The dinner hour becomes a social event of great importance if satisfactory facilities for communal dining are provided. Whether the dining room is espe cially designed for this purpose or is merely a temporarily converted living room is of little importance. What is important is that an area be provided where patients can dine together.

One home has included an interesting dining feature in its new facility. Each 25 patients have a dining area adjacent to their rooms. In each of these areas 25 lockers 12 inches by 12 inches are provided, and the patients use them to keep such things as special condiments, crackers, and the like. Both the patient and the dining room supervisor have keys to these lockers, and they are checked routinely to see that they are sanitary and free from spoiled foodstuffs or dangerous articles.

STAFF FACILITIES DESERVE STUDY

Up to this point we have concerned ourselves primarily with patient areas and patient needs, but the patient is not the only one to be considered in designing a nursing home. The staff of the home must also be considered.

It is advisable to consider a "patient control center" for every 40 beds. Such a unit should be designed as a center around which the services performed for the residents revolve. In many nursing homes this "control center" need not be as complete as the nursing station of the general hospital, but it should contain as a minimum: Charting and writing space, locked and well-lighted storage cabinets for medicines and medical supplies, a preparation area for medications, a patient call system and separate utility areas for "clean" and "dirty" use. In planning these areas it is advisable to employ the advice of a clinically oriented nurse consultant.

As in-patient facilities, the nursing control center should be spacious and well designed. In addition to medical use it can, and often does, serve many other uses. The nursing home of the future might well wish to use it as a patient information center, as the many hotels use the information units on each floor.

Since the nursing home is the total environment for some residents, why not provide a small doctor's office for every 50 patients? Such a unit would offer the same facilities as a private doctor's office. It would certainly be appreciated by physician and patient alike.

The kitchen is one of the most important units in a nursing home. Food is a major item in the life of a nursing home resident, and a major expenditure in its budget. Too much emphasis cannot be placed on the fact that a kitchen in a nursing home is a kitchen in an institution. So why not plan it as such, and specify commercial equipment for use in it?

There is some debate as to the economic soundness of providing laundry facilities in a nursing home. Some homes find it less costly and more convenient to use a commercial linen service. If a home prefers to wash its own linen, the laundry area should be designed and equipped with the latest of safety devices, and contain heavy duty commercial equipment.

HEAT, LIGHT AND POWER SERVICES

Any discussion of nursing home construction would be incomplete without some consideration of the basic services of heat, light, and power.

The heating system should be of a size and nature that will maintain the home at 75 degree F. throughout the facility. It should be designed and installed in a manner that will prevent drafts and cold spots. It should also be free of accident hazards, such as exposed heating units and steam pipes. A ceiling panel, baseboard, or convector-type hot water system has all these advantages. The radiant type hot water system may also lend itself to installation in certain nursing homes.

In planning the powerplant for larger nursing homes, it is wiser to consider the inclusion of a high-pressure, as well as low-pressure steam unit. Many items of medical and institutional equipment require high-pressure steam to operate them and, if there is a possibility that such equipment may be installed in the home, it is wiser to provide the proper steam at the time of construction.

Lighting engineers have demonstrated that the older person requires considerable more light than the younger person. Why not use high-level lighting in a nursing home? Effective use of such things as strip lighting in corridors, fluorescent lighting in dining and recreation areas, and provision of sufficient reading lights in patient rooms will bring great dividends. In addition, the use of stra

tegically placed night lights in corridors and patient rooms should reduce markedly the accident potential during late evening hours.

Provision of adequate electrical power to operate the many electrical appliances and lights in an institution has always posed a problem. In the nursing homes and homes for the aged of the future particular attention should be given to this problem. In considering the peakload factor of a given nursing home, some thought should be given to possible expansion of both beds and services, since it is becoming a corollary that any increase in medical service means a corresponding increase in electrical power demand.

Too often what is known as "incontinent odor" has been accepted as an accompaniment of caring for the aged individual, but advances made in sanitation and ventilation over the past few years prove this need not be so. A good positive exhaust steam in toilet and similar areas coupled with good cleaning procedures, will almost completely eliminate objectionable odors.

THE VALUE OF STORAGE SPACE

Earlier mention was made of patient belongings storage. Almost equally important is the provision of adequate storage space for equipment, supplies, and records. This area is often the last to be included and the first to be eliminated in hospital and nursing home design. It is a proven fact that institutions that have provided ample storage space have actually reduced operating costs by about 3 percent. It is important, therefore, that nursing home administrators and architects keep this fact in mind when planning. Construction people usually consider from 10 to 15 square feet of central storage space per bed to be adequate for nursing home purposes.

Anyone contemplating the construction of a new nursing home, or the alteration of an existing structure to a nursing home, should be sure to consult the icensing authority in his State. Many State licensure agencies maintain a staff of specially trained consultants who are anxious to assist nursing home administrators and their architects with the design and construction problems of their homes. These consultants have had experience in the nursing home field, and their advice has often saved a prospective owner or adminstrator from making serious mistakes. If these individuals do nothing else than explain the rules and regulations governing the licensure of nursing homes within the State, they will have done much to save a prospective owner from making costly mistakes.

The design and construction of living facilties for the aged is a broad new field for exploration. This article has sketched briefly some of the problems facing those who will explore it. It is hoped that some of the ideas suggested and questions raised will aid in this exploration. Unless we of today meet the challenge facing us, we may find ourselves in a worse predicament than our present senior citizens.

A VETERAN'S ADMINISTRATION REPORT

[Canadian Veteran Homes]
FOREWORD

This report is intended to document findings and observations of a three-member Veterans' Administration team that visited Canada from May 13 to May 18, for the purpose of gaining knowledge from their experience in dealing with the problems relating to homes for aged veterans and dependents.

The Administrator's Advisory Council has been studying this problem as a part of its long-range planning responsibilities. During discussions between the Deputy Minister, Canadian Department of Veterans Affairs and the VA Administrator, Deputy Administrator, and Chairman of the Advisory Council at the Hague World Veterans Federation Meeting in November 1961, it was brought out that Canada has made progress in solving their problem. While attending the VA Conference of Managers and Hospital Directors in Washington the Deputy Minister invited the VA team to visit Canada to study projects, primarily those of the Royal Canadian Legion, the veterans organization that had taken the initative in this area.

While the Canadian Department of Veterans Affairs is not a directly involved in the housing projects, the benefit programs it administers has a definite bearing on their successful operation. The report, therefore, includes a brief summary of the Department's organization and programs, the Royal Canadian Le

gion, and background information pertinent to the financing and operation of the housing projects.

We wish to express our profound gratitude to Lucien Lalonde, Deputy Minister, Department of Veterans Affairs, and John N. B. Crawford, M.D., Director General, Treatment Services, who gave us so much of their valuable time throughout the visit. They and their staffs did a magnificent job in advance preparation and the program they outlined for us was ideal. Other key officials who contributed so much to the success of our tour are:

Mr. F. T. Mace, Assistant Deputy Minister, DVA.

Mr. E. J. Rider, Director, Veterans Welfare Services, DVA.

Mr. P. E. Reynolds, Chief Pensions Advocate, Veterans' Bureau, DVA. Col. H. M. Hague, regional administrator, DVA, Montreal.

Mr. F. D. McFarlane, district superintendent, Veterans' Welfare Services, DVA, Montreal.

Maurice Thibeault, M.D., superintendent, Ste. Anne's Hospital, Ste. Anne de Bellevue, Province of Quebec.

J. R. D. Bayne, M.D., staff medical officer, Queen Mary Veterans Hospital, Montreal, Province of Quebec.

R. Hamilton, M.D., chief, psychiatric service, Ste. Anne's Hospital. Charles Roberts, M.D., medical director, Verdun Protestant Hospital, Verdun, Province of Quebec.

A. T. MCANSH, Assistant Deputy Administrator. H. F. MOORE,

Benefits Specialist, Administrator's Advisory Council.

D. M. SKINDER,

Special Assistant to the Administrator.

PART I. THE CANADIAN DEPARTMENT OF VETERANS AFFAIRS

A. DEPARTMENT ORGANIZATION

1. The Minister of the Department is one of the 22 Cabinet Ministers. He is an elected Member of the House of Commons and is the liaison between the executive and legislative branches of the Government on policy matters affecting veterans. As such he speaks for the Department while sitting as a Member of Parliament. Reporting directly to the Minister is the Deputy Minister, Chairman of the Canadian Pension Commission, and Chairman of the War Veterans Allowance Board.

2. The Deputy Minister provides administrative services to the Canadian Pension Commission and War Veterans Allowance Board, but has no program responsibility. He does have program responsibility for the Treatment Services Branch (our Department of Medicine and Surgery), the Veterans' Bureau, Veterans Welfare Services, and Veterans Land Administration. Administrative responsibilities are discharged through the Assistant Deputy Minister under whom there are: Directorate of Personnel and Administrative Services; Directorate of Engineering, Accommodation, and Transport; Directorate of Finance, Purchasing, and Stores; Directorate of Legal Services; as well as a departmental secretary; Information Services and Methods and Inspection Division. The Deputy Minister has served under two administrations and personnel changes are not expected as a result of elections.

B. PROGRAM RESPONSIBILITY

1. The Canadian Pension Commission is responsible to the Minister for adjudicating all claims for service-connected disability. It includes the determination relating to entitlement to service connection, as well as evaluation of disabilities. The Governor in Council appoints one member to be Chairman and another Deputy Chairman. Each of the 8 to 12 permanent commissioners are appointed for a period of 10 years and up to 5 additional ad hoc commissioners may be appointed for a period of 1 year. All may be reappointed. A quorum for first and second hearings may consist of two or more commissionA second hearing may be held if there is additional evidence. If the disability arose during World War I or in peacetime, there may be a first hearing and a second hearing only. If the disability arose during World War II there may be an initial hearing and any number of renewal hearings whenever new evidence becomes available. An appeal may be filed following the final hearing, and provision is made for three commissioners, none of whom previously acted

ers.

in the case, to hear the appeal in a locality in Canada reasonably convenient to the veteran where he may appear personally, offer testimony, and furnish witnesses. After the appeal the case is taken under advisement and the appellate decision is made in Ottawa. This decision is usually final and binding; however, under the act if there is additional cogent evidence not previously considered, leave to reopen may be granted. Case files are retained in duplicate since the contents are needed in field stations and in the head office where all decisions of the Commission are rendered.

2. The War Veterans Allowance Board has jurisdiction in claims for nonservice-connected monetary benefits. It consists of not less than three, nor more than five permanent members, appointed by the Governor in Council. One member is designated Chairman and another Deputy Chairman. Three additional temporary members may be appointed from time to time. The authority to adjudicate, however, is exercised by district authorities who have full power to make initial decisions and review their own adjudications. An appeal may be taken to the Board by an applicant, or the Board may review any adjudication on its own motion.

3. The Treatment Services Branch under the Deputy Minister is headed by a Director General who is a medical doctor of national reputation. He is responsible for hospital facilities, organization, administration, equipment and inspection, medical research, statistics, and planning. The following services are also under his jurisdiction: admission, dental, nursing, dietetics, and prosthetic. 4. The Veterans' Bureau is headed by a Chief and consists primarily of "pensions advocate." Its primary responsibility under the Chief Pensions Advocate is to prepare and present claims before the Canadian Pension Commission. Wherever possible, advocates are persons who have been admitted to the bar. They are located throughout Canada and are responsible for the preparation of a "statement of the case" on each appeal that is reviewed by the claimant before presentation.

5. The Veterans Welfare Services Branch, under a Director, has program responsibility for the administration of insurance, rehabilitation, training (veteran and children of war dead), and the administration of several funds established by contributions from public-spirited individuals. Welfare officers stationed throughout the country offer counseling, guidance, and practical assistance toward obtaining the necessities of life for those who seek their services. They are trained to give utmost consideration to the requirements of older veterans and widows who have problems in employment and economic fields, attempting to keep clients self-supporting, and, when this is no longer possible, to insure that needs are met through various avenues. Itinerant welfare officers are used to contact veterans and their dependents who do not have easy access to the district offices of the Department. The welfare officers on this service provide, as far as possible, in homes for the aged and elsewhere, the same services as are available in the district offices. They also investigate, report, and recommend on cases where applications are made for financial assistance. Particular attention is given to those who have had applications denied for veterans' benefits looking to alternate sources and services. Foster home situations are investigated and placement arrangements completed. This Branch maintains close association with the "Corps of Commissionaires." The corps is the private firm which contracts for work to be done by its members who are known as commissionaires. They are uniformed and are described as a smart, wellgroomed group of older veterans, who are employed in positions of trust not involving manual labor. Several thousand members of the corps are employed by Government agencies as guards and in other similar positions. Close liaison work has also been maintained between welfare officers throughout the country and Royal Canadian Legion officials to insure that veterans and their dependents who are in need of housing facilities are assisted. This assistance includes obtaining priorities for admission to low-rental housing developments operated under the jurisdiction of groups other than the Legion, including service clubs. 6. The Veterans Land Administration Branch, under the guidance of a Director, is organized into eight districts. The districts include 33 farm credit sectors further divided into 195 field areas each under the supervision of a credit advisor. While the basic program responsibility for this Branch has been to encourage veterans locating on farms through conditional grants, the program does include loans up to 90 percent toward the construction costs of individual veteran's housing. The responsibility includes guidance and close onthe-job-supervision for veteran-contractors to insure that maximum benefits and financial savings are obtained under the "build-your-own-home" plan.

PART II. THE ROYAL CANADIAN LEGION

The Canadian Legion was established over 36 years ago by a confederation of some 15 veterans' organizations. Only recently the Queen on the basis of outstanding public service awarded the Legion the honor of the prefix "Royal" and henceforth the organization has been known as the Royal Canadian Legion. The top command is similar to American service organizations in that it has a Dominion president equivalent to our national commander, and a Dominion executive council similar to the national executive council of the American organizations. There is a Provincial command for each of the 10 Canadian Provinces as American service organizations have State departments. Local branches are the same as posts in this country.

In an article written for the October 1955 Legionary the Dominion president, John O. Anderson, on the question of "Where Do We Go From Here" stated: 66 * today the task of obtaining adequate legislation is almost complete. True, there are areas where improvements could still be made and will be made but by and large the legislation picture is gratifying *** My purpose is to bring the matter to the attention of all, for there is a definite need for increased Legion activity in community affairs." He mentioned housing projects as one of the areas in which activities should be intensified.

The stature of the Royal Canadian Legion has grown materially on the basis of its community programs on a national scale. This has involved a program of physical fitness wherein national track and field competition is sponsored and clinics held for coaches throughout the nation. In addition to its welfare and assistance programs, it sponsors school scholarships and participates in drives such as the blood bank and polio campaigns.

In March 1954, during a branch Legion meeting Henry Harvey suggested that the organization form a corporation that would provide low rental housing for veterans in the Ottawa area. A charter was granted the "Older Veterans Home, Inc." by the Province of Ontario with a board of directors comprising the president and nine past presidents. Blueprints were prepared and submitted to the Central Mortgage & Housing Corp. for approval. A 200-foot square block of land was purchased from the city and in November 1955 construction was started on the initial 23-unit apartment which became the first development to be undertaken by the Legion. Since that time many units have been completed ranging in size up to 128-apartment developments-and others are under

way.

PART III. THE NATIONAL HOUSING ACT

The Dominion of Canada has provided loans to aid in the construction of lowrental housing projects or in the purchase and conversion of existing buildings and land to provide such accommodations under the National Housing Act, section 16. Operating under this section, a Government-owned (Crown) corporation, the Central Mortgage & Housing Corp., is authorized to make loans to limited dividend companies that acquire and operate low-rental facilities for families of low income and for elderly persons. This is similar to our Housing and Home Finance Agency, Community Facilities Administration.

The CMHC reports to Parliament through the Minister of Public Works. Officers include a president, vice president, and a board of directors comprising eight other members, three of whom are selected from the Canadian Public Service and five from outside the public service. An executive committee of the board consists of the president, vice president, and two other directors selected by the Board. The executive committee may exercise powers of the board. Bylaws are promulgated by the board with the approval of the Governor in Council and have the effect of law.

The limited dividend companies are chartered by a Province, usually for the purpose of constructing, holding, and managing a low-rent housing project with dividends established by the terms of its charter at 5 percent or less of its paid-up capital. Such companies may secure loans from the CMHC at a low rate of interest for up to 90 percent of the lending value of the project for a term not exceeding the useful life of the property, and in no case over 50 years. The remainder of the downpayment is obtained from the organization's treasury or public subscription sponsored by the organization. Since 1956, 150 loans have been approved.

In order to secure a loan, the limited dividend company must present evidence that conditions of shortage, overcrowding, or substandard housing exists in the area. The company must agree to a maximum ratio between rentals to be