Erie County: Project Elder Rreach

Kathy Latimer, RNC, Case Management Support Services

What is Project Elder Reach?

• An active outreach to identify older adults at risk for mental illness
• Based on the Gatekeeper Model developed and implemented by Ray Rascho in Spokane, WA. In 1978
• Utilizes non-traditional referral sources who identify older adults who do not have other supports
• Employs multi-discipline approach
• Funded by a Federal Block Grant through the Pennsylvania Department of Public Welfare, Office of Mental Health and Substance Abuse Services
• A collaborative effort between the Mental Health Base Service Unit and Area Agency on Aging and coordinated by the Erie County Department of Human Services

Staffing

• Mental Health Case Manager
  • Employed by Case Management Support Services (MHBSU)
  • Expertise in MH assessment and MH services in Erie County
  • Coordinates MH services and psycho-social needs of consumers
  • Provides ongoing case management to resistive consumers in attempt to engage them in service.
• Registered Nurse
  • Employed by greater Erie Community action Committee Area Agency on Aging
  • Expertise on medical issues and Aging System in Erie County
  • Completes nursing assessments and provides minimal nursing procedures (e.g. vital signs, blood sugars, etc)
  • Coordinates medical care for consumers
• Outreach Caseworker
  • Employed by Greater Erie Community Action Committee AAA
  • Provides training for Bridge Builders
  • Provides community information sessions
  • Provides additional support to consumers
• Case Aide
  • Licensed Practical Nurse Employed by Case Management Support Services
  • Transportation/Shopping, Medical Appointments
  • Accompanies consumer to community recreation/leisure activities
  • Provides support/diversion activities in the home/community

Referrals

• 130 referrals from 7/1/01 to 3/31/02
• Primary Reason for Referral:
  • Mental Health Issues
  • Medical Concerns
  • Self-Care Needs
  • Isolation
  • Safety Issues
  • Housing
  • Cognitive Impairment

Demographics

• 70% females
• 96% white
• 58% live alone
• 24% live with spouse or other relatives
• 81% live in urban area

Age distribution

• 4% under 60
• 18% 60-69
• 35% 70-79
• 30% 80-89
• 13% 90 and above

Mental Health

• 23 referrals determined to be SMI
• 19 referrals determined to have mental health issue
• 50 referrals were persons with dementia
• 7 referrals were persons with primary substance abuse issue.

What we have learned. Cross Training between two systems very beneficial

• Workers knowledge of mental disturbance and normal aging process increased
• Improved understanding of MH Procedures Act and Older American's Act and the parameters of each
• Greater understanding of each System and services they provide
• Aging and MH Personnel became acquainted which helped improve working relationships

Difficult to mesh two systems

• Different Regulations
• Different Philosophies for service delivery
• Different philosophies for management of employees

Older Adults are not likely to ask for help.

• Only (3) individuals self referred
• Majority deny need for service at intake

Engaging older adults in supportive service requires a great deal of effort

• Need to discern crisis from issues that can wait
• Requires patience and time to build rapport
• Relationship building starts where they are at-coffee, transportation, groceries, medications

Resiliency of Older Adults

• Housing/conditions of the home
• Older siblings and spouses caring for other older adults in the home
• 80% of referrals >80 years old
• Financial stressors: Medications, Home repair/maintenance

Loneliness very prevalent

• Isolation leads to disengagement and depression
• Enjoy the visits tremendously
• Do not want case managers to leave
• Concern for the easy access into the older adults home
• Need for education of the older adult regarding entry of strangers

Complexity of cases

• One referral reveals multiple persons in the home with needs
• Referrals generated for individuals already involved in a system
• Need for more comprehensive on-going case management service due to the complex needs of the older adult