By Tonya Vose, MSW, LCSW and Christy Wilson, MSW, LCSW, CDMS
 

	Introduction
	Why Would Someone Need Counsing in Long-Term or Nursing Home Care?
	Suicide Rates in Older Adults
	What Are the Benefits of Counseling?
	Who Pays for Counseling
	Referrals

Introduction

The stigma attached to receiving counseling or mental health services is common within the older population. This stigma is slowly declining as the general public becomes more aware of the benefits of therapeutic and supportive counseling services. The door allowing much needed services to be provided to our seniors and disabled in long-term care settings is opening.

As baby boomers reach retirement age, increasing numbers of Americans will be faced with overwhelming demands to provide necessary care. Licensed clinical social workers are skilled providers of services to seniors and those living in nursing homes, assisted living centers, and independent living centers. Home and community-based social work services and office visits are available in most areas as well. These services can come from social workers employed at counseling agencies, area agencies on aging, local health departments, social service and home care agencies.

Older adults are often hesitant to receive counseling or talk therapy. (Talk therapy involves talking about one’s mental condition and related issues with a mental health professional such as a social worker.) However, the process of building a relationship with a client in a long-term care facility is generally well accepted when a social worker is assigned to the resident. It may take more than one social work visit for a client to feel comfortable with receiving social work services. Social work was founded on the premise of “friendly visitation” and social workers have training in building relationships with clients over time. After a client has been counseled and helped by a social worker, it is not uncommon to hear appreciative family members say something such as, “I never thought Mom would see a social worker for counseling, but I am glad she did.”

Why Would Someone Need Counseling in Long-Term or Nursing Home Care?

The majority of residents in a nursing facility suffer from some kind of mental health condition possibly affecting physical, social, and cognitive functioning if not treated. It is estimated that approximately 30 percent of nursing home residents have a diagnosis of depression. Research has found that about 60 percent of long-term care residents have undiagnosed depression. At least two thirds of long-term care residents have some kind of mental health disorder, including memory problems. Typically, older Americans who are depressed also have physical problems. Common physical ailments in older people include:

• Diabetes
• Parkinson’s Disease
• Stroke
• Heart problems
• Inflammatory bowel disease
• Irritable bowel syndrome
• Some medical conditions and medications can make depression worse in the older people. They include:
  • Thyroid problems
  • Lupus (a chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood, and kidneys)
  • Kidney failure
  • Multiple sclerosis
  • Sleep apnea (a condition that occurs when people stop breathing repeatedly during their sleep and often for a minute or longer)
  • Chronic Fatigue and Chronic Pain
  • Fibromyalgia (a common and chronic disorder characterized by widespread muscle pain, fatigue, and multiple tender points)
  • Rheumatoid Arthritis (a chronic, long-term inflammatory disease that primarily affects the joints and surrounding tissues, but can also affect other organ systems)
  • Alzheimer’s disease or other related types dementia.

If depression is adequately addressed, then the quality of life for the residents usually improves significantly.

Suicide Rates in Older Adults

Senior citizens over age eighty-five are more likely to commit suicide than any other age group in America. Unfortunately, fewer than three percent of seniors receive mental health services. Identifying symptoms and seeking appropriate care is an essential part of maintaining the quality of life for the aging population. Clinical studies show that older adults see a primary care physician at least one week before a suicide.

Social workers are trained to work with physicians and other health care providers to support patients suffering a physical, emotional or other mental health disorders. Social workers can provide visits on a scheduled basis to assist those with depressed feelings while being treated by a primary care physician. Social workers often can identify problems and intervene prior to a crisis.

Mental illness is not a normal part of aging. Some feelings of sadness and loss may be a part of aging. However, anger, tearfulness, confusion, and loss of interest in former activities can be signals of something more significant going on with the patient. An undiagnosed mental health disorder accounts for a significant increase in medical costs across the nation. Left untreated, mental illness decreases the physical, emotional, and cognitive functioning.

What Are the Benefits of Counseling?

The combination of medications and talk therapy or counseling provide the best outcome for individuals who have declining physical, emotional, or mental health. Social workers are key to assisting their client’s access to services that might improve their quality of life.

There are numerous advantages of having a social worker providing counseling in long-term care facilities. The social worker visits the resident at the facility rather than the resident having to leave their home environment.

Social workers offer a knowledge base of resources to the elder, the family, and caregivers. Social workers are available to provide family sessions as well as support for the facility staff. Social workers can serve as a valuable resource to the resident and their family both as an advocate for the resident and also to assist with any concerns that may arise in the setting.

Who Pays for Counseling?

Social workers and physicians are paid by Medicare, Medicaid, or private insurance for all services provided. Medicare requires that physicians and social workers take an assigned fee. This means they will accept what insurance pays as payment in full for services. Medicare Part B covers the social worker’s fee-for-service in the long-term care setting. There are no out of pocket expenses for the resident. In the event that insurance is not available, some social workers will work off a sliding scale based on income. If you have any questions regarding payment or fees, the social worker will discuss this with you prior to initiating services.

Referrals

Often, a psychiatrist who specializes in the treatment of psychological illnesses of seniors is involved with helping the client. A licensed clinical social worker can be consulted to provide concrete resources, psychotherapy, and supportive counseling. In many cases, the counseling process can begin after the physician has written an order for social work services.

Symptoms that may trigger a social work consultation include sadness, worry, guilt, anger, fear, crying, isolation, and weight loss. Often patients are seen for problems related to their transition to a new facility, chronic pain, social isolation, decreased quality of life, drug and alcohol use, trauma such as the death of close family members and friends, and memory difficulties. Other symptoms that might prompt a therapy referral to a social worker are excessive worry about physical health, fear of others, a history of mental illness.

Counseling may not be the treatment of choice for everyone. Therefore, a consultation with a psychiatrist who has special training in geriatrics may be recommended. If you think you or a loved one might be suffering from some of the symptoms described consulting with your physician is a good idea.