MARYLAND DEPARTMENT OF HEALTH Older Adult Behavioral Health: Bridging Maryland’s Behavioral Health, Aging, and Disability Systems Stefani O’Dea, MA Director, Office of Older Adults and Long Term Services and Supports October 2018

Relevant Data Every day 10,000 Americans turn 65 years old 15-20 percent of older adults have depression, which if untreated leads to other health problems Men aged 75 and older have the highest suicide rate Up to 15 percent of older adults are at-risk drinkers Up to 23 percent deal with prescription drug misuse Falls are another significant issue for seniors. Falls are the leading cause of both fatal and nonfatal injuries for those 65 and over. Serious injuries, such as broken bones and head injuries, occur in one in five falls

Gaps in the System According to Maryland Public Behavioral Health (PBHS) data, utilization of services drops off significantly after age 65: Possible contributing factors for decreased utilization are: Medicare, accessibility of services, and early death and disability Maryland Residential Rehabilitation Programs report difficulties continuing to support individuals in their programs as they age: Possible contributing factors are: Accessibility of units, need for hands on assistance with activities of daily living, complex somatic conditions, inability to access home and community services

Gaps in the System Some Medicaid-funded services are required to be provided through the Medicaid state plan. Some services are optional for states: Maryland has a robust array of optional services compared with other states Optional services can include state plan services and programs that provisions of the Social Security Act, such as home and community waivers (1915c)

Gaps in the System Long-term Services and Supports (LTSS) may be provided in an institution (nursing facility) or in the community. Services provide assistance with: Activities of daily living: Bathing, dressing, grooming, eating, toileting, mobility Instrumental activities of daily living: Telephone use, medication management, money management, and housekeeping Assistance may be a combination of hands-on assistance, reminders, or cuing.

Maryland LTSS Home and Community Based Medicaid programs that serve individuals who need personal assistance services: Community Options Waiver (CO) — 1915c waiver Community First Choice (CFC) — state plan Community Personal Assistance Services (CPAS) — state plan

Maryland LTSS CPAS CFC Waiver Personal Assistance Services   CPAS CFC Waiver Personal Assistance Services X  Case Management/Supports Planning X Nurse Monitoring Personal Emergency Back-up Systems Transition Services Consumer Training Home Delivered Meals Assistive Technology Accessibility Adaptations Environmental Assessments Medical Day Care Nutritionist/Dietician Family Training Behavioral Consultation Assisted Living Senior Center Plus

Program Eligibility LTSS Program Medical Eligibility Financial Eligibility Technical Eligibility Other CPAS Must require assistance with at least one Activity of Daily Living (ADL) Medicaid eligible with coverage group that includes state plan nursing facility service or below 150% federal poverty level (FPL) No age limits Residence must meet Home and Community Based (HCBS) setting requirements Can access service from community CFC Must require institutional level of care Already enrolled in a waiver OR Medicaid eligible with coverage group that includes state plan nursing facility service or below 150% FPL Residence must meet HCBS setting requirements Community Options Waiver Must meet nursing facility level of care Monthly income limit is based on 300% of Supplemental Security Income (SSI). Assets may not exceed $2,000 or $2,500 depending on eligibility category Must be 18 years old Residence will need to meet HCBS setting requirements by 2019 Waitlist for individuals in community Direct access for individuals transitioning from nursing facility (NF) through MFP

Program Access Maryland Home and Community Based Services main page: https://mmcp.dhmh.maryland.gov/waiverprograms/Pages/Home.aspx Maryland Access Point (MAP): https://www.marylandaccesspoint.info/consumer/index.php?mobile=false 844-MAP-LINK (844-627-5465) TTY #711 Referrals also through the Maryland Department of Health (MDH) Community Options Administration Division: 410-767-1739

LTSS Gaps Lack of behavioral health expertise among Maryland nursing facilities, assisted living, and other home and community based service providers No specialized certification for these programs Lack of knowledge and awareness about public behavioral health services, eligibility, and access

PASRR Project Scope Maryland’s Older Adult Behavioral Health Preadmission Screening and Resident Review (PASRR) Project: Regional specialists were hired to be a resource to behavioral health providers whose clients are aging and to aging partners whose clients are experiencing behavioral health issues. The regional specialists provide behavioral health resources and consultation for older adults with behavioral health conditions for the purpose of diverting them from, or reducing the duration of, nursing facility admission

PASRR Project Scope continued Regional specialists are a resource to: Aging and Disability Resource Centers Health Departments MAP sites Behavioral Health providers Support planners Other entities involved with diversion from nursing homes and transitions from nursing home back to the community

Regional Specialists Region Contact Person/Agency Eastern: Worcester, Wicomico, Somerset, Dorchester, Talbot, Caroline, Queen Anne’s, Kent Mid- Shore Behavioral Health Inc. Meg Borders, RN 410-770-4801 ext. 322; mborders@midshorebehavioralhealth.org Western: Garrett, Allegany, Washington, Frederick Washington County Mental Health Authority Linda Cole, LCSW-C 301-739-2490 ext. 111; lindac@wcmha.org Central: Cecil, Harford, Baltimore, Carroll, Howard Anne Arundel County Mental Health Agency Vacant Southern: Anne Arundel, Prince George’s, Calvert, Charles, Saint Mary’s Petula Phillander, MPH 410-313-7356; pphillander@aamentalhealth.org Baltimore City Behavioral Health Systems Baltimore Kola Bakre 410-735-8540; kola.bakre@bhsbaltimore.org Montgomery County Montgomery County Health and Human Services Sybil Greenhut, APRN-BC 240-777-3962; Sybil.greenhut@montgomerycountymd.gov  

Past, Present, and Future Behavioral Health, aging and disability systems lack capacity and expertise; specialized services in nursing facilities and community are needed Project requires sustainable funding source Future priorities include: Assisting hospitals with patients who are “stuck”; assisting with state psychiatric hospital discharge initiatives as they relate to older adults; assisting with coordination of specialized Behavioral Health services for individuals admitted to nursing facilities; improving workforce capacity

Contact Stefani O’Dea, MA Director, Office of Older Adults and Long Term Services and Supports Behavioral Health Administration Spring Grove Hospital, Mitchell Building 55 Wade Avenue Catonsville, MD 21228 Phone: 410-402-8476 Email: stefani.odea@maryland.gov