1. 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

2. 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

3. 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

4. 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

5. Demographics
WE ALL KNOW THIS

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

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

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

9. 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

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

11. 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

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

13. 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

14. 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

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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