RD189 - Annual Progress Report of the Department of Mental Health, Mental Retardation and Substance Abuse Services, on the Effect of the Aging Population on State Agencies


Executive Summary:
The Department of Mental Health, Mental Retardation and Substance Abuse Services operates 425 state hospital beds in geriatric treatment centers or units to treat older individuals who are in crisis, who present with acute or complex conditions, or both, and who require the highly intense and structured environments of care only available in the inpatient setting. Specialized inpatient geriatric mental health treatment centers or units are available at Eastern State Hospital (ESH) in Williamsburg, Southwestern Virginia Mental Health Institute (SWVMHI) in Marion, Catawba Hospital (CH) near Salem, and Piedmont Geriatric Hospital (PGH) in Burkeville. Inpatient mental health services include a variety of intensive treatment and supports, including, among others, inpatient psychiatric and medical assessment; psychology, medical, nursing, dental and other ancillary services, physical and occupational therapy; medication management, and discharge planning.

Each of the five training centers offers treatment programming for older individuals. State mental retardation training centers provide medical and psychiatric assessment, healthcare, medical stabilization, habilitation, and development of skills needed for successful community living. Training centers also provide short-term respite care and emergency care.

Community services boards (CSBs) also provide a range of services to the older adult population, including, in part, emergency services, outpatient services, such as therapy, counseling and medication management; rehabilitation services, a range of residential service options, and day support services.

State hospitals, training centers and CSBs are serving significant numbers of older adults. Collectively, the state hospital geriatric treatment centers have served, on average, 685 older adults annually from FY 2001-FY 2005 with a combined utilization rate of 92.6% for the month of June 2006. State training centers also served significant numbers of older adults during this same period, serving on average 135 residents annually. CSBs, during this same period, served over 1,300 older adults annually.

The Department and its service providers have implemented or have proposed to implement the following programs and initiatives to address the impact of the aging population in Virginia.

• Construction of a new, state-of-the-art Hancock Geriatric Treatment Center at Eastern State Hospital is underway.

• In the Tidewater Region, CSBs are using a portion of the Services System Transformation Initiative funds allocated to the region to expand their capacity to serve older adults in their communities.

• CSBs in the Tidewater and Northern Virginia regions have proposed model pilot projects designed to divert and discharge older adults from the Hancock Geriatric Treatment Center at ESH and to provide a continuum of mental health services and supports that would enable older adults with serious mental illnesses to age in place.

• A number of CSBs have developed, implemented or plan to implement highly innovative services and programming for older individuals.

• The state geriatric hospitals and units providing specialized geriatric services are using best practices and clinical practice guidelines and are applying evidence-based approaches in their care of older adults. They are providing geriatric education and outreach and consultation services to local healthcare facilities, including nursing homes and assisted living facilities.

• The State Mental Health, Mental Retardation and Substance Abuse Services Board is updating its policy on older adults to promote the thorough assessment of need, aging in place as opposed to institutional placements where this is appropriate, and coordination and integration of services in the community. The proposed policy also encourages continued education and training to enable direct care staff to develop competencies in the assessment and treatment of older adults. It is expected that the Board will complete its review of the document and will adopt an updated policy on older adults before the end of 2006.

• The Department recently reconvened its Geriatrics Special Population Workgroup to continue efforts to better prepare for and delivery specialized services for older adults. It plans to implement a career path for direct service associates, including those providing services to older adults, to improve recruitment and retention efforts and promote greater continuity of care. The Department will continue to implement the Pre-Admission Screening and Resident Review (PASRR) program and will promote the identification and dissemination of evidence-based or best practice models of geriatric care.