Outreach for elders is short-lived success story

By John Dyer
Globe Correspondent June 5, 2011

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Gail Bissonnette has been in and out of hospitals for depression numerous times over the years, a cycle that has exacted an enormous toll on the Hudson resident, her family, and others who have helped her through difficult periods.

But, recently, when the 68-year-old mother of three, grandmother of nine, and great-grandmother of four is experiencing a difficult time and reaches for her telephone, she doesn't call for an ambulance.

Instead, Bissonnette contacts an innovative, federally funded pilot program called Elder Community Care, a service that provides seniors in area communities with limited psychiatric treatment and counseling for free, either in person or over the phone.

"I did not have to go back into a hospital for psychiatric treatment," said Bissonnette, who added that formal counseling would be too expensive for her to pursue. "I was able to stay at home. I can call daily, and I get calls from people checking to see how my day is or my week was."

Supporters say Elder Community Care works like preventive medicine for elders at risk for depression, alcohol abuse, and other often-overlooked mental illnesses that can spiral into worse conditions if they aren"t treated early.

The pilot program, which is slated to end in the fall, demonstrates how governments and the health care industry might treat more people while saving money, local officials said. They foresee a growing need as the aging baby-boom generation gradually requires more medical assistance.

"Oftentimes, elders with mental-health issues are frequent callers for public safety services, which are not the services they need but which are certainly more costly than mental health care," said Moira Anne Munns, director of Natick's Department of Human Services and its Council on Aging.

"If you connect these people to these other resources, then they are not contacting more expensive resources, like the police and fire department," she said.

Funded by a $1.2 million grant from the federal Substance Abuse and Mental Health Services Administration and organized as a partnership between nonprofits including Advocates Inc. of Framingham and BayPath Elder Services of Marlborough, the program is expiring in September.

Its positive results could influence state and federal policymakers in the future, but local officials still said they regret its departure.

"I am very sorry to see ECC ending," said Framingham's Council on Aging director, Mary Parcher.

"They are time-limited, and I don't make the rules. Sometimes you find a program that is effective medically and cost-effective, and you kind of wonder why something like that, that has proven itself, could not be funded for additional time."

Working with local officials like Parcher as well as nonprofits and other groups in 12 towns from Westborough to Sherborn, the program's counselors identify seniors who might need mental health treatment and approach them respectfully to see whether they would accept help, said Lynn Kerner, Elder Community Care's clinical and program manager.

Each client is different, said Kerner, so if counselors manage to meet with a senior, they first determine the need for counseling sessions, enrollment in a telephone service where seniors receive calls periodically for check-ins, or referrals to other agencies that might help with more serious problems.

"By and large, outreach and senior centers don't do that professional mental health work," said Kerner. "We can do a much more rigorous health exam for depression, for anxiety, for dementia."

Many seniors are reluctant to submit to psychiatric care, even in its mildest forms, like counseling, said Kerner. Their reluctance to seek help is one reason why they often are in such need of care, she said; they've gotten used to their grim outlooks or self-destructive behavior.

"People don't recognize that depression and anxiety are not a normal part of aging," said Kerner. "Sometimes people don't think to let us know Grandma or Grandpa is in trouble. People think, 'They're getting old, they're having trouble, they're depressed.' All of those things are things that need to be sorted out."

Generations prior to the baby boom are the most reluctant to accept counseling, said Elder Community Care social worker Nancy King-Bolger. "They are the pull-themselves-up-by-the-bootstraps generation and don't want to admit they are in need or suffering," she said. "We'll see a shift with the baby boomers. They're more sensitized to the idea."

Using house calls was a master stroke in reaching resistant seniors, said the Hudson Senior Center director, Janice Long. For frail seniors, finding transportation or traveling can be difficult, she said. And home visits remove the stigma of journeying to a doctor's office, which entails tacitly admitting a problem.

"It was more comfortable for them to experience a mental health visit in their own homes," said Long. "They didn't have to feel that anxiety of going to see a shrink. They didn't need to tell their child. They didn't need to be taken anywhere. It wasn't so awful."

Bissonnette said she likes the telephone service because it allows her to talk with someone about her problems. Rightly or wrongly, she said, she felt as if she were burdening her children by discussing all her thoughts. "Heart disease — that you can talk about," she said. "You don't go out and talk about depression."

Of the approximately 430 people who have been referred to the service as of March, around 300 accepted and received help ranging from phone calls to referrals for other treatment, said Kerner.

Of those who received help, around 96 percent said their mental health symptoms improved after speaking with counselors, said Kerner. Sixty-two percent said their anxiety lessened, while 48 percent reported that their previously severe depression improved. The results will be supplied to the federal authorities who funded the program, Kerner said.

The size and cost of Elder Community Care will prove to be less important than the data it provides for the future, said state Secretary of Elder Affairs Ann Hartstein. She hopes the service can receive a portion of new funds released recently by the federal government to support groups preparing the country for a growing senior population. The funds could extend the life of the pilot project, she said.

"Feeling blue is not necessarily a normal piece of aging," said Hartstein. "This project actually proved the benefits of standard, low-level intervention for elders' mental health care.

"Older people with mental-health issues can be treated. One of the myths is they can't be."

© Copyright 2011 Globe Newspaper Company.