Seniors’ Health and Housing Crossroads
Seniors’ Health and Housing Crossroads
Exploring Alternatives to Long-term Care Facilities
May 2002 - May 2004
Ontario Coalition of Senior Citizens’ Organizations
Suite 500, 3101 Bathurst Street
Toronto, Ontario M6A 2A6
(416) 785-8570 or Toll-free: 1-800-265-0779
ocsco.ca
Report Prepared and Written by:
Diana Kucharska, M.S.W.
Project Coordinator
Edited by:
Robin Hannah
Project Assistant
With Contributions from:
Seniors’ Health and Housing Crossroads Committee Members
Edna Beange, Connie Delahanty, Ann Dorion, Bill Fuller, Carol Greenlee, Eva Kushner, Bea Levis, Margaret Maybank, Ethel Meade, Marge Mintz, Don Wackley, Howard Watson
Focus Group Participants
&
Forum Attendees
Many thanks to Health Canada
and
The Voluntary Sector Initiative
for generous funding
and to
Canada Mortgage and Housing Corporation, for Support
Health Canada Project Number: 6796-15-2001-434001
Seniors’ Health and Housing Crossroads
Table of Contents
Executive Summary…………………….…………………………………………..i
Preface……………………………………………………………………………...iv
Purpose of the Project………………………………….…….…………………….1
Background………………………………………………………..……………….1
Limits of the Project…………………………………………………..……………2
Methods of Gathering Information…………………………………….…………..2
Literature review…………………………………………………………….2
Multicultural survey…………………………………………………………3
Interviews with key informants.………………………………………….….3
Focus Groups………………………………………………………………………4
The Results of the Focus Groups…………………………………………..………5
Connections Between Health and Housing………………………………………..5
Seniors Want Action…………………………………………………………….....7
Review of Day I - the Forum………………………………………………………7
Review of Day II - the Policy Writing Day………………………………………..9
Introduction to Seniors’ Issues……………………………………………………10
The 12 Key Issues and Recommendations for Change…………………………..11
Overarching Principles for All Policies…………..………..………..….…11
Housing:…………………………………………………….……………..12
Affordable Housing………….……………………………………..12
Social Housing/Senior-Only Housing…….………………………..18
Retirement Homes………………………….………………………19
Supportive Housing………………………….……………………..20
Home care and Support Services……………………………………..…...22
Model of Integrated Care……………………………………..…….25
Transportation………………………………………………………….….28
Accessibility Issues, re: disabilities……………………………………….30
Safety and Security……………………………………………………..…32
Access to Information…………………………………………………..…34
Aboriginal Issues……………………………………………………….….35
GLBT Issues…………………………………………………………….…39
Cultural and Ethnic Issues……………………………...………………….40
Ageism……………………………………………………………………..42
Mental Health and Addiction Issues………………………………………44
Conclusion……………………………………………………………………….46
Appendices………………………………………………….……………….…..47
Bibliography……………………………………………………………………..67
Contact List……………………………………………………………………...77
Executive Summary
A lack of alternatives to long-term facility care often results in premature and/or undesired admission into long-term care facilities. In this project seniors across the province of Ontario were consulted to find out what is needed to enable seniors to age in their homes and communities, with adequate support. Most seniors feel that more affordable options in housing, health care, and home support are needed.
To maintain the best possible health, seniors need adequate and affordable housing. Without it, many seniors experience both financial and mental distress that can manifest itself in reduced resistance to illness or in depression, or make current health problems worse.
Affordable housing is only part of the solution. More options in housing are also necessary to create appropriate support for seniors. Retirement homes that are regulated and available to seniors with low and diminished income are a style of housing that requires further funding. Widespread availability of supportive housing services is also key in sustaining seniors in their homes, as are other options, such as senior-only social housing.
A community-based model of elder care that provides a full range of health and support services is also an alternative that supports seniors who wish to live in community. In Canada, this model of care has been successful in Alberta and is called CHOICE, Comprehensive Home Option of Integrated Care for the Elderly. Similar models of care, such as the On Lok program of all-inclusive care in New York and San Francisco, have all helped seniors thrive in their communities, providing flexible programs that respond to the changing needs of individuals.
Many innovative housing and home care options are possible and they are more cost-effective than placing people in long-term care facilities. [1] Over the past two years, this project on health and housing has reviewed literature, held group consultations with seniors across Ontario, and debated issues in a two-day forum. Throughout all the information gathering it has been made clear that more options in housing, health care, and home support will create a healthier population of seniors who can enjoy their home life and avoid institutional care.
Preface
Health and housing are inextricably linked. Lack of affordable housing creates distress for many seniors. Lack of affordable housing options also connects to an array of other issues that influence health: transportation, access to services, home care, and home support.
The current housing situation has been declared a national disaster. [2] The increase of senior homelessness is but one of the devastating outcomes of this disaster, as is the increase of seniors who use food banks. The lack of flexible and appropriate home care and housing support services forces many seniors into long-term care facilities. Long-term care facilities cost us more money than community-based long-term care, and are so dreaded by most seniors that they refer to them as places to die, not places to live. [3]
Between one and two million seniors live below the poverty line, enduring financial hardship and high stress, in their struggle to acquire housing and health care. [4] Their lives of hard work culminate in a struggle for survival. All seniors face devaluation in a youth-centered society that does not provide sufficient or effective responses to elders' physical, mental, and health needs, let alone acknowledge their contributions to our society. Mental health experts, such as Karen Liberman, Executive Director of the Mood Disorders Association of Ontario, warn us of the silent epidemic of mental health issues and addictions among seniors, and their often “burnt-out”, financially stressed caregivers. [5]
Over the course of the Crossroads project, seniors from across Ontario, health and housing experts, and the findings of 100 reports have all reinforced what seniors have been saying in consultations for at least the last ten years: that much more funding must go into home care and affordable housing for seniors. Seniors, along with human rights activists like Frances Lankin, have urged all three levels of government to share the responsibility to provide this housing and support. According to many seniors and people like Frances Lankin, the failure of governments to respond to seniors’ repeated calls for home care and affordable housing, is a clear example of ageism. [6]
Participants in the Crossroads project’s 16 focus groups, forum, and policy writing day have developed directions that will ensure affordable housing, adequate health care, and community support.
Throughout this two-year project many problems in the area of seniors health care and housing have been revealed. The project has generated many recommendations that will address these problems. To fail to respond to the Crossroads project recommendations, which echo the recommendations of many previous consultations with seniors, the federal government would sanction the following conditions:
1. The continued premature admission of seniors into long-term care facilities, due to lack of options. Seniors often go into these facilities against their will, and often experience disastrous health problems and rapid deterioration after admission.
2. The increase of disproportionately high suicide rates of senior men. [7]
3. The continuing rise of homelessness among seniors.
4. Unregulated retirement homes and boarding houses, both of which may threaten the safety and health of seniors.
5. Seniors’ mental health issues, mental illnesses, and addictions will continue to go untreated, thus greatly compromising the quality of life.
6. A large percentage of the senior population, particularly those from cultural minorities and those with disabilities, will remain unaware of the programs and services that are available.
7. Caregiver burn-out and caregiver mental health problems will rise in proportion to the growth of the senior population.
9. Ageism will continue, furthering the devaluation of older persons, and their mistreatment, including various forms of elder abuse.
10. Aboriginal elders will continue to die at an earlier age than any other cultural or ethnic group.
11. Rather than face the homophobia and ignorance they encounter in health care and housing support services, gay, lesbian, bisexual, and transsexual seniors will go back into the “closet”, which will negatively affect their mental and physical health.
These negative conditions, among many others described in this project, can be reduced and prevented if policies change to ensure the dignity and choice of seniors. The Crossroads project has resulted in policy recommendations that are ripe with opportunities for positive change. These include the creation of adequate affordable housing options, the provision of programs and services that are sensitive to the linguistic and cultural needs of Canada’s senior population, improved transportation, and the establishment of integrated models of community-based elder care.
Many seniors end up in long-term care facilities because of lack of choice. Generating more options in health care and in housing, as well as focusing on the respectful treatment of our seniors, will generate good results. The Crossroads recommendations strive to help the Canadian government to alleviate a crisis of mental and physical health in the seniors of today, and avoid an even bigger one in the seniors of tomorrow. This crisis will cost us many more dollars to treat, than to prevent. [8]
Seniors’ Health and Housing Crossroads
Purpose of the Project
The purpose of the Health and Housing Crossroads project was to identify and explore alternatives to long-term care facilities for seniors. With this goal in mind, we explored areas where health and housing issues intersect when creating health care and housing options for seniors who intend to age in place. The report also strove to create a network of seniors who could work together and develop their knowledge and skills regarding the policy development process. It is our hope that through this project seniors from across the province will remain in an ongoing policy discussion among OCSCO, Health Canada, and Canada Mortgage and Housing Corporation.
Another goal of this project was to give voice to as wide a range of seniors as possible. This report was written by seniors, for seniors, about seniors.
Background
Over the last few years, board members and staff of the Ontario Coalition of Senior Citizens’ Organizations (OCSCO) became increasingly concerned about the number of seniors who were forced into long-term care facilities because of the lack of housing and health care options. Expanded and enhanced social policies aimed at creating housing and health options for seniors became a priority for the Coalition, whose mission is to improve the quality of life for seniors.
With the goal of creating new policies, OCSCO sought funding that would allow a province-wide consultation with seniors on alternatives to long-term facility care. The Coalition wanted to create a province-wide network of organizations and individuals who shared our goals. Synchronicity came into play, as Health Canada, through the Voluntary Sector Initiative, was then funding projects that aimed to increase the capacity of the voluntary sector to engage in creating policies on health issues. The project began in May 2002 and concludes in May 2004.
A committee of seniors drove the two-year project. This steering committee, which called itself the Seniors’ Health and Housing Crossroads committee, contributed to the development of the focus groups, Forum, policy writing day, and project report, among other tasks. (see Appendix 1, Crossroads Committee, page 48)
The Limits of the Report
This report has some limitations. Firstly, the original project design required that we consult in only 10 regions of Ontario, in 10 focus groups. By stretching our resources we actually managed to hold 16 focus groups, yet some segments of our senior population were still under-represented. We live in a multicultural society with over 100 languages spoken, [9] but our project did not, with the exception of two francophone groups, include the perspectives of seniors who do not speak English. We had no budget for multi-language interpretation, nor for holding as many culturally-specific groups as are represented throughout the province.
We did meet with spokespeople from some marginalized groups, such as the Chinese community and seniors with mental health and addiction issues.
The report is also limited in that our focus groups were held in community centres, which required that people be mobile and healthy enough to meet for a few hours. Consequently, those who are most disabled or ill did not have a significant voice. We did include caregivers. We also offered assistance with transportation to and from the group meeting places.
Methods of Gathering Information
Literature Review
The first few months of the project were spent reviewing reports and general literature on the health and housing needs of seniors. The literature review, of about 100 related reports, showed that seniors are faced with a multitude of barriers to aging in place, such as lack of home care, culturally inappropriate services, discrimination, poverty, lack of affordable housing, and elder abuse. While there are options available, they appear rife with problems and inadequacies. Too often seniors are housed inappropriately, with little concern for their well-being. With the senior population doubling in the next few decades, the literature points out that we have a long way to go in providing affordable housing and support services to all who need them, or who soon will.
The literature search also revealed that certain groups are more often the subjects of research than others. For example, although several reports covered multicultural issues, very few seemed to focus on specific needs for specific cultures. Another interesting observation was that in 100 reports on seniors’ issues, gay and lesbian issues were mentioned only once.
Overall, the literature points to the lack of health and housing options as the chief reason seniors end up in long-term care facilities. If seniors had more options, the literature assures us, they would take them. This concurs with the sentiments of seniors across Ontario.
Multicultural Survey
OCSCO held a multicultural conference on health and home care on June 2, 2003. At the conference we informed the 300 participants about our project, had seniors and staff give out information on the project, and issued a survey to willing participants. They answered questions on the most important health and housing issues, as they experienced them. We got 138 completed surveys, from 94 women and 34 men. Twenty-one ethnic groups were represented, including Jewish seniors, Caribbean-Canadians, and Tamil, West Indian, Latin American, and Vietnamese seniors. Approximately one third of respondents lived with their children, and over half lived alone. The vast majority felt that high housing costs caused financial and emotional stress. Over half of the respondents felt that good housing helped to improve their health. (Appendix 2, Multicultural Survey, page 49)
Interviews with Key Informants
During the course of the project, we spoke with approximately 20 service providers and researchers (Appendix 3, Key Informants, page51) about the health-housing issues they had studied or observed. We explored questions such as:
What are some key issues in health and housing for seniors?
What is working for seniors, in terms of helping them age in their homes and communities?
What are the challenges?
What do you propose as the solution/s?
People answered the questions from their particular area of experience and expertise. There was unanimous conviction that the health and housing requirements of seniors aren’t being met now, and, with the senior population increasing, they feel we are headed for disaster if policies don’t create more potent responses to increasing gaps.
Housing workers noted the lack of affordable options, and echoed seniors’ concerns about seniors in social housing being forced to live among younger, louder tenants with a wide range of social problems. Housing workers also talked about not feeling prepared or trained to deal with some of the mental health issues tenants present, such as schizophrenia and dementia.
Policy analysts discussed the funding rearrangements and cutbacks that have decreased the effectiveness of health care, and created affordable housing shortages, again echoing what seniors in the focus groups said.
Focus Groups
To gather a wide perspective on seniors’ health and housing issues, we met with 171 seniors in 16 focus groups. OCSCO worked with over 30 organizations to gather these groups, in both rural and urban areas of Ontario. Coordinators in each region used a variety of outreach strategies to ensure that a diverse range of senior citizens participated. (Appendix 4, Outreach Suggestions, page 53)
Although our agreement had been to hold only 10 focus groups, we stretched our resources and held 16. The additional groups allowed us to hear from seniors who were under-represented in the literature. We included seniors who, because of language and cultural barriers, were not likely to attend a mainstream group. These expanded groups gave voice to the concerns of senior South Asian women, francophone seniors, Aboriginal elders, and gay, lesbian, bisexual, and transgendered (GLBT) seniors.
We began our focus groups in February 2003. After our pilot group in Toronto, we went to Kingston, Kenora, Hamilton, Windsor, Bracebridge, Sudbury, Sault Ste. Marie, and Thunder Bay. We held two groups in Kenora, an Aboriginal group and a general one. In Sudbury we held a francophone and an anglophone group. In Toronto we had a general and a South Asian women's group. We held three in Ottawa - a francophone, an anglophone, and one for GLBT seniors. In November 2003, we held the last group at the Native Canadian Centre in Toronto. (Appendix 5, Focus Group Schedule, page 54)
We met with small groups of 8 to 14 people. Each group consisted mostly of seniors, but non-senior representatives from health and housing service organizations, as well as caregivers, were also included.
The Crossroads Committee developed a set of questions (Appendix 6, Focus Group Questions, page 55) to discover what was working for seniors to facilitate their independence in the community, and what obstacles needed to be overcome. We explored solutions.
The participants’ feedback concurred with the key informants’ position that the two key areas of concern are housing and home care. With regards to housing, people experienced great stress dealing with the lack of affordable homes, whether they were owners or renters. Renters, to keep up with rent increases, often had to skimp on food or go to food banks. Homeowners, who were living on a fixed or diminished income, noted they would not be able to keep up with the rising costs of hydro and maintenance, a thought that elicited many fears about the future, including the fear of losing their homes.
Another huge issue was home care, from acute home care needs to “light” assistance. Seniors repeatedly cited the lack of it as an enormous stress, affecting their health and compromising their independence.
Across the province there was a great deal of outcry over what has come to be known as the “bath rule”. We expand upon this rule in our Home Care section (page 22).
The Results of the Focus Groups
The issues that emerged in the focus groups were reviewed and categorized into 12 themes. These 12 categories comprised the breakout session topics at our Forum. All focus group participants, as well as every organization and individual who had shown interest in the project, were invited to the Forum to work on the issues that emerged from the groups. Within these 12 issues, the connections between health and housing were raised over and over again. Seniors also connected health and housing to many other aspects of their lives, such as isolation, transportation, and stress.
The Connections Between Health and Housing
“Health and housing are intertwined… If you can’t pay the rent, there is no dignity. You get ill, you get stressed. One goes with the other.”
Hamilton group participant
Another key issue raised in the focus groups is the relationship between health and housing. All focus group participants agreed with Health Canada, which cites housing as a determinant of health, a position also shared by community health centres and housing advocates, among others. Although the connections between health and housing are obvious to some, to others they are not.
“…when extensive studies are carried out, housing disadvantage is a unique predictor of poor health outcomes… The availability and affordability of housing plays an important role in relationship to other social determinants of health. People can go without many things, but going without housing is potentially catastrophic.” [10]
In 2003, the year we carried out the focus groups, OCSCO held a multicultural conference on health and home care. We surveyed 138 people on their health and housing issues. Almost half of the respondents noted that high housing costs cause financial and emotional stress. The other half stated that “good housing helps my health”. In this Crossroads project, seniors in every focus group spoke of the connections between health and housing.
The most profound connection between health and housing for seniors is that paying high rents, or keeping up with mortgage payments, reduces seniors’ ability to pay for nutrition, medication, and transportation to medical appointments. When housing costs consume the majority of one’s income, the effects include isolation, increased stress, and exacerbated health problems.
Approximately one quarter million Canadian seniors don’t have enough to eat. [11] It is not uncommon for these seniors to live for years without the “luxury” of buying a tea or coffee at a restaurant. A senior on a low income knows that tea at a restaurant will throw their budget off, because that $1.50 is a Kraft dinner or two, and that’s a better choice. These material restrictions, related to the problem of unaffordable housing, contribute to poor health. Having little money beyond rent restricts seniors, contributing to isolation, shame, and often despair. Mental health issues such as grief, depression, anxiety attacks, and loneliness are exacerbated.
“We need more subsidized housing. Lower than what we’re paying now. Pensions don’t go very far. We do need a lot of things that we can’t buy… A steak every now and then instead of the macaroni.”
Toronto Aboriginal group participant
“I wish the government would do something about housing because it goes hand-in-hand with health. A social life is important, so is assistance. Your choices are taken away if you don’t have help.”
Windsor group participant
There are innumerable and complex relationships between one’s health and one’s housing.
Several seniors found that their illnesses or health status dictated where they could live and how.
“I have fibromyalgia, a dysfunctional spine, and I’ve had major heart surgery. I’ve had to move into a convalescent home. I’m afraid to be alone, but I want my own space. My health has dictated where I life. The choices are lousy.”
Ottawa Participant
“If it weren’t for our arthritis, we would’ve stayed in our old place. But it was a two-storey and we couldn’t handle the stairs. The financial problems dictate health and dictate housing.”
Ottawa participant
These Ottawa participants, among many others, felt that their changing health forced them into housing situations they didn’t feel comfortable in, which furthered their stress and discomfort. More stories, and further illuminations of these relationships between health and housing, will be made throughout this report.
In addition to the issues that came up in the groups, there was also a wide-spread skepticism about the value of the report. Seniors in every group expressed the hope that this project would not produce another report that fails to generate changes that would improve the health and housing conditions for seniors.
Seniors Want Action
In every focus group seniors were skeptical about the value of the consultations in creating needed changes. They said that they had been consulted before, reports had been written, and nothing had been done. Several seniors stated they have become leery of consultations. They pointed to previous studies outlining solutions to the health and housing problems of seniors, noting that governments did not respond. Earlier reports recommending more funding for health care and housing seem to have been ignored. Senior homelessness and suicide have risen, [12] and there is a growing epidemic of mental health issues among our seniors and their caregivers. Seniors want action.
Review of Day I - The Forum
The complex relationship between health, housing, and an array of other issues was the focus of much dialogue in our two-day event in January 2004. On the first day, a large group of about 100 people discussed the themes that emerged from the focus groups. On
the second day, a smaller group of participants from the Forum put together policy recommendations based on the discussions of day one.
The Forum, entitled “Changing Regional Issues into National Policies”, was held at the Primrose Hotel, in downtown Toronto, on the day of Toronto’s first major snowstorm, January 28.
The purpose of the Forum was to bring together seniors and non-senior allies from across the province, particularly those who had participated in the focus groups, to review the major issues from the groups, and further refine them into directions for policy change. (Appendix 7, Forum Agenda, page 56 ; Appendix 8, Forum Sessions, page 58 )
Despite the winter storm, attendance was high, and the Forum turned out to be an upbeat day of networking, visioning, and hard work. Ninety-three participants, eight volunteers, and four OCSCO staff worked together to generate ideas about policies that would enable seniors to remain in their communities.
There were 59 organizations represented, from 14 regions of Ontario. (Appendix 9, page 60) Representatives from all 16 focus groups traveled by train, plane, and car to participate. The regions of Ontario represented included: Barrie, Whitby, Muskoka, Sudbury, Sault Ste. Marie, Halton-Peel, Hamilton, Kenora, Thunder Bay, Toronto, Ottawa, Keewatin, Windsor, and Almonte. Representatives from Health Canada, the Ontario Ministry of Health, and the Ontario Seniors’ Secretariat also attended. (For full contact list of Forum participants, see Appendix 12, page 77)
Forum Morning Proceedings and Keynote Speaker
The morning began with a talk entitled “Change is Possible.” Our keynote speaker was Frances Lankin, a tireless advocate for improved housing and health care, as well as a trailblazer for improvements in long-term care. Frances is currently the President and Chief Executive Officer for the United Way of Greater Toronto.
Frances discussed the changes that have occurred in society through the efforts of people like the Forum participants. She also identified ageism as a major hurdle that currently challenges our society and as one of the reasons policy changes have not been more forthcoming. Frances stressed the need to identify and name ageism whenever it is present.
Morning Breakout Sessions
Participants then went into the breakout sessions to identify the areas of concern that policies need to address. The morning sessions were:
1. Affordable housing
1. Supportive housing/senior-only housing
1. Transportation
1. Aboriginal issues
1. Accessibility
1. Ageism
1. Guiding principles
Forum Afternoon Proceedings and Guest Speaker
In the afternoon, Evelyn Theriault, chair of the Algoma Seniors’ Health Advisory Committee, described success stories of seniors in Sault Ste. Marie, who have worked as a community to create social change. One action concerned a building that was once senior-only, which, like much senior-only housing, had been converted to general social housing. The noise and violence in the building distressed seniors. They organized for change and city council agreed to return the building to its senior-only status.
Afternoon Breakout Sessions
1. Housing options
1. Integrated model of community-elder care
1. Gay, lesbian, bisexual, transgendered, transsexual issues
1. Safety and security
1. Cultural and ethnic group issues
1. Access to information and services
Review of Day II – Policy Writing Day
The next day, a smaller group of Forum participants worked together to write policy recommendations based on the feedback from the Forum. (Appendix 10, Policy Day Agenda, page 62)
The Forum subcommittee intended this second day to consist of a group of 10-20 people representing various regions of Ontario. However, as has been the case throughout the two-year project, enthusiasm and passion abounded, and we met with a working group of 43 people.
Change-management expert John Corless, of Management Advisory Service, a division of the Volunteer Centre of Toronto, oversaw the day. Early in the morning, John met with the facilitators to introduce the workshop card method of facilitation. This method was aimed at categorizing the ideas from day one. (Appendix 11, Workshop Card Method Instructions, page 64) He then led participants in writing the policy recommendations.
With one or two replacements for those who could not attend, the facilitators were the same people who facilitated the breakout sessions at the Forum. For the purpose of continuity, the topics for the groups were the same as the Forum breakout sessions, and the facilitators and participants remained in the same groups they’d been in. Groups of 3-6 people strove to develop specific policy recommendations from the Forum feedback.
Participants were equipped with notes from the Forum discussions. Under the guidance of their facilitators, and with help from John Corless, they organized their ideas into 3-5 recommendations. At the end of the day, we had 54 recommendations, from the 13 breakout sessions.
Introduction to Seniors’ Issues
Health and housing issues for seniors are many and diverse. As seniors age, health care requirements and the need for personal support increase. As an individual's health needs increase, it can be difficult and often impossible to obtain necessary supports, without moving into a long-term care facility. Most seniors want to age in their homes, or move within their own community. Currently, there are too few options in Ontario to support seniors who want to age in place.
The senior population is expected to almost double in the next 40 years. By 2041, it will increase to 22.6 per cent of the population from its current 13 per cent. Given these figures, there is a serious need for policy enhancements regarding alternatives to institutional long-term care facilities. [13]
Our consultations and literature review confirm what many organizations and individuals have been saying for years: to remain in their homes, seniors require both affordable housing options and a flexible range of health and support services. These options are needed to avoid premature, inappropriate, and undesired admission into long-term facilities, which many seniors view as “places to die, and not places to live”. [14]
The Twelve Key Issues and Recommendations for Change
In the 12 sections that follow, the themes from the focus groups and Forum are reviewed and the recommendations from the Policy Writing Day are included.
In February 2004, the Liberal Task Force on Seniors published recommendations for improved policies for seniors and there are several parallels between the Task Force recommendations and those of the Crossroads project. We have addressed these parallels in the relevant categories.
OVERARCHING PRINCIPLES FOR ALL POLICIES
Focus group participants felt that if certain principles were applied to policies, seniors would stand a better chance of receiving services guided by dignity and choice. Policies directed by a set of guiding principles tend to produce higher standards for programs and services. As Leslie Fell, a researcher who has studied international models of all-inclusive community care for seniors, observes, the best models have adhered to principles of flexibility, dignity, and choice. [15]
Policies that are true to higher principles have a better chance of meeting the needs of the senior population. As Forum participants and health activists have pointed out to us repeatedly, policies that embrace the principles outlined in this project will produce “astounding” results.
Throughout the project, seniors have spoken about the pain of being invisible, of having given a long life to a society that treats them so poorly in the senior years, forcing elder persons to struggle for health and housing. Seniors feel a loss of dignity. These are the guiding principles that seniors in the focus groups and Forum feel would generate dignity and choice:
Recommendations – Overarching Principles for All Policies
Seniors outlined eight principles that should guide policy development:
1. Policies and programs that affect seniors need to be developed in consultation with seniors.
“If seniors are taken into consideration and are consulted before any legislation is passed, the resulting legislation and/or policy would speak to seniors for their needs and for their services. The seniors are a large percentage of the population and are becoming even more numerous so it would profit the government to consult and listen to the seniors in this country.”
Cecile Paquette/Annette Blankmann, Ottawa activists [16]
“They [policy-makers] don’t talk to us first, and we can’t get their attention after. If they made decisions with us, instead of for us, there might be better results.” Kenora Aboriginal participant
2. Services should be community-driven, and managed by an elected volunteer board. The first step might be to revisit Bill 130, which abolished community boards for Community Care Access Centres and set up appointed provincial boards; seniors feel that with this change they lost their voice.
3. Programs and services should conform to seniors’ needs, not the other way around. They should also be flexible as the seniors’ needs change.
4. Health care dollars should be invested and/or reallocated to health promotion based on the broad determinants of health, including investment in education, training, and support services for formal and informal caregivers.
5. Accountable, transparent, senior-centered care should be provided in a manner that empowers and respects the individual, and includes comprehensive, accessible, and quality services.
6. Policies affecting senior care should be responsive to the needs of seniors with disabilities and impairments. Programs and services should be accessible to blind, visually impaired, deaf, and hard of hearing seniors, and those who use wheelchairs, canes, and walkers.
7. Equality of access for seniors to information and services must be guaranteed,
regardless of race, creed, language, physical ability or disability, geography, financial status, or sexual orientation.
8. Discriminatory practices toward individuals aging with addictions or mental illness must be removed.
HOUSING
In key informant interviews, in the literature search, in focus groups, and at the Forum, housing was repeatedly raised as a key issue for people’s health and well-being. Over and over again, focus group participants cited housing as the most important issue to be dealt with in the project. Seniors are so passionate to see changes in this area that we had three times as many people register for the Forum breakout sessions on housing than we had in the others. Even our expanded three housing sessions were bursting at the seams with participants. These were also the breakout sessions where the facilitators noted people’s great need to talk about the pain and stress they experience in this area.
“As Senior Canadians, we strongly believe that there should be a full range of housing options to suit the changing needs of aging people.” [17]
AFFORDABLE HOUSING
“Good housing at a reasonable cost is a social right of every citizen of this country… This must be our objective, our obligation, and our goal.”
Former prime minister Pierre Trudeau, 1973
Across the province, participants saw affordability, accessibility, supports, dignity related to choice, the opportunity to make decisions for themselves, and awareness of issues and services, as essential rights of all seniors in Canada. They expressed many concerns about the issue of affordable housing.
“Seniors end up in really bad housing. I’ve seen stuff you wouldn’t put your hateful cat in. I didn’t realize that seniors’ housing was so bad until I looked around to find a building for myself… Seniors have got the worst apartments in private homes and this really has to be brought forward... I’m a 78-year-old woman and I’m afraid to ask for a new fridge and a paint job because they’ll put up my rent. The rent situation is a catastrophe. They must freeze the rent.”
Ottawa GLBT participant
Lack of Affordable Housing: A National Crisis
Lack of affordable housing came up repeatedly in every focus group. Seniors across Ontario report feeling stressed because so much of their income is used for housing. Little or no money remains for food, transportation, and medical needs. This situation is detrimental to health. The lack of affordable housing has become such an overwhelming problem in Canadian society that the Toronto Disaster Relief Committee, among others, has declared it a national disaster. [18]
Over 12,000 seniors are waiting for affordable housing units to become available in Toronto, and many more in surrounding areas. During the year 2000, 400 people over 65 years of age were staying in the emergency hostel system across Toronto. [19]
Without a safe, affordable home there is little likelihood of maintaining health and well-being.
Although some measures have been taken recently to build affordable housing, they are insufficient to meet the crisis. The Toronto Star has reported that in the Greater Toronto Area, for example, 1,405 low-income homes will be built but advocates note that 73,700 families are on the waiting list. [20]
As housing advocate Michael Shapcott notes (in the same article), at the rate we are currently building affordable housing, “…it will take 283 years to build enough homes for the people on [today’s] social housing waiting list.”
Poverty and Affordable Housing
Poverty is intricately connected to the issue of affordable housing. People on low income cannot afford housing. As we stated earlier, seniors in every focus group shared that they don’t have enough money for food and other necessities because their shelter costs are too high.
Currently, approximately 13 per cent of Ontario citizens are seniors. Of those, 21 per cent live below the poverty line, which is roughly $19,000 per year. Senior women are twice as likely as senior men to live below the poverty line. One in 20 seniors use food banks. [21]
Shirley Hoy, Commissioner of Community and Neighbourhood Services, City of Toronto, 2001, reported during the Toronto Seniors’ Assembly Forum, “Housing: Understanding Your Rights,” that 58 per cent of seniors pay over 30 per cent of income on housing. Hoy added that market rents in Toronto increased 21 per cent from 1997 to 2000. However, there was no matching increase in pensions, leaving forum participants to wonder, how are seniors expected to be able to afford their increased rent without increased income? From 1990 to 2000, senior applicants on the social housing list rose 150 per cent. [22]
Poverty, both situational and lifelong, has a devastating effect on health. When poverty has been life-long, it creates an increased risk of cardiovascular disease, respiratory illness, and some cancers later in life. [23] If a senior is already living in poverty, the rising cost of rent forces them to go deeper into the marginal housing system, or they become homeless.
Those seniors who own their homes, purchased many years earlier, are often equity-rich but income-poor. They can be left with inadequate or no home care, because the cash-strapped public system may silently and informally judge them to be able to afford private care, rising costs, rising taxes, maintenance costs, etc. And they, too, may face high prescription costs for drugs not covered by the provincial formulary. Most pensions don’t reflect the rising costs.
Lack of affordable housing also poses safety risks. Whether a senior is in a low-rent building with poor security among a high-risk population, or is isolated and seeking companionship, seniors with compromised heath and poor housing are often easy targets for violence and abuse.
Senior Homelessness is Increasing
“We’ve been getting women in their 80s in our shelter. The shelter system is no place for the elderly.”
Shelter worker, Toronto [24]
Throughout the project, seniors have stressed the connection between housing and health. Homelessness, and its accompanying physical and emotional ailments, is an example of this connection.
Housing workers and health care workers are alarmed by the number of seniors who are “marginally housed’, a term used to refer to seniors who are at risk of losing their housing. These extremely vulnerable seniors can face drastic consequences from the slightest change in circumstance, such as a rent increase, a suddenly-needed assistive device, or a memory lapse that leads to a forgotten rent payment. They may face immediate eviction, which can mean homelessness with all its attendant health risks.
The Toronto Disaster Relief Committee (TDRC) reports:
“Virtually every homeless person we spoke with had experienced health problems as a result of being homeless. The most commonly identified health problems were in the area of mental health.”
“Shelter workers, outreach staff and homeless health service providers have witnessed an alarming increase in the number of homeless elderly people. Many of them are coping with health conditions more prevalent in the aging, such as Alzheimer’s disease…and chronic health problems such a as hypertension, heart disease, lung disease and diabetes.” [25]
I’m homeless. I’m staying with a friend. All I have is my room. I’m glad you put health and housing together, because they do go together. There’s a long waiting list, that’s shocking to find out there’s no place available. What happened to the housing, the federal and provincial housing that we worked for in the 60s and 70s? Where is it now?”
Toronto pilot participant
Other potential health problems that go hand-in-hand with homelessness include sleeplessness in shelters, malnutrition, and overexposure to sun and cold. Further problems are lack of security, lack of hygiene facilities, and violence.
One solution that addresses the lack of funding for affordable housing is the 1% solution.
“The 1% ultimately corresponds to a dollar figure that each level of government - federal, provincial, territorial, and municipal - should aspire to spend on affordable housing, over and above what they’re now spending… This would entail an additional $2 billion a year from the federal government, and an additional $2 billion a year from the provincial and territorial governments combined.” [26]
Another solution is to increase pensions. Pensions have not kept up with inflation. Rents go up, and pensions do not. As one Kenora focus group participant put it,
“Oil, electricity, you name it – it’s all up. But your pension doesn’t change, except for the cost of living, which is about 79 cents.”
Seniors in the Sault Ste. Marie focus group believe that pensions must target low-income seniors. Participants in other focus groups state that inflation must be factored into pension increases.
Recommendations – Affordable Housing
When seniors live in affordable housing, and have reasonable access to good food and transportation, they can begin to take care of their other concerns. As housing expert and TDRC member David Hulchanksi states: “Once people have housing, the rest of their lives improve.” [27]
The following policy recommendations, if implemented, will allow our senior citizens to live affordably and thus have the opportunity to improve the rest of their lives.
1. All three levels of government - federal, provincial, and municipal - need to share the responsibility for creating affordable housing, recognizing that every Canadian has the right to good housing at a reasonable rent.
2. The federal and provincial housing budgets must be increased to meet the growing demand for housing.
3. Implement the 1% recommended in 1998 by the Toronto Disaster Relief Committee, the National Housing and Homelessness Network, and others. All levels of government should spend one percent more of their total budgets on housing than they currently do, to move towards ending homelessness in the next three to five years.
4. Rents must be frozen for five years, as the revision of the Ontario Tenant Protection Act is in process. This will protect tenants from exorbitant rent increases, and help prevent homelessness caused by unfair and rapid evictions.
5. Tenant Protection Acts across Canada must revise their demolition and conversion sections to ensure that all interested parties involved in potential demolitions, particularly tenants, have a voice in decisions about whether or not to demolish, or restore, or convert, older buildings.
6. Low-income seniors on pensions should not be required to pay more than 30% of their income on housing.
7. Old Age Security Pensions must be set in relation to the actual cost of living. (Currently they are indexed to the cost of living index, which is not an accurate reflection of rising costs.)
This issue is addressed in Liberal Task Force Recommendation #3: “That the federal government undertake a complete review of seniors’ income support programs to ensure that objectives are being realized.” They report that many seniors are dissatisfied with the current system of benefits, and point out some of the disparities. Among the issues raised: “the need to increase benefit levels” and “the need to have OAS benefits fully indexed to inflation”. They also highlight a need for “better public awareness” so that seniors receive what they are entitled to - which also echoes the remarks of many of the Crossroads participants. [28]
8. The Canada Mortgage and Housing Corporation should return to its earlier mission, which was to create more housing for Canadians. CMHC ought to lead the national effort to build low-cost housing.
SOCIAL HOUSING AND SENIOR-ONLY HOUSING
Since 1995, many senior-only apartment buildings have been changed into general social housing. Seniors in the focus groups reported many problems with this, and many expressed a preference to return to senior-only housing.
Social housing is a sound concept and often works well. However, streaming seniors into housing with disadvantaged people has caused tremendous stress, and made seniors feel unsafe.
“Housing for seniors is now housing for everyone and seniors do not like it. We are in there with every kind of hard-life type, and they bring a lot of problems…and that stresses seniors even more.”
Kenora participant
In social housing there is often noise from neighbours, including music all night long, partying, and yelling. Seniors reported interruptions to their sleep, with their stress further compounded by a decreased sense of security and safety, because of violence, drug dealing, and robbery. The constant sleep disturbances made these seniors very tired and unproductive during the day, which further stressed them mentally and emotionally.
“I live in [social housing]. It’s very stressful. There’s widespread marijuana and alcohol use. Fires have been started after people have passed-out from being intoxicated. False fire alarms are frequent.”
Kingston participant
Social housing is often also substandard housing, located in areas of industrial pollution. In these cases, seniors face health risks both within the building and outside it. One woman in the South Asian group lived near a cement factory, a good example of where substandard but ‘almost affordable’ housing can be found. Through a translator, she shared that the cement dust caused her husband to develop a respiratory problem. He had to leave his job as a security guard, they had to go on welfare, and she began to develop health problems with blood pressure and cholesterol. She reported her stress levels to be very high and was visibly upset throughout the discussion.
RETIREMENT HOMES
Retirement homes are a housing option that some seniors consider. These are often privately owned and not regulated. They can be in an apartment-like complex, and may offer a simple room or a full apartment for rent. Some retirement homes may offer meals in a main dining room, as well as other services, at a cost to seniors.
Many seniors simply can’t afford this option. Seniors in the focus groups and at the Forum stated that more subsidized retirement homes are required.
One issue raised in the focus groups was the need for national standards that would guide retirement home regulation in every province. In Ontario, there is one regulatory body from which retirement homes can gain accreditation. However, it is generally the upper-end retirement homes that are able to pay dues and maintain accreditation; lower-end homes are often less able to pay the dues. Seniors see a need for regulation and licensing of both lower-end and upper- end retirement homes.
In the Forum breakout session on retirement homes, participants identified a need for the federal government to take responsibility for ensuring uniform licensing and regulations across all provinces. As it is now, most, but not all, provinces have some form of licensing or regulation of retirement homes. Ontario, for example, has no provincial licensing or regulation, and municipalities may, or may not, set standards and inspection protocols.
Recommendations – Retirement Homes
1. The three levels of government should be responsible for setting and enforcing standards and regulations for large and small retirement homes, re: safety, food services, privacy, quality of care, tenant rights, compliance with the Tenant Protection Act (TPA). Standards should be set in consultation with seniors, and be senior-focused, so seniors can live in safety and dignity.
2. The TPA must provide a more effective strategy to protect the rights of residents of retirement homes.
3. The federal, provincial, and municipal governments and stakeholders should cooperate to provide affordable options in liaison with seniors and providers.
4. More funding should be available to increase the number of retirement homes that are geared to low-income seniors.
SUPPORTIVE HOUSING
"Supportive housing is the best-kept secret in long-term care."
Linda Hill, Executive Director, Richview Residence, Supportive Housing [29]
Supportive housing covers a variety of support services, including homemaking and personal care, but not nursing care. It fills in the gap between living at home with support, and living in a nursing home. It operates as a useful alternative to long-term care facilities. Supportive housing services are practical, and offer flexibility in responding to seniors’ needs, as seniors' needs change as their health improves or declines.
However, people have to be living in, or move to, government/non-profit housing to receive these services.
Supportive housing services are preventative, rather than just for those with a very high level of need. They are useful in preventing conditions that lead to premature and unwanted admission to institutional care.
Seniors who have supportive housing services state that these services greatly reduce their stress levels and contribute positively to overall health. Where these services exist, they benefit everyone.
“What I like is the LOFT [Leap of Faith Toronto, supportive housing services] provides us with safety, security, and a social life. You can’t ask for better. It makes a difference in seniors’ lives, I’ve seen it, and it’s dignity. Everyone deserves it.”
Pilot group participant
“We need supportive housing, it’s the answer. Seniors deserve that. It’s dignity. When you go to theses places choices are taken away. We need supportive housing. I see the difference it made in my building. People live happier lives.”
Toronto participant
These excellent support services are a model of what works to enable seniors to age in place. However, they are grossly under-funded and much too few in number. Supportive housing services for seniors need to be multiplied and reinforced across Canada.
Collaboration among agencies will be critical in coordinating these services.
Recommendations – Supportive Housing
1. Through a federal/provincial/territorial agreement, current definitions of supportive housing should be consolidated to include the actual spectrum of services and needs.
2. Supportive housing should be funded as a significant segment of Home Care, with federal standards required for additional federal funding of provincial programs.
3. In establishing supportive housing programs, first priority must be given to social housing and not-for-profit buildings. All seniors who need supportive care (whether because of age-related functional impairments, mental illness, or addictions) should, however, be entitled to receive such care in their homes from the home care program (in Ontario, the Community Care Access Centres).
4. Public education about the purposes and availability of supportive housing should be targeted not only to seniors but also to the broader community.
5. In addition to operational funding, research funding is needed in the area of supportive housing to examine guidelines, best practices, and outcome evidence in other jurisdictions, as well as locally
6. Supportive housing workers (in Ontario, Personal Support Workers), like all home care workers, should be paid at the same rate that persons with similar qualifications receive when they work in hospitals
HOME CARE AND SUPPORT SERVICES
“Government should be challenged to become more creative to determine what is needed to support one’s ‘holistic’ well-being.”
Windsor participant
Seniors are fighting to make sure the definition of home care includes personal support services. Currently, home care and personal support services are two separate categories of care, which sometimes overlap. For clarity, we will refer to home care services as health services for people with chronic and acute health problems, as well as those in various stages of recovery from illnesses. Home care services generally focus on health and the maintenance of one’s body, including bathing.
Personal support services most often involve light housekeeping, assistance with activities of daily living, light house maintenance, and perhaps bathing and personal care. Personal support can overlap with home care in instances such as bathing and the supervision of medication schedules.
There are many gaps in these support services. Seniors in our focus groups reported being prematurely discharged from hospitals and then given inadequate care at home, thus resulting in poor recovery. Seniors across the province lamented the hardship they experience in trying to get help with “simple things” such as putting on a hearing aid, cleanliness in the home, bathing, and changing lightbulbs. As simple as these tasks may be, when one is unable to carry them out, and not able to afford assistance, the quality of life and one’s health are affected.
In every focus group there was a widespread sentiment that ‘it’s the little things that can make or break you’ - that help, or the lack of it, can mean the difference between keeping or losing one’s health, and one’s home.
“…trying to do things that need to be done, even changing curtains or a light bulb…they can get hurt badly, fall off a chair, off a ladder …a bit of water on the floor you can step on…what if you can’t mop it up?”
Sault Ste. Marie participant
“I’m having surgery in the fall and I’m not going to be able to do anything for six weeks…I’ve been told I won’t get any home care except if something drastic goes wrong…what about people who can’t afford to have someone to come in and do basic house cleaning?”
Sault Ste. Marie participant
Personal support becomes integral to many older adults’ health and well-being as the aging process advances. While some seniors who live in non-profit buildings are provided with personal support, it is not accessible to all seniors who need it. When a senior doesn’t have money to pay for these types of services privately, as is the case with at least 21 per cent of seniors, their well-being is greatly undermined.
Across Canada, cuts to acute care in hospitals are largely responsible for the overload that home care currently faces. With the cuts to home care in 1995, followed by cuts to hospitals in subsequent years, people who receive home care service and home care staff have been stressed almost to the breaking point. Many patients are now prematurely discharged from hospital, and now use up most of the home care hours that once went to seniors who need continuing support. [30]
Workers and those who receive home care services are frustrated by a system that no longer provides a decent response to the needs of seniors.
The 2004 Liberal Task Force on Seniors notes “the critical absence of adequate home care” for seniors in Canada. [31]
“The cutbacks in [home care] services scare me to death.”
Muskoka participant
Community Care Access Centre workers complained that they spend too much of their time and energy determining who is no longer suitable for services, based on very limiting criteria. Workers said they spend several hours each week in long meetings aimed at re-assessing cases. They complained that re-assessing seniors every six months as mandated takes up too much of their time. They also noted that the increased number of forms they are required to fill out has greatly added to the workload. A recent development in response to these added forms is to take information down on a laptop computer while visiting people in their homes. As many older people feel unwell, and vulnerable, the presence of an officious individual typing up their responses is often foreign, disturbing, and counterproductive to developing rapport and trust.
The Bath Rule
Both home care workers and seniors in focus groups complained hugely about the “bath rule”, which can make getting home support services slightly ridiculous, and in some instances traumatizing. Across the province, we heard story after story about how, in order to qualify for any kind of home support from the Community Care Access Centers (CCAC), one has to need assistance with bathing. Needing help to have a bath is the definitive assessment tool. The logic underlying this is that if you are able enough to bathe yourself, you are able to do your own housework. This manner of assessment is highly problematic in many ways.
Naturally, it deters many seniors, uncomfortable with disrobing in front of strangers, from getting other needed assistance. Seniors who can bathe themselves, yet are not able to clean or carry out other activities of daily living, are submitting to the bath rule in order to get that assistance. Some seniors also noted the “irony” of CCAC workers not being allowed to clean the bathtub, so even though you cannot bathe yourself, you are expected to be able to clean your tub - generally a more demanding task.
Due to changes in the structure of home care services, workers no longer have a regular roster of clients; workers coming to seniors’ homes change from week to week. This means that seniors are forced to disrobe in front of one stranger after another.
Many people who can bathe themselves are not able to do housework. Certain back conditions, for instance, will allow you to lift a sponge under a showerhead, but not allow the more demanding movements required to dust, vacuum, or lift baskets of laundry. Further, being ill, recovering from cancer for example, you may be very weak, though you can easily soak in a tub.
This situation is so ridiculed that there are now cartoons circulating about it. But beneath their laughter, seniors are appalled by the lack of logic and sensitivity that the “bath rule” represents.
“It’s a different person every week coming in to give you a bath. You don’t know anything about them…it’s a stranger…it’s a very uncomfortable feeling to have different people each week.”
Hamilton participant
There were few stories in the focus groups more compelling than the ones seniors told about how the lack of home care and other supports affected their health and housing. One woman in the Sault Ste. Marie group was caregiver to her husband. She lost her money, her own health (she developed rheumatoid arthritis), and, in the end, her home. If she had received home care for her husband and support for herself, she would still have her home and some financial security.
“…my husband had been sick for a long, long time and because of financial problems I couldn’t stay out in the community because any money that we had was used during the years he was sick… I was left with no money at all…they put me on welfare, which I had never been on in my life, and I was just devastated over that.”
Sault Ste Marie participant
“My wife needs continued care, which I provide. What if I get sick? My wife would have to come with me if I was admitted to a hospital. What would a person without a family do?”
Kingston participant
At the end of each focus group, we asked people what was most important to them. A frequent response was ‘staying in my home and maintaining my independence, by having needed services available’.
An effective model of care that would address the complex problems in home care and personal support services is a model of community-based elder care. This all-inclusive model of care has been successful in Alberta, California, New York, and Sweden.
An Integrated Model of Community-Based Elder care
“I think the ability to maintain your independence is very important to your mental health. Also, to have a healthy environment… You’ll have the opportunity to interact with other people.”
Hamilton participant
Seniors in every group stated that the availability of home care and support services together in one centre would be a great asset in supporting their independence.
Seniors in Ontario would like an integrated model of community-based elder care. Such all-inclusive care models exist around the world and are very successful. They also cost less than the long-term care facility model. There is international policy agreement that long-term facility care is not cost-effective or a good solution to care for elder persons. [32] Despite this, Canada has one of the highest rates of putting our seniors into long-term care facilities.
Two models are PACE in California, and CHOICE in Alberta. We can use these two examples to create a usable model of integrated community-based elder care in Ontario.
PACE - Programs of All-Inclusive Care
PACE is a model of all-inclusive care that was created by On Lok Senior Health Services in San Francisco. PACE provides medical and long-term care services to both inpatients and outpatients. Elders in the programs must live within a geographical area close to the PACE centre. Participants can receive services in their home or at the centre, depending on their health and other circumstances. Elders have many options: transportation services, attending recreational and educational programs, having meals at the centre or at home, supervision of medication, benefiting from social work services and personal support services, and others.
CHOICE - Comprehensive Home Option of Integrated Care for the Elderly
CHOICE is the Canadian version of the PACE program, located in Calgary. CHOICE helps seniors to live in dignity and with autonomy. The average participant is 81 years old. Seniors receive a flexible range of health care options and social supports, and these services can change, as the seniors’ needs change (thus the term “services follow the senior”).
Models of all-inclusive care provide a day centre, to which care recipients are transported, where meals, personal support, supervision of medication, and activity programs are available. If a senior is not well enough on some days to go to the centre, support is provided in the home, including help with dressing in the morning and getting to bed at night. Without these programs, participants would be forced to enter long-term care facilities, a more costly and, for seniors, a much less attractive alternative.
From Health Canada’s 2001 study of the cost-effectiveness of home care, we know that seniors who receive supportive care in their homes make less use of more expensive health care interventions, such as visits to doctors, emergency rooms, and acute-care hospitals, and are older when they seek admission to long-term care facilities. [33] Moreover, the strong desire of seniors to age in place has become clear enough that decision-makers must take it into account. Alternatives to institutional care should, therefore, be given top priority.
Recommendations – Home Care and Support Services
1. That the Ontario Ministry of Health and Long-Term Care establish an integrated framework for seniors’ health, based on the principles of the National Framework on Aging. [34] The provincial framework should include:
home care, including support services
community care programs (transportation, Meals on Wheels, Wheels to Meals, adult day programs, etc.)
acute care when needed
short-term facility stays while recovering from acute episodes
placement in long-term care facilities when there is no other safe option
And, since it is well known that 80-90% of elder care is provided by family members, [35] caregiver support (recognition, training, and adequate respite) must be a major component of such an integrated health care framework for seniors.
2. That the Government of Ontario, in their meetings with the federal/provincial/territorial ministers, press for job and income protection (equivalent to parental leave) to be made available, under the Employment Insurance Program, for caregivers of older family members. Pension credit for such caregivers should be equivalent to what is now available to parents who take leave from the workforce to care for children less than seven years old.
The Liberal Task Force on Seniors acknowledges the implementation of Compassionate Care Benefits for family members, but says more needs to be done. [36]
3. That, parallel to the development of a framework for seniors’ health care, pilot projects of models of integrated care for seniors be funded initially by Health Canada and instituted by provincial ministries of health. Such projects should be based on the PACE model (widely emulated, under different program names, in the U.S.) or on the CHOICE model.
In Ontario, venues for such programs should include but not be limited to:
• Community Care Access Centres
Community services organizations
Community Health Centres
Public Health Units
TRANSPORTATION
“Transportation is a problem. Politicians don’t have first-hand experience of the transportation problems that seniors face.”
Kingston participant
“Transportation means getting to the doctors, which should be a priority for seniors.” Kenora participant
In the section on the connection between health and housing, we noted that one of the most common dilemmas seniors face is spending most of their income on housing, with little left for food, physical health needs, and transportation. The availability of transportation can greatly contribute to seniors' health and well-being, for without it seniors are isolated, which affects physical and mental health.
The relationship between health and transportation is complex and affects rural and urban seniors differently.
In urban centres such as Toronto, poverty and disability can limit seniors’ access to transportation. Some thoughts from Toronto participants:
“We need more Wheeltrans, and lower the requirements to use it.”
“The Toronto Transit Commission has been saying that for at least 25 years, that they’re going to become accessible. And they still haven’t. They can’t be bothered. Are they not being made accountable?”
“It’s hard to make the TTC fares. Some seniors don’t come to weekly meetings [at the community centre] because of that.”
Seniors in rural areas often don’t have buses, or must deal with infrequent and/or expensive services. Those who don’t drive, and don’t have people to help, must pay for costly taxi service to get food and medical attention. Further, specialized health services and hospital care are generally hundreds of miles away and seniors encounter more financial and logistical obstacles travelling to get their health needs met. Sometimes neighbours are available to help, yet there may still be costs involved.
“I live in a rural area. There’s nothing in the area for me. It takes me one to one and a half hours to get anywhere.”
Ottawa participant
Seniors with walkers or canes have great difficulty using public transportation, particularly in winter. Driver services provided by the Canadian Red Cross have been severely reduced due to cuts in provincial government funding. Seniors in Sault Ste. Marie noted the extremely limited transportation options. The parallel bus service is restricted to wheelchair users, and no companions are allowed.
Accessible bus services, particularly for seniors with disabilities, can mean the difference between a life of isolation and a life that is rich and satisfying.
“I think they should have more vehicles to be able to accommodate people with walkers, where they have the low entrance in and gradual rise up to the next level.”
Sault Ste. Marie participant
In conclusion, when housing costs absorb seniors’ income, transportation costs can be prohibitive to both rural and urban seniors. Without adequate transportation, seniors cannot socialize, purchase food, or attend health appointments and may be excluded from community life.
Bus services for seniors with disabilities and illnesses need to be expanded, and their criteria changed to assist a broader range of people. In Sweden and Finland, there are innovative models of alternative transportation. Taxi services and/or adapted vehicles for people with physical disabilities are offered for the same price as public transportation. [37]
Recommendations – Transportation
Participants in the Forum identified transportation as an essential service for the senior population. The recommendations from the Forum and policy writing day were as follows:
1. Greater coordination between public and community transportation services, e.g., a centralized information phone service.
2. Innovation by exploring new partnerships to create more transportation options - such as service clubs, car dealerships, courtesy vehicles.
3. That community transportation services provided by the voluntary sector be adequately funded – including insurance coverage for volunteer drivers.
4. Increased public awareness through education and publicity about seniors’ needs in public transit, as drivers and as pedestrians, including the needs of disabled seniors.
5. That mobility barriers be eliminated and that security devices be increased and properly used in public transit for both seniors and children.
ACCESSIBILITY
“Financial problems dictate health and dictate housing. We get long-term disability or CPP. But if there’s an increase, it’s taken away. If you’re on long-term disability you have to pay taxes on the increase. So the financial limitations limit the housing.”
Ottawa GLBT participant
Seniors and health advocates in the focus groups stressed the importance of removing barriers so that seniors with impairments (in sight, hearing, cognition, or mobility) can participate comfortably in all programs and services. Whether seniors become disabled in their elder years, or have been disabled all their lives, they are distressed when facing barriers to meeting their health needs.
Costs incurred as a result of being disabled range from having to buy a cane, to the far more expensive purchase of a hearing aid. The cost of hearing aids caused stress for seniors across the province. Focus group participants feel that greater assistance is required.
“The Assistive Devices Program does not adequately compensate for equipment, especially hearing aids.”
Windsor participant
“It costs $4,000 for a hearing aid – but the government only pays $300 per ear, every 3 years – I had to pay $250 for a repair that only lasted one month.”
Sault Ste. Marie participant
Blind seniors are often excluded from knowing about and participating in senior services and programs. They cannot read the literature and often miss out on word-of-mouth information, because they are isolated.
Seniors who require the use of a cane, walker, or wheelchair have difficulties using programs and services, as well as difficulties paying for their assistive devices. Adequate transportation for seniors with physical disabilities rarely exists. If a disabled senior is fortunate enough to have scheduled and affordable transportation, there is no guarantee that there won’t be further barriers to contend with in programs, such as stairs or inaccessible washrooms.
Seniors in several focus groups stressed the importance of making their homes accessible, with grab bars and ground floor access, so one is prepared for future disability and/or weakness. Members of the Muskoka group pointed out that carpeting can interfere with wheelchair use.
Recommendations - Accessibility
1. Policies should be responsive to the needs of seniors with disabilities and impairments. Programs and services should be accessible to blind, visually impaired, deaf, and hard of hearing seniors, and those who use wheelchairs, canes, and walkers.
2. Reduce the 3-year restriction on hearing aids to one year.
3. Provide a full subsidy for hearing aids, for low-income seniors.
SAFETY AND SECURITY
“As much as I hate my apartment, I don’t go out at night because I’m scared to. I don’t feel safe…landlords abuse elders, both financially and with intimidation.” Ottawa GLBT participant
Feeling safe in one’s home and community is critical for seniors. There is a range of safety issues: security and physical safety in the home, safety outside the home, psychological safety inside and outside the home. The solutions that ensure a sense of safety may include: neighbourhood watch programs, buddy systems, phone-check programs, fall-prevention programs, elder-abuse education and prevention, electronic security systems, anti-bullying programs, anti-violence programs, and security guards.
Seniors in the Forum breakout session on safety stated they needed more information on household measures that could prevent accidents and increase overall safety. They stated they did not feel there were enough devices available to assist with household safety and didn’t know where to go for accurate, accessible information on safety in the home. Seniors in the session felt that the cost of alarm systems was prohibitive.
Seniors are often targets of crime, whether in their homes or out in the community. They are deemed less able to protect themselves by those persons or organizations looking to steal or violate, and indeed they are. Besides crime, seniors are also vulnerable to being pushed and shoved when travelling in their communities, just by hurried crowds and impatient individuals. Seniors feel that education on the issues seniors face in community needs to be available for younger people.
In social housing, where seniors live amongst troubled and marginalized groups, security issues are multiplied. As we discuss in our section on social housing, seniors there are targeted for violence, and their buildings can be dominated by drug dealers and their sense of peace destroyed by late-night activity and noise. Social housing situations, as they have evolved over the past ten years, often diminish the sense of security that seniors need and deserve.
A lack of good lighting is also a problem for seniors. Often their apartment buildings and residences lack sufficient lighting in doorways and outside passages. This makes it hard to see and also offers hiding places for violators.
Irregular bus services also pose a safety risk to seniors, who are vulnerable while alone and waiting in bus shelters, or at unprotected bus stops. Transportation issues overlap into safety issues.
In terms of psychological safety, isolation can create a sense of insecurity and also victimize seniors. Thieves and phone fraud organizations often target seniors they perceive as alone, unsupported, and not likely to consult with others. Seniors feel that phone buddy systems and telephone checking services could help with this lack of security.
Seniors proposed several solutions, which are in the recommendations that follow. One participant was very impressed with a system he found in the United States. This system is also available in Canada, and widely used in retirement homes and group homes.
“I visited a seniors’ home in the States, and they had a big button…in the central place, in the living room. And you just pressed and it automatically alerted all the emergency forces. And they came. They didn’t call or anything. They just came. It was large enough that you didn’t have to find it. You could just fall against it and it sounded the alarm.”
Toronto Aboriginal participant
Recommendations – Safety and Security
1. Building codes should be sensitive to an aging population and include safety measures that would benefit all residents and homeowners, such as good lighting, wide doorways, solid flooring, and emergency buttons.
2. Innovative assistive devices should be more readily available.
3. Safety awareness education should be available for seniors through local community centres and health clinics. Subsidies for safety devices should be part of the educational programs.
4. The federal government should launch a national campaign to educate the public on the various forms of elder abuse and the programs that can help, especially prevention programs.
ACCESS TO INFORMATION AND SERVICES
“It’s imperative that seniors know what exists.”
Toronto participant
“Seniors right across the country should have the same information.”
Hamilton participant
“What good are services if we don’t know about them?”
Thunder Bay participant
Seniors noted that having information and programs available is one challenge, but ensuring that all seniors have access to information on what is available is another. As one of our participants in Sault Ste. Marie said,
“The government needs to put fewer barriers in the way of accessing some of these programs. I’m not talking about just communication barriers, but that is one, but all the rules and regulations and run around. I think they purposely give you a lot of rules and run-around…figuring you’ll finally give up because you can’t get the right person.”
They also pointed out the need for clear language in publications, free of bureaucratic ‘gobbledygook’. Plain language is necessary.
“…if you do see pamphlets [on CPP benefits], by the time you’ve read the whole thing you wonder what the heck the first paragraph was about. They make it so complicated.”
Sault Ste. Marie participant
Seniors noted how complicated phone systems and criteria requirements for programs are barriers.
They also noted that by the time one figures out how to apply for a program, it often no longer exists.
Other issues that relate to access to information include: language barriers access to information for visually impaired seniors, agency and government outreach, and advertising.
Recommendations – Access to Information and Services
1. Information on programs and services, through all levels of government and throughout all communities, must be user-friendly and available in the languages spoken by the relevant populations. Information must be written in a manner that conforms to plain language guidelines, i.e., it will be current, complete, clear, and concise.
2. Information on health, housing, and other services should be accessible through community directories, health organization newsletters, and larger publications.
3. Funding for information should be available to make sure networking is in place and to ensure that the flow of information is current and accessible.
4. Information regarding seniors’ programs, ageism, and seniors’ rights and issues should be part of the curriculum at all levels of schooling, and should be disseminated to people who work with seniors – seniors’ organizations, social/medical providers, and the caregiver profession.
ABORIGINAL ISSUES
“Unhealthy aging is the legacy of disadvantage.”
Common saying among Aboriginal health workers
The life span of Aboriginal people has decreased with the loss of their old ways, their land, and their kin. Over three-quarters of Aboriginal people were wiped out by disease and violence when Europeans settled in North America. The outcome of these past five hundred years has decreased the health and well-being of all Aboriginal people. Relegated to reserves or disadvantaged in urban centres, Canada’s First Peoples have experienced a disproportionate amount of disease, distress, addiction, poverty, homelessness, and incarceration. These lifelong struggles mean early death.
Ruth Cyr, Director of the Aboriginal Circle of Life program at the Native Canadian Center in Toronto, shocked Forum participants when she shared that less than five percent of Aboriginal people live to be 65. Due to this stunning reality, which is the lowest life expectancy in Canada, Aboriginal persons are considered elders at age 55.
Not only do Aboriginal people die sooner than any other group, they are more likely to develop degenerative diseases earlier in their lives and with greater intensity. Further, they are more likely to experience mental health issues frequently identified with progression into old age, and deterioration of their sense of well-being, due to loss of friends, spouses, and relatives. [38]
The compromised health and frequently poor housing experienced by many Aboriginal people are part of a complex legacy of oppression and cultural genocide.
“Years ago, the seniors were able to look after themselves real good. They weren’t real sick all the time. Now today they’re sick all the time. They’re getting all kinds of diseases.”
Evelyn Sarrazin, Golden Lake [39]
Aboriginal elders are more likely to live with elevated levels of stress in their lives as a result of poverty, unhealthy living conditions, racism, cultural disruption and loss, and the related social problems in the family and in the community.
Respect for Elders
“Native people respect their elders…children are taught from a young age to respect elders.”
Muskoka participant
On the positive side, Aboriginal people are gifted in many ways. Unlike much of the Western world, Aboriginal peoples do not support the widespread devaluation and invisibility of older persons that non-Aboriginal people call ageism.
Aboriginal peoples are excellent role models for non-Aboriginal persons, in terms of presenting a social structure and a system of beliefs that value older persons. Many First Nations people actively seek out the council and company of elders.
“Elders are seen as educators, family matriarchs/patriarchs, child-care providers, political, cultural and spiritual advisors, and are often viewed as the community conscience in many of their home communities. In return, Elders are given respect, not only within the family, but also within the larger community as a whole.” [40]
To illustrate the difference in cultures, we recall part of the Muskoka focus group. Of our 10 participants, we had one Aboriginal elder. While most seniors in the group worried about what would happen to them if their illness or disability became worse, and had a range of concerns about where they would live and how their care would be managed, the Aboriginal elder did not share these concerns. She had her son, who had committed himself to her care. The other participants expressed envy toward her situation, which she attributed to the way elders are treated within her community.
However, while the valuation of elders in Aboriginal society may mean they are respected, it does not mean all their needs are met. In many cases, due to poverty and hardship, the valuing of elders does not guarantee resources, or wellness.
Poverty
In the Aboriginal focus groups in both Kenora and Toronto, the prevalence of poverty and physical disability was striking. The lack of housing and the problems of poor housing were evident. For example, four Kenora participants could not afford accommodation close to town, and were isolated in remote rental accommodation, which posed great challenges to their access to health care.
Racism
Although Aboriginal people do not suffer from ageism, they do suffer from racism. In the Kenora general group, Caucasian seniors commented on the severity of racism toward Aboriginal people there, and said that such expressions as ‘the only good Indian is a dead Indian’ are still commonly used.
Elder Issues: Urban vs. Reserve
In the Toronto group it was pointed out that the needs of elders on reserves differ from those of elders in urban centres. On reserve there is a lot of isolation and in urban centres there are too few, or zero, Aboriginal-specific services. Also, in urban centres there is a great deal of ignorance about Aboriginal history and culture, and great insensitivity to cultural issues, among service providers.
The struggle to support Aboriginal elders is the struggle to support the reclaiming of their traditional ways. Elders need to come to places where their language is spoken, and their ways and life struggles are understood.
Some regions of Ontario have responded to this in part. The hospital in Kenora has acknowledged that the large Ojibway population in the area requires Ojibway-speaking health practitioners. But such steps are just a beginning that must be followed by more potent action and greater funding.
Aboriginal elders require programs, services, and policies that respect First Nations’ culture and language. Again, having options is key. Programs and services that have been designed by Aboriginal persons, for Aboriginal persons, have been very successful, yet are under-funded and insufficiently supported. Health concerns such as diabetes (which affects Aboriginal People three times more than other groups) and depression among Aboriginal elders also require specialized health services, both within culturally specific programs and in general programs. Funding for traditional healers is critical to the health and well being of Aboriginal elders.
“A medicine man could come in and talk to individuals… Anishnawbi Health provides healers that come for a week. We have nothing to do with traditional healer services because we don’t provide them. We’re not funded for that.” Toronto Aboriginal participant
“Peer support is needed and should be supported because a lot of times people don’t have enough to be consistent. They need [an Aboriginal] staff person to work with them.”
Toronto Aboriginal participant
“I don’t know if the younger generation knows too much about that medicine that we used a long time ago.”
Evelyn Sarrazin, Golden Lake [41]
Recommendations – Aboriginal Issues
1. Provide training for all health care professionals on the history and culture of First Nations people in Canada.
2. Increase illness-prevention and health-promotion programs for First Nation’s people that will decrease the onset of diseases that may become chronic (such as diabetes, tuberculosis, heart disease).
3. Provide supportive housing options that meet the needs of First Nation’s people.
4. Ensure access to timely transportation services to meet medical/treatment needs of First Nations people.
5. Secure funding for training and education for First Nations health care providers.
6. Provide affordable housing that is accessible to First Nation’s people.
7. Ensure the availability and accessibility of holistic traditional health service delivery to all First Nations people.
GAY, LESBIAN, TRANSEXUAL, AND TRANSGENDERED (GLBT) ISSUES
One of the key findings in our literature search was that although multicultural groups and low-income groups had gained inclusion into reports and studies, the GLBT population was excluded. We observed that only one out of 100 studies mentioned this section of the senior population. Programs and services reflect this invisibility, and many service providers are unaware of who their GLBT seniors are.
The invisibility of GLBT seniors’ concerns, issues, and cultures contributes to the stress they endure. Often those who have been ‘out’ as GLBT people during their youth and middle years will feel vulnerable when approaching seniors’ services because of the homophobia they encounter, and will go back into the ‘closet’, often to the detriment of their health and well-being.
“My doctor keeps prying. Wants to know if I’m a homosexual. I want to know if he’s gay-positive. He says, “We’re all non-judgmental.” But now I don’t go to him anymore. Not unless I’m dying. I’m there for health reasons, but he tells me to go and see a social worker.”
Ottawa GLBT participant
GLBT seniors need to be included in programs and services for seniors, as well as enjoy GLBT-specific services. Here are some comments GLBT seniors made in the Ottawa focus group:
“We need a subsidized GLBT retirement home, a lesbian retirement home, and a GLBT Abbeyfield home. All of it subsidized. There aren’t enough seniors’ apartment buildings that are affordable. We need buildings for people 50 and over. And there’s a big need for strictly lesbian housing, because of violence and safety issues.”
“More anti-homophobia training...should be standard…in services, palliative care, home care, and hospitals. Make the existing programs more accessible. There should be an inclusive centre for the GLBT population, with housing-option counsellors.”
Recommendations – GLBT Issues
1. Well-trained advocates for GLBT seniors in the areas of housing, health care, and community social programs are needed.
2. All housing and health services should be required to have codes of ethics/guiding principles that foster GLBT inclusion and pride, including anti-discrimination policies.
3. Canada Mortgage and Housing Corporation needs to create funding sources to ensure the availability of housing options for GLBT seniors in the following areas:
support to stay in our own homes
integrated housing options that are affordable
subsidized GLBT retirement homes, group homes, apartments
lesbian-only subsidized housing
intergenerational lesbian/gay housing
4. All information on programs and services should include GLBT outreach and GLBT programming, such that explicit reference is made to GLBT seniors and programs specifically for GLBT seniors.
CULTURAL AND ETHNIC ISSUES
“Our senior population is rising. We have 76 different nationalities in Hamilton. About 135 languages."
Hamilton Participant
Canadian society is increasingly multicultural and many seniors, among others, have a first language that is not English. The cultural norms of many groups are unknown to their caregivers and service providers. Several focus group participants spoke of the freedom they felt when their language and culture were addressed in housing and support services. Other participants spoke of the frustration they felt because they could not access services due to language and cultural barriers.
Many focus group participants talked about the need for linguistically appropriate services. Francophone seniors in Ottawa spoke of their frustration over the lack of services delivered in French. South Asian seniors disclosed how the lack of services and staff who speak their languages prohibits their participation in programs. Over 100 languages are spoken within the senior population of Ontario. Programs and services need to address our multicultural, multilingual reality.
Seniors also emphasized that policies, programs, and services need to address issues of discrimination against cultural communities, and create policies that are culturally inclusive. Both culturally-specific programs and programs that include a variety of cultures are needed, to create a society where seniors have reasonable options.
Cultural norms, such as not taking help from outside the family, can complicate matters for those seniors who are not getting the help they need from family members. Cultural insensitivity and discrimination also affect seniors’ health and housing. Participants in the focus groups and Forum shared that, as visible minorities, many are treated in an inferior way to Caucasians in mainstream seniors’ services. Often services are embedded in a paternalistic model of care, where seniors are seen as “poor things” by most staff, instead of as valued citizens with life experience and decision-making abilities.
Some Hamilton participants’ thoughts:
“[Recreation programs] are good for the mainstream but not for ethnic.”
“[Meal programs] for culturally different people, they aren’t very conscious of them. They have their own traditions. You don’t give a Muslim a sausage.”
“We’re not inclusive enough. We’re exclusive… We have to fight that together, so the whole community benefits.”
In areas where seniors felt they were in culturally and linguistically suitable housing and programs, they noted a high degree of satisfaction.
“It [my apartment building complex] is a community of people. Of the 35,000 refugees there, there are about 6,000 Tamils. It is a community… So I have people speaking the same language, with similar ideas.”
South Asian women’s group participant
“Being surrounded by your own ethnic group gives more feeling of support.”
South Asian participant
Recommendations – Cultural and Ethnic Issues
1. Policies should give voice to the diverse cultural and ethnic communities of Ontario.
2. The delivery of services should address the special concerns expressed or implied by the language or culture of these communities.
3. Policies need to ensure that the hiring of service providers reflects the cultural, ethnic, and linguistic diversity of these communities.
4. Policies should hold government accountable for money set aside for Immigration and
Citizenship, and ensure that this money is spent on services for immigrants.
AGEISM
Ageism is discrimination based on age. In a youth-obsessed culture, people tend to devalue those who are old. Ageism is present when people ignore the opinions of older people, or speak on their behalf when they are capable of speaking for themselves. It is also demonstrated in the use of negative labels such as “old bag’, “old fart”, “gizzard” etc. In its worst form, ageism is the abuse and exploitation of seniors.
“Was anyone listening when this report was written and circulated?” Seniors have asked this question about innumerable reports written on health and housing in the last 20 years. Why haven’t their voices been heard, their needs been responded to? Frances Lankin, in her speech at the Forum, identified ageism as the reason policy changes are not made.
In many focus groups, combating ageism was deemed a significant issue.
Seniors across Ontario noted increasing levels of disrespect, and invisibility. Seniors and our non-senior allies said that negative attitudes towards aging call for widespread public education, so that both the aging process and the role seniors actually play in our society are better understood. Many seniors feel that intergenerational programs are needed.
“Seniors are invisible. Many people disregard us.”
Kingston participant
“North American attitudes towards seniors are often quite negative and the boomers of today are becoming quite ageist. More emphasis needs to be placed on early education to promote positive attitudes toward aging. Adopt-a-Grandparent programs could be a good start to bringing about a change in societal attitudes.” Thunder Bay participant
“Much needs to be done to ‘de-mystify’ the aging process.”
Thunder Bay participant
Recommendations – Ageism
1. Education on ageism is critical. Doctors, employers, health workers, and community program staff should be required to attend anti-ageism workshops on an annual basis.
2. The school system needs to include early education to promote positive attitudes towards aging.
3. The federal government needs to launch a nation-wide intergenerational education program, enlisting both the media and the education system, which would encompass the following components:
♣ positive aging and life-long learning
♣ (within cultural context) valuing cultural contributions, valuing elderly history, recognizing diversity; i.e., cultural, socio-economic, lifestyle, physical and mental, etc.
♣ clarifying exactly what ageism is and identifying the many ways it exists in our society
♣ recognition, respect, and promotion of personal autonomy
3. The federal government must develop strategies that will promote media presentation of the positive aspects of aging, and increase the visibility of older persons. The underlying principle of the dignity of older persons should be visible in all media coverage.
Ageism, elder abuse, personal security, intergenerational contact, and the struggles of new immigrants are all addressed by Liberal Task Force Recommendation #6: “That the federal government raise awareness of seniors’ issues through a national public education program.” This campaign would offer “a more positive portrayal” of Canadian seniors and their contributions to their communities, “bring generations closer together”, provide important information (on availability of services, safety issues like telephone fraud, etc.), and educate the general public about seniors and seniors’ issues (such as the complexities of elder abuse). [42]
4. All Health Canada policies and programs must be screened for ageism and discrimination vis à vis older persons.
MENTAL HEALTH AND ADDICTIONS
“Twenty percent of seniors have treatable mental health and addiction issues, but only about two percent are being treated.”
Karen Liberman, Executive Director, Mood Disorders Association of Ontario [43]
I’m prone to depression. I ask myself why the hell am I living? What’s life all about? I’m taking a hard look at this now.
Ottawa participant
In our Forum, some participants noted that the issue of mental health and addictions had been insufficiently examined in the focus groups. It is a growing problem in the senior population. Housing workers in Thunder Bay told us they are seeing more mental health problems in senior tenants than ever before. Mental health workers admitted that they do not yet have the skills or resources to properly respond but are working to break the silence that surrounds the subject of seniors with mental health and addiction problems. For these reasons we have added this as a major category.
Since the purpose of the Health and Housing Crossroads project was to examine ways in which older people can live independently, it is important to distinguish between long-term mental illnesses and addictions, and mental health issues that arise out of the frustrations attendant on maintaining independence.
In the focus groups, participants discussed their many concerns about their ability to find, and keep, suitable housing, and the effect these concerns have on both their mental and physical health. Problems in housing that lead to depression, anxiety, and the breakdown of physical health were recognized by seniors, as well as the need for counselling services. Some of the problems identified were:
increasing difficulty coping with the activities of daily living, exacerbated by the lack of support services
coping with the tasks of aging, e.g. adjusting to retirement and to lifestyle changes
coping with the loss of spouses, family, friends, social status, pets, and physical abilities
the fear of losing one's home due to unexpected events such as illness or financial problems
problems with current housing, e.g. seniors living in social housing amongst non-seniors with drug and alcohol problems; intimidating and inappropriate behaviour of younger residents in these buildings; bullying by other seniors in seniors-only buildings
As housing and health workers pointed out to us, seniors experiencing severe mental health and addiction problems have even greater difficulty finding decent affordable housing, as opposed to long-term institutional care. One mental health professional stated, "The eviction issue is a mental health issue." [44] One of the major reasons for this is the lack of services for recognizing and dealing with problems such as:
seniors with a history of severe mental illness
seniors who have experienced mental health problems all their lives who may not have been diagnosed or treated
mental health issues that become mental health illnesses, e.g. mild depression that untreated becomes severe
seniors with addictions
homelessness as a result of these problems
Recommendations – Mental Health and Addiction Issues
1. Policies need to address the growing epidemic of both mental health and addiction issues among our nation’s senior population.
2. The federal government should launch a multi-media campaign aimed at educating the public on seniors’ difficulties with addictions and their struggles with mental health issues, and on community resources.
3. Funding is required across the country for greater housing options and increased support services for seniors with mental health issues and addictions.
4. Policies that influence caregiver support programs need to address the connection between seniors’ mental health issues and the mental health issues that caregivers also experience.
5. Education and training should be required for counselors and health care providers who work with seniors, to address the complicated mental health
6. Issues of specific groups, e.g., holocaust survivors, rape survivors, torture victims, and seniors who have been victims of hate crimes such as gay bashing and racism.
7. Policies should support harm reduction programs regarding alcohol and drug use among seniors, and education for health care workers about the availability and use of such programs.
Conclusion
“If they provided services to help keep seniors in their own homes then they wouldn’t have to be building all these long-term care facilities, you know, facilities that are costing millions and millions of dollars, and the seniors themselves would be more happy. Cause a lot of these seniors don’t want to go in to these long-term care facilities but they can’t stay in their homes either because they can’t keep them up.”
Sault Ste. Marie participant
To support seniors as they maintain their independence in chosen communities, within their own homes, or in new housing, a commitment to seniors is needed by all levels of government. With seniors' health and housing seen as priorities, funding must be channeled into the following areas: housing, pension plans for low-income people before they are seniors, home care, supportive housing services, culturally-specific programs, cultural sensitivity training throughout senior services, programs of all-inclusive care, and retirement home expansion and regulation.
Appendices
Appendix 1, Crossroads Committee Members
Appendix 2, Multicultural Survey
Appendix 3, Key Informants
Appendix 4, Outreach Suggestions
Appendix 5, Focus Group Schedule
Appendix 6, Focus Group Questions
Appendix 7, Forum Agenda
Appendix 8, Forum Sessions and Facilitators
Appendix 9, Organizations Present at the Forum
Appendix 10, Policy Day Agenda
Appendix 11, Workshop Card Method Instructions
Appendix 12, Forum Contact List
Appendix 1
Seniors’ Health and Housing Crossroads Committee
Ethel Meade - Chair
Older Women’s Network, Toronto
Don Wackley - Co-chair
Parkdale Community Health Centre, Toronto
Bea Levis
Care Watch, Toronto
Howard Watson
People and Organizations in North Toronto
Eva Kushner
Canadian Pensioners Concerned, Toronto
Ann Dorion
Individual Senior, Ottawa
Connie Delahanty
Ottawa Seniors Action Network, Ottawa
Bill Fuller
Steelworkers Organizations of Active Retirees, Chapter 10, Hamilton
Margaret Maybank
Kenora Coalition of Seniors
Marge Mintz
Downsview Healthier Living Centre, Toronto
Carol Greenlee
Older Women’s Network, Toronto
Edna Beange
Toronto Seniors’ Council
Appendix 2
Multicultural Conference
Health and Housing OCSCO Questionnaire
June 2, 2003
1. What is your current housing situation?
θ Own home/condo: 67
θ Shelter: 0
θ Currently Homeless: 1
θ Renting a room: 6
θ Renting an apartment: 38
θ Supportive housing: 10
θ Living with family: 16
θ Other: 2 co-op; renting a house _________________
2. Do you live in your current situation because of…
θ
θ Location: 89
θ Supportive services: 15
θ Close to health practitioner:8
θ Affordability: 45
θ Accessible building: 9
θ Other: ________________
4. What is most important to you in your housing?
θ
θ Location: 98
θ Price: 51
θ Staff/management: 5
θ Other ________________
5. With whom do you live?
θ
θ Partner/spouse: 46
θ By myself: 51
θ With my children: 39
θ With a roommate: 2
θ Shared accommodation: 3
θ Friend(s): 1
θ Parents: 3
θ Sibling: 1
6. What obstacles do you face when trying to get home care?
θ Cost: 29
θ Fear of discrimination: 10
θ Services not available in my language: 10
θ Lack of services: 34
θ Lack of information on available services: 18
θ My family provides home care: 8
θ My pride prevents me from asking for home care: 8
θ I don’t need home care: 84
Please continue on the back of this page
7. In what ways does your housing affect your health?
(Please check all that apply)
θ High housing costs cause financial and emotional stress: 48
θ Difficult tenants negatively affect my health: 14
θ Good housing helps my health: 58
θ My health would be better if I could afford to make my home accessible (i.e. ramps, bathroom bars, etc.): 16
θ My health needs influence where I live: 20
θ Inadequate home care interferes with my independence: 12
θ Living alone negatively affects my health: 19
θ Living alone positively affects my health: 16
θ Living with family is stressful: 11
θ Living with my family reduces my stress: 27
θ My housing does not affect my health: 53
θ Other __________________
8. Age
θ
θ 91 +: 0
θ 75 – 90: 44
θ 65 – 74: 53
θ 50 – 64: 17
θ Under 50: 24
9. Gender
θ
θ Female: 94
θ Male: 34
θ Other
10. What is your cultural/ethnic background? _____________________
If you would like to be on the mailing list of the health and housing project, please add your name to the pink contact sheet at the survey table.
Thank you very much for helping us with this survey
Enjoy the conference
Appendix 3
Key Informants
Barbara Spencer, Social Worker, Thunder Bay Family Services
Ruth Cyr, Program Coordinator, Aboriginal Circle of Life Program
Native Canadian Centre, Toronto
Michael Rachlis, MD, FRCP, critic of Canada’s health care system
Vancouver & Toronto
Kwong Y. Liu, Director of Social Services, Yee Hong Centre for Geriatric Care, Scarborough
Shaista Thanyi, Seniors Program Coordinator, South Asian Women’s Centre, Toronto
Jan Robinson, Health Planner, Toronto District Health Council
Paul Williams, Associate Professor, Health Policy, Management and Evaluation
Faculty of Medicine, University of Toronto
Heather Moore, Housing Manager, Muskoka Housing, Bracebridge
Nancy McAulay, Case Mananger, Muskoka East-Parry Sound Community Care Access Centre, Bracebridge
Ruth Robertson, Case Mananger, Muskoka East-Parry Sound Community Care Access Centre, Bracebridge
Helen Johnson, Physiotherapist/Geriatric Consultant, Windsor Regional Hospital
Kristan Miclash, Executive Director, Northwestern Independent Living Services,
Kenora
Art Mior, Director (former), Kenora Non-Profit Housing Board
Karen Liberman, Executive Director, Mood Disorders Association of Ontario
Toronto
Jean Duncan Day, Facilitator, Company of Crones, Toronto
Eileen Murphy & Kathi Samson, Co-facilitators, SAGE Program, Pink Triangle Services, Ottawa
Fern Teplitsky, Toronto District Health Council
Evelyn Theriault, Chair, Algoma Seniors Health Advisory Committee, Sault Ste. Marie
Pauline Vranesich, Vice-President, Thunder Bay Council on Positive Aging
Tina Pilon, Manager, Older Adult Centre, Sudbury
Janet Esquimaux, Property Manager, Wigwamen Terrrace, Toronto
Robert McMullan, President, Abbeyfield Houses of Canada, Toronto
Christine McMillan, Council on Aging, Frontenac-Kingston
Leslie Fell, Leslie Fell & Associates
International researcher; has studied programs of all–inclusive care; Toronto
David Hulchanski, PhD, MCIP, Director, Centre for Urban and Community Studies
Professor, Faculty of Social Work, University of Toronto
Randi Fine, Coordinator, Older Persons’ Mental Health and Addictions Network of Ontario,
Toronto
Cecile Paquette and Annette Blankmann, Health care activists, Ottawa
Carol Marchetti, Director of Client Services, Etobicoke Services for Seniors, Toronto
Frances Lankin, President and CEO, United Way of Greater Toronto
Appendix 4
Focus Group Outreach Suggestions
Seniors’ social/recreational groups
Seniors’ organizations
Church groups and ministers
Rotary clubs
Veterans’ groups
Housing organizations
Housing projects
Community and recreation centres
Organizations/groups re: people with disabilities
Ethnic and cultural groups/organizations
Lesbian, gay, bisexual, transgendered, transsexual groups/organizations
Libraries
Hospitals
Caregiver programs
Social workers
Nurses
Community workers
You may also want to place flyers in grocery stores and laundromats, or on other community bulletin boards.
Ads in local newspapers are also useful.
Getting local radio or TV shows to promote the focus groups and cover the Health and Housing project are also of great value.
Appendix 5
|Seniors Health and Housing Crossroads |
|Focus Group Schedule |
|# |Date-2003 | |Location |Ally Organization |
| 1 |Feb 5 | |PILOT-Toronto |OCSCO |
| 2 |March 19 | |Toronto |OCSCO |
| 3 |March 26 | |Kingston |Council on Aging - Frontenac-Kingston |
| | | | |President: Christine McMillan |
| 4 |May 7 | |Kenora |Kenora Coalition of Seniors |
| |May 8 | | |Margaret and John Maybank |
| 5 |June 3 | |Toronto |South Asian Women's Centre |
| | | | |Seniors Program Coordinator – Shaista Thanyi |
| 6 |June 9 | |Hamilton-Kitchener |Steelworkers Organizations of Active Retirees |
| | | | |Chapter 10, Bill Fuller |
| 7 |June 18 | |Windsor |Council on Aging - Windsor-Essex |
| | | | |Deana Johnson |
| 8 |June 23 | |Central Ontario-Muskoka |Caregivers Muskoka-Parry Sound |
| | | | |Karen Boyer |
| 9 | July 7 | |Sault Ste. Marie |Seniors’ Health Advisory Council & Seniors’ Drop-In, Sue Berger |
| 10 |July 10 | |Sudbury |Lorraine Leblanc |
| | | |Francophone |Centre de Santé Communautaire |
|11 |July 15 | |Sudbury |Older Adult Centre |
| | | |Anglophone |Manager - Tina Pilon |
|12 |Sept 24 | |Thunder Bay |Thunder Bay Council on Aging |
| | | | |President - Pauline Vranesich |
|13 |Oct 21 | |Ottawa |Centre de jour Guigues |
| | | |Francophone |Andrée Fauteux |
|14 |Oct 23 | |Ottawa |Sandy Hill Community Health Centre |
| | | |Anglophone |Abe Rosenfeld |
|15 |Oct 24 | |Ottawa |Pink Triangle Services |
| | | |GLBT |Lynne Belle-Isle |
|16 |Nov 18 | |Toronto |Native Canadian Centre | |
| | | |Aboriginal |Aboriginal Circle of Life Program | |
| | | |Elders' |Director - Ruth Cyr | |
Appendix 6
Health and Housing Crossroads Project
Focus Group Questions
1. What do you like or appreciate about your current home?
2. What don't you like about your current home?
3. Do you feel there is a connection between your health and your housing situation?
If so, please describe all the ways your health and housing may be connected.
4. What programs and services are available to seniors that you know of? Please list them.
5. What do you think about these programs and services?
6. What else could be improved or added to help seniors live where they want to live, as independently as possible?
7. (a) Do you think about where you will be living in five to ten years from now?
(b) If you do think about where you will be living in the future, where do you see yourself living?
(c) How do you think where you live will affect your health?
8. (a) Do you think governments should have a role in addressing seniors' health and
housing needs?
(b) If so, what do you think governments should be doing to address issues of seniors' health and housing?
9. How do you think seniors could be more involved in discussions around health and housing issues in order to be able to have an influence on government policy in this area?
10. Of all the health and housing issues raised in these questions, which issue is the most important to you at this time?
Appendix 7
The Ontario Coalition of Senior Citizens’ Organizations presents:
“Changing Regional Issues into
National Policies”
A Seniors’ Health and Housing Forum
Primrose Hotel, 111 Carleton Street, Toronto
Pearson Room, Second Floor
January 28th, 2004
9:30 a.m. to 4:30 p.m.
AGENDA
8:30 to 9:20 a.m. Sign in
9:20 to 9:30 a.m. Please take a seat
We will begin at 9:30 a.m. sharp!
We appreciate your promptness.
1. Welcome & Introductions (9:30-9:45 a.m.)
16. Welcome & general information
17. Review of Forum agenda
18. Purpose and expected outcomes of Forum
2. Change is Possible (9:45-10:00 a.m.)
Keynote Speaker: Frances Lankin
3. Project Presentation (10:00-10:30 a.m.) Health and Housing Project Overview
Coffee & Stretch Break (10:30-10:45 a.m.)
4. Morning Breakout Sessions (10:45-12:00)
Seven breakout groups - participants have pre-registered
19. Facilitated discussions of policy ideas
Buffet Lunch ~ 12:00 noon-1 p.m.
5. Afternoon Speaker (1:00-1:15 p.m.)
Evelyn Theriault
“Senior Success Story from Sault Ste. Marie”
6. Morning Groups Report Back (1:15-2:10 p.m.)
(Maximum 3 minutes per group - 3 key points only)
7. Afternoon Breakout Sessions (2:15-3:30 p.m.)
Six breakout groups - participants have pre-registered
20. Facilitated discussions of policy ideas
3:30-3:45 p.m. – Break
8. Report from Breakout Groups (3:45-4:15 p.m.)
(Each group is limited to 3 points & 3 minutes)
9. Evaluation of the Forum (4:15-4:30 p.m.)
10. Summary of the Forum (4:15-4:30 p.m.)
Bea Levis, former OCSCO co-chair, and Chair of Care Watch Toronto
Thank you for joining us
Appendix 8
January 28: Forum
Morning Breakout Sessions: 10:45 a.m. ~ noon
All sessions are on the second floor of the Primrose Hotel
Breakout session title, room name, and facilitator are listed below.
|Affordable Housing |Supportive Housing/Seniors- Only Housing |Transportation |Aboriginal Seniors |
| | | | |
| |MacKenzie Room | | |
|Pearson Room | | | |
| | |Pearson Room |Borden Room |
| |Jim McMinn | | |
|Howard Watson |LOFT Community | | |
|People and |Services |Karen Boyer |Ruth Cyr |
|Organizations | |Caregivers Muskoka-Parry Sound |Program Coordinator, |
|In North Toronto | | |Aboriginal Circle |
| |Notes: Dennis Wellman | |of Life Services |
|Notes: Robin Hannah | | |for Seniors |
|We appreciate your promptness at the |Accessibility |Ageism |Guiding Principles |
|workshops. | | | |
|Thank you! | | | |
| |Pearson Room |Borden Room |MacKenzie Room |
|Each workshop is 1 hour and 15 minutes | | | |
|long. |Bill Fuller |Carol Greenlee |Deana Johnson |
| |Co-chair, OCSCO, Steelworkers Organization of|Older Women’s Network |Council on Aging, |
|All facilitators are skilled volunteers |Active Retirees, Hamilton | |Windsor-Essex County |
|and we appreciate their talents. | | | |
| | | | |
| |Notes: Victoria Boon | |Notes: |
| | |Notes: Nelloi |Olufunke Akinkunmi |
Afternoon Breakout Sessions: 2:15 p.m. ~ 3:30 p.m.
All sessions are on the second floor of the Primrose Hotel
Breakout session title, room name, and facilitator are listed below.
|Housing Options 1 |Housing Options 2 |Integrated Model of Community-Elder Care |GLBT Issues |
|(includes retirement home issues) |(includes retirement home issues) | | |
| | | | |
|Borden Room |Pearson Room |Pearson Room | |
| | | | |
|Howard Watson |Margaret Watson |Ethel Meade |MacKenzie Room |
|People and |Canadian Pensioners Concerned |Chair, Seniors’ Health and Housing Crossroads| |
|Organizations | |Committee; | |
|in North Toronto | |Older Women’s Network |Diana Kucharska |
| | | |Ontario Coalition of Senior Citizens’ |
|Notes: Robin H. | |Notes: Carol Greenlee |Organizations |
|Our note-takers ensure we have |Safety and Security |Cultural and Ethnic Group Issues |Access to Information and Services |
|records of the sessions. We value| | | |
|their contribution! | | |MacKenzie Room |
| |Pearson Room |Borden Room | |
|Each forum participant brings a | | |Olufunke Akinkunmi |
|unique angle to this work! We |Dr. (Tilly) Thilagavathi Chandulal |Carolann Fernandes |Lawrence Heights Community Health Centre |
|celebrate diversity! |South Asian Women’s |Hamilton Social Planning Council | |
| |Centre | | |
Appendix 9
|# |Organizations represented at the Forum |
|1 |Algoma Seniors' Health Advisory |
|2 |Alliance of Seniors to Protect |
|3 |Arya Samaj Senior Citizens' Club |
|4 |Association of Jewish Seniors |
|5 |Barrie Community Health Centre |
|6 |Bernard Betel Centre for Creative Living |
|7 |Canada Mortgage & Housing |
|8 |Canada's Association for the Fifty Plus (CARP) |
|9 |Canadian Auto Workers Local 1973 |
|10 |Canadian Auto Workers Local 598 |
|11 |Canadian Pensioners Concerned, Ontario Division |
|12 |Care Watch Toronto |
|13 |Caregivers Muskoka/Parry Sound |
|14 |Carribean Canadian Seniors' Club |
|15 |Centre de jour Guigues |
|16 |Centre de santé communautaire |
|17 |Centre de santé francophones de Sudbury |
|18 |Centre for Addiction and Mental Health |
|19 |Centretown Community Health Centre |
|20 |Commonwealth of Dominica Association |
|21 |Community Outreach Programs in Addictions (COPA) |
|22 |Community Services, City of Mississauga |
|23 |Durham Community Care |
|24 |Faculty of Social Work, University of Toronto |
|25 |Feisty Seniors |
|26 |Flemingdon Neighbourhood Services |
|27 |Frontenac-Kingston Council on Aging |
|28 |Grandparents Requesting Access & Dignity (GRAND) |
|29 |Halton-Peel District Health Council |
|30 |Health Canada |
|31 |Hebrew Club for the Blind |
|32 |Jamaican Canadian Association |
|33 |Kenora Coalition of Seniors |
|34 |Living Well Home Care |
|35 |LOFT Community Services |
|36 |Native Canadian Centre of Toronto |
|37 |Older Adult Centre |
|38 |Older Women's Network |
|39 |Ontario Association of Non-Profit Homes & Services for Seniors |
|40 |Ontario Ministry of Health & Long-term Care |
|41 |Ontario Residential Care Association |
|42 |Ontario Seniors' Action Network (OSAN) |
|43 |Peel Health |
|44 |Peel Housing & Property |
|45 |Peel Senior Link |
|46 |Providence Centre |
|47 |Punjabi Community Health Centre |
|48 |SAGE Ottawa |
|49 |Sandy Hill Community Health Centre |
|50 |Seniors' Secretariat |
|51 |Social Planning & Research Council |
|52 |South Asian Seniors |
|53 |South Asian Women's Centre |
|54 |Steelworkers' Organization of Active Retirees, 10 |
|55 |Thunder Bay Council on Positive Aging (COPA) |
|56 |Toronto Seniors' Council |
|57 |Toronto Tamil Seniors' Association |
|58 |Windsor Regional Hospital, Western Campus |
|59 |Windsor-Essex Council on Aging |
Appendix 10
The Ontario Coalition of Senior Citizens’ Organizations presents “Changing Regional Issues into National Policies”
Writing Policy Recommendations
Primrose Hotel, Mackenzie Room, Second Floor
9:30 a.m. to 3:30 p.m., January 29th, 2004
8:00-9:30 a.m. – Continental Breakfast
(Note: Facilitators meet at 8:30 a.m. for planning session)
AGENDA
Moderator: John Corless, Management Advisory Services
1. Welcome & Introductions (9:30-10:00 a.m.)
Welcome
Review agenda & process
What is a policy recommendation: ways in which recommendations can be used
Purpose and expected outcomes of the day
Goal is to write 13-55 policy recommendations,
i.e., up to 5 recommendations from each of the 13 groups (They can be made more whole, or brought together into fewer recommendations, as report is written)
2. Small Group Work (10:00-11:00 a.m.)
Seven groups of five people write recommendations
Break 11:00 a.m. – 11:15 a.m.
3. Large group feedback (11:15-11:45 a.m.)
Five minutes per group (group spokesperson reads recommendations, and larger group gives feedback)
4. Note Suggested Changes (11:45-noon)
Each group notes suggested changes on flipcharts
Lunch ~ Noon-1:00 p.m.
5. Afternoon welcome (1:00-1:15 p.m.)
6. Small Group Work (1:15-2:15 p.m.)
Six groups of five people write recommendations
7. Large group feedback (2:15-2:45 p.m.)
Five minutes per group (group spokesperson reads recommendations, and large group gives feedback)
Break 2:45 - 3:00 p.m.
8. Note Suggested Changes (3:00-3:15 p.m.)
Each group notes suggested changes on flipcharts
9. Evaluation & Summary (3:15-3:30 p.m.)
With OCSCO Co-chair, Eva Kushner
Thank you for your participation
Appendix 11
Hello Everyone!
Hope you are all excited about the forum. This memo is in regards to the “Policy Recommendation Writing Day”, January 29th.
Please note:
Meeting for All Facilitators
Thursday January 29th, 2004 - Primrose Hotel
Second Floor, Mackenzie Room
8:30 a.m. to 9:30 a.m
Topic: “Workshop Card Method of Facilitation”
Facilitator: John Corless, Management Advisory Service
(A continental breakfast will be available from 8:00-9:00 a.m.
in the Borden Room; you may bring your food to this meeting)
John will guide us in the “Workshop Card” method of facilitation, which will help us to write focused policy recommendations.
The method begins with a brainstorming and/or a review of policy ideas, and then goes into a focused writing exercise. The following are some points John will cover.
See you there!
John’s Points on the Workshop Cards Method:
A focus question provides a concrete starting point for the people involved in the team.
A focused conversation helps all parties understand the question.
The ideas are brainstormed and organized in the following way:
• The group writes down ideas on cards. One idea per-card.
• Members are asked for their first two ideas and these are collected from the group by the facilitator.
• The group decides whether there are any pairs of ideas that would naturally belong together due to their relatedness.
• The facilitator begins to place the ideas in pairs that the group has matched.
• The remainders of the ideas are considered in the same way and the facilitator places them appropriately to form clustered groups of ideas.
• Once the clusters are completed each one is given a title that reflects the main thrust of the ideas within it.
• All of the titles then form a summary of the ideas that they represent.
• These titles may further be organised in such a way that a statement may be constructed that represents all of the titles.
Here is a summarising example for cluster titles into a statement:
There was a main focus question that was posed at the beginning of the day:
What are we going to do about fundraising during the next twelve months?
Lots of ideas were produced that needed to be organised and summarised.
The ideas were grouped into clusters were they shared some common relationship.
Those clusters were then given a title.
The titles reflected the main thrust of the content of each cluster and were later placed in an order that the organisation could naturally understand and one that could communicate a message of the direction that the organisation wanted to pursue as follows:
|Cluster titles |Natural order |
|It must be fun and rewarding |1 |
|Our attitude matters to the changes funding makes|2 |
|We need to know whom are the funders |3 |
|We need to know how to get the funders attention |4 |
|We need to raise our awareness of our profile |5 |
| | |
The answer to the focus question produced was:
We are going to make it fun and rewarding with the right attitude to the changes fundraising makes. We are going to know whom the funders are and how we can get their attention and we are going to raise awareness of our profile.
Appendix 12
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Additional References for Aboriginal Issues:
1. Peter Montague, "#671 - Columbus Day, 1999," Rachel's Environment & Health News, Environmental Research Foundation, at:
2. Bartolome de las Casas, "The devastation of the Indies: A brief account," Johns Hopkins University Press, (1992). Read reviews or order this book safely from online book store. (Cited in Ref. 1)
3. Barry Lopez, "The Rediscovery of North America: The Thomas D. Clark lectures," University Press of Kentucky, (1990). Read reviews or order this book. (Cited in Ref. 1)
4. David E. Stannard, "American Holocaust: Columbus and the Conquest of the New World," Oxford University Press, (1992). Read reviews or order this book. (Cited in Ref. 1)
5. Hans Koning, "The conquest of America: How the Indian nations lost their continent," Monthly Review Press, (1993). Read reviews or order this book. (Cited in Ref. 1)
6. Ward Churchill, "A Little Matter of Genocide: Holocaust and Denial in the Americas, 1492 to the Present," City Lights Books, (1998). Read reviews or order this book. (Cited in Ref. 1)
7. Leah Trabich, "Native American Genocide still haunts United States," An End to Intolerance, Vol. 5, 1997-JUN, at:
8. "Natives, North American," , at:
9. James Craven, "Docs. on Native American Genocide," at:
10. Anon, "The history of Indian and European scalping," 2002, PageWise, Inc., at:
11. "Gold, Greed & Genocide: The untold impacts of the Gold Rush on native communities and the environment," Project Underground, at:
12. "Gold, Greed & Genocide," Project Underground, at:
13. Carmen Bernand, "The Incas: People of the Sun (Discoveries)," Harry N Abrams, (1994). Read reviews or order this book.
Appendix 13
Forum Participants - Contact List
Raymond Applebaum Patrick Ashwin
Peel Senior Link 1504 - 1140 Bloor Street
30 Eglinton Ave. West Toronto, ON M6H 4E6
Mississauga, ON L5R 3E7 (416) 588-2023
(905) 712-4413 patashwin@
ray@
Fred Balasingham Treasurer, Nidhan Singh Banwait OCSCO
OCSCO board
22 Crayford Drive South Asian Seniors
Scarborough, ON M1W 3B6 6 Newman Court
(416) 498-1491 Brampton, ON L6S 5T1
(905) 456-1428
Jennifer Barr Wally Baumgartner
Centre for Addiction and Mental 1013 Victoria Park Avenue
Health Toronto, ON M4B 2J7
P.O. Box 760 (416) 285-9399
Almonte, ON K0A 1A0 waltra@
(613) 256-1397
Jennifer_Barr@
Edna Beange Audrey Beck
404 - 1387 Bayview Avenue Barrie Community Health Centre
Toronto, ON M4G 3A5 2377 Goodfellow Ave.
(416) 482-9355 Innisfil, ON L9S 3X2
ebeange@ (705) 436-1987
Jerry Berman Sarah Bogoroch
Vice-president, OCSCO Association of Jewish Seniors
30 Elm Avenue 19 Cheval Drive
Toronto, ON M4W 1N5 Toronto, ON M3B 1RS
(416) 925-6715 (416) 444-5190
jerry.berman@sympatico.ca
Sandy Bokser Karen Boyer
Association of Jewish Seniors Caregivers Muskoka/Parry Sound
TH6, 1329 Steeles Ave. W. 98 Pine Street
Toronto, ON M2R 3N3 Bracebridge, ON P1L 1N5
(416) 736-8073 (705) 646-7677
caregive@
Jane Brackley Joan Brooks President
Ministry of Health & Long-term Care Grandparents Requesting Access &
7th floor, 415 Yonge St. Dignity (GRAND)
Toronto, ON M5B 2E7 134 Rhodes Avenue
(416) 314-0064 Toronto, ON M4L 3A1
jane.brackley@.on.ca (416) 469-5471
Cheryl Burns Hervé Casault
Peel Health 1493, rue Maxime
9445 Airport Road Ottawa, ON K1B 4E7
Brampton, ON L6S 4J3 (613) 741-2201
(905) 791-7800 hcasault@
cheryl.burns@region.peel.on.ca
Dr. Tilly Chandulal Charlotte Chiu
South Asian Women's Centre LOFT Community Services
301 - 280 Wellesley Street E. 227A Crawford Street
Toronto, ON M4X 1G7 Toronto, ON M6J 2V5
(416) 413-9431 (416) 537-3477
tchandulal@
Patricia Chrisjohn Lorne Coe
Peel Housing & Property Seniors' Secretariat
5 Wellington St. East 6th floor, 77 Wellesley St. W.
Brampton, ON L6W 1Y1 Toronto, ON M7A 1R3
(905) 791-7800 (416) 314-2534
pat.chrisjohn@region.peel.on.ca lorne.coe@.on.ca
Bess Coopersmith Ruth Cyr
Association of Jewish Seniors Native Canadian Centre of Toronto
143 Dell Park 16 Spadina Road
Toronto, ON M6B 2V4 Toronto, ON M5R 2S7
(416) 783-3206 (416) 964-9087
ruth_cyr@ncct.on.ca
Martha Dallaire Jill Davies
Association of Jewish Seniors Ontario Residential Care Assoc.
508 - 31 Four Winds Drive 218 - 2155 Leanne Blvd.
Toronto, ON M3J 1K9 Mississauga, ON L5K 2K8
(416) 650-5782 (905) 403-0500
jilldavies@orca-
Connie Delahanty OCSCO board Dillys Dix
Ontario Seniors' Action Network Toronto Seniors' Council
(OSAN) 201 - 169 Berry Road
103 - 470 Laurier Ave. W. Toronto, ON M8Y 1W6
Ottawa, ON K1R 7W9 (416) 259-9435
(613) 594-0217
c.delahanty@sympatico.ca
Ann Dorion Secretary, OCSCO Paul Dowling Ontario Association
506 - 1725 Riverside Drive of Non-Profit Homes & Services for
Ottawa, ON K1G 0E6 Seniors
(613) 526-0327 Ste. 700, 7050 Weston Rd.
Woodbridge, ON L4L 8G7
(905) 851-8821
pdowling@
Reta Duenisch-Turner Jean Duncan-Day
Bernard Betel Centre for Creative 901 - 460 Jarvis Street
Living Toronto, ON M4Y 2X8
401 - 6101 Bathurst Street (416) 925-1466
North York, ON M2R 3V5
(416) 250-8230
Janine Earl Maria Egervari
LOFT Community Services LOFT Community Services
661 Dufferin Street 102 - 245 Dunn Avenue
Toronto, ON M6K 2B3 Toronto, ON M6K 1S6
536-2761 x 228 (416) 537-0001
megervari.dunnave@
Elizabeth Esteves Robert Eves
Seniors' Secretariat Community Outreach Programs in
6th floor, 77 Wellesley St. W. Addictions (COPA)
Toronto, ON M7A 1R3 407 - 27 Roncesvalles Ave.
(416) 326-7064 Toronto, ON M6R 3B2
elizabeth.esteves@.on.ca 516-2982 x 224
director@copacommunity.ca
Andrée Fauteux Carolann Fernandes
Centre de jour Guigues Social Planning & Research Council
159, rue Murray 95 Grey Friar Drive
Ottawa, ON K1N 5M7 Hamilton, ON L9C 4S4
(613) 241-4070 (905) 389-0017
andree_fauteux@
Daphne Fletcher Bill Fuller Co-chair, OCSCO
Ottawa Seniors' Action Network Steelworkers' Organization of
408 - 258 Lisgar Street Active Retirees, 10
Ottawa, ON K2P 0C9 28 Edgemont St. North
(613) 567-4112 Hamilton, ON L8H 4C9
(416) 530-0980
Ben Goldmintz OCSCO board Fran Gower
Association of Jewish Seniors R.R. 1, 3171 Hwy 60
44 Raeburn Ave. Dwight, ON P0A 1H0
Downsview, ON M3H 1G8 (705) 635-1229
(416) 636-6717 fgower@vianet.on.ca
Carol Greenlee Rev. Clare Hart
Older Women's Network LOFT Community Services
1 - 649 Indian Rd. 1502 - 245 Dunn Avenue
Toronto, ON M6P 2C8 Toronto, ON M6K 1S6
(416) 762-6876 (416) 537-5817
clarehart@sympatico.ca
Donna Heughan Louise Hewitt
Ministry of Health & Long-term Care LOFT Community Services
10th floor, 415 Yonge St. 661 Dufferin Street
Toronto, ON M5B 2E7 Toronto, ON M6K 2B3
(416) 314-3400 (416) 913-8540
donna.heughan@.on.ca
Debbie Humphreys Ontario Helen Johnson
Association of Non-Profit Windsor Regional Hospital, Western
Homes & Services for Seniors Campus
1453 Prince Road.
Ste. 700, 7050 Weston Rd. Windsor, ON N9C 3Z4
Woodbridge, ON L4L 8G7 (519) 257-5111
(905) 851-882 hjohnson@wrh.on.ca
dhumphreys@
Deana Johnson Judith Jordan-Austin OCSCO
Windsor-Essex Council on Aging Care Watch Toronto
1168 Drouillard Ave. 209 - 350 Lonsdale Avenue
Windsor, ON N8Y 2R1 Toronto, ON M5P 1R6
(519) 971-9217 (416) 483-2030
Anne Keown Marda King
Providence Centre Native Canadian Centre of Toronto
32 Douville Court 16 Spadina Road
Toronto, ON M5A 4E7 Toronto, ON M5R 2S7
759-9321, x 4038 (416) 964-9087
annekeown@providence.on.ca
Eva Kushner Co-chair, OCSCO Gertrude Lapointe
Canadian Pensioners Concerned, 4 - 525 boul. St. Laurent
Ontario Div. Ottawa, ON K2K 2Z9
63 Albany Avenue (613) 749-3159
Toronto, ON M5R 3C2 glapointe@
(416) 538-0173
eva.kushner@utoronto.ca
Lorraine LeBlanc Livia Lebovic
Centre de santé communautaire Alliance of Seniors to Protect
19 Frood Road 128 Dalemount Avenue
Sudbury, ON P3C 4Y9 Toronto, ON M6B 3C9
(705) 670-2158 (416) 783-5796
leblancl@ llebo@sprint.ca
Magda Lenartowicz Bea Levis
Living Well Home Care Care Watch Toronto
212 Caroline Street South 54 The Queensway
Hamilton, ON L8P 3L4 Toronto, ON M6S 1A3
(905) 524-3306 (416) 767-8296
magda@
Carol Libman Sandra MacLeod
Canada's Association for the Fifty Health Canada, Jeanne Mance
Plus (CARP) Building
1304 - 27 Queen St. E. Room B1847
Toronto, ON M5C 2M6 Ottawa, ON K1A 0K9
(416) 363-8748 (613) 941-5217
clibman@ Sandra_MacLeod@hc-sc.gc.ca
Margaret Maybank OCSCO board Eva Mazerolle
Kenora Coalition of Seniors Centre de Santé Francophones de
10 Second Ave. W. Sudbury
Kenora, ON P9N 3S9 4590, rue Lafontaine
(807) 468-1862 Hanmer, ON P3P 1K6
maybank@kmts.ca (705) 969-5176
eva.mazerolle@sympatico.ca
Fay McCorkell OCSCO board Brian McDonald OCSCO board
Durham Community Care Cdn. Auto Workers Local 598
68 Resolute Crescent 4226 Theresa Avenue
Whitby, ON L1P 1G2 Hanmer, ON P3P 1N4
(905) 668-9675 (705) 969-3802
fmccorkell@
Thelma McGillivray OCSCO board Stephanie McKay
Older Women's Network 708 - 1093 Kingston Rd.
3238 Sprucehill Ave. Toronto, ON M1N 4E2
Burlington, ON L7N 2G8 (416) 690-6500
(905) 639-0447 mckaystephanie@
Christine McMillan President Jim McMinn
Frontenac-Kingston Council on Aging LOFT Community Services
17 Byron Crescent 661 Dufferin Street
Kingston, ON K7M 1H6 Toronto, ON M6K 2B3
(613) 549-3126 (416) 536-2761
jmcminn@
Ethel Meade Gail Miller
Older Women's Network SAGE Ottawa
1206 - 115 The Esplanade 305 - 57 Bayswater Avenue
Toronto, ON M5E 1Y7 Ottawa, ON K1Y 2E8
(416) 363-1289 (613) 761-5726
Gethosp@
Marge Mintz Beryl Louise Morrison
510 - 623 Finch Ave. West 59 Barnwell Drive
Toronto, ON M2R 3B4 Scarborough, ON M1V 1Z1
(416) 630-5049 (416) 297-0596
marge@eol.ca
Henk Mulder Donna Munro
205 - 325 Bogert Ave. Centretown Community Health
Willowdale, ON M2N 1L8 169 Hinton Avenue
(416) 229-1690 Ottawa, ON K1Y 0Z9
(613) 233-2317
dmunro@
Eileen Murphy Amy Nelson OCSCO board
SAGE Ottawa Carribean Canadian Seniors' Club
122 Glamorgan Dr. 79 Allingham Gardens
Kanata, ON K2L 1R4 Toronto, ON M3H 1X9
(613) 836-4670 (416) 636-9577
murphyem@
Ed Nera Sheila Neysmith
Canada Mortgage & Housing Faculty of Social Work, U of T
700 Montreal Road 246 Bloor Street West
Ottawa, ON K1A 0P7 Toronto, ON M5S 1A1
(613) 748-2810 (416) 978-3268
enera@cmhc-schl.gc.ca sheila.neysmith@utoronto.ca
Kamlesh Oberai Marlene Osbourne President
Arya Samaj Senior Citizens' Club Commonwealth of Dominica Assoc.
513 - 20 Sanderling Place 18 Maplewood Avenue
Toronto, ON M3C 3Z5 Hamilton, ON L8M 1X6
(416) 386-0780 (905) 549-4931
authentic2all@
Cecile Paquette Helen Parker
Annette Blankmann Native Canadian Centre
3 Basin Court 16 Spadina Road
Ottawa, ON K2H 8P2 Toronto, ON M5R 2S7
(613) 596-4099 (416) 964-9087
cpab@magma.ca
Linda Pataki Jacqueline Payne
Feisty Seniors Health Canada, Jeanne Mance
2 - 14 Flemingdon Road Building
Toronto, ON M6A 2N7 Room C865, AL1908C
(416) 785-8894 Ottawa, ON K1A 1B4
(613) 257-2155
Jacqueline_Payne@hc-sc.gc.ca
Anne pPeters Tina Pilon Manager
Frontenac-Kingston Council on Aging Older Adult Centre
49 - 258 Queen Mary Road 140 Durham St.
Kingston, ON K7M 2B2 Sudbury, ON P3E 3M7
(613) 544-0067 (705) 673-6227
apeters40@cogeco.ca tina.pilon@city.greatersudbury.on.ca
Jane Richardson Sophie Richmond
Halton-Peel District Health Council Hebrew Club for the Blind
600 - 6711 Mississauga Rd. 1005 - 7 Bishop Avenue
Mississauga, ON L5N 2W3 Toronto, ON M2M 4J4
(905) 814-5995 (416) 226-5855
jane@
Abe Rosenfeld Patrick Roulstone
Sandy Hill Community Health Centre Ministry of Health
211 Nelson Street 10th floor, 415 Yonge St.
Ottawa, ON L1N 1C7 Toronto, ON M5B 2E7
(613) 730-1845 (416) 326-5042
arosenfeld@sandyhillchc.on.ca patrick.roulstone@.on.ca
Kathi Sansom Parameswari Selvadurai
SAGE Ottawa 307 - 20 West Lodge Ave.
122 Glamorgan Dr. Toronto, ON M6K 2TA
Kanata, ON K2L 1R4 (416) 535-7631
(613) 836-4670
ksansom@
Mul Raj Sethi OCSCO board Sam Shapero OCSCO board
Arya Samaj Senior Citizens' Club Association of Jewish Seniors
25 Spadina 23 Shelborne Avenue
Richmond Hill, ON L4B 2Y2 Toronto, ON M5N 1Y8
(905) 737-8380 (416) 487-7803
sethimr69@
Evelyn Shulman Jessie Silver
Association of Jewish Seniors Association of Jewish Seniors
406 - 10 Shallmar Blvd. 198 Torresdale Avenue
Toronto, ON M5N 1J4 Toronto, ON M2R 3E6
(416) 787-0873 (416) 667-9935
Diana Simpson Rupinder Singh
Community Services, City of Punjabi Community Health Centre
Mississauga 519 Melita Crescent
4th floor, 300 City Centre Dr. Toronto, ON M6G 3X9
Mississauga, ON L5B 3C1 (416) 533-5644
(905) 615-3608
diana.simpson@mississauga.ca
Jeyadevi Sivagurunathan OCSCO Roberta Skanks
board Native Canadian Centre of Toronto
Toronto Tamil Seniors' Association 510 - 600 Eglinton Ave. W.
419 - 240 Wellesley St. E. Toronto, ON M5N 1C1
Toronto, ON M4X 1G5 (416) 482-9295
(416) 928-9671
ttsa@
Valerie Smith Norm Taylor OCSCO board
15 - 80 Lawton Blvd. Cdn. Auto Workers Local 1973
Toronto, ON M4V 2A2 2240 Kevin St.
(416) 487-0327 Windsor, ON N93 2W4
(519) 250-1200
caw1973retirees@
Shaista Thanyi Evelyn Theriault Chair
South Asian Women's Centre Algoma Seniors' Health Advisory
1332 Bloor St. W. 22 Grand Blvd.
Toronto, ON M6H 1P2 Sault Ste. Marie, ON P6B 1R7
(416) 431-4847 (705) 254 3395
shaistat@ evelyn.theriault@sympatico.ca
Thomas Tilbrook Thanga Velumylum
R.R. 1 Flemingdon Neighbourhood Serv.
Mountain Grove, ON K0H 2E0 704 - 48 Glenoble Drive
(613) 335-2596 Toronto, ON M3C 1C9
(416) 429-0102
Pauline Vranesich President Don Wackley
Thunder Bay Council on Positive 405 - 240 Dunn Avenue
Aging (COPA) Toronto, ON M6K 3K6
379 Erle Street (416) 530-0980
Thunder Bay, ON P7A 1N8
(807) 683-8138
Colin Wasacase Miriam Watkins
Kenora Coalition of Seniors Jamaican Canadian Association
Box 702 A8 - 231 Vaughan Road
Keewatin, ON P0X 1C0 Toronto, ON M6C 2M9
(807) 547-2653 (416) 656-0184
cwasacase@kmts.ca
Howard Watson Dennis Wellman
Canadian Pensioners Concerned, LOFT Community Services
Ontario 227A Crawford Street
15 Elmsthorpe Ave. Toronto, ON M6J 2V5
Toronto, ON M5P 2L5 537-3477 x 222
(416) 481-8323 dwellman.jgibson@
howard.watson@sympatico.ca
Reta White Norma Wilcox
LOFT Community Services 112 Brooklyn Avenue
503 - 661 Dufferin St. Toronto, ON M4M 2X5
Toronto, ON M6K 2B3 (416) 469-5838
Doreen Worden Krin Zook
452 Rabbit Lake Rd., RR 2 90 Milverton Blvd.
Kenora, ON P9N 3W8 Toronto, ON M4J 1T8
(807) 548-2212 (416) 462-2856
-----------------------
[1] - Liberal Task Force Report, Liberal Task Force on Seniors, February 2004, p. 15;
- Hollander & Chappell, “Final Report of the National Evaluation of the Cost-Effectiveness of Home Care,” Health Canada,
August 2002, p. xii.
[2] Toronto Disaster Relief Committee website, .
[3] Carol Marchetti, key informant interview, Toronto, 2002; see Appendix 3.
[4] - Chris Sarlo, Fraser Forum, online newsletter,
fraserinstitute.ca/admin/books/chapterfiles/Poverty%20Among%20Seniors%20in%20Canada-Feb04ffsarlo.pdf
- Canadian Pensioners Concerned, CPC Viewpoint, online newsletter,
canpension.ca/pages/archives/june03/poverty.html
- Canadian Council on Social Development, “Highlights: the Canadian Fact Book on Poverty 2000,”
sd.ca/pubs/2000/fbpov00/hl.htm
- “Interim Report Card: Seniors in Canada, 2003,” National Advisory Council on Aging, p. vii.
[5] Key informant interview, Toronto, 2000.
[6] “Change is Possible,” speech, Health and Housing Crossroads Forum, Toronto, 2004.
[7] Scott Simmie and Julia Nunes, The Last Taboo, McLelland & Stewart Ltd., Toronto, 2001, p. 285.
[8] - Liberal Task Force Report, Liberal Task Force on Seniors, February 2004, p. 15;
- Hollander & Chappell, “Final Report of the National Evaluation of the Cost-Effectiveness of Home Care,” Health Canada,
August 2002, p. xii.
[9] Carolann Fernandes, key informant interview, Hamilton, 2004; see Appendix 3.
[10] Toba Bryant, “The Current State of Housing in Canada as a Determinant of Health,” Policy Options, 24:52-6, March 2003,
p. 54.
[11] - Chris Sarlo, Fraser Forum, online newsletter, Fraser Institute.
- Canadian Pensioners Concerned, CPC Viewpoint, online newsletter.
- Canadian Council on Social Development, “Highlights: the Canadian Fact Book on Poverty 2000.”
- “Interim Report Card: Seniors in Canada, 2003,” National Advisory Council on Aging.
[12] Scott Simmie and Julia Nunes, The Last Taboo, McLelland & Stewart Ltd., 2001, p. 285.
[13] “Challenges of an Aging Society,” National Advisory Council on Aging, 1999, p. 4.
[14] Carol Marchetti, key informant interview, Toronto, 2002.
[15] Key informant interview, Toronto, 2002; see Appendix 3.
[16] Key informant interview, Ottawa, 2004; see Appendix 3.
[17] “Habitat - A National Seniors Housing Consultation,” One Voice – the Canadian Seniors Network, 1989, p. 19.
[18] TDRC website, .
[19] City of Toronto: Seniors – Facts, website city.toronto.on.ca/seniors/facts/htm
[20] Kerry Gillespie, “Housing cash welcome, more needed,” Toronto Star, February 27, 2003
[21] Aging with Dignity? How Governments Create Insecurity for Low-Income Seniors, August 2001. Daily Bread Food
Bank and the North York Harvest Food Bank’s annual survey.
[22] Speech, Toronto, 2001.
[23] Michael Rachlis, M.D., key informant interview, Toronto, 2002; see Appendix 3.
[24] “State of the Disaster, Winter 2000,” TDRC report, p. 13.
[25] “State of the Disaster, Winter 2000,” TDRC report, p. 12.
[26] Nick Falvo, “Canada’s shameful rate of homelessness linked to social housing,” Canadian Centre for Policy Alternatives,
CCPA Monitor, 2003, p. 13.
[27] TDRC website.
[28] Liberal Task Force Report, p. 11-12.
[29] Key informant interview, Toronto, 2004; see Appendix 3.
[30] Michael Rachlis, key informant interview, 2002.
[31] Liberal Task Force Report, p. 13.
[32] Michael Rachlis, key informant interview, 2002.
[33] Marcus Hollander, Unfinished Business: The Case for Chronic Home Care Services, A Policy Paper, August 2003.
[34] Dignity, Independence, Participation, Fairness, and Security.
[35] The overwhelming majority of family caregivers are women - wives, daughters, daughters-in-law. In the case of elderly
spouses caring for one another, the premature breakdown of such caregivers’ health is an unrecognized additional cost to
the health care system.
[36] Liberal Task Force Report, p. 14.
[37] R.A. Malatest & Associates Ltd., “Planning for Canada’s Aging Population,” 2003, p. 20.
[38] Amstrong-Esther Christopher, “Health and Social Needs of Native Seniors,” Writings in Gerontology, Advisory Council on
Aging, 1994.
[39] In Touch, vol. 9, no. 1, publication of NIICHRO, Kahnawake, 1999, p. 3.
[40] Health Canada, “A Guide to End-of-Life Care,” University of Toronto and University of Ottawa, 2000, p. 7.
[41] In Touch, p. 3.
[42] Liberal Task Force Report, p.17-18.
[43] Key informant interview, Toronto, 2004; see Appendix 3.
[44] Randi Fine, key informant interview, Toronto, 2004; see Appendix 3.
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