From Adult to Older Adult, Discovering the Transition

1. From Adult to Older Adult, Discovering the Transition CMHDA’s ASOC/OASOC Transitional Adult Subcommittee September 9, 2005

2. Did you know?........ • America’s population age 65 and older grew by 74 percent between 1970 and 1999 (from 20 million to almost 35 million). The older adult population will grow even more rapidly as 76 million baby boomers reach age 65 and older between 2010 and 2030.

3. Did you know?........ • Nearly 20 percent of those who are 55 years and older experience mental disorders that are not part of normal aging. Most common disorders, in order of prevalence are anxiety, severe cognitive impairment and mood disorders

4. Did you know?........ • As baby boomers age, the number of elderly persons who misuse or abuse illicit drugs and alcohol may increase because this age cohort has higher rates of use of these substances than previous cohorts

5. Did you know?........ • Abuse and misuse of prescription and over-the-counter drugs may also increase due to the larger numbers of baby boomers

6. Did you know?........ • Suicide rates increase with age, and may be rising among cohorts of older adults; older adults often use more lethal means when attempting suicide than younger individuals

7. Did you know?........ • The mental health services and delivery systems are extremely inadequate and unprepared. • Financing and mental health systems are inadequate to meet the challenges passed by the expected increase in the number of elderly with mental illness.

8. Why a Transitional Adult Subcommittee? • ASOC and OASOC frameworks initially identified this cohort as having special needs. Feedback from OASOC members and the Older Adult Demonstration Projects provided information on the growing needs of consumers age 55-59 years of age who often require services more reflective of Older Adult System of Care services. • The subcommittee has identified the ages of 55-59 years old as the transitional age for adults entering into the older adult population, though the transition can begin, depending upon need, prior to age 55 and could also happen anytime past the age of 59 years old.

9. Transitional Adults Include Those That Are: • Consumer/survivors transitioning from the ASOC to the OASOC • Transitioning from the ASOC/OASOC out into the community • New clients transitioning from the community to the ASOC/OASOC systems • Aging ASOC clients who do not transition into a new program, but into a new phase of life.

10. Transitional Adults Subcommittee Mission Statement The Transitional Adult Subcommittee is a subcommittee of the CMHDA Adult System of Care Committee and the CMHDA Older Adult System of Care Committee. The subcommittee membership consists of representatives from the following departments or agencies: County ASOC and OASOC coordinators and managers, mental health consumers, State Department of Mental Health, provider organizations, CMHDA, and the California Mental Health Planning Council. The subcommittee follows the work of the ASOC and OASOC frameworks and reports to those committees. The subcommittee’s mission is to ensure that there is a continuity of care for the adult transitioning from the adult system of care to the community or other phase of life or when transitioning to the older adult system of care. The subcommittee also recognizes the importance of understanding and respecting the cultural and gender issues of the adult consumer in transition. The subcommittee has identified the ages of 55-59 years old as the transitional age for adults entering into the older adult population, though the transition can begin, depending upon need, prior to age 55 and could also happen anytime past the age of 59 years old. Integrated planning should begin based on the functionality of the individual, and the likelihood that the person will need the intensive linkage to health and support services available under OASOC. The subcommittee will focus on integrated joint planning for the purpose of building a bridge for the adult between adult services and the special needs of older adults. The subcommittee strives to ensure that the adult consumer is in charge of his or her treatment and care.

11. Issues for Transitional Adults Health • The parallel process of changing physical health and mental health can create increasingly complicated symptoms. • New issues including declining health and mental acuity; fear of dementia, heart attacks, increased pain, medical disabilities, etc. • When individuals age within a system, the adjustment to new staff such as; doctor, nurse, case manager, clinician, or team (primary contacts with in the system) may be difficult......this adjustment is with the individual as well as staff. • Depression and higher risk for suicide increase with age

12. Issues for Transitional Adults Health cont. Given the above, there is a need for: • Planning for increased older adult supportive mental health services in community, including elder programs within regional support teams • Improved service coordination and communication with medical providers (PCPs, Dentist, Pharmacist, Podiatrist., etc…) • Triage and recruitment of geriatric specialists in medicine and pharmacology.

13. Issues for Transitional Adults Abuse • Substance use and abuse issues (OTC, illegal drugs, prescription, alcohol) • Dependent Transitional Adult Abuse (either as victims or perpetrators) • Physical • Emotional • Sexual • Fiduciary • Self-neglect

14. Issues for Transitional Adults Spirituality and Feelings • Search for meaning and purpose in one's life (past, present and future) • Appreciation of one’s culture/history • Accepting new roles • Seeking out own cultural identity • Spiritual issues and faith-based supports • Unresolved guilt and grief

15. Issues for Transitional Adults Family • Transitional adults often play many roles simultaneously, which can create conflict, including being parents, grandparents, care providers, spouse, etc. • Fear of losing independence • Fear of abandonment - living lonely • Dependent transitional adults who are at risk of losing their caretakers (their parents) • Unexpectedly becoming primary caretakers to grandchildren or other extended family

16. Issues for Transitional Adults Aging Process • Death & dying issues • Ageism-Anger/fear at being marginalized because of age • Body imagery • Managing physiological/emotional changes of aging • Career stresses & “maintaining the course”

17. Issues for Transitional Adults Social Security and Retirement • Social Security benefits need to be addressed, especially in light of the changes which will likely occur to Social Security Benefits and Disability Benefits funds in the near future. • SSDI, SSI, SSA • Retirement brings on fear of being useless (loss of job and earner role); what to do with that free time

18. Issues for Transitional Adults Housing • Affordable housing is an important issue especially for persons in residential care settings. • Homes are licensed to care for persons either 18-59, or age 60 and over.  While age waivers are allowable, persons may be required to move which can be disruptive and costly.  • Living Options • Independent • Assisted living • Senior housing complex • Shared housing • Affordable Housing • Intentional Living Communities • Olmstead Planning / Avoidance of pre-mature SNF placements

19. Issues for Transitional Adults • Loss of friends and relatives through death and disability • Crises – How to cope with emerging stage of life issues • Legal issues • Living Wills • Durable Powers of Attorney/Advance Directives • Probate Issues

20. Future Areas of Focus • Enhance support for transitioning adult • Ongoing training for ASOC & OASOC • Increased funding for services (e.g., housing, unserved and underserved) • Leveraging resources • Coordinated services (community wide) • Address issues of parity in healthcare • Medical • Pharmacy • Mental Health

21. CMHDA ASOC/OASOC Transitional Adults Subcommittee Membership Current members are from: • CMHDA’s ASOC Committee (county coordinators and managers) • CMHDA’s OASOC Committee (county coordinators and managers) • California Mental Health Directors Association (CMHDA) • California Institute for Mental Health (CIMH) • State Department of Mental Health • California Mental Health Planning Council • Telecare • Mental Health Consumers/ Family Members

22. Become A Member If you are interested in joining the ASOC/OASOC Transitional Adult Subcommittee, please contact Heather Anders at (916) 556-3477 ext. 119 or at handers@cmhda.org.

23. Next Steps/Recommendations/ Questions