1. 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

2. 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

3. 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

4. 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)

5. 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.

6. 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

7. 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

8. 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

9. Program Access Maryland Home and Community Based Services main page:
Maryland Access Point (MAP):
844-MAP-LINK ( ) TTY #711
Referrals also through the Maryland Department of Health (MDH) Community Options Administration Division:

10. 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

11. 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

12. 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

13. 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
ext. 322;
Western:
Garrett, Allegany, Washington, Frederick
Washington County Mental Health Authority
Linda Cole, LCSW-C
ext. 111;
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 ;
Baltimore City
Behavioral Health Systems Baltimore
Kola Bakre ;
Montgomery County
Montgomery County Health and Human Services
Sybil Greenhut, APRN-BC ;

14. 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

15. 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 Phone: