Every day for two years Francis Christian, a dedicated member of Vimy Branch in Halifax, N.S., made his way to the Camp Hill Veterans Memorial Building for a very special visit to one of its residents. Christian was there—seven days a week—to make sure a former RCMP colleague got at least one good meal a day when he was no longer able to feed himself.
“I’d known him for 50 years,” though their relationship blossomed in his friend’s final days, says Christian, now 85. “I went in every day to spoon-feed him.” Two years ago, he was called in for the family vigil when his friend died. “It hurt to say goodbye; we were just like family.”
But a bruised heart hasn’t kept Christian from the work he loves; he’s still a fixture at Camp Hill, visiting at least three or four times a week. “He’s so friendly,” says former army nurse Mary Glanville, who turns 88 in April. A resident for seven years, she looks forward to visits from Christian and other Legionnaires, and to the chats about sports and the daily news.
“It makes a great deal of difference to people who can’t get out,” she says. Legion visitors are “always cheerful and eager to please.” Residents appreciate their support and help to run an occasional errand, to accompany them on outings, for companionship. “There are an awful lot of people here who don’t have family close by,” she says. Without Legion visitors, many “would just be stuck in here.”
In hundreds of hospitals and veterans’ care facilities large and small across the country, thousands of Royal Canadian Legion volunteers take the time to honour and comfort veterans. There is a huge demand for the services these people provide because Veterans Affairs Canada has 3,300 veterans in contract beds reserved in 171 facilities. It also supports another 7,300 veterans in community long-term care facilities.
Aside from companionship, the men and women provide another gift: healthier and longer lives to veterans and to themselves.
“Older adults who feel socially connected have lower blood pressure, better immune response and are able to handle life’s ups and downs better than those who feel isolated or lonely,” says Dr. Louise Hawkley, a social neuroscientist at the University of Chicago who has researched the health side of loneliness.
Many ill-health effects are caused by stress, which are amplified by loneliness and isolation. The stress hormone cortisol, which surges through the body in response to stress, enables our flight-or-fight response to get us out of danger. But under chronic stress, like that of someone who is in pain, frightened or bored, this hormone wreaks havoc with immune response and blood pressure. “Meaningful relationships improve the ability to tolerate whatever the world tosses your way,” says Hawkley. “Social connectedness gives a person the feeling there’s nothing to worry about, there’s nothing they can’t handle.”
“It’s well documented that people need social contact to be healthy,” adds Elsie Rolls, director of veterans’ services at Camp Hill. “Everybody needs social contact; they need to be connected to people.” Visits add to recreational programming to relieve boredom, the biggest curse of the nursing home. “If we didn’t have those sorts of things, residents become bored and then become ill.”
Some residents, she says, may not even want to get out of bed. “They think ‘what’s the point? Nobody’s going to see me anyway.’ But if they know somebody may drop in, it’s more of a reason to get up, to do their hair or shave. There has to be a reason you want to get up and make sure you are socially presentable.”
Legion visiting programs are very important to veterans, says Norah Keating, a member of Veterans Affairs Canada’s Gerontological Advisory Council and a researcher on issues of aging at the University of Alberta. “Probably the most important relationship for older adults is with people of the same generation who share the same history or have had similar experiences.” Although family relationships are also extremely important, says Keating, visits can focus on quality of care rather than fun. Elders in care aren’t sure whether family visits are done for pleasure—or a sense of duty. In voluntary relationships, there’s no doubt. “The bonus of the volunteer programs by Legion members to veterans is that they really do share some similar history.”
“Legion visitors are always visible as being from the Legion and that’s certainly something recognized by these folks even with more advanced dementia,” says Kelly Sprackett, co-ordinator of volunteer services at the Broadmead Care Society in Victoria. It operates the Lodge at Broadmead, where about 60 per cent of the 225 residents are veterans, as well as a Veterans Health Centre day program.
“In a care facility there are few people who know them other than the frail old person often with pretty high levels of health and cognitive problems,” says Keating. “The nice thing about connecting with someone, like a Legion visitor, is it helps with resurfacing of your own identity. They think ‘this is someone who knows who I am, who I have been.’ They may not know them personally, but they know because of that shared experience, a connection will be made.”
It’s a feeling many visitors recognize. “An ongoing feeling of camaraderie was created during the war,” says Barbara Bolli, co-ordinator of the Legion sick and visiting program for Broadmead, and a member of the Victoria Ex-Servicewomen’s Branch. “It resonates amongst us veterans.”
“I know where they’re coming from,” says Christian, “because I was there, too.”
Because of this connection and the affiliation, Legion visits have a cumulative effect, even if they’re not daily. Hawkley likens it to the comfort of a good marriage where one partner travels a lot. Even when one spouse is on the road “the feeling of security in the marriage doesn’t alter.” The sight of those Legion uniforms in the hallways, or knowing that a Legionnaire will always be on hand during regular bingo night, or for a Thursday chat provides a similar kind of security to veterans. That’s important for small or remote branches to know—even a few regular visits over the course of a year will make a difference.
Bob and Jo-Ann MacEachern have been visiting veterans in long-term care facilities for the Grand Bend, Ont., Branch for about 15 years. “When we first started out we had 17 veterans” in Parkwood Hospital in London and smaller nursing homes in other small towns near to Grand Bend. Many were friends and former branch comrades. “Because we were from a small town, it was more social,” says Jo-Ann. But it also meant the duties could be sad, as they saw friends or neighbours go suddenly downhill.
Today, there are fewer to visit. “They’ve all passed away except for two,” says Bob. Even though the couple has relocated from Grand Bend to London, they continue their visits to a veteran in the Veterans Care Program at Parkwood who was “adopted” by the branch, and to a former Grand Bend Branch member at a smaller long-term care facility in Exeter. “We take a little gift (long-distance telephone calling cards, flowers, greeting cards) and ask if there’s anything they need.” For instance, one asked for sweat pants, which make it easier to dress in the morning when you’re in a wheelchair. They visit the veteran in the small care facility about four times a year.
By contrast, there always seems to be a Legionnaire in the hallways of Camp Hill. “We have a huge program,” explains Tom Waters who—after 14 years—is carrying on with his volunteer work as Nova Scotia/Nunavut Command’s Camp Hill Legion representative. “We’re probably talking 500 to 600 people over the year.”
Legionnaires visit veterans individually. Groups of them help with recreational programs, involving bingos and bus tours. Sometimes visitors join the gang in the lounge. They sit in on a veterans’ council meeting. Nearby branches come in to provide entertainment and hold events for veterans and their family members at the branch, to which they’re whisked onto the famous, wheelchair-friendly Callow buses. Some branches ‘adopt’ veterans who have no family visitors or Legion affiliation, and visitors take these veterans out to buy essentials like clothing and toiletries and other items, including canned milk which they can’t get at Camp Hill. Some run errands, taking veterans’ watches or shoes for repair. And sometimes the subject is more serious—a veteran will ask for the Legion’s help in sorting out legal affairs or problems with family or staff.
Legion visitors “are invaluable,” says Rolls. “There’s so much they give to the veterans, it’s amazing. There’s support for staff and family members as well. We really appreciate all the support they give. We’d be in a hard way without them.”
There are enough Legion visitors in the facility, home to 175 veterans ranging in age from their late 70s to nearly 100, that “every vet gets a visit,” says Waters. Typically, visitors drop in on regulars, but “if they go by a room and see a vet sitting there doing nothing, staring out the window, they’ll introduce themselves and start talking. They’ll ask if the vet was in the army, navy or air force, and talk a bit about him, and then about family, and get him perked up a bit.”
Legion visitors often take veterans to the lounge, says Glanville. Not only does this get the veterans out of their rooms, but it gets them interacting with other residents and visitors, too.
Broadmead estimates their 200 or so visitors donate about 1,000 hours every month. Seven area Legion branches take turns doing monthly visits, says Bolli. Thursday is Legion visiting day when a group of uniformed Legionnaires visit residents, distributing small gifts like toothbrushes and tissues. “Each branch has a day to go,” says Bolli. Aside from that, Legion visitors also volunteer to help out at various activities.
“It’s very important for us. Even though the branch is disbanding this will still go on,” she says. The branch is ensuring that the cost of the small gifts—about $140 a month—will continue to be covered for several years. “We all really enjoy going and wouldn’t miss it for anything.”
Visiting is as good for the visitors as it is for the residents.
“The last Korean War veteran has left our volunteer program (except for those who volunteer in Legion groups),” says Sprackett. “They were really reluctant to give it up because they knew it was good for their health to be coming; they pushed it as long as they possibly could and we’ve been trying to adapt the volunteer program to accommodate people whose health isn’t as predictable anymore.”
“One of the things we’ve found in our research is the huge benefits older adults get from contributions they make to their communities,” says Keating, contributions that often go unrecognized in Canada. “I’m delighted you’re doing this article. It’s nice for Legion members to know how much they’re appreciated. There’s all this discourse about older adults and how they’re burdensome and unproductive and not really contributors.”
Volunteering disproves this and continues or restores the volunteer’s sense of purpose.
“It’s a pleasurable thing,” says Bolli. “It makes you feel good.” In a generation of women with the attitude they’d rather wear out than rust, doing their part feels good. “I have a focus for the day,” she adds.
“It’s the pleasure you get seeing their faces light up, especially when you’re in uniform,” says Eileen Margaret Smith, 87, of the Victoria Ex-Servicewomen’s Branch who’s been visiting at Broadmead for nine years. “You look forward to it. I wouldn’t want to miss it. I’m carrying on as long as I can. I always feel like I’m one of the lucky ones; that there but for the grace of God go I. I’m lucky to be in good health and to be able to help.”
“I get as much out of it as they do,” says Christian. “A lot of people my age stay in bed, but this gives me something to do.”
Such volunteering may be fun, but Legionnaires can also take pride in the serious results of their visits, says Keating. “It’s an important thing the Legion is doing.” The Legion’s focus on veterans’ welfare is reassuring to residents and their families, who know that the keen eyes of Legion visitors catch inadequacies. And because there’s a national organization behind them, they can be sure there will be follow-up in individual cases, and as policy at the national level.
“In all those years,” adds MacEachern, “I never saw anything wrong, and neither did any vet complain”—save one concerned about a change in food service. If things are in tip-top shape for unannounced visits, he says, it sets the visitors’—and families’—minds at ease about how the veterans are being treated on a day-to-day basis.
“By making sure care is good for veterans, the Legion is also having an impact on the care for other seniors,” says Keating.
Another Pair Of Eyes
Brenda Montgomery of Centennial Branch in Dartmouth, N.S., is a no-nonsense retired nurse, herself married to a veteran, who knows the importance of her work as a volunteer in the Long Term Care Surveyor Program.
“I keep my eyes open,” says Montgomery. “If I come across something from my perspective that’s particularly worrisome I have immediate resources.” If the problem can’t be addressed by the resident’s family or the director of care at the facility, Montgomery calls in Veterans Affairs Canada.
“It gives the family reassurance, just the idea that somebody else is checking in on their health and care,” she says. “It’s very worthwhile.”
The Long Term Care Surveyor Program is a partnership between Veterans Affairs Canada (VAC), which foots the bill ($129,000 in 2007), and The Royal Canadian Legion, which administers the program and provides the volunteer workforce. It has benefits at every level, from addressing unmet needs of individual veterans, to informing people of changes in policy at VAC as well as advocacy positions and convention resolutions for the Legion, and also raising the bar for the standard of care for non-veterans in long-term care.
As part of its commitment VAC has used resident satisfaction surveys at larger priority access bed sites. But with approximately 7,300 other veterans accommodated in more than 1,900 facilities scattered across the country, VAC visits were limited by manpower and distance. “Prior to Legion involvement, VAC staff surveyed residents, but the sheer volume of clients dictated visits would be infrequent and spotty at smaller facilities across the country,” says Carlos Lourenso, director of VAC’s home and residential care programs. “The partnership with the Legion allows us to get to more places and see more veterans.”
“When Legion volunteer surveyors came on the job five years ago, about 2,000 residents were surveyed; in 2007 about 3,000 surveys were conducted and volunteers are on track for 4,000 in 2008,” says Lourenso.
That puts a smile on the face of Pierre Allard, director of the Legion’s Dominion Command Service Bureau, which recruits and trains volunteers and administers the program for VAC. “We developed the program jointly with VAC,” he explains. “We were not too pleased with the level of care, and were saying a standardized level of care was not provided in all veterans’ facilities.” The VAC Gerontological Advisory Committee, the Legion and other veterans’ organizations recommended regular visits to survey residents in community facilities. Early this decade the Legion and VAC started putting together a program.
“It’s a natural and positive partnership,” says Lourenso. “The Legion is a wonderful national organization with branches and volunteers across the country, and a vested interest in the well-being of veterans.” VAC has promised to ensure a high level of care for veterans in need, and “the Legion is a partner in ensuring that commitment is fulfilled.”
“We worked hand-in-hand with VAC developing the program,” says Allard. In 2003 the Legion began advertising for volunteers, and conducted six training series over a month and a half “so we could have a sufficient number of surveyors to start.” Recruitment and training continues. There are now about 150 trained volunteer surveyors across the country who are tasked by VAC to survey veterans residing in long-term care facilities about their satisfaction with services in 10 aspects of care, including safety, security and hygiene; food quality; access to medical services; social and recreation opportunities; and spiritual and pastoral support.
The Legion and VAC review different parts of the information and use it for a variety of purposes.
The confidential client satisfaction questionnaires go directly to VAC. “It’s anonymous and non-personal,” says Lourenso; and “not for our eyes,” says Allard.
Summary reports, however, “go first to Dominion Command where they are examined to see if there is any issue,” says Lourenso. “This can fast-track issues or problems or needs to be addressed.”
“Maybe 90 to 95 per cent of the time they’re good,” says Allard, “but once in a while we identify a problem.” Problems that affect an individual or a facility are referred to VAC. “We act accordingly, working with the facility to resolve the issue,” says Lourenso. In the summer, the Legion alerted VAC of concerns arising from summary reports about safety, persistent odour and missing property in a small Ontario facility. This prompted investigation by a VAC district nursing officer and resulted in the transfer of unhappy residents to other facilities.
The Legion and VAC review the summary reports to spot more systemic issues, too. These often give rise to advocacy issues for the Legion or result in resolutions on the convention floor. VAC uses “the wealth of information from the summary reports, questionnaires and results from their own professional surveyors who cover the largest facilities,” says Lourenso. It “becomes the cornerstone of our quality assurance for long-term care.”
One such systemic issue identified early on related to food, a topic of keen interest in residential care settings. “Food is a fluctuating and volatile satisfaction indicator,” says Lourenso. When reports and questionnaires revealed unhappiness about food was pervasive, it resulted in the establishment of uniform standards for food preparation and delivery. Result: “In four to five years, there was a significant increase in satisfaction.”
And that’s information that will make Montgomery smile, too. Since food is a hot button issue, she plans her visits around mealtime. “I can gather a lot of information in social conversation then,” and asks questions about palatability, what happens if something’s served the resident doesn’t like. She also notices mealtime practice, whether residents are gathered shortly before service, or shepherded into the dining room hours in advance.
She uses all her senses while in the facility, noticing cleanliness and orderliness, smell, noise. She takes her time. “Someone may say ‘I don’t want to say anything’ for fear it will affect their quality of care,” she says. “I tell them I’m speaking to five people, so they’ll never know who said it.” And of course, the questionnaires delivered to VAC are depersonalized and anonymous so residents don’t need to worry about recrimination or retribution for survey answers.
Montgomery listens carefully. When one resident said he didn’t read the newspaper anymore, gentle probing revealed he needed glasses. A call to VAC remedied the situation.
“That kind of personal interaction is important,” says Lourenso. It is the difference between a friendly visit and a business meeting. “The visit isn’t just about gathering information,” notes Lourenso, who began his career with VAC as a counsellor who visited facilities. “It’s about social contact. It’s about listening and hearing people.”
The trend today is for veterans to enter care later, when they’re less healthy and they are less able to look after their own interests. That makes the program even more vital. “I see two strengths (of the program),” adds Montgomery. “One is from a system perspective, keeping Veterans Affairs and the Legion aware of what’s going on. The other is the facilities know somebody is concerned.”
She has seen a slow improvement over the five years she’s been conducting surveys. “Generally speaking most facilities are very good. They’re better than they used to be even 15 years ago.”
It’s gratifying when she returns to a facility and sees a problem has been corrected. “It’s very satisfying from a personal perspective. I feel as if I’m doing a really useful function in providing information to the Legion and VAC; hopefully it improves the quality of care for residents.
“I plan to continue as long as I’m able.”
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