Programs and facilities necessary for the proper care and treatment of the senile are many and varied. This study is concerned with one of the institutional resources: the policies and procedures governing admission to Valleyview Hospital, an institution designed specifically for the aged with other disabilities of senility. To apply "operational" tests to policy and procedure, a sample of (30) applicants from the waiting list were selected for study, the purposes being (a) to determine what factors were operative in securing admission, (b) how the stated criteria for assessing priority of admission were utilized. A number of special personal circumstances affected the appropriateness of the group. Apart from this, it was found that the formal criteria for acceptance of applications to the hospital are employed with reasonable consistency, when measured against the time an individual applicant spends on the waiting list. It was also found that when a community agency initiated the application, admission was granted after relatively short periods on the waiting list, if there was no other resource readily available. Prom this study, the roles of the social worker in pre-admission services can be delineated as (a) helping the applicant to find other forms of care over the waiting period, (b) helping the Medical Superintendent to assess priorities for admission, and (c) helping applicants and families to accept the need for hospitalization when this is justifiable. Recommendations for needed changes in procedures and in legislation are made, particularly in the present cumbersome application arrangements, which require certification of the applicant as mentally ill before an application can he placed on the waiting list. Development in the community of specialized types of boarding and nursing homes for the care of the less severely handicapped by emotional and behavioural disturbances is also recommended. / Arts, Faculty of / Social Work, School of / Graduate

The purpose of the study was to design a reliable and valid assessment instrument that would provide a multidimensional profile of the elderly resident of a long term care facility. Use of this instrument would be a method of collecting and corrmunicating information concerning the full range of problems experienced by this group, in a form that is suitable for use at different levels of decisionmaking. The instrument consists of 31 unweighted items measuring functioning in 5 essential areas - cognitive, physical, emotional, social, and instrumental. Ratings were based on the observations of long term care staff who were in close contact with the individual over extended periods. Reliability and validity were tested using a non random sample of 76 elderly residents of one extended care unit. Both test-retest and interjudge reliability proved to be high and item analysis indicated that, with the exception of 2 items, the instrument provides levels of functioning appropriate to the sample population. The instrument also showed a high degree of internal consistency with the 3 major components identified as - cognitive behaviour, independence in daily living, and physical functioning. The validity of the instrument and its subsections was demonstrated through significant relationships with external criteria, namely - the number of problems listed on the multidisciplinary problem-oriented record, a health index measure, and a mental status rating. Further evidence of the instrument's validity was its ability to predict, retrospectively, 72 percent of the sample deaths in the first year following admission. Although only a preliminary form of analysis, this showed that a high level of mental functioning, combined with a low level of independence in daily living, was predictive of death within 3 to 9 months in the sample population. The implications of these results are discussed along with suggestions for further research in the area. Finally, potential uses for the assessment instrument in the field of long term care are provided. / Applied Science, Faculty of / Nursing, School of / Graduate

This dissertation reports on the evolution of an observation instrument designed to examine a series of dyadic interactions between service providers and elderly clients. The encounters took place in the physical context of the client's home and under the auspices of two different kinds of urban service agencies. Staff members and elderly clients of In-home Nursing and Interaction agencies participated in the study. The coding system (Service Provider/Client Dyadic Interaction Coding System or SP/CDICS), is comprised of 28 carefully defined and described behavioral categories. The categories were developed through literature reviews and a series of preliminary observations conducted in agencies similar to but not included among the sampled agencies. A majority of the defined behavioral categories require moderate levels of observer judgment. A Field Manual was developed to train the five observers who collected the data. This was supplemented with a videotape constructed to further assist observers in the learning and subsequent use of the code, particularly with non-verbal and paralinquistic aspects of the behaviors. Fifty-one service providers and 147 clients comprised the sample of observed dyads. The coded observational data were examined in the expectation that there would be recurrent patterns of behavior. Factor analysis resulted in the delineation of ten client and five service provider behavioral patterns that appear to be interpersonally meaningful. The derived service provider and client behavioral factors were correlated with other measurements available on the same population. These included several service provider personality and attitude measures as well as observer and client evaluations of the encounter. The comparisons, in general, tended to confirm the interpretations given to the described factors, further supporting an assumption that the SP/CDICS is a useful and valid instrument.

No description available.

published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

No description available.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

No description available.