Reclaiming joy: pilot evaluation of a mental health peer support program for older adults who receive Medicaid.

PURPOSE: Stigma and lack of access to providers create barriers to mental health treatment for older adults living in the community. In order to address these barriers, we developed and evaluated a peer support intervention for older adults receiving Medicaid services. DESIGN AND METHODS: Reclaiming Joy is a mental health intervention that pairs an older adult volunteer with a participant (older adult who receives peer support). Volunteers receive training on the strengths-based approach, mental health and aging, goal setting and attainment, community resources, and safety. Participant-volunteer pairs meet once a week for 10 weeks. Participants establish and work toward goals (e.g., better self-care, social engagement) that they feel would improve their mental health and well-being. Aging services agencies provide a part time person to manage the program, match volunteers and participants, and provide ongoing support. Outcomes evaluation for this pilot study included pre/postintervention assessments of participants. RESULTS: Thirty-two participants completed the intervention. Pre/postassessment group means showed statistically significant improvement for depression but not for symptoms of anxiety. Quality-of-life indicators for health and functioning also improved for participants with symptoms of both depression and anxiety. IMPLICATIONS: The Reclaiming Joy peer support intervention has potential for reducing depression and increasing quality of life in low-income older adults who have physical health conditions. It is feasible to administer and sustain the intervention through collaborative efforts with minimal program resources and a small amount of technical assistance.

Residential outcomes for nursing facility applicants who have been diverted: where are they 5 years later?

PURPOSE: The purpose of this longitudinal study was to determine the length of community tenure for adults aged 60 and older after application for nursing facility (NF) admission and to examine the proportion of older adults who lost community tenure due to either (a) death while a community resident or (b) permanent NF admission. DESIGN AND METHODS: In this 5-year prospective study, we tracked older adults who had applied for NF admission and were diverted (residing in the community 30 days later). Four waves of NF applicants (N = 2,882) were identified, and those diverted (n = 599) were tracked for 60 months at 3-month intervals. RESULTS: Sixty months after diversion, 18.0% of older adults (n = 108) were residing in the community, 39.2% died as community residents (n = 235), and 42.7% (n = 256) became permanent NF residents. In all, 414 diverted older adults (69.1%) died during the 5 years following NF application, with the majority of deaths occurring while older adults were community residents. IMPLICATIONS: This longitudinal study documents the capacity of NF applicants aged 60 and older to remain in the community long term, which was previously unknown. Policymakers now have data indicating that for many NF applicants, diversion does not simply delay NF admission; rather, diversion helps older adults avoid permanent NF placement until death.

Hospice use by older adults knocking on the door of the nursing facility: implications for social work practice.

Since 1983, federal funding has been available for hospice services. However, research studies have found that hospice is underutilized by people with terminal illnesses and their families. Low-income older adults are particularly at risk for underutilization. This study examined utilization of hospice services by nursing home applicants in one Midwestern state. Characteristics of users and non-users, and potential barriers to hospice use were examined. Findings further document that hospice is underutilized, especially by the Medicaid population, and point to barriers to hospice utilization. Specific recommendations are made to help practitioners increase hospice access.