Serving Older Adults with Behavioral Health Needs

Module 3: Aging Services Partners in Older Adult Behavioral Health

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Presented by Oregon Health Authority, Health Systems Division and Portland State University Institute on Aging

Introductory Modules

1. The Everyday Experience of Aging

2. Behavioral Health Partners in Older Adult Behavioral Health

3. Aging Services Partners in Older Adult Behavioral Health

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Clinical Modules

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4. What’s Happening with Gladys?

5. Bill’s Search for Lois

6. Has Anyone Seen George?

7. We Have Another Call About Nell!

8. Behavioral Health Issues and Advance Care Planning

Module 3 objectives

• Describe aging population trends

• Provide an overview of aging and disability services in Oregon

• Describe how services are organized at the community level

• Describe challenges of meeting the needs of older adults with behavioral health issues

• Explain the role of Aging and People with Disabilities in bridging service gaps

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Module 3 objectives

• Describe aging population trends

• Provide an overview of aging and disability services in Oregon

• Describe how services are organized at the community level

• Describe challenges of meeting the needs of older adults with behavioral health issues

• Explain the role of Aging and People with Disabilities in bridging service gaps

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Module 3 objectives

• Describe aging population trends

• Provide an overview of aging and disability services in Oregon

• Describe how services are organized at the community level

• Describe challenges of meeting the needs of older adults with behavioral health issues

• Explain the role of Aging and People with Disabilities in bridging service gaps

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Module 3 objectives

• Describe aging population trends

• Provide an overview of aging and disability services in Oregon

• Describe how services are organized at the community level

• Describe challenges of meeting the needs of older adults with behavioral health issues

• Explain the role of Aging and People with Disabilities in bridging service gaps

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Module 3 objectives

• Describe aging population trends

• Provide an overview of aging and disability services in Oregon

• Describe how services are organized at the community level

• Describe challenges of meeting the needs of older adults with behavioral health issues

• Explain the role of Aging and People with Disabilities in bridging service gaps

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Top: Tara Manitsas, Melissa Howtopat, Lavinia Goto

Bottom: Paul Iarrobino, Lee Girard

Demographics

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Number of Older Americans

65 + years• 14.1% • 44.7 million

85 + years• 6 million

2013

Source: U.S. Census Bureau

Source: U.S. Census Bureau

15Source: U.S. Census Bureau

16Source: U.S. Census Bureau

Respondent-Assessed Health Status

A Profile of Older Americans: 2012, AoA, ACL

Civilians Ages 18 to 64 Years Living in the Community for the United States and States, by Disability Status: 2013

Total Disability # Disability %

United States 196,541,629 20,714,303 10.5%

Oregon 2,440,752 307,872 12.6%

Americans With Disabilities: 2010, United States Census Bureau, 2012

A lot of baby boomers now. . . I think a lot more of them have substance abuse issues. . .

Melissa Howtopat

Care Coordinator, Region 9 AAA

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Long Term Support Services Coordinator

NorthWest Senior and Disability Services

You have an aging population. . . I think that mental health issues have always been there, but it seems to be more prominent.

Lavinia Goto

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Services

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Aging and People with Disabilities (APD)

• Primary responsibilities:• Older Americans Act Services to people 60 years and older

• Oregon Project Independence

• Services to seniors and people with disabilities (Medicaid)

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Niles-Yokum & Wagner (2010) The Aging Networks (7th Edition)

Access to services

• Information and referral/assistance

• Outreach

• Care management

• Transportation

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Nutrition programs

• Home delivered meals

• Congregate meals

• Nutrition counseling and education

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Support services

• Personal care

• Homemaker/chore

• Adult day services

• Family caregiver support, including • Caregivers of people with

dementia younger than 60 years

• Grandparents caring for grandchildren

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Disease prevention and health promotion

• Physical fitness

• Fall prevention

• Chronic disease management

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Protection of rights

• LTC ombudsman

• Prevention – elder abuse, neglect and exploitation

• Legal assistance

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Oregon Project Independence (OPI)

• State funded program

• Older adults & people with disabilities

• Sliding fee scale

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OPI services

• Personal care

• Housekeeping

• Meal preparation

• Respite care

• Adult day services

• Transportation

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OPI eligibility criteria

• Activities of Daily Living • Mobility• Eating• Elimination• Cognitive or behavioral functioning

• Instrumental Activities of Daily Living• Meal preparation• Medication management

• Natural support system

• Income

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Aging and People with Disabilities (APD)

• Determine eligibility for Medicaid and other state & federal benefits

• Case management services

• In-home services

• Nursing and community care services

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APD Medicaid services

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Compiled from CMS, 2014

Medicaid eligibility criteria

• Financial eligibility

• Activities of daily living (ADL) and Instrumental activities of daily living (IADL)

• Service needs are not fully met by natural support

29,000 people were received Medicaid services through this program in 2013-2015

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Financial criteria

• 300% Supplemental Security Income

• < $2,000 individual

• < $3,000 couple

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I/ADL service needs: Client Assessment/Planning System (CAPS)

• Mobility • Ambulation• Transfers

• Eating• Elimination

• Bladder and/or bowel care• Toileting

• Cognitive• Adaptation • Awareness• Judgment and decision making

memory• Orientation

• Behavior• Demands on others • Danger to self or others• Wandering

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CAPS scores

• Medicaid service priority level: < 13

• OPI service priority level: < 18

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Aging and Disability Resource Connection

ADRC

www.ADRCofOregon.org

1-855-ORE-ADRC (673-2372)

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ADRC

• One-stop, “no wrong door”

• Available to all regardless of age or income

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Aging & Disability Resource Connection

An ADRC is a hub for an access to a number of programs, so we’re the front door. In our field, there is no wrong door. We have lots of doors. The goal through the ADRC is to be a very robust front door for all of our services. It could be adult protective services, family caregiver, and often times consumers don’t know exactly. Our job is to have a conversation, . . . Help the consumer realize what it is we can provide assistance with.

Paul Iarrobino

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ADRC Program ManagerMultnomah County Aging, Disability and Veterans Services

ADRC Services

• Information & Assistance

• Health & Wellness

• Benefits counseling

• Entryway into publically and privately funded long-term care programs

• Person centered options counseling

• Special initiatives• Dementia capable workforce

• ADRC Mental Health Program

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Person Centered Options Counseling

• Help consumers find needed information and services

• Decision support

• Planning

• Follow up

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Dementia capable workforce

• ADRC Dementia training • http://www.oregon.gov/dhs/spwpd/Pages/sua/AvailableOnlineTraining.aspx

• www.HelpforAlz.org (part of the ADRC website)

• Early memory loss programs (with Alzheimer’s Association of Oregon)

• Outreach and marketing

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ADRC Mental Health Program

• Each ADRC implementing evidence-based program

• Depression, anxiety, substance abuse

• Examples of programs:• PEARLS

• Healing Pathways

• Project Hope

• Healthy Ideas

• Solution-Focused Brief Therapy

• ADAPT

• ASIST

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Organization of aging services

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APD Field offices

2

k

2

1

2

9

12

13

4

7

5

6

10

11

14

14

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Clatsop, Tillamook, Yamhill,

Polk, and Marion Counties:

Type B Transfer AAA

Offices

Columbia and Washington

Counties:

APD Offices

Multnomah County:

Type B Transfer AAA

Offices

Clackamas County:

APD Offices

Linn, Benton and Lincoln

Counties:

Type B Transfer AAA

Offices

Lane County:

Type B Transfer AAA

Offices

Douglas County:

APD Offices

Type B Contract AAA

Coos and Curry Counties:

APD Offices

Jackson and Josephine

Counties:

APD Offices

Type B Contract AAA

Hood River, Wasco, Sherman,

Gilliam and Wheeler Counties:

APD Offices

Deschutes, Jefferson

and Crook Counties:

APD Offices

Klamath and Lake

Counties:

APD Offices

Morrow and Umatilla

Counties:

APD Offices

Baker, Union and

Wallowa Counties:

APD Offices

Malheur, Harney and

Grant Counties:

APD Offices

Linn

Clackamas

Grant

Malheur

Wallowa

Deschutes Lane

APPENDIX B: AREA AGENCY ON AGING/AGING AND PEOPLE WITH DISABILITIES Planning and Service Districts – Field Office System

Harney

Columbia

Union

Umatilla

Morrow Gilliam

Crook

Wheeler Jefferson

Wasco

Sherman

Hood River Multnomah

Baker

Benton

Lincoln

Polk

Yamhill

Washington Tillamook

Douglas Coos

Curry Jackson

Josephine Klamath

Lake

Marion

Clatsop APD Offices

Type B Contract

APD Offices

Type B Transfer

AAA Offices

Field Offices

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• Assess for Medicaid eligibility (CAPS) for long-term services and supports

• Financial services (SNAP, Medicare Savings

Plan)

• Preadmission screening licensed nursing facility

• Adult protective services

• Regulatory programs (In-home, adult

foster care, RCF, AL, NH)

• SHIBA (Senior Health Insurance Benefits

Assistance)

State Unit on Aging Area Agencies on Aging

• Oversite of Older Americans Act services

• Partners with 17 AAAs• Planning and coordination

• Contract with and oversee Older Americans Act services provided by local service providers

• Administer Oregon Project Independence

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Types of AAAs

• Type A

• Type B

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Oregon Association of Area Agencies on Aging & Disabilities (O4AD)

Type A

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Oregon Association of Area Agencies on Aging & Disabilities (O4AD)

Type B

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Oregon Association of Area Agencies on Aging & Disabilities (O4AD)

Aging & Disability Resource Connection

Coordinated network of:

• Area Agencies on Aging

• Centers for Independent Living

• APD field offices

• Developmental disabilities/intellectual disabilities

• Veterans Services

• Behavioral Health

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Challenges: Meeting the need

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Stigma

I think there is a lot of stigma around counseling and treatment for older adults, and I think that’s partially because of how they were raised and they are really focused on just ‘I’ll deal with it my way’, ‘It’s not that big of a deal’. They kind of sweep it under the carpet.

Tara Manitsas

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Peer Mentoring CoordinatorNorthWest Senior and Disability Services

Access

We have a lot of programs that are low cost or free just by virtue of age, you qualify. So if you’re 58 that creates another barrier because you don’t meet the qualifications of the Older Americans Act.

Paul Iarrobino

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Barriers

More and more the individual’s situations are a lot more complex: having a behavioral health issue, health issues coupled with long-term trauma issue, instability financially.

Lee Girard

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Community Services ManagerMultnomah County Aging, Disability and Veterans Services

Barriers

One way was about 3 hours, and then sitting there and doing the assessment, go through the home and see what the needs are, and then driving back is one whole day.

Melissa Howtopat

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Care Coordinator, Region 9 AAA

Challenges related to Behavioral Health• Stigma

• Older adults (e.g., depressed, isolated) often invisible

• Workforce is unprepared

• Accessing behavioral health services • Finding willing providers knowledgeable about aging

• Age appropriate services

• Transportation

• Financial constraints

• Eligibility requirements

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Bridging service gaps

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What behavioral health services staff should know

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So generally, we say if you have a question about whether you are eligible or not, go head give us a call.

Lee Girard

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What behavioral health services staff should know

• Awareness of services for all people, not just older adults, people with disabilities, people with restricted income or long-term care needs

• There are a lot of supports within the aging system that are prevention-focused

• ADRC and AAA evidence based programs

• Individuals with capacity have the right to make their own decisions

• If you have a question or have identified a need, call

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Bridging the gaps

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Acknowledgements

This training was developed by Portland State University on behalf of Oregon Health Authority, Health Systems Division

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Special thanks to:Interviewees• Lavinia Goto, Project Manager, Long Term Support Services Innovator Agent,

NorthWest Senior and Disability Services

• Lee Girard, Community Services Manager, Multnomah County Aging, Disability and Veterans Services

• Melissa Howtopat, Care Coordinator, Region 9 Area Agency on Aging, The Dalles

• Paul Iarrobino, Program Manager, Multnomah County Aging, Disability and Veterans Services

• Tara Manitsas, Peer Mentoring Coordinator, NorthWest Senior and Disability Services

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Special thanks to:Oregon Health & Science University EdCOMM:

• Manager, Creative Services: Larry Dlugas

• Photography: Jeff Ball, Aaron Bieleck and David Wakeling

• Videography: Jeff Ball, Steven Wong, Jr. and David Wakeling

• Editing: David Wakeling

Editing by Karen R. Jones

Narration by David Loftus

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This training was prepared by Portland State University

• Project Director: Diana White

• Project Co-director: Linda Dreyer

• Project Manager: Natasha Spoden

• Project Staff: Alan DeLaTorre, Aubrey Limburg, Julie Reynolds, Megan Rushkin and Sheryl Elliott

• Project Graduate Research Assistants: Candace Lewis Laietmark, Litxia Barrett and Lu Pang

• Project Staff Support by: LeAnne Fettig

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