News to Note

'In Whose Hands?'

IOM Report: Boost Work Force, Fund Training to
Address Elder Substance Abuse, Mental Health

Training of health and social service professionals across all disciplines should include competence in care of older adults with substance use and mental health problems, says a new report from the Institute of Medicine. According to the committee that wrote the report, the magnitude of the problem is so great that no single approach or isolated changes in a few federal agencies or programs will address it.

The committee conservatively estimated that between 5.6 million and 8 million older Americans—14 percent to 20 percent of the nation's overall elderly population—have one or more mental health conditions or problems stemming from substance misuse or abuse. Rates of accidental and intentional misuse of prescription medications are increasing. And, although the rate of illicit drug use among older individuals is low, studies indicate that it will probably increase as the baby boomers age.

The report, The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?, calls for a redesign of Medicare and Medicaid payment rules to guarantee coverage of counseling, care management, and other types of services crucial for treating substance use problems and mental health conditions so that clinicians are willing to provide this care. Organizations that accredit health and social service professional schools and license providers should ensure that all who see older patients—including social workers, nurses, physicians' assistants, and primary care physicians—are able to recognize signs and symptoms of geriatric substance misuse and abuse and mental health conditions and provide at least basic care, the committee said.

News to Note

Again, it's about care coordination

Report Gives New 'Guiding Principles' of Quality
Care for Elders with Multiple Chronic Conditions

A just-released report from the American Geriatrics Society, Patient-Centered Care for Older Adults with Multiple Chronic Conditions: A Stepwise Approach, offers a new set of "guiding principles" to better individualize and coordinate care for this growing population.

More than half of adults 65 and older have at least three chronic conditions such as heart disease, dementia, arthritis, or diabetes. About 93 percent of Medicare expenditure goes to care for these patients, according to the Centers for Medicare and Medicaid Services. Following standard clinical guidelines for each condition is often not appropriate for patients with many health problems because treatment for one must be considered in light of the effects, benefits, and drawbacks of the other and the interactions between them.

The contribution of the care team. "The report's new principles to guide providers through this maze are not just for physicians but expressly apply to other members of the care team as well," said Scott Miyake Geron, director of IGSW and associate professor at Boston University School of Social Work. In fact, the document serves to underline the importance of the team contribution and integrates the goals of care management with the medical perspective, which makes practical reading for all.

All five of the new principles to improve care for elders with multiple chronic conditions contain elements that are basic to the care coordination that social service practitioners provide, Geron said. "Eliciting and taking into account a patient's preferences, assessing the complexity and feasibility of treatment options for an individual patient, and maximizing benefits and minimizing risks, especially after the patient leaves the hospital with a complicated care plan, are examples," he said.

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Care Management Practice

Latest skills, tools, resources. With current developments in the health and long-term-care system, this role remains crucial, especially in managing the care of individuals who wish to live as independently as possible. Sign up now to receive a 10 percent discount (enter code ENews1012)! Or, visit the course page for details.

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Care Transitions

As moves between different levels of care, different settings, and different providers increasingly characterize the health and long-term-care experience of older adults, proper planning and management of care transitions has become an essential skill for social service practitioners who work with elders and their families. View this video clip about guided care, a care-transition model that originated in a primary care setting and is discussed in detail in this course.

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Copyright © 2012 Trustees of Boston University. All rights reserved. This article may not be duplicated or distributed in any form without written permission from the publisher: The Institute for Geriatric Social Work, Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, U.S.A.; e-mail: igsw@bu.edu.