Fiscal-year 2009 & 2010 Budgets







FISCAL YEAR 2010 BUDGET(PROPOSALS AND CHANGES)

INITIAL PROPOSAL IN HOUSE ONE BY THE GOVERNOR FOR FISCAL YEAR 2010


ASAPS will have somewhat less(about 2 %) than in 2009.
COAs will see their formula grants return to the levels of 2009.
Line items for EOEA have been consollidated. For example all of the housing services will be on one line item(9110-1800)



 FISCAL YEAR 2009 BUDGET LINE ITEMS(PROPOSALS AND CHANGES)


 CHANGES IN THE FISCAL YEAR 2009 BUDGET

In the Fall of 2008 Governor Patrick used his 9-C cuts authority to decrease funding for the ASAPS. As a result some home cares have either established waiting lists and/or reduced the number of hours for which clients may receive services.

In January of 2009  he announced further cuts:

  • Councils of Aging experienced a decrease in their formula grants and are losing about one million dollars state-wide.
  • Local aide was cut and this will also impact senior centers.
  • There was not further significant changes for the home cares.



The MAMHC has submitted two line items to the Massachusetts Legislature for the fiscal year 2009 budget. Below is a background statement followed by the two line items(one for EOEA and one for DMH).

ACTION STEP:

PLEASE CONTACT YOUR MASS STATE REPRESENTATIVE/SENATOR AND ASK THEM TO MAKE THESE LINE ITEMS(9110-1640 and 5046-1000)BUDGET PRIORITIES.

 

NARRATIVE EXPLANATION


This request was developed by members of the Mass Mental Health and Aging Coalition, which includes Mass Home Care, Mass Association of Older Americans, Mass Councils on Aging, National Association of Social Workers(Mass Chapter)and geriatric mental health providers. The appropriation for this account was $350,000 in FY 2007. The projects funded in FY 2007 were for direct mental health services, medication adherence, and improving outreach skills of frontline workers. Grants began effective February 1, 2006.


Chronic mental illness has been found to be a significant predictor of nursing home admission. As many as 20% of older adults in the community and up to 37% in primary care settings experience symptoms of depression. Nearly 17% of older adults misuse or abuse alcohol and medications; and although the majority (87%) of older adults see a physician regularly about 40 % of those who are at risk do not self-identify or seek services for substance abuse problems and are unlikely to be identified by their physicians. 8.5% of seniors on MassHealth have a chronic mental illness. Older adult males have the highest suicide rate of any age group with a rate almost six times (65 per 100,000) the suicide rate of the general population (10.6 per 100,000). The number of older adults with mental illness is expected to double to 15 million in the next 30 years. Almost two thirds of older adults with a mental disorder do not receive needed services. Most will never be diagnosed, more will never be treated. Among those who are treated, most will receive poor quality care.


The financial and social cost of unrecognized and untreated or poorly treated mental illness among older adults is high. Depression and other psychiatric conditions contribute to: (1) premature nursing home admission; (2) higher medical costs through more frequent visits to physicians; (3) delayed recuperation from chronic somatic illness – like cancer, strokes, and heart disease; (4) increased use of emergency medical services;
lowered employment productivity by family caregivers; (6) caregiver depression and
premature death; and (8)suicide.


The stigma surrounding the receipt of mental health treatment is one significant, and key, barrier to identifying and treating mental health conditions among older men and women. Older adults often do not want to be identified with the traditional mental health system

.
There is no state program that addresses the needs of elders with significant mental health problems that put them at risk of requiring institutional care. Neither the Department of Mental Health, nor the Executive Office of Elder Affairs have adequately addressed elder mental health resources. Mental health is currently not a home care purchased service. A survey of ASAP directors in 2005 regarding mental health services had the following findings:


  • 95% of ASAPs expect their staff to work with elders who have a mental illness, even though care managers are not specifically assigned to work with this population
  • .
    90% of ASAPs reported that they did not have specific staff assigned to work with elders experiencing mental health concerns.

  • 86% of ASAPs indicated that they did not have a follow up plan to assist an elder who had a confirmed MH concern
  • .
    68% of ASAPs did not have a formal procedure to deal with an elder’s mental health challenge.

  • As many as 7,668 elders (19% of caseload) have mental health needs.


Our goal is to provide geriatric mental health and support services for elders in the Massachusetts whose MH impairments threaten their ability to live in the least restrictive setting. Our proposal is to create a mental health program which uses a specially-trained workers to respond to MH issues, and has the capacity to arrange for not only personal care services for physical impairments, but the ability to purchase (out of line item 9110-1630) mental health services. Like the current protective services program, MH services should be available without regard to income, so that referrals from community sources, such as hospitals, doctors, COAs/senior centers, could be enrolled in a consistent, care managed program statewide, with uniform intake, assessment and service delivery. This would create a system of services for elders dealing with mental health issues.


“At risk” for the purposes of this program shall be defined as individuals who have, or are at significant risk of depression; anxiety disorders; suicidal tendencies; violent or aggressive behavior; alcohol or drug abuse; medication misuse; post-trauma symptoms; obsessive-compulsive behavior, including hoarding; institutionalization due to a mental illness. Services will include: geriatric mental health care management, geriatric mental health clinical assessment, crisis stabilization; in-home treatment engagement services, community-based and in-home mental health and substance abuse services, medication monitoring and compliance assistance; counseling; supportive day and adult day health services; peer support; and family and caregiver education.


The initial “engagement” phase is critically important in the MH context, since many elders will perceive the need for mental health services as a stigmatizing failure on their part, and will be reluctant to seek or use supports. The ASAPs will need to use geriatric MH care managers to establish initial relationship, or to work with other community contacts that have already engaged the elder, to establish the relationship needed to explore MH services. In addition to direct therapeutic services, the MH program requires the underwriting of this geriatric MH care manager, who is also responsible for securing any collateral services or supports that the elder needs in addition to MH services.


Each elder in this program will benefit from an interdisciplinary team made up of the geriatric care manager, the mental health service providers, and other community resources. Service plans built around the consumer’s needs shall be developed by this team. The geriatric caremanager will be responsible for arranging all the collateral housing and support services necessary to ensure that the elder is able to remain living in the least restrictive setting appropriate to his or her needs.


**We are proposing in this account to serve 500 elders in FY 2009. This would require 16 geriatric care managers, each with an active caseload of 30 clients per worker, at a cost of $40,000 + 25% fringe benefits + 20% overhead/supervision x 16 workers = $960,000. Purchased MH services, not counting any home care purchased services from item 9110-1630, would average $5,000 per elder, or a total of 500 x $5,000 = $2,500,000. In addition, we are proposing $150,000 for consumer-oriented public education regarding mental health; $125,000 for cross-disciplinary training of appropriate mental health specialty staff and aging service agency staff; and $250,000 for competitive grants to councils on aging and senior centers for geriatric mental health outreach to elders residing in the community.


**We are also requesting a second line item in the DMH budget that would be used to develop critical MH services currently not available to the elderly: geriatric mental health clinical assessment, crisis stabilization; in-home engagement and treatment services, medication monitoring and compliance assistance; counseling and psychotherapy; supportive day and adult day health services; peer support; family and caregiver education; assertive community treatment; and community residential services.


Total appropriation requested: $3,985,000 in line item 9110-1640 and
$2,000,000 in line item 5046-1000

 

MA Aging & Mental Health Coalition Proposed FY ’08 Geriatric Mental Health Line Items


Executive Office of Elder Affairs 9110-1640

For the Geriatric Mental Health Services program of regionally-based, collaborative geriatric mental health services for the elderly, as a component of the home care program under Chapter 19A, including contracts for care management services with aging service access points or other qualified entities for the home care program. Said program shall include geriatric mental health care management, geriatric mental health clinical assessment, crisis stabilization; in-home treatment engagement services, community-based and in-home mental health and substance abuse services, medication monitoring and compliance assistance; counseling; supportive day and adult day health services; peer support; and family and caregiver education. Geriatric mental health services shall be provided without regard to functional impairment level and income, to elders who have, or are at significant risk of depression; anxiety disorders; suicidal tendencies; violent or aggressive behavior; alcohol or drug abuse; medication misuse; post-trauma symptoms; obsessive-compulsive behavior, including hoarding; institutionalization due to a mental illness. All treatment plans written under this program shall be developed by an inter-disciplinary team comprised of staff from an aging services access point, mental health service providers, councils on aging, senior centers, and other agencies providing services to the elder, as appropriate. Treatment plans shall be developed in consultation with the elderly person requiring mental health services or an appropriate representative of said person. The executive office of elder affairs shall establish, by regulation, financial eligibility guidelines which provide a procedure for reimbursement by elderly persons for all or part of the cost of mental health services. If it is determined that the elderly person in need of mental health services has resources from any governmental program or private insurance policy to pay for part or all of said services, funds from this item shall be used as the payer of last resort or to supplement such other payments, as appropriate. If it is determined that an elderly person does not have sufficient resources to pay for mental health services, no reimbursement for any such costs shall be charged to the elderly person; provided that not less than $150,000 shall be expended for consumer-oriented public education regarding mental health; provided further that not less than $125,000 shall also be expended for cross- disciplinary training to upgrade the skill and knowledge of appropriate mental health specialty staff and aging service agency staff; provided further that not less than $250,000 shall be contracted on a competitive basis with councils on aging and senior centers for geriatric mental health outreach to elders residing in the community.……..…$3,985,000

 

Department of Mental Health 5046-1000

For a program of regionally-based, collaborative geriatric mental health services for residents of the Commonwealth 60 years of age or older who have a serious mental illness. For purposes of this line item “serious mental illness” shall be defined as behaviors characterized by the presence of, or significant risk of: depression; anxiety disorders; suicidal tendencies; violent or aggressive behavior; medication misuse; post-trauma symptoms; obsessive-compulsive behavior, including hoarding. The department, in consultation with the executive office of elder affairs shall develop such services as: geriatric mental health clinical assessment, crisis stabilization; in-home engagement and treatment services, medication monitoring and compliance assistance; counseling and psychotherapy; supportive day and adult day health services; peer support; family and caregiver education; assertive community treatment; and community residential services, provided that an amount no greater than $100,000 shall be spent to develop a Massachusetts Geriatric Mental Health and Substance Abuse Intervention Plan in collaboration with the executive office of elder affairs, the department of public health, and the Massachusetts Aging and Mental Health Coalition; provided further that the department shall submit said plan to the house and senate committees on ways and means and the joint committee on mental health not later than January 16, 2008. ……….. $1,000,000

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