HMA Spotlight
Addressing Behavioral Health Needs in an Aging Population
America’s healthcare and behavioral health systems are not adequately supporting the mental health and substance use needs of older adults. Unless improved with targeted and innovative policies and operational changes, those systems will do an even poorer job in the immediate future as our country rapidly ages. The result will be an increased number of older adults with untreated mental health disorders, cognitive disorders, and/or substance use disorders, increased rates of hospitalization and institutionalization, and vastly increased care costs.
Available statistics make clear the challenges:
- The number of older adults in this country is expected to grow from approximately 56 million in 2020 to 85 million in 2050. Without substantial breakthroughs in treatment and prevention, the number of older adults with diagnosable mental disorders will increase from about 11 to 17 million and those who misuse alcohol and other drugs will increase from 2 to 3.5 million.
- During those three decades, the number of Americans with dementia will also nearly double from 7 to 13 million. Many of these elders will have co-occurring behavioral health conditions, such as depression, anxiety, psychosis, and behavioral disturbances which will greatly strain family resources and coping.
If present performance is any predictor of the future, our systems of care now in place will not be able to handle the coming needs. Today fewer than half of older adults with mental or substance use disorders get any treatment at all because of limited-service capacity and access. Much of the care that is provided comes from medical and behavioral health providers without specific training or experience in older adult mental health and substance use disorders. The so-called digital divide—in which many older Americans are uncomfortable with telehealth or lack the equipment or bandwidth to use it—disproportionately impacts those with behavioral health disorders who live in rural communities and/or have limited economic means.
To adequately care for these vulnerable older adults, our approach and systems must change. That will require increased attention, investment, and thoughtful planning. Fortunately, there is clinical, operational, and policy expertise available to guide what will necessarily be a decades-long effort.
How HMA can help
HMA works with a range of clients. We work with federal, state and local governments, trade associations, provider organizations and community-based provider organizations (CBOs), delivery systems, managed care organization (MCO) plans, and philanthropic funders, to design, implement, and sustain effective models and systems of care for older adults with mental health and substance use needs.
We bring together a cross-sector, multidisciplinary team of experts in older adults’ needs and mental health and substance use focused on strategy, policy, clinical, operations, and finance systems. Our team members have rich backgrounds across government, payers and provider systems. We understand our clients’ needs because we’ve been in your shoes.
Workforce & Capacity Building
- Workforce planning: embedding peers, age-friendly training
- Identify and implement caregiver support models
- Develop mental health/substance use and aging coalitions
Policy, Planning & System Redesign
- Plan state and local policy and system redesign
- Incorporate mental health and substance use in multi-sector plans on aging and age-friendly communities
- Build age friendly systems of health and mental health/substance use care
Integrated & Specialized Care Models
- Establish integration models within and between systems
- Implement care coordination/care transition models, including post-acute care
- Develop housing models that integrate mental health and substance use care
- Establish specialized models of care for older adults with serious mental illness and/or substance use disorders
Evidence-Based & Preventive Interventions
- Embed evidence-based practices for older adult mental health and substance use needs
- Design suicide prevention and crisis systems that supports older adults
- Integrate psychoeducation for older adults and their families
Financing & Technology Infrastructure
- Design financing and optimization of revenue models
- Embed tech-enabled care solutions
Provider Access
- Conduct workforce planning, including age-friendly training
- Identify and implement caregiver support models
- Design financing and optimization of revenue models
Discrimination and Awareness
- Provide psychoeducation for older adults and their families
Service Access
- Plan state and local policy and system redesign
- Establish integration models within and between systems
- Implement care coordination/care transition models, including post-acute care
- Incorporate mental health and substance use in multi-sector plans on aging and age-friendly communities
- Build age friendly systems of health and mental health/substance use care
- Embed tech-enabled care solutions
Recent Project Examples
Strategic planning
An Area Agency on Aging (AAA) hired HMA to assess the needs of its client population and develop strategies to enhance behavioral health services and supports. The mental health and substance use needs of older adults, and especially those with both Medicaid and Medicare are among the highest. Through this project, the AAA focused on finding ways to expand service access to older adults. HMA prepared several recommendations to contract with health plans to help older adults access behavioral health services.
Multi-sector plans on aging development
A county hired HMA to help develop a multi-sector plan on aging. Multi-sector plans on aging provide an opportunity to address the unmet mental health and substance use needs of older adults. HMA analyzed relevant assessments and plans and facilitated broad community engagement to help shape the development of the plan.
Skilled nursing facilities practice improvement
A state health department hired HMA to enhance the quality of care of skilled nursing facility residents with substance use disorders. Many residents, including older residents, of nursing homes have unidentified and untreated substance use conditions. HMA delivered on-site technical assistance, in-person staff training, policy and procedure development, community partnership building, and regional forums to foster shared learning.
Affordable housing with integrated services sustainability
A long-term care trade association hired HMA to develop a braided financial and partnership service model to integrate health, mental health and social services to support aging in place. Integrated service and financial models can better support the often co-occurring physical, mental, and social needs of older adults. HMA conducted stakeholder engagement, service gap analysis, and strategic alignment to support the development of a sustainable service model.
Post-acute care guide
A state-level hospital association hired HMA to support its hospitals and their staff on post-acute care transitions. Post-acute care transitions are critical to ensuring that older adults have a successful recovery. These transitions are important for preventing complications after leaving an acute care setting like a hospital. The association hired HMA to create first-of-its-kind post-acute care (PAC) guides to support clinicians and family members to find post-acute care resources to address behavioral health needs.
Rural access to services for older adults
A foundation hired HMA to improve access to integrated care for older adults who were dually eligible for both Medicaid and Medicare. Older adults residing in rural communities have poorer access and outcomes than their urban peers. HMA created a toolkit of actionable solutions for state policymakers to address older adults’ mental health needs and social isolation conditions in rural communities.
Contact our experts:
Patrick Meadors
Associate Principal
