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Caring for today's elderly--and preparing for tomorrow's: CMHCs are employing a variety of approaches to meet seniors' diverse needs.

We all know about the oncoming wave of aging baby boomers--and that they will pose many challenges for community-based mental healthcare providers. But taking care of today's seniors is difficult enough. Older facilities often were not designed with aged bodies in mind. Programs have to be developed, revised, and updated to meet the unique and changing needs of seniors with behavioral health issues. And finding staff with expertise in geriatric care is no easy task.

These and many other issues are facing community-based mental healthcare providers as they care for today's elderly--and prepare for tomorrow's. Below are profiles of how three organizations are handling particular aspects of eldercare (although it's important to note that each has a broad elderly services program).

A Diverse Array of Services

Senior services is an exciting area with lots of room for innovation, as evidenced by the Masters Program, a partial hospitalization and outpatient program at Valley Mental Health (Salt Lake City) for seniors with behavioral health issues (and possibly dementia). In addition to standard group psychotherapy approaches for patients with mental illnesses and/or substance abuse disorders, the Masters Program has several intriguing programs to improve patients' quality of life, explains Program Manager Natalie Thornley, LCSW. In fact, the Masters Program has been recognized by SAMHSA's Center for Mental Health Services for exemplary practices in providing mental health services for older adults.

Partnerships are an important part of the Masters Program's success. "We look to and involve ourselves with partners to meet the myriad of needs that an older adult might have that directly or indirectly impact their mental health," says Amanda Lambert, the Masters Program's community relations liaison. For example, the program has teamed up with Boston University researchers to help seniors with hoarding behaviors. Case managers, using cognitive-behavioral techniques, actually assist clients with cleaning out their homes, says Thornley.

Other clients benefit from the Masters Program's Cyber Cafe, a computer lab with related programming designed to enhance seniors' connectivity and stimulate their minds. Seniors who attend one of the programs are eligible for a refurbished computer for $30--free if they have perfect attendance--through a program in partnership with the state. Older veterans, from a generation with considerable stigma toward mental illness, are able to release long-held feelings in a group designed especially for them, in coordination with the VA.

The Masters Program also nurtures partnerships with outside physicians. Thornley notes that most programs keep their psychiatric care in-house, but the Masters Program has a doctor and a geriatric nurse practitioner who coordinate behavioral healthcare with clients' primary care physicians, allowing outside physicians to remain in control of clients' medical care.

The Masters Program soon will be tackling a commonly misunderstood--and underrecognized--population: geriatric sex offenders. Thornley notes that the Masters Program was the first in Utah to receive the go-ahead to provide services for newly released sex offenders over age 60. In addition to mental healthcare, patients will receive counseling on end-of-life issues, grandchildren concerns, and other topics that aren't part of standard sex offender services designed for younger adults. Valley Mental Health will even electronically monitor some patients' whereabouts.

Designing With Seniors in Mind

When Life Works NW decided to move its older adult services into a different building in 2004, staff were presented with a blank canvas--an empty building in Beaverton, Oregon, that they could design as they saw fit. Life Works decided to take advantage of this opportunity and create a facility tailored to the unique needs of elderly clientele with chronic mental illnesses and/or Alzheimer's disease.

To start with, the one-story facility (meaning no tricky stairs to navigate) is designed with two main entrances, explains Kathy Bales, LCSW, BCD, older adult services director. At the front of the building is a main lobby/reception area for clients with medical management and therapy appointments; at the rear is a drop-off entrance for clients arriving for day services via one of Life Works' six buses with wheelchair lifts. This separation allows for minimal disruption for both groups of clients, explains Bales.

The elderly's needs were taken into account in overhead and underfoot design. Fixtures offering broad, nonglare light illuminate corridors and therapy rooms, while slip-resistant--yet sufficiently soft to cushion falls--carpeting aids clients' mobility. An interior, circular hallway decorated with artwork provides restless clients a place to work off steam, and some even have organized into a "hall-walkers club" to get in daily exercise. Handrails throughout provide an added measure of safety. In fact, all aspects of the facility--including bathrooms--are designed to be compliant with the Americans with Disabilities Act.

Designing for seniors' unique needs was not an expensive endeavor, explains Bales: "You just had to make your choices early on," instead of going back and correcting mistakes. She says the new facility is a vast improvement over the last location for the older adult services--a former bank that did not allow for wide corridors and easy access.

Ahead of the Baby-Boom Curve

Thirty years ago, older adult services weren't receiving a lot of attention; after all, the upcoming surge in elderly baby boomers was decades away. But Prairie View, Inc., in Newton, Kansas, already was serving older adults and was beginning to expand services for this population. For example, Prairie View was offering support groups for families affected by Alzheimer's disease before the Alzheimer's Association was founded. The organization, which serves all ages, now has a service mix that includes outpatient, partial hospitalization, and inpatient mental health services, as well as community-outreach efforts, for seniors.

Mary B. Carman, PhD, vice-president of operations/older adult services, and a 30-year veteran of Prairie View, says that when Prairie View began providing specialized services for older adults in the 1970s, "We were kind of lonely back in those days." Few of her peers were focusing on this population. Geriatric mental healthcare has become more of a focus for the field in the ensuing years, but Dr. Carman points out that there is still a dearth of behavioral health professionals trained to meet older adults' mental health needs. Prairie View has been an exception, having more staff providing mental health services to older adults than all the other community mental health centers in Kansas, she says.

Dr. Carman says staff cannot simply be shifted to an older adults program to meet this growing population's needs: Behavioral health professionals require specific training. In fact, many of today's psychology interns and social work students have never seen an older adult in a clinical or training program, she adds. Dr. Carman believes important topics of study include medications and their side effects, physical illnesses and conditions common in the elderly (such as urinary tract infections, heart problems, significant arthritis, etc.), the different types and causes of dementia, competence in working with families, and how mental illnesses affect the elderly.

Dr. Carman says community mental health centers should work with other organizations that serve the elderly on program development and to share personnel and resources, a tactic that has worked for Prairie View. She says that agencies will benefit by broadening their focus beyond the seriously mentally ill population (which represents 5% of the older adults seen at Prairie View); she recommends providing informational talks on aging at community events, which can generate referrals for care. In fact, Dr. Carman notes that such outreach can have long-term consequences. She recalls that a person who attended one of her community-outreach talks was impressed and decided to use Prairie View's services when she developed a problem ten years after attending the lecture!

To send comments to the author and editors, please e-mail


In Behavioral Health Management:

* "Late-Life Depression: Old Truths and New Lessons," September/October 2004, page 46

* "Maximizing Treatment of Substance Abuse in the Elderly," March/April 2004, page 38

In Behavioral Healthcare Tomorrow:

* "An Anti-Freudian Approach to Improve Life for Dementia Patients," February 2005, page 10

* "Arts Therapies Promote Wellness in Elders," April 2003, page 7


RELATED ARTICLE: Seniors' mental health becomes a White House priority

Currently 36 million adults age 65 and over live in the United States. By 2030, this population is expected to double. This year, nearly 3 million of today's 78 million baby boomers will turn 60. Given the growing elderly population, it is critical that the nation turn its attention to preventing one of the leading--but often overlooked--causes of death among this population: suicide.

In December, the White House Conference on Aging made an important first step in bringing the problem of elderly suicide to the attention of policymakers. The conference, which meets every ten years to advise the President and Congress on issues affecting older Americans, recognized the importance of addressing older adults' mental health needs. Delegates selected improving recognition, assessment, and treatment of mental illness among older Americans as one of the top ten priority issues to be addressed with policy recommendations to the President and Congress over the coming decade. This marks an important step in the fight to advance mental health and suicide prevention for older Americans.

Individuals 60 and older comprise approximately 16% of the U.S. population, yet they account for 22% of our nation's suicides. Mood disorders, which affect more than two million older adults, play an important role in elderly suicides. Research suggests that up to 75% of seniors who die by suicide have seen their primary care physician within the last month of their life, providing strong rationale for advancing early intervention and prevention initiatives.

Suicide prevention among the elderly requires family members, caregivers, and health professionals to recognize warning signs and risk factors to promote early intervention. The White House Conference on Aging's recognition of mental illness as a public health priority among America's aging population is the first step; policymakers still must work toward implementing effective policies, programs, and strategies to curb suicide among the elderly. Making plans now to meet the mental health needs of today's seniors and the growing needs of aging baby boomers will ensure that America can enrich and protect the lives of our nation's senior citizens for years to come.

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Title Annotation:SENIOR SERVICES
Author:Edwards, Douglas J.
Publication:Behavioral Healthcare
Date:Feb 1, 2006
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