Mental Health Issues in Later Life Information and Resources.
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Mental Health Issues in Later Life
Information and Resources
Four Communication Styles
1. Clear and Direct
2. Clear and Indirect
3. Masked and Direct
4. Masked and Indirect
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
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
Masked and Direct
Masked and direct communication occurs when
the content of the message is unclear, but directed
to the appropriate family member
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
Communication Behaviors
1. Assertive
2. Aggressive
3. Passive
4. Passive-Aggressive
Assertive
1. Assertive communication involves standing up for personal rights and expressing thoughts, feelings, and beliefs in direct, honest, and appropriate ways
Aggressive
2. Aggressive communication involves directly standing up for personal rights and expressing thoughts, feelings, and beliefs in a way that violates the rights of others
Passive
3. Passive communication involves violating your own rights by failing to express honest feelings, thoughts, and beliefs
Passive-Aggressive
4. Passive-aggressive communication involves expressing your needs and feelings in an unclear and confusing manner
Initiating a Difficult Conversation
Bringing up mental health concerns with an older adult can be difficult
Mental Health Issues in Later Life
Identifying Resources
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
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
Crisis Intervention
Fargo Suicide Line 1-800-273-TALK
Grand Forks Northeast Human Service Center (701) 775-0525
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
Mental Health Issues in Later Life
Barriers to Accessing Services
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
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
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)
What mental health information do older adults need? 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
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
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)
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.
Mental Health Issues in Later Life
Legal Interventions
Legal Interventions
Care and Distribution of Property Wills Living Wills Living Trusts
Protective Arrangements Restraining Order Protection Order Commitment
Legal Relationships
1. Power of Attorney
2. Durable Power of Attorney
3. Limited Payeeship
4. Conservatorship
5. Guardianship
Mental Health Issues in Later Life
Financial Assistance
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
Low-Cost Mental Health Services
Pastors and Parish Nurses
Employee Assistance Programs (EAP)
Community Mental Health Centers
Other Programs
Private or Employer Provided Insurance Medicare Medicaid Veteran’s Administration Indian Health Service
Medicare
A national health insurance program for people 65 and over and for younger workers who have become totally disabled
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
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
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
Community-based Services
There is very limited coverage of community-based services through Medicare
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
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”
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
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
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
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
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
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
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
Veteran’s Administration
Provides medical benefits to enrolled veterans Emphasizes preventive and primary care Ensures that veterans with service-connected
disabilities and those below the low-income threshold are enrolled
Veterans may obtain care at any VA facility across the country
Veterans Administration
Veterans are eligible for psychiatric care if they have 50% or more psychiatric-related disability and if that disability was incurred during military service
Indian Health Service
A federal healthcare program for members of federally recognized American Indian and Alaska Native Tribes and their descendants
HIS is an agency in the Department of Health and Human Services that operates a comprehensive health service delivery system
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