Older Americans with mental illness are unnecessarily segregated in nursing homes and other isolating environments, instead of being integrated into community services.
So says the Bazelon Center for Mental Health in a new report, “Last in Line: Barriers to Community Integration of Older Adults with Mental Illnesses and Recommendations for Change.”
The report finds that states have largely ignored older adults in planning for the Supreme Court–mandated expansion of community services for institutionalized people with mental disabilities. “Many older people with mental illnesses or dementia are still isolated in nursing homes and other institutions, where they may receive no more than custodial care,” said Robert Bernstein, executive director at the Bazelon Center.
In 1999 the Supreme Court ruled in Olmstead v. LC that people with disabilities—including mental disabilities—have the right to receive publicly financed services in the most integrated setting possible. Since that ruling, federal and state agencies have begun planning to reduce needless institutionalization and expand community programs.
But the rights of older Americans have received little attention in this process, according to the Bazelon Center. The center analyzed national data and literature on the issue, then focused on five states: Pennsylvania, Alabama, Illinois, Michigan, and Nevada. The legal advocacy group conducted site visits in the five states and reviewed relevant state documents, such as long-term-care studies, legislative bills, testimony, and geriatric mental health training materials and manuals.
“Our findings offer a snapshot of neglect and disregard of the rights of older Americans with mental illnesses all across the country,” said Bernstein. “The problems we found in these states typify those we’ve seen and heard about elsewhere.”
The report identified numerous barriers to community integration for older people with mental illnesses, including these:
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Stigma among older adults about the receipt of mental health services
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Lack of knowledge about geriatric mental health issues on the part of primary care physicians, mental health practitioners, and senior service providers
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Lack of coordination between aging and mental health agencies
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Lack of transportation to assist seniors in accessing services
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A dearth of in-home mental health services
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Inadequacy of Medicaid and Medicare reimbursement schemes to finance community-based mental health services for older adults
The report includes general recommendations to address the barriers to community integration identified in virtually every state. An addendum includes recommendations to address specific problems in the five states the Bazelon Center studied in depth.
“This is a call to action for states not only to plan services for older adults, but also to address the underlying reasons why older people continue to be segregated,” concluded Bernstein. “Older adults with mental disabilities have waited far too long for the community integration that is their right.”
The executive summary of the report is posted on the Web at www.bazelon.org/issues/elders/publications/lastinline.htm.
