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NS GovLab

Construction Zone Begins

Home Sweet Home A Conceptual Approach for Aging in Place

September 2018

This paper documents our adventures on the

winding, challenging and illuminating Route of Aging. PRESENTED BY:

Aileen Nasager

Dennis Pilkey

Stephen Amirault

Substantive contributors and former team members:

Jon Kincade

Kenzie Finlayson Buck

Michele Banfield

ROUTE OF AGING

This and other blank pages are for two-sided printing purposes.

i

TABLE OF CONTENTS EXECUTIVE SUMMARY .............................................................................................................................. III

1 INTRODUCTION ............................................................................................................................. 1

2 HOW MIGHT WE ............................................................................................................................ 2

2.1 Evaluate if and how to enable people to remain in their homes as they age? .............. 2

2.2 Assumptions ................................................................................................................... 2

2.3 The Construction Team .................................................................................................. 3

3 SENIORS CONTEXT ......................................................................................................................... 4

3.1 Living Arrangements ....................................................................................................... 4

3.2 Housing ........................................................................................................................... 5

3.3 Income ............................................................................................................................ 5

4 ENERGUIDE HOME EVALUATION ...................................................................................................... 6

4.1 Overview of Home Energy Assessment (HEA) Program ................................................. 6

4.2 Strengths of HEA Program .............................................................................................. 6

4.3 Weaknesses of HEA Program ......................................................................................... 6

4.4 HEA Program Process Relation ....................................................................................... 7

4.5 The HEA possible correlation with AIP Assessment: ...................................................... 7

5 MODELS & BEST PRACTICES ............................................................................................................ 8

5.1 Other Models .................................................................................................................. 9

5.2 Overall Learnings and Key Insights ............................................................................... 10

6 HOUSEHOLD CIRCUMSTANCES ....................................................................................................... 11

7 TYPES OF HOME ASSESSMENTS ...................................................................................................... 12

8 HUMAN CENTRED DESIGN – INTERVIEWS ........................................................................................ 13

9 PROTOTYPE SESSION 1 ................................................................................................................. 14

10 PROTOTYPE SESSION 1A ................................................................................................................ 17

11 REIMAGINING HOME SESSION ....................................................................................................... 18

12 PROTOTYPE SESSION 2 ................................................................................................................. 25

13 PRELIMINARY ASSESSMENT TOOL CONTENT ..................................................................................... 27

14 TECHNICAL CONSIDERATIONS ......................................................................................................... 29

14.1 Data Ownership and Management .............................................................................. 29

14.2 Format/platform ........................................................................................................... 29

15 LIMITS AND RISKS FOR THIS PROTOTYPE........................................................................................... 30

16 TESTING OF THE PROTOTYPE .......................................................................................................... 32

17 PRELIMINARY ASSESSMENT TOOL ................................................................................................... 34

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18 CONTINUED TEAM ENGAGEMENT................................................................................................... 35

19 CONCLUDING PERSPECTIVE............................................................................................................ 36

20 APPENDIX A – STATISTICAL OVERVIEW ............................................................................................ 38

20.1 Appendix A.1 – Population Pyramids ........................................................................... 39

20.2 Appendix A.2 – Nova Scotia Population Estimates....................................................... 41

20.3 Appendix A.3 – Nova Scotia Seniors Living Conditions ................................................ 42

20.4 Appendix A.4 – Nova Scotia Sources of 2015 Income .................................................. 44

21 APPENDIX B – RESOURCES ............................................................................................................ 45

22 APPENDIX C – PEOPLE/ORGANIZATIONS CONSULTED ........................................................................ 46

23 APPENDIX D – SYNTHESIS MEETING RESULTS ................................................................................... 58

24 APPENDIX E – PROTOTYPING ONE RESULTS ..................................................................................... 63

25 APPENDIX F – PROTOTYPE TWO PITCH FEEDBACK – MAY 22, 2018 .................................................... 65

26 APPENDIX G - PROTOTYPE TESTING PACKAGE ................................................................................... 69

27 APPENDIX H - ACRONYMS ............................................................................................................. 76

iii

Executive Summary The six members of the original Route of Aging team are part of the first cohort of NS GovLab for

Seniors. This is a social innovation lab consisting of volunteers focussing on different ways to

address seniors’ issues and opportunities in Nova Scotia. Our team of six used the success of the

EnerGuide home evaluation as a model for an Aging in Place (AIP) strategy for seniors.

The Route of Aging team started with the question “How might we evaluate if and how to enable

people to remain in their homes as they age?”.

The success of Nova Scotia’s Home Energy Assessment program, a provincial iteration of Natural

Resources Canada’s successful EnerGuide home evaluation currently administered by Efficiency

Nova Scotia, seemed to be a good model to review for potential adaptation to an AIP1 strategy. A

review of the program and best models and practices for seniors from other jurisdictions showed

there were many good resources and several assessment vehicles already in place. Team

members carried out interviews to inform our work early in the developmental phase.

The following are key steps taken or considered by the team and are described in detail in the

report and the appendices:

• Synthesis work from the research and interviews resulted in 80 observations from the

interviews being summarized under nine categories.

• Key among the observations were the gaps, overlaps, lack of knowledge of services,

lack of consideration by health professionals, absence of age friendly solutions

• Exploration of several alternative approaches.

• Development of a conceptual approach for a “Ground Zero” concept with an “Aging

Hub” at its core. The need for a strong information hub that is proactively developed

and managed is essential for our work and that of several of the other teams.

• A “Reimagining Home” concept, based on the Home Energy Assessment program, was

developed.

• The Preliminary Assessment was identified as the part of the model that would be

developed in more detail with a Preliminary Assessment Tool as the focus of

attention.

• A detailed conceptual outline of the tool was developed. Comments and suggestions

were received from 19 of over 30 people who were invited to provide feedback on the

tool.

• Comments were largely favourable with many good suggestions received with respect

to its further development. Several of the responders asked to be kept involved and

even offered to help.

1 Appendix H provides a list of acronyms used in this report.

iv

Based on research, talking to a wide variety of people and applying critical thinking, the current

systems and the present way of looking at the “problem” is not working nor is it sustainable even

at the present level.

This report reflects our team’s journey towards identifying a route for a more efficient, accessible

and empathetic way to enable our population to age in place. Each section of this report is

chronologically reflective of the segments and associated work product of phase one of our

Fellowship. They were part of this journey and we would not have reached the destination we

have without making these pitstops and, at times, detours.

This paper presents a broad bold model for an AIP strategy for Nova Scotia. It is built on the

success of the work that led to creation of Efficiency Nova Scotia and, if further developed, will

aim to grow into an aging hub network that will support and connect the diverse silos of existing

resources and services for the betterment of all. As we have come to learn, behind every senior is

a concerned friend, neighbor, or family member. Herein is a broad bold vision. It is not a small

easily tested prototype.

NS GovLab Page 1 Aging at Home

1. Introduction NS GovLab is a social innovation lab that will amplify, support, and advance innovation in

the Nova Scotia public service. NS GovLab is bringing together a wide range of partners to

experiment on a systems-level change related to our aging population. Government

recognizes that as our population ages, our communities, social programs, and workplaces

will need to adapt. But how?

NS GovLab creates an opportunity to apply social innovation theory and methodology to

the challenge of Nova Scotia’s aging population and shifting demographics. Together we

will test and learn from new policy, program, service, and process ideas in an inexpensive

and safe way.

The first of several cohorts of “Fellows” met at White Point Resort from March 25 to 27,

2018 to explore this approach to social innovation and program development. In addition

to learning about each other, organizational and research methods were reviewed to

provide a common vocabulary and approach to the research. Informed by a statistical

review of seniors centred data, aging perspectives and issues, as understood by

participants were explored.

Themes emerged, based on wide ranging exploration in small groups. Individuals aligned

themselves into four to six-person teams to discuss the selected theme of interest to

them. Wrestling the theme into a defining question enabled the creation of a starting

approach for a prototype project that would:

• Be scalable

• Entail low risk

• Be based on diverse research methods


2. How might we

2.1 Evaluate if and how to enable people to remain in their homes as they age?

This paper will be developed and added to as we explore this question. Our starting position is to

review the success of the Home Energy Assessment program and determine which elements of it

could be adapted in assessing AIP initiatives. Other models will be explored, contextual

information summarized, and best practices researched.

2.2 Assumptions It is important that any underlying assumptions in the above be recognized, understood and

challenged appropriately. One potential assumption is that of believing that people want to and

can stay in their homes. A key part of the any evaluation is to include an assessment of both the

desire and ability of the occupants to remain in their current home. A corollary to this is a need

for an assessment of how long they might stay in their home as well as conditions that might

necessitate a move. In 2016, twenty-three percent of people 65 years of age and over reported

that their dwelling was inadequate, not affordable or not suitable.

While the Home Energy Assessment program refers to both the term assessment and the term

audit, the former may create concern for those who worry that an unfavourable assessment

would lead to an adverse outcome, while the latter may generate a more negative impression if it

is felt that an inspection would be taking place which might also lead to an adverse outcome. As a

result, another term such “survey” or “review” might be a more appropriate and, welcomed,

descriptor.


2.3 The Construction Team

Aileen Nasager, Energy Solutions Advisor, Specialist, Efficiency Nova Scotia

For nearly a decade Aileen has been a sustainability advisor, providing guidance on energy

efficiency and conservation solutions to Nova Scotians. In tandem with her passion for sustainable

design, she recognizes the importance of integrating universal design into the art of building

science so that all may live safely, comfortably and sustainably in place.

Dennis Pilkey, Retired Civil Servant, Part-time Management Consultant

Dennis has been a long-time advocate and practitioner of evidence-informed planning. Recent

consulting work has been focussed on supporting United Way of Halifax planning and programs as

well as working with local non-profit organizations.

Jon Kincade, Independent Consultant, JK : UX

Jon's independent consulting practice focuses on user experience analysis and digital marketing

strategy for private and public organisations. Human centered design principles guide the

development of digital and physical assets that connects business goals with end user needs.

Kenzie Finlayson Buck

In 2008, Kenzie moved from the prairies to study International Development at Dalhousie. She fell

in love with Nova Scotia and decided to stay put. She's passionate about community capacity

building and environmental stewardship. In March, she completed a four year stint with French

Programs & Services at Education & Early Childhood Development. In between job-hunting, she

focuses her energy on sustainable woodlot management and shoreline restoration at Mattatall

Lake. On Thursday afternoons, she volunteers at the SPCA Thrift Store in Dartmouth.

Michele Banfield, Senior Policy Analyst, N.S. Department of Health and Wellness

Michele is passionate about health promotion, addressing environmental barriers to living a

healthy and enjoyable life. She is continually drawn to spaces that encourage curiosity and

innovative practices to do so.

Stephen Amirault, Regional Education Officer, Department of Education and Early Childhood

Development

Stephen is an educator with more than 40 years in the Nova Scotia public school system, with an

extensive background in administration, student services, school improvement, principal support

and advisor to governing school boards. International work includes quality assurance inspections

of schools delivering Nova Scotia curriculum in China, Egypt and the United Arab Emirates.

ROUTE OF AGING


3. Seniors Context Appendix A contains detailed statistics from which the following highlights were developed.

According to the 2016 Census of Population, there were 183,415 persons 65 years of age and

older living in Nova Scotia. This was 19% of the total population which was two and a half times

the 8% share of seniors in 1961. In 1961, towards the end of the baby boom, 35% of the

population were less than 15 years of age compared to 14% in 2016. The population pyramids in

Appendix A.1 demonstrate the effect of the aging population as the “bulge” moves up the age

chart. The shortage of schools and teachers of the 60s and 70s has given away to health facility,

nursing home and doctor shortages.

1961 1991 2016

0 to 14 15 to 64 65 & over

3.1 Living Arrangements In 2016, there were 171,820 seniors, age 65 and over, in Nova

Scotia not living in institutions. Data for the following sections

is based on those seniors not living in institutions.

Over 106,000 were ages 65 to 74, 50,000 were ages 75 to 84

and just under 16,000 were ages 85 and over.

Twenty-seven percent lived alone, 56% were couples living

together and almost 17% were couples or single seniors living

with either relatives or non-relatives. For persons aged 65-74,

63% were couples and 22% lived alone. This changed

dramatically to 27% and 48% respectively for those who were

85 and over.

Living alone Couple only Couple or lone senior living with son or daughter Couple or lone senior living with others

35%

57%

8%20%

67%

13% 14%

67%

19%

FIGURE 1 PERCENTAGE OF POPULATION BY AGE GROUP

0

20000

40000

60000

80000

100000

120000

65 to 74 75 to 84 85 andover

Seniors Living Arrangements


3.2 Housing In 2016, almost 80% of Nova Scotians owned

their own home and almost 20% lived in rented

accommodations. The share of renters

increased from 18% for those ages 65 to 74 to

27% for those ages 85 and over. Those with a

mortgage decreased from 25% for those ages

65 to 74 to 11% for those ages 85 and over.

Only 5.5% of people ages 85 and over lived in

subsidized housing.

Less than 4% of seniors lived in condominiums.

Seniors 65 and over estimated the average

value of their dwellings to be almost $440,000

while those 85 years of age or more estimated

the value to be slightly over $450,000. The

average value of all dwellings in Nova Scotia is

$230,400. Seventy-eight percent of people

aged 65 to 74 reported that their housing was adequate, suitable and affordable compared to 70%

for those aged 85 and over.

Ninety-one percent of seniors lived in accommodations with two or more bedrooms and 22% had

four or more bedrooms. These numbers were only slightly less for those 85 years of age and over.

3.3 Income In 2015, the average income of people 65 years of age and over

was $36,075 compared to $41,430 for all ages. The after-tax

amount for both numbers would likely reduce the differential.

Comparable after-tax amounts do not seem to be readily

available.

The After Tax Low Income Measure2 (LIM-AT) is a well recognized

widely accepted measure of poverty. Based on this measure,

31,075 seniors, about 18%, lived with low incomes.

Forty-one percent of seniors’ income came from OAS and CPP,

while almost 33% came from private pension plans. Less than

2% of income came from RRSPs. Employment income provided a

little over 12% of income and investments another 8%.

2 LIM(AT) is a relative measure of poverty that is set at 50% of the median Canadian Income adjusted for family size and

composition. 2016 Census income data is based on 2015 income.

0

20000

40000

60000

80000

100000

120000

65 to 74 75 to 84 85 and over

Owner with mortgage Owner no mortgage

Renter subsidized Renter not subsidized

Government transfers

Other income

Registered Retirement Savings Plan (RRSP)

Private pensions

Investment income

Employment income

0%

20%

40%

60%

80%

100%

All ages 65 and over

Source of Income


4. EnerGuide Home Evaluation

4.1 Overview of Home Energy Assessment (HEA) Program The EnerGuide rating for homes and its associated label is the official mark of the Canadian

Government as relates to energy performance in housing. Natural Resources Canada (NRCan)

offers training for energy advisors (EAs) through regional service organization (SOs) partners to

assess the energy performance and potential energy savings for homes during various stages

(design, construction or renovation). EAs and SOs use NRCan’s official marks and proprietary

software tools under a licensing agreement; they operate as independent businesses.

Efficiency Nova Scotia (ENS) is the primary organization that currently administers the EnerGuide

Energy Efficiency Home Evaluation in Nova Scotia. ENS works with seven partner SOs who conduct

assessments in various parts of the province; there is some overlap as to which territories each

covers. Currently open only to electrically heated homes, participants are drawn to the program

through marketing initiatives and through word-of-mouth. A large part of the HEA enrollment fee

is subsidized through ENS (through energy efficiency funding from Nova Scotia Power and through

the federal Low Carbon Economy Fund). All participants are charged a flat rate of $99+HST to

enroll the home and have the initial assessment done. A pre-retrofit report is sent to the

participant identifying cost-effective energy efficiency measures. From this report, participants

have the required information to decide if they want to move forward with certain energy

efficiency upgrades. If the participant chooses to move forward with implementing any or all the

energy efficiency measures recommended, other incentives, in the form of rebates or financing

options, are made available which offset or assist with the cost of the measure(s) undertaken.

By implementing a particular energy efficiency initiative, it is assumed the participant will save

money and in turn, there will be a reduction in energy bills. A post-retrofit summary is provided to

the client which: identifies savings achieved and offers an elevated EnerGuide rating as correlates

to the depth of work performed.

4.2 Strengths of HEA Program A strength of the program is that it offers an opportunity to collect various levels of information

about a home which could be used to target alternate opportunities for improvement of the

building envelope or the occupant experience. It also fills an important information gap that many

homeowners have, especially in the case of those who are purchasing a new-to-them home and

know little about the home and in the case of those who are experiencing a specific issue

(elevated energy consumption levels, poor air quality) which would be peripherally identified

during the prescriptive assessment.

4.3 Weaknesses of HEA Program The primary weakness of this program relates to securing participant acquisition as this is

impacted by marketing initiatives and or funding presences or absences. A secondary weakness

relates to moderate income household participants who haven’t met the income cut off for the

no-charge assessment program (HomeWarming) and would like to pursue the HEA program,

however, cannot afford the recommended upgrades as they may not be approved for the


financing option through the third-party lending party. The HomeWarming program, currently

jointly run by the Clean Foundation (electrically heated homes through funding from Nova Scotia

Power) and ENS (non-electrically heated homes through funding from PNS) provides no-charge

assessments and recommended upgrades to income-qualified participants.

4.4 HEA Program Process Relation The HEA general process correlates quite strongly with what an AIP assessment program might

look like as: assessors would require training from a reputable third party ratings provider;

marketing initiatives would need to be undertaken which could prove costly; participation would

need to be subsidized or incentivized for many as would the completion of the recommended

upgrades; a final assessment would need to provide a rating as to what safety concerns were

mitigated by the upgrades undertaken and what concerns remain with steps for future resolution.

4.5 The HEA possible correlation with AIP Assessment:

The EnerGuide for homes rating program was initiated in 2006 and has seen numerous iterations

over the years. The longevity of the HEA program in NS can be attributed greatly to the fact that it

embodies and promotes a nationally recognized rating program and in turn, has been supported

in part by various levels of government over the years. Having all SO partners receiving the same

EnerGuide energy advisor training and in turn, following the same prescriptive assessment

process, has allowed the program and its documentation to remain fairly uniform leading to a

recognized end product. People by nature want to achieve a higher performance level in most

things they undertake, and it is no different when it comes to housing. If given the opportunity,

they will pursue upgrades that will lead to energy reduction and at the end of the day, a more

comfortable home. Some undertake the program out of consideration of the environment and

wanting to reduce reliance on fossil fuels, however, many are driven solely by economic concern.

When savings are proven beyond what is quantified in the post-retrofit report, participants know

satisfaction from having pursued the process and undertaken the initiatives.

TRAINING MARKETING INIATIVES

PARTICIPANT ACQUISITION

SUBSIDIZED ENROLLMENT

PRELIMINARY ASSESSMENT & PROVISION OF PRE-RETROFIT

REPORT

PROVIDE FINANCIAL

ASSISTANCE FOR

PARTICIPANTS TO PURSUE UPGRADES

FINAL ASSESSMENT & PROVISION

OF POST-RETROFIT

REPORT AND RATING


5. Models & Best Practices Housing NS has two programs to help seniors who want to stay in their homes:

• Home adaptations for Seniors Independence - This program helps homeowners (65+) pay

for home adaptations so seniors with low incomes can stay in their homes independently

for longer periods of time. A one-time forgivable grant of up to $3,500 is available.

• Senior Citizens Assistance Program - This program helps senior homeowners (age 65+)

who would like to remain in their own homes but cannot afford necessary repairs. The

funding covers repairs that are a threat to health and safety, which includes repairs to

roofing, plumbing and heating; cosmetic repairs are not covered. A grant of up to $6,500

is available.

The National Association of Homebuilders (NAHB) offers a Certified Aging in Place (CAPS)

designation, where select builders and remodelers become certified as AIP specialists; provincially

this course is offered under the Canadian Home Builders Association Nova Scotia. A CAPS

Specialist is trained in Universal Design Principles, which, when implemented, make a home more

livable for all ages and stages of life.

The Community Aging in Place – Advancing Better Living for Elders (CAPABLE) through the John Hopkins University School of Nursing, is a client-centered home-based intervention to increase mobility, functionality, and capacity to AIP for low-income older adults. CAPABLE is comprised of an occupational therapist intervention, a client-centered nurse intervention and safety and access to handyman services. Each service synergistically builds on the others by increasing the participants’ bio-psycho-functional capacity to function at home. The patient decides on functional goals, such as taking a bath or walking to church, as opposed to medical ones, such as reducing blood sugar or blood pressure level.

1.1. The National Council on Aging (NCOA) has a list (2017) of evidence-based programs3 and

best practices related to home assessments and home modifications (primarily regarding

fall prevention/safety).

There are numerous self-assessment guides for homeowners available; notably those produced by

CMHC (Canada) and AARP HomeFit Guide (US). A booklet for AIP, titled Thinking About Your

Future: Plan now to Age in Place, was developed in 2015 by a federal, provincial, and territorial

Ministers Responsible for Seniors working group which may in near future be published as a

fillable PDF version on the federal website. There are also numerous private companies (with

certified CAPS on staff) who offer for-fee home assessment services.

According to Canada Mortgage and Housing Corporation (CMHC), there are two overarching

categories that describe housing options for AIP:

Accessible housing uses universal design principles to design housing that can accommodate a

range of abilities. Universal design principles can be used to evaluate existing buildings, or in the

3 http://stopfalls.org/wp-

content/uploads/2017/09/home_modification_programs_consumers.pdf

http://stopfalls.org/wp-content/uploads/2017/09/home_modification_programs_consumers.pdf

http://stopfalls.org/wp-content/uploads/2017/09/home_modification_programs_consumers.pdf


design of new ones. There are seven principles4: equitable use; flexibility in use; simple and

intuitive use; perceptible information; tolerance for error; low physical effort; size and space for

approach and use. CMHC has an array of public fact sheets online that speak to universal design of

various living spaces in the home, as well as low or no cost options to assist homeowners.

Adaptable housing is a type of design that allows homes to be easily modified or adapted to

changing circumstances of those living there, reducing future renovation costs. A model of

adaptable housing design called FlexHousing™ was developed in 1995 by CMHC5, incorporating

principles of adaptability, accessibility, affordability and Healthy Housing. CMHC also has a self-

assessment guide available for those wishing to make adaptations to their home6

Also, worth mentioning is Apartments for Life (Netherlands) - Although this is a model for shared

housing (55+) and may be beyond the scope of this prototype, there is value in learning more

about this initiative and its possible application to aging in one’s own home. In particular, there

are four key values upon which the Apartments for Life are based:

• autonomy (remaining in charge of your life)

• use it or lose it (over provision of care may be more damaging than under provision of care)

• embrace a ‘yes’ culture (freedom and encouragement to enjoy the simple pleasures of life)

• family-centered approach to care giving

5.1 Other Models Aside from remaining in one’s own home, there are a range of other housing options7 available

that may be suitable for particular needs or preferences:

• Co-housing/home sharing - involves sharing a home with a friend or family member

• Co-operative Housing (Co-ops) - legal associations that provide housing in return for a

share in the maintenance or other tasks

• Life Lease Housing - religious or charitable organizations often operate this

condominium-like option; residents pay upfront and monthly fees for the right to live in

the home for a specific period

• Supportive Housing - refers to independent apartments with access to services like

housekeeping, personal support and healthcare available for free or at a reduced cost

4 What is Universal Design, Centre for Excellence in Universal Design - accessed at

http://universaldesign.ie/what-is-universal-design/the-7-principles/the-7-principles.html#p5

5 https://www.cmhc-schl.gc.ca/flex/en/lemo.cfm

6 Maintaining Seniors Independence Through Home Adaptations - A Self-Assessment Guide

(CMHC; revised in 2016) - accessed at https://www.cmhc-schl.gc.ca/odpub/pdf/61087.pdf

7 Housing Options for Seniors, Canada Mortgage and Housing Corporation - accessed at

https://www.cmhc-schl.gc.ca/en/co/acho/seniors-housing-finance-tips/housing-options-

seniors.cfm

http://universaldesign.ie/what-is-universal-design/the-7-principles/the-7-principles.html#p5

https://www.cmhc-schl.gc.ca/flex/en/lemo.cfm

https://www.cmhc-schl.gc.ca/odpub/pdf/61087.pdf

https://www.cmhc-schl.gc.ca/en/co/acho/seniors-housing-finance-tips/housing-options-seniors.cfm

https://www.cmhc-schl.gc.ca/en/co/acho/seniors-housing-finance-tips/housing-options-seniors.cfm


• Retirement Communities - these residences combine independent living with access to

support and recreational facilities

• Retirement Homes - for-profit businesses that offer a full range of accommodations,

services and healthcare support

• Nursing Homes and Assisted Living Facilities - similar to retirement homes but are

sometimes operated as not-for-profit residences by the federal government

• “Garden Suites” - a small, single-dwelling often connected to or sharing the property of

another dwelling

5.2 Overall Learnings and Key Insights *Overall, most studies and models found for home assessment and home modifications aim to

reduce the incidence and severity of falls. This is a significant risk for those who wish to age in

place. Aging well is a multi-layered concept that includes many more elements beyond reduced

risk of falling. Home modifications should always be person-centric, encompass functional goals,

and be considered in the context of the broader environment/community supports. Other

important elements of AIP that should/could be incorporated into a home assessment model are

enriched environments (supporting cognitive health), use of telecare/technology (such as bed

sensors and personal alarm devices), access to services, embracing of informal caregivers, and

enabling autonomy.

Consideration should also be given to some of the barriers/challenges to remaining at home (as

described in the ENABLE-AGE Project in the UK):

• physical barriers in the home (i.e. stairs)

• stigma/symbolism of “age-related” home modifications or technologies based on

aesthetic look

• easy to hide increasing frailty (especially for those who may not want to ask for help or be

a burden to family)

• fearfulness that leads to reduction in social participation

• barriers outside the home (transportation, for example)

• loneliness

• challenges to accessing services (lack of awareness about what is available, negotiating

bureaucracy, mistrust, disruption of routines, stigma, age discrimination, weather, etc.)


6. Household Circumstances People live in households. When a qualified professional enters a home, the range of

circumstances they might use to assess it include such things as:

• Household composition - size, ages, relationships

• Rental versus ownership

• Type of building/accommodation

• Racial visibility, culture, language, religion

• Physical and mental health, cognitive challenges, addiction issues, required medications

• Eating habits, access to healthy foods

• General condition of cleanliness and state of repair

• Economic circumstances

• Supports/services provided by agencies/organizations

• Mobility/physical needs, use of assistive devices

• Pets

• Transportation needs

• Social Supports

The section on Preliminary Assessment Tool Content elaborates on the above.


7. Types of Home Assessments There are several home and in-person assessments being done across the province.

Beyond health:

- Senior Safety Coordinators around the province often play this roll in the most holistic way.

These are reported to be well established programs and their newer programs as well. Contact

names are available for these.

Primarily health based (these can sometimes include broader assessments like the need for snow

clearing or a new stoves, etc.):

- Continuing Care Coordinators do assessment for services and needs and whether or not

someone is ready for long-term care

- Occupational therapist and Social Workers will do home and in-person assessments to determine

ability to return to home after a stay in hospital

- Emergency Health Services (EHS) has been running a program to check on people in their home

and do a mini assessment

Both the EHS and the NSHA were doing an assessment of their program as it was being used as a

pilot, however, its public availability is unknown.

It was suggested by Michele that sometimes things need to be drawn to understand connections.

Talking about "home assessments" raises the question of "assessing for what"? So far, our

conversations have mostly been around structural changes to a home and home care, but we

should keep in mind many of the other pieces/needs for aging in place. While not a complete

picture, the above figure includes those things identified by Michele’s preliminary research. The

writing in blue is the existing types of home assessments (and who might do them).


8. Human Centred Design – Interviews Appendix C – People/Organizations Consulted provides summary notes and insights from the

interviews that were conducted to inform our work. Five seniors, ranging in age from 70 to 98,

four professionals, three organizations, one contractor and one caregiver family were interviewed.

In addition, three team members had informal interviews with family members, friends,

colleagues and industry professionals with a personal or professional interest in the seniors’

agenda. These informal discussions represent potential for more in-depth interviews later in the

research development.

As advised by the NS GovLab team, “The goal of the inspiration phase during human centred

design is to deepen your team’s understanding of your “How Might We” question. It gives you the

opportunity to test assumptions and gather diverse perspectives from multiple individuals. In the

end, we hope you have collected some rich and detailed information for the synthesis workshop

on April 23rd.”

The interviews were the main focus of team activity prior to the April 23 meeting. At that meeting

team members shared their observations and insights from the interviews. The synthesis work

resulted in summarizing 80 Observations under nine summary categories:

• Attitudes: Pride & Independence

o Economic versus personal benefit and well-being

o Rational Needs Assessment versus irrational behaviours, choices and attitudes, i.e.

programs and services assume people can and always do act according to the

rational definition of self (or best) interest implied by the goals/objectives of the

program/service

• Attitudes: Empathy & Training

o The empathy/training that is required to retrofit/build places where people can

properly age in place is lacking

• Navigation & Accessibility

o Services are disconnected and siloed

o There are many services out there but if you don't know about them...getting

access to them is difficult

o There is no formal directory of qualified renovation skills/expertise = word of

mouth

• Readily available "adaptations" to AIP are ugly/institutional

• Technology

• Caregiver

• Obstacles

• Gaps

See Appendix D Synthesis Meeting Results for the detailed insights and observations from the

April 23 meeting.


9. Prototype Session 1 At a team meeting prior to the Prototyping Session 1 held at Acadia University, the team

developed the following three “How Might We” themes:

• How might we create a culture that normalizes supports and services for AIP in a way that

is attractive to user and provider?

• How might we better connect existing services and create a more navigable and cohesive

system of services and supports?

• How might we create and promote awareness and reduce stigma for those providing

supports and services for seniors?

At the Acadia meeting the team developed 52 observations, related to these three themes, during

the brainstorming sessions; these are shown in Appendix E. It was observed that each of the

above and related observations collectively “informed” our original How Might We question but

did not address it directly.

The next step led to selecting two or three ideas from the brainstorming session from a longer list

generated by voting on each of the most innovative and the most likely to succeed. From the short

list the team evaluated each of the three ideas using the scoresheets provided. The three ideas

our team voted on were:

• Ground Zero

• Aging is Sexy

• Neighbourhood Watch

Based on the voting, it was agreed that Ground Zero would be the one to be prototyped and

developed. Jon agreed to develop the concept and a storyboard for it. Gert’s Story was the result:

https://trello-attachments.s3.amazonaws.com/5ac22dde094cddd3794c84a3/5af9f2da271ba00037eb25ba/5be52563fc7d0f0d3747171fdfd37ca6/Home_Audit_and_Hub_Concept_May_2018_JK_v_1.2.mp4



The related and linked .mp4 file of Gert’s story is much easier to follow.

The Aging Hub is the core of Ground Zero identified at Acadia. Jon expressed interest in continuing

work on refining and updating the presentation of this concept.



Conceptual staffing overview of the Aging Hub:


10. Prototype Session 1a At the team meeting of April 14, we reviewed our previous work and how well we were working together on a shared understanding and direction. We all agreed that we thought there was a strong team spirit with good connections, willingness to listen to each other and learn as we go. There was also general agreement that the linear process we were being asked to follow has not worked in developing our ideas. The process has led us down a much different path and in a different direction than the one that brought us together. Aileen presented an excellent conceptual overview of an approach that is closer to our original concept and is outlined further in section 11. Kenzie proposed that we could split into sub-groups and each work on different prototypes/projects. Dennis reviewed the Reimagining Home document he had sent out. The team discussed our respective understandings of the “Ground Zero” theme envisaged at Acadia. It was clear that we did not have a common view, or did not understand, what was agreed at Acadia. Part way through our meeting, we received an e-mail from Jon advising of the “Ground Zero” video he prepared. We agreed we would review his contribution after completion of our roundtable contributions. The outcome of our discussion was as follows:

• We would revert to our original “How might we” for our prototype • Use the “preliminary assessment” concept as the basis for a prototype/project • Use Aileen’s presentation to provide enhanced detail • Following Kenzie’s suggestion, have different people work on specific aspects as we

develop what must be done • Future interviews and research will be targeted to inform specific aspects of what we are

trying to do The team enjoyed the Gert’s Story concept Jon put together. The tone was perfect, and a lot of the content was in balance with what we had been discussing at the meeting - in fact, it was almost as though he were mentally with us as the input synced up perfectly. It also helped clarify the Acadia “Ground Zero” concept with better terminology and good graphical explanation. Following the review of the presentation, we reaffirmed our preference for the original approach and not getting sidetracked into a technical infrastructure piece. The need for a strong information hub that is proactively developed and managed is essential for our work and that of several of the other teams. This is a good concept with potential to fill major gaps in knowledge and able to support some of the planned prototypes. The Department of Seniors has an excellent working relationship with 211, a possible beginning infrastructure for the hub.

Work on the aging hub will continue somewhat independently of ideas in the following section which presents a conceptual approach for a prototype that uses the EnerGuide home evaluation as a model adapted to meet the more complex needs of a home assessment.



Home Energy Assessment • Schedule an Energy Assessor

• 2-3 hour assessment

• Detailed report within two weeks

• Review report, select projects, engage

contractors

• Final assessment & efficiency rating

The Program • National Standards

• Marketing

• Incentives

• Reporting

• Resources

• Advisory

Contracted Services • Heating/cooling

• Windows/doors

• Electrical/plumbing

• Insulation/air leakage

• etc.

11. Reimagining Home Session How might we evaluate if and how to enable people to remain in their homes as they age?

This prototype is based on the success of the EnerGuide home evaluation. It will help determine

what elements of it could be adapted in assessing aging at home initiatives.

Energy Efficiency Home Evaluation

Home Energy Assessment Details

The assessment takes 2-3 hours to complete depending on the size and age of the home. The

advisor takes detailed measurements of the home, documents the home’s insulation, heating and

cooling and ventilation systems and completes a blower door test to measure air leakage.

Efficiency Nova Scotia

Efficiency Nova Scotia provides advice and guidance on many topics, including:

• How to use the Home Energy Assessment Report to its fullest;

• Finding and working with a contractor;

• Comparing contractor recommendations;

• Understanding the science behind energy efficient home renovations;

• Identifying the upgrades and energy efficiency products that are right for the home.


Preliminary Assessment • Context

• Aspirations

• Health overview

• Economic overview

• Home assessment

• Preliminary Report

The Program • Standards

• Marketing

• Incentives

• Reporting

• Resources

• Advisory

Secondary Assessment(s) Additional in-depth assessments

based on preliminary report such as:

• Home care

• Support services

• CAPS (home modification)

Reimagining Home

The proposed prototype for this project is the preliminary assessment. Its purpose is to develop

and test this approach as a first step to directly answering our first how might we question. It will

• Engage a qualified professional(s) CAPS (or CAPE)?

• Use, with changes as needed, current instruments where they exist as well as adapting

analogous ones

• Assess and adapt best practices to NS and this approach

• Inform each of the other aspects of the model

• Incorporate HCD at every step of the way

• Evolving approach that changes as more is learned

Additional Components

• Gap Analysis

• Inventory (see Aging Hub)

o Programs & services

o Private and public

• Navigation Services

Additional Components • Home care services

• Health/medical

• Placement services, if needed

• Financial planning

• Support services

o Outdoor maintenance

o Banking, shopping, etc.

• Housing support

• Residential care

• Supportive technology

Public and Private Services • Accessibility renovations

• Heating/cooling

• Windows/doors

• Electrical/plumbing

• Insulation/air leakage

• Plus additional components


The following content provides additional conceptual detail for developing the preliminary, and

perhaps subsequent, assessments.

Helping people to stay in or get out, when they want and how they want

The tool assesses four general areas of being with an aim to determine needs and propose

solutions, while identifying gaps in service areas.

The Generac™ software program/sales tool was suggested as a model for a possible software-

based in-home assessment app for those who are unable to complete an online assessment tool

and don’t want or are unable to be assessed over the phone.

(http://www.generac.com/generaccorporate/media/lms/powerplaytrainingdatesandregistrationf

orm.pdf).

As Airbnb™ has created an extremely user-friendly online marketplace for those who wish to list

or find properties for short or long-term stay, a user-friendly, attractive online (or in-home)

general assessment tool should be available to assist interested parties in determining in-home

and in-community needs while providing an opportunity to match and propose service solutions

and identify service gaps for third-party review.

• RIDE SHARE

•APPOINTMENTS

•PLEASURE TRIPS

•OTHER

•COMMUNITY EVENTS

•HEALTHCARE SITES

•WELLNESS SITES

•FEATURED SPOTS

•VOLUNTEERING

•WORKING FOR $

•FINDING HELP

•MEET & MINGLE

•NEED A HAND?

•HOMESHARING

•NEED AN ASSESSMENT?

HOUSEHOLD MATTERS

PEOPLE

GETTING AROUND

PLACES

http://www.generac.com/generaccorporate/media/lms/powerplaytrainingdatesandregistrationform.pdf

http://www.generac.com/generaccorporate/media/lms/powerplaytrainingdatesandregistrationform.pdf


People

Want to Volunteer?

Need Some Help?

Looking for $ Work

Meet and Mingle

• Determining what types of household needs exist

with consideration given to: housing preferences

(as is, cohousing – space available or seeking space,

or other); assessment of needs (physical person or

home); maintenance tasks required in or out of the

home

• Informing on what solutions are readily available

relating to: housing preferences/accommodation;

assessment delivery service; maintenance

professionals

• Inform Ground Zero (Aging Hub) on existing gaps

• Determining if participant is satisfied with work available to them – paid or unpaid

• Determining if participant’s social needs are being met

• Informing on opportunities available to them should existing needs not be met regarding

work and socialization

• Determining if occupant is well informed

regarding community and regional events

• Determining if occupant is up-to-date

regarding medical and wellness sites in their

geographical area

• Providing information on featured spots,

accessible to all and deemed to be of

beauty and interest

Household Matters

Need an Assessment?

Not Sure?

Looking to Homeshare?

Need a Helping Hand?

Places & Spaces

Wellness Sites Healthcare Sites

Featured SpotsCommunity Events


• Determining if occupant’s transportation

requirements are being met and can continue

to be met in the near to mid term

• Provide alternate transportation

recommendations for local and long-distance

travel (focus on critical care and appointments

of a personal nature)

• Inform of opportunities for alternate

travel (focus on leisure and wellness)

The need to build on, rather than duplicate,

existing assessment tools and procedures was

noted. A number of these are outlined in

earlier sections of the paper.

Proposed Marketing and Assessment Approach

Part 1: PROMOTING ‘AGING IS SEXY’ To be run before and during the launch of “Seniors Navigators” implementation. Field work/prototype:

• Conducted by volunteers, e.g. Department of Seniors, NS GovLab, GoverNext

• Survey public in various spaces, e.g. malls, parks, waterfront

• Solicit opinions from those who look obviously over 65 as well as those who look like they may be close? Might also extend to those who look to be the children of seniors? All of these are affected and therefore offer important perspectives

Questions:

• Are you a senior citizen? or Are you responsible for a senior?: o Whether they are offended by this question or not, offer a friendly, “Aging

is Sexy” with the Aging is Sexy pin o “We’re volunteers with the Department of Seniors and we’re seeking

public insight surrounding [the positives, fears and stigma around] aging, and how to ensure that we have a full-picture of services and programs available to older people as NS’s population ages. We are also promoting the newly launched positions of ‘Seniors Navigators’ who are public servants who offer comprehensive assessments for any person aged 60 or older, and helps people better navigate the programs and services available to them”

o Would you be willing to answer a few questions? It’ll take about XX minutes now, or, we can arrange a phone call with you at a time that is convenient for you

Getting Around

Pleasure Trips Other

Appointment Assist

Ride Share


• Have you seen the Positive Aging Guide?: o If yes, ask how they use it and if they have noticed any gaps. Offer them

the flow-chart of steps detailed below. o If not, explain what it is “Essentially, the Yellow Pages for services for

seniors” Offer them a free copy, with the flow-chart of steps detailed below

Tailored questions:

• Have you had any type of home assessment for aging? Or Have your parents had a home assessment? Or Do you work in a field offering services/ caring for senior citizens?

o If yes to any of these questions, ask for feedback on experience and perceived gaps in assessment experience.

• Would you like to have an assessment done by a Senior Navigator? Do you think that would be useful? Why? Why not? Probe to get more detail.

Other important questions:

• Do you see yourself as being independent?

• What is independence for you?

• Do you see yourself wanting/being able to stay in home as you age?

• Do you want to continue to stay in place as you age? For how many years? Have you ever thought of these questions before?

• Do you have a contractor that works on your home?

• Do you have a strong support network of friends or family that live close by? Conclusion:

• For this reason, the position of ‘Senior Navigators’ were created. The Senior Navigators can be scheduled to do an assessment of your needs/potential future needs and give you some resources to help guide you. They can be available when you’re 65 or 80 or 100, whatever your age, as your needs change. They’re there to help you get what you need and age with prowess.


Part 2: LAUNCH OF ‘SENIOR NAVIGATOR’ Step 1: Positive Aging Guide 2017 is made available. It is currently available online: https://novascotia.ca/seniors/pub/37679PositiveAging_2017_Online_P4.pdf This guide includes hyperlinks to websites and e-mail addresses. (Question for team: How is this directory made available to seniors and their families? Online only? Can printed copies be mailed to those over xx age for example? Either it’ll be helpful to them or they’ll ask someone to help them understand what it is. It’s basically the Yellow Pages for seniors, and they all know what the Yellow Pages are). Step 2: Overview of the Positive Aging Guide and how to use it. Step 3: Can’t find what you need in the Positive Aging Guide? Refer client to Information and Referral (p. 9) and call one or all of the following: 211 Nova Scotia, or Public Inquiries – NS Government: [email protected], or Federal Government General Inquiries: 1-800-O-CANADA Can’t find what you need there either? Contact your ‘Senior Navigator.’ Step 4: The Senior Navigator delves deeper to find if the needed program/service is available.

• If so, provides information to client.

• If unavailable, the Senior Navigator tracks gaps in services and reports this information back to Department of Seniors (or whoever?).

Step 5: Department of Seniors (??) identifies needs and makes a call to action to the private sector/NGO’s/Not-for-profits/post-secondary students to fill this gap. Hopefully, these people get on board in whatever way possible (may just be a small tweak or something larger) as the demand has been determined, not imagined.

If no one steps in, government bears responsibility to fill the gap.

https://novascotia.ca/seniors/pub/37679PositiveAging_2017_Online_P4.pdf

mailto:[email protected]


12. Prototype Session 2 The second prototyping session was held at the MicMac Aquatic Club on May 22, 2018. At this

session the team confirmed their commitment to the prototype and approach described in the

previous section. Further discussion resulted in agreement on starting with developing the

contents, and possibly an app, for the pre-assessment.

We were advised that external guests had been invited to review each team’s ideas right after

lunch. The team completed the following pre-formatted poster to assist with the presentation as

well as further refine our approach.

Our original HMW question was refined to:

HMW evaluate how well people can age in place in their current homes and contexts and then

guide their efforts to improving their situation.

As a first step, we identified the need for a tool that will allow anyone who wants to do a

comprehensive AIP assessment. This tool could be self-administered or administered by family or

friends of persons interested in using it. It could also evolve into a tool for use by appropriately

trained and vetted professionals. A secondary purpose of the tool would be to allow use of data

from the collective AIP assessments to be useful for subsequent needs-based analysis.


The intended impact of the tool would include such things as:

• Move from a reactive to proactive approach for policy and program planning and

services by providing a new and improved ability to see themes, clusters and

what’s on the horizon

• Directs people to specialized assessments, when needed, e.g. CAPS, HEA, CCA

• Creates awareness of services and programs available to meet current and

planned needs

• Enables navigation of the system, or lack thereof, to identify and meet immediate

needs

• Identification of gaps in services and programs

The users and big questions shown in the above chart are examples of items to be considered as

we develop both the content and the app for this first phase of our prototype.

Review and Feedback

The eight guests were divided into four “panels” and were paired with representatives from each

of the four teams. In our case three of our team were part of two of the panels. Two of us co-

presented our idea while one took notes (see Appendix F – Prototype 2 Pitch Feedback). We had

three to five minutes to present our idea and then the balance of the 15-minute session was for

feedback. We were not allowed to answer questions nor enter a dialogue with panel members.

Members on the panel who were from our team were not allowed to comment.

Overall the feedback from all four panels was very positive. We received many good suggestions

and suggestions for sources of information that will directly help in our planning. We were

encouraged to think “BOLDER” in our planning and execution. The notes in Appendix F will be a

key part of our ongoing planning.


13. Preliminary Assessment Tool Content The following is the type of content to be included in the preliminary assessment tool. Empathy

and sensitivity are essential in designing and conducting the assessment. All questions must be

optional and clearly understood to be so. The Goals of the Preliminary Assessment Tool are:

• Gather basic comprehensive information for a household interested in AIP alternatives

• Enable identification of potential further in-depth assessments where needed

• Make participants aware of additional resources available to them

• Produce a preliminary report for the household directed to those who initiated it, subject

to any privacy considerations

• Enable creation of a data repository to inform government programs and services that

o Allows a proactive approach to planning

o Identifies gaps in services

o Leads to improvements in co-ordination and responsiveness of current programs

13.1.1 Household Characteristics • Age, gender, relationship of household occupants

• Gender, culture, race identity

• Language – spoken, known

• Citizenship status, place of birth

• Religion

• Pets

13.1.2 Health • Physical and mental health, cognitive challenges, addiction issues, required medications


• Acute and chronic conditions

• Current or anticipated/feared health issues

• Family history of known genetic health traits, e.g. Alzheimer’s

• Current use of health care services, e.g. family doctor, public or private care

13.1.3 Living Conditions • Eating habits, access to healthy foods

• Exercise patterns

• Hobbies, leisure activities

• “Work” – paid, volunteer

• Evidence of or potential for “elder abuse”

13.1.4 Lifestyle • Dining out/Entertainment

• Travel/vacation

• Clothing

• Home furnishings


13.1.5 Financial Overview • Who manages/controls the household finances

• Areas of concern or opportunity, i.e. sufficiency of financial resources

• General economic circumstances

• Receipt of CPP, GIS, GIS supplement?

• Determine if any other government grants or sources of income that might apply

• Income tax management

13.1.6 Supports • General level of independence/dependence on others for support

• Family members or friends providing support. What type? How much?

• Government or other agencies providing support. What type? How much?

• Services that would be helpful or are needed

• Engagement of private services

13.1.7 Social Interaction • Use of social media

• Visits from/to family and friends

• Participation in community events

• Degree of isolation


• Barriers to socializing

13.1.8 Condition of the Home/House • CAPS assessment, or

• Degree of cleanliness or the reverse

• State of repair

• Currency of electrical, plumbing and heating (including oil tank)

• Energy efficiency

• Evidence of hoarding

• Outdoor maintenance needs

• Accessibility

• Falls hazards

13.1.9 Aspirations • Knowledge about AIP

• Expectations for AIP in current home or some alternative

• Circumstances that might change the above


14. Technical Considerations

14.1 Data Ownership and Management The following need to be considered:

• Ownership and responsibility for all aspects of a central repository of information

collected must be clearly assigned.

• Managing and updating the data with appropriate quality control procedures

• Collecting and using the data will require appropriate training and vetting of those

involved in this activity.

• Access to at least summary data should be as wide as possible balanced with safeguards

for confidentiality and privacy.

• All privacy safeguards will have to be considered.

• Data collected from the Preliminary Assessment, and any subsequent assessments, would

be best if integrated into a larger database or information hub, similar to that described

earlier in this paper.

14.2 Format/platform An intelligent app built for a platform such as an iPad or other smart tablet would likely be the

best for the Preliminary Assessment tool. In addition, an on-line variant for self-administration

should also be considered. Both versions should have the option of having the results, without

identifying information, added to a central data repository.

The app should include the ability to produce an attractive summary report of the input from the

tool. Additional reporting of results from application of the information is the next step that is not

addressed at this time.

P.E.I. has developed an online home energy audit assessment tool for P.E.I. residents. The

platform is like that which is envisioned for our proposed tool. It can be reviewed at:

https://www.princeedwardisland.ca/en/service/do-your-own-energy-audit-online.

There are good background notes as well as a set of frequently asked questions. The first two of

twelve steps can be completed without “signing-up”. It appears to be a friendly easy-to-use tool

with lots of graphics.

https://www.princeedwardisland.ca/en/service/do-your-own-energy-audit-online


15. Limits and Risks for this Prototype The proposed prototype for our team is the Preliminary Assessment part of the Reimagining Home

overview, which has four major components:

• Program – responsibility of the Province. This program does not currently exist.

• Preliminary Assessment - this prototype. One of the purposes of this prototype is to

provide key information related to each of the other three components.

• Secondary Assessments – many of these are already available and would likely cover most

of the needs identified by the Preliminary Assessment.

• Public and Private Services – A complete inventory of these does not exist. Gaps, overlaps

and awareness of available programs is an issue. A registry of qualified and vetted private

services is needed. This should include, as a minimum, criminal and vulnerable record

checks for people working under the umbrella of the program.

This prototype is being developed in the context of a larger vision for a comprehensive AIP

strategy. Most of the components needed do not currently exist and therefore the success of the

prototype results need to be measured in terms of what is learned and how it informs other

aspects of the overall vision.

Phase one for this prototype is development of the Preliminary Assessment Tool. Details related

to this tool and its development are outlined above.

At least the following are needed for the further testing of the prototype:

• Conduct additional tests with seniors and interested parties to determine the validity of

belief that the preassessment approach is a good one as well as the need for a related

pre-assessment tool.

• The word “assessment” for this approach may be met with resistance by many who are

already concerned about losing their home for any reason. A descriptive word or phrase

that conveys the supportive intent needs to be considered. Messaging and marketing will

also have to be developed with both empathy and sympathy for the wide-ranging

audience to whom this effort is directed.

• Develop a testing plan for determination of the validity of the idea and value of a pre-

assessment tool:

o Package that includes an overview of the tool, its purpose and fit within a pre-

assessment framework

o One-page introductory statement that puts this work in context of NS GovLab

o Privacy waiver

o Set of standard questions to guide the testing

o List of potential interviewees

o Time frame


Development of the tool and its content will require additional research and professional

resources beyond the capacity of the team. Some of these are described in the next section.

Additional steps to be done depend on feedback from the testing as well as appropriate support

and guidance of the NS GovLab Co-creation Team. They include such things as:

• Limited use of the tool to test the contents and the functioning of the tool

o Review contents and the tool with selected officials and professionals

o Use it with several seniors in a wide variety of circumstances, both with self-

completion and led by a knowledgeable person. The seniors should understand

the limits of this first step, i.e. information collection only. The report at this stage

will include just a summary of information provided. A more comprehensive

report may be produced when the ability to do so becomes available

• Development of materials to support and explain its use

• Engagement and training of professionals to carry out a formal Preliminary Assessment

• Engagement of professionals and seniors to draft a conceptual outline for a Preliminary

Assessment Report

• Develop Preliminary Assessment Reports for those who have completed the assessment

• Analyze, adapt, modify, grow as this approach moves along


16. Testing of the Prototype For the reasons stated above, a full prototype test of the preliminary assessment is not practical.

Phase one of our prototype is the Preliminary Assessment Tool. Again, the complexity and

resources needed to do this are extensive. As a result, the idea of a Preliminary Assessment Tool

was put to the test. This was done using the testing package, included in Appendix G.

As the Preliminary Assessment is intended to cover a comprehensive range of areas that could be

addressed (or queried), we prepared a detailed overview of the content that would need to be

considered and included in this foundational preliminary assessment tool (mechanism); specific

questions have not yet been developed. To test this preliminary assessment content with

potential users, our team distributed nearly three dozen Preliminary Assessment Content Testing

Packages to both urban and rural contacts. We received feedback from 19 (>60%) respondents. Of

those respondents, there were nearly an equal number of respondents from the field of health

care (30%) and those who self identified as family supports to elders (35%); of the balance, 15%

identified as community support workers and 10% identified as independent elders.

All respondents were supportive of the idea and potential usefulness of this tool. Most

respondents felt the breadth of content to be very extensive and the categories to be quite

comprehensive. A few respondents highlighting overlooked subcategories. Some recommended

overlapping subcategories be consolidated. Several respondents brought attention to the

subjectivity of the assessor in reporting non-quantitative responses. Of those who commented on

the role of the senior navigators, a high percentage felt the role to be integral to the aim of the

preliminary assessment. It was strongly felt that the senior navigator was best positioned to track,

monitor and communicate gaps and that their presence should be felt locally. In addition, it was

pointed out that the navigator role would be challenging to fill as it would require individuals

“capable of assessing others across a multitude of silos” – and the role would “best be filled by

one who had not only an interest in seniors but a strong knowledge background and various skill

strengths” including but not limited to: people skills, evaluation skills and analytical skills. As such,

it was recommended that a two-tiered system of evaluator/assessors and program/service

implementors could best fill the competing needs that would be identified through the

preassessment tool.

Key points made by some respondents included:

• unsure how to link to programs and services

• stressed that “the tool should be able to assist in both private and public spheres as well

as give financing options for care”

• such a tool is needed to identify the types of resources needed seniors have for assistance

to age in place

• the need is tremendous


To address these comments, the navigator portal is intended to have information on:

• current local and regional programs and services

• links to financing and discounts that are currently available through varying third party

organizations (i.e., Housing Nova Scotia, Efficiency Nova Scotia etc.)

• provide a space for the private sector to share a business listing, subject to meeting

minimum criteria

From the feedback, further review of and consideration for the assessment tool to serve as a

foundational information resource is justified. Such a resource would be a key element needed to

build a broad, dynamic navigator portal. An informed, diverse group of skilled and trained

professionals who would be needed to serve in the dual role of assessor and navigator – a Senior

Solutions Advisor (SSAs). These SSA roles could be further enhanced by building on the expertise

and knowledge base of those currently holding roles of senior safety coordinators, furthermore,

these coordinators as well as local agencies would be well positioned to populate the knowledge

base which the SSA would draw from.


17. Preliminary Assessment Tool The following is needed for further development of the Preliminary Assessment Tool Content:

• Samples of assessments/tools to avoid re-inventing that which already exists, e.g.

Minimum Data Set Home Care Canada Version, Lawton IADL

• Jurisdictional Search

• Literature Review

• Audits/Assessments/Tools used by government departments, NGOs, businesses, etc. that

could be incorporated

• Any required permission for use of current tools

• Development of the questions and structure for the tool

• Development of the draft tool for consideration by qualified professionals and potential

clients


18. Continued Team Engagement A key question for the team is the extent to which further development can be done on a

volunteer basis by team members. Three of the original team members have decided not to carry

on with this project. The remaining three team members have conducted and completed testing

of the concept proposed for the Preliminary Assessment Tool. In addition, they have worked

collectively to complete preparation of this report as a document of our journey, findings and

development of the overall model as well as more detail for one selected aspect of it. Ongoing

participation in the presentation of this report and any subsequent development of the ideas it

contains will be a decision to be made by each of the remaining team members. We are each open

to discussing the best way to remain engaged with this work or explain or explore any parts of it.


19. Concluding Perspective Our team, The Route of Aging, set out to determine if and how seniors could stay in their homes

as they aged within the Nova Scotia context. Over a five month period we spoke formally and

informally with diverse seniors and senior stakeholders around the province including but not

limited to:

• family members;

• religious leaders;

• medical professionals providing direct and indirect care;

• community leaders;

• government officials; and

• those in the private sector providing services to seniors.

The responses were varied and passionate, often very personal. None of them were unaffected by

this question or could provide a clear recommendation for a way forward. Many we spoke to

emphasized the need for better communication amongst those who provide services that would

assist seniors, whether private or public sector. Just as many spoke of the diverse basket of

resources currently on offer. Almost all acknowledged that there were gaps amongst the plethora

of resources but that there was also a lack of direct and timely connection to existing resources.

We often heard of messages left and, if returned at all, not within a reasonable timeframe.

We learned that sometimes what triggers a senior having to leave their home and enter a hospital

is something that could have been avoided had they been better informed, had identified and had

an appropriate service in place. For example, a fall that requires a hospital stay and triggers a

move to a long-term care bed in a neighboring community away from family, has far reaching and

expensive consequences. The costs of these outcomes can be extreme – from the emotional and

likely physical toll on the senior and their family, to the financial toll on our system. If a senior can

stay at home longer, by and large, they will be healthier and happier. It will be more affordable for

a system that needs to be prudent to accommodate the boomer demographic bulge on the verge

of shifting into the silver sector. A proactive preventive strategy is far more cost effective than

dealing with reactionary outcomes.

For a good example of a successful preventive strategy, we simply need to look within our own

province. There are many examples of organizations and companies (as we shouldn’t ignore the

successes of the private sector in this regard) who excel in leading and navigating complex

programs and services that are beneficial to those affected. Some of these are recognized and

well-regarded beyond the Nova Scotian borders. Chief amongst them would be the “energy friend

to all”, Efficiency Nova Scotia (“ENS”). Few people likely wonder who is behind the toll-free

number seen on all marketing and public materials and just as likely few people ever wonder who

responds to those emails sent to: [email protected]. In practice, responding to those phone

calls and e-mails about energy efficiency is a full-time job, in fact, several full-time jobs of well-

trained and knowledgeable people.

ENS is Canada's first electricity efficiency utility which operates independently from both

government and Nova Scotia Power. It is run by a board of directors and regulated by the Nova


Scotia Utility and Review Board. Created by government in 2009, it delivers energy efficiency

programs and to date, more than 400,000 people have participated in their programs.

Every day, employees of ENS help Nova Scotians by recommending alternatives to a more efficient

approach and guide them towards existing programs and services. By reaching out to the main

phone line or email address, any citizen would connect directly to a small team of Energy Solutions

Advisors (ESAs), who weekly field hundreds of calls and emails from Nova Scotians on a variety of

topics. The expectation for this small team of advisors is to respond to all inquiries within 48 hours

- if they don’t know the answer to the question put to them, they will research it and respond

within 48 hours. There is accountability and they work hard to provide the most accurate and

timely guidance available. They are navigators and are passionate about what they do. There is

one number, one email, one space to look to for guidance when a Nova Scotian is wondering:

• where to recycle their mercury bulbs

• which heating system to install

• or what the benefits of solar photovoltaic systems are

Those who reach out have an expectation that they will get an answer in a timely fashion and this

is met – it is not a special outcome but rather an expected outcome. If a caller is seeking a private

sector recommendation, specific names are not provided but rather the caller is directed to an

online vetted directory of partners who work within the field of efficiency and meet minimum

performance criteria. These vendors have committed to providing and maintaining high levels of

quality and service.

Our Route of Aging team sees many potential synergies between the ENS approach and that

needed to overcome the challenges and recognise the opportunities that come from the extensive

research and consultation documented in this report. There are many hard working and

passionate people who front the programs, services and organizations that serve our population

in general and especially our seniors. They are not unlike those who serve as the frontline ESA

staff at ENS. The silver sector needs what the Province has given to the population that seeks to

be more energy efficient: an independent and efficient information and resource hub that can

offer seniors, their families and supporting professionals a one-stop stop, modelled on the

structure that has made Nova Scotia’s approach to energy efficiency such a success. It could be

staffed by existing professionals from all sectors – staff who have an established level of customer

service skills and have the passion, knowledge, sensitivity and training to deal with maturing

adults and their stakeholders who are reaching out for diverse help, sometimes coming from a

very vulnerable state – in short, Senior Solutions Advisors or Senior Navigators.

The vision presented in this report is a bold one. It is much bigger than the simple phase one tool

we used for testing. Efficiency Nova Scotia is one of the most highly tested, and proven,

organizations in the province. It could be considered as a model, even prototype, for a

comprehensive AIP approach. The start of ENS was much more modest than what exists today. It

grew and adapted to meet emerging needs and opportunities. At the least, its approach and its

growth path need to be studied as a proven successful model. The Route of Aging team believes

this report provides a foundation for further exploration of the conceptual approach presented in

it.


20. Appendix A – Statistical Overview

Appendix A.1 – Population Pyramids

Appendix A.2 – Nova Scotia Population Estimates

Appendix A.3 – Nova Scotia Seniors Living Conditions

Appendix A.4 – Nova Scotia Sources of 2015 Income


20.1 Appendix A.1 – Population Pyramids 1961 1971

1981 Male Female

1991

50000 25000 0 25000 50000

0 to 4

5 to 9

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 to 84

85 and over

50000 25000 0 25000 50000

0 to 4

5 to 9

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 to 84

85 to 89

90 and over

50000 25000 0 25000 50000

0 to 4

5 to 9

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 to 84

85 to 89

90 and over

50000 25000 0 25000 50000

0 to 4

5 to 9

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 to 84

85 to 89

90 and over


2001 2006

2011 Male Female

2016

50000 25000 0 25000 50000

0 to 4

5 to 9

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 to 84

85 to 89

90 and over

50000 25000 0 25000 50000

0 to 4

5 to 9

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 to 84

85 to 89

90 and over

50000 25000 0 25000 50000

0 to 4

5 to 9

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 to 84

85 to 89

90 and over

50000 25000 0 25000 50000

0 to 4

5 to 9

10 to 14

15 to 19

20 to 24

25 to 29

30 to 34

35 to 39

40 to 44

45 to 49

50 to 54

55 to 59

60 to 64

65 to 69

70 to 74

75 to 79

80 to 84

85 to 89

90 and over


20.2 Appendix A.2 – Nova Scotia Population Estimates Number by Gender and Age Group

1961 1991 2016

Male Female Male Female Male Female

0 to 14 131,197 125,131 94,829 90,894 68,384 64,299

15 to 64 212,660 204,602 308,632 306,371 313,570 318,950

65 to 74 18,927 19,813 29,736 36,048 52,352 56,231

75 to 84 9,408 10,370 15,245 22,359 23,692 29,141

85 and over 2,052 2,847 3,189 7,666 7,089 14,910

Total 374,244 362,763 451,631 463,338 465,087 483,531

65 and over 30,387 33,030 48,170 66,073 83,133 100,282

As percentage of Total Population

1961 1991 2016


0 to 14 35.1 34.5 21.0 19.6 14.7 13.3

15 to 64 56.8 56.4 68.3 66.1 67.4 66.0

65 to 74 5.1 5.5 6.6 7.8 11.3 11.6

75 to 84 2.5 2.9 3.4 4.8 5.1 6.0

85 and over 0.5 0.8 0.7 1.7 1.5 3.1

65 and over 8.1 9.1 10.7 14.3 17.9 20.7

As percentage of 1961

1961 1991 2016


0 to 14 72.3 72.6 52.1 51.4

15 to 64 145.1 149.7 147.5 155.9

65 to 74 157.1 181.9 276.6 283.8

75 to 84 162.0 215.6 251.8 281.0

85 and over 155.4 269.3 345.5 523.7

Total 120.7 127.7 124.3 133.3

65 and over 158.5 200.0 273.6 303.6

Source: Statistics Canada

Cansim Table 051-0001 Estimates of population, by age group & sex for July 1

98-311-XCB2011017 extracted April 2, 2018

Historical Age Pyramid

Above accessed April 2, 2018

Note: 2016 Estimates are based on 2011 Census


20.3 Appendix A.3 – Nova Scotia Seniors Living Conditions (restricted to persons aged 65 and over)

Family characteristics of seniors

65 and over 65 to 74 75 to 84 85 and over

# % of Total #

% of Total #

% of Total #

% of Total

Total Persons 171820 105765 50335 15725

Seniors living alone (one-person households) 46730 27.2 23170 21.9 16055 31.9 7510 47.8

Couple living without a son or daughter present 96775 56.3 66615 63.0 25865 51.4 4290 27.3

Couple living with a son or daughter present 10570 6.2 7455 7.0 2610 5.2 505 3.2

Lone senior living with a son or daughter present 7520 4.4 2910 2.8 2830 5.6 1785 11.4

Living with other relatives or with non-relatives only 10220 5.9 5610 5.3 2970 5.9 1635 10.4

Not Included - living in institutions 11595

Tenure including presence of mortgage payments and subsidized housing

Total Persons 171820 105765 50335 15725

Owner 136760 79.6 86795 82.1 38545 76.6 11420 72.6

With mortgage 35360 20.6 26445 25.0 7175 14.3 1745 11.1

Without mortgage 101400 59.0 60350 57.1 31370 62.3 9680 61.6

Renter 35055 20.4 18970 17.9 11790 23.4 4300 27.3

Subsidized housing 6155 3.6 3270 3.1 2015 4.0 870 5.5

Not subsidized housing 28905 16.8 15700 14.8 9770 19.4 3435 21.8

Condominium status

Total Persons 171820 105765 50335 15725

Condominium 6480 3.8 3540 3.3 2185 4.3 765 4.9

Not condominium 165330 96.2 102230 96.7 48145 95.6 14960 95.1


Value (owner-estimated) of dwelling

65 & over 65 to 69 70 to 74 75 to 79 80 to 84

85 & over

Total - Value (owner-estimated) of dwelling 247690 62020 46390 42945 42150 54190

Average value of dwellings $ 439706 456584 423020 433705 426904 450271

Median value of dwellings $ 320995 341794 314485 313536 301014 319959

Not applicable 59195 18840 12405 9610 8530 9815

Number of Bedrooms

65 and over 65 to 74 75 to 84 85 and over

# % of Total # % of Total # % of Total # % of Total

Total Persons 171820 105765 50335 15725

No bedrooms 160 0.1 115 0.1 20 0.0 20 0.1

1 bedroom 15535 9.0 8845 8.4 4870 9.7 1815 11.5

2 bedrooms 49550 28.8 29040 27.5 15630 31.1 4885 31.1

3 bedrooms 68400 39.8 43725 41.3 19110 38.0 5560 35.4

4 or more bedrooms 38175 22.2 24030 22.7 10705 21.3 3440 21.9

Housing Indicators

Total Persons 171820 105765 50335 15725

Adequate, suitable and affordable 131695 76.6 82835 78.3 37840 75.2 11020 70.1

Inadequate: major repairs needed 12110 7.0 7530 7.1 3405 6.8 1180 7.5

Not suitable 2050 1.2 1230 1.2 595 1.2 230 1.5

Not affordable: 30% or more of household income is spent on shelter costs 28895 16.8 16120 15.2 9215 18.3 3565 22.7

Not adequate, not suitable and/or not affordable 40125 23.4 22930 21.7 12495 24.8 4705 29.9


20.4 Appendix A.4 – Nova Scotia Sources of 2015 Income

All Ages

65 Years of Age & over

Number

of People

Total Income

(x 1,000)

% of

Total

Income

Median

Income

Average

Income

Number of

People

% of Total

People

Total

Income (x

1,000)

% of

Total

Income

Median

Income

Average

Income

Total income 724560 30020815 31,580 41,433 175370 24.2 6326390 25,170 36,075

Total employment income 499440 19683320 65.6 40460 8.1 788090 12.5 . Investment income 163280 1610930 5.4 68610 42.0 502880 7.9 . Private pensions 136510 3003460 10.0 103490 75.8 2073990 32.8 . Registered Retirement Savings Plan (RRSP) 11010 104950 0.3 11010 100.0 104950 1.7 .

Other income 106460 688165 2.3 31460 29.6 129450 2.0 . Government transfers 555290 4929990 16.4 174430 31.4 2727030 43.1 .

Government transfers details: Employment Insurance 93000 766675 2.6 5520 5.9 48685 0.8 . Old Age Security (OAS) and net federal

supplements 174550 1418435 4.7 171360 98.2 1402360 22.2 . Canada Pension Plan (CPP) and Quebec

Pension Plan (QPP) 239040 1672060 5.6 167410 70.0 1184865 18.7 . Canada Child Tax Benefit 107750 452840 1.5 450 0.4 1250 0.0 . Goods and Services Tax Credit (GST) and

Harmonized Sales Tax Credit (HST) 279790 115070 0.4 76760 27.4 30595 0.5 . Workers' Compensation 19730 184575 0.6 5200 26.4 37980 0.6 . Social Assistance 30750 193795 0.6 1500 4.9 6170 0.1 . Provincial Refundable Tax Credits and Family

Benefits 239010 91925 0.3 61430 25.7 14965 0.2 . Other government transfers 75440 34610 0.1 330 0.4 150 0.0 .

Source: Statistics Canada. Table 111-0035 - Characteristics of seniors, taxfilers and dependents, seniors with

income by source of income and age groups, annual (dollars unless otherwise noted), CANSIM

(database). (accessed: April 3, 2018 )


21. Appendix B – Resources From the HomesRenewed U.S. based website (accessed April 12, 2018):

Mission: To significantly increase the number of American homes prepared for residents to live

throughout the modern lifespan.

HomesRenewed supports and influences incentives that’ll nudge people to take action for home

updates through a broad coalition of stakeholders who are more powerful when acting together.

The house itself is outdated. Updating homes isn’t new. Over the years we have improved our

homes to embrace science and technology advances by adding indoor plumbing, electricity,

central air conditioning. Now fiber optic cable comes to our homes and solar collectors cover our

roofs. Policy often drives change by regulating and subsidizing infrastructure and home updates;

e.g., water and sewer systems, the electric grid, weatherization subsidies and solar tax credits.

The HomesRenewed Purple Tag program. modeled after Energy Star tags identifies building,

technology and home medical products that prepare the home for the modern lifespan and are

eligible for cost savings. Other incentives may include rebates, tax savings, or reduced insurance

premiums.

The site includes The MetLife Report on Aging in Place 2.0 The report is sub-titled Rethinking

Solutions to the Home Care Challenge. This report was developed by the MetLife Mature Market

Institute in consultation with Louis Tenenbaum a consultant focussed on universal design and

Aging in Place.

http://www.homesrenewed.org/

http://www.homesrenewed.org/stakeholders/

http://www.homesrenewed.org/purple-tag-program/

http://www.homesrenewed.org/wp-content/uploads/2017/10/Aging_in_Place_2.0_Report_FINAL-Web.pdf


22. Appendix C – People/Organizations Consulted Senior Interview - age 70 lives alone in family home

• Limited income, has concerns about being able to maintain home, pay for such things as medical/dental, vehicle

• Has assessed grants for roof, oil tank, insulation

• Currently does not require Homecare support but feel that in the future she will need help with meals, checking in on eating habits, perhaps diet list, help with housework and grocery shopping if she is no longer capable.

• Isolation and loneliness are a concern. She worked in a boarding home for seniors. Feels there is a lack of support from volunteer groups to meet the religious, cultural, etc. needs of seniors. Could also visit seniors who live a home alone or are shut-ins, even those who have caregivers.

• Feels that there should be nurses who work in collaboration with doctors to review such things as physical health, mental state, and medications as sometimes the elderly are reluctant to share personal concerns with their doctor.

• Government could have someone that checks in on seniors several times a week for those who live alone.

• Technology concerns with the advance of new technology. E.g. getting a new cell and being able to download contact list; not understanding how technology works; changing Internet provider and losing all e-mails and contacts.

Senior Interview - age 98 lives alone

What does” Aging in Place” mean to you?

- “Means that there are so many things that I would like to do but can’t and need

support to help me. You have to be willing to be open to having thigs done

differently, in someone else’s way. You have to be flexible as everyone doesn’t do

it the same way”

Homecare

- Is able to provide all needed services she requires at this point, she doesn’t

require respite, shopping (as family does this for her), preparing her bed

- Believes they should have a program that if needed, that seniors could have

someone stay in their home with them during the night

- Wonders if there is enough staff for nursing homes, same as the doctor shortage

- Would like homecare to be able do such things as errands, grocery shopping, and

drug store pickups. Apparently, they can do some but it involves a lot of

paperwork.

- As well, they are not permitted to take seniors to the grocery store, etc. She is

concerned about seniors who do not have family or friends to do this for them

(doctors appointments, etc.)

Services

- Homecare

- Senior safety Protection

- Home Grants (roof replacement)


- Occupational therapist through continuing care for bath lift

- Veteran’s Affair (weekly house cleaning, grounds- lawn and snow removal)

- CNIB

a) Twice met with staff in travelling clinic that came to Yarmouth to

discuss daily living, performing household and leisure duties as a

legally blind person

b) Did two visits to help with appliance usage e.g. marking range

knobs with fluorescent tape

c) Send audio books

Technology

- Telephone with hearing aid compatibility and large numbers

- Hearing Aids (top of the line) with computerized component to raise/lower

volume/adjust to surround sounds

- Optelec (for sight impaired)

- Bathtub lift (worked with OT to find suitable model)

- Lifeline

- She noted that senior with hearing/sight impairments cannot easily adjust to

“gizmos” having too many “contraptions”

Organization Interview – CNIB

Certified specialists provide training that enables people who are blind or partially sighted to

develop or restore key daily living skills, helping enhance their independence, safety, mobility and

emotional well-being. The following rehabilitation services are available through Vision Loss

Rehabilitation Nova Scotia:

• Low vision services: to help you learn to use the sight you have left

• Essential skills of daily living: to help you build the skills you need live safely and independently

• Travel and mobility instruction: to help you learn to travel safely and independently with vision loss

• Adjustment to vision loss: counselling to help adjust to the social and emotional impact of vision loss

More information on rehabilitation services is available at: ns.visionlossrehab.ca.

CNIB Peer Support Programs ensure individuals with vision loss have ongoing opportunities to

connect either one-to-one and or attend monthly peer support groups.

• One-to-One Peer Support Program

• Monthly Peer Support Program

• Family Peer Support Program

• Parenting with Vision Loss Peer Support Program

• Parenting Children with Vision Loss Peer Support Program

• Post-Secondary Peer Support Program

http://ns.visionlossrehab.ca/


The Vision Mate Program matches individuals living with vision loss with specially-trained

volunteers who offer companionship and one-on-one assistance with day-to-day tasks and

errands.

Children and Youth Programs offer a range of peer support and camp experiences where kids can

just be kids, while learning about self-advocacy, developing leadership skills, and making new

friends.

• Summer Day Camp

• Youth Discussion Group

• Youth Retreat

The Recreation Programs provide an opportunity for individuals with vision loss to connect with

others who have similar interests – from self-defence, knitting, painting and sculpting to a love of

books, walking and movies.

• Audio Book Club

• Create Night

• Family Fun Days

• Knitting Club

• Walking Club

• Living Safe

The Advocacy Program is aimed at breaking down barriers and creating an inclusive society in which people with vision loss can thrive.

Organization Interview – YACRO

Housing

• Small options Homes (17 total in Yarmouth & Halifax)

o Usually 3 to 4 residents per home, several with 5

o Feel it is better to keep numbers low, in a congregated setting, “based on fit”

rather than specific criteria

o Criteria for clients: all ages (child to senior) with a diagnosed disability

(intellectual mainly, but physical as well)

o Supported by Department of Community Services (DCS). DCS receives referrals

they do assessments through the Disability Support Program. Additional

information is at:

https://novascotia.ca/coms/disabilities/documents/disability_support_program_p

olicies.pdf

• Independent Living Support Program (through DCS) with one in Yarmouth and one in

Halifax (27 apartments in total)

o For adults only that require less than 21 hours of support per week. Assessed for

need, but a lot is based on individual’s choice. Located throughout Yarmouth and

Halifax, rented apartments. Selection may be limited as clients may be restricted

by such things as finance, mobility and accessibility.

o The 21-hour maximum limits some as they may require slightly more support and

next step could be a small options or group home. With aging population the

https://novascotia.ca/coms/disabilities/documents/disability_support_program_policies.pdf

https://novascotia.ca/coms/disabilities/documents/disability_support_program_policies.pdf


needs increase, if YACRO provides more than 21 hours they do not get the funding

for the additional hours.

o Assessment for 21 hours is done through DCS in collaboration with YACRO.

Sometimes they do the 21 hours on a trial basis. Additional assessments are done

in collaboration with DCS using a case conference process.

o Work with Housing Nova Scotia

YACRO (Yarmouth Association for Community Residential Options)

• Serve children to adult

o Provide some support to keep adults and children in their homes

o Main focus are the housing options described in first section

o Provide respite services for children and Day camps for children with disabilities

o Small options started as unlicensed homes, developed so they wouldn’t be

associated with all the bureaucracy for Homes for Special Care Act. When this

happened, it became a regulatory process which created intrusion into lives of

residents and affected economies of providing support, e.g. “night awake staff by

regulation” which would not be required in a private home.

o Has become liability and regulatory driven, e.g. two residents got into a physical

altercation and had to be separated into different homes. It was difficult to get

the required approvals to move from one home to another even on a temporary

basis. This didn’t alter the fact that this was a crisis situation which needed

immediate attention. It also required a lot of paperwork.

o Legislation should be less restrictive

o Another problem/difficulty is discussing/addressing diverse programs with

different sets of regulations depending on groups/needs. Creates a tremendous

amount of training for staff with so many people one has to answer to, e.g. Fire

Marshal, licensing, Child Welfare Regulations, Homes for Special Care Act, etc…

• Structure: Board (governance board) - organizational Chart available.

o YACRO buys their own homes, builds equity through maintenance, vehicles. In

Halifax, they rent some homes but are buying more and renting less. Initially they

had an arrangement with RBC using a process that worked for both. Initially this

included short term loans with mortgages and creative ways. After a number of

years they now have enough equity to continue growing and purchase on their

own (approximately $15 million a year through the bank). When negotiating with

DCS they look at rental value per diem. DCS responsible for rent amount, YACRO

responsible for mortgage.

• Beliefs/Philosophies

o Philosophy is not for “congregated setting” with the Independent Living Support

Program but residents having a choice. This may create a congregated setting as

clients like to be close to their friends, social support.

o Aging in place is also their philosophy although regulations make it difficult when

people need more support than what they currently have. Needs sometimes

must be assessed on a regular basis. They receive no additional funding for aging

in place initiatives.


• Needs:

o Not enough funds to support residents of (ILSP) or group homes maintenance

o Transportation costs, their vehicles must conform to VARB regulations and

inspections

o Mobility access equipment is expensive (lifts, etc.)

o Medical/dental costs are not covered by the province

o Access to services is one of their biggest issues (specialists, mental health,

medical). Some services are not available or are limited in the community. Others

have long waiting lists.

• Community Agencies

o VON

o Occupational Therapy

o Housing

o Physio therapy

o Mental Health

• YACRO Social Enterprises

o Shanty Café & consignment

o All-Ways-US (environmentally friendly, all-natural products)

o these allow clients to have meaningful work based on ability and also allows

YACRO to tailor jobs for best fit, number of hours, flexibility

o Inter-generational collaboration is made possible with social enterprises.

Professional Interview - Senior Safety Coordinator

• Senior Safety Program

o Provides senior with information, support, referrals and safety

o Goal is to educate seniors on crime prevention, health and wellness, and promote

safe and independent living in their homes for as long as possible.

o Focus on: Senior Abuse, Financial Abuse, Neglect, Personal Safety, Household

Security, Fraud and Scams, Vial of Live, Emergency Planning, Falls Prevention

o Provide connections for: Continuing Care, Home Care, Caregiving Support,

Housing Options

• Wish List:

o Would like to see something along the lines of an emergency shelter for seniors as

they have seen an increase with people who may be “couch surfing” or living in

cars. There has been an increase of people moving to the area due to inexpensive

housing and then cannot maintain their homes as they age and do not have the

support of family/friends.

o Foster senior - similar to fostering children and youth.


Professional Interview - Continuing Care Coordinator, by phone

Home Care Assessment

• Referrals come from several sources

• Takes 1.5 to 2 hours to complete in the seniors’ homes

• Instrument used is the Minimum Data Set of Home Care Canadian Version which includes

the following categories:

o Personal Section (language, education, et)

o Referral Information

o Cognitive Patterns (memory recall, skills for daily decision making, indicators of

delirium etc.

o Communication/Hearing Patterns (making self understood, ability to understand

others, etc.

o Vision Patterns (vision limitations/difficulties, decline etc.)

o Mood and Behaviors Patterns (indicators of depression, anxiety, sadness,

behavioral symptoms, etc.)

o Social Functioning (involvement, change in social activities, isolation, etc.

o Informal Support Services

o Physical Functioning (this includes the IADL-Instrument Activities of Daily Living

which assess meal preparation, housework, managing finances, managing

medications, phone use, shopping, transportation and the ADL instrument which

assesses bathing, dressing, grooming, etc.

o Continence in last 7 days (bladder, bowel,)

o Disease Diagnosis (heart, circulation, neurological, musculoskeletal, etc.

o Health conditions and Health preventative measures (premature measures,

problem conditions pain, falls, lifestyle, etc.)

o Nutrition/Hydration status

o Dental status (oral health)

o Skin condition

o Environmental Assessment (lighting, flooring, heating, personal safety, etc.)

o Service Utilization, e.g VON, meals on wheels, special treatments/therapies

programs

o Medications (number, compliance/adherence, etc.)

• Data is entered into a program to determine the person’s needs, then look at what

supports are required and which of their programs would best fit.

• Need to do a re-assessment/visit at a minimum of over a year. Home care staff will report

to the coordinator any concerns or need for additional service consideration.

• Collaborate with a variety of stakeholders/community agencies (VON, Red cross, social

workers, physio, OT, etc.)

• Can do some bridging where a family needs some support

• Have a small amount for specialized equipment where individuals do not have the funds

(e.g. sleep apnea machine)


• Barriers:

o Loneliness is big factor for people living alone

o Transportation

o No geriatric teams

Contractor Interview

Former Energy Auditor (LIH program), Owner of a home modification construction company

Key Insights from Discussion

• It is challenging to find quality workmanship (re: home modifications) and challenging also

to secure trained, empathetic professionals suitable to work in these environments

• Seniors are reluctant to consider home modifications in preparation for aging as they fear

they will: reduce the value of the home (non-urban) and be an eyesore

• When working on senior modification projects, it can be challenging to determined who is

the client (end user, cheque signer, family member etc.)

• Clients are reactionary not preparatory. Most of his clients are referred through: Housing

NS, Veterans Affairs, Occupational Therapist (via word of mouth or reputation)

• Legislation is the driver for adoption of accessible/universal design in NC

• Aging in place is specific to the person in the home as such as assessment would have a

few core, shared baseline line items and balance would be tailored for the situation

(urban/rural; type of challenge etc.)

• Home modification projects are excessively challenged through outdated and non-

dimensional permitting requirements

• Architects need AIP/UD training

Professional Interview

Former Energy Evaluator (LIH program), Former Energy Auditor (private sector)


• The focus of design should not just be on universal design but on community design;

seniors need a hub to go to and a way to get there - rural areas are better organized in this

respect (legions or other organizations offer transportation) - the comment was made

"Never mind aging in place, might as well be bury them in place"!

• Builders are not focusing on aging in place as there is little to no demand for it. The

majority of people purchasing/commissioning NHC are middle-aged professionals and

they are not thinking about aging. Builders will always build what the client wants. No

demand, it doesn't get done

• It is not necessarily the layout of the home that can be a safety challenge but the contents

- older people have older homes and older things; antique furniture is awkward, rugs are

unsafe as are thresholds between rooms.

• Attics in older homes are an overlooked hazard area; rodents and electrical issues are

hidden issues, as such, an assessment should cover this area



Former Energy Auditor (private sector); Former Insurance Agent


• AIP is a terrible moniker; what is essentially logical design to encompass a life cycle should

have a "sexier" name such as: transitional design or simply universal design. The term

“Aging in Place” is ageist.

• NC is more important to target as it is where we can guarantee long term solutions – with

retrofits, modification is not always possible – we need to start with new construction – as

like the bulge that correlates to the aging demographic, housing stock also have bulges in

terms of accessibility/aging in place and when you overlay these two bulges, they don’t

correlate – we can’t change the past but we can prepare now for the future to have a

better “bulge correlation”

• The success of promoting transitional design will lie in the marketing. Phones weren't

"sexy" until Apple. It is up to the visionary/marketers who will drive people to think in the

ways they are not but need to be. This should start younger (i.e., kids learning about

energy efficiency, recycling at school), as it is the children who direct their parents.

Senior Interview – Rural NS

Senior, widow 30+ years, living at home in same community 60+ years


• Seasonal isolation is challenging - fear of the snow - stuck in

• Would benefit from a senior hotline - just to chat, get through difficult times

• Lived in same house 68 years, widowed for 40 years - biggest challenge is transportation

(lack thereof) - hates imposing on others to get to appointments – she always manages

but often is costs her $$

• If she left house for an apartment she would lose regular access to her outside gardens

which would impact her state of being

• Hardest thing besides transport issues is finding someone to do the easy things. It is not

the great big jobs that are the most challenging to find help with but rather the little ones

– like changing a light bulb

• Seniors need to help each other more (i.e., retired electricians, plumbers etc.) with an

exchange of services or skilled services offered at reasonable prices as most cannot afford

the “going rate” – even offering a ratio of an hour of billable services would go a long way



Senior, living at home in same community 70+ years


• The role of the home support worker has changed dramatically over time in terms of: cost,

time spent with client and scope of tasks – twenty years ago the home support worker

took their clients to appointments, grocery shopping to social outings – this role has not

been replaced by any one service

• Arguably the most important part of the visit (socialization) is overlooked and not

supported – less so as the field has modernized


Paramedic, serving rural communities 1-2 years


• The Visit Program – this program allows people (seniors and non-seniors) who suffer from

chronic illness to stay in their homes and have check-ups as needed, allows paramedics to

monitor to ensure “deterioration” is within realm of acceptability so individual can remain

at home

• Falls Prevention program – very important as falls are one of biggest things preventing

people from staying home. With this program, if paramedic transports after a fall then

hospital must refer them to this program; if paramedics don’t transport, they can refer to

the program

• Available resources are utilized for things that are not necessary (i.e., paramedics

providing drives to appointments)

• Better to identify candidates for Fall Prevention Program for all residents who reach a

certain age (i.e., 65)

• By and large people don’t know how dire things are for seniors; an adopt-a-senior

program would be helpful as seniors without family or neighbours/friends are invisible

• Senior related services are vastly underfunded by the federal gov. as the monies provided

to the province do not take into consideration the per cent of the population who are

seniors but are rather based on a general population, of which Nova Scotia does not

currently represent


Senior, widow, living well independently with assistance

• By living in a community within walking distance to all amenities and with neighbours

nearby, it is possible to live independently

• Having the means to afford assistance when required (i.e.: bring in wood daily in winter;

maintain drive and stairs; trusted trades) allows her to live on her own

• By not letting that “which is not” prevent her and her peers from trying to fill the gaps on

their own (i.e., formed a community group that gathers to discuss health issues and

concerns and invites medical practitioners to speak with the group and accept questions)


• Planning early, having determined one’s wishes in advance allows freedom from stress

when expected things end up happening (i.e., a spouse passes; a fall occurs)

Organization Interview – Housing Nova Scotia

Observations:

• Multiple grant/loan options exist for low income seniors to cover a wide variety of

scenarios/home modifications

• Programs are well-accessed (huge waiting list)

• HNS does not advertise as word of mouth has been so successful thus far

• Seniors must hire their own contractors to do the work as HNS can not "recommend"

someone

• Referrals to HNS are common from a variety of sources (i.e. folks that are already in the

home for other reasons such as OTs, contractors, and home care services.)

Insights:

• There are viable options available to low income seniors to make modifications to their

homes

• Obtaining a high-quality contractor to do the work may be a challenge for a senior

Caregiver Interview – Person caring for their parents

Observations:

• -despite the fact that preventative efforts were made to modify the home to allow future

aging-in-place, other circumstances (health challenges) lead to the house being no longer

suitable

• AIP (staying in their home) was much easier when both people were high functioning and

healthy; once one person in the relationship faced declining health, the burden was too

great on the other

• Despite being active their whole lives, there was little motivation/desire to do "rehab

exercises" prescribed by OT after a hospital stay as they 'didn't see the point'

• Caregiver started to notice her parents hiding things from her and not taking medication,

which was very difficult to monitor when not present in the home 24-7

• Parents were too proud to ask for help and care services when needed

• There are limited assisted living options in rural NS

• When the means to get outdoors and get around declines, so do social interactions and

health

Insights:

• Home modifications are only one piece of the puzzle, and do not allow aging in place in

isolation of other things

• Supports for caregivers are low

• Many seniors are too proud to ask for/accept help when needed

• A decline in activity = a decline in health


Senior Interviews – several older, frail aboriginal seniors

The following notes and observations are based on interviews involving those who are on the

spectrum of VERY old and needing A LOT of care. This contrasts with those at the other end of the

spectrum who may be thinking about or starting to notice some effects of aging and could use a

hand here and there.

At it’s most basic, the duty of care rests HEAVILY with the immediate or extended family. The

family must figure out how to do things they didn’t know they’d have to do, and to navigate a

fragmented system. Given their lack of expertise in these areas, they’re unsure exactly how to

proceed. But these things need to be done, and they need to be done now, so the family takes on

most of the responsibility as best they can, giving up most of their free time to do so.

There are a lot of different moving parts and things to keep track of (e.g. appointments,

medications, monitoring health, meals, bathing, church). This senior couple are lucky that they’ve

been able to live long lives together. Without the support of her husband, the wife would certainly

have been in an assisted-living residence, years ago.

This senior couple are also blessed with an incredibly supportive family, including two retired

daughters who willingly make weekly drives into Halifax (from Truro and from Port Williams). They

take turns making meals and caring for their parents, in big and small ways. What used to be day-

trips to Halifax, however, have now become regular, multi-night stays as their parents need

evermore, continuous care.

Another senior female was discharged from the hospital after having spent six weeks there with

flu, then pneumonia. She is on two tanks of oxygen a day now and can no longer stand up, sit

down, move around, or use the washroom without someone there to help her.

Home Instead’s services have been upped from 3-hour shifts, 5 days a week, to 8-hour shifts, 7

days a week. They will need to replace one of the home-care workers in their rotation as one of

their current home-care workers, does not offer bathing services. Bathing services were not

previously needed by her, and suddenly, they are. It’s been weeks since she has had anything but

a sponge-bath.

The VON was requested by the doctor at the hospital on her behalf, and to start, they will be

coming once weekly to check on her health. The questions asked during the VON assessment were

strictly related to things like blood pressure, swelling, breathing.

This senior female used to do Yoga for Older Seniors once a week, which was led by a relative who

is a yoga instructor and osteopath. She moved to Port Williams a couple years back and the senior

couple have not had a regular fitness regime since. They miss it dearly but even if the class still

existed, they wouldn’t be able to get to it without someone transporting them there as they can

no longer walk the two blocks, just the two of them.

A supportive relative will be connecting with Community Services in order to see whether it will be

possible to add one of their ‘people’, for a lunch-time check-in between Home Instead’s shifts. She

feels strongly that her parents now require care 24-hours a day, out of necessity, and, because it

would be preferable than having all these different people coming in and out all day long, which


still leaves gaps of time where no one would be around should her parents need them in that

moment.

Despite the recent, significant shift upwards in need, her parents (in their mid-late nineties)

maintain that they will not be moving into an assisted-care setting, but that their care will

continue coming to them at their apartment. They have the luxury of being able to afford this

lifestyle.

The following are noteworthy during last week’s initial VON assessment at this senior’s home:

• Neither the family, nor the VON Nurse, had ever heard of the Department of Seniors

before. It only dawned on the family last week during the VON Assessment, that

“Department of Seniors” is an actual governmental department that exists and is not just

a nickname. Not sure that’s a great sign in relation to public’s awareness and empathy

towards seniors.

• The senior female was disappointed to hear the VON were coming in the first place. Her

experience in the past is that they’ve been ‘unreliable.’ This was highlighted by the fact

the VON Nurse said she’d arrive “after lunchtime” that day, and in fact, arrived at 8:30

pm. While the VON doesn’t schedule specific times as their visits may lag depending on

their client’s needs for that day, it is understandable to see why she would simply perceive

this as the VON being ‘unreliable.’ If the hospital hadn’t requested the VON to visit, she

would likely not be having them come in, even though the VON is providing her with a

very worthwhile service, for free.

• The VON Nurse didn’t introduce herself and simply began talking with the senior’s

daughter-in-law and asking her all the questions at a volume that would be inaudible to

the seniors. This demonstrated blatant ignorance and was very disrespectful on the part

of the VON nurse. Ten minutes into her visit, the senior male finally asked (as politely as

possible), “So who are you and why are you here?”. This situation, again, shows the lack of

empathy that many service providers have towards seniors.


23. Appendix D – Synthesis Meeting Results INSIGHT(S) INSIGHT(S) INSIGHT(S) INSIGHT

-Attitudes: Pride & Independence

-Economic versus personal benefit and well-being

-Rational Needs Assessment versus irrational

behaviours, choices and Attitudes, i.e. programs

and services assume people can and always do act

according to the Rational definition of self (or

best) interest implied by the goals/objectives of the

program/service

-Attitudes: Empathy &

Training

-The empathy/training that is

required to retrofit / build

places where people can

properly age in place is

lacking

-Navigation & Accessibility

-Services are disconnected

and siloed

-There are many services out

there but if you don't know

about them...getting access

to them is difficult

-There is no formal directory

of qualified renovation

skills/expertise = word of

mouth

Readily available

"adaptations" to AIP are

ugly/institutional

BUILT FROM THE FOLLOWING: BUILT FROM THE

FOLLOWING:

BUILT FROM THE

FOLLOWING:

BUILT FROM:

Clients are reactionary not proactive CAPs as info program

connectors

Government can't/won't vet

contractors or services (2)

Changes coming to building

code

Concerns over social isolation in the future Builders will build what people

want

Who can we call to do

modifications? Government

can't recommend..."Ask your

neighbours"

DHH/HHH: Not well enough to

cope on their own but not sick

enough to qualify for services

(7)

Feelings of stigma and shame may inhibit people

from seeking services (renos; mobility)

Marketing needed People learn of the grants

available through word of

mouth (e.g. at hospitals,

through contractors, etc...)

(11)

"Policy wonks get to develop the

gap analysis" (2)


What to do when mom says "I don't want..." Key is in marketing Word of mouth happens when

interactions occur in hospital

(11)

Responding to need: few clients

seek to prepare [need vs.

demand}

Pride is a major reason seniors may refuse to take

advantage of available services (12)

Zoning and permitting rules

aren't sensitive to aging in place

driven MOD's

MLA's, MP's, hospital are how

people learn about HNS

programs (11)

Criteria for program

inclusion/qualification (1)

"You're not putting me in a home. I'll die here first."

(3)

Permitting challenges with

modifications

A Senior's Navigator (similar

to an Immigration Navigator)

: It assumes things are too

complex (6)

Current programs are hard to

access [re: eligibility

requirements]

Persuade people to what they need The DUA gives $3,000 for

project X. But need "Y" is what

contractor has noted as needed

(2)

Having multiple conversations

leads to confusion (6)

Older homes hard to retrofit -

key is new builds

Forget "Aging in place...dying in place." Working for seniors = different

schedule "late start"

Identifying supports is

challenging

Modifications are not blending

in

Stigma of accepting help "50%of the contractors out

there are old school guys who

are set in their ways" (2)

Seniors get conflicting

information

Target: New home

construction...must legislate

Issue of seniors living in cars/couch surfing Person who owns the home

hires their own contractor

A lack of a written record of

advice creates doubt

Builders will build what people

want

We need our son & neighbours to manage our

property

Household circumstances aren't

scoped as part of needs

assessment (2)

"Word of mouth triage" =

NSP, HNS, ENS (2)

"Loneliness is a big, big factor" Needs assessment happens

independently of the impetus of

a visit by a care provider (2)

"I don't have a map of the

system" (2)

RD worries about social isolation (6) Rebranding Informal conversations

provide leads to

people/services - People want

to contribute

Status continues to change over time Architects need specific training


Needs change over time with status CAPs Training Certified Aging

in Place is available

but...accessible?

With foresight and help, it is possible to age in place "The sub-contractors I hire

don't empathize and aren't

sensitive" (2)

" I can't work on the business

and scale my empathetic

approach" (2)


INSIGHT INSIGHT INSIGHT INSIGHT INSIGHT

There are needs for Aging in

Place that don't fall into

"programs" (e.g. UPS on the

step; cleaning/snow removal)

Tech Caregiver Obstacles Gaps

BUILT FROM: BUILT FROM: BUILT FROM: BUILT FROM: BUILT FROM:

Medical/dental costs not covered

by province

Needs being met by

technology means

different things to

different age cohorts

(5)

$18,000 forgivable loan after

needs assessment (11)

Long turnaround

time for call-backs

Seniors Emergency Shelter

(similar to SHYFT - youth

homelessness, transition house -

Supportive Housing Youth Focus

Team

Having to confirm with "too much

legislation" (1)

"I don't want too many

gizmos" (5)

Grants for modifications are

available: $6,500 & $18,000

(11)

Transportation is a

barrier

Senior-living in apartment versus

home

Legislative issue: Need to be

diagnosed with a disability

(usually cognitive but not

explicitly) (1)

Device to monitor, near

and far

3000 applications per year for

HNS loans (D)

$6,500 is max (11) "Foster Seniors"

Not sexy, store nor

equipment

HNS funding comes via grants,

loans, etc. (11)

High number of

applicants, very long

waitlist (11)

There is a lot of pressure on

child/caregivers

There are no set

geriatric teams

"If your mom is found wandering

we'll have to call Protection

Services"

Responsibility of caregiver in

identifying what supports are

needed conflict with the stated

needs of the senior


It is hard to monitor meds if no

one is there

Trustee services: Financially,

seniors are a challenge for them

(7)


24. Appendix E – Prototyping One Results How might we create a culture that normalizes

supports and services for aging in place in a

way that is attractive to user and provider?

How might we better connect existing

services and create a more navigable and

cohesive system of services and supports?

How might we create and promote awareness and

reduce stigma for those providing supports and

services for seniors?

BRAINSTORM BRAINSTORM BRAINSTORM

"Aging is amazing" ..message marketing Bring in other resources not tagged as 'seniors.'

E.g. Community happiness program in

Windsor/Sackville

Hotline/chatline for loneliness

Recognize contribution of seniors Create a quality program/certification process Marketing campaign "sexy"

Celebrating success Service standards (government) Normalize the aging cycle

More age-friendly communities BBB for Senior Services Citizen involvement

Look at other models or culture shifts "Ride Share" Experience for service providers

to better understand

A mesh network

Work with co-curricular programs at universities Boards of seniors’ interests Department of Seniors' role?

Seniors Helping Seniors (Help network, e.g.

trades)

A gap app that makes a service outage map Audit existing "awareness" campaign or initiatives

Inclusive education re: natural cycle of aging Create a liaison and cross-connection team to

bring ideas together and cross-pollinate

between things

Engaging a part of the support and service industry

to do an HCD project

Rideshare Improve inter and intra municipal

communications

"Try on Aging" initiative (e.g. heavy bag, trick

glasses, tall shoe, etc.)

Matching network (app) Ask private sector actors what they need

regularly

Identify areas where stigma exists and persists

Promote Intergenerational community

development

Look at best practices Ask everyone to explain what they currently think

about aging (prompting self-reflection)

Seniors shadowing government agencies' staff Intergovernmental seniors perspective/lens Use a decentralized currency to reward

objectives/outcomes that align to the 'How might we?'

question


Platform/interface for knowledge/resource sharing Create a SPACE for services to self-identify

(gives opportunity to vet/audit/certify

Create a senior lens for government programs and

planning

Identify service gaps Talk to providers to understand language used (e.g.

is it unique or specialized? Should it be?)

Promote Blue Zones "dot" (e.g. Liverpool) Create a pyramid scheme that builds bottom

layers/reproduces based on the incentive of increased

empathy

Physical boards/ interfaces where seniors can

create and feed data to other places

Target post-secondary students to encourage

awareness of needs of aging population and how

students can be of service...i.e. Community capacity

building

Seniors Navigators Training for service providers to understand working

with an aging population

Create a total systems map Gap map

Geriatric teams

Add meta data layers to existing systems/ tools

that contain information about this topic

Create a physical literal center of the aging

universe


25. Appendix F – Prototype Two Pitch Feedback – May 22, 2018

At this meeting the following guests were invited to listen to the pitches and provide feedback on

the proposed prototypes:

➢ Simon d’Entremont, Deputy Minister Seniors

➢ John Hamblin, Founder, Startup Canada Halifax and Aging 2.0 NS Chapter

➢ Ed Leach, CEED, Aging 2.0 Chapter member

➢ Sharique Kahn, Aging 2.0

➢ Gerald (Jerry) Lawson, Director, Information and Communications Technology, Investment

Attraction, NSBI

➢ Jennifer McGill, Associate, David Pier (Part of the Core team for the Food Security Lab

project)

➢ Shaun Kenny, CTO, CheckIn Technologies

➢ Gabrielle White, Senior Service Designer, Service NS

PITCH 1 --- ATTENDEES: Gerald (Jerry) Lawson; Gabrielle White; Andrew @ GovLab

Jerry

• LIKES assessment approach (went through “it” with his parents, still going through it;

there was no assessment except with a doctor)

• WISHES re: ownership of data and that it can be commercialized (his experience with this

in past is that varying gov. depts have “lawyered up” and this is the main issue re: the

data)

• Thinks it is very interactive and the data can be explored

• Wonders if we can come up with questions (layperson type)

Gab(by)

• Wonders if it is a two way user therefore direct interaction; someone seeking something,

someone providing something (referenced Houzz - https://www.houzz.com/ - where

partners are prequalified and when it comes to a vulnerable group, this would be a

requirement); thinking more of a one on one interaction rather than a tool – Jon then

emphasized a high touch relationship, Gab likes that people could post what they need

(i.e., ,crowdsourced solutions) and there could be multiple avenues that could be explored

• References an ongoing basis whereby a community could be created

Andrew

• Wondered if it was in person or online; Dennis countered asking what is preferred;

Andrew clarified that one would be expensive, the other cheap; thought in house would

be better but the range of expertise needed would be wide to do the assessment

https://www.houzz.com/


PITCH 2 --- ATTENDEES: Ed Leach; Jennifer McGill; Rayna, Kenzie, Michele @ GovLab

Ed

• Wondered where HMW question came from; continued to tell us origin (McMaster U) and

confirmed it to be the right terminology

• Referenced his mother who passed away 10 years before, very head-strong; emphasized

that the mindset of the person is more important that the disability/dysfunction

• Mentioned Carmel O’Keefe (https://www.dal.ca/faculty/health/occupational-

therapy/faculty-staff/faculty/carmel-o-keefe.html) as a person of importance we should

connect with – professor at school of Occupational Therapy – she did training for Shaw

Group (AIP) re: their residential developments, provided cameras to seniors and had them

take pictures of things that frustrated them

• Wonders who will run the app?

• Wonders how we will target the head-strong types? Noted that those with Alzheimer and

dementia need engagement if they cannot participate

• Must consider who seniors respect; who are their role models? Who has done this?

• Really likes the idea a lot

Jennifer

• She has two parents going through “this” now; she can imagine them doing this

assessment for themselves – really likes that it gets to more of the Ownership and

Engagement piece – as such, the idea is a “bright possibility – offers Accountability. Makes

the comment re: Ownership of Reality which she finds intriguing and sees how one can be

more proactive; thinks the human centered approach to understanding things usually

done in the white tower to be very useful

• She has no wishes

• There are challenges around the data and privacy

• She notices a Gap on intersections, assuming we haven’t discussed all though – the gap

being the Affordability Gap (stems from her work on leading Food Insecurity project)

• Very important that we get in at the right opportunity\

• The application and utility of the tool are to be considered – emphasized getting in early

• Seniors don’t want to be burdens; the info our tool can provide would provide Awesome

Advantages to the caregiver – they would create a conversation

• Referenced the lady who worked her whole life but never felt poor until she retired

https://www.dal.ca/faculty/health/occupational-therapy/faculty-staff/faculty/carmel-o-keefe.html

https://www.dal.ca/faculty/health/occupational-therapy/faculty-staff/faculty/carmel-o-keefe.html


PITCH 3 --- ATTENDEES: Shaun Kenny; John Hamblin; Lynn; Margaret @ GovLab

Lynn

• Wondering who the tool is limited to

• Important part is trying to connect right person to the needs (reliable contractor)

• Need to know the network is Reliable

Shawn

• Very interested in PII – the Data

• Thinks it is a great question for platform

• Re: what we are collecting, we need to capture basic/core things; don’t think big – if there

is need for it in the future but not now, don’t take it now; don’t be a Data Hoarder

• Keep it simple

• Keep it personally identifiable (encrypted); reference to Privacy by Design Standards

• Re: aggregating info. For stats, at that point it is not analysis for the person, but it is

classification; there are lots of tools that can classify large data and give good results –

important to have someone to review

• Recommended flow: Aggregate the info; classify; put it in buckets for predictive data. This

is a Great Idea; then can determine sectors to connect based on classifications – maybe

certain demographics are pushed towards community groups, housing supports or

students for research

• As people enter the info he recommends we look at the info that people are starting to

flag (and then recommend – keeps from having to move away)

• References Classification of Profiles whereby people with certain needs get linked to

certain supports

Margaret

• Was wanting us to make a distinction between Tool and Assessment; it needs to be

valuable and you should peel it apart

• She has yet to meet an assessment tool that is very innovative

• Current assessments group people from 55-70 or frail/elderly – wonders what an

assessment in the home looks like

• Thinks this is the Right question to look at – others are looking at AIP but it is very siloed

• Recommended we reach out to Elaine Moody @ Dal who is building a Toolkit (www.cfn-

nce.ca/about-us/biography-pages/moody,-elaine/)

http://www.cfn-nce.ca/about-us/biography-pages/moody,-elaine/

http://www.cfn-nce.ca/about-us/biography-pages/moody,-elaine/


PITCH 4 --- ATTENDEES: Simone d’Entremont; Sharique Kahn; Stephen, Adele @ GovLab

Sharique:

• This is a very important “problem”

• Wondering what the tool looks like

• Referenced the situation where 1 senior owns an apt., and another is looking for one

• Should narrow down what is a tool

• Referenced elder abuse and the need to ensure the assessor is not taking advantage of

the senior

Simone:

• He is Super interested in the topic

• The policy is to allow people to AIP as long as they want vs. going to a nursing home for

$72,000 annually

• Commented on the many levers in the provincial government to keep people at home but

they don’t offer them as a Portfolio of Options

• Referenced millions of dollars spent annually on programs such as LIH (low income

housing) assessments and no-charge upgrades; referenced the Home Heating rebate for

which many are eligible but not aware and privacy rules prevent the government from

informing them – they have spent lots of $$$$ but the problem is that they don’t have a

non-stop shop which suggested they are not doing well enough

• Referenced NB and it’s Home First policy and Home First brochure and said, “They are

Doing it Better” (http://www2.gnb.ca/content/dam/gnb/Departments/sd-

ds/pdf/HomeFirst.pdf)

• Thinks someone from government or other should walk through the house and tell them

how to do it and thinks there is a business case for suggesting it

• We have a lot of Tools and Checklists so thinks it makes sense to make it someone’s job to

do it (assessment)

• Wondering if we put it in one place (website, person) – Segway to Jon bringing up Ground

Zero concept where he references the data layer and the two-way osmotic relationship

• Comments regarding How Bold Should we Get – infers we should get bolder

• Our cohort has a good handle on all the questions, better to Go CRAZY

• Referenced Navigator Pilot that ran last year (contact = Faizal Nanjia, Exec. Dir. PNS Dept. of Seniors) but they became very territorial (211 and volunteers ran it – learning takeaway – be careful to go into communities)

• Dept. of Seniors is signing a MOU with the NSFM

Adele

• Thinks our group and her group should talk

http://www2.gnb.ca/content/dam/gnb/Departments/sd-ds/pdf/HomeFirst.pdf

http://www2.gnb.ca/content/dam/gnb/Departments/sd-ds/pdf/HomeFirst.pdf


26. Appendix G - Prototype Testing Package The following e-mail soliciting feedback, with a .pdf attachment as shown in the next few pages,

was sent to over 30 people:

Hi ??,

Intro sentence here. The attached is the seniors project I mentioned. The following provides the

context for this project:

I am one of 24 people accepted as “Fellows” to the first cohort of NS GovLab for Seniors. This is a

social innovation lab consisting of volunteers focussing different ways to address seniors’ issues

and opportunities in Nova Scotia. Our team of six is using the success of the home energy

evaluation program as a model for an aging-in-place strategy for seniors. As a small part of this we

are proposing a preliminary assessment approach with an online tool that could be used by

professionals, friends, family or individual seniors to develop a profile of their situation and then

determine what might be needed or available to help them age-in-place. We know that the

components to make this work are not yet in place.

The attached package provides more detail on this initial project. The feedback we need could

address such questions as:

- Do you understand what is being proposed? - What are the strengths or potential value of the proposed concept? - What challenges need to be considered in developing the proposed tool? - What would be your expectations of such a tool if you were to use it? - What key pieces of information have not been included? - What should we have asked and didn’t?

Any help and feedback that you can provide would be appreciated. A response by e-mail would

work or, if you prefer, we could meet to discuss the project and above questions.

Personal Information Collection Form

NS GovLab

NS GovLab is a social innovation lab that will amplify, support, and advance

innovation in the Nova Scotia public service. As a fellow of NS GovLab, I am

working with a team to conduct human-centered research to build and

testing a prototype with potential end users.

We are seeking to better understand the potential value of a preliminary

assessment tool to help individuals and families examine their situation and

get a better understanding of what is needed and is available to allow them

to age in their own home. We feel that your experience can contribute to

informing our work in this area.

The NS GovLab Fellowship is bound by the principles and requirements of the

Nova Scotia Freedom of Information and Protection of Privacy (FOIPOP) Act.

The personal information that we collect will only be used for research and

evaluation purposes in keeping with the access and privacy provisions of the

Nova Scotia FOIPOP Act and the Nova Scotia Personal Information

International Disclosure Protection (PIIDPA) Act.

We will not disclose your personal information to other organizations or

individuals except as required to fulfill the purpose(s) of the program or

service and only to the extent required or authorized by law.

Under the privacy provisions of the FOIPOP Act you have the right to

correction of, and access to, your personal information. To obtain access or

request a correction, please contact the Health Privacy and Access Office by

email at [email protected] or phone (902) 424-5419 or 1-855640-

4765.

I acknowledge that I have read and understand the above information regarding the

collection, use, and disclosure of my personal information:

Name Signature Date

Preliminary Assessment Tool


NS GovLab

We are part of a team that is looking at innovative ways to assist people, who want to, remain in their homes as

they age. Based on adaptation of the successful Energy Efficiency Home Evaluation program, we have developed a

conceptual framework that will allow people to remain safely and comfortably in their homes as they age. A key

component of the framework is a “Preliminary Assessment” of the home and the people that live in it. A

“Preliminary Assessment Tool” that can be used by individuals, families or professionals has been proposed as a

first stage to enable carrying out a preliminary assessment to assist people with determining their needs and

required resources to remain in their homes.

The Goals of the Preliminary Assessment Tool are:

• Gather basic comprehensive information about or for a household interested in AIP (Aging in place) alternatives

• Enable identification of potential further in-depth assessments where needed

• Make participants aware of additional resources available to them

• Produce a preliminary report for the household directed to those who initiated it, subject to any privacy

considerations

• Enable creation of a data repository to inform government programs and services that o Allows a proactive

approach to planning

o Identifies gaps in services

o Leads to improvements in co-ordination and responsiveness of current programs

The following is a detailed conceptual overview of content to be included in the preliminary assessment tool. Empathy

and sensitivity will be essential in both designing and conducting the assessment. All questions must be optional and

clearly understood to be so. Specific questions have not yet been developed.

Household Characteristics

• Age, gender, relationship of household occupants

• Gender, culture, race identity

• Language – spoken, known

• Citizenship status, place of birth

• Religion

• Pets

Health

• Physical and mental health, cognitive challenges, addiction issues, required medications


• Acute and chronic conditions

• Current or anticipated/feared health issues

• Family history of known genetic health traits, e.g. Alzheimer’s

• Current use of health care services, e.g. family doctor, public or private care

Living Conditions

• Eating habits, access to healthy foods

• Exercise patterns

• Hobbies, leisure activities



NS GovLab

• “Work” – paid, volunteer

• Evidence of or potential for “elder abuse”

Lifestyle

• Dining out

• Entertainment

• Travel/vacation

• Clothing

• Home furnishings

Financial Overview

• Who manages/controls the household finances

• Areas of concern or opportunity, i.e. sufficiency of financial resources

• General economic circumstances

• Receipt of CPP, GIS, GIS supplement?

• Determine if any other government grants or sources of income that might apply.

• Income tax management

Supports

• General level of independence/dependence on others for support

• Family members or friends providing support. What type? How much?

• Government or other agencies providing support. What type? How much?

• Services that would be helpful or are needed

• Engagement of private services

Social Interaction

• Use of social media

• Visits from/to family and friends

• Participation in community events

• Degree of isolation


• Barriers to socializing

Condition of the Home/House

• CAPS (Certified Aging in Place Specialist) assessment, or

• Degree of cleanliness or the reverse

• State of repair

• Currency of electrical, plumbing and heating (including oil tank)

• Energy efficiency

• Evidence of hoarding

• Outdoor maintenance needs

• Accessibility



NS GovLab

• Falls hazards

Aspirations

• Knowledge about aging-in-place

• Expectations for AIP in current home or some alternative

• Circumstances that might change the above

Do you have any questions?

Do you have any comments?



NS GovLab

Conceptual Aging-in-Place Framework

A proposed prototype for this project is the preliminary assessment. Its purpose is to develop

and test this approach as a first step to directly answering our first how might we question. It will

• Engage a qualified professional(s) CAPS or CAPE?

• Use, with changes as needed, current instruments where they exist as well as adapting

analogous ones

• Assess and adapt best practices to NS and this approach

• Inform each of the other aspects of the model



NS GovLab

• Incorporate HCD at every step of the way

• Evolving approach that changes as more is learned

Senior Navigators If these positions were created, they would have a unique role in our system.

Senior navigators would have a deep knowledge of the services/programs available for seniors to

support aging in place. They would be available to work with, assist and support seniors and their

families while they learn to navigate the services/programs/agencies that are available to enable

seniors to stay at home. Senior navigators could also assist individuals in the completion of the

Preliminary Assessment Tool.

What are your comments on the benefits of such a position if it were to be created?

_______________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Keep me informed of this initiative

By phone: _______________________________

By e-mail: ____________________________________


27. Appendix H - Acronyms

AARP American Association of Retired Persons

AIP Aging in Place

CAPABLE Community Aging in Place – Advancing Better Living for Elders

CAPE Certified Aging in Place Evaluator

CAPS Certified Aging in Place Specialist

CARP Canadian Association of Retired Persons

CCA Continuing Care Assistant

CMHC Canadian Mortgage and Housing Corp.

CPP Canadian Pension Plan

EA Energy Advisor

EHS Emergency Health Services

ENS Efficiency Nova Scotia

GIC Guaranteed Income Supplement

HCD Human Centered Design

HEA Home Energy Assessment

HMW How Might We?

IADL Instrumental Activities of Daily Living

LIM-AT Low Income Measure, After Tax

NAHB National Association of Homebuilders

NCOA National Council on Aging

NGO Non-governmental Organization

NRCan Natural Resources Canada

NSHA Nova Scotia Health Authority

OAS Old Age Security

SO Service Organization

SSA Senior Solutions Advisors

VON Victorian Order of Nurses

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