From Adult to Older Adult, Discovering the Transition

1. From Adult to Older Adult, Discovering the Transition CMHDA’s ASOC/OASOC Transitional Adult Subcommittee June 9, 2004

2. Definition of Transitional Adults • Transitioning from the ASOC to the OASOC • Transitioning from the ASOC out into the community • Transitioning from the community to the ASOC/OASOC systems – brand new clients • Aging ASOC clients who do not transition into a new program, but into a new phase of life.

3. Transitional Adults Subcommittee Mission Statement The Transitional Adult Subcommittee is a subcommittee of the CMHDA Adult System of Care Committee and the CMHDA Older Adult System of Care Committee. The subcommittee membership consists of representatives from the following departments or agencies: County ASOC and OASOC coordinators and managers, mental health consumers, State Department of Mental Health, provider organizations, CMHDA, and the California Mental Health Planning Council. The subcommittee follows the work of the ASOC and OASOC frameworks and reports to those committees. The subcommittee’s mission is to ensure that there is a continuity of care for the adult transitioning from the adult system of care to the community or other phase of life or when transitioning to the older adult system of care. The subcommittee also recognizes the importance of understanding and respecting the cultural and gender issues of the adult consumer in transition. The subcommittee has identified the ages of 55-59 years old as the transitional age for adults entering into the older adult population, though the transition can begin, depending upon need, prior to age 55 and could also happen anytime past the age of 59 years old. Integrated planning should begin based on the functionality of the individual, and the likelihood that the person will need the intensive linkage to health and support services available under OASOC. The subcommittee will focus on integrated joint planning for the purpose of building a bridge for the adult between adult services and the special needs of older adults. The subcommittee strives to ensure that the adult consumer is in charge of his or her treatment and care.

4. Issues for Transitional Adults Health • Declining health and mental acuity; fear of dementia, heart attacks, increased pain, medical disabilities, etc. • There is a parallel process for physical health and mental health • When individuals age within a system, the adjustment to new staff such as; doctor, nurse, case manager, clinician, or team (primary contacts with in the system) may be difficult......this adjustment is with the individual as well as staff. • Depression and higher risk for suicide

5. Issues for Transitional Adults Health cont. • Need for planning for increased older adult supportive mental health services in community / Elder Programs within Regional Support Teams • Improved service coordination and interface with medical providers (PCPs, Dentist, Podiatrist., etc…) • The need for Geropharmacology and affordable treatment

6. Issues for Transitional Adults Abuse • Substance use and abuse issues; increased need for medications along with side effects • Elder abuse • Fiduciary abuse

7. Issues for Transitional Adults Spirituality and Feelings • Search for meaning and purpose in one's life (past and future) • Spiritual issues • Unresolved guilt and grief • Unfinished Emotional Business

8. Issues for Transitional Adults Family • Older adults who are also parents to grand-children, nephews and nieces etc. • Fear of becoming dependent on someone else • Relationship issues with children & spouse, including former partners • Fear of abandonment • Living alone – family concerns • Dependent transitional adults who are at risk of losing their caretakers (their parents)

9. Issues for Transitional Adults Aging Process • Fear of dying • Anger/fear at being marginalized because of age • Fear of becoming ugly and/or unattractive in various ways • Ageism • Managing physiological/emotional changes of aging • Career stresses & “Maintaining the Course”

10. Issues for Transitional Adults Social Security and Retirement • Retirement and SS benefits needs to be addressed, especially in light of the changes which are going to occur to Social Security Benefits and Disability Benefits funds in the near future. • Fear of being useless (loss of job and earner role); what to do with that free time

11. Issues for Transitional Adults Financial and Housing • Financial issues, especially as they relate to healthcare • Affordable housing is an important issue especially for persons in residential care settings. • Homes are licensed to care for persons either 18-59, or age 60 and over.  While age waivers are allowable, persons may be required to move which can be disruptive and costly.  • Living Options – relocate or stay • Retirement Finances/Money Management/Advance Directives • Affordable Housing • Intentional Living Communities • Olmstead Planning / Avoid pre-mature SNF placements

12. Issues for Transitional Adults • Loss of friends and relatives through death and disability • Realistic/Unrealistic Expectations • Crises – How to Cope • Guardianships • Living Wills/Durable Powers of Attorney/Legal/Probate Issues

13. Future Areas of Focus • Need for system change • Need for training for ASOC on needs of older adults • Need for increased funding for services (e.g., housing) • Need for coordinated services • Need for regulation of the insurance system for older adults accessing services

14. Next Steps/Recommendations

15. CMHDA ASOC/OASOC Transitional Adults Subcommittee Membership Current members are from: • CMHDA’s ASOC Committee (county coordinators and managers) • CMHDA’s OASOC Committee (county coordinators and managers) • California Mental Health Directors Association (CMHDA) • California Institute for mental Health (CIMH) • State Department of Mental Health • California Mental Health Planning Council • Telecare • Mental Health Consumers

16. Become A Member If you are interested in joining the ASOC/OASOC Transitional Adult Subcommittee, please contact Heather Anders at (916) 556-3477 ext. 119 or at handers@cmhda.org.

17. Questions