macomcon

MAKING COMMUNITY CONTACTS

STEPS IN GETTING HELP: Timing is important when considering outside professional help for an elder experiencing mental and/or emotional difficulties. Generally speaking, as soon as you suspect or have evidence of a problem, try to get the person to seek help. However, developing rapport--a personal relationship--with both the elder and the mental health service network may prove to be the single most important factor in getting an older person in to see a professional quickly and efficiently when the time arrives. In approaching mental health service providers:

Find out who to call, what to expect, and how to mobilize assistance ahead of time in order to decrease your and their frustration and increase the likelihood that the distressed older person will get the help he or she needs.

Locate possible sources of assistance in your community well ahead of time (e.g., mental health centers, private counselors or therapists) because many agencies are overcrowded and have long waiting lists for services.

Contact each agency and ask if they have a brochure or other materials which describe the type and range of services that they provide. If possible, pick it up in person so you have a personal contact.

Review the services offered, circling anything you don't understand while looking for language that suggests they work with older adults.

Meet and talk with a representative of the organization, preferably the mental health professional.

Ask questions about their services (see below) and also offer information about your role, the needs of older adults in your community, and possible ways that you might help older adults access their services in the future.

IMPORTANT INFORMATION: Specific information useful in matching mental health providers/agencies with a particular elder's needs includes finding out what kind of service they offer. A partial listing of common services potentially applicable to the elderly are given below.

COMMON SERVICES:

Evaluation, Diagnosis

Discharge-planning services

Medication therapy

Crisis services

Education Day treatment/day care programs

Case management for seriously mentally ill

Discharge-planning services

Case consultation Hospitalization

Ask if they provide crisis or emergency services (e.g., ability to assist if you identify a person who is suicidal and has the means to carry out the act). If they do, find out what kind of services (e.g., 24-hour answering service which can contact a professional who is available by telephone; emergency appointments during working hours; emergency appointments after-hours; referral to a hospital emergency room; in-home assessments when needed). If they don't provide crisis services, it is important to ask who else in the community might provide that type of assistance.

Find out if they provide any specialized services for older people (e.g., outreach, in-home services, day care, groups, supportive services, liaisons with other aging agencies); in particular, what percentage of their total client group is over the age of 65 years. It is appropriate to ask if they have any professionals on staff who are especially interested in the problems and issues of older people, and if that person has any special training to work with older people.

Do they provide consultation to community service providers or family members regarding the care and treatment of older people who are mentally and emotionally distressed? (Can you phone them or schedule a time to review your concerns about signs and symptoms you have observed before scheduling an appointment for the person to be evaluated? Can you ask for their guidance in responding to a situation that is troubling you? Can you ask them questions about how to respond, or what to do with a client?). If so, is there a charge for this service, and how much is it?

Location of services can be critical, because accessibility and transportation are concerns for many elderly. One needs to know if services are available through clinic/community agency offices, offices in other community agencies or outreach sites, hospital offices, in homes, or on-site a other community programs or services (e.g., screening at well-elderly clinics or senior centers). If it's a community mental health center (CMHC), finding out the geographical area they serve and if they have outreach clinics in outlying areas is important. If so, also find out what days/hours they are staffed and by whom.

Once services are located and deemed appropriate, one needs to know how to access these services--what the admission process is. Important initial information includes how to make an appointment, with whom to speak to do so, whether elder clients must call themselves, or if an advocate/helper can make the appointment on their behalf. (Some CMHCs have policies that the client must make the request.)

In order for the elderly clients to feel more at ease, it can be helpful to have information about what to expect on their first visit--who they would encounter first (a secretary, receptionist, physician, insurance person, nurse, social worker, etc.)? In practices that have several professionals, such as CMHCs, how decisions are made about which mental health professional this particular client will see can be important information. Are cases assigned on a random basis (e.g., whomever is available), or are they assigned specifically to a therapist who has particular interest or expertise in the presenting problem of the identified patient? Also notable, do they have a waiting list? If so, how many weeks/months is it? Is there a mechanism to get clients in quickly when needed? If so, what is it? If not, to whom do they usually refer people for help?

How much services cost is a critical factor, because so many elder adults are living on fixed incomes? In order that fees and billing procedures do not become a barrier to getting needed help, it is best to have this information up-front for the client to consider. In addition to finding out about the "usual" fees for service, you may need to know if they offer a sliding scale fee based on income. If so, who qualifies? They may not give you the scale itself but can tell you what percent fee reduction a person with a given income would be given. If they "slide," the kind of income information they require will be important. Also ask if they bill insurance for the client and if they take Medicare and/or Medicaid. If so, find out when the client is billed--before the insurance payment is received or after (e.g., whether clients pay their portion at the time of service or are billed later). Some counselors may not be eligible for Medicare, Medicaid, or insurance reimbursement because of state regulations restricting their reimbursement. Critical for lower income elderly is information regarding exceptions for clients who clearly need services but are unable to pay.

COMMUNICATING WITH PROFESSIONALS: Although you may have good instincts and intuition, and are absolutely correct about your belief that the person is in need of professional services, you need to communicate the information very clearly and convincingly. The following steps and questions may help you organize your thoughts in order to describe the behavior you see in a way that helps the professional understand the severity of the situation.

1. What is your real concern? What are the behaviors you observe/see?

2. How often does it happen (e.g., cries every morning, twice a day, once a week)?

3. How long does the behavior last (e.g., do they just mention "life has no meaning" and then move on with the conversation, or do they focus entirely on how awful they feel while you are visiting)?

4. Does it seem to have gotten worse over time (e.g., forgetting names of friends last year, but has difficulty calling family members by name this year)?

5. Who is it really a problem for; the older person, the family, neighbors, friends, caregivers, others (e.g., sometimes the person's behavior is upsetting to others but isn't really a "problem" for the elder; they are not in distress)?

6. Is the behavior safe? Is it dangerous? If so, what might happen? What are your concerns for the person (e.g., pulls out onto the road without checking traffic and may kill themselves as well as other persons)?

7. Are our expectations realistic? Is it possible that the person is just stressed, tired, or physically not feeling well? Are we expecting the elder to perform like a 60-year-old when they are 80? Remember, slowing of responses does not imply impairment of thinking capacity. Is the older person's or family's expectations realistic (e.g., expect the person with cognitive impairment to be able to learn new information or remember events)? Are we, or the family, or neighbors, or whomever, wanting more from the older person than is practical, given their real-life limitations (e.g., person with stroke has uncontrollable crying because of part of the brain that was affected)?

8. What is the person's mental status (e.g., can they take in information from the environment, understand it, and use it)? Are they confused? If so, is this a recent problem (suggesting delirium), or is this a worsening of an existing problem (suggesting dementia)? Do they have a history of mental illness, "nervous breakdowns," or hospitalization for "nerves?" Are they already taking a medication for "nerves," to help them sleep, or to improve their mood? Is physical illness or disability influencing the elder's mental outlook, emotional status and/or behavior? Has there been a change in overall health? If so, what was that? Have they started a new medication which may be causing adverse side effects?

9. Has something upsetting happened recently, such as a recent move or loss of someone or something important?

Remember, the older person may not be as accurate, in terms of history and past experiences, as a family member or some other person who is close to the individual and knows them well. Many times, an outside person can see changes that the older person simply can't see. As a result, getting additional information from another person is often extremely helpful.

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