(3) The Canadian library scene

ht. Libr. Rev. (1969) 1, 213-223

IFLA LIBRARIES IN HOSPITALS SUB-SECTION HOSPITAL LIBRARY SURVEYS

(3) The Canadian Library Scene

H. C. CAMPBELL? AND VIRGINIA F. LUDLOW:

The growing role of the federal government in national welfare schemes has been apparent in Canada since the end of World War II. There is now a national pension plan, growing hospital and medical care, social and unemployment insurance, and a variety of other forms of social assistance for individuals in every part of the country. Each provincial government administers welfare services, and local municipalities share to some extent in the responsibility. Some idea of the extent of their services can be gained from the inauguration by the Federal Govern- ment of the Canada Assistance Plan1 and the various separate measures to combat poverty and increase economic opportunity in urban’and rural areas.

The purpose of the Canada Assistance Plan is to replace the existing federal-provincial shared programmes of public assistance with a single comprehensive measure. Under this plan an Advisory National Council on Welfare has been established to help the government in various ways so that a co-ordinated system of public welfare can come about in Canada.

In 1961 a Royal Commission on Health Services was appointed by the Federal Government. Its two volume report2 represents the final state- ment of the Commissioners who were asked “to inquire into and report upon the existing facilities and the future need for health services for the people of Canada and the resources to provide such services, and to recommend such measures, consistent with the constitutional division of legislative powers in Canada, as the Commissioners believe will ensure that the best possible health care is available to all Canadians”.

The Federal Government’s Department of National Health and

f Chief Librarian, Toronto Public Library. s Head, Travelling Branch, Toronto Public Library. 1 Canada Assistance Plan (1965). Ottawa: Queen’s Printer. 2 Canada. Royal Commission on Health Services (1964-1965). Ottawa: Queen’s Printer.

214 H. C. CAMPBEI.1, ANI) \'. I'. LUDLOW

Welfare looks after the health programmes of the country as a whole in co-operation with the health departments of the ten provinces and other Canadian territories. The four main federal services are:1

The National Health Grant Programme began in 1948. Its objective is to help rectify any deficiencies in the public health services provided by the provinces, some of which are wealthier than others, and the national health programme acts to smooth out inequalities.

The Hospital Insurance and Diagnostic Services Act, which came into force in 1958, “provides for federal contributions to participating provinces of a specified share of the costs of hospital care and diagnostic services”. All the provinces participate. In late 1964 the plan covered 19 million Canadians and gave an average of 99% coverage.

The Medical Research Council established in 1960 provides medical research scholarships and grants.

Indian and Eskimo Health Service. Over 200,000 Eskimos and Indians are eligible for medical and hospital care at public expense. In addition the Dominion Government’s Department of Northern Affairs and National Resources provides moneys for hospital care and for special purposes such as building water supply and sewage systems.

Medicare, a comprehensive medical insurance for all Canadians, administered by the provinces with federal fiscal contributions, is under active discussion between federal and provincial authorities.2 It will cover all residents for all medically necessary services.

How much does Canada actually spend on health costs out of the gross national expenditure, and how much will we spend in the future? For a recent economic projection see Table I.3

TABLE I

Year

1971 1981 1991

Forecast of “/ of per capita gross national expenditure total Pojmlation which will be spent on health services

22,590,ooo 6.04 28,247,OOO 6.63 35,107,000 6.35

1 News and views on the economics of medicine. Can. med. Ass. 3. 91, 1035 (1964). 2 Canada. Department of National Health and Welfare (1966). Health and welfare ser-

vices in Canada: a report prepared for the Canada Year Book. Ottawa: Queen’s Printer. 3 Canada. Royal Commission on Health Services (1964-1965). Vol. 1, Pt. 5, Ch. 19.

Ottawa: Queen’s Printer.

HOSPITAL LIBRARIES CANADA 215

In 1966-67 the Department of National Health and Welfare had $1,267,428,800 to spend; the estimates for 1967 to 68 asked for a total of $1,392,903,400. In addition the National Research Council of Canada, including the Medical Research Council, asked for 3 121,693,OOO of which the sum of $420,000 would go for library books and journals.

How does Canada’s budget expenditure on health from public sources in relation to Canada’s total government expenditure compare with that of other countries? The following partial table is from a recent World Health Organization survey.

TABLE II

C0llntYJJ Tear covered % of total budget’

New Zealand 1964165 16.3 .Japan 1963/64 11.6 Australia 1962163 11.3 United Kingdom 1964 8.8 Sweden 1962 8.1 South Africa 1963 7.3 Canada 1962/63 5.9 Mexico 1965 5.2 Brazil 1962 4.6 Netherlands 1962 4.5

In the health programmes of the various provinces there are certain variations caused by regional conditions. Newfoundland, for instance, with its total area of 156,185 square miles divided between the island of Newfoundland and the mainland of Labrador, has only two incor- porated cities and over 60% of its population of 501,000 is scattered in villages and small towns up and down the rugged coast. The scattered population is a serious problem and the limited taxable capacity has hindered the growth of municipal services. Matters that in the rest of Canada would be the responsibility of the local municipal government must be carried out by the provincial government in Newfoundland. The Provincial Health Department, for instance, provides 18 cottage hospitals in some of the little communities and employs the doctors to staff them. Voluntary agencies are also very important, such as the International Grenfell Association with its chain of little hospitals. In a more densely populated province these hospitals would be largely municipal and staffed by local doctors in private practice.

Similarly, in Prince Edward Island, with its tiny area of 2194 square miles of rural and agricultural land, the province has control of much that would be municipal elsewhere.

D

216 H. C. CAMPBELL AND V. F. LUDLOW

In contrast, in a more densely populated and industrialized province such as Ontario, which is the second largest province with an area of 412,582 square miles and a population (in 1965) of 6,731,OOO (over one third of all Canada), the emphasis is on decentralized administration. l

The Ontario Department of Health takes responsibility for public health (administration and nursing), rehabilitation, mental health, en- vironmental sanitation, epidemiology, industrial hygiene, tuberculosis prevention, nursing, maternal and child health, dental services, health information and publicity, laboratories, medical statistics, the Ontario Hospital Services Commission, cancer research, and drug and alcohol- ism addiction research. The usual fields for the other provincial departments of health (which may or may not be combined with welfare) would be similar. It does not take responsibility for providing hospital patients with reading material.

Continuing to use Ontario as an example, the Ontario Hospital Services Commission will provide medical books and journals for hospitals’ medical libraries-“all the medical books we want”, as a hospital superintendent said recently. But it will not provide books for patients’ libraries.

How great is the need? Patients needing library services will be found in nearly all types of hospitals. Canada has a total of 1397 hospitals, including private and federal hospitals : 2 11,044 beds in all.2

Of these, by far the most, 110,241 beds, are for general care; 66,613 for mental; 20,863 for chronic; 6747 for tuberculosis; 3149 for convalescent; 2809 for orthopaedic; and 622 for contagious. This means that 90,625 beds across Canada are occupied by the three categories of patients, mental, chronic and convalescent, who most desperately need not merely “a book to read” but the broad services of a well-organized library.

We can only guess how many additional people in Canada are in residences for the aged and nursing homes, or house-bound through illness or age in their own homes. The responsibility for bringing library service to all these handicapped people would seem to rest squarely on the institution whose raison d’t%re is to bring library service to all the citizens within the geographical area for which it is established: the public library.

What is the Canadian library as a whole doing for these handicapped people? We must confess that in Canada service to handicapped readers

1 Canada. Department of National Health and 1Yelfare (1966). Provincial health services by province. (Health Care Series No. 20.) Ottawa: Queen’s Printer.

2 Canadian Hospital Association (1966). Canadian Hosj,itaZ Dire&y. Toronto: Canadian Hospital Association.


is an undeveloped field. There is as yet no Canadian Library Association counterpart of the American Library Association’s Association of Hospi- tal and Institution Libraries, the Library Association’s, Hospital libraries and handicapped readers group, or the International Federation of Library Associations’, Libraries in Hospitals Sub-section. What is done, is done on the regional, or more often on the local, level.

To find what the needs are, and what is being done, let us look at the country from east to west. A Report on Services for the Ill and Aged of Canadian Public Libraries was prepared in December 1965 by Virginia F. Ludlow, for the Toronto Public Library Board. It has been updated on the basis of more recent information collected in April 1967 and June 1968.

This later information may not have materially changed the state of events as reported in 1965; but it does indicate a promising increase in services to the handicapped and in awareness of the problem, on the part of many public libraries across Canada.

LIBRARY SERVICE FOR PATIENTS IN HOSPITAL

Newfoundland and the Maritimes According to estimates of revenues and accounts to be voted for the

public service of the various provincial governments, for the fiscal year ending 3 1 March 1968, Newfoundland and the three maritime provinces (New Brunswick, Nova Scotia and Prince Edward Island) spent a total of about sj 114,020,400 on their health budgets, and supported 17 1 hospitals and a total of 19,880 beds. For comparison, the sums listed for Public Libraries, which fall under the provincial Departments of Educa- tion, totalled $949,052.

No public library in Newfoundland and the Maritimes is attempting to run a library service in any hospital. “The public library system in Newfoundland is far from being efficiently administered and adequately stocked. Indeed, it might be said that it belongs to the horse and buggy era in a space age : to the one-room-school, unlicensed-teacher-age in the era of modern regional schools.“1 As one public library remarked in 1968: “Our resources are too hard stretched as it is.”

Quebec Quebec, the largest province, has a population of 5,838,000, of which

80% are French speaking. Approximately 2,900,OOO residents are

1 Jessie B. Mifflin (1966). A report on Public Library Serr'ires in the Province of Newfoundland and Labrador, p. 1. St John’s,

218 II. C. CAMPBELL AND \‘. E‘. LUDLO\\

without public library service .l The province has a public health budget of $454,480,000 and two recently established health programmes of medical assistance and hospital insurance. There are 283 hospitals in Quebec, with a total of 58,552 beds. The City of Montreal’s hospitals are well provided with medical libraries. There are well-organized libraries for patients in most of the Montreal hospitals, usually run by volunteer members of the various women’s auxiliaries. The large mental hospital St-Jean de Dieu has an extensive patients’ library service with a complete programme of bibliotherapy planned.

Ontario

Ontario has a population of 6,731,OOO and a high percentage of elderly residents (8.2% are over 65 years of age, compared to the average for Canada of 7.6%). With Department of Health estimates for 1966-67 of $249,299,000, Ontario supports 317 hospitals with a total of 69,900 beds. The province has the highest number of beds for chronic, convalescent and mental patients: 7693, 1879, and 21,566 beds respectively.

Several public libraries are providing service to their local hospitals. The City of Brantford sends books and staff to the general hospital. Hamilton Public Library loans deposits to long-term patients in the children’s hospital, using a retired librarian and volunteers for book circulation and story telling. Oshawa Public Library provides books and weekly staff visits to the local hospital. Ottawa Public Library provides books and a part-time non-professional staff member to two hospitals in the city. In St Catharines, the public library has placed a deposit of books, frequently changed, at the psychiatric wing of a large general hospital. Fort William Public Library has definite plans to begin library service in the city’s active treatment and chronic hospitals.

The Municipality of Metropolitan Toronto is composed of several boroughs, each with its own, autonomous public library system, which takes responsibility for library services to the hospitals and handicapped of its area according to the local need, and its resources. Scarborough Public Library, for instance, provides books and assistance to a hospital for chronic and convalescent care and two active treatment hospitals (totalling over 1300 beds) ; and is investigating service to a large nursing home.

The Toronto Public Library set up a special branch in 1956 to co- ordinate services to hospitals and the handicapped. It has kept away from active treatment hospitals with their quick turnover of patients, and concentrated on the hospitals where patients may stay for weeks

1 Quebec. Ministke des AfFaires Cultwelles. Service des Biblioth&ques Publiques (19G5-- 1966). Rapport 5e, p. 3.


or months. With a staff of four, this branch stocks and staffs three hospitals for extended care: a convalescent hospital; a home for cerebral palsied adults; a paraplegic retraining lodge; and a psychiatric hospital (working closely with the hospital volunteers) : a total of about 1900 beds in all. It stocks and supervises libraries in three large municipal homes for the aged (totalling 1300 beds, many of them for bed-care patients) and provides books in two other hospitals whose libraries are staffed by volunteers. The Boys and Girls Department of the Toronto Public Library stocks and staffs a library at the city’s large children’s hospital, and maintains a deposit of books in the children’s section of a psychiatric hospital. Between 1946 and 1967 the public library maintained a branch library in the 1500-bed veterans’ hospital just outside the city of Toronto; this service being transferred to the hospital authorities when the hospital passed from the control of the Canadian Department of Veterans’ Affairs.

The Prairie Provinces : Manitoba, Saskatchewan, Alberta

The three prairie provinces cover a total area of 757,985 square miles. Manitoba has a population of 962,000 and a high ratio of elderly people-9% compared to Canada’s national average of 7.6%. The city of Winnipeg’s high concentration of the province’s population and of specialized health facilities has influenced the pattern of health services development in Manitoba. Saskatchewan, with a population of 95 1,000 has an even higher ratio of elderly people-9.3%. The highly profitable mining and oil fields have influenced the province’s recent development in all areas. Alberta has a higher population than either of the other Prairie provinces, 1,451,OOO; and the highest rate of population increase, 55% since 1951. The percentage of elderly people here is low. The Alberta health services are influenced by the principles of personal and local responsibility. Manitoba has 108 hospitals with a total of 10,760 beds, and health estimates for 1966 to 67 of 528,214,980, exclusive of receipts from federal and municipal governments. Saskatchewan has 169 hospitals and 12,110 beds, and a public health budget of $25,054,150. Alberta has 154 hospitals containing 18,670 beds and public health estimates of $43,483,500 for 1966 to 67.

In Winnipeg, Manitoba, the public library of the city provides books and staff to the children’s hospital. In Saskatchewan, the North Central Saskatchewan Regional Library based in Prince Albert provides books for two local hospitals. In Alberta, the Calgary Public Library has operated a small library in the Alberta Children’s Hospital for 15 years. There is a permanent book collection of about 2000 books and public library staff visit weekly.

220 H. C. CAMPBELL AND V. F. LUDLOW

British Columbia

British Columbia, the province of the Rocky Mountains and the Pacific coast, has an area of 366,255 square miles and is the third largest province geographically. Its population is 1,789,OOO with a very high percentage, 9*6%, of residents over 65 years of age. Half the province’s population lives in the two cities of Vancouver on the mainland and Victoria on Vancouver Island, in the southwestern corner of the province. This concentration of population, as in Manitoba, has influenced the organization of health services. British Columbia supports 126 hospitals, with 19,060 beds. Its health budget for 1965 to 66 was $65,167,600.

The Greater Victoria Public Library works actively in nine Victoria hospitals (chiefly chronic and convalescent) providing books and library staff, and has set up a highly successful special department for hospitals and the handicapped. Burnaby Public Library has recently set up a visiting service to 24 private hospitals and rest-homes, manned by the library staff.

LIBRARY SERVICES TO OTHER HANDICAPPED READERS In addition to service to patients in hospitals, there are the related services for those who are physically handicapped but not hospitalized: those who live in homes for the aged, special residences, and schools, or attend rehabilitation and recreation centres and clubs for senior citizens, or are shut-ins confined to their homes by illness or age. What are the public libraries doing for these people?

Newfoundland and the Maritimes

In Nova Scotia, the Annapolis Valley Regional Library, with its headquarters in Annapolis Royal, gives a limited “request” service. Books are selected and left at a scheduled stop for the very few shut-ins who have requested them. The Halifax Public Library has established a shut-in service, in co-operation with a service club, for eligible residents of the city. The Dartmouth Public Library also plans to set up a delivery service for shut-ins, with the help of volunteers. The Halifax Library Association has set up a special committee on library service to the handicapped, to prepare a report and approach different levels of government to institute a service for handicapped readers.

In New Brunswick, the St John Public Library provides book deposits, frequently changed, at two homes for the aged, whose residents may telephone in requests which are filed at the library. It also provides book deposits to a school for children suffering from cerebral palsy.

HOSPITAL I.IBRARIES CANADA 221

The York Regional Library, with its headquarters in Fredericton, has opened a branch in a new home for the aged; and books will be sent in rotation to various old people’s homes in the area which the York Regional Library serves.

Ontario The Public Libraries of several cities of Ontario, outside metropoli-

tan Toronto, report services of some kind to those who cannot reach libraries because of age or physical handicap. Brantford, a city of about 60,000, organized a service to shut-ins which is believed to be the first in Ontario and still is the largest regular one. Borrowers’ books are changed every two weeks, and over 200 books are distributed per month. Shut-in services, making use of volunteers for delivery and pick-up of books, are conducted in other Ontario cities’ public libraries : Chatham, Hamilton, Ottawa, and Windsor; in Fort William Public Library such projects are under investigation.

Book deposits are placed in homes for the aged by Brantford, Chat- ham (where bed-care patients in the infirmary are also visited), Belle- ville, and Ottawa Public Libraries, the Northeastern Regional Library System(headquarters Kirkland Lake) and Wentworth County Library (headquarters Hamilton) ; and Fort William Public Library is consider- ing this service. Several public libraries schedule bookmobile stops at senior citizens’ housing areas. Book deposits or film showings arc arranged in clubs and centres for the aged or handicapped by Oshawa and St Catharines Public Libraries and in schools for the handicapped by Oshawa Public Library.

IMetropolitan Toronto is composed of five boroughs each having its own library system. East York Public Library runs a service to shut-ins in one area of the borough, using Red Cross volunteers for book deliveries. The library also stocks and staffs a small room in an apartment community for retired and elderly people.

‘In the Borough of Scarborough the public library provides books for over 1000 residents of three homes for the aged; schedules bookmobile stops at senior citizens’ apartment buildings; is extending its present small shut-in service; and has a special library programme for nearly 250 children in four schools for retarded and mentally disturbed children.

Toronto Public Library places book deposits, changed on request, in seven homes for ambulant elderly people as well as the three large metropolitan homes for the aged situated within the boundaries of tile city of Toronto; and in three clubs for the aged.

222 Ii. c. C A M I’ N I; L L AN 1) V . F . I. U I) I. 0 \I

The Prnirie Provi/rces : Mannitoba, Saskatchewan, Alberta

In the Prairie Provinces the public libraries seem to have concentrated on the non-hospitalized handicapped. The Winnipeg Public Library, in Manitoba, places book deposits in nursing homes, a Home for the aged, and a day centre for senior citizens. A service to shut-ins provides home delivery and pick-up of books, in co-operation with visiting nurses and a women’s service club. This library cherishes its good relationship with social agencies and is ready to expand its services to the handicapped as needed.

In Saskatchewan, the North Central Saskatchewan Regional Library, headquarters in Prince Albert, places books in homes for the aged in its area. These are visited by the library staff, and special requests are filled. The Saskatoon Public Library places books in a home for the aged and a recreation centre for elderly people. Its service to shut-ins, run with the assistance of a service club, now has about 50 regular readers. Groups organized for the handicapped, such as deaf and crippled children’s groups and mental hospital patients, are encouraged to take organized tours of the library; and a film series on pioneer days (which are within living memory in the Prairie Provinces) has been designed for senior citizens’ programmes. The Regina Public Library runs a shut-in service which fills telephoned requests and makes weekly deliveries with the help of a service club.

The Calgary Public Library in Alberta has no organized service to homes for the aged; but volunteer workers or hospital staff pick up books for handicapped persons. Films are provided free of charge for patients’ viewing in all hospitals and nursing homes. Edmonton Public Library for years has had regular bookmobile stops in two areas of housing for the aged. The Medicine Hat Public Library provides library service and books at the city’s Rehabilitation Centre.

British Columbia

Vancouver Public Library has not organized any special services for the handicapped, but a bookmobile makes a scheduled stop at an area of housing for senior citizens. The Greater Victoria Public Library, on Vancouver Island, has set up a highly successful special department for hospitals, homes for the aged, and shut-ins. As well as its nine hospitals, th,e Library serves 18 homes for the aged and about 185 shut-ins in their own homes. New Westminster Public Library, too, is enthusiastic about its expanding service to shut-ins and a library staff member spends several hours a week selecting books and visiting.

Libraries right gross the country 1laL.e reported very favourably on


the large-print series published especially for readers with poor eyesight. Libraries from the Atlantic to the Pacific are stocking them and finding them a source of satisfaction and pleasure to their aged and handicapped borrowers. Hamilton Public Library (Ontario) even reports that it has supplied book catalogues of large-print titles to all the opticians in the city.

Library architecture in relation to the handicapped should surely re- ceive more attention than it does in Canada. Several public libraries have recently installed ramps for wheelchairs: Chatham and Oshawa (in Ontario) have done so, and the Hamilton Public Library (Ontario) is building ramps in its branch libraries where possible. The Regina Public Library (Saskatchewan) in an imaginative plan, utilizes a shal- low ramp, suitable for wheelchairs, which leads from the street level to the main library rotunda and elevators and is kept ice-free in winter by hot pipes in its floor.

This report has emphasized the factual situation in Canada with re- gard to services to persons in hospitals and at home who are unable to reach public libraries. In recent years some slight and increasing im- provements in the quality and quantity of these services are being recorded. There are still many parts of Canada without adequate public library service, and without plans for hospital and home services.

The implementation of some recommendations of the Royal Commis- sion on Health Services could alter this situation. It is estimated that a new national health care programme may spend $500,000,000 pei annum. Less than $100,000 is at present being spent on Canadian hospital public library service. The next few years may see a considerable change in the attention being given to this matter in Canada.

Documents

(3) The Canadian library scene