IOWA COALITION ON MENTAL HEALTH AND AGING Policy and Administration Workgroup INTRODUCTIONS MY NAME IS JOEL OLAH AND I AM ……..AT THE …….. I’M ALSO CHAIR OF THE ICMHA POLICY AND ADMINISTRATION WORKGROUP I’M GOING TO REVIEW SOME OF THE EFFORTS THAT WE HAVE TAKEN UP

PRIMARY GOALS Make mental wellness a priority issue for policy makers Make mental wellness a priority among program administrators LAST SPRING WE IDENITIFED TWO GOALS THAT PERTAINED TO POLICY AND ADMINISTRATION

OBJECTIVES Establish the business case for aging and mental health issues Support policies & programs that advance education & training Support policies & programs that advance outreach & clinical services AND WE DETERMINED THAT WE WOULD REACH THOSE GOALS BY PURSUING THESE OBJECTIVES

The Business Case Quality of life Financial inefficiencies Demographic imperative Quality of life Financial inefficiencies SINCE THEN, WE HAVE CREATED A ‘BUSINESS CASE’ FOR WHY PEOPLE SHOULD PAY ATTENTION TO ISSUES PERTAINING TO MENTAL HEALTH AND AGING OPUR CASE FOCUSES ON THREE KEY POINTS DEMOGRAPHIC IMPERATIVE QUALTIY OF LIFE ISSUE ECONOMIC EFFICIENCY

Demographics WE ALL KNOW THIS

Iowa Nursing Home Population BUT IM NOT SURE HOW MANY PEOPLE KNOW ABOUT THIS

Quality of Life THESE ARE OTHER REASONS WHY WE SHOULD PAY ATTENTION TO THESE ISSUES…..

Suicide Rate by Age Per 100,000 Older people: 12.7% of 1999 population, but 18.8% of suicides. (Hoyert, 1999)

Medicare Expenditures Total Health Expenditures: $211.4 Billion Total Mental Health Expenditures: $1.2 Billion (0.57%) Outpatient Mental Health: $ 718 Million (0.34%) CMS, 2001 A LOT OF MONEY IS BEING ALLOCATED FOR MENTAL HEALTH CARE BUT AS A PROPORTION OF TOTAL OUTLAYS, MENTAL HEALTH CARE IS UNDERRFUNDED

PERHAPS THIS IS A BETTER DEPICTION OF THE LACK OF SPENDING ON MENTAL HEALTH CARE

Depression in Older Adults and Health Care Costs WE THINK MORE SHOULD BE ALLOCATED TOWARDS MENTAL HEALTH SERVICES BECAUSE NOT TREATING MENTAL HEALTH CORRESONDS WITH DRIVING UP THE COSTS OF OTHER FORMS OF CARE Unutzer, et al., 1997; JAMA

Monthly Per Person Costs by Age: Severe Mental Illness MORE EVIDENCE 4

New Hampshire Total Monthly Costs Per Person Over Age 65 $4,000 Medicaid Medicare $3,500 $3,000 $2,500 $2,000 $1,500 $1,000 WE ARE WORKING ON OBTAINING DATA SPECIFIC TO IOWA BUT IN THE MEANTIME WE CAN LOOK AT HEW HAMPSHIRE ANOTHER SMALL RURAL STATE AND SEE HOW MUCH MENTAL ILLNESSES COST $500 $0 COPD Diabetes Depression Alzheimer's Dementia Cardiac Dysrhymias Schizophrenia Heart Failure Hypertension Osteoarthrosis Cerebrovascular

Medicare Expenditures on Alzheimer’s Disease AD complicates treatment of other coexisting conditions Inability to manage own care When hospitalized, AD patients stay longer, and cost more WHEN UNIDNETIFIED AND TREATED, DEMENTIA COMPLICATED THE TREATMENT OF OTHER CONDITIONS

NATIONAL ATTENTION FORTUNATELY, THERE IS AN INCREASING AMOUNT OF NATIONAL ATTENTION BEING DIRECTED TOWARDS THESE ISSUES

2005 White House Conference AT OUT LAST COALITION MEETING, WE WERE ABLE TO INFORM THE IOWA DELEGATION TO THE WHITE HOUSE CONFERENCE ON AGING ABOUT ISSUES PERTAINING TO MENTAL HEALTH AND AGING

Positive Aging Act Reintroduced May 31, 2005 – Last Wednesday, Senators Hillary Rodham Clinton (D-NY) and Susan Collins (R-ME) and Representatives Patrick Kennedy (D-RI) and Ileana Ros-Lehtinen (R-FL) announced the introduction of the Positive Aging Act of 2005 to improve access to mental health services for America’s senior citizens. THIS PAST YEAR , THE POSITIVE AGING ACT WAS PASSED AND IS BEING INCLUDED IN THE RE-AUTHORIXATION OF THE OLDER AMERICANS ACT

Support policies & programs that advance education & training Continue to support ICMHA public education efforts NOW IM GOING TO TALKS ABOUT SOME OF THE PARTICULAR EFFORTS WE WILL BE SUPPORTING…. CONTINUE PUBLIC EDUCATION CAMNPAIGN

Support policies & programs that advance education & training Training conferences Online training administration Online training participation CONTINUE TO SUPPORT TRAINING EFFORTS, WHETHER THEY ARE DONE IN –PERSON OR ON-LINE

Support policies & programs that advance education & training Continuing Education Requirements WE ALSO ARE CONSIDERING THAT ANYONE WHO PROVIDES CARE TO OLDER ADULTS SHOULD HAVE A MINIMUM AMOUNT OF REQUIRED TRAINING IN MENTAL HEALTH ISSUES… THIS INCLUDES SOCIAL WORKERS, NURSE, PSYCHOLOGISTS, NURSES AND DIRECT CARE WORKERS

Support policies & programs that advance outreach & clinical services Screening efforts integrated into other preventive services WE NEED TO FIGURE OUT THE BEST WAY TO CONDUCT SCREENING EFFORTS

Support policies & programs that advance outreach & clinical services Increase payments to non-MD mental health providers (county dollars, Medicaid, supplemental insurance) Support inclusion of older adults in peer training academy WE THINK NON-MD PROVIDERS SHOULD GET INCREASED INCENTIVES TO PROVIDE CARE… AT THE STATE LEVEL THAT CAN OCCUR THROUGH THE MEDICAID PROGRAM, THE COUNTY BASED SERVICE SYSTEM AND THROUGH PAYMENTS MADE BY MEDICARE SUPPLEMENTAL INSURANCE PROGRAMS BASED HERE IN IOWA

Support policies & programs that advance outreach & clinical services Increase payments to non-MD mental health providers (county dollars, Medicaid) in nursing home locations Promote and monitor use of tele-health in nursing home care INCREASED PAYMENTS TO NURSING HOMES COULD BE EARMARKED FOR MENTAL HEALTH SERVICE DELIVERY…. WE SEE TELEHEALTH AS A POTENTIALLY EFFICIENT AND EFFECTIVE FORM OF SERVICE DELIVERY. AT THE VERY LEAST, IT IS SOMETHING THAT WARRANTS SOME SORT OF FURHTER INVESTIGATION

Support policies & programs that advance outreach & clinical services Establish primary care – mental health collaborative models WE ARE EXCITED BY THE PROGRESS OF THE PILOT PROGRAMS AND SUPPORT THEIR CONTINUED DEVELOPMENT AND EXPANSION