Mental Health Issues in Later Life

1. Mental Health Issues in Later Life Information and Resources

2. Four Communication Styles • Clear and Direct • Clear and Indirect • Masked and Direct • Masked and Indirect

3. Clear and Direct Clear and direct communication is the most healthy form of communication and occurs when the message is stated plainly and directly to the appropriate family member

4. Clear and Indirect In this style of communication, the message is clear, but it is not directed to the person for whom it is intended

5. Masked and Direct Masked and direct communication occurs when the content of the message is unclear, but directed to the appropriate family member

6. Masked and Indirect Masked and indirect communication occurs when both the message and intended recipient are unclear. In unhealthy family relationships, communication tends to be very masked and indirect

7. Communication Behaviors 1. Assertive 2. Aggressive 3. Passive 4. Passive-Aggressive

8. Assertive • Assertive communication involves standing up for personal rights and expressing thoughts, feelings, and beliefs in direct, honest, and appropriate ways

9. Aggressive • Aggressive communication involves directly standing up for personal rights and expressing thoughts, feelings, and beliefs in a way that violates the rights of others

10. Passive • Passive communication involves violating your own rights by failing to express honest feelings, thoughts, and beliefs

11. Passive-Aggressive • Passive-aggressive communication involves expressing your needs and feelings in an unclear and confusing manner

12. Initiating a Difficult Conversation • Bringing up mental health concerns with an older adult can be difficult

14. Mental Health Issues in Later Life Identifying Resources

15. Non-crisis Assistance • Many mental health services can be located in the telephone book or by referral from a local clinic or hospital • Special populations such as veterans and Native Americans my be eligible for services at designated clinics • Assistance is available online at www.ndsu.nodak.edu/sdc/ndseniorinfo/locator.htm

16. Crisis Intervention • In a crisis situation contact the following resources: • North Dakota • 1-800-472-2911 • Bismarck • West Central Human Services Center • (701) 328-8889 • 1-888-328-2112

17. Crisis Intervention • Fargo • Suicide Line • 1-800-273-TALK • Grand Forks • Northeast Human Service Center • (701) 775-0525

18. Crisis Intervention • National • Call 1-800-SUICIDE / 1-800-784-2433 • Call 1-800-273-TALK / 1-800-273-8255 • Call 911 and ask for help. Tell them you are in suicidal danger

20. Mental Health Issues in Later Life Barriers to Accessing Services

21. Individual Barriers to Seeking Mental Health Care • Stigma about mental illness or treatment • Denial of problems • Lack of collaboration and coordination with primary care, mental health providers and aging services providers • Gap in services • Lack of professional staff trained in the provision of geriatric mental health services • Lack of organized efforts by older consumers to secure mental health services • Access barriers including transportation and distance to services • Financial barriers

22. Systemic Barriers to Seeking Mental Health Care • Lack of mental health services • Cost of mental health care • Lack of parity between mental health and physical health • investments made by governments and health insurance companies in mental health are disproportionately small • Poor quality of care in mental health hospitals/facilities • Need for services to facilitate active community participation • Insufficient implementation of mental health policy, plans, programs, and legislations • Stigma associated with mental disorders; resulting in exclusion

23. Affects of Mental Illness Stigma • Persons with mental disorders unwilling to seek help • Isolation and difficulty in making friends • Damage to self-esteem and self-confidence • Discrimination because of mental disorders • Fewer resources are provided for mental health than for other areas of health (Mental Health Policy and Service Guidance Package: Advocacy for Mental Health, World Health Organization, 2003)

24. Menu of available services and contact information Transportation Timely appointments Nursing home residents need a consult at least twice a year Routine assessments Rural providers In-home services and outreach Grief counseling/support groups Information on how services are paid for Assistance with and information about medications Importance of nutrition What mental health information do older adults need?

25. Outreach to older adults • Educate the community • Utilize TV, Radio, health fairs, workshops, conferences, human service centers, public forums, churches, aging services newsletters, banks, mailings, fundraisers. • Develop one-on-one relationships to build a framework of trust before suggesting mental health services. • Senior Centers • good environment to distribute health information

26. What do providers need? • Knowledgeable professionals to train staff • Counseling for residents at basic care facilities • Assistance • backup in dealing with seniors’ psychiatric conditions. • Education/training in identifying mental health problems; appropriate responses; assessment; gerontology • More staff that can go into homes • Tele-medicine resources • Time and resources (including financial)

27. What do providers need? • Referral resources • More places to refer-may have to wait months before getting an appointment • Team case management • More Medicare providers for mental health • Appropriate services that are not just extensions of current services. • Information on services and who pays for them. • Updates on medications • Flexibility in clinic scheduling for multiple appointments for rural clients • They need to be on the same day for transportation.

29. Mental Health Issues in Later Life Legal Interventions

30. Legal Interventions Care and Distribution of Property • Wills • Living Wills • Living Trusts Protective Arrangements • Restraining Order • Protection Order • Commitment

31. Legal Relationships • Power of Attorney • Durable Power of Attorney • Limited Payeeship • Conservatorship • Guardianship

33. Mental Health Issues in Later Life Financial Assistance

34. Financial Barriers to Services • Financial assistance for the provision of mental health services comes from federal, state and private sources • Options are available to help people pay for mental health care

35. Low-Cost Mental Health Services • Pastors and Parish Nurses • Employee Assistance Programs (EAP) • Community Mental Health Centers

36. Other Programs • Private or Employer Provided Insurance • Medicare • Medicaid • Veteran’s Administration • Indian Health Service

37. Medicare • A national health insurance program for people 65 and over and for younger workers who have become totally disabled

38. Medicare • Fee for service health plan with two parts: • Part A (Hospital Insurance) includes care in hospitals, skilled nursing facilities, hospice, and some home health care • Will help cover mental health care given in a hospital. In a psychiatric hospital, coverage is limited to 190 days • Part B (Medial Insurance) is optional in includes doctors services, outpatient hospital care • Helps to pay for mental health services given outside a hospital, including visits with a doctor, clinical psychologist, or clinical social worker and lab tests

39. Partial Hospitalization • A structured program to provide intensive psychiatric care through active treatment • Usually more intense, takes longer, and is more involved than care in a doctor’s or therapist’s office • Generally provided during the day and does not require an overnight stay • Provided through hospital outpatient departments and community mental health centers • Benefits are unlimited and a 20% co-payment is required

40. Medicare Advantage Plan • Most of elderly are currently covered under traditional Medicare • A growing number now receive coverage through a managed care plan, or Medicare Advantage (Part C) • A Medicare advantage plan is offered by a private company that contracts with Medicare to provide benefits • Individuals should consult with the plan’s membership materials and call the plan for details about mental health care • Choice of providers is limited with a Medicare Advantage plan

41. Community-based Services • There is very limited coverage of community-based services through Medicare

42. Medicaid • A joint federal and state program that covers medical costs for people with low incomes and limited resources • Covers additional services beyond the Medicare limit, for example nursing care beyond the 100 day Medicare limit, eyeglasses and hearing aids. It pays for long-term care for the elderly and those of all ages with disabilities who meet the eligibility requirements

43. How to Apply for Medicaid • Medicaid applications are available through your County Social Service Office. They can be requested in person, by phone, over the internet or in writing • Telephone numbers of County Social Service Offices are listed in local telephone directories under “Government Offices – County”

44. Medicaid Mental Health Coverage • Rehabilitation services • Including individual and group therapies, psychosocial services and physical occupational and speech therapies, recommended by a doctor • Targeted case management services • Services that help people gain access to medical, social, educational or other services • Medicaid can also coordinate activities and services like housing or legal services

45. Medicaid Mental Health Coverage • Hospice services are also available to help with a terminal condition including • symptom control • help with daily living • nursing care • counseling • respite care and drugs • Some home and community based services are available

46. Home and Community-Based Services • Case Management to assess needs, help with care planning, provider selection, referrals and service monitoring • Respite Care for relief to full-time care givers • Personal Care Services to help with bathing, dressing, transferring, toileting, and supervision • Adult Family Foster Care to provide a safe, supervised family living environment, 24 hours a day in a state licensed setting

47. Home and Community-Based Services • Chore Service that includes snow removal and heavy cleaning • Homemaker Service to provide household cleaning, laundry, and meal preparation services • Emergency Response System (Lifeline) for telephone emergency response

48. Home and Community-Based Services • Non-medical Transportation or Escorts to help with grocery shopping and other errands • Adult Day Care for a at least three hours per day of attended care in a group setting • Environmental Modification for limited assistance to modify a home to enhance independence

49. Home and Community-Based Services • Specialized Equipment to reduce the need for help from other people • Training Family Members to improve the skills of non-paid primary caregivers in the family • Adult Residential Service to individuals living in a social model Alzheimer’s facility

50. Qualifying for Home and Community-Based Services • To qualify for services under the Medicaid Waiver Program, an individual must be • A Medicaid recipient screened at a nursing facility level-of-care • At least 65 years of age or disabled by Social Security Disability criteria • Capable of directing his/her own care • Living in his or her own home or apartment and • Able to have his or her service/care needs met within the scope of the waiver • The Medicare Waiver pays for services only; the client pays his or her own living expenses