Executive Summary

A series of 12 focus groups was conducted as part of the Review of Veterans' Care Needs Project. The purpose of the focus groups was to collect qualitative information to identify veterans' current and future care needs, address gaps in support and services, and explore problems experienced by veterans and their caregivers in accessing support and services, including reasons for nonuse.

Three types of focus groups (veterans, caregivers, and service providers) were held in Halifax, Montreal, London, Toronto, Regina and Vancouver during the month of April 1997. The veteran groups included a random sample of health care-eligible veterans age 65 and older, excluding veterans residing in institutions; caregiver groups included a random sample of informal caregivers of veterans (generally spouses or children); and service provider groups consisted of persons with the same predominant veteran or senior client base.

The following sets out the summary of findings from the twelve focus groups. The detailed description for each of the three types of focus groups follows this summary.

Care Needs of Veterans

The care needs for veterans mentioned by each of the three types of participants included the following:

1. The VIP services available, especially housekeeping and groundskeeping;
2. Medical assistance, prescription drugs, transportation, and meals-on-wheels;
3. Ready access to information on available services, including referrals through any one service provider;
4. Assistance with changes needed to living accommodation space in order to prolong independent living;
5. Respite services for caregivers;
6. Home locations, home designs and services that take into consideration seniors' desire for continued independent living after leaving their family home;
7. Removal of the stigma of "institutional care" and replacement with "supportive care" to seniors who need built-in full-time care and still want to live independently with dignity;
8. Adaptation of infrastructures such as bus routes, busses, grocery stores, etc., to meet the needs of seniors who want to live independently in their communities;
9. Community involvement in the seniors' living environment to give them social contact and to encourage younger people to be exposed to aging and seniors' changing needs; and
10. Therapeutic services (e.g., physiotherapy, occupational therapy, psycho-social therapy) to ensure the well-being of veterans and seniors (Noted by service providers).

Gaps In Support and Services

The gaps in support and services to be addressed in order for seniors to live in keeping with the philosophy of "independent living" included the following:

1. Accessible social and physical activities, organized in cooperation with veterans and caregivers;
2. Communications on available services to make services easily found, given the number of acronyms and overlapping services available from various levels of government and private sector agencies;
3. Assistance with financial planning, including income tax preparation and preparation of wills and funeral arrangements;
4. Assistance to spouses of veterans, similar to that made available to veterans, including continuation of benefits after the death of the veteran;
5. Counselling services to assist with seniors' decision-making processes as their accommodation needs change;
6. In-home and face-to-face assessments yearly as opposed to once every two years were seen as important by both veterans and caregivers. They believed that health conditions could change quickly within a year and did not want to have consultations in this regard conducted over the telephone;
7. Peer as well as family support programs were seen as very important and currently lacking;
8. Expansion of the VIP Program to include major spring and fall cleaning were seen as essential and beyond the current service; and Many thought that information must reach caregivers and families of veterans.

Barriers to Service Use and Suggestions for Raising Service Awareness

Many of the barriers associated with using the variety of available services were caused by a lack of easily available and accessible information. Because many of the veterans and the caregivers relied upon word-of-mouth, information was perceived to be out of date, inconsistent, or related to a service which was not available to them. All, including the caregivers, thought that doctors should be aware of services and make the information available. As well, the service providers believed that there should be in-service seminars and a registry of each other's services made available to them in order that they could make "referrals" whenever needed.

Because there were services generally available from a variety of organizations, many wanted one point of reference. This could be in the form of a reference guide, a DVA newsletter, a contact person over the telephone or any one service provider. As well, services should be spelled out as opposed to using acronyms, which many thought to be confusing.

Lack of use of services was also seen by the caregivers to be caused by information only going to the veterans. While this might not be problematic for some families, for others it meant a lack of access to services. Associated with this barrier were the attitudes of some veterans who felt "too proud" to apply for a service. For that reason, distribution of information to the family and/or the caregivers should be considered.

While specific problems of female veterans did not come up very often, perhaps because very few of the participating veterans were female, the issue was raised. It was noted that some of these veterans were not actively involved with their Legion and therefore did not benefit from the information generally available from that source and subsequently found out later about services they should have been using. While some thought that accessing services should be up to the individual, all thought that they should be made aware of these though the media as well as from DVA and the medical profession.

Some also thought technology such as voice mail was stopping some veterans from using services. Many believed that a call for information should be handled promptly by a person in each and every instance.

Lacking the ability or disposition to seek out information was also noted as a common cause for some not using services. Again, improving on the information distribution methods was noted as the solution.

It was quite clear that some preferred not to use services, though they were eligible. Their rationales were based on the strong belief that only when absolutely essential should a veteran use services. This belief was founded in the concern over costs and fear that services could be cut if overused, as well as a belief that one should continue to try to do "chores" on one's own in order to maintain fitness.

In some instances, ethnicity was cited as the reason for services not being used. While this was respected by some, others thought a greater effort should be made to reach ethnic minorities.

Finally, many of the veterans and the caregivers believed that services were not used because of problems encountered with DVA personnel. There was a view that application and review procedures must be consistent and not depend upon any one DVA employee. As well, some thought staff should be knowledgeable of veterans and their contributions to Canada as an indication of respect. Such treatment would go a long way for veterans to believe that they "deserved" services and that they were not being treated as welfare recipients. Coupled with these concerns was also the pride many of the veterans had. For some, to have to apply and go through several appeals was an insult, and as a result they would not apply. For others, they simply feared that they would not be accepted and therefore did not apply.

KEY MESSAGES

A number of ‘key messages' became evident throughout the discussions and were delivered by all groups. These can best be summarized as follows:

• Veterans are very proud and want to remain independent.
• There is an overriding concern about the lack of access to VAC services and programs for spouses of veterans.
• Information on VAC and other services and programs (provincial and community) is needed by all concerned (veterans, spouses/caregivers and service providers).
• There is a growing social isolation among veterans and their spouses.
• There is a great desire among veterans and their spouses for face-to-face, in-person counsellor contact (visits) rather than impersonal and infrequent telephone calls. They find telephone technology and answering machines frustrating and difficult to handle.
• Staff training respecting veterans' experiences and needs is required, as well as training in dealing with the elderly.
• All veterans should be treated equally.

POLLARA strongly recommends that the findings of this qualitative study be taken into consideration along with the results of the other components of the Review of Veterans' Care Needs project. To this end, it is anticipated that these qualitative results will give depth and understanding to the results from the upcoming quantitative study.