Housing & Services that Work forHomeless Older Adults

DMH Housing InstituteJune 12, 2012

2029 Century Park East Suite 4393Los Angeles, CA 90067www.alaseniorliving.org

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Objectives

1) Review the challenges and experiences of housing homeless older adults in permanent supportive housing during the first year

2) Discuss partnership with LAC DMH Genesis

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Bonnie Brae Village Community

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Bonnie Brae Village Community

Onsite Supportive Services Intensive Case Management Crisis Intervention Counseling Recreational Programming & Activities

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Population (N = 45) At Entry• Average Age: 66 years old• Average Length of Homelessness: 7 years• Chronic Health Conditions (30% have ≥ 3)

Hypertension - Arthritis - Alcohol Abuse• Income Level and Source

$836/monthSSA and SSI VA pension (2)

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Population (N = 45)• Mental Health Diagnoses

Major Depressive D.O. w/ anxietySchizophrenia – paranoid typeBi-polarPTSD

• Health Insurance 28 Dual eligible (62%)11 Medi-Cal only (24%)2 VA benefits (4%)4 Insured after housed (9%)

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Staffing Pattern2.5 FTE and 1 MSW Intern

1.0 Clinical Specialist – LCSW1.0 Social Worker- MSW0.5 Service Coordinator

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Staffing

Recommended ExpertiseMental health training with a background in gerontology and a focus on serving the older adult populationCompetence with Medi-Cal and MedicareConversant in healthcare and medication issues

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Relevant Training Topics

Death and Dying Advanced directives and health care decisionsHospital / SNF DischargePublic GuardianHoarding

Systemic Challenge: In-patient substance abuse Tx for older adults

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Procedures Intake and assessment tools

- Psycho/Social - Problem Scale- MMSE - Falls

Assessment- Clock Draw

Client Management Software- AASC Online (Pangea Foundation)

Follow-up/ well checks Establish relationships with physicians Collect emergency contact information

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Recommended Infrastructure Transportation Physical Environment

- Home Secure Program Landline

- PERS/EARS (St. Barnabas) Relationship with emergency response

personnel Relationship with lead social workers at local

hospitals

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Challenges Unique to Older Adults • High Mortality• Need for Higher Level of Care• Managing Systems of Care (IHSS/Caregivers)General • Illegal Activity• Public Intoxication/Substance Abuse• Language and Cultural Challenges

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• Difficulty adjusting to the major life change- Mismatched coping skills

• Mixed response about services onsite- Stigma about mental illness and services

• Attitudes are not constant Gratitude Entitlement Dissatisfaction Acceptance

ChallengesEmotional Response to Housing

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Statistics for 2010 - 2011

Mortality: 4 deaths in 12 monthsHousing Retention Rate: 88% (98%)Service Engagement: 88% Evictions: 0

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In-Kind Service Partners Genesis- LAC DMH (MSW, RN, Psychiatrist) St. Barnabas Senior Services Silverlake Medical Center St. Vincent’s Medical Center Housing Works

- Housing Retention and Substance Abuse Work

USC Tingstad Older Adult Counseling Center- Geriatric Assessment Program (GAP)

Shelter Partnership- Household Goods Donations

- In-service Trainings for Staff

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Featured Partner: GENESIS- Operational Agreement with LAC-DMH

effective November 2011

- Schedule and Frequency

- Current Caseload

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Featured Partner: GENESIS

Partnership Goals

1)Improve tenants access to mental health services in a non-clinical setting2)Improve care coordination between onsite social workers and DMH clinicians

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Featured Partner: GENESIS

Benefits

•Access to a multidisciplinary team of professionals•Access to culturally and linguistically diverse staff•Field-based delivery model is flexible and convenient for older tenants

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Conclusions• Older adults represent a diverse population

with different needs and preferences• Service partners give tenants access to a

broader range of services both on and offsite

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Thank You

Debbie Woodward, LCSWClinical Supervisor

Deborah@alaseniorliving.org