the Vancouver Project

Summary of eleven focus group meetings

In total, this study involved eleven focus groups, primarily with seniors, but also with service providers and health care professionals, as follows:

Brock House seniors discussion group

Crossreach Adult Day Care seniors

Service providers - 2 groups

Jewish Community Centre seniors discussion group

Brittania Community Centre - Vietnamese seniors' group

Health care professionals

Sunset Community Centre - Punjabi seniors' group

First Nations seniors' group

Carnegie Centre - Seniors' Drop-In Room

SUCCESS - Chinese seniors group

After meeting with each group, the notes taken during the session were transcribed. These were later analyzed using a program called QSR Nud.ist(r) which allows us to attach general themes to text. These themes are not pre-determined, but arise out of the focus-group data itself. Altogether, we identified 18 separate themes, as follows:
Themes Identified in Six or More Groups:

Health Care Problems

Products and Services

Financial Constraints

Diversity

Housing

Safety

Recognition-Representation

Transportation

Care Facilities

Home Care

Social Network

Additional Themes Identified

Positive Factors

Macro-economic and Social Forces

Sponsored Immigrant issues

Independence

Technology

Discrimination

Nutrition

Of these, the first eleven were identified as problems in six or more of the focus group meetings. In the following summary, we have provided a more in-depth view of the various dimensions of each of these most popular themes as well as more succinct descriptions of the remaining seven topics which received less attention by participants overall. In addition to posing problems, focus group participants also suggested potential solutions. These are available together with the complete account of each of the problem areas.
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Themes

Health Care Problems

Insufficient level of health care service
There's no clear easy access to health services: e.g. appointments for examinations, referrals to specialists, Emergency care, wait lists for surgery, etc.

The hospital bed shortage has resulted in hasty discharge of seniors who seek help in Emergency or post-operatively.

Doctors only allow short 15 min. appointments - seniors need longer

Too few rehabilitation centres/services

Many healthcare agencies are strictly funded by donations and provide limited services

Fear among seniors of moving toward multi-tiered health care

There is little communication as to what health units have to offer

Seniors in rural areas cannot access health care easily

Narrowly defined Pharmacare and MSP coverage

Medicines are free in theory through Pharmacare but many medicines are often not included on the Pharmacare list, including those which are no longer prescription only

The dispensing fee is often very difficult for seniors to pay, especially when they are often or chronically sick and need many medications

Pharmacare needs to approve proper size dosages for medications - currently, seniors are often given double doses because lower doses are not available

Many types of medical services and equipment are not covered by MSP or Pharmacare. E.g. dental care, annual detailed physical check-up, alternative medicine, low-tech items and equipment, exercise/swim programs, hearing aids, glasses, scooters, lifts etc.

User fees for preventive and rehabilitative services have been raised, making them unaffordable for many seniors who need frequent treatments, e.g. physiotherapy.

Health care plans (especially extended health care plans) have not kept pace with escalating health care costs, hence seniors increasingly absorb more of the cost.

"Snowbirds" who go to the U.S. and get sick only receive $75 per night for their hospital costs when they seek reimbursement form their B.C. Medical plans.

Inconsistent coverage and lack of portability between the provinces

There's a weak relationship between the federal government's National Health Act and its implementation by different provinces

As a 'retirement province,' B.C. absorbs more costs for seniors than other provinces because medical plan contributions, etc. are not transferable between the provinces

Some provinces' health care plans cover more medical costs than others, e.g. 'fair' reimbursement for Snowbirds who get sick in the U.S., hearing aids

Substance abuse and the medical system

Alcoholism and substance abuse are quite common among seniors

The drug problem in the Downtown Eastside is complex. Some doctors prescribe drugs inappropriately, e.g. painkillers, which the recipients sell on the street to obtain money for illegal drugs. Accordingly, some doctors won't prescribe painkillers at all, making it difficult for people who really need them.

The need for more diagnostic expertise in mental health

Physicians need to be able to diagnose mental illness (e.g. dementia, Alzheimer's etc.) more accurately, since the specificity of the condition can affect treatment, waiting periods, etc.

Ageism by health care professionals

Seniors are often not treated with the respect they deserve by health professionals, some of whom too readily attribute illness symptoms to old age

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Products & Services

Lack of availability of services appropriate for seniors

Space is prioritized for other uses

Paucity of affordable rehabilitative activities, educational and recreational programs, e.g. pottery, special exercise and nutrition programs

Support services often lacking, e.g. elevators in seniors buildings, assistance with shopping

Proportion of resources dedicated to seniors' programming (e.g. in recreation centres) is very limited

High cost as a barrier to access of valuable services for seniors

Installation cost of telephones

Exercise and other recreational facilities can be very expensive

Cremation and burial costs are extremely high (inflexible rules around subsidies for certain types of coffins, etc.)

Poor communication of the services available to seniors

Many seniors don't know about benefits or services to which they are entitled, e.g. GAIN, Adult Day Care Centres, etc.

Inadequate outreach by community services - can result in cancellation of existing programs due to low participation rates

Overwhelming supply of information which is difficult to sort through

Need for more enriched, community-based services and long-term planning in this direction on the part of the government

E.g. Parks near schools could spare a corner for free-standing Respite/ Day Care /Convalescence / Hospice care transitional community facilities which are small, local, more community-based, and have the opportunity to relate to different generations

Services must be adequate to cope with expected increases in numbers of seniors.

Barriers to service access due to poor planning or management

Facilities that seniors could use are often not wheelchair-accessible

Institutions (e.g. banks, stores, ferries) with long line-ups should designate special queues for seniors only

People with arthritis (i.e. many seniors) are not accommodated in public institutions (e.g. with higher chairs, etc.)

Few public washrooms and many are locked during daytime hours when seniors like to walk (seniors need to relieve their bladders frequently)

Many services, but little coordination / integration among them which renders them inaccessible, or results in fragmented care

Unsuitability of various products for seniors

Packaging is difficult to open

Writing/instructions are too small to read

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Financial Constraints

Taxes are too high for seniors

High taxes decrease the income of seniors and compromise their independence

Seniors should not be taxed on pensions, the contributions for which have been taxed once already. Alternatively, seniors should pay a graduated income tax dependent upon their total income

GST reduces the limited income that many seniors already have and should be removed from services such as roofing which seniors cannot do for themselves

Seniors shouldn't have to pay school taxes - no longer have school-age children

Pensions are too low for many seniors

Seniors' low income affects all spheres of their life, i.e. health, housing, access to services, etc.

Some believe that government pensions should be awarded on the basis of means testing (i.e. for the most needy), while other think they should be universal

The poor receive the smallest pensions and hence have a hard time meeting basic expenses; this is especially so for immigrant seniors who must start from scratch (have no furniture, etc.)

People approaching retirement are concerned that the CPP fund will run out soon

CPP clawbacks are inconsistent with demographic trends whereby seniors are increasingly numerous.

Some people are unable to secure work, but do not qualify for a government pension

Applies to people aged around age 55 who have been laid off, etc.

Immigrant seniors who are supported by the family often do not qualify for pension and hence are also denied other benefits such as bus passes, etc., even though they are no more financially secure than pensioners and other social security recipients.

Welfare and disability pensions are too low and/or the regulations are too rigid

estrictions stipulating a ceiling on the amount of savings a welfare recipient can have prevent poor people (including older citizens) from ever getting ahead. Older people have been forced to hide money in adult children's accounts at the risk of those funds being misappropriated by the children.

Disability pensions are too low to meet basic expenses, but regulations do not permit recipients to meet the shortfall by taking on part-time work

The receipt of pension benefits for a disability (i.e. money paid in whilst working) can result in welfare clawbacks

Some seniors do not know about the benefits to which they're entitled

More efforts should be made to inform seniors re: benefits to which they're entitled

Charges levied by bans, insurance companies, etc. can be too high and their policies not favourable to seniors

Seniors' savings are often inadequate due to their greater longevity and disproportionately higher costs of living - banks could cancel service charges for seniors etc.

Long-term insurance policies should be eligible for tax breaks

Seniors should be eligible for benefits for care of grandchildren

Some seniors take over care of their grandchildren and hence should be eligible for care benefits - this may not be the case if a grandparent assumes care of a grandchild before he/she was apprehended from the parents by the state.

Grandparents who care for children in the home should receive a daycare allowance because daycare outside the home is subsidized (they shouldn't be considered free labour)

Women are often financially disadvantaged

Many women of the current generation of seniors have little knowledge of money management

Women are often less eligible/receive lower pensions due to their work histories (interrupted by child-rearing, often worked part-time consistent with social expectations of their era) and, in some cases, discriminatory pension policies

Women often have unequal access to (and less knowledge of) other support such as extended health care plans

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Diversity

Seniors are too often treated as a homogeneous group

Selective help rather than a universality policy would better reflect the diversity of seniors' financial circumstances

Research into seniors issues needs to take into consideration ethnic diversity, demographic details etc., and to include more different types of organizations etc.

Based on their experiences with repressive regimes, or due to a history of persecution (e.g. Holocaust survivors, refugees, etc.), many immigrants harbour a fear of government and others in authority

Many seniors are themselves unwilling to integrate with others unlike themselves, to appreciate diversity.

The Canadian government, authorities and society in general impress their own cultural standards of independence etc. on immigrant families (e.g. by forcing elderly parents to live separately from their families to qualify for social assistance, within the school system, etc.) which has resulted in a breakdown in the traditional age hierarchy characteristic of certain immigrant groups - this is seen as detrimental by seniors of these groups who have suffered a loss of status as a result.

Many seniors experience language barriers to service access

Immigrant seniors experience more difficulty with learning English/French

Affordable/free ESL classes should be designed specifically for seniors, irrespective of the time they have spent in Canada

Interpreters and translation services are needed in key institutions (hospitals, clinics, etc.) and public offices.

Public notices and letters issued by government offices, etc. should be translated into various languages

Seniors who do not speak English/French are more susceptible to financial abuse - the government and banks need to take extra precautions to protect them

Language barriers can accentuate the generation gap between grandparents and grandchildren (i.e. when grandparents cannot speak English

Certain services need to be targeted specifically to particular ethnic groups

Adult day care centres and extended care facilities rarely cater to specific ethnic groups whose language, culinary, religious, and cultural needs are often quite distinct

Efforts to resettle immigrant seniors are inadequate

More information about services available to immigrant seniors should be delivered in an appropriate fashion.

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Housing

A paucity of affordable housing for seniors

Low-cost or affordable housing is very hard to come by - very long wait-lists

Most low-cost housing is not specifically allocated to seniors - have to compete with general public

Low housing standards that impact seniors

SROs (single-room occupancy) occupied by many poor seniors are extremely run-down

Owners of SROs often withdraw services such as housekeeping, but charge the same rent; seniors cannot cope on their own, so these buildings become very unhygienic

Many seniors have been the victims of leaky condos - not in a position to buy another property, cannot sell and have received little help from the government

Need for more variety in the types of seniors housing provided (vis-à-vis levels of care)

Seniors' housing is typically geared to higher levels of care but 'personal care' or 'aging in place' facilities for more independent seniors is inadequate

There is often considerable friction when seniors have to transfer between different levels of care (own home to a facility, or different types of facility), largely because of the absence of a smooth continuum of care (there's a big gap between the types of care provided in different facilities)

Need for safer housing for seniors

Seniors need to feel secure from home invasions.

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Safety

Physical hazards

Seniors are more susceptible to accidents due to unsteadiness, poor health, etc.

Fear of accidents due to poorly marked steps etc.

Require LifeLine, MedicAlert, Neighbours Helping Neighbours programs etc. so that seniors who experience an emergency in the home can easily get help

Crosswalk lights are too short for seniors to cross in safety - seniors have little input into these decisions

Fear of criminal victimization

Many seniors do not go out after dark for fear of robbery, mugging, etc.

Seniors feel especially vulnerable at sky-train stations, bus-stops, even in stores

The Downtown Eastside is especially unsafe for seniors in the neighbourhood due to the drug trade, etc.

Concern for community safety after a rash of highly publicized home invasions (overplay by the media?)

Abuse by people known to seniors

Seniors are often abused-mentally, physically, financially-esp. when the senior is vulnerable due to poverty and/or alcoholism, ill health, language barriers and/or immigrant status, etc.

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Recognition-Representation

Seniors experience, knowledge, wisdom and skills are typically underutilized

Society is not tapping into the wealth of skills and experience that seniors offer - there are very few programs designed to give them the opportunity to use these skills, e.g. they could act as teacher's assistants.

Without activities or useful roles seniors often become sick. Opportunities to share their knowledge and skills stimulates seniors and keeps their minds sharp.

There is a lack of respect for seniors in Canadian society

Seniors are inadequately represented in decision-making positions

Seniors are inadequately represented in the policy-making arena, even when such policies affect them considerably (e.g. re: traffic control)

When seniors are included on boards etc. (e.g. in recreation centres), lip service is given to their involvement; their contributions tend to be marginalized

There are barriers to seniors' participation in policy setting and change, such as "Turfitis" (people are often overly protective of their own turf)

Most seniors lack political power because they are not involved in organizations such as unions, working situations (private companies, etc.) whereby they can put pressure on the government

MPs rarely contact seniors in their riding to elicit their views

There's no strong group to represent seniors in parliament

There's a lack of an effective voice for seniors with the exception of one national organization (CARP) and, on a more local level, Legion divisions for veterans (limited by their mandate).

Volunteers who work with seniors (often seniors themselves) are not accorded the recognition they deserve

Front-line workers who donate their time are overlooked for those who donate money

Volunteers rarely receive the kind of training they need for their positions

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Transportation

The cost of transportation can be prohibitive for seniors

A rise in bus fares or gas prices affects the elderly more because many of them live on limited incomes

Transportation discounts (bus passes, Taxi-Savers) are essential to facilitating affordable transportation for seniors, although not all older persons are eligible, e.g. people on disability pensions who do not yet qualify for CPP.

Taxicabs are often the only viable means of transportation and these prove too expensive for many

Seniors cannot always travel on weekdays when the fare on B.C. Ferries is waived.

More flexibility is needed in the transportation system which is often difficult for seniors to use

HandiDart is only available to people with physical disabilities, has to be booked 2 days in advance and is typically very inefficient and unreliable

Mini-busses which make scheduled pick-ups and drop-offs closer to peoples' homes are needed

Busses are often difficult for seniors to board and extremely jerky (increasing the possibility of falls) - more disability-friendly busses are essential

Bus drivers don't always wait for seniors who cannot board as quickly as younger passengers

Seniors experience barriers to service access due to a paucity of appropriate transportation options

Seniors living in "rural" areas who do not drive have difficulty getting medical assistance during inclement weather

Seniors face many barriers to participation in community centres, social gatherings etc. and to access of essential services (e.g. doctor's appointments), due in part to their need for transportation which is not available over short distances.

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Care Facilities

More healthy seniors suffer when people needing different levels of care are housed in the same facility

A smoother continuum of care options is necessary

'Low level' ('Personal') care for relatively healthy seniors is especially scarce

More and more mentally disabled patients are transferred to intermediate care facilities and hospital wards, making the environment unsuitable (too depressing, demoralizing) for people who are physically disabled but mentally alert for whom no other choices are available in many cases

Family involvement in care decisions

Caregiver incentives would encourage more family members to care for seniors at home

A lack of family support (e.g. when seniors have moved from other provinces) can make care decisions more limited and difficult to arrive at

Families can sometimes take too much control in decisions affecting seniors' care (guardianship issues)

Everyone stands to benefit from the intergenerational mixing in facilities

Having children and seniors' facilities in adjacent buildings or within close proximity is good for both age groups - this way children can see that seniors are human

Care facilities are insufficient to meet current needs and wait-lists for appropriate care are often extremely long

Wait-lists for facilities covered by Medicare are often 2years +

Of the existing facilities, very few cater to the needs of ethnic minorities

Seniors are often placed in facilities distant from their spouse's home or in institutions of very poor quality

Care is often difficult to organize due to poor information, lack of integration of services

Organizing care requires considerable coordination - difficult to do under stress or when sick

GPs typically have very little information to offer their patients trying to arrange care for themselves or a spouse

There are not enough Adult Day Care facilities

Of the existing facilities, very few cater to the needs of ethnic minorities

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Home Care

More home care should be available so as to keep seniors out of institutions and to provide post-operative follow-up support for seniors

Cutbacks have resulted in fewer home care workers

The provision of home care is often inflexible - seniors can be bathed daily (which they don't always need) but cannot have someone do housework for them, etc. (which they may need more).

Provision of home care should be more inclusive such that more seniors are eligible for these services

Home makers are currently limited to two hours per person which is often insufficient

Neither government health nor private plans provide sufficient coverage for the provision of home support which is often what seniors who have experienced health setbacks need the most.

Family members are often too busy these days to provide sufficient care for seniors

Private home care is too expensive for most seniors

Seniors have been discharged from hospital before they are able to cope alone with no home care in place.

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Social Network

Seniors lack social contacts necessary for ease of access to services

Once they retire, few elderly people are hooked into networks of people who know how best to access appropriate services.

Many seniors experience loneliness and isolation

Migrants to the province, and seniors with busy or estranged family members are often extremely isolated; this is especially true of very poor seniors

Community drop-in centres for seniors or Adult Day Care centres can be important venues for isolated seniors to socialize and make new friends

Many seniors have been isolated for so long they have lost many of their social and communication skills (psychological barriers to breaking out of isolation)

Some seniors, particularly those who are "frail", don't ever leave their homes and hence do not draw attention when they become sick or even die in their homes undiscovered

Seniors may be house bound due to heavy (grand) child care responsibilities

Transportation difficulties can exacerbate the isolation of many seniors, particularly those who are frail or unwell.

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Macro-economic and Social Forces

The deleterious effect of macroeconomic and social forces such as development plans, capital investment, the value of the Canadian dollar, etc. on the lives of seniors

CPP claw-backs and a reduction in services are inconsistent with demographic trends, i.e. increasing numbers of seniors, in Canada

Women are often less eligible/receive lower pensions due to their work histories (interrupted by child-rearing, often worked part-time consistent with social expectations of their era) and, in some cases, discriminatory pension policies. By the same token, women often have unequal access to other support such as extended health care plans

The social safety net is inconsistent from one province to the next because the federal gov't now has less control over provincial standards

As a 'retirement province,' B.C. absorbs more costs for seniors than other provinces because medical plan contributions, etc. are not transferable between the provinces (affects health, housing etc.)

The working class, including seniors, are paying for the rich man's pension. The wealthy don't need pensions, but receive them anyway.

Seniors have to pay income tax on pensions which is difficult and unfair - have already been taxed on the contributions (double-taxed).

When a person receives welfare there's a ceiling on the amount of money the recipient can have in the bank before welfare is canceled or clawed back. This prevents poor people from ever getting ahead. E.g. (1) One man had to start using up his CPP pension at age 53 when he became disabled. This is now running out, so he had to go on welfare instead, but his income was clawed back by a big chunk because of his receipt of pension income - this was money he paid in while working - doesn't seem fair. E.g. (2) Other seniors have been forced to 'hide' their savings in their children's accounts at risk of their children stealing them, lest they be penalized by social assistance.

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Positive Factors

Factors which have a positive influence on quality of life for seniors

Living in a democratic country and enjoying freedom has a positive effect on seniors' well-being

The high standard of living in Canada has a positive effect on seniors' well-being

The government's generous and humanitarian policies, whereby everybody has food to eat and clothing to wear, have a positive effect on seniors' well-being

The fact that poor people can apply for social assistance and hence survive independently of their children can have a positive effect on seniors' well-being

Making new friends at places like the Carnegie Centre can affect seniors' lives in many positive ways, but some seniors are so used to being isolated that they no longer find it easy to converse. They have lost their communication skills.

Sponsored Immigrant Issues

The problems experienced by seniors due to their legal / economic status as sponsored immigrants in Canada

Immigrant seniors experience difficulty in integrating into Canadian society

Family sponsorship used to be free but now costs the sponsor $1500 per person (this can be VERY expensive when there are, say, 5 family members-parents and younger siblings-to sponsor). This places a heavy financial burden on the sponsor before the parents even arrive and then the sponsor has to support them for 10 years. The worry of financial debt effects all family members, especially the seniors who may feel guilty etc.

Independence

The importance of independence to quality of life for seniors and factors which affect independence

Frail seniors in particular find that they are very isolated, that they are not integrated into the community. This is a key problem of this subgroup. (Many causes, but part of the problem lies in the failure of community organizations to prioritize seniors and to solicit their input re: programming, see below).

Many seniors lack control over their own destiny - control over seniors by family members can be excessive, esp. when seniors are deemed incompetent and family members have guardianship (although this is not true of all 'controlled' seniors)

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Technology

Problems that seniors have with new technological innovations - difficulty of use, need for training, expense, etc.

Technology is "overwhelming everything," e.g. ATMs (while banks are closing), new VCRs need 'an engineering degree' to operate - can be extremely scary for seniors and add to stress, especially when they are seeking help and are faced with automated transfer systems instead of a person when they phone gov't agencies, etc.

"Hi-tech" can be confusing, e.g., answering machines, VCRs, computerization; automated telephone forwarding, esp. when associated with essential services and gov't offices can be extremely stressful for seniors

Complex technology, particularly elaborate answering services, contribute to the problem of inaccessibility of services, are another piece of seniors' isolation; seniors need to be able to get to a person

Many seniors don't like to use technology such as bank machines, automated telecommunications, etc. They like to speak to a person when they phone, go to the bank etc. Some seniors' services are on the Internet, but they don't know how to use it so they're inaccessible to many (the women's seniors' is a good innovation, but not for this generation). The last 10-15 years has moved very quickly in the direction of technology, the Internet etc. - seniors haven't had the chance to catch up or prepare, things change so quickly

Discrimination

Experience of discrimination due to age, ethnicity, or combination.

Seniors are often not treated with the respect they deserve by health professionals, some of whom too readily attribute illness symptoms to old age

Immigration, esp. refugees are seen to drain money from the welfare pool - unfair, "we're the one's paying for them!"; one woman points out that many of them are the children of immigrants

Canada is still a racist society which has a negative affect on the well-being of this group of seniors

Parents who immigrate when they are aged 60-64 are not eligible for social assistance, but are unable to get work in this country due to their age, lack of Canadian experience, language skills, etc.

Bus drivers don't always wait for seniors who cannot board as quickly as younger passengers

The dependency period during which sponsored seniors are ineligible for a gov't pension is far too long at 10 years. This has been raised over time from 3 to 5 to 10 years. This can create a tremendous financial burden for the family as a whole, and seniors feel the strain. This policy is therefore very divisive of the family and discriminatory.

Seniors are subject to harassment by social services and other organizations. E.g. when they are almost due for their Canada Pension (e.g. at age 64) and apply for disability coverage social services etc. demand medical examinations, thus making the application process very lengthy (up to a year!)

Nutrition

Seniors lack adequate nutrition due to social, physical, and financial changes that they experience

Many seniors are confused by the whole question of whether food additives and genetically modified foods are safe - much alteration and adulteration of foods, but people don't what the long-term effects will be, so they don't know what to buy anymore - they're not eating like they used to

Many seniors suffer from poor nutrition

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General Advisory Committee Coordinating Committee Focus Groups Reports