Creating A Continuum Of Care For Older Persons With Behavioral Health Needs In Southeast Pennsylvania: continued

Recommended Action at State and Local Levels

Appoint staff from the Department of Aging and the Office of Mental Health and Substance Abuse Services to create a mechanism that addresses proactively the changing demographics and promotes closer inter-system collaboration. Joint planning to facilitate systems integration at the state level could include: developing written common objectives; funding joint pilot programs; creating permanent staff positions within departments devoted to behavioral health and aging issues; and creating mechanisms to encourage/require collaborative service delivery at the local level.

Appoint staff from the Philadelphia Office of Mental Health and the Philadelphia Corporation on Aging to develop and implement a joint plan to create a continuum of care for older adults with behavioral health needs based on the Community Support Program (CSP) model. The plan should outline goals, objectives, action steps, timeframes, and a research/evaluation component. It should also provide guidelines for written agreements on local collaboration, including how to resolve cross-system disagreements. Resource allocation also should be a focus. This joint planning effort will lay the foundation for the systems integration necessary to create the continuum of care.

Establish dedicated funding for services to older adults with behavioral health needs (such as exists for children) within the next budgeting cycle for the state and the county. A higher level of flexibility than currently exists should be built into this new funding stream in order to develop an array of services sensitive to the individual needs of older adults.

• The 2000-01 state mental health budget includes funding for two geriatric pilot projects that will require integration of the behavioral health and aging systems. This commitment is an important step in addressing the needs of this underserved population; however, it is only the first step. Starting with the 2001-02 budget, the state should set aside additional new funding each year.
• At the local level, Community Behavioral Health (CBH) should make behavioral health services for older adults a priority in its annual plan for the allocation of CBH reinvestment dollars. An infusion of new funding from CBH will be necessary to make the continuum of care a reality.

Develop comprehensive, integrated protocols for the health, aging, and behavioral health systems that ensure continuity of care in serving older adults. Representatives from all three systems should participate on committees and task groups, including the Delaware Valley Mental Health/Aging Advocacy Committee, the Pennsylvania Coalition on Mental Health and Aging, and the Southwest Pennsylvania Partnership on Aging.

Create a state and city task force that identifies what federal policies need to be changed in order to create a continuum, and advocate for these changes. At minimum:

• Medicare should establish parity for outpatient behavioral health services benefits;
• Medicaid should increase professional behavioral health services' funding to the market value; and
• Federal programs such as Qualified Medicare Beneficiary (QMB) and state programs such as PACE should be made more accessible and affordable for older adults.

Restructure managed care and Medicare advisory boards to better address the myriad of needs of older adults with behavioral health issues by including, at minimum, one gerontologist and one geriatric psychiatrist. This will ensure a higher level of sensitivity to, and reimbursement for, the complex, interacting medical and behavioral health treatment needs of older adults.

Require that staff in both systems of care be familiar with cross-systems collaboration procedures. Service providers and other professionals should be cross-trained to understand (and identify) behavioral health, physical health, and aging issues and how to access appropriate resources. Regular joint meetings between staff of both systems are needed to identify opportunities for collaboration, including how to resolve difficult situations involving individual elderly.

Require that all nursing and medical students be trained in identifying behavioral health issues, referral processes, and treatment modalities as they relate to older adults. This will enable all physicians and nurses to identify mental health needs in the elderly and promote effective treatment services.

Require training for all personal care and nursing home direct care on mental health and aging issues, including: aging sensitivity, understanding mental illness, dealing with behavioral problems, and knowing how to get help for older adults.

Draft Position Paper: last updated 5/9/00
Written by the Delaware Valley Mental Health Aging Advocacy Committee