In the 1990s, Caron Treatment Centers designed a strategic focus on care for the adolescent population, based on market needs, which was followed by a focus on young adults and college students a decade later. Now, the organization is reinventing its program for the senior population, based on today’s healthcare realities.
“We began to see alarming statistics about the rapid growth of addiction and substance-use disorder in those over the age of 50, and society is now beginning to take note of this,” Doug Tieman, Caron president and CEO, tells Behavioral Healthcare. “We need to focus more energy and resources on them. And it’s not just a program, but a system of care.”
Tieman says Caron will design care delivery with longer term treatment and sustained recovery for the older adult. Although the ultimate treatment goals might be the same as for younger patients, seniors have distinctly different needs and will require a tailored clinical approach.
“We need to address the fact that they might have two martinis a day and take Xanax [alprazolam], so now what will they do in a nursing home situation?” he says.
It’s not an uncommon patient profile. There are increasing numbers of seniors who are casual consumers of alcohol based on a lifestyle they’re accustomed to, who then might add benzodiazepines because of a death of a spouse, for example, then perhaps add a pain medication related to a medical issue, such as a joint replacement. Now when that individual struggles with daily life, the medical treatments and lifestyle choices can turn into dependence and addictions. Tieman says the older adults can become “accidental addicts.”
The statistics demonstrate the potential need for addiction treatment. According to a December 2014 study from the National Institutes of Mental Health, prescription use of benzodiazepines increases steadily with age. Of those ages 65 to 80 who used benzodiazepines, 31.4 percent received prescriptions for long-term use, compared to 14.7 percent of users ages 18 to 35.
Jamie Huysman, PsyD, LCSW, senior clinical advisor to Caron’s Boomer and Older Adult Programs, says there are enormous unmet needs, and the organization wants to change the recovery paradigm for those age 50 and older. Huysman works with AARP, the National Association for Social Workers and other groups to advocate for improvements in care delivery for older adults.
The market for senior services is growing overall. According to the federal Administration on Aging, by 2020, there will be 75 million people in the United States age 60 and older.
Tieman says Caron is still weighing the possibility of accepting Medicare or Medicare Advantage payment as it focuses on the senior population, but the administrative burden and the idea of taking publicly funded reimbursement makes the avenue less appealing to the not-for-profit organization. Caron traditionally files claims with commercial insurers and accepts self payment. This year, Caron will also provide $20 million in charity care, from a budget of $100 million, Tieman says.
“And the beauty of that is it allows us a lot of streamlined operating functions, not having to deal with government,” he says. “We’re going to balance whether we want to move into that or continue with our long term philosophy to make sure we raise a lot of money and have the capability to give that away to those that are financially challenged.”
Hanley Center sale
Recently, Caron sold two of its properties in Florida to Origins, including the long-established Hanley Center. Tieman says the brick-and-mortar sale provides funding to create new resources.
“The sale of the Hanley Center will help us increase our laser focus on what we want to do and provide the added resources to add to care capabilities for seniors in Florida that we did not have at the Hanley site,” he says.
With sale of the Hanley Center, Caron now has a total of 440 beds overall, which includes 140 in Florida.
As part of its upcoming master-campus plan in Pennsylvania, Caron will build a new medical center to treat co-occurring conditions, and in Florida, where the Renaissance property provides longer-term care, Caron will look to add similar services specific to senior populations. For now, the Boomer and Older Adult Programs will continue to reside at the flagship center in Pennsylvania.
According to research from The University of Pennsylvania:
There are 2.5 million older adults with an alcohol or drug problem.
Six to 11 percent of elderly hospital admissions are a result of alcohol or drug problems—14 percent of elderly emergency room admissions, and 20 percent of elderly psychiatric hospital admissions.
Widowers over the age of 75 have the highest rate of alcoholism in the United States.
Nearly 50 percent of nursing home residents have alcohol related problems.
Older adults are hospitalized as often for alcoholic related problems as for heart attacks.
Nearly 17 million prescriptions for tranquilizers are prescribed for older adults each year. Benzodiazepines are the most commonly misused and abused prescription medications.