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