability and from actual observation that the variation of the functional ability among individuals increases as the age of people . . . increases..(4) There are also differences between socio-economic groups, environment being a major factor.

B. Use of Health and Medical Services People over 65 use more medical treatment services than other age groups. From July 1, 1974 to June 30, 1975, in Alberta (information is not available for the City of Edmonton), this age group used almost twice as many medical

services per 1,000 population as the general population. Excluding obstetrical services, seniors used more of every type of medical service per 1,000 people than the general population (with the exception of minor surgery, diagnostic radiology, anaesthesia, and "other diagnostic and therapeutic services").(5) In terms of institutional medical and treatment services, seniors use more hospital bed days per 1,000 people than any other age group. They are (6) in hospital more frequently and stay in hospital longer. Of 900 auxiliary hospital beds in the Edmonton district, in 1976, people over the age of 65 occupied 810 (90%) and of 1,936 nursing home beds seniors occupied 1,743 (7) (90%).

It follows that, of the total spent on medical treatment services, the proportion used by seniors is disproportionately larger than their numbers compared to the general population.

C. Orientation of the Health Care System Health and medical treatment services in Canada are primarily oriented towards treatment of disease particularly in institutional settings. Alberta has developed a system of health care strongly emphasizing institutions including active treatment hospitals, specialized hospitals, auxiliary hospitals and nursing homes. To reduce the cost to the individual of adequate care, the Federal and Provincial governments instituted universal health care insurance, which for seniors covers almost the full range of medical and dental costs. In Alberta seniors are not required to make premium payments. There is little available in personal preventive health services in Edmonton for older people. There have been some developments in prevention of institutionalization, early discharge from hospital (through the Edmonton Home Care Program), and early diagnosis (through the Geriatric Public Health Nurse, Edmonton Local Board of Health). Because of limited scale, their potential long-range impact on the health care treatment system is difficult to measure.

Separations from Active Treatment Hospitals per 1,000 population Edmonton population 1972

0-14

5-44

45-64

65+

Obstetrics

Total Population 0 male

Mean Length of Stay in Active Treatment Hospitals

both

Edmonton population 1972

0-14

15-44

45-64

65+

, x. female

Obstetrics

Source, Hospital Bed Supply â&#x20AC;&#x201D; Edmonton and Calgary

Total Population

Costs of Medical Services per Person in Alberta

70 —

60 —

50 —

40-

30 —

20 —

10 —

dollars 1971

1972

1973

1974

1975

Medical treatment services, to a certain extent reflect supply and demand. If supply increases, demand or usage will rise. This is accentuated by the fact that costs of medical care are not borne directly by those who use these services most. Those who admit people to institutional treatment are not hampered by cost considerations. One effect may be that problems which could be treated by less intensive services are frequently treated by more intense more costly services. Decision-makers are becoming more aware and concerned about the increasing costs of medical care. There are indications that the Federal government is attempting to limit increases in its cost-sharing with the provinces. D. Health and Medical Treatment Services Type of Service Delivery

- Active Treatment Hospitals (See Appendix V)

Description

Existing service providers

Active treatment hospitals generally provide short-term treatment for acute health problems or short-term rehabilitation. -

Charles Camsell Hospital Edmonton General Hospital Misericordia Hospital Royal Alexandra Hospital University of Alberta Hospital

Specialized hospitals

- Aberhart Hospital - Dr. W. W. Cross Cancer Institute - Glenrose Provincial General Hospital

No. existing beds

- Rated = 4,096

Existing = 3,880

Operating cost per unit of service - $140 - $150 per bed day average Cost to senior

- None

Projected Demand -

65 years +

All Ages

bed days/year

1976

209,967

790,489

1981

254,464

863,027

1986

307,943

936,064

Operating Costs - 65 years + Low ($140/day) High ($150/day)

All Ages Low ($140/day)

High ($150/day)

1976

$29,395,380

$31,495,050

$110,668,460

$118,573,350

1981

$35,624,960

$38,169,600

$120,823,780

$129,454,050

1986

$43,112,020

$46,191,450

$131,048,960

$140,409,600

Active Treatment Hospitals 1976

76 75

58 42 41

Specialized Hospitals 1976

76 75

..,

67 64 51

62 54

42 41

28 27 26 19 6 7 18

5 2

1 90

Type of Service Delivery -

Description

Public Health Nursing (See Appendix VI) Public health nursing is one of the major preventive health services in the community. It attempts to prevent illness (or health problems) or to find problems at early stages so that appropriate treatment can be implemented before the problem becomes of crisis proportion.

Existing service provider -

Edmonton Local Board of Health

No. people served

Not available.

No. Units of Service Per Year

65 years +

All Ages

355

161,483

2,122

37,709

Group health education sessions -

1,263

School and clinic attendances Visiting services

Operating Cost

$2,194,085

Cost to senior

None

Projected Demand -

65 years +

School and clinic attendances Visiting services

Group health education * Sessions Projected Cost For Service For All Ages

All Ages

1976

1981

1986

355

430

521

2,122 2,572 * 68 82

3,112 99

1976

1981

1986

161,483 176,323 191,245 37,709 41,152 ** 32,797 35,804

44,635 38,834

** Attendances -

1976

- $2,194,085

1981

2,393,520

1986

2,592,980

Board of Health Clinics 1976

64 51

52 49 50

â&#x20AC;¢\53

73 74 59

58 42

27 37 26

25 19

Type of Service Delivery - Co-ordinated Home Care (See Appendix III) Description

- Arranges for, co-ordinates and aids in financing health and supportive social services to people of all ages in order that they may remain in or be returned to their home environment.

Existing service provider - Edmonton Home Care Program Co-ordinates Following Services for Eligible Persons Visiting nurse Visiting orderly Physical therapy Homemaker Home help (housecleaning) 65 years +

All Ages

924

1,246

93,731

supervised days 126,393

No. people served No. units of service per year

Occupational therapy Nutrition counselling Laboratory services Supplies and equipment Drugs and dressings

No. units of service per person

101.44 supervised days

Operating cost

$411,184

Operating cost per unit of service

$3.25 per supervised day

Cost to senior citizen

Sliding fee dependent upon service used and net income. Range*

Projected DemAnd All ages

Minimum Cases

Maximum Cases

1976

1,246

2,332

1981

1,360

2,546

1986

1,475

2,762

* Based upon the range of 2.67 (1976 actual) to 5 patients per 1,000 population. Range Minimum

Maximum

1976

$411,184*

$1,818,630

1981

448,800

2,204,070

1986

486,750

2,667,390

Projected Costs

* This is a developing program. The 1977-78 budget is $583,867. 23

Type of Service Delivery - Nursing Homes (See Appendix 1) - The nursing home program was developed to provide care for persons who do not require the medical and professional nursing care given in general and auxiliary hospitals, but because of age, mental or physical conditions require more care than is provided in a senior citizen's lodge. Nursing homes provide the following services:

Description

Accommodation, meals and laundry; - Personal services such as help and supervision in cleanliness, mobility, safety, feeding and dressing; - Special diets where necessary. - Routine drugs and dressings as ordered by the attending physician; - Recreational, diversional and re -activational activities. Existing service providers - See attached sheet. No. existing beds

- 1,936 (excludes Edmonton Veterans Home)

No. people on waiting list - 282 Present demand

- 2,218

Operating cost

- $13,779,480

Operating subsidy per unit of service by government

- $19.50 per bed/day.

Cost to senior

- $5.00 per day for standard bed

Projected Additional Demand* -

Minimum

Medium

Maximum

1976

283

364

651

1981

329

340

383

1986

350

364

410

Demand based on three projections, Minimum demand based on current complement; Medium and Maximum projections based upon Alberta Hospital Services Commission guidelines of 4.0 and 4.5 beds per 1,000 catchment population respectively.

Projected Costs** -

Capital Costs Minimum

1976

Operating Costs To Government

$13.6 million

1981

15.8

1986

16.8

1976

Medium

Minimum $15.8 million

Maximum

$17.5 million $31.3 million 16.3

18.4

17.5

19.7

Medium

Maximum

$16.4 million $18.4 million

1981

18.1

18.8

21.1

1986

20.6

21.4

24.1

** Projected capital costs use the three demand projections based upon a 1976 cost estimate of $48,000 for construction and equipment costs.

Nursing Homes 1976

76 75

â&#x20AC;&#x17E;

Nursing Homes Number of Beds

Name and Address Edmonton Central Park Lodge 5905 - 112 Street

134

(Edmonton Veterans Home (D.V.A.) (11440 University Avenue

150)

Good Samaritan (Mt. Pleasant) Nursing Home 10530 - 56 Avenue

196

Good Samaritan (Southgate) Nursing Home 4225- 107 Street

225

Dr. Angus McGugan Nursing Home 10410 - 111 Avenue

225

Hardisty Nursing Home 6420 - 101 Avenue

226

Holyrood Nursing Home 9510 - 80 Street

Jasper Place Central Park Lodge 8903 - 168 Street

100

Jubilee Lodge Nursing Home Ltd. 10333 - 76 Avenue

128

Sherbrooke Lodge 13210 - 114 Street

120

Venta Nursing Home 13525 - 102 Street

TOTAL BEDS - EDMONTON CITY 1,664 Sherwood Park Nursing Home 2020 Brentwood Blvd., Sherwood Park

100

Youville Home 9 St. Vital Avenue, St. Albert

162

River Crest Lodge Fort Saskatchewan

Good Samaritan Nursing Home Stony Plain

TOTAL

2,086

Number of Persons on Waiting List for Nursing Home Beds

300 275 —

250 — 225 — 200 —

175 — 150 — 125 —

100 '75

50 25

February 1974

June 1974

December 1974

June 1975

December 1975

June 1976

Type of Service Delivery -

Description

Day Hospital (See Appendix VII)

- Provides therapy, socialization and health teaching on a day time basis to assist the elderly and the handicapped in maintaining a minimum standard of health, in order that they can either continue to function in the community, or live in a senior citizen home.

Existing service provider - Norwood Day Hospital No. people served

- 131 (first 10 months of 1976)

No. units of service

- Averages 59 patients per month.

No. units of service per person

- Average attendance per patient.

Operating cost

- $97,725

Operating cost per unit of service

- $22.90 per patient per day. (Average $726 per patient per year.)

Projected Demand - Program in Edmonton too small and relatively unknown to make valid projections as to demand.

Type of Service Delivery - Auxiliary Hospitals (See Appendex X) - Auxiliary hospital care is designed for people of all ages who do not require active hospital care and treatment nor an intensive or comprehensive program of rehabilitation but who do require regular and continuous medical attention, skilled technical nursing provided under appropriate supervision on a 24-hour basis and, in addition, special techniques for the improvement or maintenance of functioning.

Description

Existing service providers

- a) Allen Gray Auxiliary Hospital b) Good Samaritan Auxiliary Hospital c) Grandview Auxiliary Hospital d) Lynnwood Auxiliary Hospital e) Norwood Auxiliary Hospital f) St. Joseph's Auxiliary Hospital

No. beds available

- 898

No. people on waiting list - 235 - $12,783,030

Operating cost Operating subsidy per unit of service by government

Cost to Senior

- $39 per diem (does not include portion paid by senior) -

First 120 days each additional day

Standard Ward

Private Ward

No charge

$3.50

$7.50

$4.00

Projected Demand*

Minimum 1976

Maximum

978

1,150

1981

1,122

1,320

1986

1,277

1,502

Projected Subsidy by Government

Operating Minimum

1976

Maximum

- $13,575,176

$15,462,630

1981 - 15,573,975

18,322,324

1986 - 17,723,450

20,848,583

Minimum and Maximum demand projections are based on Alberta Hospital Services Commission guidelines of 1.7 and 2.0 beds per 1,000 catchment population respectively.

Projected Costs**

Capital Costs Maximum

Minimum 1976 -

( 80 beds)

1981 -

(144 beds)

9.4

1986 -

(155 beds)

10.1

$5.2 million

(252 beds) $16.4 million (170 beds)

11.1

(182 beds)

11.8

** Based upon 1976 cost estimate of $65,000 per bed for construction and equipment.

Auxiliary Hospitals 1976

76 75

Auxiliary Hospitals* Number of Beds

Name and Address

Allen Gray Auxiliary 7510 - 89 Street Good Samaritan 97 Street and 71 Avenue

200

Grandview Auxiliary 6215 - 124 Street

200

Lynnwood Auxiliary 8740 - 165 Street

100

Norwood Auxiliary 11135 - 105 Street

148

St. Joseph's 107 Street and 82 Avenue

198 40)

(University Hospital (Aberhart Wing

TOTAL

938

Source: Alberta Hospital Services Commission

Type of Service Delivery - Central Placement Office (of Edmonton and Rural Auxiliary Hospital and Nursing Home District #24) (See Appendix VIII) Description

Provides assessment and placement for those people seeking admission to auxiliary hospitals, nursing homes and day hospital in District #24.

Existing service provider - Edmonton and Rural Auxiliary Hospital and Nursing Home District #24 No. units of service per year

- 2,000 (assessments)

No. units of service per person

- One assessment (occasionally re-assessment).

Operating cost (1976)

- $83,880 (projected from first 10 months of the year)

Operating cost per unit of service

- $41.94 per assessment.

Projected Demand

- 1976

2,000 assessments

- 1981

2,423 assessments

- 1986

2,933 assessments

Projected Cost

- 1976

$ 83,880

- 1981

101,620

- 1986

123,000

Type of Service Delivery - Physicians (See Appendix IV) Description

The physician is the base and usual entry point into the health care system. Physicians provide a variety of diagnostic and medical treatment services.

Existing service provider - 1,1065 physicians in Edmonton a) b) c) d) No. people served

general practitioners medical specialists surgical specialists laboratory specialists

- Total population.

No. units of service per year -

All Ages

65 years +

14,224 per 1,000 females 8,391 per 1,000 females 13,229 per 1,000 males Operating costs (1975)

5,789 per 1,000 males

- Amounts paid to practitioners by Alberta Health Care Insurance Commission. 65 years +

All Ages

$114,569 per 1,000 females $78,718 per 1,000 females $117,900 per 1,000 males Projected Physicians Needed -

$53,232 per 1,000 males

1976 - 1,065 1981

1,161

1986 - 1,259 Projected Costs to Alberta Health Care Commission for service to seniors only. (1975 dollars constant) 1976

$3,680,499

1981

$5,320,478

1986

$7,681,544

Type of Service Delivery - Psychiatric In-Patient Services (See Appendix XI) Description

Psychiatric in-patient services are available in four of the five active treatment hospitals in the city and in the Alberta Hospital, Edmonton. They provide intensive care for persons with severe emotional or mental disorders.

Existing service providers

No. spaces available

a) b) c) d) e)

University of Alberta Hospital Edmonton General Hospital Royal Alexandra Hospital Misericordia Hospital Alberta Hospital, Edmonton

- 899 beds

No. persons served

65 years + 154 (Alberta Hospital not available)

No. people on waiting list

4,067

Not available.

No. units of service per year -

65 years + 24.6 (Alberta Hospital not available)

Cost to senior citizen

All Ages

All Ages 71.3

- No charge.

Projected bed demand

Minimum

Maximum

1976

155

342

1981

169

394

1986

183

448

Type of Service Delivery - Health Care Insurance (See Appendix II) Description

- The system of health care insurance is designed to pay for health and medical treatment services.

Components a)Basic Health Benefits

pays for required services of general practitioners and specialists under an approved schedule of benefits and certain oral surgical, optometric, chiropractic and podiatric services.

b)Alberta Hospitalization Benefits Plan - pays for required hospitalization. c)Optional Health Benefits - pays for services included and administered by Alberta Blue Cross including ambulance, nursing care, naturopath, appliances, drugs and dental care. d)Extended Health Benefits - provides dental goods and services, optical goods and surgical and medical appliances, equipment and supplies for a chronic or recurring condition. No. people served

- All seniors.

Cost to senior

- Mane.

Projected additional demand - See under individual services.

Type of Service Delivery - Home Nursing Services (See Appendix IX) Description

Existing service providers

No. people served

Home nursing agencies provide nursing and related services in the home, place of business, or other locations (some agencies provide private duty work in nursing homes, auxiliary hospitals, or active treatment hospitals). The services provided are medical treatment, rehabilitation or support. a) Victorian Order of Nurses b) Nurses Private Duty Registry c) Alberta Male Nursing Service d) Health Care Services - Upjohn Ltd. e) Comcare Ltd. f) Edmonton Hone Services Ltd. - Different operating procedures and record keeping make comparisons and compilations Impossible.

No. of people on waiting lists - Not available. Present total demand

- Not available.

No. of units of service per year - Not available - visits. Operating costs

- Not available.

Operating cost per unit of service

- Not available.

Cost to senior citizen

- Dependent upon service.

Projected Demand - (Victorian Order of Nurses only) Visits Seniors Only

Total Population

1976

16,644 visits

1981

20,172

38,820 "

1986

24,408

44,448 "

Projected Operating Costs

33,768 visits

(Victorian Order of Nurses only) (Constant 1976 dollars) Seniors Only

Total Population

1976

$149,796

$303,912

1981

$181,548

$349,380

1986

$219,672

$400,032

E. Special Interest Areas and Suggested Options As the numbers in the age group above 65 grow, more people will have chronic health problems. More resources will have to be spent on the construction and operation of institutional health care facilities if services are developed on the same basis as in the past. For example, meeting the 1976 demand for nursing home beds in the Edmonton District is estimated to cost between $13.6 million and $31.3 million. The development of alternate modes of care would allow use of existing institutional care facilities more efficiently. Further development of alternate modes such as home care and out-patient services would also permit the maintenance of independence. The health care system needs considerably more emphasis on preventing health problems. Indications are that adequate preventive services can save (8) up to 25% of the need for crisis treatment of health problems. Prevention is considered by health professionals to be "better" than treatment.

1. Preventive Health Services General preventive health programs have had a cumulative effect over time; the life expectancy for males born in the Prairie Provinces in 1931 was 63.5 years and for females 65.5 years. In 1971 the life expectancy of a person born in that year was 70.6 and 77.6 years for males and females respectively. In 1931, a person reaching the age of 65 in the Prairie Provinces could expect to live an additional 13.6 (males) or 14.4 (females) years. A person reaching 65 years of age in 1971 could expect to live an additional 14.8 (males) or 18.5 (females) years in the Prairies.(9) The adding of years to the life-span does not necessarily mean that these years will be free from health problems. Only a small portion of our "health dollar" is spent on prevention. Considerably more emphasis must be placed in this area. a) Public Health Nursing - The Public Health Nursing service is probably the most significant of the preventive health services available in the community. Available data indicate, however, that the quantity of service utilized by senior citizens is proportionately low. This may be a reflection of a service which is strongly oriented to other population groups. 36

The Public Health Nursing Service of the Edmonton Local Board of Health should have the capacity to provide home visits to older people. The objectives should be to provide basic health assessment within the social and living environment of the older person, to refer individuals in need to appropriate resources; follow-up, and provide information about services to older people. Similar services are available in Scotland and other European countries. (10) The goal of such a program would be to provide visits to all seniors once a year and as required. Approximately 30 full-time public health nurses would be necessary, requiring about a 30% increase in the budget of the Public Health Nursing Service. A more limited service could begin by visiting those non-institutionalized people over the age of 75. This would reduce the target population from (11) over 30,000 to about 10,500. Some would not require visits on a yearly basis, some would refuse the service. Those residing in institutions would not require it. Based upon the work capacity of an average public health nurse, it is recommended that the Edmonton Local Board of Health add the equivalent of 12 public health nurses and as many certified nursing aides to provide home visits to people over the age of 75 and those "at-risk" in the 65-74 age group. The actual allocations of staff and staff time would be dependent upon the concentration of older people with problems. Home visiting should be provided by all staff public health nurses. This would provide better coverage than employing specialized nurses. Based on the 1976 Annual Report of the Edmonton Local Board of Health, it is estimated that the average annual cost per nurse in the employ of the Local Board of Health is $20,678 (1975-76 budget year). The annual cost of this service would not be greater than $496,000. 2. Physicians Services Edmonton has 1065 physicians who are active in some way in the health field.* This represents 2.3 physicians per 1,000 population. Canada averages 1.7 physicians per 1,000 population.** From this it would appear that Edmonton has better than average coverage of physicians' services. A specific study would be necessary to assess the adequacy of this establishment for the future. * Excludes interns and residents. ** Includes interns and residents.

3. Family Relief Services Current community opinion is that the number of senior citizens who live with married or unmarried children is declining. The family of the senior citizen frequently desires, and should be encouraged, to care for their aged parent or relative. The health care insurance system in Alberta provides a financial incentive for senior citizens to be placed in extended care facilities. While many senior citizens in the community are barely able to manage on pension and other income supplements, persons residing in nursing homes pay $5.00 per day or a total of only $150 per month and are frequently able to save a considerable portion of their monthly income. The financial burden of care provided by the family rests with the family. Thus, in Alberta there is an incentive, at least financially, to seek institutional care. In many other societies, it is the traditional role of the family to care for its older members. In Canada and Alberta there is little incentive and little support for the family accepting this role. If community resources were available, and if families could have certain periods of time away from the continuing responsibility for their aged parent (or spouse), they might be more willing to accept responsibility for such care. a) Relief Beds in Extended Care Facilities - When beds are available some limited services are now provided. Additional beds in extended care facilities should be committed so that families or relatives looking after aged relatives can have relief from this responsibility on a periodic basis. One weekend per month plus a two-week holiday period during the year might be sufficient encouragement for more families to look after their aged relatives. This would equal a maximum of 36 days of care per year. This is 10% of the days of care which would be required if long-term institutional placement were necessary. b) Home Care Relief - The Edmonton Home Care Program operated by the City of Edmonton is a structure for assessing the health and related needs of individuals and organizing (and funding) services to meet these needs in the home environment when the individual is capable of being effectively treated and supported in the home. 38

One specific service of the Edmonton Home Care Program allows for relief for an 8-hour period per week using the homemaker service. To enable people to remain in their homes, the relief aspect should be expanded to encourage people to provide care for the older spouse or parent. Holiday Relief - Provide a two-week period once yearly to provide relief to the family caring for an aged relative. Service to be provided on a 24-hour basis when necessary, for a 14-day period. If, for example, this service is provided by a homemaker, the cost of the two-week relief would be approximately $539. While this is considerably more than the cost of nursing home care for the same period of time, it is substantially less than long-term nursing home care which might be required if the family was unable to assume continued responsibility. Eight-Hour Relief - Should be expanded to provide relief to families of people who are not now qualifying for the Home Care Program. This service could be provided on a once-weekly basis. The cost of this service would be approximately $42 for one eight-hour period per week. The extent of potential demand for these services is not known. No data are presently available which indicates the number of older people who are living with adult children or other relatives. 4. Day Hospital The Day Hospital program provides services similar to those required by patients in nursing homes but on an out-patient basis. It is a demonstrated alternative to institutionalization. The known unmet demand for Day Hospital services is quite small. It is expected that as the Day Hospital Program becomes more widely known, the demand for the service will increase. Alone, or coupled with home care, this service could be quite effective in maintaining the independence of seniors and preventing institutionalization.

A study should be undertaken of those people residing in and applying for admission to nursing homes to determine how many could use Day Hospital effectively. Consideration could then be given to expanding the Day Hospital Program. 5.

Rehabilitation Services Many people, including some health professionals, view older people as

constantly ill, having only a short remaining life span, and therefore poor investments for certain types of health care treatment. Some health care professionals state that many of the rehabilitative services of hospitals are not as readily available to older people as they are to younger people. Rehabilitation services, properly administered, in conjunction with proper health teaching can be of tremendous value in assisting the older person adjust to his environment. Older persons in active treatment hospitals, may require rehabilitative treatment for ailments that would have lesser impact upon persons of younger age. In addition to a greater emphasis on rehabilitation in active treatment hospitals, auxiliary hospitals and nursing homes should emphasize rehabilitation programs to return the individual to independent (as much as possible) community life. 6. Physicians and Home Visits It appears, in Edmonton, that it is the exception rather than the rule for physicians to make home visits. Yet home visits by physicians are viewed (12) by a visiting geriatrician as an essential part of general practice service. Home visiting provides the physician with information about the environment of his patients, and assistance available in dealing with health problems. Information from the Alberta Health Care Insurance Commission(13) indicates that for the year ending June 30, 1975, medical practitioners provided 923 home visits to males and 1,382 home visits for females per 1,000 population over the age of 65 in Alberta. This compares with 197 (males) and 238 (females) home visits per 1,000 general population for Alberta. If the pattern for all Alberta holds true for Edmonton and the number of visits per 1,000 senior citizens does not change, physicians provide 12,848 home visits 40

to males and 23,246 home visits to females over the age of 65 in Edmonton; a total of 36,094 home visits for the year, or more than one home visit per senior citizen per year. It should be observed that nursing home visits are considered home visits. One physician, who has a relatively large number of elderly persons in his practice, indicated that he does approximately 20 home visits per year. (14) Home visits take considerably longer than do office visits and must (15) include travelling time. The Alberta Health Care Insurance Commission pays up to $16.20 for a 'first' office visit for a new illness in which a history must be taken, up to $20 is allowed for the same type of service at a patient's home. Therefore, with a longer visit and including transportation time, the dollar difference has almost no impact and, therefore, physicians paid on a fee-for-service basis are not likely to provide this service to any large extent. A new fee schedule should be established enabling physicians to provide home visits, particularly to older people at a fee that would be commensurate with the time involvement. 7. Diagnostic Clinics Those who are widowed, those in the oldest age group, and those with low levels of morale and physical health are likely to contact non-physicians for health advice. ". . . The group that could conceivably benefit most by physician care or referral opt largely for non-medical advice instead . .

,(16)

While it has been recommended by persons in the community that diagnostic clinics be established (akin to the existing 'Well-Baby Clinics' operated by the Local Board of Health) at which an older person can get a brief check-up by a public health nurse or physician; diagnosis is of little value without adequate treatment. The Edmonton Local Board of Health has indicated that general clinic screening is an inefficient approach; that screening for specific problems is more effective.

Many older persons are likely to cover-up problem symptoms and attribute them to old age. Others, however, will visit a physician at the slightest ache or pain. Yet, it is highly desirable for older persons to recognize symptoms as possible health problems. It is equally desirable for medical treatment personnel to quickly treat or refer an older person to where adequate treatment facilities are available. 8.

Geriatric Units A medical treatment facility with the staff fully conversant with health

problems as they manifest themselves in the elderly should be available in Edmonton. There is presently in existence a Federal-Provincial working party examining the need for, feasibility, and structure of 'Geriatric Units' in hospitals. "A Geriatric Unit in a hospital is an in-patient area which provides assessment, treatment and rehabilitation programs for the elderly for periods up to 60 days". (17) "The minimum size for an economic operational unit is 20 beds. This could serve patients from 400 acute care beds. Maximum administrative size is 40 beds".(18) This implies that the proposed geriatric units would be more of a back-up or referral unit to which patients already in hospitals could be referred.

Geriatricians There is no physician practicing in the city with specific training to

deal with the special problems of older people. Dr. L.H. Anholt states: "with regard to acute geriatric care the great and glaring deficiency is (19) adequate assessment". With regard to people being admitted to extended care facilities, these people ". . . usually have one or two diagnoses, one of which is usually 'senility'. In the geriatric population if there are not 5 or 6 diagnoses at least, then appropriate evaluation has not been (20) done." Concern has been expressed at the lack of "interest" by physicians in the elderly,". . . primary care physicians . . . to date certainly â&#x20AC;?(21) have not distinguished themselves to providing exemplary care of the aged. (22) The Snider Study indicates that those older persons who need referral to physicians' services most get the least, and ". . . only 4.2% of respondents or their spouses claimed any contact with one health or related agency , (23) in the two years previous to our interview' 42

A geriatrician could be a consultant, providing information and assistance to other physicians on specific problems of older people; a teacher, educating potential and practicing physicians in the specific problems of the elderly and a medical practitioner providing direct service to those persons who could not be treated by a physician in general practice. Dr. Graham Clarkson has made suggestions for the quantity of geriatricians.

. . . The total number of geriatricians required in . . . Alberta

with the present age mix would be in the order of 25 to 30 . .

for

Thus, Edmonton, with a 1976 projected population of about 136,000.(25) approximately 22% of the projected senior citizen population, would require the equivalent between 5.5 and 6.6 geriatricians. With the projected population growth, and assuming a need for a 5.5 to 6.6 geriatricians for a population of approximately 30,000 persons above the age of 65, Table XXI indicates the number of geriatricians necessary in future years. Projected costs for geriatrician services use 1975 dollars and assume that the cost of a geriatrician would be equal to the average age fee paid to the medical specialists by the Alberta Health Care Insurance Commission ($46,072). (26) TABLE XII

PROJECTED REQUIREMENTS AND COSTS FOR GERIATRICIANS IN EDMONTON 1976, 1981 and 1986

YEAR

POPULATION 65+

LOW

HIGH

LOW COST

HIGH COST

1976

30,620

5.5

6.6

$253,400

$304,000

1981

37,109

6.7

$308,700

$368,600

1986

44,908

9.7

$368,600

$447,000

Given the number of physicians in Edmonton and the present style of practice, geriatricians could be gradually introduced into the Edmonton medical scene. It is hypothesized that the presence of two geriatricians in the City of Edmonton might be sufficient to initiate the service. 43

Costs for geriatricians could be covered by the Alberta Health Care Insurance Commission on fee-for-service items; and the University of Alberta for teaching services.

10. Mixed Level of Care Facility The shifting of people from residence to residence; from one care facility to another (when different complexities of care are required) causes difficulty for many seniors in this position. It can also contribute to difficulty in marital relationships due to physical separation as well as other social problems. It has been proposed to the authors that facilities should be constructed to provide accommodation along with care as needed. Such facilities should have the capacity to provide accommodation (as is the case with senior citizens self-contained units); lodge-type care (meals, laundry service and limited supervision); and nursing home type care. Staff and equipment requirements beyond the basic core should be purchased on a fee-for-service basis from existing community suppliers. This type of facility would require close collaboration between the Alberta Housing Corporation, the Alberta Hospital Services Commission, Alberta Health Care Insurance Commission and the Edmonton Home Care Program. Funds for construction of the accommodation portion could be provided by the Alberta Housing Corporation. The Architectural Branch, Real Estate & Housing Department, has indicated an estimated additional 30% of floor space would be needed for the services provided for persons needing lodge-type accommodation, nursing home type care, and auxiliary hospital type care, above and beyond the usual amenity space provided in self-contained senior citizens housing developments. The Edmonton and Rural Auxiliary Hospital and Nursing Home District #24 has built nursing homes and auxiliary hospitals on the same site. A new extended care centre being constructed in the Dickensfield area will combine nursing home and auxiliary hospital services. No information is presently available which would provide an accurate picture of the costs involved (construction, land, facilities, manpower).

11. De-institutionalization - Re Integration Many senior citizens admitted to extended care facilities dispose of their houses, furniture and other possessions. Some at the application stage will also do this as they feel that such actions quicken the admission process. Until 1975, a nursing home could not discharge a patient against his will. Notwithstanding the turnover rate, a patient could have remained in the nursing home for years whether or not that service was actually required. When interviewed, nursing home operators indicated different viewpoints as to whether or not patients in residence were capable of using a less intensive level of care. One operator of an auxiliary hospital stated that they had patients who could do with lesser care. The Central Placement Office indicated that all persons on the waiting list for extended care facilities need that care, although in some instances because there are no alternatives for community care. Independence is difficult to maintain in an extended care facility. Many individuals find that it is easier to let other people do things for them. Staff in extended care facilities often find it easier to do things for patients than to encourage patients to do things for themselves. There is little opportunity for the individual, once he or she is in an extended care facility, to return to community life. For some the process of institutionalization takes place. Institutionalization has been described as taking place in ".

. an institution in which a

rigid, comprehensive and Impersonal regime allowed no scope for individual decisions on the part of the inmate . . . and, demanding only their compliance, led to emotional apathy, lack of spontaneity, and an incapacity for active adjustment to events which were common-place to non-institutionalized (27) individuals . . ." Extended care facilities are changing from a custodial, residential framework to a greater thrust toward rehabilitation. People seeking admission to extended care facilities should be made aware of this thrust: that when they are well enough to cope with community life they will be returned to the community, and that extended care facilities offer primnrily medical and rehabilitative treatment not custodial care.

For patients of extended care facilities who can physically care for themselves (perhaps with some support of community services) a re-education program is a necessary component in the community re-integration process. This type of program would gradually teach the individual how to cope in the community. It would assist a person to find living quarters, set-up a housekeeping regime, shop and prepare meals, and to obtain needed resources. Such a program may even include care at the extended care facility as weekend or out-patients. This would provide a transitional phase to the process. Further in-depth study is needed to determine the staffing, methodology and costs for such a program. It could begin on a pilot project basis in one nursing home or auxiliary hospital after assessment of patients to determine what number of them can be returned to community life. 12. Use of Active Treatment Hospital Beds The active treatment hospital is our most crucial and most expensive medical treatment service. If we examine the use of these hospital beds by people 65 years of age and over in Edmonton and compare with other Canadian cities (Kingston, Metro Toronto, Hamilton, London, Winnipeg and Calgary) some interesting things are revealed. The number of patient days used per 1,000 population, 65 years of age and over is highest in Edmonton. The mean length of stay in active treatment hospitals is exceeded only by Calgary. The number of separations per 1,000 population 65 years of age and over is highest in Edmonton. Although the figures compared are 1971 and 1972, the Ontario Ministry of Health in 1976, has indicated that it has been able to reduce the number of active treatment hospital beds per 1,000 population from 5 to 4 per 1,000 population. This has been due to two major factors: the cooperation of practicing physicians in reducing the length of stay of their patients and the growing use of Home Care. Similar attempts should be made in Edmonton to reduce hospitalization.

Patient Days per 1,000 Population

and over

in Active Treatment Hospitals in Selected Cities * 7,000 — 6,000 —

5,000 —

4,000 3,000 — Kingston Metro Toronto Hamfon

London

Winnipeg

Mean Length of Stay of People

Edmonton

Calgary

and over

in Active Treatment Hospitals in Selected Cities

Kingston Metro Toronto Hamilton

London

Winnipeg

Edmonton

Calgary

Separations from Active Treatment Hospitals per i,000 Population

Kingston Metro Toronto Hamilton

and over in Selected Cities

London

Winnipeg

Alberta Cities 1972, Ontario and Manitoba 1971 Source: Hospital Bed Supply — Edmonton and Calgary

Edmonton

Calgary

13. Hospital Discharge Planning There are indications,(28) that some seniors are being discharged from active treatment hospital without notification to their families, without determination whether their accommodation is suitable for their present health condition or whether assistance is available in their home. The completion of active medical treatment does not necessarily mean that the senior is fully capable of returning to his former place of residence or to take up his usual activities. Seniors are hospitalized more frequently than other age groups and tend to stay in hospital longer than other age groups. Appropriate and adequate plans for discharge are crucial with the senior himself, his family and, where necessary, appropriate service agencies. "Discharge planning", or the linking of community resources for the patient after discharge, is usually the responsibility of the hospital Social Service Department (if the attending physician refers his patient). Adequate "discharge planning" should be a priority in hospitals. 14. Convalescent Care Community people have suggested that short-term convalescent facilities be established in which the individual could regain his full strength and through intensive health education be taught how to care for himself. Some people (extent not known) because of lack of appropriate housing or appropriate support in the home, should not be returned immediately to their own homes, but require a further period of convalescence in an appropriate setting after their initial period of hospitalization. This service is available in the Glenrose Hospital, the extent to which it should be expanded is not known. 15. "Comprehensive Geriatric Service" A "comprehensive geriatric service" is a system of organizing and delivering health and related services for older people on a geographical base as defined by Graham Clarkson.(29)To be optimally effective, it must be through the co-ordinated effort and utilization of institutional, ambulatory, home care, and social service agencies. The majority of components for such a

"comprehensive geriatric service" now exist, but on a limited scale, and operating in an unco-ordinated fashion. Considerable research and possibly a number of years experience on a demonstration project basis will be necessary to determine the proper mix and value of such an organization of health and related services in Edmonton. The catchment area of a "comprehensive geriatric service" could vary between 50 to 120 thousand population and "its boundaries, as far as possible, should be comparable to present community services and tied-in with catch(30) ment areas that have been developed for health and welfare services." Using City population projections as a guide (466,503 estimated for 1976) the number of "comprehensive geriatric service" units could be between 4 and 9. The lower number of such would be more appropriate for a large city because the services and population are within a limited geographic area. It is suggested that a committee of local health and related professionals be struck to examine the feasibility of "comprehensive geriatric services" in Edmonton. That the terms of reference for such a committee should include: a) To define a comprehensive geriatric service in the Edmonton context. b) To determine which services should be included. c) To define the catchment population. d) To define the system of management. e) To determine estimates of added costs.

CHAPTER IV INCOME

The amount of income available on retirement is a crucial concern for many seniors. While there is a great diversity of income levels among seniors, they are generally seen as a low income group. The inflationary situation of the past few years has had a significant impact on seniors who had attempted to save for retirement. The peak earning period of an individual is between 30 and 50 years of age. A person reaching retirement in 1977 had his peak earning period between 1942 and 1962. Although no data are available for 1942, average household income in the Prairie Provinces in 1951 was $3,261.00; in 1961, 32) People reaching retirement $4,355.00; and in 1975 $13,573.00. (31, now had fewer dollars to save during their peak earning years, and these dollars have been severely reduced in purchasing power by inflation. Inflation has necessitated increased reliance of seniors on government transfer payments such as Old Age Security Pension, Guaranteed Income Supplement, etc.

A. Level of Income The 1975 cross-Canada survey of income indicates that 76.4% of people over the age of 65 had income of less than $5,000.00; 69% had income less than $4,000.00; and 53.1% had income less than $3,000.00 (median income $2,911.00). This compares with the total population which had 45% with income less than $5,000.00; 38.4% less than $4,000.00; and 28.7% less than $3,000.00. Families which spent on the average 62% or more of their income on food, clothing and shelter are considered to be in straitened (33) The income level at which this applies in areas of circumstances. comparable size to Edmonton in 1974 was $3,456.00 for a single person and $5,008.00 for two people. 14.4% of families and 58% of individuals between 65 and 69 years of age had incomes below this level; 23.3% of families and 65.3% of individuals over the age of 70 had income below this level. These figures suggest that many seniors received the bulk of their income from government transfer payments (or have only a small amount of outside income).

In 1974, 39.7% of the lowest fifth of Canadians income earners were 65 years of age and over, compared to 5.5% of the highest fifth of income earners. (34) B. Assets and Debt In 1970, 6.5% of Canadian households with head over the age of 65 had no liquid assets compared with 6.2% of all households. Families headed by seniors had the highest liquid assets of any age group $6,978.00 (all families $3,365.00). 79% of seniors were without consumer debt compared to 42.8% for all families. On the average seniors owed the least $172.00, compared to all families $944.00.(35)

C. Sources of Income The majority of seniors in Alberta (1970) (75,130; 63.35%) had government transfer payments as their main source of income, 19.02% (22,560) employment, 17.62% (20,900) other income; and 1.42% (1,690) had no income. (36) A 1975 nation-wide survey of retired people indicates that of those with income of less than $2,000.00 13% of men and 3% of women had job related pensions; 25% of men and 19% of women had Canada or Quebec Pension benefits; 73% of men and 36% of women Old Age Security Pension; 2% of men and 2% of women private pensions. Of retired people with income between $2,000.00 and $4,999.00, 34% of men and 8% of women had job related pensions; 49% of men and 26% of women had Canada or Quebec Pension Plan benefit; 83% of men and 82% of women had Old Age Security Pensions; 6% of men and 4% of women had private pensions. Of retired people with an income of $5,000.00 or greater, 71% of men and 46% of women had job-related pensions; 71% of men and 23% of women had Canada or Quebec Pension Plan benefits; 81% men and 72% of women had Old Age Security Pensions; 18% of men and 27% of women had private pension plan. (37*) There is little difference between the senior population of Canada, Alberta and Edmonton as to proportion receiving the Federal Old Age Security Pension and Guaranteed Income Supplement benefits.

TABLE XIII PROPORTION OF SENIORS IN CANADA, ALBERTA AND EDMONTON RECEIVING FEDERAL OLD AGE SECURITY AND GUARANTEED INCOME SUPPLEMENT BENEFITS 1976*

(number of pensioners in parenthesis) Canada

Alberta

Edmonton

Old Age Security Pension

44.7%

42.8%

Benefits Only

(895,779)

(58,535)

(13,228)

Guaranteed Income Supplement

33.6%

35.8%

36.7%

Partial Benefits**

(673,337)

(48,961)

(11,337)

Guaranteed Income Supplement

21.7%

21.4%

20.5%

Maximum Benefits

(434,863)

(29,267)

( 6,336)

Total

100 %

(2,003,981)

(136,764)

(30,901)

Figures for Canada and Alberta are for month ending December 31, 1976. For Edmonton, month ending July 31, 1976. Source: Old Age Security Office, Department of National Health and Welfare.

Includes people receiving spouses allowance.

Proportions of Seniors Receiving Old Age Security Pensions and Supplements Edmonton, Alberta and Canada 1976 *

50 — 40 — 30 —

Partial

G IS

36.7

35.8

33.6

Full

G IS

GIS

20 —

20.5

21.4

Edmonton

Alberta

Canada

* Source: Old Age Security Office, Dept. National Health Et Welfare Alberta and Canada are at end of 1976, Edmonton is July 1976

Based upon the number of seniors receiving the Old Age Security benefits, the income of seniors in July, 1976 was as in Table XIV.

TABLE XIV MONTHLY INCOME OF INDIVIDUAL SENIORS IN EDMONTON JULY 1976*

Less Than Single person

Greater Than

$302.19

$302.20 - 340.19

Married person

293.62

293.63 - 318.92

Total Persons

13,228

11,337

Greater Than

$340.19 $318.92 4,599

1,737

* Based on Old Age Security Pension and Guaranteed Income Supplement levels. Source: Old Age Security Office. Department National Health and Welfare. The maximum Old Age Security benefits in January, 1977 were $285.48 for a single person and $553.14 for a married couple per month in Alberta. This forms the base or minimum income for seniors in Edmonton (and Alberta). In 1974, there were almost 16,000 private and employment pension plans operating in Canada. While the number of people covered is increasing, the proportion of workers in private and employment pensions is not increasing (38) significant1y. In 1973, over 600,000 Canadians were receiving benefits (39) from private pension plans with an average annual benefit of $2,105.00. Information on beneficiaries of private pension plans is not available for Edmonton. Nationally in 1961, 47.6% of males between the ages of 65-69 were in the labour force, by 1974, this had declined to 29.3%. This may be a function of the lowering of the. age of receipt of Old Age Security Pension between 1966 and 1970 and the introduction of the Guaranteed Income Supplement. In 1971, 3,690 seniors (13.5%) in Edmonton were in the labour force. In 1974, 1.86% of the total labour force in Canada was over 65. 29.83% of those over 65 were employed on a part-time basis (4.03% of the part-time labour force).

By December 1976, workers 65 years of age and over had declined to 1.5% of (41) the total Canadian labour force. The data suggest that a significant but decreasing minority of older people are working past the normal retirement age. There is little evidence to suggest that more seniors would seek work if such were available. D. Adequacy of Income There is no concensus as to how much income is adequate. In Alberta, the combines maximum benefits of Old Age Security Pension, Guaranteed Income Supplement and Alberta Assured Income Plan form an income base (except for those without the residence requirements). In Edmonton in 1976, more than 20% of seniors had only this basic level of income. As a base to measure adequacy of income, the Social Allowance rates (Alberta Social Services and Community Health) will be used. TABLE XV MONTHLY SOCIAL ALLOWANCE RATES ALBERTA SOCIAL SERVICES AND COMMUNITY HEALTH

Single Adult

Two Adults

$53 + 20% = $63.60

$106 + 10% = $116.60

Clothing

16.00

32.00

Personal expenses

12.00

24.00

Household expenses

6.00

10.00

Laundry

2.00

5.00

14.00

$113.60

$201.60

Food

Utilities Sub-Total

The Social Allowance Program in Edmonton will allow $185.00-$245.00 per month for rental accommodation. The combined monthly maximum benefits of Old Age Security Pension, Guaranteed Income Supplement and Alberta Assured Income Plan

in January 1977 were $285.48 (single person) and $553.14 (couple). Using the lower rental figure for a single person and higher figure for a couple, Social Allowance would provide $298.60 for a single person and $446.60 for a couple. This suggests that the base income for a single senior is not adequate, while that for a couple is adequate. It would appear that the amount paid by a senior for shelter would have a large bearing on the adequacy of income as this is the largest single item. Married seniors, because of shared accommodation would be better off than single seniors. The advent of Canada Pension Plan - Retirement Pension, is starting to have an impact on the income senior citizens. Since 1971, the proportion of people qualifying for the maximum benefits of the Guaranteed Income Supplement have been steadily decreasing. The proportion of people qualifying for partial benefits of the Guaranteed Income Supplement increased between 1971 and 1974 but the rate of increase slowed between 1974 and 1976. The proportion of people qualifying for Old Age Security Pension only decreased between 1971 and 1974 but began to increase again after 1974. It is expected, in future years, with the increased number of persons qualifying for Canada Pension Plan and increases in Private and Employment pensions, the significance of the Guaranteed Income Supplement for the majority of seniors will gradually diminish. TABLE XVI PROPORTION OF SENIORS RECEIVING O.A.S. AND G.I.S.* 1971, 1974, 1976 Canada

O.A.S. only

Partial G.I.S.

Full G.I.S.

1971

50 %

22.5%

27.5%

100%

1974

42.1%

32.2%

25.7%

100%

1976

44.7%

33.6%

21.7%

100%

1971

42 %

26.5%

31.5%

100%

1974

39.1%

34.6%

26.3%

100%

1976

42.6%

35.8%

21.4%

100%

Alberta

54 Source: Old Age Security Office. Department of National Health and Welfare.

There is no concensus as to how much income is adequate for a senior. The income that seniors have, however, must be protected as to its purchasing power.

E. Income Security Programs

Type of Service Delivery - Income Security Programs (See Appendix XX)

Description

Income security program provide income to all people over the age of 65. In Alberta, a minimum standard is set by the combined benefits of 0.A.S.P., G.I.S. and A.A.I.P.

Existing service providers

a) Old Age Security Pension b) Guaranteed Income Supplement c) Alberta Assured Income Plan d) Canada Pension Plan - Retirement Pension e) War Veterans Pensions f) War Veterans Allowance g) Civilian War Allowance h) Social Allowance i) Private Pension Schemes

Statistical information available only for Old Age Security Pension and Guaranteed Income Supplement.

No. people served - Old Age Security Pension - 30,700 Guaranteed Income Supplement - 17,470

Projected Demand -

0.A.S.P.

G.I.S.

1976

30,700

17,470

1981

37,100

21,110

1986

44,900

25,540

F. Special Interest Areas and Suggested Options a) Alberta Assured Income Plan This program provides benefits of up to $45.01 for a single person and $47.20 for each person of a married couple. There is a direct relationship between this program and the Federal Guaranteed Income Supplement in that these qualifying for G.I.S. also receive the A.A.I.P. The Federal Old Age Security Pensions and Guaranteed Income Supplement are geared to the cost of living (with increases quarterly) while the Alberta Assured Income Plan has no provision for increases. For example, if the maximum combined benefits of the O.A.S. and G.I.S. for a single person rise 10% to $275.20 per month, the overall increase in income for those seniors qualifying for maximum benefits will have increased by only 8.4%. Thus, increases in pension benefit do not keep pace with increases in the cost of living. The Alberta Assured Income Plan should increase its benefits to seniors with the cost of living. b) Canada Pension Plan The Canada Pension Plan - Retirement Pensions, is expected to increase its maximum benefits as the maximum contributory earnings increase. Since payment of benefits by the Canada Pension Plan began, there has been a decline in the number of people in Alberta receiving full benefit of the Guaranteed Income Supplement (while there has been an increase in the proportion qualifying for partial benefit). It is anticipated that further development of the Canada Pension Plan may substantially reduce the importance of the Guaranteed Income Supplement in future years. Proposed ammendments to the Canada Pension Plan would enable spouses not in the labour force to make contribution to the plan; would allow contribution to be split on dissolution of a marriage and allow for maternity leave from the labour force.

Implementation of these proposed amendments would assist in the financial preparation for retirement. C. Private Employment Pension Plans The vast majority of private employment pension plan are not transferrable between employees and it is usual that the employee terminating employment does not receive that portion of premium paid by the employee or any interest on his own premium. It is suggested that private employment pensions be transferrable between employers. Because there is considerable variation between pension schemes, it might be more feasible to give the employee the amount of contributions of both employer and employee plus accrued interest.

CHAPTER V HOUSING

A. Housing of Seniors Safe and decent housing at a reasonable price is crucial to the older person. Housing is related not only to a sense of contentment and satisfaction, and therefore to emotional well-being, but has an important bearing on physical health. It is important to consider housing in the context of accessibility to services seniors require. Most (about 81%) of seniors are living in housing, either owned or rented, or with family or friends. About 19% live in special housing. The majority of people over the age of 65 in the Edmonton Metropolitan area (in 1971) lived in single detached dwellings - 65.5%; 32% in apartments; 2.2% in semi-detached and row housing; and 0.3% in mobile homes. From 1966 to 1971 the proportion living in semi-detached - row housing and apartments had decreased slightly. In 1971, 66% of seniors owned their own homes while 34% rented. There was a 9% decrease in owned accommodation from 1961 to 1971 (42) The 1974 study, and a corresponding increase in rented accommodation. "Operation New Roof" (43) indicated that 60% of seniors interviewed owned their dwellings while the remainder rented. Most seniors who owned their own homes (56.5%) paid 15% or less of their income for housing. Most (54.3%) renters paid up to 35% of their income for (44) Central Mortgage and housing (9.7% paid 15% of their income or less). Housing Corporation recommends that families and individuals spend between 25 - 30% of gross annual income for housing. Public housing for individuals and families charging a rent geared to income, charge between 16.7% and 25% of family income for rent, depending on the size of income and number of dependents. A study by C.M.H.C. Indicates that in Edmonton in 1974, 9.4% of seniors owning their dwelling paid more than 30% of their income for housing; while 56.1% of renters paid more than 30% of income for housing. (45) With increases in rental rates since 1974, it is hypothesized that the proportion paying more than 30% of income for housing will have increased, while the proportion of owners paying more than 30% of their income for housing will

have decreased. The cost of accommodation may be a very significant factor in determining the amount of discretionary income available to seniors. Little information is available as to the quality of housing and amenities in housing occupied by senior citizens. Operation New Roof indicated that 95% of their sample self - rated their accommodation as "adequate" to "very good". Only 4% of dwellings were rated as being in "poor" condition. Of dwellings occupied by seniors, (in 1971 - Metropolitan Edmonton) 16% were built in the period 1920 or before; 21% the period 1921-1945; 46.2% the period 1946-1960; 9.1% the period 1961-1965; 6.4% the period 1966-1970; (46) Most of the dwellings occupied by and 1.6% the period 1970-1971. seniors had running water - 97.7%; bath or shower - 89.5%; flush toliet 91.5% and furnace heating - 93.3%. Specialized housing for senior citizens exists in a variety of forms in Edmonton both with and without additional services. These types of housing include self-contained units, lodges, private homes for special care, public housing, nursing homes and auxiliary hospitals (see chapter on Health and Medical Treatment. Most are subsidized by government). Approximately 19% of seniors live in these types of accommodation. TABLE XVII TYPES AND CAPACITY OF ACCOMMODATION FOR SENIOR CITIZENS IN EDMONTON Capacity

Type

2,052

Self-contained units Lodges

556

Private Homes for Special Care

185

Public Housing

88 1,936*

Nursing Homes Auxiliary Hospitals

973* TOTAL

5,790

* 90% occupied by senior citizens Table XVIII entitled Types of Accommodation and Basic Services Included, indicates the services available in each type of specialized housing.

TABLE XVIII TYPES OF ACCOMMODATION AND BASIC SERVICES INCLUDED Other Medical Treatment

Type of Accommodation

Accomodation

Meals

Laundry

Supervision

Self-Contained Units

yes

Lodges

yes

Private Homes for Special Care

yes

Public Housing

yes

Nursing Homes

yes

y.eS

yes

Auxiliary Hospitals

yes

Personal Care

Nursing Care

Location ob-

0 Existing Housing o Proposed or Under Construction

(77

76 75

67 0 62 51

50 28 38

27 3626

20 19

7 18 15

3 5 2

Number of Senior Citizen Housing Units 1976

o 1 -50 Units LS, 51 â&#x20AC;&#x201D; 100 Units 78

Units

0 101 +

L 68 65

62 51

50 28 27

24 23

25 09

7 10

18 15

12 3

5 4 2

1 90

B. Housing Services Type of Service Delivery - Self-Contained Senior Citizen Accommodation (See Appendix XIII) Description

- Self-contained senior citizen accommodation is low cost (generally subsidized) apartments or cottages for seniors who are able to care for themselves.

Exisitng service providers - a) Greater Edmonton Foundation b) Voluntary Organizations (See listing) No. spaces presently available - 1,989 units No. people served - 2,140 No. of people on waiting list - minimum 2,301 maximum (at Sept. 1976) 4,240 Not all persons were applying for 1976, as it was estimated there is a two year wait. People waiting for accommodation for 1976 are: 2,367 - maximum

1,094 - minimum* Present demand - 3,234 - minimum

4,507 - maximum

Operating Cost - $5.37 million (estimate based upon $225 average monthly subsidizing per unit) Cost to senior - Most units presently being developed are rent geared to income. Rents range from 16.7% to 25% of income. Projected additional demand -

People

Units

Minimum

Maximum

1976

1,094

2,367

870

1,942

1981

1,347

2,868

1,055

2,353

1986

1,606

3,471

1,277

2,848

Minimum

Maximum

* minimum estimate is based on the proportion of applicants for senior citizen accommodation, registered with the Senior Citizen Housing Registry who indicated they wanted housing in 1975-76. Maximum estimate is based upon all applicants whether or not they have registered with the Senior Citizen Housing Registry.

Capital*

Projected cost -

Minimum

Maximum

1976

$25.23 million

$56.32 million

1981

14.38 million

20.94 million

1986

17.31 million

25.23 million

63 Cost estimates provided by Alberta Housing Corporation based on construction - $ 24,00-. per unit; land cost - $4,000. per unit; furnishings - $1,000. per unit.

Senior Citizens' Residences â&#x20AC;&#x201D; Municipal 1976

76 75

Senior Citizens' Residences — Private 1976

77 •

76 75

Number of Applicants to Senior Citizen Housing by Census Tracts â&#x20AC;&#x201D; some estimations were necessary in the transfer from subdivisions to census tracts.

0-50 51-100

101-150 151+ 77

76 75

73 74

Senior Citizens Accommodation

Bachelor Units

One Bedroom Units

Total Units

Lauderdale 103 Street and 129 Avenue

Golden Duplexes 80 Street and 95 Avenue

272

340

Belvedere Lodge 6410 - 134 Avenue

Elmwood Lodge 15901 - 87 Avenue

McQueen Lodge 10910 - 142 Street

Northway Lodge 6205 - 135 Avenue

Ottewell Lodge 6675 - 92 Avenue

Rosslyn Lodge 10920 - 133 A Avenue

Garneau House 11003 - 87 Avenue

Name and Address Sunset Cottages 75 Street and 111 Avenue

Kiwanis Place 10330 - 120 Street

Kensington Court 131 Avenue and 125 Street

Southgate Veterans Villa 5210 - 106 Street

Villa Maria Polish Veterans Home 9203 - 144 Avenue

Emmnnuel Home 13425 - 57 Street

Central Village I & II 10707 - 117 Street

continued Bachelor Units

Name and Address

One Bedroom Units

Total Units

Meadowcroft 11445 - 135 Street

308

112

420

Springtime Village 10825 - 79 Avenue

St. John's Ukrainian Senior Citizens Residence 13516 - 102 Street

German Pentacostal 9920 - 83 Avenue

Buchanon Manor 121 Avenue and 88 Street

888

582

TOTAL

1,470

Senior Citizen Housing Planned or Under Construction Number Units

Name and Location Edmonton Bethany 99 Street & 83 Avenue

Edmonton Beulah

Edmonton Boyle Street 93 Street & 103A Avenue

171

Edmonton Canora 151 Street & 102 Avenue

98 158

Cathedral Close 103 Street & Jasper Avenue Edmonton Chinese Elders 96 Street & 102 Avenue

Inglewood

Edmonton Norwood 95 Street & 117 Avenue

Edmonton Holy Trinity 106 Street & 84 Avenue

Edmonton St. Andrews Ukrainian Orthodox 82 Street & 101 Avenue

64 (2 phases)

Edmonton St. Basil's II 108 Street & 70 Avenue

Strathcona Place 108 Street & 76 Avenue

232 24

Edmonton Millbourne Alliance 79 Street & Millbourne Road TOTAL

1,109

Type of Service Delivery - City Housing Registry (See Appendix XIV) Description

The City Housing Registry provides listings of available accommodation to people seeking housing. It also records the demand for rental accommodation.

No. of people served

- 83 seniors (9 months)

Present demand

- 110 estimate for 1976

Cost to senior

- None

Operating cost

- Not available

Projected Demand

- 1976

- 110

1981

- 133

1986

- 162

Projected Costs

- Not available

Type of Service Delivery - Senior Citizen Home Improvement Program (See Appendix XIV) - Makes one time grants of up to $1,000.00 available to senior citizens of limited income to improve and/ or repair owned dwellings

Description

No. of people served - 4,626 (estimated no. of grants approved in Edmonton) No. units of service - 4,626 grants (as of August 1976) Operating costs - estimated $4,678,100.00 for Edmonton (assumes maximum grant plus administrative costs). Operating cost per unit of service - $1,001.26 per household receiving grant (assumes maximum grant) Projected demand - 1976

4,818

1981

1,021

1986

1,227

Projected costs - 1976

$ 4.9 million

1981

1.03 million

1986

1.24 million

Type of Service Delivery - Senior Citizens Housing Registry (See Appendix XIV) Description

The purpose of the senior citizens housing registry is to collect, record and keep up to date information on seniors applying for subsidized housing. To provide seniors with accurate, up to-date information relating to type, cost, location of, and procedures for applying for subsidized housing.

Existing service provider - Society for the Retired and Semi-Retired No. people served

- 5,390

No. units of service per year - 10,572 (estimated contacts, by telephone, office interviews) No. units of service per person - 2 approximately Projected Demand

Projected Cost

- 1976

6,040

1981

7,319

1986

8,858

- Not available

Type of Service Delivery - Housing Placement (See Appendix XIV) This service of the City Housing Registry includes visiting those people who request housing to determine their need; contacting rental agencies etc., to obtain listing of available housing; escorting seniors to new housing, helping seniors to more possessions to new accommodations, undertaking friendly visiting as a follow-up to see how the senior is making out in the new living arrangement.

Description

Existing service provider - City of Edmonton

No. people served - 286 No. unit of service per year - 512 visits No. units of service per person - average 1.8

Operating cost - $16,000.00 estimate Operating cost per unit of service - $31.25 per housing visit

Cost to senior - none People Served

Visits

1976

286

512

1981

347

620

1986

419

751

Projected demand -

Projected cost - 1976

$16,000.

1981

19,375.

1986

23,469.

Type of Service Delivery - Lodge Type Accommodation (See Appendix XIII) - Provides congregate living facilities with board and laundry.

Description

Existing service provider - a) Greater Edmonton Foundation b) Voluntary Organizations (see listing)

No. units available - 660 (includes private homes for special care)

No. people served - 741 No. people on waiting list

Present demand -

44 (includes only these applying for Greater Edmonton Foundation Lodges. Special Care homes did not have waiting lists at time of contact.) Minimum

Maximum

785

829

Operating cost - In lodges room and board rates cover operating costs. There have been operating deficits paid by the City of Edmonton. Recent legislation permits the sharing of operating deficits between the municipality and Province. Projected additional demand* -

Minimum

Maximum

1976

39 units

46 units

1981

109 units

111 units

1986

130 units

133 units

Minimum additional demand based upon number of applicants registered with the Senior Citizen Housing Registry indicating desire for Lodge units in 1975-76. Maximum demand based upon all applicatns whether or not they have registered with the Senior Citizens Housing Registry.

Projected additional costs - (Capital Only)* Minimum

Maximum

1976

$ 507,000.

$ 598,000.

1981

1,417,000.

1,443,000.

1986

1,690,000.

1,729,000.

* Based on minimum and maximum demand projections and 1976 cost estimate of $13,000. per unit.

Senior Citizens Lodge Type Accommodation Name and Address

Number Single Rooms

Number of Double Rooms

Total Rooms

Kiwanis Place 10330 - 120 Street

Belvedere Lodge 6410 - 134 Avenue

Bethany Lodge 6115 - 92 Avenue

Elmwood Lodge 15901 - 87 Avenue

McQueen Lodge 10910 - 142 Street

Northway Lodge 6205 - 135 Avenue

Ottewell Lodge 6675 - 92 Avenue

Rosslyn Lodge 10920 - 133 A Avenue

Emmanuel Home 13425 - 57 Street

Canterbury Court 8403 - 142 Street

130

140

394

475

TOTAL

Lodge Units Planned

Name and Address

Number of Rooms

Edmonton Pleasantview 111 Street and 53 Avenue

Meadowlark Lodge 156 Street and 97 Avenue

TOTAL

132

Private Homes for Special Care

Name and Address

Number of Beds

Bonnie Doon Eventide 9310 - 82 Avenue

Canadian National Institute for the Blind Residence 12010 Jasper Avenue

Sunset Lodge 11034 - 124 Street

Ukrainian Senior Citizens Home of the Holy Eucharist 11935 - 65 Street

TOTAL

185

Homes For Special Care 1976

76 75

28 27

26 6 7

C. Special Interest Areas and Suggested Options 1. Subsidized Housing Subsidized housing is at the present in short supply compared to the demand. There are 1,945 existing units in Edmonton. 1,698 units are planned for completion in 1976-77 but as of June 1976, there were 5,390 unduplicated applicants listed with the Senior Citizen Housing Registry. The number of applicants is expected to increase as rental rates for non-subsidized housing continue to climb, as the apartment vacancy rates continues low, and alternatives to subsidized housing are limited. a) Distribution of Units - Senior citizens housing is widely distributed in the comminity (excluding newer subdivisions). However, a number of census tracts with high concentration of seniors have no specialized senior citizen housing; this include census tracts 20, 23, 30, 32, 45, 54, 59. The price and availability of land have a direct bearing on the location of senior citizen housing. In past years, senior citizen housing was developed where land was available at low cost. A recent trend has been noted of constructing senior citizen housing developments in areas with high senior citizen composition. It is strongly suggested that this trend continue so that older people may remain in neighborhoods with which they are familiar, have developed friendships and are aware of the available resources. Subsidized housing developments must have good access to transportation, shopping facilities, recreational opportunities and other resources so that seniors may maintain their independence. These factors should be taken into account when senior citizen housing is considered. A study should be undertaken to develop criteria for the selection of sites for senior citizen accommodation. b) Type of Units - Many seniors feel very strongly about the type of units supplied. The overwhelming preference appears to be for "one bedroom" unit over the "bachelor" units. The Alberta Housing Corporation has indicated that there is little additional cost in providing one-bedroom as opposed to bachelor units. It is suggested that the current trend towards construction of one-bedroom units be continued.

e) Accessibility - All housing developments should be constructed and equipped to accommodate wheelchairs. Facilities should be designed to accommodate the decline in manual dexterity which some seniors face. d) Safety - Both grip rails and non-slip bath tub surface should be standard equipment to reduce chances of accidents in bathtubs. Front controls on stoves are necessary to avoid the danger of reaching over hot elements. Flashing lights and alarms of varying pitch should be utilized to safeguard those seniors with hearing difficulties. e) Amenities - It is important to realize that housing is more than shelter alone. Good housing, not only satisfies the need for a roof over one's head but also the need for security and a sense of community. It is with this in mind that the following suggestions have been made regarding facilities to be included in subsidized housing. (i) A Dining Facility - should be included in each self-contained housing development, perhaps cafeteria style. Meals would be optional, supplied at cost, and residents could be required to indicate their desire for a meal service the previous day so that quantities could be estimated. The provision of a regular nutritious meal would provide residents with the opportunity for social interaction as well as inexpensive nutrition. This facility could be open to senior citizens in the surrounding community perhaps through a "wheels-to-meals" program. This would also broaden the sphere of social interaction. For this proposal to be economical, a minimum number of units per development would have to be established. Further study would be required to determine the economic level. Congregate meals might, however, reach a broader clientele if located in senior centres which combine a variety of services. In a centre, such meals could also be linked to outreach services for lonely and isolated seniors.

(ii) A Guest Room - could be provided in each development and could assist people with friends and relatives living outof-town and permit them to visit periodically. This could be rented on a cost basis. However, unless this were used frequently, the cost per day for rent would be very high. While this might benefit some seniors, that space used for a "guest room" could possibly be better used as accommodation for another senior.

The provision of subsidized housing is an extremely expensive program. It is estimated that the capital costs to meet the demand in 1976 would be between $25 million and $57 million. Not withstanding the costs, the benefits of high rise senior citizen housing are beginning to be questioned by the authors. Senior citizens high rises must be prevented from becoming ghettoes. However, specialized housing can offer mutual supports to residents. They can have specialized facilities lacking in commerical rental accommodation. While there are a great many applications to senior citizen housing, if other viable alternatives were available, the demand for specialized senior citizen housing could be reduced. 2.

Co-operative Housing Two attempts to develop co-operative senior citizen housing, for

middle income seniors are in process. These are the McQueen Senior Citizen Housing Co-operative and the Essex Society (in the Highlands area). Information for these organizations is that they are encountering difficulties from funding sources. These difficulties related to factors that the applicant group was not a low income group (funding for co-operative housing is designed for low income people); the group they were designing the units for could not afford the rental rates without a rental supplement (no agreement exists between the Provincial and Federal Governments which allows for rent supplement).

3. Rental Supplement - In view of data suggesting that a large proportion of seniors are paying over the recommended C.M.H.C. guidelines for rent, it has been suggested that the government initiate a program of rental supplements. This would enable seniors to remain in their chosen rental accommodation without having to pay in excess of the recommended proportion of their income toward rent. In many cases seniors have carefully chosen their rental accommodation taking into consideration the familiarity of the neighborhood, access to service and proximity to family and friends. Rents are increasing every year, climbing out of reach of more and more seniors. The alternative for many of these seniors is often subsidized accommodation. Data from the Senior Citizen's Housing Registry indicates that of the completed questionnaires (2,355 as of August 1976) 48% reported paying half or more of their income for rent. Paying such a proportion of income for rent may be a major factor in senior applying for subsidized residence. A rental supplement program may alleviate some of the pressure for subsidized senior citizen housing. In 1974 the Central Mortgage and Housing Corporation conducted a (47) housing survey in Edmonton examining, among other things, proportion of income paid for rent. Of the 5,042 households with heads over 65 years of age surveyed, 3,343 (66.3%) were paying more than the C.M.H.C. recommended proportion of 25% of their income for rent. Thus it is expected that most seniors in Edmonton are paying over the recommended proportion of their income for rent. One method of calculating the amount to be subsidized by the government would be for the senior to pay 25% of his income for rent and the government pay the remainder. This amount would fluctuate depending on two variables - the seniors income and the rent. A ceiling would be necessary both for the maximum income allowable and the maximum rent supplemented under the program. An estimate of cost to provide rental supplement to one senior citizen has been calculated on the maximum pension available to a single senior citizen ($3,338.40 per year as of June, 1976). The average rent in Edmonton was estimated at $224.00 per month (based on Housing Registry's statistics for March 1976).

A senior receiving the maximum pension would be required to pay $834.60 per year for rent. The government, if responsible for the remainder, would pay $1,858.40 per year. Table XIX compares the possible cost to government of rental supplement with the cost of subsidized housing. TABLE XIX COMPARISON OF COSTS RENTAL SUPPLEMENT AND SUBSIDIZED HOUSING

Average Cost of Subsidized

Cost of Rental Supple-

Potential

Housing to Government

ments

Saving to Government

(operating and capital)

For 1 senior

$225/mo./sr. = $2700/yr.

$154.45/mo./sr. =

for self-contained unit

$1,853.40 based on

$846.60/yr.

Sr. paying average rent & receiving maximum pension benefits For 4,237 srs.

$11,439,900/yr.

$7,852,855.80

(estimated num-

$3,587,045 /yr.

ber overpaying for rent in Edmonton 1976)

Indications are that it could be less costly for government to supplement seniors' rent in their own rental accommodation than to subsidize them in specialized housing. The cost of this program could be shared by the Provincial and Federal governments as is the subsidy for specialized housing. 79

A rental supplement program, however, does not provide a solution to the general problem i.e., the low supply of vacant rental accommodation in Edmonton.

Homeowners Supplement Community people have suggested that in addition to the rental supple-

ment program a financial supplement is required to meet the needs of senior citizen homeowners with high costs. This type of program would be designed particularly for seniors who are still paying off their mortgages and have other payments to make as well (e.g. taxes, repairs). This program could be a further incentive for senior citizen homeowners to remain in their own homes. Such a program would be difficult to administer, the supplement would have to be dependent upon income and costs. Could seniors purchase a larger, more expensive house if the government was to supplement them? Further detailed study of this proposal is necessary.

Senior Citizens Home Improvement Program The one-time grant of up to $1,000.00 presently offered to senior

citizen homeowners has been suggested by professionals as often insufficient to complete expensive repairs i.e. foundation work; or to complete more than one job when such is needed to adequately repair the home. An Evaluation Survey prepared by the Policy and Planning Division of Alberta (4Q) Housing and Public Works in February 1977, v indicated that 22.4% of a random sample of seniors who had received the S.C.H.I.P. grant, reported that the grant had not been sufficient to improve their home. Consequently, it has been suggested that the grant be increased as a solution to the problem. An alternative would be for the Provincial government to make a lowcost loan available to completerepairs over and above the grant. The loan could be repaid either over a five year period or at the time of the sale of the house. The improvements made to the home would increase its' market value or make it more salable in the future, thereby minimizing the cost to the senior.

Table XX compares the estimated costs of the existing S.C.H.I.P. program, and the suggested loan program.* TABLE XX COMPARISON OF ESTIMATED COSTS S.C.H.I.P. AND LOAN PROGRAM

Cost of S.C.H.I.P. per

per Senior

Senior

/To Gov't

Over 1 yr. Period

(1) $1,011.26/

Cost ot Loan Program

To Sr.

To Gov't

To Sr.

(2) Subsidy of

$1,080.00

interest

I Senior

rate and administrative costs Over 5 yr.

$1,011.26/

Period

Senior

Subsidy of

$1,400.00

interest rate and administrative costs

The explicit objective of the S.C.H.I.P. is to prevent seniors from applying to subsidized housing. While contributing factor, the authors question the ability of S.C.H.I.P. to achieve this goal on a large scale without other supportive services (1)Assuming full grant + estimated administration costs; Administration - 1976/77 Province allotted $255,830. for Alberta; Edmonton has estimated 20.4% (4,626) of applications therefore estimated $52,112. for Edmonton ($11.26/ applicant) (2)At 8% interest per annum (comparable to interest on Residental Rehabilitation Assitance Program (R.R.A.P.)) loans.

The cost of the loan program if collected, over a one year period, could be a burden to some seniors. However, cost may be offset by the satisfaction of being able to remain in their own home. Improvements made to the home as a result of the loan could increase the market value. Thus, the financial burden to the senior could be minimized if the loan was repaid when the house was sold. Alternately, interest on the loan could be collected monthly and the capital itself at the time of the sale of the house. The cost of the program could be assumed by the province as a corollary to the existing S.C.H.I.P. program. The actual cost to the Provincial government would be low. Further exploration of the feasibility of this concept should be explored. 6.

Interim Housing Interim housing has been suggested as a means of meeting the short

term housing needs of senior citizen's. It would be designed for those senior's who have been evicted and/ or for those senior's who need some place to stay in the interim between, for example, high cost rental accommodation and moving into subsidized accommodation. It would be necessary to set a limit on length of stay e.g. three months. This means of housing could be made available in newly proposed subsidized accommodation with a certain number of rooms set aside specifically for this purpose. This, however, does not solve the problem of short housing supply. Temporary housing could become "permanent" if not carefully regulated.

Emergency Housing Another type of temporary accommodation has been suggested to meet

the needs of those seniors experiencing crisis situations in their home, victims of fires, etc. These persons would require immediate, short term housing. This could be integrated with interim accommodation set up in existing subsidized housing.

Clustered Housing Clustered housing is defined as a small group of units or cottages

linked to a supervisory person by intercom. This would allow seniors independent living with the added security of knowing that help is readily available in case of an emergency. The addition of an intercom system to existing groups of self-contained cottages would add greatly to the security of the residents at minimal cost. This addition would necessitate the availability of someone to act on distress calls. Paid staff would make this proposal expensive. Perhaps a link with local firehalls, where staff are prepared to respond to emergencies would be feasible.

Moving Subsidies It has been suggested that moving subsidies could be made available

to seniors to offset the high cost of moving e.g. moving vans, telephone installation, etc. This could perhaps be established as a set proportion of moving costs or a proportion based on income with a maximum income level. There is little available data regarding the mobility rate of seniors. However, the prevailing concept is that seniors are generally not highly mobile. Federal Census data tends to support this - in Edmonton in 1971 52% of all seniors had occupied their dwellings for more than ten years. The number of seniors requiring moving subsidies cannot be determined but it can be speculated that it would be small. People qualifying for social allowance can have moving costs paid. Special provision for seniors is questionable. 10. Group Foster Homes This mode of housing and care could serve as an intermediary step between independent and dependent living. It would be designed to meet the needs of seniors requiring assistance with medication but not nursing care. Four or five seniors would live together under supervision. Housing of this type could be situated in renovated older housing owned by the City. Some seniors could be relatively self-sufficient e.g. sharing cooking, cleaning facilities, and would only need minimal supervision 83

concentrated in the area of medication. Other seniors might need more extensive supervision. The supervisory personnel could for example be supplied with rent-free accommodation on the premises, in lieu of services; they could be a couple with one person working outside of the group home. In this way the additional operating costs of this type of housing could be minimized. No information is available which would indicate potential demand. 11. Central Housing Application A central application office would provide seniors with a one-step centre to apply for subsidized accommodation. Presently seniors applying to a particular project must visit each project. This often presents problems to seniors e.g. transportation difficulties. A central placement office would alleviate this problem. Seniors could obtain information, apply to the project of their choice and have their completed application forms returned to each desired project using one central point of contact. At present each project has it's own application form and is subject to its' own interpretation. A standardized application form should be considered for all subsidized housing.

The Central Application Office could perhaps be administered in conjunction with the present Senior Citizens' Housing Registry and thereby take advantage of the centralized location, existing staff and volunteers. Little additional cost beyond that presently being provided to the Senior Citizen Housing Registry would be necessary.

CHAPTER VI

COMMUNITY SUPPORT PROGRAMS

A. Community Support Most older people desire to and do live independently in the community. A study in British Columbia(49) indicated that about 10% of seniors required some community support to maintain their independence. Community help programs attempt to assure a continued level of independence in surroundings which are familiar. A wide variety of services would be necessary to meet many of the particular needs in this area. Presently support programs include home maintenance, homemaker and meal services. Escort services, shopping assistance and volunteer transportation exist in an unorganized fashion through churches, and senior citizens centres. Home Care, home nursing and other health related services are discussed in Chapter III, Health and Medical Services. (50) has indicated that the inability The Senior Citizens Housing Registry to maintain a home is a primary reason for applying to specialized senior citizens housing. A survey conducted in early 1976, by the Beverly Unit, (51) indicates that about 51/2% of seniors require Edmonton Social Services, some type of home maintenance service. The provision of a low-cost, nutritious meal can be of great benefit to many seniors, particularly those unable to prepare meals themselves. The Meals-On-Wheels program and meal services at senior citizens centres are significant in meeting this need. Homemaker services are provided to only a small number of seniors, the demand for this service (date available only from the Family Service Association) is almost twice as great as the supply being provided. Further development of services in this area, coupled with increased housing options and preventive health services may be the key to maintaining the senior as an integral member of the community. Little in-depth study has been undertaken in North America which would indicate the potential demand for many of these services. More study is necessary before adequate planning for suggested services can be undertaken. 85

B. Community Support Services Type of Service Delivery - Home Maintenance Services (See Appendix XVII) Description

- Providing services which will assist the senior living in the community to remain in his own home. Such services include assisting with minor repairs, snow-shovelling, lawn work, housekeeping.

Existing service providers

a) Home Services for Seniors (Edmonton Social Services) b) Strathcona Senior Citizens and Handicapped Home Services

Statistical information available only from Home Services for Seniors. No. people served

- 389 per month average

No. people on waiting list - 35 average (includes those not served) Present demand

- 424 per month

No. units of service per year - 4,668 cases (not necessarily all different cases) - 6,818 contacts (estimated - does not reflect total contacts due to number of volunteers and volunteer hours) No. average units of service per person

- 1.5 contacts per case

Operating cost

- $133,377

Operating cost per unit of service - $19.56 per contact (which average 2 to 21/2 hours) Since statistics do not reflect involvement of volunteers or community service workers, this cost is based primarily on reports of handymen and cleaning ladies time involvement $28.57 average cost per case per month Cost to senior

No cost if income under $4,000 86

Minimum* Cases per Month

Maximum Cases per Month

1976

424

1,117

1981

514

1,353

1986

622

1,638

Projected Demand

* Minimum projection based on actual 1976 caseload, maximum based on Beverly Unit survey. Projected Cost

Minimum

Maximum

1976

$145,364

$347,967

1981

$176,219

$421,486

1986

$212,956

$510,269

Location of Social Services Offices

<I Alberta Social Services and Community Health o Edmonton Social Services

â&#x20AC;˘ Edmonton Social Services Office with Home Services for Seniors Staff 76

75 65

62 51

50 28 27 26

6 7

(

18 16

5 2

Type of Service Delivery - Meals-On-Wheels (See Appendix XVII) - Provision of a well-balanced meal and diet to ill or frail older people or handicapped individuals in their homes to allow continued residence on as independent base as is possible.

Description

Existing service provider - Meals-On-Wheels (Victorian Order of Nurses)

No. people served (1976)

65 years +

All Ages

680

773 44,755 meals

No. units of service

57.9 meals average

No. units of service per person Operating cost

$95,500

Operating cost per unit of service -

$2.13

- Fee based upon income.

Cost to senior

Projected Additional Demand - 65 years +

Meals

All Ages

Meals

1976

680

39,372

773

44,755

1981

816

47,246

916

53,036

1986

988

57,205

1,096

63,458

Projected Cost

Seniors

All Ages

1976

$ 83,862

$ 95,500

1981

$100,633

$112,967

1986

$121,847

$135,166

Type of Service Delivery - Homemaker Service (See Appendix XVII)

Description

Homemaker service provides an in-home service to individuals and families who are not able to maintain independent functioning without support. It provides service through an individual who can undertake the complete care of the household.

Existing service providers - a) Family Service Association of Edmonton b) Comcare (Canada) Limited c) Edmonton Home Service Limited d) Health Care Services Upjohn Limited Statistical information available from Family Service Association of Edmonton only. 65 years + No. people served

62 cases

No. people on waiting list

56 cases

Present demand

All Ages 342

118 cases

No. units of service per year -

8,224 hours

No. units of service per person -

132.6 hrs. per case

Operating cost

$45,172

Operating cost per unit of service Cost to senior citizen

45,886 hours

$250,958 $5.47 per hour

- Sliding fee based on income.

Type of Service Delivery - Congregate Meals (See Appendix XVII) Description

These are meal services operated by the senior citizens centres. The extent and type vary considerably. Basically, they offer a noon meal, however Strathcona Place and Operation Friendship offer one evening meal per week.

Existing service providers - a) Strathcona Place b) Operation Friendship c) Lions Senior Citizens Recreation Centre Statistical information available only from Strathcona Place. No. units of service per year

- 19,887 meals

Operating costs

- $27,786.44

Operating cost per unit of service - Averages $1.40 per meal Cost to senior

Actual cost of meal dependent upon food costs and items selected averages $1.40 per meal.

Projected Additional Demand - Not available. Projected Costs

- Not available.

C. Special Interest Areas and Suggested Options 1. Escort Service - An escort service for less mobile seniors would be an asset. Such a service would link volunteers with seniors requiring transportation and assistance to attend physicians, dentists or other appointments or shopping. Many of these services would be inaccessible for these seniors if they had to manage on their own. An escort service would be economically impractical if it required paid staff. The success of such a program would be dependent on volunteers. This service exists but in an unco-ordinated fashion through some of the senior citizens centres (particularly Operation Friendship which received a grant from the Winspear Foundation for operating a shopping service) and the Volunteer Action Centre. The Operation Friendship service, initiated originally as a shopping service for more dependent older people in the Boyle Street-McCauley area, has been broadened to include trips to doctors, physio-therapists, etc., and broadened geographically to include Norwood and other referrals. This service has provided escorts to an average of 30 people a month between February and June of 1977. Further observation of this service is necessary before any consideration is given to larger scale Implementation. 2. Laundry Service - Some professionals have suggested that a low-cost laundry service should be made available to seniors. Several possible ways of organizing this service are: a) Operation of a low-cost laundromat by a senior centre. b) Organization of volunteers to assist seniors in the use of laundromats. c) Operation of a 'co-operative' laundry by a group of seniors. Laundry service could be important for seniors with limited washing facilities and for families looking after incontinent seniors. Any single solution to this problem would face problems of geography and transportation. No information is available relating to potential demand for this type of service.

3. Home Maintenance Service - This service should be expanded to meet more of the needs of seniors living in the community. The reason most frequently stated by seniors for the desire to enter specialized housing is the difficulty of maintaining their own homes to reasonable standard. There are no data currently available regarding the number of people who would be able to remain in their homes if the present Home Help service were to be expanded. Many seniors who could benefit from assistance with home maintenance are not aware of the existence of such a service and so do not have the opportunity to consider it as an alternative. This service had existed from time-to-time for a number of years with temporary funding from a variety of sources. In November 1975, Edmonton Social Services initiated the Home Services for Seniors program. A portion of the demand for this service (those who are aware of the service) can be measured by statistics prepared by the Home Services for (52) Seniors program. Monthly statistics for 1976 revealed that an average of 389 cases were given service and 35 applicants were not given service (on waiting list, withdrew request or not able to be served). 35 applicants represents 39% of average new applicants per month (89 average new applicants) * Table XXI indicates the projected demand for this service based upon the present level of service provided by the Home Services for Seniors program.

* Of 89 new applicants, 50 (60.5%) received services; 31 (35%) were placed on a waiting list or not served; 4 (4.5%) were not eligible for service. 92

TABLE MKT PROJECTIONS OF MONTHLY DEMAND FOR HOME SERVICES FOR SENIORS BASED ON 1976 LEVEL OF SERVICE, APPLICANT LEVEL AND POPULATION PROJECTIONS* Population of Seniors

Year

Demand No. of Cases (Households)

1976

30,620

424

1981

37,109

514

1986

44,908

622

*Assuming all new applicants would receive service if supply available.

TABLE XXII HONE SERVICES FOR SENIORS COST PROJECTIONS BASED ON PRESENT LEVEL OF SERVICE AND PRESENT LEVEL OF APPLICANTS AT $28.57 PER CASE*

Year

No. Cases at Present Level of Service Monthly Annually

No. Cases at Present Total Cost Total Cost at $28.57 Per Case Level of Applicants at $28.57 Per Month Monthly Annually Per Case

1976

389

4,668

$133,377

424

5,088

$145,364

1981

471

5,652

$161,478

514

6,168

$176,220

1986

570

6,840

$195,419

622

7,464

$213,246

* Average cost per case per month.

While the Home Services for Seniors program began in the fall of 1975, with service available through the seven units of Edmonton Social Services, it was curtailed in April 1976, to availability in only three service units. This was due to budget cutbacks. Because of curtailment, applications were discouraged. It is clear that the survey conducted by the Beverly Unit, Edmonton Social Services in the month preceeding the service curtailment and the resulting increase in service applications, more closely suggests the actual demand for the service. In early 1976, the Beverly Unit, Edmonton Social Services, conducted a telephone survey of senior citizens in their area to inform them of the availability of Home Services for Seniors. They identified 3,059* seniors of whom 2,932 were contacted. Based on population projections from the 1971 Federal Census, the total estimated senior citizen population in the Beverly area was (37) 3,589. Thus, of this population, 81.76% were contacted. The month immediately following this survey (April 1976), the Beverly Unit had a 37.8% increase in new applicants. Caseload of the Beverly Unit was 113 cases, 36.5 cases per 1,000 population. The same proportion applied to the rest of the city would mean a service population of 1,118 cases per month. TABLE XXIII DEMAND AND COST PROJECTION FOR HOME SERVICES FOR SENIORS BASED ON BEVERLY UNIT EXPERIENCE

Year

No. Cases Per Month at 36.5 Cases Per 1,000 Population

No. Cases Per Year

Cost at $28.57 Per Case Month

1976

1,117

13,404

$382,952

1981

1,354

16,248

$464,205

1986

1,639

19,668

$561,915

* Identification of seniors was undertaken by updating the 1974 Federal voters list. 94

To meet the demand as projected from the Beverly Unit survey, it would be necessary to immediately increase the capacity of the Home Services for Seniors program to pre-April 1976 levels. Information from the Strathcona Senior Citizens and Handicapped Home Services, which operated from December 6, 1976 to March 31, 1977, was not available. The demand for these services may in fact be larger than represented by the Beverly survey. 4. Wheels-To-Meals - A "Wheels-to-Meals" program should be instituted in addition to the existing Meals-on-Wheels program. A study of nutrition in (53) states that the elderly, particularly men, appeared to be the A1berta most vulnerable group in respect to nutrient deficits ". . . Lowest calorie intakes were recorded in the elderly . . ." and despite this ". . . the degree of overweight was highest in the elderly, particularly in women . .

n(54)

No information is available in Canada which would provide an indication of the demand for such a service. Six of the senior citizens centres have meal services (Strathcona Place, Alex Taylor School, S.C.O.N.A., Lions Senior Citizens Recreation Centre, McCauley Drop-In and Bissell Drop-In). Strathcona Place provided about 17,600 meals in 1976; S.C.O.N.A. provided 154 meals in July 1977; information was not available from other centres. The Meals-onWheels program provided meals to 680 seniors in 1976. Thus, there is a demand for meal services for the elderly. In the United States, in order for localities to receive federal costsharing, they must have a set of basic services; meal services are among these. Many cities in Britain have "luncheon clubs" where seniors are brought to partake of congregate meals and other activities. Congregate meals could be effectively organized in senior citizens centres, a number of which already have meal services. The development of volunteer drivers to transport lonely, isolated and frail seniors in conjunction with a congregate meal service could be an effective way of implementing a Wheels-to-Meals program. These same seniors, could then take part in the activities of the senior centre. The feasibility of developing this service should be further explored.

CHAPTER VII PERSONAL SOCIAL SERVICES

Personal Social Services are defined as those which ". . . complement, supplement, or are in place of, services rendered by families or friends. "(55) The services considered here relate to the need for companionship, emotional support, and information. People are social beings and it is necessary for all people to have relationships with others. Relationships with friends and relatives are very important to older people. It has been suggested by professionals that relationships to relatives become more significant as friends known for many years (56) reveals that almost half of seniors have less contact with die. Snider relatives than they had at age 45. Similarly 46.7% had less contact with close friends now than at age 45. However, less than a quarter of seniors desired The lessened amount of and desire more contact with friends and relatives.(57) for social contacts may be a factor in increased loneliness and isolation of seniors. Friends and relatives contribute to the well-being of the older person. The Snider Study notes the type of contribution made by friends and relatives as considered by seniors. Relatives contribute psychological support to 38.8% of respondents; nothing - 30.8%; physical chores - 9.7%; transportation - 7%; everything - 4.6%; financial support - 2.4%; health related - 0.2%; and others - 6.3%. Friends contributed social-psychological support to 60.9% of respondents; nothing - 30%; physical chores - 3.7%; transportation - 2.7%; More financial support - 1%; everything - 0.2%; other things - 1.5%.(58) seniors see the contribution of friends and relatives as social-pshcological support than anything else. However, 30% of seniors (not necessarily the same 30%) see friends and relatives contributing nothing. Many professionals working with older people consider loneliness to be a major problem of the aged. Snider indicates that more than 37% of seniors are at least sometimes lonely.(59) The design of services must take into account the major loneliness factor. Generally speaking, the lonely and isolated seniors are among those who are not involved in activities and services for older people. Outreach programs would be an effective way of dealing with the problems. 96

Age 65 In most cases (particularly for men) brings retirement and with it sudden role changes. Women who have been in the home alone now find themselves in almost constant face-to-face contact with their spouses. More than one-third of seniors are widowed. Older people frequently have married children and grandchildren living in different parts of the country. Many of the supports, emotional and otherwise that are assumed by the family in other societies, are not available to older people. These changes can be crises to older people, many should have professional help in dealing with these problems. To prevent problems from becoming crises, people should seek appropriate assistance. Many people, including seniors, are not aware of or do not know what services particular agencies provide. In a specific list of 35 service agencies, the level of awareness that these agencies existed was 54.3%; in (60) terms of accuracy of identification, the awareless level fell to 28.9%. Accurate identification of services is less than a third. Personnel at some senior citizen centres have said that many seniors give-up seeking a service when they have to contact agency after agency to get help. Informationreferral services are of a great assistance to people needing help. All senior citizen centres provide information to seniors in the centre and many seniors who use centres will phone for that information. Two city-wide information services exist, A.I.D. Service of Edmonton has less than 2%'(539) of enquiries relating to services for seniors. The Society for the Retired and Semi-Retired operates an information-referral service particularly for seniors which received more than 675 enquiries per 1,000 senior citizens. The availability of this information-referral service was advertised through an enclosure with Alberta Assured Income Plan cheques (reaching about 57% of seniors). While the knowledge of services appears to be low, it is anticipated that newer generations of seniors, with higher levels of education, and changing attitudes towards services, will make more use of information services. Services relating to these needs will require particular attention over the next ten-year period as a new generation of seniors emerges with a different attitude and expectations regarding services and service availability.

B. Personal Social Services Type of Service Delivery - Information and Referral Services (See Appendix XVIII) The provision of accurate information on all services affecting seniors and appropriate referral linkages to assume that all seniors have access to all available services.

Description

Existing service provider - a) AID Service of Edmonton b) Society for the Retired and Semi-Retired

No. units of service per year - For seniors only (enquiries) Society - 20,677

AID - less than 300

No. units of service per person - 0.675 enquiries per senior

Projected Demand

- 1976 - 20,677 1981 - 25,048 1986 - 30,313

Projected Costs

Impossible to estimate because the staff are involved in numerous services. It has not been possible to separate out staff time and space requirements.

Type of Service Delivery - Legal Counselling

Description

- Provides information and advice on legal matters to people who cannot afford lawyers.

Existing Service Providers

a) Student Legal Services b) Strathcona Place Society

Statistical information is available from Strathcona Place Society only. In 1976, this service provided advice and counselling to 36 seniors.

Type of Service Delivery - Personal and Family Counselling (See Appendix XVI) Description

Personal and Family Counselling agencies provide a service which is essentially a ". . . process involving a . . . relationship between two parties (where a party may be an individual or a group) wherein: 1. The role of one of the parties is to provide help or assistance (counsellor). 2. The other party has sought help or assistance (counsellor). 3. The techniques primarily involve verbal and non-verbal social interactions between the parties. 4. The goals relate to the improved functioning, behavior, self-concept and/or adjustment of (61) the counsellor."

Existing service providers - A. General Counselling Agencies Catholic Family Services Jewish Family Service City of Edmonton Social Services Family Service Association of Edmonton Alberta Social Services & Community Health Salvation Army - Family Services Pastoral Institute of Edmonton B. Specialized Counselling Agencies Department of Veterans Affairs Canadian Mental Health Association Native Counselling Services of Alberta Alberta Alcohol & Drug Abuse Commission Edmonton & Rural Auxiliary Hospital and Nursing Home District #24 Edmonton Local Board of Health Community Nursing Service Unit

100

Existing service providers (cone d)

C. Senior Citzens Agencies Operation Friendship Society for Retired & Semi-Retired D. Hospitalâ&#x20AC;˘Social Service Department Misericordia Hospital Edmonton General Hospital University of Alberta Hospital Royal Alexandra Hospital Alberta Hospital - Edmonton Glenrose Hospital

When counselling agencies were contacted for information, agency personnel generally estimated 5% of the caseload was older people. An exception is the Jewish Family Service which estimates 20% (77 based on 1976 statistics) of its caseload is older people. The majority of counselling agencies do not keep statistical information by age. The Society for the Retired and Semi-Retired stated they had 79 long-term cases during 1976. Operation Friendship does not keep records of counselling cases separate from overall statistical information. Edmonton Social Services has noted an almost doubling of its caseload (33 to 64) between May 1976 and May 1977. The information obtained was insufficient to give an indication of total use or need.

101

Type of Service Delivery - Outreach (See Appendix XV) Description

- Outreach services attempt to reach seniors living alone in the community who are adverse to asking for needed help or becoming involved in organized activities or those who lack basic information relating to services and those for various reasons do not have access to services.

Existing service providers - a) Operation Friendship b) Senior Citizens Opportunity Neighborhood Association c) Society for the Retired & Semi-Retired d) Strathcona Place Society No. people served

- 928

No. units of service per year

4,832 visits by Operation Friendship - 3,600 telephone contacts) 756 visits 109 events

Strathcona Place Society

Statisticalinformation for Society for the Retired and Semi-Retired and Senior Citizens Opportunity Neighborhood Association not available. Operating Costs

- Operated as part of Senior Citizens Centres Programs costs not separable.

a) Outreach Visiting

Through referrals (professionals, neighbors, and relatives) and household surveys, contact with isolated seniors is attempted. This is an initial phase and attempts to identify the needs of the lonely, or isolated senior and obtain needed services for him.

b) Friendly Visiting

This program is a follow-up or continuation of involvement with seniors who need a one-to-one social involvement to assist in breaking the loneliness and isolation.

102

c) Telephone Contact

Telephone contact programs are a service to the homebound senior, providing regular, perhaps daily contact with lonely or ill seniors. The reassurance of a daily call can provide a sense of security knowing someone is concerned.

d) Telephone Buddy System - A variation of the telephone contact, links seniors with other seniors. This may have other positive results such as new friendships.

103

Type of Service Delivery - Senior Citizens Centres (See Appendix XII) Description

- Senior centres provide a facility at which services to older people can be provided and a place where seniors can meet and inter-act with each other.

Existing service providers - Alex Taylor School Drop-In Jewish Senior Citizen Drop-In Lions Senior Citizen Recreation Centre Operation Friendship a)Bissell Drop-In b)McCauley Drop-In Senior Citizen Opportunity Neighborhood Assn. (S.C.O.N.A) Society for the Retired and Semi-Retired Strathcona Place Society West Edmonton Seniors No. people served

- 9,624 (membership or user lists, assuming no individual uses more than one centre. Does not include S.C.O.N.A.)

Present demand

- 9,624

Operating Costs

- $15,000 - $111,000

Cost to senior

- Charge for membership varies with centre. Charges exist for some programs. Not necessary to be a member to use services.

Projected Demand

Projected Costs

Users

Centres

1976

9,624

1981

11,652

1986

15,313

- Costs of centres vary substantially depending upon size of centre, services provided, rent paid if any, and salary costs.

104

Senior Citizen Centres 1977

o Existing Centres A Proposed or Under Construction 78

75 A 66-a

64 51

52 49

50 28

SERVICES AVAILABLE IN SENIOR CENTRES: THE "LARGER" CENTRES LIONS SENIOR CITIZEN CENTRE

SOCIETY FOR THE RETIRED AND SEMI-RETIRED

STRATHCONA PLACE

DROP-IN CENTRE

INFORMATION-REFERRAL *

EDUCATION & ACTIVITY PROGRAMS

FRIENDLY VISITING

TELEPHONE CONTACT (Telephone Buddy)

COUNSELLING-CASEWORK

MEAL SERVICES

HOUSING PLACEMENT SERVICE

LEGAL COUNSELLING **

HEALTH CLINICS **

NUTRITIONAL COUNSELLING **

DAY CARE FACILITIES

OUTREACH

OTHER SERVICES

Housing Registry

Banking Service New Horizon Projects Housing Project

* ALL THREE CENTRES PROVIDE INFORMATION AS REQUIRED; ONLY THE SOCIETY HAS FORMAL COMMUNITY WIDE INFORMATION-SERVICE. ** THESE SERVICES EXIST IN PART; I.E.: STUDENT LEGAL SERVICES, CITY HEALTH NURSES VISIT THE SOCIETY & STRATHCONA PLACE ON A REGULAR BASIS.

SERVICES AVAILABLE IN SENIOR CENTRES: THE "SMALLER" CENTRES OPERATION FRIENDSHIP (2 CENTRES)

WEST EDMONTON SENIORS

ALEX TAYLOR SCHOOL-DROP-IN

JEWISH SENIOR CITIZENS DROP-IN

SCONA (OPEN FEB. '77)

DROP-IN CENTRE

ACTIVITY PROGRAMS

OUTREACH 'VISITING

INFORMATION-REFERRAL

MEAL SERVICES

OTHER SERVICES

BLOOD

JEWISH

PRESSURE

FAMILY

CLINIC

SERVICES

MEMBERS OR USERS OF SENIOR CENTRES* 1976 Society for the Retired and Semi-Retired

1789

Strathcona Place Society

1200

Operation Friendship

139**

West Edmonton Seniors

290

Lions Senior Citizens Recreation Centre Jewish Senior Citizens Drop-In Alex Taylor School Drop-In TOTAL

5996 130 80 9624***

Does not include SCONA opened in 1977. * *

Operation Friendship does not keep membership list. This is the estimated number of Seniors who use the two (Bissel and McCauley) drop-ins.

***

This assumes that there is no duplication of members between centres.

107

RECREATIONAL AND EDUCATIONAL PROGRAMS OF SENIOR CENTRES ALEX TAYLOR SCHOOL

JEWISH SR. CITIZENS DROP-IN

LIONS SENIOR CITIZENS CENTRE

BISSELL DROP-IN

MCCAULEY DROP-IN

CARDS

CRAFTS

BINGO

+ _

BIRTHDAY CELEBRATION

DANCING

+ _

FIELD TRIP

BAZAAR

READING

+ _

CHOIR

LECTURES

+ _

+ +

SEWING

SWIMMING

MUSIC CLASSES

FILMS

NUTRITION CLASS

+ _

LIBRARY

SUMMER CAMP GAMES

+ _

+ _ +

DRAMA

RELIGIOUS HOLIDAY PARTIES KEEP FIT KNITTING - CROCHETING CREATIVE WRITING LAPIDARY ART CLASSES

STRATHCONA PLACE

SOCIETY RETIRED & SEMI-RETIRED

WEST EDMONTON SENIORS + + _ + + +

Continued)

LIONS SENIOR JEWISH ALEX TAYLOR SR. CITIZENS CITIZENS CENTRE SCHOOL DROP-IN

STRATH- SOCIETY WEST BISSELL MCCAULEY CONA RETIRED & EDMONTON DROP-IN DROP-IN PLACE SEMI-RETIRED SENIORS _

JP READING

RT EXHIBIT

1ANT CARE

MRITAGE

C. Special Interest Areas and Suggested Options 1.

Information Brochure An information brochure outlining services available to seniors should be

produced. It should contain all relevant information pertaining to services for seniors, and it must be available to all seniors. The publication of such a brochure could be a project of a senior centre or senior citizens group. The Society for the Retired and Semi-Retired has recently (June 1977) produced such a brochure (and does so periodically). Such a brochure could be produced every two years and distributed to all households with seniors. 2.

Legal Counselling Community people have suggested that legal counselling should be available

to seniors who cannot affort lawyers. This would be especially helpful in terms of landlord and tenant legislation, consumer and family law, and wills. This service is presently available, but is not currently extensively used by seniors. No change to service is required at this time. 3.

Counselling or Social Casework Services There is a need for increased counselling services for older people.

Family and marital problems, bereavement and the adjustment to separation will require an increasing involvement with skilled counsellors. Counselling services are not widely used by seniors at present, yet an increased demand is noted. Some 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 loneliness. Staff at the Society for the Retired and Semi-Retired have noted a difference in attitudes toward counselling between younger and older seniors. Counselling agencies, without some other form of involvement with seniors, are not widely used. The provision of counselling services at senior centres would be an approach to more readily meet this need.

110

4. Outreach Programs Outreach programs should be available on a city-wide basis wherever there are lonely, isolated or homebound seniors. The operation of outreach programs by senior centres has benefits in terms of enlistingsenior volunteers, and attempting to involve the lonely isolated seniors in group activities. These programs should be expanded.

Employment Placement Service An employment service designed to match interested seniors with jobs

should be considered. Indications are that this service would not be widely used. (62, 63)

Adopt-AGrandparent Program Operating on a basis similar to Uncles-At-Large or Big Sisters, an

Adopt-A-Grandparent program matches school-age children with seniors. Providing for both, new interests through sharing of their time and interests. A program of this type would be operated most effectively from a senior centre on a voluntary basis.

Senior Centres The centre idea emerged from the recognition that the needs of seniors

include affiliation and enrichment. The recreational and social activities of a centre help fill these needs. New friendships through shared group activities assist the senior in maintaining a sense of self-worth, interest, and responsibility. A senior centre as a convenient place for socializing proved insufficient; other basic concerns intruded to prevent full participation. This led to programs designed to reach out to seniors suffering from loneliness, unable to risk joining a centre, or to enjoy the freedom of their retirement. Outreach programs, information-referral services, counselling are examples of centre programs developed to meet these needs.

111

7.(a) Types of Centres - Four types of centres are recommended for Edmonton based upon suggestions by community and literature review. 1) Neighborhood Drop-In Centres - Recreational and social activity centres operated on a neighborhood basis. They are to be centrally located in neighborhoods, close to seniors to avoid lengthy travel time. They should be located in existing community facilities, e.g., church halls, school classrooms, old houses or community centres. They require sufficient space to allow activities designed for a variety of group sizes and needs. They must be physically accessible to seniors, located on existing transportation routes. They need not have permanent facilities as changing population patterns will affect distribution and density of seniors, therefore the user group. Neighborhood centres must be responsive to the change. Concentrating on the needs of local seniors, programming particularly in the recreational and educational area should be largely determined by the users. The neighborhood centre will be a primary place for interaction between seniors and may be the primary point of entry into the service network. Costs will depend on space, personnel and programs. Use of existing community facilities and intensive use of volunteers in leadership and program roles should result in lower operating costs. 2) Multi-Purpose Centres - Multi-purpose centres are to be designed to serve a large portion of the senior population on a geographic base. They will offer a variety of support services to enable seniors to remain in their own homes, to partake of more activities (recreational and educational) and to function more effectively. While offering a variety of services the centre will particularly specialize in an area of service and be a resource in that area to other centres. (e.g. the Lions Senior Citizens Recreation Centre having highly developed and specialized leisure services would specialize in this area; the Society for the Retired and Semi-Retired with a well developed community information service would specialize in information provision).

112

3) Special Needs Centres - These centres serve small areas where there are many seniors who are lonely, isolated, and of low income, etc. They are to be small but provide a variety of support services. They are to have highly developed outreach programs. 4) Day Care Centres - This type of centre is for seniors who are frail and require supervision. A day care centre provides a place where the senior can spend a day or a few hours to obtain an enriching experience. The senior lives at home with the day care centre enabling the family to have time away from the responsibility of constant care. Programming is to be influenced by the functional abilities of seniors who attend, aimed at those whose health or functional ability make it difficult to attend neighborhood centres. It will have a high staff involvement and less strenuous activitiesâ&#x20AC;˘ than regular centres. Support services such as occupational, recreational and physical therapy could be provided. It could operate as a component of a multi-purpose centre. Further explorations of the need for and potential structure of a day care centre should be undertaken.

7.(b) Services in Centres - The following services have been suggested by community people for inclusion in centre programs: 1) Outreach Programs - Each centre's services will include some method(s) of contacting or visiting seniors. The purpose of an outreach program is three-fold:- to locate isolated, lonely and homebound seniors; to involve them in activities; and to connect them with services. Various types of outreach programs are to be utilized. Outreach should be available from all senior centres and undertaken on a geographic and population base.

2) Meal Services - Cafeteria or dining room service with regular daily availability would be of benefit to many seniors. A wheels-to-meals program would closely co-operate with this service. Not all centres would require meal services. The multi-purpose and special needs centres would most appropriately provide this service. 113

3) Counselling-Casework Service - Senior centres would be an effective and convenient location for counselling services for older people. The accessibility and identification of qualified counsellors with centres would enable seniors to obtain professional counselling in a secure environment. This service should be provided in all centres, on a part-time basis by an existing counselling agency. 4) Housing Placement - A city-wide housing placement service would assist seniors find new residences and with relocating. This service need be available only at centres with a high proportion of renters in the area. It would be of particular import to seniors who are frail, of limited income and in areas of particular housing scarcity. This service should be provided as an extension of the City of Edmonton Housing Registry. 5) Legal Counselling - Of particular importance would be advice on wills, landlord and tenant rights, consumer and family law. This service is not widely utilized by seniors. As each centre is different, the availability of service is not on an equal basis. It is recommended that a set of basic services be available in all centres. These basic services are: a) Drop-in b) Educational and recreational programs c) Information and referral d) Outreach programs e) Counselling And in multi-functional and special needs centres: f) Congregate meals

Funding for these services would be provided for in the budgeting of the centres with the exception of counselling which would be provided by an existing counselling agency. 114

Other services deemed necessary by the users should be also be provided, but these are to be on a centre-by-centre basis. C. Distribution and Number of Centres Community people have suggested the need for centres in Calder, Beverly, Bonnie Doon, and Jasper Place. The State of Pennsylvania (U.S.A.).has developed quantitative guidelines for centres based upon population. These state that there should be a "neighborhood" centre for every 5,000 seniors and a "multi-purpose" centre (64)If these guidelines are to serve a population of every 10,000 seniors. applied to the City of Edmonton, there should be three multi-purpose centres and six neighborhood centres. At present, nine centres exist and two are in the planning stages (Northgate Lions Centre and a Calder Centre). The Society for the Retired and Semi-Retired, Lions Senior Citizens Recreation Centre, and Strathcona Place most closely approximate multi-purpose centres. West Edmonton Seniors, Jewish Senior Citizens Drop-In and Alex Taylor School Drop-In most closely resemble neighborhood centres. Bissell Drop-In, McCauley Drop-In, and S.C.O.N.A., 'because of the particular population they serve should be considered "special needs centres" and represent resources over and above those recommended. With the implementation of the Calder and Northgate Lions Centres, Edmonton will have three multi-purpose centres and five neighborhood centres. It is recommended that centres be established in Jasper Place, Bonnie Doon and Beverly. Based on the 1976 usage of centres, Table XXIV indicates the potential number of centre users in 1981 and 1986 assuming there is no increase in the proportion of centre usage. This does not include S.C.O.N.A. which opened in 1977.

115

TABLE XXIV PROJECTION OF NUMBERS OF SENIOR CENTRE USERS TO 1986 (Based on 31.43% of Seniors Using Centres) Projected Number 65 years + City of Edmonton

Year

Number of Users

1976

30,620

9,624

1981

37,109

11,663

1986

44,908

14,115

With the increasing educational levels, and greater emphasis on preventive services, it can be speculated that the proportion of seniors using centres will increase. It is recommended that the Pennsylvania guidelines be adopted in Edmonton but that provisions be allowed for areas of special need which would be over and above the guidelines.

TABLE XXV NUMBER OF SENIOR CENTRES NEEDED IN EDMONTON USING PENNSYLVANIA GUIDELINES

Year

Population

Multi-functional Centres (10,000 seniors)

1976

30,620

1981

37,109

1986

44,908

Neighborhood Centres (5,000 seniors)

With the completion of the Northgate Lions and Calder Centres and the implementation of centres in Jasper Place, Beverly, and Bonnie Doon, Edmonton would have sufficient centres until some time between 1981 and 1986.

116

D. Costs of Centres Costs of centres vary substantially dependent upon such factors as services provided, space, and operator. A program-by-program analysis of costs is not available. A range of costs (based on 1976-77 dollars) based on existing centre costs gives an indication of costs for future centres. TABLE XXVI

RANGE OF COSTS OF CENTRES BASED ON EXISTING CENTRES 1976-77 Type

High Cost

Low Cost

Average

No.

"Neighborhood

$ 25,000

$ 3,500*

$18,000

$111,00

$83,000

$98,000

Centres" "Multi-purpose Centres"

* The Jewish Senior Citizen Drop-In did not have a paid staff person for much of 1976.

E. Location of Factors Senior centres should be located in areas of high senior concentration. They should be located on major transportation routes to be accessible. On the average, about half of centre users live within a one-mile radius of the centre. (65) Theproportion of centre users diminishes greatly the further one gets from the centre. Edmonton Transit uses a guideline of about 20 minutes as the maximum travelling time it should take to get from any area to downtown., (67) This would be a useful rule of thumb for the location of centres.

117

CHAPTER VIII LEISURE SERVICES Introduction Leisure services are provided for senior citizens by a number of agencies within Edmonton. Most seniors currently satisfy their leisure needs at senior citizen centres, at clubs and at specific rooms set aside at a particular time for seniors. Some seniors take part in courses and programs set-up for adults of all ages but this is true of only about 1% of the senior citizen population. In the last 2 - 6 years, courses especially designed for senior citizens have been set-up and offered by educational institutions, by the Edmonton Parks and Recreation Department and by other agencies.

Recreation Recreation services for senior citizens include both programs designed for senior citizens and assistance to seniors in organizing their own activities. Table XX11.1 shows the present breakdown of recreation programs that are currently being offered to senior citizens within Edmonton. Following that is an outline of present activities in which seniors are involved within the 5 Districts of Edmonton Parks and Recreation and at other agencies. There are many recreational activities being done at the 7 senior citizen centres in Edmonton but these have already been outlined in the section on Centres.

118

TABLE XXVII OUTLINE OF CURRENT RECREATIONAL PROGRAMS OFFERED TO SENIOR CITIZENS IN EDMONTON

1. Social Activities: Billiards (Pool), Bingo, Bridge (Duplicate and Contract), Cribbage, Ping Pong, Scrabble, Shuffleboard, Social Dances, Teas, Whist. 2. Physical Activities: Keep Fit, Yoga. 3. Aquatics: Free Swim. 4. Visual Arts: Crocheting, Knitting, Lapidary, Liquid Embroidery, Macrame, Painting (oil, acrylic, water), Pottery, Quilting, Rug Hooking, Sewing, Stitchery, Tatting, Weaving, Woodworking. 5. Performing Arts: Choir, Drama Classes, Instrumental Music, Learn to Dance, Orchestra, Scottish Dancing Lessons, Square Dancing Lessons. 6. Special Events and Field Trips: Bazaars, Bus Tours, Camping Trips, Exhibits, Senior Citizen Olympics, Senior Citizen Week, Special Parties, Trips to Game Farm, Conservatory, etc.

119

A. Recreation Services and Facilities for Senior Citizens in the 5 Districts of Edmonton Parks and Recreation West District 1. Senior Citizen Groups/Clubs a. Meadowcroft 8eni-ocrs High -Rise 11445 - 135 Street b. Northwest Drop-In Kensington Hall 12130 - 134A Avenue c. Seniors Afternoon Group Grovenor Community Hall 14325 - 104 Avenue d. Neighborhood Friendship 11012 - 122 Street e. Elmwood Lodge 15902 - 82 Avenue f. Senior Swingers Kensington Community League 12130 - 134A Avenue

No. of Seniors Involved 50 - 75 40 12 12 75

2. Proposed Recreational Facilities a. Social and Recreation Room Meadowcroft Seniors High-Rise 11445 - 135 Street b. Root at Craft Centre West 121 Street and 109A Avenue c. Room at Jasper Place Town Hall 15625 Stony Plain Road d. Carona Home 3. Recreation Programs a. Bingo - Jasper Place Town Hall Northwest Drop-In Elmwood Lodge b. Whist, Bridge, Cards - Meadowcroft Seniors High-Rise Northwest Drop-In Jasper Place Town Hall c. Yoga - Meadowcroft Seniors High-Rise d. Pool, Shuffleboard - Northwest Drop-In e. Crafts - Seniors Afternoon Group f. Other Social Activities - Meadowcroft Seniors High-Rise Elmwood Lodge

120

North District 1. Senior Citizen Groups/Clubs

No. of Seniors Involved

a. Beacon Heights Senior Citizens 44.8 - 118 Avenue b. We Care Centre Villa Maria 144 Avenue & 92 Street

20-30 40-50

2. Recreation Facilities a. Recreation Room Multi-Purpose Lounge Villa Maria 144 Avenue & 92 Street b. Room at Beverly Recreation Centre 42 Street & 111 Avenue 3. Recreation Programs a. Bingo - We Care Centre b. Social Activities - We Care Centre Recreation Room, Villa Maria Beacon Heights Senior Citizens c. Adult Swim Lessons - Eastglen Pool (seniors get 11 price) 11438 - 68 Street - Eastglen Pool (seniors get Â˝ price) d. Adult Free Swim Central District 1. Senior Citizen Groups/Clubs a. Riverdale Seniors Riverdale Hall 93 Street & 100 Avenue b. Parkdale Seniors Parkdale Hungarian Church 11701 - 86 Street c. Eastwood Seniors 11803 - 86 Street 2. Recreation Facilities Except for Strathcona Place, all the other senior citizen centres are located in the Central District. 3. Recreation Programs a. Senior Citizen Ladies Keep Fit - Kiwanis Place b. Social Activities - Riverdale Seniors Parkdale Seniors Eastwood Seniors All other programs are listed under the centres.

121

South-East District 1. Senior Citizen Groups/Clubs a. Ritchie Friendship Ritchie Community Hall 7728 - 98 Street b. Strathearn Seniors Strathearn School 8728 - 93 Avenue Strathearn United Church c. Holyrood Seniors Holyrood School d. Assumption Seniors Assumption Catholic Church 9040 - 95 Avenue e. Bonnie Doon Friendship Club Bonnie Doon Community Hall 9240- 93 Street

No. of Seniors Involved 30 30

12 30 30

2. Recreation Facilities a. Craft Room St. Kevins School 10005 - 84 Street b. Social/Card Room St. Kevins School 10005 - 84 Street 3. Recreation Programs a. Socials - Ritchie Community Hall Strathearn School Assumption Catholic Church Bonnie Doon Community Hall Holyrood School b, Crafts - Strathearn United Church Bonnie Doon Community Hall c. Cards - Assumption Catholic Church St. Kevins School Strathearn United Church d. Special Event - Field Trips - Ritchie Community Hall Bonnie Doon Community Hall Assumption Catholic Church - Strathearn School e. Teas Assumption Catholic Church Strathearn United Church Bonnie Doon Community Hall

122

South-West District 1. Senior Citizen Clubs/Groups

No. of Seniors Involved

a. McKernan Friendship Club McKernan Baptist Church 2. Recreation Facilities 50 - 100 a. St. Pauls Church 11526 - 76 Avenue b. McKernan Baptist Church 11103.- 76 Avenue c. Strathcona Place (outlined in section on centres) 3. Recreation Programs a. Socials - St. Pauls Church b. Dances - St. Pauls Church - St. Pauls Church c. Lunch McKernan Baptist Church - St. Pauls Church d. Bingo e. Guest Speaker- McKernan Baptist Church

123

B. Y.M.C.A. The Y.M.C.A. does not offer any programs specially for the senior citizens. Seniors are encouraged to participate in adult programs and activities. Seniors do attend these activities at the Y.M.C.A. but tend to take part in individual activities. Many seniors swim in the pools, use the gyms for jogging and use the exercise rooms. At this time, seniors are given no special rates. The Y.M.C.A. is planning a special program for seniors at off-peak times. They also plan to offer the use of the facilities of the Y.M.C.A. to seniors at reduced rates during these off-peak hours.

C. Y.W.C.A. The Y.W.C.A. aim at integration of seniors into adult programs. They invite seniors into their adult programs and activities by letting them in at half price. Seniors attend craft classes, fitness programs and swimming programs. It is estimated that approximately 1% (30/3000 per session) of the participants in the adult programs and activities are senior citizens. The Y.W.C.A. offers one special program for seniors - Yoga for 50's and over. They tried a Quilting Class for seniors but not enough seniors registered. They are also planning a multi-craft program for seniors.

D. Edmonton Art Gallery #2 Sir Winston Churchill Square The Gallery offers a special art program for senior citizens. The seniors are currently paying $30.00 per person for this course although if a Provincial grant is given, the seniors will get a $25.00 rebate. There was a 10-week program at the Gallery from January 25 - March 30, 1977 from 1:30 - 3:30 p.m. This course consisted of drawing, oil painting, acrylic painting, and water colors with the participants deciding which area they wish to cover. The participants must pay for their own materials. This course was offered for the first time this year and it was fully registered (15). Another program will be held April 13 - May 25, a 7-week program that is actually a continuation of the first.

124

E. Senior Citizens Organizations There are 51 senior citizens groups or associations in the city. Most of these groups are connected to a church, community league or ethnic group and provide weekly or semi-weekly programs. Membership in these groups range from 20 - 30 to a few hundred. The MAP shows the location of these clubs. TABLE XXVIII SENIOR CITIZENS GROUPS Church and Community League Groups --Retired Professional Groups

000

,.... 30 11

Ethnic Associations

Residence Social Clubs

5 51

The church-sponsored groups are oriented to the elderly members of the various churches. They provide programs on a weekly or semi-weekly basis, usually one afternoon. Programs are operated by volunteer church members. An attempt to involve all the shut-in or less active seniors in the church is a significant feature of these programs. The community groups are very similar to the church-sponsored groups with the major distinction being the absence of religious affiliation. They operate on a similar basis although all the members take a more active part in the program development than in some of the church-sponsored groups.

Ethnic groups are very similar with the exception of the orientation to a particular ethnic group. Programs are closely related the the language and cultural tradition of the particular group. In Edmonton, there are two Ukrainian and two French-Canadian senior citizens groups. Several of the church groups could also be considered ethnic, South Side Seniors and Trinity Pioneers, both operating from Trinity Lutheran Church, conduct some of their programs in German. Chinese Senior Citizen Recreation Group operated out of the Chinese United Church.

1 25

0 Location of Club

76 75

64 51

52 49

0 71

63 0

28 27

26 6 7 18

3 5 2

Residence Associations are operating in most of the major senior citizens residence complexes. The programs are oriented to the residents. Senior citizens residences have an advantage over the other community groups because they present a highly visible and centralized group. Many community clubs and organizations volunteer their time or service to the programming of such residences. The age of residents of such complexes are somewhat higher than the city average. This presents some different program limitations. Retired Professional Groups are composed of seniors who have retired from a particular profession. They are largely social organizations but some do provide considerable input into policy decisions affecting their members. Many seniors involved as members of these clubs or organizations attend one or more of the major centres for certain scheduled activities. Transportation was cited as a major difficulty for many others to attend programs outside their own community or church. For many seniors, these community groups are their only organized involvement outside their homes. Several of the church groups attempt to bring seniors who are residents of senior citizen homes and nursing homes to their regular programs. The concerns expressed by these groups tend to be specifically related to their own situations. The difficulty of understanding problems were mentioned which combined with the infirmities of age makes mobility fairly difficult. Most of these organizations operate on a limited budget which they raise themselves through various fund-raising endeavors or through support from their church organization. The variety of these groups is very significant. No two groups or associations are the same. They all represent attempts to program for seniors needs in their own particular area.

126

F. Recreation for Seniors in Hospitals, Auxiliary Hospitals and Nursing Homes

1. In the active treatment centres in Edmonton, little if any recreation is offered to the patients. 2. In the auxiliary hospitals, 80% of the patients are elderly and many are in wheelchairs. Most centres have a recreation department with 2 or 3 full-time staff plus volunteers. Most of the centres offer the same kind of recreation service to their patients and an explanation of the types of service follows: a. Physical Activity Programs:Bowling, shuffleboard, exercise program for wheelchair patients, gardening, cooking, sewing, handicrafts.

b. Social Activities:Card games, bingo, monopoly.

c. Parties and Special Occasions:Christmas Day, Valentine's Day, birthday parties, weddings and church services.

d. Entertainment:Films, entertainers like singers, bands, drama groups are brought in if they are free. e. Reality Programming:Current events, spelling bees, counting, identification of colors.

f. Out-trips:- (most centres have their own van) Shopping centres, major attractions at the Jubilee Auditorium and Coliseum, A.C.T. Centre, church services, parks, football games, picnics, scenic drives. The facilities at the centres usually include a multi-purpose room, lounge areaand an open green space for summer activities. The extended care centres looked at were the Aberhart Hospital, Allen Gray, Charles Camsell, Dr. W.W. Cross Cancer Institute, Glenrose, Good Samaritan,

127

Grandview Auxiliary, Lynnwood Auxiliary, Norwood Auxiliary and St. Joseph's Auxiliary. To give some idea of the numbers involved in the activities and services provided, averages have been included for all the auxiliary hospitals. Type of Service Physical Activity Social Activity Parties Entertainment Reality Programming Out-trips

No. of Times/Month

No. Involved

2 4 1 2 Daily 25

20 20 40 20

It is estimated that only 50% of the patients get involved in these activities. 3. In the nursing homes, the seniors are more active and independent than those in an auxiliary hospital. Most nursing homes have a recreation staff of at least one full-time person. The facilities usually include lounges, multi-purpose rooms, space outside during the summer and the patients' rooms. Similar types of programs, activities and services are provided in nursing homes that are provided at auxiliary hospitals. These include:

a. Physical Activity Programs:Sewing, leather work, woodwork, sing-song, daily exercise programs. b. Social Activities:Men's group, ladies' group, bingo, cards. c. Parties and Special Occasions:Birthday parties, Canada Day, Dominion Day, etc. d. Entertainment:Movies, entertainers brought in. e. Reality Programming:Spelling bees, current events, color identification. f. Out-trips:- (most nursing homes have no transportation vehicle and must pay for it) A.C.T. Centre. Strathcona Place, shopping centres, major city attractions, sight-seeing. To give some idea of attendance, estimates have been made for the average nursing home.

128

Type of Service Physical Activity Social Activity Parties Entertainment Out-trips

No. of Times/Month 3 4 1 1- 2 1

No. Involved 20 20 40 25 - 40 15

129

G. Education Education courses especially designed for senior citizens are currently being offered by the Department of Extension, University of Alberta, by Alberta College and by Grant MacEwan College. These courses have only been offered within the last two years. The University, and Continuing Education Services of the Edmonton Public Schools offer seniors special rates if they take any adult class or course, although less than 1% of the senior citizen population takes advantage of this service. Table XXII.3 below shows the types of programs that have been designed for senior citizens within the last two years by the different educational institutions. Then there is an outline of the programs offered by insttutions involved in education services for seniors in Edmonton.

TABLE XXIX OUTLINE OF CURRENT EDUCATIONAL CLASSES OFFERED TO SENIOR CITIZENS IN EDMONTON

1. Writing, Literature - Anecdotes for Your Anecdotage, Hemingway Ho!, Publish Before You Perish, Writing Fiction, Writing Non-Ficition, Writing Your Community History 2. Music 3. Geography, Politics, Travel -

Music Appreciation, Music for Oldsters

Around the World in 15 Days, China and You, Contemporary Canadian Issues, Contemporary Issues, Our Environment

4. Physical Activities - Hatha Yoga for Seniors, Seniors on Skis, T'ai Chi Ch T wan, Winter Mountain Experience 5. Other -

Basic Design Workshop, Comparative Religions, French for Fun, Mysteries of Man, What's Cooking

130

LYNNWOOD AUXILIARY HOSPITAL (100 Auxiliary Patient Beds) The Lynnwood Auxiliary Hospital has an active recreation program with a defined philosophy, set of objectives and a policy and procedure manual. The staff consists of: 1 1 1 1

full-time full-time part-time part-time

supervisor recreation aide recreation aide recreation driver

371/2 hour/week !I

20 20

An operating budget is provided of $200/month. A wheelchair bus (hydralic lift) is provided. Gas and maintenance comes from a hospital vehicles budget not recreational budget. Bus capacity = 5 wheelchairs, 5 walking passengers.

Programs There is a wide variety of programs in the recreation department based on 1. 2. 3. 4.

hospital population seasonal changes/events community and hospital resources on hand patient interest and participation

The number of patients involved in any program fluctuates over time. All patients are involved in some way with recreation. Patients are encouraged to participate in those programs that are of interest to them. An attempt is made to foster new interests or encourage the use of adoptive techniques to facilitate the participation in programs already of interest to patients. Some patients are active in a large variety of programs. Others are more limited in their capabilities and therefore more limited in their active participation.

131

PROGRAMMES 1.

Entertainment Singers - individual, group, choir Dancers - school of dance Square Dancing Ethnic Dancers Bands Solo instruments Magicians Teas, Parties, Cabarets, Bazaars Happy Hours.

2. Community Involvement Occurs in a variety of programmes, some listed above. 1. Schools - visitations to hospital. 2. Churches - Sunday Services; Auxiliary Groups, Youth Groups - put on entertainment or sponsor parties. 3. Area - Community Groups 4. Guides/Scouts and other Youth Groups 5. Volunteers for programmes (also Volunteens) 6. Donations from Mens/Womens Service Clubs as well as their participation in many programmes. 3. Crafts daily sessions demonstrations of new crafts ie. some woodwork, ceramics, stitching, etc. 4. Music Listening to music appreciation groups sing-a-longs rhythm bands encourage instrument playing where appropriate. 5. Art Programmes wide variety banner making painting, drawing, etc., paper mache 6. Activity Programmes Birthday Parties Bowling Shuffleboard Tossing beanbags, balls, etc., Baking Exercise Programmes Films, Movies, Slides Speakers Bingo Home-cooked Dinners Gardening Barbeques, picnics

Special events - K7-Days, Christmas, etc. (Parties, special programmes) Poker Playing, Horsehoes Games, Cards Reading, Discussion Groups, Current Events

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7. Sensory Training/Reality Orientation 8. Resident's Council Meeting Recreation Planning Meeting (Recreation Staff and Patients) Patient's Programme - theirs to plan and organize once/monthly 9. Outtrips with bus to various community programmes Lounges for drinks Out to supper or lunch Tour of patients of interest Shopping Movies . Morning rides Picnics, trips to lakes, provincial parks, etc., Camping, provincial trips Concerts and special programmes at Jubilee, Sportex, Coliseium, etc. Sports activities Rundle Park Centre Programmes.

133

1. University of Alberta The University pays the fees for senior citizens who enroll in any undergraduate courses offered by the University although the senior must meet the requirements of any faculty. Any professional course like medicine, law, dentistry is closed to a senior citizen because of his age. Twenty-two senior citizens are registered in various courses for the 1976/1977 season.

Faculty of Extension, Corbett Hall, University of Alberta The Faculty of Extension offers two services to senior citizens. Seniors can obtain a scholarship to take part in a language course if there is a demonstrated need on the part of the senior for this and if the language course is already fully registered. The senior must only pay for his books. This service is used very rarely as only one senior has received this scholarship in the last year. Since May 1975, the Extension Department has offered a spring session for senior citizens during the first three weeks of May of each year. The following courses will be offered during 1977 free-of-charge for seniors: Basic Design Workshop, Writing Fiction for Pleasure, Writing Non-Fiction for Pleasure, Writing your Community History, Hemingway Ho!, T'ai Chi Ch'wan, Senior Citizens as leaders, Contemporary Canadian Issues, Comparative Religions, Music Appreciation, Around the World in Fifteen Days, Our Environment, China and You, and Mysteries of Man. These programs are held during the day at the University. As well, several social activities are organized and a drop-in centre staffed at the Students Union Building during these three weeks. Senior citizens who come from out of town can stay at Lister Hall free-of-charge on a weekly basis during this spring session. The cost for these services to senior citizens is underwritten by the Department of Advanced Education and Manpower. The budget covers the seniors' tuition fees, honoraria for instructors, residence costs, meals, some social events, transportation rebates, part-time staff and the printing of brochures.

134

The staff consists of Monda Wadsworth, Extension Assistant, one parttime person who works four months to plan the social activities, and one part-time staff to work at the drop-in centre. The programs have always been almost completely filled. They are planned in consultation with seniors. In order to expand these programs, the budget would have to be greatly increased as it would mean more permanent staff and greater costs for tuition, honoraria, etc. Some Statistics - University of Alberta Budget:

1977 - $21,000 1976 - $17,500

Registration:

1977 - expect over 200 1976 - 195 1975 - 220

No. of seniors who were in residence facility - 1976 - 77.

Program Basic Design Workshop Writing Fiction for Pleasure Writing Non-Fiction for Pleasure Writing Your Community History Hemingway Ho! T'ai Chi Ch'wan Senior Citizens as Leaders Contemporary Canadian Issues Comparative Religions Music Appreciation Around the World in Fifteen Days Our Environment China and You Mysteries of Man

14 Programs

Total No. of Hours 22.5 22.5 22.5 22.5 22.5 15 19 10 10 12.5 18 3/4 6 1/4 6 1/4 6 1/4

216.5

Registration Limit 15 20 20 50 20 30 20 50 50 50 50 30 50 35

490

135

2. Alberta College There are about 10 programs offered to senior citizens at Alberta College, 10041 - 101 Street, on Fridays during the fall and winter semesters. These programs are a joint project of members of the Edmonton Association for Continuing Education, with Alberta College, Alberta Consumer and Corporate Affairs and Grant MacEwan Commmity College being the participating agencies. Seniors must either register in advance or at the first session of the course with the registration fee being $3.00 per course. Most courses go from 10:00 a.m. to 12:00 noon and are from 4 - 12 weeks in length. There is a social half-hour scheduled from 9:30 a.m. - 10:00 a.m. on the Fridays with the price of the coffee being paid by Alberta College. These programs were first offered in September 1976. The program selection arose out of a seminar held in the spring of 1976. Fifty senior citizens were randomly selected and invited to participate in this seminar which outlined possibilities for seniors who then made suggestions on what kind of programs they wanted. The programs offered by Alberta College are funded by the Department of Education - Continuing Education Division, although the Creative Writing Program is funded by the Department of Culture. Approximately $1500.00 is provided for instructor costs per semester. Alberta College provides the space and contributes administrative costs (an estimated $500.00 per semester). The following programs have been offered by Alberta College since September 1976: French For Fun, Music For Oldsters, Contemporary Issues, Publish Before You Perish!

136

The following are statistics for attendance at these programs: TABLE XXX ALBERTA COLLEGE STATISTICS No. Hours

Programs French For Fun Music For Oldsters Contemporary Issues Publish Before You Perish Anecdotes For Your Anecdotage

Maximum Registration

No. Registered No. Registered Winter Fall

20 12 20

20 20 25

17 12

18 12 10

3. Grant MacEwan College Senior citizens who are taking non-credit courses in the evening must pay the full rate. Grant MacEwan College has sponsored two Creative Writing classes at the Society for the Retired and Semi-Retired; one last fall and one over this winter. As well, Grant MacEwan sponsors the following courses at Alberta College for senior citizens: Comparative Religions, What's Cooking, Hatha Yoga for Seniors, Seniors on Skis and Winter Mountain Experience. The section on Alberta College explains the set-up of these courses. TABLE XXXI GRANT MACEWAN COMMUNITY COLLEGE STATISTICS

Programs Comparative Religions What's Cooking Hatha Yoga For Seniors Seniors on Skis Winter Mountain Experience

No. Hours

Maximum Registration

No. Registered Fall

No. Registered Winter

20 9

25 25

10 8

20 14

18 24

5 days

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4. Edmonton Public Schools Continuing Education Services, 10820 - 101 Street Senior citizens are allowed into continuing education courses at half price. The numbers of seniors taking advantage of this service is less than 1% of all adults. The majority of women are in the sewing, art and cooking classes; the majority of men in the woodworking classes. There are no special programs just for senior citizens.

138

List of Possible Recreation Programs for Senior Citizens

a. Social Activities: 1. 2. 3. 4. 5. 6.

Bingo Bridge (Contract & Duplicate) Cribbage Dancing Darts Euchre

7. 8. 9. 10. 11. 12.

Library Monthly Dancing Parties Photography Club Pool Shuffleboard Whist

b. Physical Activities: Bird Watching Walks Bowling Carpet Bowling Croquet Culture Physique - exercise program to music 6. Curling 7. Cycling 8. Fishing and Hiking

1. 2. 3. 4. 5.

9. Fitness - a program designed for seniors to keep in shape 10. Golf 11. Horseshoes 12. Ladies Billiards 13. Lawn Bowling 14. Skating 15. Yoga

c. Aquatics: 1. Free Swim 2. Learn-to-swim 3. Water Exercises in the pool d.

Visual Arts: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

Aluminum Etching Artex Basketry Bazaar & Gift Ideas Beadwork Candlemaking Ceramics Copper Enamelling Crocheting Decoupage Dressmaking Flower Making Jewellry Knitting Lapidary

17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32.

Liquid Embroidery Macrame Modge-Podge Oil Painting Pottery (greenware) Quilting Raffeene Sewing Stitch Weaving Tatting Tin Crafts Upholstery Water colors Weaving Wood Carving Wood Working

139

e. Performing Arts 1. 2. 3. 4. 5. 6. 7.

Band Belly Dancing Choir Chorale Group Drama Group Folk Dancing Instrumental Music

8. 9. 10. 11. 12. 13. 14.

Learn to Dance Male Chorus Orchestra Group Scottish Country Basics Square Dancing Square Dancing Basics Stage Productions

7. 8. 9. 10. 11. 12.

New Year's Eve Ball Monthly Outings (concerts) Pool Tournaments Potluck Suppers Senior Citizens' Week Teas and Luncheons

f. Special Events 1. 2. 3. 4. 5. 6. g.

Bazaar Bus Tours Christmas Dinner & Party Games Night Get Acquainted Night Maple Sugar Visit

Cultural Activities 1. Centennial Celebrations 2. Ethnic Group Celebrations 3. French Canadian Club Activities

4. Internation Night (monthly) 5. Spanish classes 6. Ukranian Christmas

h. Special Summer Events 1. Croquet Tournament 2. Horseshoe Tournament 3. Klondike Dance and Barbeque 4. Senior Citizens' Olympics

5. 6. 7. 8.

Softball Tournament Summer Camping Trips Summer Days Bus Trips Summer Picnic Day

140

List of Possible Educational Programs for Senior Citizens

a. Language 1. Conversational French 2. Creative Writing: a) b) c) d) e)

Pleasure Local history Memoirs Public speaking How to publish

3. General English Literature: a) Contemporary b) Writing and appreciation of poetry c) Critical appreciation of novels 4. Study through dramatization of literature (and poems) popular in first half of 20th Century. 5. Basic English (Reading and Writing) slanted to help the disadvantaged. 6. Study of Spanish

b. Music 1. Music Appreciation 2. Singing 3. Playing simple instruments c. History and Politics 1. Current Events: a) Canadian-American issues, (e.g. ecology, power, oil, etc.) b) Canadian Federal Government (i.e. type of political science.) c) Problems of northern residents and residency.

141

2. Public Relations: a) Public relations per se. b) Writing economic and political commentaries. c) How to lobby (includes letters, briefs, etc. to government and bureaucracies). 3. Overview and comparison of world histories and religions (topic to be developed by group). 4. Financial management and Investment as related to provincial resources. (includes Alberta and Arctic). 5. Early Canadian identity. d. Exercise (Physical fitness) 1. Fitness through awareness of body: a) Gentle Yoga b) Home exercises )

c) Bio-energetics

e. Business Skills and Finance 1. Basic management of finances: a) Investments b) Wills, Leases c) Estates, womens' rights f. Science 1. Study of resources in Alberta area: a) Geography of Alberta and local area in particular b) Astronony -with trips to planetarium c) Archeology in general - any local trips and diggings if available d) Urban planning and development g. Crafts and Manual Training 1. Pottery, maccrame, - general revival of home crafts 2. Wood working for men and women 3. "Do it yourself" - simple home repairs for men and women.

142

a) b) c) d)

Electrical Plumbing Carpentry Window Reparis etc.

4. Blue Prints - how to read, draw, etc. h. General 1. Indoor-outdoor - balcony - gardening 2. How to create and produce a T.V. programme see language #2 History #3.) 3. Libraries - how to understand - how to use (begin locally then afield - see Science #1). 4. Choosing a retirement home - merits, etc. of types of living 5. Resource person in senior citizen programme: a) What is involved b) How to know needs and cope

143

CHAPTER IX TRANSPORTATION Based on the 1975 Civic Census and the registration file of the Disabled Adult Transportation System (D.A.T.S.), about 4.8% of Edmonton's senior citzens fall into the category of people considered dependent. Approximately 22.4% of seniors would be considered semi-dependent, these individuals experience difficulty with regular transit. About 72.8% of the seniors are independent and do not experience major problems in regard to transportation. A. Existing Transportation (1) Private Automobile - The Province of Alberta driving licensing regulations stipulate that an individual 69 years of age and older is required to take an annual medical examination. The 1971 Federal Census indicates that 8,475 (50%) household heads over the age of 65 out of a total of 16,960 household heads own automobiles in Edmonton. For the city as a whole 82% of all households own automobiles. About 80% of the senior citizen car owners are males. In respect to age 48% of the senior citizens owning cars are in the 65 to 69 years age group while 52% are 70 years of age and older. The private automobile is the most widely-used form of transportation by senior citizens. The automobile is available to all three mobility classes. Many senior citizens own a car, others who are unable to afford a car or are unable to obtain a license for medical reasons, depend to a large extent on family and friends to travel. (2) Taxi - Taxi companies provide on demand, door-to-door service. The cost to the user is $1.20 for the first mile and .l0c for every 1/6 of a mile thereafter (1977). Taxis are available to all three mobility classes. Taxi companies do recommend, however, to their drivers, not to lift persons from wheelchairs as they are liable in the event of an accident. In addition, some companies charge an additional fee for handling wheelchair individuals.

144

(3) Ambulance - Smith's Ambulance Limited, the main ambulance service in the City of Edmonton, provides service at a flat rate of $29 plus $1.00 per mile. Smith's Ambulance Limited provides an on demand, door-to-door victims service for elderly individuals requesting it. Senior citizens are not required to pay for this service as it is one of those covered by the Extended Health Benefits. (4) Edmonton Transit - The City of Edmonton through the Edmonton Transit System, provides life-time courtesy bus passes for senior citizens residing within the City limits. Latest statistics (1976) show 18,000 to 20,000 such passes in active use. The passes are available at a minimal charge of $5.00 to cover processing costs. The following is a list of eligible restrictions for those obtaining a senior citizen's courtesy pass: Passes are available to: i) Any person 65 years of age or older who has resided in the City of Edmonton for the past 12 consecutive months and is able to produce valid proof of age. ii) The spouse of a senior citizen in receipt of a courtesy pass is also eligible, regardless of age. iii) A widow/widower whose spouse would have been 65 years of age, is entitled to a pass regardless of their age, providing they can produce proof of age of the deceased. iv) Women 60 to 65 years of age, who can produce proof that they are receiving Social Allowance from Alberta Social Services and Community Health. These women are required to obtain a letter of authorization from Edmonton Social Services, 6th floor C.N. Tower, before applying for their courtesy pass. v) Individuals able to produce proof of being in receipt of a War Veterans Allowance. The above persons may obtain their courtesy pass on Tuesday, Wednesday or Thursday, between the hours of 8:30 a.m. to 4:30 p.m. at Senior Citizen Transportation, #307 Canadian Imperial Bank Building, 101 Street and Jasper Avenue, Edmonton, Alberta. Edmonton Transit surveys indicate that senior citizens comprise approximately 10% of the total ridership. Table XXXII compares senior citizens ridership to Edmonton Transit ridership from August 1975 to December 1976. 145

TABLE X/XII TOTAL AND SENIOR CITIZEN TRANSIT RIDERSHIP Total

Senior Citizen Ridership

1975 August September October November December

3,678,646 4,670,853 4,828,957 4,670,822 4,811,800

454,869 449,641 539,805 552,328 590,486

12.4 9.6 11.2 11.8 12.3

1976 January February March April May June July August September October November December

4,884,962 4,686,067 5,092,605 4,586,059 4,406,738 4,432,436 4,292,023 4,016,605 4,893,295 4,949,445 5,184,974 5,051,373

469,378 435,929 470,259 351,956 444,285 537,108 543,000 467,870 539,162 572,628 547,256 497,008

9.6 9.3 9.2 7.7 10.1 12.1 12.7 11.6 11.0 11.5 10.5 9.8

Individuals in the independent and semi-dependent classes are generally able to use Edmonton Transit, however, some semi-independent individuals do have difficulties in using Edmonton Transit buses, and are registered with Disabled Adult Transportation System. (5) Disabled Adult Transportation System (D.A.T.S.) - A person who is totally unable to use Edmonton Transit buses, is eligible to use D.A.T.S. Individuals desiring to use the system must register with the City. There is no fee for registration. The D.A.T.S. user is charged $0.50 per one-way trip, which is paid to the driver. In addition, the Callow Coach is available for charter at a cost of $9.00 per hour. Persons desiring to use D.A.T.S. are required to give 24 hours advance notice for reservation service and 48 hours advance notice for subscription service.

146

1. Profile of Senior Citizen Registration i) Age - Senior citizens make up the largest proportion of D.A.T.S. registrants (3,800). The 65 years and older group comprises 62.5% of the total registry. Within this group, the largest percentage are those persons over 75 years of age, constituting 49.1% of the total. Table XXXIII depicts the age distribution of all D.A.T.S. registrants. TABLE XXXIII D.A.T.S. REGISTRANTS BY AGE GROUP

Age Group

% of D.A.T.S. Registrants

15 - 24

5.5

25 - 34

4.4

35 - 44

4.5

45 - 54

8.6

55 - 64

13.0

65 - 74

15.8

75 - 84

26.4

85 - 94

20.3

95+

2.4

ii) Age-Sex - The age-sex distribution (Table XXXIV) indicates that females are dominant in every age group except those between 15 - 44 years of age. In the older groups female dominance is more prominent due to the longer survival rates of females.

I 47

TABLE XXXIV AGE-SEX DISTRIBUTION OF D.A.T.S. REGISTRANTS

Age Groups

% of Total Male Female

% of Total Male

% of Total Female

15 - 24

2.9

2.6

6.9

4.5

25 - 34

2.4

2.0

5.6

3.5

35 - 44

2.4

2.1

5.8

3.6

45 - 54

3.9

4.7

9.4

8.1

55 - 64

4.9

7.1

11.6

12.2

65 - 74

6.6

9.2

15.7

15.9

75 - 84

10.3

16.1

24.5

27.7

85 - 94

7.5

12.8

17.9

22.1

95+

1.1

1.3

2.6

2.3

42.0%

58.0%

100.0%

iii) Disabilities - D.A.T.S. registrants over the age of 65 have a wide range of disabilities. For example: broken hips senility Parkinson's Disease blindness arthritis heart conditions stroke victims iv) Walkers/Wheelchairs - The majority of D.A.T.S. registrants are confined to wheelchairs (dependent) 54%. Walkers (semi-dependent) consists of 46% of the registrants. In respect to senior citizen registrants (Table XXXV) the breakdown is very similar to the average for all the registrants.

148

TABLE XXXV WALKERS (SEMI-IN]).) - WHEELCBAIR (DEPENDENT) BREAKDOWN BY SEX FOR SENIOR CITIZENS Females Wheelchairs Walkers

Males Walkers Wheelchairs

Age Group 65 - 74

41.5

58.5

51.4

48.6

75 - 84

39.1

60.9

51.9

48.1

85 - 94

44.0

56.0

42.8

57.2

95+

41.7

58.3

30.0

70.0

2. Trip Behavior of Senior Citizen Registrants i) Total - Senior citizen registrants constitute over 60% of the total registry, however they only take 19.1% of the trips. The average weekly trip rate for senior citizens is 5.3 while for all D.A.T.S. registrants the rate is 7.0.* Table XXXVI shows the percentage breakdown of trips made according to age and walker (semi-independent)/wheelchair (dependent).

TABLE XKXVI AGE DISTRIBUTION OF TRIP MAKERS BY MODE OF MOBILITY Age Group

Walkers

Wheelchairs

15 - 24

20.3

4.8%

15.5%

25 - 34

19.5

7.6%

11.9%

35 - 44

9.1

4.2%

4.9%

45 - 54

20.3

10.4%

9.7%

55 - 64

11.9

6.2%

4.7%

65 - 74

6.9

2.1%

4.8%

75 - 84

11.2

5.6%

85 - 94

0.6

0.6%

95+

0.4

0.1%

0.3%

* IBI user survey. Working Paper 3, Exhibit 17 - January 1977. Based on one-way trips recorded for a week in October 1976. Senior citizens made 27% of all trips during that week.

149

ii) Purpose - Trips made by senior citizens are predominately for medical and personal purposes. The average weekly trip rate for medical purposes by senior citizens is 4.4 compared to 4.7 for all users. Personal, recreational, and shopping trip rates for senior citizens is 4.2 while all users have an average trip rate of 3.6. Table XXXVII shows that all individuals 65 years of age and older represents well over 25% for trips taken for personal, shopping, recreational and medical reasons.

TABLE XXXVII TRIP PURPOSE BY AGE GROUP Age Group

Personal Work

Shopping

Medical

Recreation

Education

6.0%

16.6%

15 - 24

30%

21.7

25 - 34

10%

30.4

7.1

6.0%

8.3%

35 - 44

15.2

14.2

3.0%

8.3%

45 - 54

15%

17.3

28.5

30.3%

25.0%

55 - 64

10%

13.0

21.4

15.2%

8.3%

65 - 74

15%

2.2

14.2

12.1%

8.3%

75 - 84

15%

7.1

27.3%

25.0%

85 - 94

7.1

95+ 100%

100%

3. Auxiliary Hospitals Four auxiliary hospitals in the city own and operate buses. i) Lynnwood Auxiliary Hospital - A Dodge Maxi van with hydraulic wheelchair lift, is used for the Community Out-trip Program. The program is designed for recreational purposes in order that residents of the hospital can go shopping and attend special events. The van has a capacity for 5 wheelchairs and 2 persons on jump-seats or a total of 10 persons on jump-seats. The van is only used on a group basis.

150

TRANSPORTATION FOR SENIOR CITIZENS EXISTING

Cost to User

Clientele

Service Arrangment

- gas - maintenance - depreciation

- self - friends - relatives

- on demand

Private Automobile

1 - dependent , 2 - semi-independent 3 - independent

Taxi

1 - dependent 2 - semi-independent 3 - independent

$1.20 for first mile $0.10 for every sixth of a mile thereafter

1 - dependent 2 - semi-independent 3 - independent

- $29.00 flat rate plus $1.00 per mile

. 1

' 2.

â&#x20AC;˘

Ambulance

' 4.

1 - semi-independent 2 - independent

- $0.35 per one-way trip - Senior Citizen pass $5.00 processing fee -

â&#x20AC;˘

EdMonton Transit

, 1 - dependent 2 - semi-independent 5.

DATS

Nursing Home/Auxiliary Hospital Buses

1 - dependent 2 -.semi-independent

- $0.50 per one-way trip - $9.00 :Jr hour for charter

' - on demand

- scheduled routes

. - 24 hour advance booking for reservation service and charters - 48 hour advance booking for subscription service

- Through recreation office at Nursing Home or Auxiliary Hospital

ii) Grandview Auxiliary Hospital - A Dodge Maxi van with a capacity of 5 wheelchairs and 2 walkers is used for similar purposes as the Lynnwood Auxiliary Hospital. The van is used on a group basis and only residents are eligible. The van is used about 20 times a month. iii) Norwood Auxiliary Hospital - The Norwood Auxiliary Hospital in conjunction with the Angus McGugan Nursing Home operates the Extended Care Program. This program has two buses available. A converted school bus, with hydraulic ramp, has a capacity of 8 wheelchairs and 8 - 12 walkers. This particular bus is also available to the Lynnwood and Grandview Auxiliary Hospitals. The second bus is a Dodge Maxi-van with a manual wheelchair ramp. It has a capacity for 5 wheelchairs and 3 walkers. The buses are used for recreational purposes, on a group basis and only for the residents of the Norwood and Angus McGugan complex. iv) Aberhart Auxiliary Hospital - For recreational purposes only, the hospital operates a Dodge Maxi van with a capacity of 5 wheelchairs and 2 walkers. The van is available to residents of the hospital. For all hospitals it was indicated that the buses are extensively used. Arrangements for trips are made by the recreation offices at each hospital. Drivers are generally staff persons from the recreation office or volunteers. Residents of the auxiliary hospital fall in the semi-independent and dependent categories. B. Identification of Problems This portion of the section identifies problems associated with each transportation mode in terms of the mobility classes (dependent, semi-dependent, independent). (1) Private Automobiles - No major problems. (2) Taxi - Senior citizens on limited incomes would have difficulty in using taxis. In addition, during peak hours there could be a considerable waiting period. Dependent senior citizens in wheelchairs would be required to provide their own attendant to assist them boarding the taxi. 152

(3) Ambulance - There are no major difficulties with the ambulance service in the city. Costs are generally covered by agencies or health plans. (4) Edmonton Transit - Senior citizen bus passes have time restrictions in regard to use. Passes cannot be used prior to 8:30 a.m. and between 4:00 and 5:30 p.m. Bus coverage is not complete, especially in the suburbs where many of the new senior citizens homes and recreation centres are located. This entails long walks to and from bus stops, long on-board time and transfers. This is especially a problem to the semi-independent senior citizen. The bus itself will pose many difficulties to senior citizens. High steps, crowds, accelerating and braking and lack of stanchions present problems to the senior citizen transit user. (5) D.A.T.S. - Priority service is provided to those handicapped individuals confined to wheelchairs (dependent) and to persons making work, educational and medical trips. Occasional users of D.A.T.S., which many senior citizens are, are required to make reservation at least 24 hours ahead of time. At present D.A.T.S. is unable to supply an on-demand type of operation. A problem identified during the D.A.T.S. users and non-users surveys, indicates that a significant percentage of D.A.T.S. registrants, who have been registered by nursing homes and auxiliary hospitals, were unaware of the fact that they were registered and were unaware of the D.A.T.S. service. (6) Nursing Homes/Auxiliary Hospital Buses - No major problems experienced. C. Priorities for Development It should be noted the private automobile and ambulance service are not discussed in this section. The private automobile is not a service provided by society, and ambulance services are available to all categories of senior citizens on demand. Development priorities are predominately in the semi-independent and dependent categories. There are three transportation services that require improvement to their present delivery system.

153

(1) D.A.T.S. - An on-demand type service during the off-peak hours. One or two vehicles could be set aside for the purpose of such a service. This would assist senior citizens especially in the dependent category to go shopping and visiting. The feasibility of an on-demand type service will be tested during the summer of 1977. (2) Edmonton Transit - During the regular City Council meeting on November 12, 1974, the following recommendation was passed: "That the Edmonton Transit System commence immediately with a program for providing necessary changes relative to bus operating and physical facilities in order to minimize the difficulties presently being experienced by people in Category C - Individuals Who Can Use Existing Public Transportation Facilities With Difficulties." Improvements should take place in two areas: i) Vehicles

lower steps. - installation of grab bars, stanchions or seat arms. (The cost to do this will vary by vehicle, but this should not exceed $250 to $300.) - Set aside one or more of the front seats for priority use by senior citizens. These seats could be signed "Reserved for Senior Citizens".

ii) Scheduling - improve service to suburban areas where many senior citizens homes and centres are located. - provide general route and schedule information together with information on safe boarding and alighting methods to senior citizens. (3) Subsidized Taxi Service - This would be a new type of service directed at the semi-independent senior citizens. These individuals have difficulties using Edmonton Transit and have low priority on D.A.T.S. The concept of a D.A.T.S/taxi system was recommended by IBI in their assessment of the present D.A.T.S. operation. The Transportation Planning Branch will be conducting a feasibility study to assess this concept.

154

TRANSPORTATION FOR SENIOR CITIZENS Priorities for Deve:opment

De e den

Private Automobile

Subsidized Service

2. Taxi

3. Ambulance

2. Scheduling -

1. Vehicle_ . 4. Edmonton Transit â&#x20AC;&#x201D;

On demand servLce during off neak hours

Accommodation of multi-purpose trips for residynts - medical - visitr . 'r ,, - shon

PATS '

Nursing Home/Auxiliary' Hospital buses

steps bus furniture stanchions and handrails suburban service

CHAPTER X SERVICE PRIORITIES

The scheme of "priorities" indicates the major emphases in the service system as it presently exists, the emphases recommended over the next ten years, and the developmental priorities. The priority scheme presented reflects the joint thinking of study staff and members of the "technical advisory committee" based on the following factors: 1. Quantity of existing services. 2. Philosophical assumptions (see introduction). 3. Other implicit personal values. 4. Demand for existing services. 5. Costs of existing services. The services have been broken down into seven categories for priority identification. Categories are not always mutually exclusive. The categories are as follows: Income Support

Community and Social Services

Housing

Transportation

Home Services

Leisure Services

Health and Medical Treatment Three categories of service recipients are used: dependent, semiindependent and independent. These are analytical constructs and do not represent rigid classifications. Individuals may change from one status to another at any time. The higher the priority of a service, the lower the number.

156

Working Definitions for Priority Indentification

Independent

- refers to people living in the coimuunity requiring only minimal support such as income maintenance and preventive programs on a regular basis.

Semi-Independent

- refers to people requiring some or periodic assistance in carrying out activities of daily living.

Dependent

- refers to people requiring regular daily assistance to carry out many of the activities of daily living.

157

EXISTING PRIORITIES

HEALTH AND

INCOME SUPPORT GROUP

Dependent People

MEASURES

HOUSING

1-01d Age Security 1-Auxiliary Hospitals 1Pension 2-Guaranteed Income supplement 2-Alberta Assured Income Plan 3-Canada Pension Plan

2-Nursing Homes

5-Private & Employmeat Pensions Same as for 1-Lodges Semi Independent people in dependPeople ent category 2-Private Homes for Special Care 3-Nursing Homes

Same as for people in dependent category

2- ---

1-Physicians' Services 1-Active Treatment Hospitals 2-Auxiliary Hospitals

3-Nursing Homes 3-Home Help 3-Senior citizens Home Improvement Program 4-Home Care 4-Renters Assistance 4-Day Hospital

4-Disabled Veterans Pensions and Allowances

Independent people

HOME SERVICES MEDICAL TREATMENT

51-Home Help

COMMUNITY AND SOCIAL SERVICES TRANSPORTATION

1-Ambulance

LEISURE SERVICES

1-Social Activities

2-Information and 2-Physical activity Referral Service programming 3-Meals-on-Wheels

3-Aquatic Programs

4-Friendly -Outreach

4-Visual Arts Programs

Visiting Services 4-Telephone Contact 4-Homemakers("Health Aides") 5-Public Health Nursing 5-Counselling

1-Physicians Services 1-Active Treatment Hospitals

2-Sonior Citi- 2-Home Care zens Home Improvement program 3-Nursing Homes 3-Renters 3-Public Health Assistance Nursing

1-Meals-on-Wheels 1-Disabled Adult 1-Social Activities Transportation System 1-Ambulance 2-Visual Arts Program 2-Information and 2-Edmonton Referral Service Transit 3-Friendly Outreach Visiting Services -Telephone Contact 4-Counselling

3-Physical Activity Programming

4-Employment Placement

4-l'utfermlny Arth Progrâ&#x20AC;&#x153;111 -Orgonlzatlootti Ahtstanco 6-Physical A,tivity Programming 7-, !It I at ng t1

4-Aquatic Programs 4-Day Hospital 4-Housing 4-Self-contained (Senior Citizens Placement Apartments) Service 5-Shared living situations 1-Self-contained(seniorl-Home Help 1-Physicians Services 1-Information and 11-Social Activities citizens apartments) 1-ittive treatment hosp. Referral Service 2-Lodges 2-Renters Asst.2-Home Care 2-Edmonton Trans. 2-Visual Arts Prcgrams 2-Private lvmes for special care 3-Shared living 3-Housing 3-Public Health Nursing 3-Counselling 3-Ambulance 3-Organ1za1ion of Field situations Registry l.il yvonis trips &

PRIORITIES FOR DEVELOPRENT

INCOME surmyrrGRINP

MEASCRES

HEALTH AND HOUSING

Dependent 1-Private Pensions 1-Group Foster Homes

2-Morning Poses, Auxiliary Wasp.

DOME SERVICES MEDICAL TREATMENT

1-Holiday and 1-Geriatricians. Crisis Relief Geriatric Unit. Day Hospital. Day Care 2-Emergency 2-Public Health Accoundation Ren:al Supplement 3-Rome Help 3-Relief Beds

3-Lodges. Hones for Special Care 4-Shared Living. Self 4-Housing Contained Placement 5-lienters' Assistance

7-D.V.P. & D.V.A.

Same Xs Dependent 1-Croup Foster Homes S-al:n-dependent Category

1-Rental Supplenent

COMMUNITY AND SOCIAL SERVICES

TRANSPORTATION

LEISURE SERVICES

IAtheels to Meals I-D.A.T.S.

1-Social Activities. Oran'ration of Field Trips and special events

2-Day Care

2-Visual Arcs Programming Continuing Education

2-Subsidized Taxi

3 -Senior Sitters 3-Ambulance

3-Physical Activity

4-Reactivation Units, Holding Unit. 5-Nursing Homes. Auxiliary Hospital. 6-Health haintenance Clinics

4-Outreach

4-5quatic Events

1-Cerlatricians.

1-Wheels to Meals 1-Subsidized . Taxi

1-Social Activities

2-Day Care

2-D.A.T.S.

2-Physical Activity Programming

3-Outreach

3-Anhulance

3-Aquatic Programming

5-Heals on Wheels Homemaker 6-Laundry Service Shopping and Business Service. Legal Counsel!ing 7-Hone Nursing 7-Nutrition Counselling 8-P1.ysiciannâ&#x20AC;&#x17E;Hospitals 8-Info and Referral 9-Escort Service 10-Personal Counselling 11-Adopt-A-Grandparent/Adopt-AChild 12-Employment Service

Geriatric Unit. Public Health 2-Home Care

2-1.0dges(revlsed role) 2-Emergency Accommodation Homes for Special Home Help Care I-Holiday and 3-Day Hospital 3-Shared Living

Crisis Relief

4-Self-ContaineJ

5-Nursing Pones

4-ge-Acrivation Unit, 4-Heusinc Holding Unit Placement. Central Housing Registry 5-Relief Beds 5-S.C.S.I.P. 6-Health Maintenance 8-Renters'

Assistance

Clinics 7-Home Nur,ing 8-Physicians and Hospitals

4-Hell, on Wheels 4-E.T.S.

4-Visual Arts Programming Continuing Education

5-Homemaker 6-Shopping and Personal Business Service Laundry Service 7-Legal Counselling

8-Info I. Referral, Info Brochure 9-Reintegration 10-Counselling

11-Adopt-A-Grandparent/Adopt-AChild 12-Employment Service 13-Senior Sitters

ireeeodcnt

S i me as Depen,'ent I-Shared Living Category 2-Self-Contained

3-Lodges

1-Bone Help Rental Supplement 2-Interim Housing. S.C.R.I.P. 3-HonSing P1,enent 4-Centrul Housing Registry

I-Public health

1-Info Referral

1 -E.T.S.

1-Organizational Assistance

2-Nomc Care

2-Food Service

2-Ambulance

ocial Activities 2-,

5-Rentrrst Assistance

5-Pospltals

3-Health Maintelance Clinic: 4-Physicians

Nutritional Counselling 1-Legal Counselling 4-Personal Counselling Personal in:Anes, service 5-Infn Brochure 6-FopIvyment Service 7-Adopt-A-Grandparent!Adopt-AChild

3-Continuing Education 4-Physical Activity Programming/Aquatic Progra4ming 5-Organlzatlon of Field Tclps I Social Fsent , fi-Vi...a) Arts I Performing Arts Programming

159

SUGGESTED PRIORITIES

CROUP

INCOME SUPPORT MEASURES

HOUSING

Dependent

1-0-A.S.

I-Nursing Homes

2-C_P_P_

3-Private Pensions 3-A.A.I.P.

HONE

HEALTH AND SERVICES MFD[CAL TREATMENT

1-Holiday and I-Physicians Crisis Relief I-Auxiliary Hospitals 1-Hospitals 2-Emergency 2-Ceriatricians. 2 -Lodgea Accommodation Psychogeriatricians Geriatric Unit. Public Health 2-HOmes for Special Care 3-Day Hospital, 3-Group Foster Homes 3-Rental Supplement Home Care 3-Home Help 3-Shared Living

COMMUNITT AND SOCIAL SERVICES TRANSPORTATION 1-Ambulance

LEISURE SERVICES 1-Social Activities

2-Wheels to Neale 2-D.A.T.5. Meals on Wheels Info and Referral

2-Physical Activity Programming

3-Day Care, 3-Susidized Senior sitters Taxi

3-Continuing Education 3-Visual & Performing Arts Programmang

3-D.7.P. Disability 4-Self-Centained

4-Housing Placement

4-Relief Beds, Holding 4-Outreach, Units. Health MainHomemaker tenance Clinics

4-Organization of Field Trips & Special Events

5-Auxiliary Hospital Re-Activation Units

5-Aquatic Programming

4-Renters' Assistance 4-S.C.H.I.P.

Same as Dependent SemiIndependent Category

1-Self-Contained Nursing Homes

1-Physicians,Hospitals 1-Wheels to Meals I-Ambulance 1-Home Help Meals on Wheels, Holiday and Outreach, Day Crisis Relief Care Homemaker

2-Home Care. Home 2-Group Foster Homes 2-Housing Nuiaing. Geriatric Placement Unit. Public Health Emergency Acconmodation Geriatricians Rental Supplement 3-Shared Living

3-Central Housing Registry

3-Health Maintenance Clieics

4-Lodges

4-Renters Assistance. S.C.H.I.P.

4-Day Hospital, Reactivation Units. Relief Beds. Holding Units 5-Nursing Homes

5-Homes for Special care

Independent Szne as Dependent 1-Self Contained Category 2-Shared Living

3-Cadges

5-Re-integration service 6-Counselling, Adopt -A-Grand parent/Adopt-A Child. Escort Service, Shopping and Business Service, Laundry Service 7-Employment Service

1-Home Help

2-Rental Supplement, Renters' Assistance, S.C.H.I.P.

3-Central Housing Registry 4-Housing Placement Interim Housing

1-Physicians, Hospitals,Health Main:enance Clinics 2-Public Health

2-Info and 2-D.A.T.5. Referral, Info Brochure, Shopping and Personal Business Services Laundry Service 3-Counselling. 3-Subsidized Legal CounselTaxi Sing, Escort Service, Nutritional Counselling. Senior Sitters 4-Adopt-A-Grand- 4-E.T.S. parent/Adopr-AChild

1-Social Activities

2-Physical Activity Programming

3-Visual Performing Arts Programming 3-Continuine Education

4-Aquatic Programming

5-Employment Services, Reintegration service

1-Info Brochure Info/Referral 2-Personal Counselling,

1-Organizational Assistance 2-E.T.S.

2-Social Activities

Nutritional

3-Home Care

Counselling Feed Service Legal Counselling Personal Business Service 3-Adopt-A-Grand- 3-Ambulance parent/Adopt-AChild 4-Employment Service

3-Physical Activity Programming 4-Continuing Education 5-Organization of Field Trips and Special Events 6-Visual Arts Programming 7-Performing Arts Programming 8-Aquatic Programmieg

160

REFERENCES

1. 1974.

City of Edmonton and Edmonton Sub-Region Population Projections . Research and Long Range Planning Branch, City of Edmonton Planning Department: Edmonton.

2. 1969.

Edmonton Services to the Elderly . Social Services Planning Section, City of Edmonton Social Services Department: Edmonton.

3. Snider, Earle L. 1973. The Medical Services Research Project: Health Care and the NonInstitutionalized Senior Citizen in Edmonton. Medical Services Research Foundation of Alberta: Edmonton. 4. Howell, J.M. n.d. "Early Detection of Signs of Aging". Mimeographed. 5. 1975. Annual Report for the Year Ended June 30, 1975 Care Insurance Commission: Edmonton. p.33-4.

. Alberta Health

6. Clarkson, Graham "Hospital Bed Supply: Edmonton, Calgary." Mimeographed. n.d. 7. Edmonton and Rural Auxiliary Hospital and Nursing Home District #24. Correspondence. 8. Schwenger, Cope 1975. Paper presented at the Annual Meeting of the Canadian Association on Gerontology: Toronto 9. 1974. Perspective Canada. Statistics Canada: Ottawa. p.33. 10. Craig, Jan. 1976. Notes from interview with. 11. 1974. City of Edmonton and Edmonton Sub-Region Population Projections Research and Long Range Planning Branch, City of Edmonton Planning Department: Edmonton. 12. Williamson, Professor J. 1976. Notes from interview with. 13. 1975.

Annual Report for the Year Ended June 30, 1975 Care Insurance Commission: Edmonton. p.34.

. Alberta Health

14. Blunder, A. G. 1977. Telephone conversation with January 1975. 15. Alberta Health Care Insurance Commission. 1976. Verbal information. 16. Snider, Earle L. 1973. The Medical Services Research Project: Health Care and the NonInstitutionalized Senior Citizen in Edmonton. Medical Services Research Foundation of Alberta: Edmonton. p.127. 161

17. 1976. "Guidelines for Geriatric Units In Hospitals: Preamble". Second draft, June, 1976. p.l. Mimeographed. 18. Ibid. p.2. 19. Anholt, L.H. 1975. "Geriatrics and Gerontology Province of Alberta". Mimeographed. p.6. 20. Ibid. 21. Ibid. p.7. 22. Snider, Earle 1973. The Medical Services Research Project; Health Care and the NonInstitutionalized Senior Citizen in Edmonton. Medical Services Research Foundation of Alberta: Edmonton. 23. Ibid. p.120. 24. Clarkson, Graham 1976. "The Development of Comprehensive Geriatric Services". Behavioral Research and Service Newsletter. IV:(3):8. 25. 1974. Population Projections for Canada and the Provinces: 1972 - 2001 Statistics Canada: Ottawa. p.121. 26. 1975. Annual Report for the Year Ended June 30, 1975. Alberta Health Care Insurance Commission: Edmonton. p.21. 27. Wing, J.K. 1967. "Institutionalization in Mental Hospitals". In: Thomas J. Sheff (ed.) Mental Illness and Social Processes. Harper and Row: New York. p.219. 28. 1976."Brief prepared by the Edmonton Social Planning Council at the request of Co-ordinators of Volunteer Services to Seniors". December, 1976. Mimeographed. 29. Clarkson, Graham 1976. "The Development of Comprehensive Geriatric Services". Behavioral Research and Service Newsletter. IV:(3):8. 30. Ibid. 31. 1975. Canada Year Book. Statistics Canada: Ottawa. 32. 1975. Income Distribution by Size in Canada. Statistics Canada: Ottawa. 33. Ibid. p.18. 34. 1974. Income Distribution by Size in Canada. Statistics Canada: Ottawa. p.86.

162

35. 1974. Perspective Canada. Statistics Canada: Ottawa: Table 7.17. 36. 1971. 37. 1977.

38. 1976.

Income of Individuals

. Census of Canada: Ottawa.

Retirement in Canada . Social Security Research Reports. Policy Research and Long Range Planning (Welfare); Health and Welfare Canada: Ottawa. p.19. Pension Plan in Canada 1974

. Statistics Canada: Ottawa.

39. Ibid. 40. Brown, Joan C. 1975. How Much Choice? Retirement Policies in Canada. Canadian Council on Social Development: Ottawa. p.45. 41. Alberta Bureau of Statistics. Personal Communication. 42. 1976. Housing in Edmonton: Direction for the Future . Research Report No. 13. Research and Long Range Planning Branch, City of Edmonton Planning Department: Edmonton. 43. Hannochko, Fred, et. al. 1974. Operation New Roof: A study of the Housing of Senior Citizens in Edmonton. Operation New Roof: Edmonton. 44. Central Mortgage and Housing Corporation. 1974. Unpublished data. 45. Ibid. 46. 1976. Housing in Edmonton Directions for the Future . Research Report No.13. Research and Long Range Planning Branch: City of Edmonton Planning Department: Edmonton. 47. Central Mortgage and Housing Corporation. 1974. Unpublished data. 48. 1977. Evaluation of the Senior Citizens Home Improvement Program. Unpublished report by Alberta Housing and Public Works. 49. Garrett, Lorna and Hill, Marg 1972. A Study of Community Care for Seniors. Social Planning and Review Council of British Columbia: Vancouver. 50. Senior Citizens Housing Registry. Personal Communication. 51. Gilbert, David. 1976. Home Services for Seniors: Case Findin_g in the Beverly Area. Edmonton Social Services: Edmonton. Mimeographed. 52. 1977. Unpublished statistics compiled for the Home Services for Seniors Program, Edmonton Social Services.

163

53. 1975 Nutrition Canada: The Alberta Survey Report. Department of National Health and Welfare: Ottawa. 54. Ibid. p.147. 55. Hepworth, H. Philip 1975. Personal Social Services: A Glossary of Terms. Canadian Council on Social Development: Ottawa. p.24. 56. Snider, Earle L. 1973. The Medical Services Research Project: Health Care and the NonInstitutionalized Senior Citizen in Edmonton. Medical Services Research Foundation of Alberta: Edmonton. 57. Snider, Earle L. 1977 Health and Related Needs of the Elderly. Medical Services Research Foundation of Alberta: Edmonton. p.50. 58. Snider, Earle L. 1973. Ibid. 59. Snider, Earle L. 1977. Ibid. p.56. 60. Snider, Earle L. 1973. Ibid. p.113-9. 61. n.d. A Proposal for the Study of the Counselling Service Delivery System of the Greater Edmonton Area. Unpublished. 62. 1972. The Golden Years. . .A Tarnished Myth. The National Council on the Aging: Washington. 63.

Personal Communication with Mr. T. Edwards, "Over 45 Group".

64.

Corresponsence with National Institute of Senior Centres: Washington, D.C.

65. 1974.

Strathcona Place: A Descriptive Evaluation. Social Planning Unit, Edmonton Social Services.

66.

Personal Communication. Transportation Planning Branch, City of Edmonton Planning Department.

164