As a regular feature of this blog, we highlight our professional partners who have committed their knowledge, passion, skills, and time to protect older adults in their community.
Cassie Cramer, Somerville Cambridge Elder Services
photo credit: Stephanie Becker
What do you do professionally and do you ever encounter elder abuse and self-neglect issues in your work?
I am a peer advocate, co-chair of the MA Aging and Mental Health Coalition and social worker in a mental health program at Somerville Cambridge Elder Services. Before I started this position, I worked in Elder Protective Services for 5 years. My background in elder abuse, neglect and self-neglect led me to the position I have today, providing longer-term support to people and advocating for the development of these supports statewide.
How do behavioral health issues play a role in elder abuse and neglect?
In Protective Services I learned a lot; specifically I learned about when and why things go wrong. I found that by far, our biggest systematic failure was the lack of accessible (in-home) mental health services for older adults. Without on-going support in the community, people cycle through Protective Services- chronically “at-risk” and facing bleak outcomes.
In Protective Services, I saw first-hand how behavioral health conditions can lead to poor self-care. Poorly monitored diabetes or blood pressure can cause catastrophic health problems. Behavioral health conditions can cause isolation, cutting ties with would-be caregivers and social supports. Substance use among family members is often underlying abuse, exploitation or neglect. Substance use and other behavioral health conditions among older adults can lead to problems with housing and risk of homelessness. I found that well-meaning providers are often quick to defer to institutionalization when older adults are facing crisis- people frequently called and expressed their view that an individual be “placed somewhere” because they “didn’t belong in the community.”
My observations are reflected in statistics: untreated behavioral health conditions among older adults are associated with higher health care use, development of preventable health problems, lower quality of life, caregiver stress, suicide and high rates of institutionalization. Studies have shown that failure to provide mental health treatment in the community increases the likelihood of nursing facility admission by a factor of three, and that institutionalization is likely to occur at a much younger age. Older adults with behavioral health conditions face many barriers to accessing traditional supports including lack of transportation, cost of co-pays, isolation, high levels of stigma around mental health, ageism among providers, and difficulty coordinating appointments due to co-occurring cognitive conditions, like dementia. For these reasons, older adults are least likely to receive mental health support.
What do you think is the best way to prevent elder abuse and self-neglect?
The MA Aging and Mental Health Coalition advocates for the development of a statewide network of in-home behavioral health supports, including case management, peer support, and therapy. In the small pilot programs scattered across the state, we have already begun to see the effectiveness of these supports. In the program where I work, we are able to help people at risk of homelessness by taking referrals for people in the early stages of eviction, acting as a liaison with housing management and developing creative solutions to help stabilize tenancy. We help people in medically inappropriate housing, no longer able to climb the stairs of a walk-up apartment, move into accessible units. We help people who are not receiving any medical care start seeing a primary care doctor or enroll in managed care programs, receiving in-home support from a nurse case manager. We also have an older adult peer specialist on staff who helps people who are isolated, often conducting visits in a local cafe or the library. Unfortunately these budding programs and success stories represent what is possible, rather than a reality for most people, who do not have access to in-home mental health support. A statewide network of in-home behavioral health supports is needed to ensure that all people- regardless of age or a mental health condition- have the opportunity to live full healthy lives in the community.
Is there anything else you would like to add about yourself or your work?
The Aging and Mental Health Coalition meets monthly in Boston and is open to anyone interested in joining our advocacy efforts. If you would like more information, you can contact me at firstname.lastname@example.org or 617-628-2601 x3089