Older Adults

1
Older Adults Mental Health Services
in Iowa
2
OVERVIEW

• The Business Case
• The Historical Record
• Vision for the Future

3
THE BUSINESS CASE

• Demographic imperative
• Service Use
• Quality of life
• Financial inefficiencies

4
Increasing Number of Older Iowans
5
Mental Illnesses among Older Iowans
6
SERVICE USE

• Community based services
• Nursing homes other residential settings
• Community Mental Health Centers many have
  little history of serving this population

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Community based care

• Specialty clinics CMHCs
• Inpatient psychiatric hospitals
• Primary care
• Community hospitals

8
County-based mental health
Parkview Center, Sac City
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Kaskie et al. Study (2007)

• Few CMHCs target programs towards older adults
• Little use of CMHCs by older adults
• Not a lot of specialty contact
  (lt 20 see a specialist in outpt
  setting)

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Inpatient Psychiatric Care
11
Buckwalter UIHC Study

• Admission status
• 65 Mood Disorder
• 35 Dementia
• 50 Mixed

12
Kaskie et al. (2007)

• Not a lot of specialty inpatient care

13
Primary Care
14
Kaskie Medicare Study

• Most common place to obtain care
• More than 70 of MH diagnoses for older Iowans
  occur in a generalist outpatient office

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Community Hospitals
16
Kaskie Medicare Study

• Second most common place to obtain care
• Nearly 20 of MH diagnoses take place in a
  generalist setting, inpatient and outpatient
  services

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Emergency Care

• Not coded

18
Care for Co-occurring Dx

• 1 out of 5 MH dx only
• Very little co-occurring MH dx
• 4 out of 5 MH other DX

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Oakland Estates, Oakland
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Mental Illnesses in Nursing Facilities
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Targeted efforts

• Third most common place to receive MH treatment
• Dementia Special Care
• 65 Specialized Care Units
• 1,200 beds

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QUALITY OF LIFE
24
Suicide Rate by Age Per 100,000
Older people 12.7 of 1999 population, but 18.8
of suicides. (Hoyert, 1999)
25
October 7, 2000 (AP) Actor Richard Farnsworth, a
former stuntman and two-time Academy Award
nominee, died of a self-inflicted gunshot wound
Friday night. He was 80.
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EXPENDITURES

• Total Medicare Expenditures
• 211.4 Billion
• Total MH Expenditures 1.2 Billion (0.57)
• Outpatient Mental Health
• 718 Million (0.34) CMS, 2001

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Iowa Expenditures
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Inefficiencies
30
Depression in Older Adults and Health Care Costs
Unutzer, et al., 1997 JAMA
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Monthly Per Person Costs by Age Severe Mental
Illness
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New Hampshire Total Monthly Costs Per Person Over
Age 65
4,000
Medicaid
Medicare
3,500
3,000
2,500
2,000
1,500
1,000
500
0
COPD
Diabetes
Depression
Cardiac
Dysrhymias
Dementia
Alzheimer's
Hypertension
Schizophrenia
Heart Failure
Osteoarthritis
Cerebrovascular
33
Medicare Expenditures on Alzheimers Disease

• AD complicates treatment of coexisting conditions
• Inability to manage care
• Hospitalized AD patients stay longer, cost more

34
HISTORICAL EFFORTS
35
NATIONAL MOVEMENT
36
2004 Program Initiative
37
2005 White House Conference
38
Positive Aging Act Reintroduced

• May 31, 2005 Senators Hillary Rodham Clinton
  (D-NY) and Susan Collins (R-ME) and
  Representatives Patrick Kennedy (D-RI) and Ileana
  Ros-Lehtinen (R-FL) announced the introduction of
  the Positive Aging Act of 2005 to improve access
  to mental health services for Americas senior
  citizens.

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IOWA FORUMS

• Quick Fixes (1998)
• Iowa Mental Health Forum (2000)
• Mental Health System (2001)
• Mental Health System Redesign (2005)
• Creation of Division of MHDS (2006)
• MH Systems Improvement (2007)
• Report sent to Governor Legis 1/31/08

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Quick Fixes (1998)
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Key Findings

• public mental health system is in transition.
  
• increased use of managed behavioral healthcare
  to administer services.

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Problems

• older adults are not involved in managed
  behavioral healthcare
• data is difficult to obtain

43
Mental Health Forum (2000)
44
Organizational Chart (2000)
45
Mental Health Forum (2001)
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Older Adults Roundtable

• Many persons did not know where to seek help.
• Dementia should be included in mental health
  care
• Implement multi-disciplinary treatment
  approaches

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Subsequent Legislative Actions

• 2005 Mental Health System Redesign
• Adult, followed by child in 2006
• 2005 Mental Health Parity in Iowa
• 2006 Creation of Division of MHDS
• Formation of Alzheimers Taskforce
• Report to Governor Legis 1/08
• Mental Health System Improvement
• Report to Governor Legis 1/31/08

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Training Efforts (2002)
Training to Enhance ServiceDelivery toOlder
Adults with Mental Illness
Lila Starr, Project Officer
Funding Period April 15, 2002 to September 30,
2002
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Four Training Sessions (N268)

• Creston
• Dubuque
• Ottumwa
• Spencer

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Mental Health and Aging Programs and Services
in the State of IowaAmes, IA 2003
Iowa Public Health Conference
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Collaborative Models of Mental Health Care Pilot
Programs Lila Starr, DHS 2004
Iowa Department Human Services
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THE IOWA COALITION ON MENTAL HEALTH AND AGING

• April, 2005
• Three Workgroups
• www.icmha.org

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ICMHA Membership Roster
Osceola
Winnebago
Lyon
Dickinson
Emmet
Kossuth
Worth
Mitchell
Howard
Winneshiek
Allamakee
OBrien
Sioux
Palo Alto
Hancock
Cerro Gordo
Clay
Floyd
Chickasaw
Fayette
Clayton
Buena Vista
Humboldt
Butler
Pocahontas
Franklin
Bremer
Plymouth
Cherokee
Wright
Sac
Black Hawk
Buchanan
Delaware
Calhoun
Dubuque
Calhoun
Grundy
Webster
Woodbury
Hamilton
Hardin
Ida
Jones
Jackson
Boone
Story
Marshall
Benton
Linn
Tama
Carroll
Greene
Monona
Crawford
Clinton
Cedar
Shelby
Guthrie
Dallas
Polk
Jasper
Poweshiek
Iowa
Johnson
Audubon
Scott
Harrison
Muscatine
Cass
Madison
Washington
Warren
Keokuk
Pottawattamie
Adair
Marion
Mahaska
10
Louisa
Clarke
Mills
Montgomery
Adams
Union
Lucas
Monroe
Wapello
Jefferson
1-9
Henry
Des Moines
Fremont
Page
Taylor
Ringgold
Decatur
Wayne
Appanoose
Davis
Van Buren
Lee
0
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Outreach Efforts ICMHA Regional
MeetingsFall, 2007

• Council Bluffs (Southwest 8) Dubuque (Scenic
  Valley)Sioux City (Siouxland)Waterloo (Hawkeye
  Valley)

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IOWA COALITION ON MENTAL HEALTH AND
AGING

• Education and Training Workgroup

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PRIMARY GOALS

• Increase public awareness about mental health and
  aging issues
• Expand the supply of qualified mental health
  service providers

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IOWA COALITION ON MENTAL HEALTH AND AGING

• Outreach and
• Clinical Services Workgroup

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PRIMARY GOALS

• Promote mental wellness among aging Iowans
• Increase supply of qualified mental health
  service providers
• Improve access to qualified mental health service
  providers
• Integrate mental health services into usual
  places of care

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IOWA COALITION ON MENTAL HEALTH AND AGING

• Policy Administration Workgroup

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PRIMARY GOALS

• Promote mental wellness among aging Iowans
• Increase supply of qualified mental health
  service providers
• Improve access to qualified mental health service
  providers
• Integrate mental health services into usual
  places of care

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VISION FOR THE FUTURE
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HF2780

• In 2006, the Iowa Legislature established the
  Division of Mental Health and Disability Services
  (MHDS) within the Department of Human Services
  (DHS). With the enactment of HF2780, the general
  assembly sought a service system disabilities
  which emphasizes the ability of persons with
  disabilities to exercise their own choices about
  the amounts and types of services received that
  all levels of the service system would seek to
  empower persons with disabilities to accept
  responsibility, exercise choices, and take risks
  that disability services are individualized,
  provided to produce results, flexible, and
  cost-effective and that disability services be
  provided in a manner which supports the ability
  of persons with disabilities to live, learn,
  work, and recreate in communities of their
  choice.

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Mental Health Systems Improvement

• With the recent passage of the State's bill, the
  Department of Human Services (DHS) Division of
  Mental Health and Disability Services (MHDS) form
  planning workgroups.  These workgroups are to
  make recommendations to the MHMRDDBI commission,
  to the DHS director, and the legislature.  The
  legislation states
• "In order to build upon the partnership between
  the state and the counties in providing mental
  health and disability services in the state, the
  workgroups established for purposes of this
  subsection shall engage equal proportions
  representing the department, counties, and
  service providers.  The county and provider
  representatives shall be appointed by the
  statewide associations representing counties and
  community providers.  In addition, each workgroup
  shall include a representative of the commission,
  the mental health planning and advisory council,
  consumers, and a statewide advocacy organization"

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Bureau of Older Adult Mental Health Services

• The Bureau of Older Adult Mental Health Services
  will expand and improve the care provided to
  older Iowans with mental illnesses and
  co-occurring mental illness and substance use
  disorders. The Bureau will provide program
  administration and service management that
  reflects a commitment to principles of
  accountability, decency, ease of access, respect
  for self-determination and responsiveness to an
  older individuals unique situation and personal
  preferences. In this manner, the Bureau will
  establish a compassionate and welcoming culture,
  and a determination to help older Iowans overcome
  the challenges of aging and live with dignity and
  safety in the communities of their choice.

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BOAMHS Goal 1

• Ensure the provision of empathic and welcoming
  care to older Iowans with mental illnesses and
  co-occurring mental illness and substance use
  disorders a priority among policy makers, program
  administrators and provider organizations across
  the state of Iowa.

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BOAMHS Goal 2

• Increase the involvement of older adult
  consumers, their caregivers, and the general
  public with improving the care of older Iowans
  with mental illnesses and co-occurring mental
  illness and substance use disorders.

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BOAMHS Goal 3

• Increase the number of qualified providers of
  evidence based mental health and substance abuse
  services targeted towards older Iowans with
  mental illnesses and co-occurring mental illness
  and substance use disorders.

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BOAMHS Goal 4

• Develop early identification and prevention
  programs targeting older Iowans with mental
  illnesses and co-occurring mental illness and
  substance use disorders.

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BOAMHS Goal 5

• Increase the provision of specialty and emergency
  mental health services to older Iowans.

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BOAMHS Goal 6

• Establish a statewide system of care in which
  qualified mental health providers can serve older
  adults with mental illnesses or co-occurring
  mental illness and substance use disorders
  through a referral or co-location process that
  upholds the principle of no wrong door

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BOAMHS Goal 7

• Establish an administrative culture, which
  upholds principles of continuous quality
  improvement

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Where do things stand?
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• THANK YOU