1. 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

2. 2 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

3. 3 Bonnie Brae Village Community

4. 4 Onsite Supportive Services  Intensive Case Management  Crisis Intervention  Counseling  Recreational Programming & Activities

5. 5 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)

6. 6 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%)

7. 7 Staffing Pattern 2.5 FTE and 1 MSW Intern 1.0Clinical Specialist – LCSW 1.0Social Worker- MSW 0.5Service Coordinator

8. 8 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

9. 9 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

10. 10 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

11. 11 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

12. 12 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

13. 13 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 Challenges Emotional Response to Housing

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

15. 15 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

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

17. 17 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

18. 18 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

19. 19 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

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