From Adult to Older Adult, Discovering the Transition

From Adult to Older From Adult to Older Adult, Discovering Adult, Discovering

the Transitionthe Transition

CMHDA’s ASOC/OASOC Transitional Adult Subcommittee

September 9, 2005

Did you know?........Did you know?........

• America’s population age 65 and older America’s population age 65 and older grew by 74 percent between 1970 and grew by 74 percent between 1970 and 1999 (from 20 million to almost 35 1999 (from 20 million to almost 35 million). The older adult population will million). The older adult population will grow even more rapidly as 76 million grow even more rapidly as 76 million baby boomers reach age 65 and older baby boomers reach age 65 and older between 2010 and 2030. between 2010 and 2030.


• Nearly 20 percent of those who are Nearly 20 percent of those who are 55 years and older experience 55 years and older experience mental disorders that are not part of mental disorders that are not part of normal aging. Most common normal aging. Most common disorders, in order of prevalence are disorders, in order of prevalence are anxiety, severe cognitive impairment anxiety, severe cognitive impairment and mood disorders and mood disorders


• As baby boomers age, the number of As baby boomers age, the number of elderly persons who misuse or abuse elderly persons who misuse or abuse illicit drugs and alcohol may illicit drugs and alcohol may increase because this age cohort has increase because this age cohort has higher rates of use of these higher rates of use of these substances than previous cohorts substances than previous cohorts


• Abuse and misuse of prescription Abuse and misuse of prescription and over-the-counter drugs may also and over-the-counter drugs may also increase due to the larger numbers increase due to the larger numbers of baby boomers of baby boomers


• Suicide rates increase with age, and Suicide rates increase with age, and may be rising among cohorts of may be rising among cohorts of older adults; older adults often use older adults; older adults often use more lethal means when attempting more lethal means when attempting suicide than younger individuals suicide than younger individuals


• The mental health services and The mental health services and delivery systems are extremely delivery systems are extremely inadequate and unprepared.inadequate and unprepared.

• Financing and mental health Financing and mental health systems are inadequate to meet the systems are inadequate to meet the challenges passed by the expected challenges passed by the expected increase in the number of elderly increase in the number of elderly with mental illness.with mental illness.

Why a Transitional Adult Why a Transitional Adult Subcommittee?Subcommittee?

•ASOC and OASOC frameworks initially identified this cohort as having special needs. Feedback from OASOC members and the Older Adult Demonstration Projects provided information on the growing needs of consumers age 55-59 years of age who often require services more reflective of Older Adult System of Care services.

•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.

Transitional Adults Transitional Adults Include Those That Are:Include Those That Are:

• Consumer/survivors Consumer/survivors transitioning from the ASOC transitioning from the ASOC to the OASOCto the OASOC

• Transitioning from the Transitioning from the ASOC/OASOC out into the ASOC/OASOC out into the communitycommunity

• New clients transitioning New clients transitioning from the community to the from the community to the ASOC/OASOC systemsASOC/OASOC systems

• Aging ASOC clients who do Aging ASOC clients who do not transition into a new not transition into a new program, but into a new program, but into a new phase of life.phase of life.

Transitional Adults Transitional Adults SubcommitteeSubcommittee

Mission StatementMission StatementThe 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.

Issues for Transitional Issues for Transitional AdultsAdults

HealthHealth• The parallel process of changing physical The parallel process of changing physical

health and mental health can create health and mental health can create increasingly complicated symptoms.increasingly complicated symptoms.

• New issues including declining health and New issues including declining health and mental acuity; fear of dementia, heart attacks, mental acuity; fear of dementia, heart attacks, increased pain, medical disabilities, etc.increased pain, medical disabilities, etc.

• When individuals age within a system, the When individuals age within a system, the adjustment to new staff such as; doctor, adjustment to new staff such as; doctor, nurse, case manager, clinician, or team nurse, case manager, clinician, or team (primary contacts with in the system) may be (primary contacts with in the system) may be difficult......this adjustment is with the difficult......this adjustment is with the individual as well as staff. individual as well as staff.

• Depression and higher risk for suicideDepression and higher risk for suicide increase with ageincrease with age


Health cont.Health cont.

Given the above, there is a need for:Given the above, there is a need for:• Planning for increased older adult Planning for increased older adult

supportive mental health services in supportive mental health services in community, including elder programs community, including elder programs within regional support teamswithin regional support teams

• Improved service coordination and Improved service coordination and communication with medical providers communication with medical providers (PCPs, Dentist, Pharmacist, Podiatrist., (PCPs, Dentist, Pharmacist, Podiatrist., etc…)etc…)

• Triage and recruitment of geriatric Triage and recruitment of geriatric specialists in medicine and pharmacology.specialists in medicine and pharmacology.


AbuseAbuse• Substance use and abuse Substance use and abuse

issues (OTC, illegal drugs, issues (OTC, illegal drugs, prescription, alcohol)prescription, alcohol)

• Dependent Transitional Dependent Transitional Adult Abuse (either as Adult Abuse (either as victims or perpetrators)victims or perpetrators)

– PhysicalPhysical– EmotionalEmotional– SexualSexual– Fiduciary Fiduciary – Self-neglectSelf-neglect


Spirituality and FeelingsSpirituality and Feelings• Search for meaning and purpose in one's Search for meaning and purpose in one's

life (past, present and future)life (past, present and future)• Appreciation of one’s culture/historyAppreciation of one’s culture/history

– Accepting new rolesAccepting new roles– Seeking out own cultural identity Seeking out own cultural identity

• Spiritual issues and faith-based supportsSpiritual issues and faith-based supports• Unresolved guilt and griefUnresolved guilt and grief


Family Family • Transitional adults often play many roles Transitional adults often play many roles

simultaneously, which can create conflict, simultaneously, which can create conflict, including being parents, grandparents, care including being parents, grandparents, care providers, spouse, etc.providers, spouse, etc.

• Fear of losing independenceFear of losing independence• Fear of abandonment - living lonelyFear of abandonment - living lonely• Dependent transitional adults who are at Dependent transitional adults who are at

risk of losing their caretakers (their risk of losing their caretakers (their parents)parents)

• Unexpectedly becoming primary caretakers Unexpectedly becoming primary caretakers to grandchildren or other extended familyto grandchildren or other extended family


Aging ProcessAging Process• Death & dying issuesDeath & dying issues• Ageism-Anger/fear at being Ageism-Anger/fear at being

marginalized because of agemarginalized because of age• Body imagery Body imagery • Managing Managing

physiological/emotional changes physiological/emotional changes of agingof aging

• Career stresses & “maintaining Career stresses & “maintaining the course”the course”


Social Security and RetirementSocial Security and Retirement• Social Security benefits need to be Social Security benefits need to be

addressed, especially in light of the addressed, especially in light of the changes which will likely occur to changes which will likely occur to Social Security Benefits and Disability Social Security Benefits and Disability Benefits funds in the near future.Benefits funds in the near future.

– SSDI, SSI, SSASSDI, SSI, SSA• Retirement brings on fear of being Retirement brings on fear of being

useless (loss of job and earner role); useless (loss of job and earner role); what to do with that free timewhat to do with that free time


HousingHousing• Affordable housing is an important issue especially Affordable housing is an important issue especially

for persons in residential care settings.for persons in residential care settings.– Homes are licensed to care for persons either 18-59, or Homes are licensed to care for persons either 18-59, or

age 60 and over. While age waivers are allowable, persons age 60 and over. While age waivers are allowable, persons may be required to move which can be disruptive and may be required to move which can be disruptive and costly. costly.

• Living Options Living Options – IndependentIndependent– Assisted livingAssisted living– Senior housing complexSenior housing complex– Shared housingShared housing

• Affordable HousingAffordable Housing• Intentional Living CommunitiesIntentional Living Communities• Olmstead Planning / Avoidance of pre-mature SNF Olmstead Planning / Avoidance of pre-mature SNF

placementsplacements


• Loss of friends and Loss of friends and relatives through death relatives through death and disabilityand disability

• Crises – How to cope Crises – How to cope with emerging stage of with emerging stage of life issueslife issues

• Legal issuesLegal issues– Living WillsLiving Wills– Durable Powers of Durable Powers of

Attorney/Advance Attorney/Advance DirectivesDirectives

– Probate IssuesProbate Issues

Future Areas of FocusFuture Areas of Focus

• Enhance support for transitioning adultEnhance support for transitioning adult• Ongoing training for ASOC & OASOC Ongoing training for ASOC & OASOC • Increased funding for services (e.g., Increased funding for services (e.g.,

housing, unserved and underserved)housing, unserved and underserved)• Leveraging resourcesLeveraging resources• Coordinated services (community wide)Coordinated services (community wide)• Address issues of parity in healthcare Address issues of parity in healthcare

– MedicalMedical– PharmacyPharmacy– Mental HealthMental Health

CMHDA ASOC/OASOC CMHDA ASOC/OASOC Transitional Adults Transitional Adults

Subcommittee MembershipSubcommittee MembershipCurrent members are from:Current members are from:• CMHDA’s ASOC Committee (county coordinators CMHDA’s ASOC Committee (county coordinators

and managers)and managers)• CMHDA’s OASOC Committee (county CMHDA’s OASOC Committee (county

coordinators and managers)coordinators and managers)• California Mental Health Directors Association California Mental Health Directors Association

(CMHDA)(CMHDA)• California Institute for Mental Health (CIMH)California Institute for Mental Health (CIMH)• State Department of Mental HealthState Department of Mental Health• California Mental Health Planning CouncilCalifornia Mental Health Planning Council• TelecareTelecare• Mental Health Consumers/ Family MembersMental Health Consumers/ Family Members

Become A MemberBecome A Member

If you are interested in joining the If you are interested in joining the ASOC/OASOC Transitional Adult ASOC/OASOC Transitional Adult

Subcommittee, please contact Subcommittee, please contact Heather Anders at (916) 556-3477 Heather Anders at (916) 556-3477

ext. 119 or at ext. 119 or at [email protected]@cmhda.org. .

Next Steps/Next Steps/Recommendations/ Recommendations/

QuestionsQuestions

Documents

From Adult to Older Adult, Discovering the Transition