Distinguished Elders Partial Hospital Program

A unique program that blends traditional, established methods of mental healthcare, with more contemporary approaches into a holistic model, addressing all aspects of the elder's life. Services can be provided in the Partial Hospital Program or the Outpatient Program including Intensive Outpatient Programs (IOP).

During the past two decades, healthcare professions have vastly improved healthcare services to the elder population. Previously, medical professionals were inexperienced in diagnosing and managing the mental health disorders associated with aging. Consequently, geriatric care received little attention. The elderly were a disadvantaged minority with inadequate access to mental health care whose treatable symptoms were often attributed to the inevitable deterioration of aging.

But times have changed and the elderly segment of the population has grown. Today, the average physician who treats adult patients, regardless of specialty, spends over 45 percent of the time treating elderly people.

The increasing contact between healthcare professionals and elderly patients has fostered a better understanding of the distinctions between the normal aging process and concerns and symptoms that can be treated and resolved. Many debilitating conditions previously thought to be the inevitable results of old age can be treated and resolved. Such is the case with many of the mental, emotional and behavioral problems of this population.

Partial Hospital Program (PHP) and Intensive Outpatient Programs (IOP)

InnerWisdom's unique mental health Partial Hospital Program and Intensive Out patient Programs has been designed for the retired and elder person, focusing on the emotional, mental, social, economic and spiritual well being of the client. Mental health and substance abuse issues can be addressed in this program.

InnerWisdom's Partial Hospital Program is not Adult Day Care. The Distinguished Elder's Partial Hospital Program requires active participation in group activities and is limited to a specific time-frame. Clients must qualify for the program by meeting specific symptom criteria.

Service Includes

• Life Skills Development
• Behavior Modification
• Self-Esteem Building
• Grief Management  
• Activities of Daily Living
• Medication Management including Medication Education 
• Managing a Medical Condition and Mental Health Condition Simultaneously
• Social Skills and Communication Skills Development
• Coping Skills Development
• Independent Living Skills
• Living in a Group or Assisted Living Environment

Suportive Service Include

• Supervision and admission by a qualified physician
• Managing medication 
• Transportation to and from the program as needed
• Meals and snacks provided
• Dealing with family issues 
• Identification of other needs and referrals to community based providers
• Managing life situations: planning and implementing needs 
• Continuum of care plan developed during their treatment stay
• 30, 60 and 90-day follow-up after discharge

Providing Mental Health Services For

• Coping with life changes
• Coping with chronic physical illness
• Managing depression
• Managing mental illness
• Managing anxiety
• Working through grief and loss
• Substance abuse recovery
• Misuse of prescription medication with medication education and appropriate use of prescriptions 
• Diminished ability to perform daily routines, including forgetfulness and helplessness 
• Managing chronic disabling pain
• Dealing with cancer and other potentially life threatening illness
• Cardiovascular/Stroke recovery
• Family support in dealing with recovering family members

Recognizing Signs and Symptoms

Even in the absence of troubling symptoms, the elder person should generally visit physicians more often than their younger counterparts. Beyond age 65, individuals should receive an annual physical exam. Although there are many normal physical changes that accompany advancing age, new symptoms or physical changes should not be automatically dismissed as the effects of old age. Any change in a person's usual physical or mental state should be evaluated, particularly if the change is relatively rapid, has not been previously experienced, or affects ability to carry out daily activities.

Symptoms requiring evaluation include

• Fatigue, sleeplessness, poor appetite, rapid change in weight
• Unexplained change in mood
• Irritability
• Memory loss that comes on rapidly
• Headaches and/or dizziness
• A tendency to fall, shaking of the hands or head, limb weakness
• Sexual problems
• Breathlessness, chest pain
• Depression
• Anxiety
• Apathy and loss of interest
• Isolation
• Withdrawn behavior
• Slowness of movement or thoughts
• Forgetfulness
• Confusion
• Taking pain or other mood altering medications more often than prescribed

Check List for Mental or Emotional Health Changes

• Finds it difficult to complete a sentence; forgetting words or what the discussion is about
• Misplaces important items such as food, money or bank records
• Seems confused, especially early in morning and before bedtime
• Forgets how to use common items or perform simple tasks
• Unable to identify day, month, year or season
• Becomes disoriented when in familiar surroundings
• Sleeps at unusual times and is restless throughout the day
• Appetite dramatically decreases/increases
• Suffers dizzy spells or severe headaches
• Visually displays depressed mood or sadness
• Lacks pleasure or interest in usual activities
• Hopeless, worthless, indecisive, irritable, preoccupied with thoughts of death or suicide
• Problems in concentrating, feels exhausted, complains about aches and pains
• Becomes restless, trembles, or shows signs of increased muscle tension
• Experiences difficulty breathing, heart palpitations, or accelerated heart rate
• Trouble swallowing
• Exaggerated reactions to sudden sounds, feels edgy or keyed up
• Experienced recent losses (spouse, home, employment, friends, activities, etc.)
• Diagnosed with illness (cancer, heart disease, stroke, diabetes, etc.)

Health and Healthcare

Many older adults have at least one chronic condition and many have multiple conditions. The most frequently occurring conditions are: arthritis, hypertension, hearing impairments, heart disease, cataracts, orthopedic impairments, sinusitis, and diabetes.

Approximately 60% of health care expenditures are attributed to the elderly population, as well as 35% of hospital discharges, and 47% of hospital days.

Stress in Later Life

Common stresses of late life can lead to problem behavior. Physical illness, especially chronic illness, often raises issues of dependence vs. independence, control vs. lack of control, and self care vs. disability. Dependent behavior creates increased stress on caregivers, and resentment when the individual does not help as much with self-care as he or she seems physically capable of doing.

Demanding behavior is sometimes a sign that the individual wants more control over his or her life. Helping the individual , even the institutionalized patient, to find ways to gain more control can often decrease dependent or demanding behavior.

Role reversal occurs when the child becomes caretaker. This situation is often uncomfortable for both the parent and the child, and can be a source of conflict and tension. Again, allowing the parent to retain as much control as possible often lessens some of the tension created by this uncomfortable situation.

Poor or non-compliance with treatment is another problem for the physically ill older adult. Sometimes non-compliance is due to the individual's not understanding the reason for the treatment. Other times it represents the elder person's understandable but misguided attempt to maintain a degree of control. Allowing older adults to have some control in other areas of their lives can be one way to improve compliance with treatment.

Social isolation with feelings of loneliness and aloneness is a problem among the older adults, especially the homebound and the widowed. Efforts to reduce the amount of social isolation can result in a major improvement in a individual's emotional outlook.

Special Health Problems of Older Adults

The diverse and complicated health problems cut across the disciplines of medicine, psychiatry, social work, and nursing. As a result, they may overwhelm a health professional who does not have the time or capacity to investigate all the nuances of the situation. Moreover, the main complaint may overshadow other less urgent, but still important, secondary problems.

The multiple and interdisciplinary health demands of older adults require a coordinated effort from many health care professionals for optimal treatment. Uncoordinated efforts may produce conflicting management plans that hinder each other.

In many cases, facilities offering one type of service may lack other services needed by their clients. Older adults with both physical maladies and mental problems may attend a mental health center where medical services are not available. Similarly, people with a mixture of complaints may only receive services at social service agencies, nutrition sites, or ambulatory medical care clinics.

Added to the difficulty of organizing health services for this age group is their frequent lack of mobility. The older adult may be homebound, lack access to transportation, reside in a care facility, or simply be unwilling to attempt an excursion outside their usual places.

But for the older adult, chronic conditions are usually of chief concern, requiring a different approach than treatment of acute illness. When the older adult suffers acute illness, it is more likely to occur in the presence of a chronic, complicating malady that may follow or be aggravated by the acute condition and often becomes a serious health problem.

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