COVER

WAREHOUSING THE ELDERLY

RAE CORELLI October 6 1986
COVER

WAREHOUSING THE ELDERLY

RAE CORELLI October 6 1986

WAREHOUSING THE ELDERLY

COVER

Once there was a woman in Winnipeg who became smitten with a man who was already having an affair. Eventually, she persuaded him to abandon his relationship and become involved with her. Their sexual activity grew blatant and upset the neighbors, and, as a result, they ran away, got married and moved into a downtown hotel. But after two days they were evicted because they had no money. They also had no choice but to return to the place they had fled—the Oakview Place nursing home on Ness Avenue in the Winnipeg suburb of St. James. The man died at 93 in 1982, seven years after the marriage. He spent the last five years of his life alone; his wife died in 1977. Their passions, said Oakview director of care Darleen Rowley, were not exceptional among the elderly and illustrated the continuing inability of nursing homes to design surroundings in which residents could engage in sexual activity. Said Rowley: “It is just as natural for people in their 70s and 80s to have sexual needs as to be hungry.”

But creating sexual freedom for their clients is only one of the challenges facing the 2,543 institutions —nursing homes, homes for the aged and chronic-care hospitals—across Canada that provide special care of one kind or another for the more than 200,000 people 65 and over who are too physically ill, disturbed or infirm to look after themselves. Some of the other challenges:

1. Improving the image. Institutions, particularly nursing homes, want to be recognized for their ability to offer special care, not simply for providing places in which old people go to die.

2. Helping families. Some institutions want more provincial money so they can hire social workers to help families deal with the guilt often as-

sociated with putting a relative into a home.

3. Providing more privacy. Many institutions—again, nursing homes in particular—are forced by the way they were designed and by long waiting lists to put two and sometimes more people in each room.

4. Persuading governments to improve home-support services. There are thousands of people in chronic-care hospitals and nursing homes who could manage on their own if they had help with such tasks as shopping, cooking, cleaning and bathing.

Solutions to those and other problems are urgent: more than eight per cent of Canadians 65 and over are already in institutions—one of the highest rates in the world— and that age group, according to Statistics Canada, will increase to six million or 21 per cent by the year 2031, from the present 2.5 million, slightly less than 10 per cent of the total population. More significant, for those offering institutional care, is the fact that the numbers of Canadians 85 and over—those most in need of health and home-support services— is growing even faster. Only two per cent of those 65 to 69 are in institutions, compared to 14 per cent for people over 85. Said University of Manitoba sociologist Mark Novak in his 1985 book Successful Aging-. “As our population ages, more and more people will need nursing-home care. In Ontario and Manitoba, for instance, all nursing-home beds are filled all the time; a person often has to wait up to a year to get into one.”

Whatever the future holds, it is the present and the immediate needs of their clientele that preoccupy the people who run the centres that care for the elderly. Doreen Stephenson, the administrator of Winnipeg’s Oakview Place, said that nursing homes must

learn how to deal with two major problems: the sexual drive of some residents and the effect on children and grandchildren of placing their parents or grandparents in a home. Stephenson said that Oakview Place wanted more money so it could hire a social worker to help families cope with guilt and sense of loss. However, it was a need that the Manitoba government did not acknowledge. Said Stephenson: “There is no tangible payback to relieving family anxiety.” Carol Burrows, co-ordinator of the Ottawa-Carleton Council on Aging, said families are overtaken by guilt “because they haven’t come to terms with their own aging.”

Sexual: Stephenson said that some residents wanted to remain sexually active, but many nursing homes were not designed to accommodate that need—the beds were all singles and most of the rooms were shared—and so the staff had discussed such makeshift arrangements as mattresses on the floor and making a “visiting room” available. The problem with the “visiting room,” said Oakview’s Rowley, was that residents faced the indignity of having to apply for permission to use it. Stephenson said that the sexual drive of the elderly had been ignored by the medical profession, which not only refused to recognize it but turned aside suggestions that doctors might be able to help.

The missing element at Oakview— and other centres across the country— is the opportunity to be alone. Said Louis Novick, executive director of Montreal’s 387-bed Maimonides Hospital Geriatric Centre, where two-thirds of the rooms are private: “Human beings need privacy as much as they need to socialize.” Ottawa’s Carol Burrows said that those who care for the elderly would like to furnish more privacy, but many centres, built years ago when such needs were not understood, did not have room.

Clamor: There is a lack of space not only for privacy but for new admissions to most institutions across the country. The University of Manitoba’s Mark Novak said the clamor at the door was aggravated by the lack of home-support services for three main groups: those too poor to keep their own homes going but not poor enough to get provincial financial aid; the elderly, particularly women, with no pension other than old-age security; and those who live in rural areas too sparsely populated to offer any homesupport services at all. Said Novak: “When people have to leave their homes, it has less to do with illness than with the lack of community support.”

Betty Havens, the Manitoba provincial gerontologist, agreed with Novak that community support services are more desirable than institutions for many over-65s. Said Havens: “We’re not going to find the answers by simply building buildings. Unfortunately, that’s the thing to do. Buildings get names attached to them. They become marks of prestige, almost like shrines. But what makes a community are the services, not the buildings.” Christine Lawrence, assistant executive director of the provincially funded Alberta Council on Aging, said money should be diverted from institutional to home-care programs. The problem, said Lawrence, was that politicians could get more credit by promoting institutional care. Said Dr. Neena Chappell, director of the centre on aging at the University of Manitoba: “One of the primary determinants of whether you become institutionalized is the informal support group around you. The more support you have, the more likely your chances of staying in the community.” Jean-Pierre Belanger, director of program evaluation for the Quebec government’s centre for local community services, said that the province was using community supports to allow people “to live at home as best they can for as long as they can. More and more people want to die at home.”

Ill: Several experts say that improved home-support services would not only help our over-65s keep their independence, but they would also make more room available in nursing homes for those who languish in hospitals because there is no place else for them to go. Old people, many of them chronically ill, occupy nearly half the beds in the country’s 1,400 hospitals at any given time. The demand is bound to increase because the fastest-growing old-age group is the one most vulnerable to chronic illness: those 85 and up. The solution, said a 1976 report to the Science Council of Canada, is not more hospital beds but treating the chronically ill elsewhere, perhaps in their own homes. Canadian sociologist Joan Eakins Hoffman once did a hospitals study which showed that “an increasing proportion of their beds are filled by patients for whom they can provide little active medical treatment.” Three years ago The Winnipeg Free Press quoted Dr. Colin Powell, head of geriatric medicine at Winnipeg’s St. Boniface General Hospital, as saying that the hospital usually had about 50 patients waiting up to nine months for space to become open at a personal-care institution.

Dr. David Skelton of Edmonton, the

only geriatric medical specialist in Alberta, said that the elderly have different medical needs from the rest of the population, but that his own profession was largely unprepared for what he called the “grey wave” of the 21st century. Said Skelton: “We are in a crisis situation.” He estimated there were no more than 50 geriatric medicine specialists in Canada, but that the country could use 200 “immediately.” If there were more specialists and a greater emphasis on home care, said Skelton, then more old people would not have to enter institutions for some time.

But in many parts of the country, home support is either scanty or nonexistent. In Halifax, Dalhousie University’s Barbara Keddy, who teaches the sociology of aging, said home care in Nova Scotia is “unco-ordinated and fragmented” and often available only to those who can pay for it. The situation is similar in other parts of the country, especially outside big cities, and as a result the pressure on special-care institutions is unrelenting. There is a yearlong waiting list for admittance to the Father Dowd Memorial Home in Montreal’s Côte des Neiges district, and director AÍ Eisenring said that the list would get longer as life expectancy and the proportion of over-65s in the population increase. (Manitoba’s Betty Havens disagrees; she said demand will decline toward the end of this century and pick up well into the next.)

Traumatic: Said Eisenring:

“When a person moves into a place like this, it is a traumatic experience. In a sense, it’s the end—they’re being removed from their families and society. We are dealing with people who essentially have no choice, and once they realize they belong here they usually adapt well.” Added Marian Currie, 57, a supervisor at Father Dowd: “Some of them accept the place right away and some never do. For an old person, there is nothing to beat staying at home.”

The residents of Father Dowd are divided on that point. Agnes Hayes is an 85-year-old former magazine circulation consultant who is nearly blind. “Personally,” said Hayes, “I don’t like the idea of being institutionalized—period. But I’ve adjusted to it, and I’m not that far from eternity.” For her part, Catherine Sullivan, an 84-yearold former advertising executive with

10 grandchildren, moved into Father Dowd several years ago to be with her husband who had been stricken with Alzheimer’s disease. When he died four years ago, said Sullivan, “I went home for two or three weeks, but I was so lonesome I came back.” She spent most of the summer visiting a daughter in Kingston, Ont., and other relatives in that province and goes each weekend to the home of a married daughter in Montreal. Added Sullivan: “Some families of the people here visit once in a while but, really, they just forget them here. Some people here resent being here and never come out of

their rooms.” Since 1983 the Quebec government has been placing increasing numbers of people suffering from Alzheimer’s and mental disorders caused by strokes into nursing homes occupied by relatively lucid people. Said Sullivan: “It’s not the same here. A lot of people don’t like what’s happening.” Many share that view.

Last July, a social work survey of conditions at Father Dowd contained

the results of a poll among 18 residents who were asked how they felt about mixing confused old people with those still alert. Nearly 95 per cent said that they were sympathetic, but 44.4 per cent said that the newcomers made them feel depressed. Roughly one-third said that they avoided confused residents. The respondents were also asked to complete the sentence: “Old people usually are. . . .” Nearly three-quarters gave what the survey called a “totally negative” response. Asked to identify the positive aspects of aging, 11.1 per cent said there was “nothing good” about it. About 17 per cent said it was a “blessing” because it meant they were “nearing the end” of their lives.

The elderly are often quick to defend their institutional homes. Said Estella Barter, 80, of Ottawa’s Glebe Centre, a home for the aged: “I don’t call this an institution; to me, this is home.” Jennis Aris, 90, moved into Glebe Centre 11 years ago. “It’s a heartbreak when you have to sell your furniture and wedding presents, but I’ve never been sorry for one minute.” Said Dorothy Langley, 88: “An institution is an institution no matter what you call it, but this is my home. I haven’t got much sympathy for anyone here. Nine out of 10 have never had it so good.” Eileen Elliott, 74, also dismissed the critics: “There are some that don’t like it. They’d rather crab.” Donald McNiece, 72, says that he does not care whether they crab or not. He said he avoids the less capable residents because “I’m sure I’d find it very depressing.”

Ghetto: To Jean-Claude Pageot, a recreational science expert at the University of Ottawa, depression among the elderly in institutions is understandable. Society, said Pageot, z is misguided in its conviction I that everything should be done £ for the elderly. Said Pageot: x “Most of the elderly don’t want to live in a golden ghetto. They want to live a normal life. If we place them in a situation where everything is perfect, their faculties will deteriorate.” But for most of the nation’s over-65s, perfection holds no menace— it is merely the opportunity to continue living at home.

RAE CORELLI

DAN BURKE

JOANNA BRAND

ALISON HARE

DEBORAH JONES

CHRIS WOOD

ASHLEY GEDDES