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Caring for today's elderly—and preparing for tomorrow's

February 1, 2006
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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 Café, 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 LifeWorks 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. LifeWorks 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 LifeWorks’ 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.