Housing Services that Work for Homeless Older

Housing & Services that Work for Homeless Older Adults DMH Housing Institute June 12, 2012 2029 Century Park East Suite 4393 Los Angeles, CA 90067 www. alaseniorliving. org

Objectives 1) Review the challenges and experiences of housing homeless older adults in permanent supportive housing during the first year 2) Discuss partnership with LAC DMH Genesis 2

Bonnie Brae Village Community 3

Bonnie Brae Village Community Onsite Supportive Services § Intensive Case Management § Crisis Intervention § Counseling § Recreational Programming & Activities 4

Population (N = 45) At Entry • Average Age: 66 years old • Average Length of Homelessness: 7 years • Chronic Health Conditions (30% have ≥ 3) Hypertension - Arthritis - Alcohol Abuse • Income Level and Source $836/month SSA and SSI VA pension (2) 5

Population (N = 45) • Mental Health Diagnoses Major Depressive D. O. w/ anxiety Schizophrenia – paranoid type Bi-polar PTSD • Health Insurance 28 Dual eligible (62%) 11 Medi-Cal only (24%) 2 VA benefits (4%) 4 Insured after housed (9%) 6

Staffing Pattern 2. 5 FTE and 1 MSW Intern 1. 0 0. 5 Clinical Specialist – LCSW Social Worker- MSW Service Coordinator 7

Staffing Recommended Expertise § Mental health training with a background in gerontology and a focus on serving the older adult population § Competence with Medi-Cal and Medicare § Conversant in healthcare and medication issues 8

Relevant Training Topics § § § Death and Dying Advanced directives and health care decisions Hospital / SNF Discharge Public Guardian Hoarding Systemic Challenge: In-patient substance abuse Tx for older adults 9

Procedures § Intake and assessment tools - Psycho/Social - Problem Scale - MMSE - Falls Assessment - Clock Draw § Client Management Software - AASC Online (Pangea Foundation) § Follow-up/ well checks § Establish relationships with physicians § Collect emergency contact information 10

Recommended Infrastructure § Transportation § Physical Environment - Home Secure Program § Landline - PERS/EARS (St. Barnabas) § Relationship with emergency response personnel § Relationship with lead social workers at local hospitals 11

Challenges Unique to Older Adults • High Mortality • Need for Higher Level of Care • Managing Systems of Care (IHSS/Caregivers) General • Illegal Activity • Public Intoxication/Substance Abuse • Language and Cultural Challenges 12

Challenges Emotional Response to Housing • Difficulty adjusting to the major life change - Mismatched coping skills • Mixed response about services onsite - Stigma about mental illness and services • Attitudes are not constant Gratitude Entitlement Dissatisfaction Acceptance 13

Statistics for 2010 - 2011 Mortality: 4 deaths in 12 months Housing Retention Rate: 88% (98%) Service Engagement: 88% Evictions: 0 14

In-Kind Service Partners § Genesis- LAC DMH (MSW, RN, Psychiatrist) § St. Barnabas Senior Services § Silverlake Medical Center § St. Vincent’s Medical Center § Housing Works - Housing Retention and Substance Abuse Work § USC Tingstad Older Adult Counseling Center - Geriatric Assessment Program (GAP) § Shelter Partnership - Household Goods Donations In-service Trainings for Staff 15

Featured Partner: GENESIS - Operational Agreement with LAC-DMH effective November 2011 - Schedule and Frequency - Current Caseload 16

Featured Partner: GENESIS Partnership Goals 1) Improve tenants access to mental health services in a non-clinical setting 2) Improve care coordination between onsite social workers and DMH clinicians 17

Featured Partner: GENESIS Benefits • Access to a multidisciplinary team of professionals • Access to culturally and linguistically diverse staff • Field-based delivery model is flexible and convenient for older tenants 18

Conclusions • Older adults represent a diverse population with different needs and preferences • Service partners give tenants access to a broader range of services both on and offsite 19

Thank You Debbie Woodward, LCSW Clinical Supervisor Deborah@alaseniorliving. org 20