Addressing COVID-19 Worry and Social Isolation in Home-Based Primary Care

2020 ◽  
Author(s):  
Rachel Elizabeth Weiskittle ◽  
Michelle Mlinac ◽  
LICSW Nicole Downing
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Social Workers ◽  
Social Isolation ◽  
Mental Health Providers ◽  
Health Providers ◽  
Home Based Primary Care ◽  
Home Based ◽  
Socially Isolated

Social distancing measures following the outbreak of COVID-19 have led to a rapid shift to virtual and telephone care. Social workers and mental health providers in VA home-based primary care (HBPC) teams face challenges providing psychosocial support to their homebound, medically complex, socially isolated patient population who are high risk for poor health outcomes related to COVID-19. We developed and disseminated an 8-week telephone or virtual group intervention for front-line HBPC social workers and mental health providers to use with socially isolated, medically complex older adults. The intervention draws on skills from evidence-based psychotherapies for older adults including Acceptance and Commitment Therapy, Cognitive-Behavioral Therapy, and Problem-Solving Therapy. The manual was disseminated to VA HBPC clinicians and geriatrics providers across the United States in March 2020 for expeditious implementation. Eighteen HBPC teams and three VA Primary Care teams reported immediate delivery of a local virtual or telephone group using the manual. In this paper we describe the manual’s development and clinical recommendations for its application across geriatric care settings. Future evaluation will identify ways to meet longer-term social isolation and evolving mental health needs for this patient population as the pandemic continues.

scholarly journals Evaluation of an initiative to improve advance care planning for a home-based primary care service

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michelle B. Cox ◽  
Margaret J. McGregor ◽  
Madison Huggins ◽  
Paige Moorhouse ◽  
Laurie Mallery ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Decision Maker ◽  
Care Service ◽  
Do Not Resuscitate ◽  
Substitute Decision Maker ◽  
Home Based Primary Care ◽  
Home Based ◽  
Before And After ◽  
Advance Care

Abstract Background Advance care planning (ACP) is a process that enables individuals to describe, in advance, the kind of health care they would want in the future. There is evidence that ACP reduces hospital-based interventions, especially at the end of life. ACP for frail older adults is especially important as this population is more likely to use hospital services but less likely to benefit from resource intensive care. Our study goal was to evaluate whether an approach to ACP developed for frail older adults, known as the Palliative and Therapeutic Harmonization or PATH, demonstrated an improvement in ACP. Methods The PATH approach was adapted to a primary care service for homebound older adults in Vancouver, Canada. This retrospective chart review collected surrogate measures related to ACP from 200 randomly selected patients enrolled in the service at baseline (prior to June 22, 2017), and 114 consecutive patients admitted to the program after implementation of the PATH ACP initiative (October 1, 2017 to May 1, 2018). We compared the following surrogate markers of ACP before and after implementation of the PATH model, chart documentation of: frailty stage, substitute decision-maker, resuscitation decision, and hospitalization decision. A composite ACP documentation score that ascribed one point for each of the above four measures (range 0 to 4) was also compared. For those with documented resuscitation and hospitalization decisions, the study examined patient/ substitute decision-maker expressed preferences for do-not-resuscitate and do-not-hospitalize, before and after implementation. Results We found the following changes in ACP-related documentation before and after implementation: frailty stage (27.0% versus 74.6%, p < .0001); substitute decision-maker (63.5% versus 71.9%, p = 0.128); resuscitation decision documented (79.5% versus 67.5%, p = 0.018); and hospitalization decision documented (61.5% versus 100.0%, p < .0001); mean (standard deviation) composite ACP documentation score (2.32 (1.16) versus 3.14 (1.11), p < .0001). The adjusted odds ratios (95% confidence intervals) for an expressed preference of do-not-resuscitate and do-not-hospitalize after implementation were 0.87 (0.35, 2.15) and 3.14 (1.78, 5.55), respectively. Conclusions Results suggest partial success in implementing the PATH approach to ACP in home-based primary care. Key contextual enablers and barriers are important considerations for successful implementation.

Interdisciplinary Team Perspectives on Mental Health Care in VA Home-Based Primary Care: A Qualitative Study

2019 ◽  
Vol 27 (2) ◽  
pp. 128-137 ◽  
Author(s):  
Suzanne M. Gillespie ◽  
Chelsea Manheim ◽  
Carrie Gilman ◽  
Jurgis Karuza ◽  
Tobie H. Olsan ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Qualitative Study ◽  
Mental Health Care ◽  
Interdisciplinary Team ◽  
Home Based Primary Care ◽  
Home Based

scholarly journals TRANSFORMING DEMENTIA SERVICE DELIVERY: THE MENTAL HEALTH GERO-CHAMPIONS PROGRAM

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S380-S380
Author(s):  
Regina M Koepp
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Medical Center ◽  
Neurocognitive Disorders ◽  
Mental Health Providers ◽  
Health Providers ◽  
Mental Health Clinics ◽  
Outpatient Mental Health ◽  
Health Clinics ◽  
Clinical Support

Abstract In order to provide effective mental health care to older adults with major neurocognitive disorders (e.g., Alzheimer’s disease and related dementias) within outpatient mental health clinics, mental health practitioners must possess a basic understanding of these disorders, the needs of and challenges faced by people living with dementia and their families, and effective treatment approaches for this population. The Mental Health Gero-Champions Program was established in 2015 at a large Veterans Affairs medical center with the aim of providing clinical support and opportunities for training to multidisciplinary mental health providers to enhance skills in assessing and treating older adults with neurocognitive disorders. This presentation will provide an overview of the Mental Health Gero-Champions Program, describe the development and implementation of this program, and discuss challenges and successes in sustaining this transformative initiative over time.

scholarly journals Perspectives of Veterans Affairs mental health providers on working with older adults with dementia and their caregivers

2020 ◽  
pp. 1-12
Author(s):  
Mary F. Wyman ◽  
Corrine I. Voils ◽  
Ranak Trivedi ◽  
Lisa Boyle ◽  
Daniel Goldman ◽  
...  
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Veterans Affairs ◽  
Mental Health Providers ◽  
Health Providers

scholarly journals VA Compassionate Contact Corps: A Phone-Based Intervention for Veterans Interested In Speaking With Peers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 206-206
Author(s):  
Lisa Gualtieri ◽  
Maura Campbell ◽  
Heather Davila ◽  
Jacquelyn Pendergast ◽  
Prince Taylor ◽  
...  
Keyword(s):  
Primary Care ◽  
Social Connection ◽  
Voluntary Service ◽  
Phone Calls ◽  
Home Based Primary Care ◽  
Home Based ◽  
Common Interests ◽  
Socially Isolated

Abstract The VA Voluntary Service has developed and implemented a new social prescription program called Compassionate Contact Corps which was created during the COVID-19 pandemic when in-home volunteers could no longer enter Veterans’ homes. The program targets Veterans who are lonely, socially isolated or seeking additional social connection. Volunteers and Veterans are matched based on common interests. Trained volunteers provide support by making periodic phone calls. Program referrals are made from VA providers in several clinical programs (e.g. Home-based Primary Care). To date, CCC has been implemented in more than 80 sites in the VA, with 310 volunteers, 5,320 visits, and 4,757 hours spend with Veterans.

Home-Based Care and Primary Care Settings for Delivery of Geropsychology Services to Older Persons

2019 ◽  
Author(s):  
Srijana Shrestha
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Primary Care Providers ◽  
Mental Illnesses ◽  
Care Providers ◽  
Primary Care Clinics ◽  
Home Based

Despite high rates of mental illnesses, older adults face multiple barriers in accessing mental health care. Primary care clinics, and home- and community-based senior-serving agencies are settings where older adults routinely receive medical care and social services. Therefore, integration of mental health care with existing service delivery systems can improve access to mental health services and reduce the unmet mental health needs of seniors. Evidence suggests that with innovative components mental health provided in collaboration with primary care providers with or without co-location within primary care clinics can improve depression and anxiety. Home-based models for depression care are also effective, but more research is needed in examining home-based approaches in late-life anxiety treatment. It is noteworthy that integrative models are particularly helpful in expanding the reach in underserved communities: elders from minority and low-income backgrounds and homebound seniors.

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