JOURNAL OF T H E AMERICAN GERIATRICS SOCIETY Copyright 0 1979 by the American Geriatrics Society
Vol. XXVII, No. 8 Printed in U.S.A.
Counseling the Isolated Elderly* ELOISE RATHBONE-McCUAN, PhD** and CAMILLE CLAYMON, MSW George Warren Brown School of Social Work, Washington University, St. Louis, Missouri
ABSTRACT: Increasing interest is manifest in the development of alternative models of counseling for older persons. Irrespective of the particular model used, the counseling of aged persons who have emotional and psychologic problems may require a treatment plan for health, mental health, and social services, to resolve the problems and to assess the functional limitations. Health and mental health centers employing both professional and nonprofessional counselors need to determine the value of adding outreach components to their services, and agencies which already have outreach programs may need to determine their relevance and effectiveness. Effective outreach requires a high level of gerontologic knowledge and clinical skills with aged patients. Agencies and clinics can design and implement mechanisms for supporting the elderly as they make use of multiple sources of service. Mobilization of the family and other informal helping networks in the community, the establishment of better coordination mechanisms within clinic and service programs, and multipleservice integration will improve the efficiency and effectiveness of long-term community care and follow-up programs.
Experience in the development of noninstitutional mental health service for the elderly has shown that few of them can be adequately treated exclusively by traditional psychotherapeutic counseling in the office of a mental health professional. Clearly, counseling is an important service, yet the needs of the elderly frequently require supportive or interventive resources and direct service assistance from multiple agencies. When the implementation of a comprehensive, individualized service plan requires multi-agency functions, counseling facilitates the old person’s entry into a service system and helps to establish and maintain a new equilibrium between independent, dependent, and interdependent functioning. In these instances, the counseling vehicle assists the elderly person to organize his/her life in a way that makes it possible to obtain the required services and live harmoniously within a style of life characterized by active involvement with a diverse group of helpers and “significant others.” ~-
~
~-
~
This presentation will focus on community-level systems for service delivery and the role of counseling within them. The assumption is made that elderly persons frequently require a variety of services that can be provided only from a combination of formal and informal service attachments. Furthermore, without the availability of these resources, counseling services are not likely to be adequate in meeting the diverse physical, social and economic needs of most aged persons. If these assumptions are correct, initially the counselor may need to play a very active role in comprehensive assessment, in facilitating the old person’s access to other services in the community, and in monitoring the services received to insure compliance with the individual service plan. The counselor’s fulfillment of these functions lessens the possibility that the elderly person’s daily functioning is made more difficult because of the need to rely on external sources of assistance and that his/ her self-esteem is lowered by threatening and depersonalized interactions.
~~
* Presented as part of the Symposium on Recent Developments in Counseling the Older Adult, a t the 31st Annual Scientific Meeting of the Gerontological Society, Dallas, TX, November 16-20, 1978. * * Address for correspondence: Eloise Rathbone-McCuan, PhD, Assistant Professor, George Warren Brown School of Social Work, Washington University, Box 1196, St. Louis, MO 63130.
OUTREACH AND ASSESSMENT-THEIR INTERRELATIONSHIP The frail and vulnerable elderly with medical and psychosocial needs often do not benefit from
355
RATHBONE-McCUAN AND CLAYMON
outreach services. Kahana et a1 (1) suggest that community outreach programs represent one potentially useful method for overcoming the reluctance of the aged to ask for help. More effective methods of outreach must be developed among traditional service programs and more innovative strategies should be planned, demonstrated, and evaluated. Many program efforts designated as “outreach” services do not provide an opportunity for the problem-oriented assessment which is vital for matching the person with appropriate agencies. Services are often developed to fit a single presumed need and clients must translate their total needs into the scheme of a single service agency (2). In addition, outreach services tend to be designed or implemented in ways which are less than optional for the successful recruitment of the aged. One of the greatest barriers to the implementation of outreach is the difficulty encountered in locating members of the target population. We are consistently surprised to note that most communities have such a meager knowledge base concerning the most at-risk of the elderly living in those communities. All too often, aged persons presumed to be socially isolated and out of touch with sources of service are, in fact, not unknown to components of the service system. They are merely lost because they have previously initiated contact with at least one agency, have been determined by that agency to be serviced, and then have been added to the inactive-record group until they reappear for services. Such persons are often relegated to “case closed,” dropout, or inactive status after one or two agency contacts. In these instances, they are erroneously considered by agency personnel to have benefited maximally from the service provided or to be unable to benefit from the service offered either because their condition cannot be alleviated or they lack motivation. Systems for identifying at-risk persons, based upon the client populations of diverse agencies over time, usually are not available throughout a community as a means of rapid and accurate identification of those who could benefit from outreach. This is hard to accept as inevitable, in view of the technologic resources for maintaining case identification and tracking procedures. Identification is insufficient in and of itself. Outreach efforts directed toward the elderly person in need of services often fail to enable that person to make initial contact with the needed services. This problem is sometimes related to choosing inappro-
356
VOl. xxvrr
priate means for initiating contact. More basically, failure results from faulty selection and assignment of those who conduct outreach activities. It appears that many agencies deploy their least skilled personnel to undertake the most difficult task of developing a relationship between the service representative and the aged person. This is the pivotal point of early intervention. Much skill is required to develop a trusting relationship with an older person who is endangered by behavioral or situational conditions and who is personally or socially vulnerable (3). A significant amount of skill is required to encourage aged vulnerable people to make initial contacts with service agencies. Such a relationship: 1) should not threaten the aged person’s perceived decision-making power; 2) should guarantee that trust will not be violated; 3) should emerge in accordance with an appropriate time sequence; 4) should ensure the possibility of objectivity and empathy; 5) should build on strengths and adjust for limitations; 6) should withstand resistance; and 7) should ensure persistence toward objectives without denying personal will. The Group for the Advancement of Psychiatry (4)has stressed the importance of these aspects of professional practice in all professional helping relationships with the aged. Outreach services designed to assure the elderly person’s effective involvement in the service delivery system should include provisions for a comprehensive assessment of service needs in terms of the individual’s current and potential functioning. Questions of what will be of assistance to the older person can be answered only through knowledgeable assessment of both ability and disability factors and their interactions. Only through this means is it possible to plan a potential match between an individual and the service sources. Schaie and Schaie (5) noted that assessment is inevitably related to the intent to do something for, or to, the individual being assessed. Both assessment and intervention from initial outreach through the services spectrum imply a gerontologic knowledge base and the translation of this knowledge into interventive strategies. Development and design of effective intervention should be linked with some view or perspective of the aged and the aging process (6). The dysfunctional outcomes of too little knowledge are often compounded by attitudes held by professionals toward the elderly. These are reflected in negative or avoidance responses related to the practitioner’s personal fear of aging, conflicts with parents trans-
August 1979
COUNSELING THE ISOLATED ELDERLY
lated into the relationship with clients, failure to recognize rehabilitative and restorative potential, greater concern and priority given to the less impaired elderly, and the professional peer pressures which denigrate service delivery to aged as opposed to younger population groups. Practitioner-related barriers such as these can be overcome through education, ongoing training, and other opportunities for personal and professional development. AGENCY RESPONSE TO THE ELDERLY AFTEROUTREACH Outreach conducted by competent practitioners involved in comprehensive assessment of the older person’s need and potential is not a guarantee that the client will gain entry into the service delivery system. If the aged person reaches the point of readiness to request and accept services, he or she may be confronted by problems such as: a) agencies may lack appropriate personnel or resources to implement the steps of the individualized service plan, b) the client may be refused by an agency deemed appropriate based on ineligibility or unacceptability, or c) an agency may be overwhelmed by the tasks necessary to ensure that services are provided to clients when and where needed. The “aged client turn off” is not an uncommon or particularly mysterious phenomenon. If the preparation of the old person to utilize services is thwarted by the internal dynamics of a service organization or its interorganizational problems with the larger service system, the elderly client is justified in feeling exploited and negatively disposed toward future outreach efforts. Agency-related barriers to service for the elderly are not easily resolved. Many agency responses to aged persons simply reflect the lack of adequate assessment of the clients or the transmission of incorrect information about their needs and capacities. Some agencies are prone to fit the client’s needs to the service offerings available within that agency, and to ignore issues of how well the services fit the client. Another common agency response is to delay the delivery of services either intentionally or unintentionally, to accommodate the time table of the agency rather than the needs of the client: Few single agencies can provide all the services that may be required by the elderly. The process of linking the “reached” client with appropriate services within an agency system re-
quires a thorough and accurate inventory of the range of services available, an updated assessment of the capacity of each service component to handle additional clients, a determination of the extent to which each service is offered in a manner that is optimal for utilization potential, and an objective evaluation of each agency’s capacity to facilitate multiple-agency involvement on behalf of elderly persons. This entails a recognition that circumstances within service delivery systems are not static but require ongoing monitoring to permit sound judgments regarding the adequacy of the system to meet the needs of particular persons. Implicit in this recognition is the prolonged nature of the outreach function. FACILITATION OF MULTISERVICE UTILIZATION
It is not acceptable to assume elderly clients can carry out the recommendations of a service plan requiring lengthy, repetitive, or complicated negotiations of even a single agency. The incapacity of the old person to carry out recommendations related to a single service agency becomes compounded in proportion to the number of components of the service system to be inx’olved. Therefore the professional responsible for initial contact at the point of entry must evaluate the client’s capabilities in this respect as yet another area of assessment relevant to effective service utilization. To the extent that the old person is considered to require ongoing assistance in both system negotiation and compliance with recommendation, the linking function initiated by the outreach worker must be sustained over time. Certain professional functions may be presumed to be useful in facilitating the old person’s utilization of multiple services sponsored by different agencies. These functions, viewed from an overall perspective, go beyond what is proposed in the traditional “case monitoring” approach, and are potentially integrated by both organizational and interpersonal mechanisms. Professional functions, practitioner strategies, and inter-organizational vehicles can all be employed to facilitate service utilization. Within larger service organizations there is usually at least one professional designated for liaison with other agencies. With minimal effort the official functions of this professional can be redefined and expanded to address this aspect of the client’s need. Individual practitioners have at their disposal an accumulated network of quasi personal-professional 357
VOl. X X V I I
RATHBONE-McCUAN AND CLAYMON
relationships with representatives of other service organizations. These relationships can sometimes serve as the preliminary bases for forming more structured interorganizational vehicles. Increasingly, communities with a diverse and expansive network of services to the elderly are establishing councils, committees, and task forces to determine why clients are “falling through the service gaps,” to suggest ways to reduce the frequency of this failure, and to recommend a permanent interorganizational structure to overcome this serious deficiency throughout the network. What is specified here does not take into consideration nonprofessional and informal interpersonal mechanisms to facilitate effective service utilization. Increasingly, service providers are asking what strategies may be effective for enhancing involvement of community resources which are outside organizations within the formal service delivery system. These resources comprise a continuum ranging from naturally occurring supportive social networks arising from kinship patterns, through friendships and group membership networks, to concerned individuals and groups previously unacquainted with the elderly clients, and finally to potential cadres of specially trained paraprofessionals to act as liaisons between the clients and the service delivery system. The mobilization of familiar resources requires the application of skills which emerge from a model of intergenerational relationships, whereas the mobilization of nonkinship resources requires group work, community development, and training techniques. In general, the more naturally occurring and less formally structured the potential supportive resource, the more likely it is to develop linkages between clients and resources on an individual-toindividual basis. Such linkages may be more effective once established, but also may require intensive initial development and maintenance. If the
368
nonprofessional support is more formal and less natural, greater mobilization may be required. Formal mechanisms may be needed to integrate clients and resources systematically in coordinating the clients’ service utilization experience. In some cases the family is available. However in a greater number of cases the family is ineffective, or their resources are inadequate. These are appropriate reasons for shifting the focus and identifying and developing other resources. The strategy to accomplish these objectives involves the careful exploration of the many factors involved in matching the needs of the old person with the source of facilitative assistance. Agency after agency attempts to plan and implement programs for tapping the less formally organized resources of the community. Although the techniques and strategies for achieving this goal have not been perfected or standardized, agencies frequently overlook the current available knowledge. In doing so, agencies are not taking full advantage of the spectrum of resources in place throughout the community.
REFERENCES 1. Kahana E, Felton B and Fairchild T Community services and facilities planning, in Community Planning for an Aging Society, ed. by M P Lawton, R J Newcomb and TO Byerts. Stroudsburg, PA, Dowden, Hutchinson & Ross, 1976, pp 227-239. 2. Ibid., p 230. 3. Ferguson EJ: Protecting the Vulnerable Adult. Ann Arbor, MI, Institute of Gerontology, 1978, pp. 28-53. 4. Group for the Advancement of Psychiatry: T h e Aged and Community Mental Health: A Guide to Program Development. New York, Group for the Advancement of Psychiatry, 1971, pp 35-38. 5. Schaie KW and Schaie JP: Clinical assessment and aging, in Handbook of the Psychology of Aging, ed. by J E Birren and KW Schaie. New York, Van Nostrand Reinhold, 1977, PP 692-723. 6. Estes CL and Freeman HE: Strategies of design and research intervention, in Handbook of Aging and the Social Sciences, ed. by R H Bienstock and E Shanas. New York, Van Nostrand Reinhold, 1977, pp. 537-557.
Vol. XXVII, No. 8 Printed in U.S.A.
Counseling the Isolated Elderly* ELOISE RATHBONE-McCUAN, PhD** and CAMILLE CLAYMON, MSW George Warren Brown School of Social Work, Washington University, St. Louis, Missouri
ABSTRACT: Increasing interest is manifest in the development of alternative models of counseling for older persons. Irrespective of the particular model used, the counseling of aged persons who have emotional and psychologic problems may require a treatment plan for health, mental health, and social services, to resolve the problems and to assess the functional limitations. Health and mental health centers employing both professional and nonprofessional counselors need to determine the value of adding outreach components to their services, and agencies which already have outreach programs may need to determine their relevance and effectiveness. Effective outreach requires a high level of gerontologic knowledge and clinical skills with aged patients. Agencies and clinics can design and implement mechanisms for supporting the elderly as they make use of multiple sources of service. Mobilization of the family and other informal helping networks in the community, the establishment of better coordination mechanisms within clinic and service programs, and multipleservice integration will improve the efficiency and effectiveness of long-term community care and follow-up programs.
Experience in the development of noninstitutional mental health service for the elderly has shown that few of them can be adequately treated exclusively by traditional psychotherapeutic counseling in the office of a mental health professional. Clearly, counseling is an important service, yet the needs of the elderly frequently require supportive or interventive resources and direct service assistance from multiple agencies. When the implementation of a comprehensive, individualized service plan requires multi-agency functions, counseling facilitates the old person’s entry into a service system and helps to establish and maintain a new equilibrium between independent, dependent, and interdependent functioning. In these instances, the counseling vehicle assists the elderly person to organize his/her life in a way that makes it possible to obtain the required services and live harmoniously within a style of life characterized by active involvement with a diverse group of helpers and “significant others.” ~-
~
~-
~
This presentation will focus on community-level systems for service delivery and the role of counseling within them. The assumption is made that elderly persons frequently require a variety of services that can be provided only from a combination of formal and informal service attachments. Furthermore, without the availability of these resources, counseling services are not likely to be adequate in meeting the diverse physical, social and economic needs of most aged persons. If these assumptions are correct, initially the counselor may need to play a very active role in comprehensive assessment, in facilitating the old person’s access to other services in the community, and in monitoring the services received to insure compliance with the individual service plan. The counselor’s fulfillment of these functions lessens the possibility that the elderly person’s daily functioning is made more difficult because of the need to rely on external sources of assistance and that his/ her self-esteem is lowered by threatening and depersonalized interactions.
~~
* Presented as part of the Symposium on Recent Developments in Counseling the Older Adult, a t the 31st Annual Scientific Meeting of the Gerontological Society, Dallas, TX, November 16-20, 1978. * * Address for correspondence: Eloise Rathbone-McCuan, PhD, Assistant Professor, George Warren Brown School of Social Work, Washington University, Box 1196, St. Louis, MO 63130.
OUTREACH AND ASSESSMENT-THEIR INTERRELATIONSHIP The frail and vulnerable elderly with medical and psychosocial needs often do not benefit from
355
RATHBONE-McCUAN AND CLAYMON
outreach services. Kahana et a1 (1) suggest that community outreach programs represent one potentially useful method for overcoming the reluctance of the aged to ask for help. More effective methods of outreach must be developed among traditional service programs and more innovative strategies should be planned, demonstrated, and evaluated. Many program efforts designated as “outreach” services do not provide an opportunity for the problem-oriented assessment which is vital for matching the person with appropriate agencies. Services are often developed to fit a single presumed need and clients must translate their total needs into the scheme of a single service agency (2). In addition, outreach services tend to be designed or implemented in ways which are less than optional for the successful recruitment of the aged. One of the greatest barriers to the implementation of outreach is the difficulty encountered in locating members of the target population. We are consistently surprised to note that most communities have such a meager knowledge base concerning the most at-risk of the elderly living in those communities. All too often, aged persons presumed to be socially isolated and out of touch with sources of service are, in fact, not unknown to components of the service system. They are merely lost because they have previously initiated contact with at least one agency, have been determined by that agency to be serviced, and then have been added to the inactive-record group until they reappear for services. Such persons are often relegated to “case closed,” dropout, or inactive status after one or two agency contacts. In these instances, they are erroneously considered by agency personnel to have benefited maximally from the service provided or to be unable to benefit from the service offered either because their condition cannot be alleviated or they lack motivation. Systems for identifying at-risk persons, based upon the client populations of diverse agencies over time, usually are not available throughout a community as a means of rapid and accurate identification of those who could benefit from outreach. This is hard to accept as inevitable, in view of the technologic resources for maintaining case identification and tracking procedures. Identification is insufficient in and of itself. Outreach efforts directed toward the elderly person in need of services often fail to enable that person to make initial contact with the needed services. This problem is sometimes related to choosing inappro-
356
VOl. xxvrr
priate means for initiating contact. More basically, failure results from faulty selection and assignment of those who conduct outreach activities. It appears that many agencies deploy their least skilled personnel to undertake the most difficult task of developing a relationship between the service representative and the aged person. This is the pivotal point of early intervention. Much skill is required to develop a trusting relationship with an older person who is endangered by behavioral or situational conditions and who is personally or socially vulnerable (3). A significant amount of skill is required to encourage aged vulnerable people to make initial contacts with service agencies. Such a relationship: 1) should not threaten the aged person’s perceived decision-making power; 2) should guarantee that trust will not be violated; 3) should emerge in accordance with an appropriate time sequence; 4) should ensure the possibility of objectivity and empathy; 5) should build on strengths and adjust for limitations; 6) should withstand resistance; and 7) should ensure persistence toward objectives without denying personal will. The Group for the Advancement of Psychiatry (4)has stressed the importance of these aspects of professional practice in all professional helping relationships with the aged. Outreach services designed to assure the elderly person’s effective involvement in the service delivery system should include provisions for a comprehensive assessment of service needs in terms of the individual’s current and potential functioning. Questions of what will be of assistance to the older person can be answered only through knowledgeable assessment of both ability and disability factors and their interactions. Only through this means is it possible to plan a potential match between an individual and the service sources. Schaie and Schaie (5) noted that assessment is inevitably related to the intent to do something for, or to, the individual being assessed. Both assessment and intervention from initial outreach through the services spectrum imply a gerontologic knowledge base and the translation of this knowledge into interventive strategies. Development and design of effective intervention should be linked with some view or perspective of the aged and the aging process (6). The dysfunctional outcomes of too little knowledge are often compounded by attitudes held by professionals toward the elderly. These are reflected in negative or avoidance responses related to the practitioner’s personal fear of aging, conflicts with parents trans-
August 1979
COUNSELING THE ISOLATED ELDERLY
lated into the relationship with clients, failure to recognize rehabilitative and restorative potential, greater concern and priority given to the less impaired elderly, and the professional peer pressures which denigrate service delivery to aged as opposed to younger population groups. Practitioner-related barriers such as these can be overcome through education, ongoing training, and other opportunities for personal and professional development. AGENCY RESPONSE TO THE ELDERLY AFTEROUTREACH Outreach conducted by competent practitioners involved in comprehensive assessment of the older person’s need and potential is not a guarantee that the client will gain entry into the service delivery system. If the aged person reaches the point of readiness to request and accept services, he or she may be confronted by problems such as: a) agencies may lack appropriate personnel or resources to implement the steps of the individualized service plan, b) the client may be refused by an agency deemed appropriate based on ineligibility or unacceptability, or c) an agency may be overwhelmed by the tasks necessary to ensure that services are provided to clients when and where needed. The “aged client turn off” is not an uncommon or particularly mysterious phenomenon. If the preparation of the old person to utilize services is thwarted by the internal dynamics of a service organization or its interorganizational problems with the larger service system, the elderly client is justified in feeling exploited and negatively disposed toward future outreach efforts. Agency-related barriers to service for the elderly are not easily resolved. Many agency responses to aged persons simply reflect the lack of adequate assessment of the clients or the transmission of incorrect information about their needs and capacities. Some agencies are prone to fit the client’s needs to the service offerings available within that agency, and to ignore issues of how well the services fit the client. Another common agency response is to delay the delivery of services either intentionally or unintentionally, to accommodate the time table of the agency rather than the needs of the client: Few single agencies can provide all the services that may be required by the elderly. The process of linking the “reached” client with appropriate services within an agency system re-
quires a thorough and accurate inventory of the range of services available, an updated assessment of the capacity of each service component to handle additional clients, a determination of the extent to which each service is offered in a manner that is optimal for utilization potential, and an objective evaluation of each agency’s capacity to facilitate multiple-agency involvement on behalf of elderly persons. This entails a recognition that circumstances within service delivery systems are not static but require ongoing monitoring to permit sound judgments regarding the adequacy of the system to meet the needs of particular persons. Implicit in this recognition is the prolonged nature of the outreach function. FACILITATION OF MULTISERVICE UTILIZATION
It is not acceptable to assume elderly clients can carry out the recommendations of a service plan requiring lengthy, repetitive, or complicated negotiations of even a single agency. The incapacity of the old person to carry out recommendations related to a single service agency becomes compounded in proportion to the number of components of the service system to be inx’olved. Therefore the professional responsible for initial contact at the point of entry must evaluate the client’s capabilities in this respect as yet another area of assessment relevant to effective service utilization. To the extent that the old person is considered to require ongoing assistance in both system negotiation and compliance with recommendation, the linking function initiated by the outreach worker must be sustained over time. Certain professional functions may be presumed to be useful in facilitating the old person’s utilization of multiple services sponsored by different agencies. These functions, viewed from an overall perspective, go beyond what is proposed in the traditional “case monitoring” approach, and are potentially integrated by both organizational and interpersonal mechanisms. Professional functions, practitioner strategies, and inter-organizational vehicles can all be employed to facilitate service utilization. Within larger service organizations there is usually at least one professional designated for liaison with other agencies. With minimal effort the official functions of this professional can be redefined and expanded to address this aspect of the client’s need. Individual practitioners have at their disposal an accumulated network of quasi personal-professional 357
VOl. X X V I I
RATHBONE-McCUAN AND CLAYMON
relationships with representatives of other service organizations. These relationships can sometimes serve as the preliminary bases for forming more structured interorganizational vehicles. Increasingly, communities with a diverse and expansive network of services to the elderly are establishing councils, committees, and task forces to determine why clients are “falling through the service gaps,” to suggest ways to reduce the frequency of this failure, and to recommend a permanent interorganizational structure to overcome this serious deficiency throughout the network. What is specified here does not take into consideration nonprofessional and informal interpersonal mechanisms to facilitate effective service utilization. Increasingly, service providers are asking what strategies may be effective for enhancing involvement of community resources which are outside organizations within the formal service delivery system. These resources comprise a continuum ranging from naturally occurring supportive social networks arising from kinship patterns, through friendships and group membership networks, to concerned individuals and groups previously unacquainted with the elderly clients, and finally to potential cadres of specially trained paraprofessionals to act as liaisons between the clients and the service delivery system. The mobilization of familiar resources requires the application of skills which emerge from a model of intergenerational relationships, whereas the mobilization of nonkinship resources requires group work, community development, and training techniques. In general, the more naturally occurring and less formally structured the potential supportive resource, the more likely it is to develop linkages between clients and resources on an individual-toindividual basis. Such linkages may be more effective once established, but also may require intensive initial development and maintenance. If the
368
nonprofessional support is more formal and less natural, greater mobilization may be required. Formal mechanisms may be needed to integrate clients and resources systematically in coordinating the clients’ service utilization experience. In some cases the family is available. However in a greater number of cases the family is ineffective, or their resources are inadequate. These are appropriate reasons for shifting the focus and identifying and developing other resources. The strategy to accomplish these objectives involves the careful exploration of the many factors involved in matching the needs of the old person with the source of facilitative assistance. Agency after agency attempts to plan and implement programs for tapping the less formally organized resources of the community. Although the techniques and strategies for achieving this goal have not been perfected or standardized, agencies frequently overlook the current available knowledge. In doing so, agencies are not taking full advantage of the spectrum of resources in place throughout the community.
REFERENCES 1. Kahana E, Felton B and Fairchild T Community services and facilities planning, in Community Planning for an Aging Society, ed. by M P Lawton, R J Newcomb and TO Byerts. Stroudsburg, PA, Dowden, Hutchinson & Ross, 1976, pp 227-239. 2. Ibid., p 230. 3. Ferguson EJ: Protecting the Vulnerable Adult. Ann Arbor, MI, Institute of Gerontology, 1978, pp. 28-53. 4. Group for the Advancement of Psychiatry: T h e Aged and Community Mental Health: A Guide to Program Development. New York, Group for the Advancement of Psychiatry, 1971, pp 35-38. 5. Schaie KW and Schaie JP: Clinical assessment and aging, in Handbook of the Psychology of Aging, ed. by J E Birren and KW Schaie. New York, Van Nostrand Reinhold, 1977, PP 692-723. 6. Estes CL and Freeman HE: Strategies of design and research intervention, in Handbook of Aging and the Social Sciences, ed. by R H Bienstock and E Shanas. New York, Van Nostrand Reinhold, 1977, pp. 537-557.
