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Older Adults & Mental Health Services in Iowa

Older Adults & Mental Health Services in Iowa. OVERVIEW. The Business Case The Historical Record Vision for the Future. THE BUSINESS CASE. Demographic imperative Service Use Quality of life Financial inefficiencies. Increasing Number of Older Iowans.

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Older Adults & Mental Health Services in Iowa

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  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

  7. Community based care • Specialty clinics – CMHCs • Inpatient psychiatric hospitals • Primary care • Community hospitals

  8. County-based mental health Parkview Center, Sac City

  9. 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 (< 20% see a specialist in outpt setting)

  10. 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 visits in a generalist outpatient office

  15. Community Hospitals

  16. Kaskie Medicare Study • Second most common place to obtain care • Nearly 20% of MH visits in a generalist inpatient and outpatient services

  17. 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

  19. Oakland Estates, Oakland

  20. Mental Illnesses in Nursing Facilities

  21. Targeted efforts • Third most common place to receive TX • Dementia Special Care • 65 Specialized Care Units • 1,200 beds

  22. QUALITY OF LIFE

  23. Suicide Rate by Age Per 100,000 Older people: 12.7% of 1999 population, but 18.8% of suicides. (Hoyert, 1999)

  24. 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.

  25. EXPENDITURES • Total Medicare Expenditures: $211.4 Billion • Total MH Expenditures: $1.2 Billion (0.57%) • Outpatient Mental Health: $ 718 Million (0.34%) CMS, 2001

  26. Iowa Expenditures

  27. Inefficiencies

  28. Depression in Older Adults and Health Care Costs Unutzer, et al., 1997; JAMA

  29. Monthly Per Person Costs by Age: Severe Mental Illness

  30. 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

  31. Medicare Expenditures on Alzheimer’s Disease • AD complicates treatment of coexisting conditions • Inability to manage care • Hospitalized AD patients stay longer, cost more

  32. HISTORICAL EFFORTS

  33. NATIONAL MOVEMENT

  34. 2004 – Program Initiative

  35. 2005 White House Conference

  36. Positive Aging Act Reintroduced • May 31, 2005 – Last Wednesday, 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 America’s senior citizens.

  37. IOWA FORUMS • Quick Fixes (1998) • Iowa Mental Health Forum (2000) • Mental Health System (2001)

  38. Quick Fixes (1998)

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

  40. Problems • older adults are not involved in managed behavioral healthcare… • data is difficult to obtain…

  41. Mental Health Forum (2000)

  42. Organizational Chart (2000)

  43. Mental Health Forum (2001)

  44. 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

  45. 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

  46. Four Training Sessions (N=268) • Creston • Dubuque • Ottumwa • Spencer

  47. Iowa Public Health Conference Mental Health and Aging: Programs and Services in the State of IowaAmes, IA 2003

  48. Iowa Department Human Services Collaborative Models of Mental Health Care Pilot ProgramsLila Starr, DHS 2004

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