Integrating mental health parity for homebound older adults under the medicare home health care benefit

Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.     

Treating Older Persons with Severe Mental Illness in the Community: Impact of an Interdisciplinary Geriatric Mental Health Team

Little information is available concerning community-based interventions to treat the growing number older persons with severe mental illness. This study examined treatment efficacy of a specialized interdisciplinary geriatric mental health team (mental health geriatric interdisciplinary teams or MHGITs) for 69 older clients with severe mental disorders. Depression, life satisfaction, health, and psychiatric and medical hospitalization data were gathered. A decrease in depressive symptoms and in psychiatric hospitalizations, and an increase in life satisfaction at 6 months were found. No change in health nor medical hospitalizations were reported. This study provides preliminary support for the feasibility and efficacy of a MGHIT approach in treating older community-dwelling adults with severe mental illnesses. Implications for social workers are discussed.     

Correlates of Depressive Symptoms among Homebound and Semi-Homebound Older Adults

ABSTRACT

This study aimed to provide a national profile of homebound and semi-homebound older adults with depressive symptoms and to compare risk factors of depressive symptoms by homebound status. A sample of 1,885 homebound and semi-homebound older adults was selected from Round 1 of the National Health and Aging Trends Study (NHATS). The prevalence of depressive symptoms was 43.9% in homebound older adults and 28.1% in semi-homebound older adults, representing over 830,000 and 1.4 million individuals in the population, respectively. Nearly two-thirds of homebound and over half of semi-homebound older adults with clinically significant depressive symptoms also had significant anxiety symptoms. Results from logistic regression showed that younger age, certain medical morbidities, severity of functional limitations, and pain were common risk factors for depressive symptoms among homebound and semi-homebound older adults. Some differences in the risk factor profile emerged between the homebound and the semi-homebound populations. Alleviating the burden of depression in the semi-homebound population may focus on early prevention that considers the diversity of this population. Home-based, integrated programs of health and mental health services that simultaneously address the medical, psychiatric, and neurologic comorbidities and disabilities of homebound older adults are needed to meet the complex needs of this population.     

Racial Differences in Attitudes Toward Professional Mental Health Treatment: The Mediating Effect of Stigma

Stigma associated with mental illness continues to be a pervasive barrier to mental health treatment, leading to negative attitudes about treatment and deterring appropriate care seeking. Empirical research suggests that the stigma of mental illness may exert an adverse influence on attitudes toward mental health treatment and service utilization patterns by individuals with a mental illness, particularly African Americans. However, little research has examined the impact of stigma on racial differences in attitudes toward seeking mental health treatment. This study examined the hypothesis that stigma partially mediates the relationship between race and attitudes towards mental health treatment in a community-based sample of 101 African American and White older adults. Multiple regression analyses and classic path analysis was utilized to test the partial mediation model. Controlling for socio-demographic factors, African American older adults were more likely to have negative attitudes toward mental health treatment, and they also reported more public and internalized stigma than their White counterparts. As hypothesized, the relationship between race and attitudes toward mental health treatment was partially mediated by internalized stigma, suggesting that internalized stigma may cause older adults to develop negative attitudes about mental health treatment. The partial mediation model was not significant for public stigma, however. Implications for social work research and practice are discussed.     

社会医疗保险对老年人健康水平的影响：基于浙江省的实证研究

本研究根据2010年浙江省城乡老年人口生活状况调查的数据认为,对于老年人的社会医疗保险问题,不仅要关注保险覆盖面的扩大,更应关注不同保险项目参保老人之间的健康平等。在揭示医疗服务使用与健康水平负向关系这一主效应的基础上,研究发现,职工医保作为moderator可以改善使用较多医疗服务老人的健康水平,新农合的作用则相反。研究希望对医疗保险的改革思路进行反思,全民医保的改革思路不仅是医疗服务可及性的提高,更应该是不同社群享有平等的医疗福利,并最终促进健康结果的平等。     

Mental Health Problems and Behavioral Disruptions in Nursing Homes:

This paper describes a study that examines knowledge of mental health problems and management of behavioral disruptions by social workers in nursing homes. Since a significant number of nursing home patients have mental health problems (estimates range from 50 to 80 percent) which present behavioral disruptions, this knowledge is critical. Results indicate that social workers are not prepared to provide needed services because they do not have adequate knowledge about the management of behavioral disruptions or the identification of mental health problems of nursing home patients. Recommendations are that social workers employed in nursing homes should have gerontological training and that national policy changes are needed to develop guidelines for qualifications of nursing home social workers. Nursing homes are not meeting the needs of older adults with mental health problems when social workers do not have the knowledge needed to provide nursing home services.     

High Life Satisfaction: Exploring the Role of Health,Social Integration and Perceived Safety among Mexican Midlife and Older Adults

We sought to investigate the relationship of high life satisfaction with important physical health, mental health, social integration and perceived safety factors among midlife and older Mexican adults. We examined 2,200 midlife and older adults (aged 50–101 years) from the Mexican arm of the Study on global AGEing and adult health (SAGE) and used binary logistic regression models to identify key factors associated with high LSA. Our final logistic regression model revealed self-rated health, affect, interpersonal activities and perceived safety on street to be significantly associated with high life satisfaction. Results from this study add to the nascent literature on subjective well-being of midlife and older Mexicans. Although social work with older adults is not well established in Mexico, researchers and practitioners should collaborate on the development and implementation of social worker-led strategies for prevention and intervention to enhance well-being among midlife and older Mexicans.     

Health Service Utilization and Expenditure of the Elderly in China

Using data from the China Health and Retirement Longitudinal Survey, we employed counterfactual propensity score matching to examine the association between income and health service utilization and expenditure of the elderly in China. The results demonstrated that income did not differentiate whether the poor elderly in China visited a doctor when suffering an illness, but their expenditure on medical treatment was significantly associated with income. Subgroup analysis further indicated that the medical demands of female, older, and rural elderly were more likely to be reduced by their income compared with their counterparts.     

Structuring Mental Health Within Senior Services: A Case Study of an Outpatient Mental Health Clinic Serving Latinos

The article presents a case study of an outpatient mental health clinic serving Latino older adults. The study explored staff perceptions on the clinic development and the context within an immigrant multicultural community. The study used in-depth, semistructured interviews with support staff, clinical social workers, and administrators. Interviews were analyzed using a thematic content analysis. The mental health clinic formation was perceived by staff as an ecological process stemming from the needs of the Latino immigrant senior clients. A close knit and interdependent culture allowed the clinic to adjust to diversity and changing cultural contexts.     

A Model for Community-Based Mental Health Services for Older Adults:

The mental health needs of older adults have historically been underserved by existing mental health service delivery systems. This paper presents a model for the delivery of comprehensive mental health services to older adults in their own homes, based on sound clinical practice, and incorporating a cross-cultural perspective coupled with a strong social and community support base.     

Implementing a Gero-Infused Curriculum in Advanced-Level MSW Courses in Health,Mental Health and Substance Abuse: An Evaluation

This article presents evaluation results from a curricular innovation aimed at increasing the capacity of social work graduates to serve older adults in health, mental health, and substance abuse settings. Working as a team, faculty developed, incorporated, and evaluated gerontology-infused syllabi and teaching modules in multiple sections of the 3 courses, with 2 sections serving as a comparison group. Results indicated that students exposed to the gero-infused curriculum increased their age-related knowledge and self-competence from pre- to posttest, and achieved a greater increase in knowledge than did the comparison group. Implications of the findings to social work education are discussed.     

Changes in flourishing from adolescence to young adulthood: An 8-year follow-up

Most research on mental health among adolescents and young adults concentrates on understanding mental illness. However, mental health is more than the absence of mental illness. Among adolescents and young adults, positive mental health—a combination of emotional, social and psychological well-being—is related to higher prosocial behaviour, school integration and self-concept. However, much of the research on positive mental health among young adults has been with college students. Limited research has examined the presence and correlates of positive mental health, or flourishing, among a nationally representative sample of US young adults. This study extended from another researcher's original examination of positive mental health among US adolescents to describe the prevalence of flourishing among these same individuals in young adulthood. Our sample included 1090 individuals from the 2011 Panel Study of Income Dynamics Transition into Adulthood Supplement. Univariate and bivariate tests were used to describe the prevalence of flourishing during young adulthood and changes from adolescence to young adulthood. We used multivariable logistic regression to examine the relationships among indicators of healthy development and flourishing. Results suggest that flourishing improved during the transition into young adulthood and that targeting factors like life skills and civic engagement may enhance flourishing.     

Racial/Ethnic Disparities in Access to Medicare Home Health Care: The Disparate Impact of Policy

The Balanced Budget Act of 1997 dramatically decreased reimbursements for traditional Medicare home health patients. A multivariate analysis of Medicare Current Beneficiary Survey data showed that African American and “other” users experienced greater decreases in home care between 1996 and 1998 than did White users. These results suggest (a) race/ethnicity is an independent factor in determining service use post-BBA and (b) health policy has a disparate impact on minority older adults. Capitated payment systems must be pursued cautiously to avoid negative effects on vulnerable populations. The potential for current and future Medicare policy changes to negatively affect vulnerable populations is also discussed.     

Relationships Among Caregiving,Income, Gender,and Health: A Cross-Sectional Examination of a Representative Sample of Older Americans

Although there is substantial evidence to support the effect of burden on caregivers, few studies have compared caregivers to their noncaregiving counterparts on the basis of health and well-being outcomes. This study examines the relationship between caregiving and health and whether other factors may have stronger influence on well-being measures. Using a nationally representative sample of older adults in the United States (N = 3,005), this study examines relationships between caregiving status, gender, and income, and 9 outcomes (self-rated physical and mental health, time since seeing a doctor, time since most recent pap smear or prostate-specific antigen [PSA] test, depression, loneliness, stress, anxiety), using logistic and linear regression models. Results support that paradoxically, caregiving was associated with increased likelihood of PSA test in male caregivers, although data also indicated higher levels of anxiety and stress, as might be expected. Income was associated with 8 of 9 outcomes, and gender predicted depression, anxiety, stress, and self-rated mental health. The study highlighted the importance of psychosocial stressors, such as income and gender, on the health outcomes of older adults who may be caregiving. Considering complexity of unique experience is necessary to accurately assess vulnerability to poor mental health or health-related outcomes.     

Older Americans Act Related Homebound Aged: What Difference Does Racial Baclkground Make?

This research examined racial differences in wellbeing among 440 older persons receiving home based services connected with Older Americans Act funded nutrition sites. These data clearly indicate that compared with white homebound aged, black aged receiving homebased services have more limited economic resources and live in more impoverished neighborhoods, are more irnpaired in their health and functional status, have more limited social resources and have more limited knowledge and access to services. Service utilization appears similar for both groups and the life perspective of blacks is somewhat higher than that of white homebound aged.     

Older Americans Act Related Homebound Aged: What Difference Does Racial Baclkground Make?

This research examined racial differences in wellbeing among 440 older persons receiving home based services connected with Older Americans Act funded nutrition sites. These data clearly indicate that compared with white homebound aged, black aged receiving homebased services have more limited economic resources and live in more impoverished neighborhoods, are more irnpaired in their health and functional status, have more limited social resources and have more limited knowledge and access to services. Service utilization appears similar for both groups and the life perspective of blacks is somewhat higher than that of white homebound aged.     

Health and Medical Services Use: A Matched Case Comparison Between CCRC Residents and National Health and Retirement Study Samples

Little is known about the health status of adults living in continuing care retirement communities (CCRC). Using matched-case control, 458 adults from the Health and Retirement Study (HRS) or a CCRC-based sample were compared on total comorbidity, self-rated health, home health services use, and hospitalizations. At year 2, the CCRC sample reported more comorbidities (96%) but significantly better self-rated health (96% good/excellent) than the HRS sample (93% comorbidity, 73% good/excellent; p < .01). There were no significant differences in frequency of home health use or hospitalization. Living in a CCRC appears to be associated with higher self-ratings of health in this sample.     

Challenging the exclusion of people with mental illness: the Mental Health Housing and Accommodation Support Initiative (HASI)

Without appropriate support, people with mental illness can be excluded from stable housing and social and community participation. Transitional models of support for people with acute mental illness have addressed clinical symptoms and hospitalisation, but they have not facilitated stable housing and community integration. In contrast, individualised housing models aim to improve mental health, housing and community outcomes. These programs are costly and require collaboration between agencies. This article discusses the evaluation findings of one such program – the NSW Mental Health Housing and Accommodation Support Initiative (HASI). The longitudinal mixed‐method evaluation assessed whether HASI supported people with high levels of psychiatric disability to improve housing, mental health and community participation. We discuss the challenges clients within the program faced prior to joining HASI and the changes experienced while in HASI. We conclude by drawing policy implications for programs supporting people with mental illness to live in the community.     

The Role of Internal Health Locus of Control in Relation to Self-Rated Health in Older Adults

ABSTRACT

The present study examined how internal health locus of control is associated with older adults’ self-rated health. Multivariate analyses with older participants (aged ≥ 60) in the MIDUS II (n = 1,533) showed that internal health locus of control was not only directly associated with positive ratings of health but also interacted with gender and race. The positive impact of internal health locus of control on self-rated health was particularly greater in females and Whites than their counterparts. Findings highlight the important role of internal health locus of control in the psychological mechanism of health and call attention to group-specific strategies for health promotion.     

Social Context in Mental Health Service Use Among Young Adults

Examining the sources of health communication that young adults with mental health challenges receive regarding service use is critical to curbing the societal concern of unmet mental health needs of this population. Semistructured interviews were conducted with 59 young adults, all of whom were diagnosed with a mood disorder and used public mental health services and additional public systems of care during childhood. Thematic analysis was utilized. Of the 59 participants, 45 nominated at least one supportive adult, with a total of 97 relationships analyzed. Results indicate that the majority of messages came from informal supports (e.g., family) who spoke positively about mental health services. Fewer messages came from formal supports (e.g., professionals). Messages included statements surrounding beliefs toward services, social norms (approval and disapproval), self-efficacy, and image considerations around using services. These findings can suggest ways that mental health service engagement interventions can leverage communication from informal supports. Future research can explore what messages young adults find most influential in persuading them to use mental health care consistently and the relationship between messages and health behavior.