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OUR NATIONS' ELDERS SPEAK
Building A Supportive Social Environment
by Susan Judith Ship
with the assistance of
Reaghan Tarbell[Unwanted Social Isolation]
[Inuit and Ethnocultural Minority Communities Underutilize Formal Supports]
[Access to Information on Seniors Programs and Services]
[Important Services and Programs Encompass]
[Barriers to Elders’ Access to Information]
[Housing for Elders]
[Phases of the Continuum of Care within the Community]
[Social and Recreational Activities for Elders]
[Building a Supportive Social Environment]
Unwanted Social Isolation
Unwanted social isolation occurs when elders have difficulty accessing needed health, social or other supports which would enable them to live independently in their normal environment and must leave their home and/or community because they can no longer care for themselves. Unwanted social isolation also occurs when elders experience a narrowing of social relationships, have few opportunities for meaningful social interaction with family, friends, neighbours and other community members as well as few opportunities for social and recreational activities.
At the most advanced stages of life, many elders are confronted with a series of events that lead to isolation such as the death of a spouse, friends or acquaintances, geographic separation from children and physical handicaps that limit their ability. Those who are homebound because of illness are particularly isolated.
Widowed persons may be in especially lonely and isolated situations complicated by language barriers, lack of transportation and other types of problems. Some immigrant elders may not have had the opportunity in their middle years to establish social networks and may not have formed relationships, which would sustain them throughout the years.
Seniors who have moved to another city to be near their children may find that their families cannot fulfill all their social needs.
Ageing in Place, with Respect and with Dignity
This is the process by which a person remains in his or her living environment despite the physical and/or mental decline that may accompany the ageing process." Continuity in important features of lifestyle, social relationships and attitudes are central to elders’ perception of their well-being. Therefore, housing and other health and supports should be designed to help elders maintain continuity in their lives and according to their priorities. As elders wish to remain in their existing homes in their communities, moving to a special care facility, particularly if it is located outside the community, should be a last resort. Elders’ housing needs should be linked to the provision of a range of integrated support services which would allow them to function independently and interdependently for as long as possible.
The problems to "ageing in place" in northern and remote First Nations and Inuit communities are quite different from those in large urban centres and require culturally appropriate solutions. Aboriginal elders come from large extended families that traditionally took care of their needs in old age. There is greater resistance to institutionalization of elders outside the community and the creation of age-segregated housing units, which are viewed as incompatible with cultural norms. At the same time, out-migration of family members as a result of deteriorating socio-economic conditions, coupled with the limited range of health, home and other supports makes it very difficult for elders, requiring increased levels of care, to remain in their homes and communities.
Migration to Canada, for many Ethnocultural Minority elders, has meant a loss of extended family and community networks. In many cultures, children took care of parents in old age but family support systems are changing. There is and will be a greater acceptance of institutional care for elders in ethnic-specific homes for the aged as a result of the process of acculturation to the current dominant Canadian norms and its impact on the traditional immigrant and ethnic family structure as well as economic pressures. The varied needs of many Ethnocultural Minority elders are often unmet in rural and large urban centres as formal supports are geared to the dominant culture. Available services from ethnocultural organizations are uneven, with elders from more recently arrived communities or from communities with fewer resources and those living in rural areas being the most disadvantaged.
Social support systems may be formal or informal as well as include personal support services required by elders to remain in their homes and communities. Social supports offer opportunities for socializing, enable elders to cope with daily living tasks and provide assistance in times of illness or crisis. Family, friends and neighbours make up the informal support system.
Families are the basis of informal supports and constitute the most important caregivers for First Nations, Inuit and Ethnocultural Minority elders, although the family support patterns in Ethnocultural Minority communities are more complex. Aboriginal elders receive more assistance from informal networks than from formal agencies as opposed to mainstream Canadians.
Formal supports include the range of community and institutional services. Elders from First Nations, Inuit and Ethnocultural Minority communities underutilize formal supports because:
- they are often geared to the dominant culture
- inability or difficulty speaking English or French
- different cultural attitudes towards accepting assistance
- lack of transportation
- services may not exist, particularly in remote and northern Aboriginal communities
- some elders may not wish to participate in services outside their local community
- some elders may be more comfortable with services provided by Ethnocultural or Aboriginal organizations
Access to Information on Seniors Programs and Services:
Unwanted isolation and a diminished quality of life occur when elders experience difficulty accessing information on programs and services designed to improve their quality of life and enhance their capacity for independent living. Aboriginal elders, both on and off reserve, generally have limited knowledge of federal programs and services, which they identified as important to them. Their families and community caregivers may often be unaware of the full range of services and programs that are available. Ethnocultural Minority elders also have limited knowledge of federal programs and services for seniors, although they may be more aware of services provided by Ethnocultural organizations.
Important Services and Programs Encompass:
health care and health-related services
annuities and other forms of assistance
Barriers to Elders’ Access to Information Include:
* the inability or difficulty in speaking and / or reading English or French * cultural barriers * inadequate publicity of resources * inappropriate ways of publicizing programs and services by agencies * poor eyesight * inability to get around due to mobility or transportation problems or weather * lack of knowledge of programs and services among immigrants in general
Ways to Improve Access
- Translate existing pamphlets into Aboriginal and Ethnocultural Minority languages.
- Produce pamphlets detailing information on what is available and distribute to elders through members of ethnocultural organizations or Band councils and Health Centres.
- Hold information sessions for elders, their families and community workers.
- Use personal contact such as telephones and face-to-face contact more frequently.
- Use the ethnic and /or community-based media such as newspapers, television and radio.
- Set up services to assist elders in the collection of needed documents and in the filling out of forms.
"Continuum of Care within a Community": Housing for Elders
This concept was developed to meet the challenges of accommodating the needs of elders in northern and remote First Nations and Inuit communities and assisting them in remaining independent and autonomous in the community for as long as possible; close to family, friends and neighbours. It is an elastic concept, which can be adapted to meet the needs of Ethnocultural Minority elders in metropolitan, urban or rural areas. It refers to "the progression from completely independent living in the community to very dependent living in a long term care facility as well as all the appropriate housing options and interconnected health home and social support services linked to every stage of that progression."
Phases of the Continuum of Care within the Community:
Phase 1: Basic entitlements. Ensure that elders access their basic entitlements to health care, income and housing as well as basic information and referral services - the point of entry into "the continuum of care."
Phase 2: Home Support Services. Homeowners or adults living on their own may require assistance in carrying out daily living activities. Funded and administered at the provincial level, homemaker services are the most basic and the most widely used. They vary by community but usually include meal preparation, light cleaning, housekeeping, laundry, assistance with bathing and dressing and in northern and remote areas, hauling water and chopping wood. Other home supports include meals-on-wheels, volunteer driving service, shopping, yardwork, home repairs and friendly visiting, which could be provided by Band councils, voluntary organizations or volunteers.
Phase 3: Coordinated Home Care Program. Funded by provincial or territorial agencies, this program is operated primarily out of the Health Centres in First Nations and Inuit communities. Regional Health Boards’ staff administer the program and coordinate the package of services required by the individual.
The package of services can include nurses, homemakers and handypersons as well as occupational, speech and physiotherapy services operated as outreach programs from hospitals.
Other support services include an Adult Day Care Program, which supports independent living for frail elders over 80. The program usually provides a nutritious meal in a social setting, opportunities for socializing and peer group activities in a supportive setting. This may be operated out of a hospital, community centre, voluntary organization, home for the aged or ethnocultural centre. Respite care is a planned short-term stay for an elder in a personal care home or hospital to provide relief for the family caregiver.
Phase 4: Service Enriched Housing Projects. These may be ethnically specific or ethnically neutral. Located in rural, urban or major metropolitan areas and linked to formal agencies, they provide coordinated services to elders in housing projects, allowing them to maintain their independence, autonomy, dignity, culture and community identity.
Services include transportation, meals, monitoring, social and recreational activities which are provided by agencies, volunteers, families, community-based organizations or elders themselves for a modest fee.
Phase 5: Institutional Care in the Community. There is a growing movement toward building multi-level care facilities, particularly in Ethnocultural Minority communities in the major metropolitan areas, where high levels of personal care can be provided without forcing relocation of individuals outside the community. In rural and remote areas, local community groups, usually non-Aboriginal, have developed these facilities although some provide their First Nations and Inuit residents with traditional foods.
Phase 6: Institutionalized Chronic Care. Small units in hospitals located outside First Nations and Inuit communities generally provide institutionalized chronic care for elders. Many elders experience culture shock, loss of family and friends and as such, many elders would prefer to die at home. Some Ethnocultural Minority communities have developed chronic care facilities, such as the Jewish community’s Maimonides Home for the Aged in Montreal, which helps elders retain the links to culture, family, friends and community.
Social and Recreational Activities for Elders
An essential element of wellness is activity. Many elders would benefit from more social and recreational activities. Elders need to have someone to talk to regularly to keep them alert and involved.
Mutually rewarding relationships with family, friends and neighbours provide elders with emotional support. Some elders may feel the need to belong to informal or formal groups. Cultural upbringing may determine which groups will appeal to elders but other considerations such as individual life experiences may also play a role.
Elders may not participate in social and recreational activities for the following reasons:
- language barriers
- cultural differences
- religious taboos
- mobility or physical health problems
- elders’ own attitudes to joining groups or not wishing to go alone to an activity
- not knowing about activities
- can’t afford activities
- lack of activities or facilities or funding for activities.
Meeting the social and recreational needs of elders is an excellent way to deepen their involvement in the community. It strengthens community bonds and fulfills the psychosocial and emotional needs of elders.
Building a Supportive Social Environment Involves:
access to information on seniors programs and services easy access to health, home and social support services living independently and interdependently for as long as possible in one’s existing home and community supportive social, family and community networks meaningful and mutually rewarding relationships participation in social and recreational activities
